A Binational Study of Patient-Initiated Changes to Antiretroviral Therapy Regimen Among HIV-positive Latinos Living in the Mexico–U.S. Border Region

Research is lacking on factors associated with antiretroviral therapy (ART) sub-optimal adherence among U.S. Latinos, who are disproportionately affected by HIV and face substantial health care barriers. We examined self-reported, patient-initiated changes to ART (i.e., made small/major changes from the antiretroviral drugs prescribed) among HIV-positive Latinos. Trained interviewers administered surveys to 230 participants currently on ART in San Diego, U.S. and Tijuana, Mexico. We identified factors independently associated with ART changes. Participants were Spanish-language dominant (86%), mean age of 41 years, male (77%), and born in Mexico (93%). Patient-initiated changes to ART were reported in 43% of participants. Being female, having ≥1 sexual partner (past 3 months), ≤6 years since HIV diagnosis and poor health were associated with increased odds of ART changes. Findings raise concern about sub-optimal adherence among this binational population. Longitudinal studies are needed to further explore adherence barriers and avenues for intervention.     

Glucocorticoid effects on changes in bone mineral density and cortical structure in childhood nephrotic syndrome

The impact of glucocorticoids (GC) on skeletal development has not been established. The objective of this study was to examine changes in volumetric bone mineral density (vBMD) and cortical structure over 1 year in childhood nephrotic syndrome (NS) and to identify associations with concurrent GC exposure and growth. Fifty‐six NS participants, aged 5 to 21 years, were enrolled a median of 4.3 (0.5 to 8.1) years after diagnosis. Tibia peripheral quantitative computed tomography (pQCT) scans were obtained at enrollment and 6 and 12 months later. Sex, race, and age‐specific Z‐scores were generated for trabecular vBMD (TrabBMD‐Z), cortical vBMD (CortBMD‐Z), and cortical area (CortArea‐Z) based on >650 reference participants. CortArea‐Z was further adjusted for tibia length‐for‐age Z‐score. Quasi‐least squares regression was used to identify determinants of changes in pQCT Z‐scores. At enrollment, mean TrabBMD‐Z (?0.54 ± 1.32) was significantly lower (p = 0.0001) and CortBMD‐Z (0.73 ± 1.16, p < 0.0001) and CortArea‐Z (0.27 ± 0.91, p = 0.03) significantly greater in NS versus reference participants, as previously described. Forty‐eight (86%) participants were treated with GC over the study interval (median dose 0.29 mg/kg/day). On average, TrabBMD‐Z and CortBMD‐Z did not change significantly over the study interval; however, CortArea‐Z decreased (p = 0.003). Greater GC dose (p < 0.001), lesser increases in tibia length (p < 0.001), and lesser increases in CortArea‐Z (p = 0.003) were independently associated with greater increases in CortBMD‐Z. Greater increases in tibia length were associated with greater declines in CortArea‐Z (p < 0.01); this association was absent in reference participants (interaction p < 0.02). In conclusion, GC therapy was associated with increases in CortBMD‐Z, potentially related to suppressed bone formation and greater secondary mineralization. Conversely, greater growth and expansion of CortArea‐Z (ie, new bone formation) were associated with declines in CortBMD‐Z. Greater linear growth was associated with impaired expansion of cortical area in NS. Studies are needed to determine the fracture implications of these findings. © 2013 American Society for Bone and Mineral Research.     

Discordance Between Patient and Surgeon Satisfaction After Total Joint Arthroplasty

We surveyed 331 patients undergoing total hip or knee arthroplasty pre-operatively, and patients and surgeons were both surveyed 6 and 12 months post-operatively. We identified variables (demographic factors, operative factors and patient expectations) as possible predictors for discordance in patient–surgeon satisfaction. At 12 months, 94.5% of surgeons and 90.3% of patients recorded satisfaction with the outcome. The discordance between patient and surgeon satisfaction was mainly due to patient dissatisfaction–surgeon satisfaction. In an adjusted analysis, the strongest predictors of discordance in patient–surgeon satisfaction were unmet patient expectations and the presence of complications. Advice to potential joint arthroplasty candidates regarding the decision to proceed with surgery should be informed by patient reported outcomes, rather than the surgeon's opinion of the likelihood of success.     

An electropalatographic investigation of linguopalatal contact in participants with acquired apraxia of speech: A quantitative and qualitative analysis

The current study aimed to provide a comprehensive analysis of linguopalatal contact patterns in participants with acquired apraxia of speech (AOS). Tongue‐to‐palate contacts were recorded for three participants with AOS during consonant singletons and consonant clusters using the Reading Electropalatograph (EPG3) system. Amount and pattern of linguopalatal contact were analysed using qualitative and quantitative analysis methods and the degree of spatial variability was quantified. The results obtained for each of the apraxic speakers were individually compared to those obtained by a control group (n = 5). Misdirected articulatory gestures and distorted spatial configurations for alveolar fricatives were detected in the linguopalatal contact patterns recorded for each of the participants with AOS. Lingual overshoot, right‐side dominant contact, and increased spatial variability were also evidenced by some participants. True omission errors were absent. Overall, the combination of qualitative and quantitative analysis techniques proved valuable in providing a comprehensive analysis of linguopalatal contact in AOS. Results provided support for a motoric account of articulatory and prosodic deficits in AOS.     

Personality and Psychological Factors as Predictors of Disordered Eating Among Female Collegiate Athletes

This article examined the relationship of perfectionism, psychological well-being (self-esteem and optimism), reasons for exercising and appearance orientation to eating disorder classification among 204 female collegiate athletes. Multivariate analyses showed that only self-esteem, exercising to improve appearance and be more attractive, and appearance orientation differentiated significantly between the symptomatic/eating disordered athletes and those who were asymptomatic. No differences existed between the two groups of athletes on perfectionism, optimism, or exercising for fitness/health. For athletes, self-esteem, appearance orientation and exercising to be attractive and improve appearance were most important for understanding their level of disordered eating.     

Prevalence of Disordered Eating and Pathogenic Weight Control Behaviors Among Male Collegiate Athletes

The aim of this study was to determine the prevalence of disordered eating and pathogenic weight control behaviors in male collegiate athletes. Male collegiate athletes (N?=?732) from the across the U.S. completed questionnaires online. Results suggested that (a) most eating disturbances occur at the subclinical level, (b) exercising and dieting were the most commonly used weight control practices, and (c) athletes who participate in weight class sports are more likely to be classified as symptomatic and engage in pathogenic eating and weight control behaviors compared to endurance sport or ball game athletes. Implications for professionals working with athletes and recommendations for future research are discussed.