Treatment of Hypertension Among African Americans: The Jackson Heart Study

Hypertension treatment regimens used by African American adults in the Jackson Heart Study were evaluated at the first two clinical examinations (2415 treated hypertensive persons at examination I [exam I], 2000–2004; 2577 at examination II [exam II], 2005–2008). Blood pressure (BP) was below 140/90 mm Hg for 66% and 70% of treated participants at exam I and exam II, respectively. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treatment targets were met for 56% and 61% at exam I and exam II, respectively. Persons with diabetes or chronic kidney disease were less likely to have BP at target, as were men compared with women. Thiazide diuretics were the most commonly used antihypertensive medication, and persons taking a thiazide were more likely to have their BP controlled than persons not taking them; thiazides were used significantly less among men than women. Although calcium channel blockers are often considered to be effective monotherapy for African Americans, persons using calcium channel blocker monotherapy were significantly less likely to be at target BP than persons using thiazide monotherapy.     

A Novel Colorectal and Cervical Cancer Education Program: Findings from the Community Network for Cancer Prevention Forum Theater Program

Medically underserved populations continue to be disproportionately burdened by cancer. The exact reason for this disparity has not been fully elucidated, but likely involves multiple factors. We explored the potential utility of a novel community-based cancer education program called Forum Theater (FT), aimed at raising awareness about colorectal (CRC) and cervical cancer (CxC) screening among African–American, Hispanic, and Vietnamese populations. We also determined audience likelihood of obtaining CRC and CxC screening in the 6 months following performances. Thirty FT performances were held between September 2011 and July 2012. A brief survey was administered at each performance, eliciting responses on key CRC and CxC screening questions. A total of 662 community residents (316 Hispanic, 165 African–American, and 181 Vietnamese; overall mean age 50.3?±?16.4) participated in performances. The survey response rate was 71.1 %. After seeing FT performances, the majority responded correctly (>70 %) on CRC and CxC screening questions. In comparison to Hispanic and Vietnamese participants, African–Americans were less likely to report that CRC and CxC are preventable (p?<?0.05), that timely and regular screening saves lives (p?=?0.05), and that CxC screening should begin at age 21 for most women (p?<?0.05). Our findings suggest that FT may be an effective strategy to disseminate cancer screening information. Lack of awareness that CRC/CxC screening saves lives and that CRC/CxC is preventable, as reported by African–Americans, may not stem from lack of knowledge or misconceptions alone, but may be influenced by a sense of fatalism regarding cancer outcomes in this population.     

Posttraumatic Growth Following Cancer: Links to Quality of Life

This study examined the linkage of posttraumatic growth (PTG) to quality of life (QOL) among individuals newly diagnosed with cancer. Individuals (26 men, 36 women) reported PTG 3 months postdiagnosis (T1) and 3 months later (T2). Cross‐sectional analyses revealed a linear association between PTG and QOL—more PTG was related to worse mental health at T1 (β = ?.28). PTG, however, revealed a quadratic relationship with depressive symptoms at T1 and physical health at T2: Individuals with high or low levels of PTG had fewer depressive symptoms and better QOL than those with moderate levels. Longitudinal analyses revealed a linear association between PTG and QOL; more PTG at T1 predicted better physical health at T2. There were no longitudinal curvilinear associations. Although the linear links of PTG to QOL were contradictory within this study, both of the curvilinear relations, although not robust, confirm previous research. Further analyses differentiated low, medium, and high PTG groups in terms of perceiving cancer as stressful, intrusive thoughts, and coping strategies. Overall, relations of PTG to adjustment may be more complex and dynamic than previously assumed. Clinicians should consider the notion that more growth may sometimes, but not always, be better.     

Mast cell activation syndrome

In 1984, interstitial cystitis (IC) was considered a rare psychosomatic disorder in post-menopausal women. In 2014, the Interstitial Cystitis Association of America (ICA) celebrated its 30^th anniversary. We’ve come a long way since 1984 and great progress has been made. IC is now recognized as a condition that afflicts both men and women of all ages, including children and teenagers. It is not a psychiatric disorder. Though it was once thought to be an orphan disease (defined as affecting less than 200,000 people), we now know that there are millions of women and men who suffer from IC/BPS (bladder pain syndrome). In looking back over this period, there were seven key reasons why the ICA became so successful: an extremely dedicated ICA staff, Board of Directors and volunteers; a very strong Medical Advisory Board and participation of many other urologists from across the country and around the world; cooperation of the media; epidemiological studies; the ICA’s Pilot Research Program; our representation in Congress; and a strong working partnership with the National Institutes of Health (NIH). Our history may prove useful to other advocacy groups.     

Linkage to and retention in care following healthcare transition from pediatric to adult HIV care

Outcomes following healthcare transition (HCT) from pediatric to adult HIV care are not well described. We sought to describe clinical outcomes following HCT within our institution among young adults with behavioral-acquired (N?=?31) and perinatally-acquired (N?=?19) HIV. We conducted a retrospective cohort study among HIV-infected adults who attempted transition from pediatric to adult HIV care within our institution. The primary end point was retention in care, defined as the completion of at least two visits over 12 months following linkage to adult care. Additional end points include time to linkage to adult care, and changes in CD4?+?T cell count and HIV RNA across time. Outcomes were compared between perinatal and behavioral HIV cohorts. Binary data were analyzed using the Fisher exact test and continuous data were analyzed using the Mann–Whitney test. Forty-three (86%) of 50 patients were successfully linked to adult care. The median time to linkage was 98 days. Fifty percent of patients achieved full retention in care at 12 months post-linkage. Though those with behavioral-acquired HIV attempted transfer at an older age, the groups did not differ in rates of linkage and retention in adult care. CD4?+?T cell counts and rates of viral suppression did not differ between pre- and post-HCT periods. Despite high rates of successful linkage to adult care in our study population, rates of retention in adult HIV care following HCT were low. These results imply that challenges remain in the adult HIV care setting toward improving the HCT process.     

The transformation of the meaning of death in complicated grief group therapy for survivors of suicide: A treatment process analysis using the meaning of loss codebook

We examined the therapeutic process of grief change in survivors of suicide participating in complicated grief group therapy (CGGT) using the meaning of loss codebook (MLC). Complicated grief group therapy is a multimodal group psychotherapy designed to restore normal grieving in persons with complicated grief. Using video data, we evaluated transition points in psychotherapy associated with meaning reconstruction: retelling the narrative of the death, having an imaginal conversation with the deceased, and memory integration. The MLC codes captured most of the voiced statements of participants, provided a valuable lens for articulating the therapeutic process, and affirmed that CGGT facilitated effective grief.