Jessica Davila - Academia.edu (original) (raw)

Papers by Jessica Davila

Research paper thumbnail of Assessing HIV Testing and Linkage to Care Activities and Providing Academic Support to Public Health Authorities in Houston, TX

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Background-Health departments often have little knowledge of HIV testing and linkage activities o... more Background-Health departments often have little knowledge of HIV testing and linkage activities outside of those they directly fund. Many health departments also have limited access to outside academic expertise. Methods-We conducted a survey of health organizations in the Houston/Harris County region to determine the number of HIV tests completed in 2011, activities that organizations conducted to promote linkage to care for persons newly diagnosed with HIV, and barriers to linkage to care. We also convened a Scientific Advisory Council to advise the local health department on HIV prevention activities. Results-In 2012, 55 of 84 organizations (65.5%) completed the survey, and 43 of those 55 organizations reported conducting HIV testing, so were included in this analysis. Organizations reported conducting 210,565 HIV tests in 2011, 50.9% under health department contract. The median number of tests per organization was 1045 (IQR 159 and 3520). Over 90% of the organizations used active linkage to care methods, but only 46.5% had written linkage to care protocols. Barriers to linkage to care most often reported were client refusal, followed by staff capacity and funding limitations. The Scientific Advisory Council provided valuable informal expertise to the local health department.

Research paper thumbnail of Epidemiology of Hepatocellular Carcinoma in Hispanics in the United States

Archives of Internal Medicine, 2007

Background: To our knowledge, no detailed analysis exists of the incidence and mortality of hepat... more Background: To our knowledge, no detailed analysis exists of the incidence and mortality of hepatocellular carcinoma (HCC) among Hispanics in the United States. In previous studies, the rates for Hispanics have not been reported separately from other racial or ethnic groups. Methods: We used information on patients diagnosed as having HCC from 13 registries in the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute to calculate race-specific, ageadjusted incidence rates (AIR) between 1992 and 2002. We also used California and Texas state death records from between 1979 and 2001 to calculate race-specific, age-adjusted mortality rates for liver cancer excluding intrahepatic cholangiocarcinoma. For Hispanics and Asians/ Pacific Islanders, the rates were calculated for nativeborn subjects and immigrants separately. Results: In SEER, the yearly AIRs were higher by 1.2fold in Hispanics than in blacks (6.3 vs 5.0 per 100 000 person-years of the underlying US population) and by 2.7-fold than in non-Hispanic whites (2.4 per 100 000 personyears) but lower than in Asians/Pacific Islanders (10.8 per 100 000 person-years). The median age at HCC diagnosis in Hispanics (64 years) was intermediate between whites (the oldest) and blacks (the youngest). Between the periods 1992-1995 and 2000-2002, there was a 31% increase in the incidence of HCC in Hispanic men and a 63% increase in Hispanic women. The race-specific, ageadjusted mortality rates were remarkably similar in California and Texas and were highest in immigrant Asian/ Pacific Islanders followed by native Hispanics. The rates for native Hispanic men were more than twice as high as those for immigrant Hispanic men. For Texas, the rates for native Hispanic men were 65% higher than those for immigrant Hispanic men. Conclusion: Hispanics in the United States have high rates of HCC that are second only to Asians/Pacific Islanders.

Research paper thumbnail of Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome

The American Journal of Medicine, 2008

Research paper thumbnail of A randomized trial to test a peer mentor intervention to improve outcomes in persons hospitalized with HIV infection

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 23, 2016

Few interventions have been shown to improve retention in HIV care, and none have targeted the h... more Few interventions have been shown to improve retention in HIV care, and none have targeted the hospitalized patient. Peer mentoring has not been rigorously tested. We conducted a randomized, controlled clinical trial of a peer mentor intervention. Eligible adults were hospitalized, and were either newly diagnosed with HIV infection or were out of care. The intervention, based on the information, motivation, and behavioral skills model, included two in-person sessions with a volunteer peer mentor while hospitalized, followed by 5 phone calls in the 10 weeks after discharge. The control intervention provided didactic sessions on avoiding HIV transmission on the same schedule. The primary outcome was a composite of retention in care (completed HIV primary care visits within 30 days and between 31 and 180 days after discharge) and VL improvement (≥1 log10 decline) 6 months after discharge. We enrolled 460 participants in 3 years; 417 were in the modified intent-to-treat analysis. The...

