Journal of Health Care for the Poor and Underserved, 2022
AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic r... more AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic retinopathy (DR) among Mexican migrants in the U.S. METHODS Adult visitors (n=508) at Mexican consulates in California with self-reported diabetes underwent questionnaires and fundus photography. Photographs were graded for DR by retina fellows in Mexico via teleophthalmology. Participants were contacted with results and provided referrals when necessary. RESULTS Nearly all (97.6%) participants were aware that diabetes can cause vision loss. One-quarter (24.4%) had undergone an eye examination in the past year. Barriers to care were cost (53.9%) and insurance (45.6%). Most (85.4-91.1%) reported that Spanish-speaking providers and provision of screening in primary care would increase participation in screening. Any DR, vision-threatening DR, or proliferative DR were found in 30.2%, 9.9%, and 5.4% of participants, respectively. Nearly one-fifth (19.5%) received referrals. CONCLUSIONS Screening in Mexican consulates may improve DR detection and treatment among Mexican migrants in the U.S.
Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have s... more Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have studied its applicability to youth in international settings. The current study used a participatory approach to design a measure of empowerment for youth from a rural, Indigenous community in Guatemala and aimed to compare this new measure to extant measures. Youth co-researchers (aged 19-22) collaborated in the development of four culturally relevant empowerment scales through a formative process involving classroom observations and focus groups. Newly developed scales and two widely used, extant scales were administered to a school-based sample of 273 youth (mean age = 14.7, SD = 1.6). Exploratory factor analysis (EFA) showed that one of the newly developed PE scales called Self-Efficacy for Community Action (SECA), which was moderately correlated with the extant scales, appeared to more effectively capture empowerment in the local context than the extant measures. These results suppor...
Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and cu... more Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and culture conversion. Alternatives to these methods are needed for those patients whose sputum tests are smear or culture negative. Here, we examine anti-phospholipid IgM antibody level changes as a biomarker for treatment response in smear positive TB patients. Serum samples were obtained from 40 pulmonary TB patients at the start and end of the intensive phase treatment (IPT) from the CDC-TB Trials Consortium randomized clinical trial in Kampala, Uganda. Samples were screened by ELISA for IgM levels against five phospholipids found in Mycobacterium tuberculosis and host cells. Lipid antigens included cardiolipin (CL), phosphatidyl inositol (PI), phosphatidyl ethanolamine (PE), phosphatidyl choline (PTC), and sphingolipid (SL). Levels of IgM against all phospholipids significantly decreased (p = 0.034, 0.001, 0.008 0.008, 0.040, respectively) following anti-TB drug treatment in patients wit...
Purpose: Native American adolescents in the United States suffer from significant health disparit... more Purpose: Native American adolescents in the United States suffer from significant health disparities in depression, substance use and suicide. Research regarding culturally competent, community based, youth positive interventions that promote youth connection is needed to inform a response. The Gathering of Native Americans (GONA) is a strengths-based intervention intended to promote adolescent wellbeing and resiliency. Published research regarding its effects is extremely limited. Our evaluation of the GONA intervention in two California sites in 2012-2014 employs mixed-methods in order to answer the primary research question: Among adolescent Native Americans, what is the relationship between participation in GONA and resilience?
Background: Although social networks are an increasingly recognized influence on contraceptive us... more Background: Although social networks are an increasingly recognized influence on contraceptive use, little is known about if and how social influences are discussed during women’s contraceptive counseling visits. Methods: We performed a mixed-methods analysis of audio recordings of contraceptive counseling visits. We examined predictors of discussion of social influence arising in a contraceptive counseling visit and analyzed the content and process of social influence discussions. Results: Social influences were mentioned in 42% of the 342 visits included in the sample, with these discussions most commonly initiated by patients. Younger patients were more likely to have social influence mentioned than older patients. The content of social influence focused on side effects and adverse events, with the sources of influence being predominantly patients’ friends and the media, with little input from partners. Providers were more likely to engage around the content of the social influence than the social influence itself. Conclusion: The frequency with which social influence was mentioned in these visits supports the importance of women’s social context on their contraceptive decision making. However, the fact that patients initiated the discussion in the majority of cases suggests that providers may not recognize the relevance of these influences or may not be comfortable engaging with them. Increasing providers’ ability to elicit and engage patients about their social context with regard to contraception could enhance providers’ ability to understand women’s contraceptive preferences and provide appropriate counseling to address their specific concerns or questions. Copyright 2015 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc. In the United States, unintended pregnancy is a major public
To determine whether adult minority patients with medically refractory temporal lobe epilepsy (TL... more To determine whether adult minority patients with medically refractory temporal lobe epilepsy (TLE) experience significantly longer times to anterior temporal lobectomy (ATL) following presurgical evaluation. A retrospective cohort study of 223 adult patients with epilepsy (PWE) and unilateral mesial temporal sclerosis who completed presurgical evaluation in the epilepsy monitoring unit at University of California, San Francisco, between January 1, 1993 and December 31, 2010, with follow-up through December 31, 2012. Log-rank test was performed for Kaplan-Meier survival curves of time to ATL stratified by race/ethnicity and by limited English proficiency (LEP). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards and Weibull modeling. African Americans (AAs) and Asian/Pacific Islanders (Asian/PIs) experienced significantly longer times to surgery than whites in Kaplan-Meier plots (log-rank test p = 0.02 and p = 0.005, respectively). AAs and Asian/PIs also had longer times to surgery after adjusting for frailty, LEP, sex, age, mesial temporal sclerosis (MTS) laterality, and nonconcordant ictal electroencephalography (EEG) (adjusted HR = 0.22, p = 0.006; adjusted HR = 0.25, p = 0.003, respectively). Patients with LEP experienced significantly longer times to surgery than patients proficient in English (log-rank test p = 0.0085; adjusted HR = 0.48, p = 0.041). In Cox modeling, nonconcordant ictal EEG studies (adjusted HR = 0.47, p = 0.01), left-sided MTS (adjusted HR = 0.69, p = 0.023), and female sex (adjusted HR = 0.72, p = 0.048) were risk factors for longer times to surgery. AA and Asian/PI patients as well as those with LEP have significantly longer times to ATL following presurgical evaluation. Future studies should be aimed at identifying the source of these disparities and developing targeted interventions to address them. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
Journal of acquired immune deficiency syndromes (1999), Aug 12, 2017
While HIV stigma has been identified as an important risk factor for HIV transmission risk behavi... more While HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs), or how gender may modify associations. We pooled data from the 2008 and 2013 Sierra Leone DHS. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations. 24,030 (69.5%) of 34,574 respondents who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs, respectively (AOR=2.07; 95%CI, 1.55-2.77; AOR=2.9...
Journal of Health Care for the Poor and Underserved, 2022
AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic r... more AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic retinopathy (DR) among Mexican migrants in the U.S. METHODS Adult visitors (n=508) at Mexican consulates in California with self-reported diabetes underwent questionnaires and fundus photography. Photographs were graded for DR by retina fellows in Mexico via teleophthalmology. Participants were contacted with results and provided referrals when necessary. RESULTS Nearly all (97.6%) participants were aware that diabetes can cause vision loss. One-quarter (24.4%) had undergone an eye examination in the past year. Barriers to care were cost (53.9%) and insurance (45.6%). Most (85.4-91.1%) reported that Spanish-speaking providers and provision of screening in primary care would increase participation in screening. Any DR, vision-threatening DR, or proliferative DR were found in 30.2%, 9.9%, and 5.4% of participants, respectively. Nearly one-fifth (19.5%) received referrals. CONCLUSIONS Screening in Mexican consulates may improve DR detection and treatment among Mexican migrants in the U.S.
Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have s... more Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have studied its applicability to youth in international settings. The current study used a participatory approach to design a measure of empowerment for youth from a rural, Indigenous community in Guatemala and aimed to compare this new measure to extant measures. Youth co-researchers (aged 19-22) collaborated in the development of four culturally relevant empowerment scales through a formative process involving classroom observations and focus groups. Newly developed scales and two widely used, extant scales were administered to a school-based sample of 273 youth (mean age = 14.7, SD = 1.6). Exploratory factor analysis (EFA) showed that one of the newly developed PE scales called Self-Efficacy for Community Action (SECA), which was moderately correlated with the extant scales, appeared to more effectively capture empowerment in the local context than the extant measures. These results suppor...
Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and cu... more Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and culture conversion. Alternatives to these methods are needed for those patients whose sputum tests are smear or culture negative. Here, we examine anti-phospholipid IgM antibody level changes as a biomarker for treatment response in smear positive TB patients. Serum samples were obtained from 40 pulmonary TB patients at the start and end of the intensive phase treatment (IPT) from the CDC-TB Trials Consortium randomized clinical trial in Kampala, Uganda. Samples were screened by ELISA for IgM levels against five phospholipids found in Mycobacterium tuberculosis and host cells. Lipid antigens included cardiolipin (CL), phosphatidyl inositol (PI), phosphatidyl ethanolamine (PE), phosphatidyl choline (PTC), and sphingolipid (SL). Levels of IgM against all phospholipids significantly decreased (p = 0.034, 0.001, 0.008 0.008, 0.040, respectively) following anti-TB drug treatment in patients wit...
Purpose: Native American adolescents in the United States suffer from significant health disparit... more Purpose: Native American adolescents in the United States suffer from significant health disparities in depression, substance use and suicide. Research regarding culturally competent, community based, youth positive interventions that promote youth connection is needed to inform a response. The Gathering of Native Americans (GONA) is a strengths-based intervention intended to promote adolescent wellbeing and resiliency. Published research regarding its effects is extremely limited. Our evaluation of the GONA intervention in two California sites in 2012-2014 employs mixed-methods in order to answer the primary research question: Among adolescent Native Americans, what is the relationship between participation in GONA and resilience?
Background: Although social networks are an increasingly recognized influence on contraceptive us... more Background: Although social networks are an increasingly recognized influence on contraceptive use, little is known about if and how social influences are discussed during women’s contraceptive counseling visits. Methods: We performed a mixed-methods analysis of audio recordings of contraceptive counseling visits. We examined predictors of discussion of social influence arising in a contraceptive counseling visit and analyzed the content and process of social influence discussions. Results: Social influences were mentioned in 42% of the 342 visits included in the sample, with these discussions most commonly initiated by patients. Younger patients were more likely to have social influence mentioned than older patients. The content of social influence focused on side effects and adverse events, with the sources of influence being predominantly patients’ friends and the media, with little input from partners. Providers were more likely to engage around the content of the social influence than the social influence itself. Conclusion: The frequency with which social influence was mentioned in these visits supports the importance of women’s social context on their contraceptive decision making. However, the fact that patients initiated the discussion in the majority of cases suggests that providers may not recognize the relevance of these influences or may not be comfortable engaging with them. Increasing providers’ ability to elicit and engage patients about their social context with regard to contraception could enhance providers’ ability to understand women’s contraceptive preferences and provide appropriate counseling to address their specific concerns or questions. Copyright 2015 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc. In the United States, unintended pregnancy is a major public
To determine whether adult minority patients with medically refractory temporal lobe epilepsy (TL... more To determine whether adult minority patients with medically refractory temporal lobe epilepsy (TLE) experience significantly longer times to anterior temporal lobectomy (ATL) following presurgical evaluation. A retrospective cohort study of 223 adult patients with epilepsy (PWE) and unilateral mesial temporal sclerosis who completed presurgical evaluation in the epilepsy monitoring unit at University of California, San Francisco, between January 1, 1993 and December 31, 2010, with follow-up through December 31, 2012. Log-rank test was performed for Kaplan-Meier survival curves of time to ATL stratified by race/ethnicity and by limited English proficiency (LEP). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards and Weibull modeling. African Americans (AAs) and Asian/Pacific Islanders (Asian/PIs) experienced significantly longer times to surgery than whites in Kaplan-Meier plots (log-rank test p = 0.02 and p = 0.005, respectively). AAs and Asian/PIs also had longer times to surgery after adjusting for frailty, LEP, sex, age, mesial temporal sclerosis (MTS) laterality, and nonconcordant ictal electroencephalography (EEG) (adjusted HR = 0.22, p = 0.006; adjusted HR = 0.25, p = 0.003, respectively). Patients with LEP experienced significantly longer times to surgery than patients proficient in English (log-rank test p = 0.0085; adjusted HR = 0.48, p = 0.041). In Cox modeling, nonconcordant ictal EEG studies (adjusted HR = 0.47, p = 0.01), left-sided MTS (adjusted HR = 0.69, p = 0.023), and female sex (adjusted HR = 0.72, p = 0.048) were risk factors for longer times to surgery. AA and Asian/PI patients as well as those with LEP have significantly longer times to ATL following presurgical evaluation. Future studies should be aimed at identifying the source of these disparities and developing targeted interventions to address them. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
Journal of acquired immune deficiency syndromes (1999), Aug 12, 2017
While HIV stigma has been identified as an important risk factor for HIV transmission risk behavi... more While HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs), or how gender may modify associations. We pooled data from the 2008 and 2013 Sierra Leone DHS. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations. 24,030 (69.5%) of 34,574 respondents who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs, respectively (AOR=2.07; 95%CI, 1.55-2.77; AOR=2.9...
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Papers by Maureen Lahiff