Research paper thumbnail of HIV Testing Implementation in Two Urban Cities

Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance i... more Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown. We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions. In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC. Given unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.

Research paper thumbnail of Utilization and Determinants of Adjuvant Therapy Among Older Patients Who Receive Curative Surgery for Pancreatic Cancer

Pancreas, 2009

We conducted a population-based study to describe the utilization, determinants, and survival eff... more We conducted a population-based study to describe the utilization, determinants, and survival effects of adjuvant therapies after surgery among older patients with pancreatic cancer. Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients older than 65 years who received surgical resection for pancreatic cancer during 1992-2002. We constructed multiple logistic regression models to examine patient, clinical, and hospital factors associated with receiving adjuvant therapy. Cox proportional hazards models were used to examine the effect of therapy on survival. Approximately 49% of patients received adjuvant therapy after surgery. Patient factors associated with increased receipt of adjuvant therapy included more recent diagnosis, younger age, stage II disease, higher income, and geographic location. Hospital factors associated with increased receipt of adjuvant therapy included cooperative group membership and larger size. Adjuvant treatments associated with a significant reduction in 2-year mortality (relative to surgery alone) were chemoradiation or radiation alone but not chemotherapy alone. Our findings suggest that adjuvant chemoradiation and, to a lesser degree, radiation only are associated with a reduction in the risk of mortality among older patients who undergo surgery for pancreatic cancer. However, receipt of adjuvant therapy varied by period and geography as well as by certain patient and hospital factors.

Research paper thumbnail of Self-Reported Pain in Persons With Dementia Predicts Subsequent Decreased Psychosocial Functioning

The American Journal of Geriatric Psychiatry Official Journal of the American Association For Geriatric Psychiatry, Oct 1, 2009

Objectives: Pain self-report is the assessment gold standard in cognitively intact populations bu... more Objectives: Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia. Design: Longitudinal. Patients and caregivers were assessed every 4 months for 24 months. Setting: Veterans Affairs Medical Center, Houston, TX. Participants: One hundred seventy-one patients over age 60 years diagnosed with dementia in the previous year and with no previous aggression were recruited from Veterans Administration clinics. Measurements: Pain, agitation, depression, involvement in pleasant events, caregiver burden, psychosis, and patient/ caregiver relationship quality (mutuality). Results: Pain scores at each time period were predictive of increased agitation and depression and decreased pleasant event frequency 4 months later. Conclusions: Our results suggest that persons with dementia who affirmatively respond to pain questions are at higher risk for developing negative psychosocial states. (Am J Geriatr Psychiatry 2009; 17:873-880)

Research paper thumbnail of Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

PLOS ONE, 2016

Poor retention in HIV medical care is associated with increased mortality among patients with HIV... more Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA) is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC). Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV.

Research paper thumbnail of Incidence and Survival of Pancreatic Head and Body and Tail Cancers: A Population-Based Study in the United States

Pancreas, 2010

Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No s... more Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No studies have examined whether the demographics, disease characteristics, and patient survival with pancreatic body/tail cancers are different from pancreatic head tumors. We used the Surveillance, Epidemiology, and End Results (SEER) registry to identify 43,946 cases of pancreatic cancer. The yearly incidence and survival rates were calculated. Cox proportional hazards model examined temporal trends in survival. The incidence rate for pancreatic head cancer has remained at 5.6% per 100,000, whereas the rate for pancreatic body/tail cancers has increased by 46% between 1973 and 2002. The 3-year survival rate has increased slightly for both groups. The Cox proportional hazards model analysis confirms this improvement. The 3-year survival rate for local-stage pancreatic body/tail cancer is 20.0% compared with 9% for local-stage pancreatic head cancer. This study indicates that the incidence of pancreatic head cancer has remained stable, whereas the incidence of pancreatic body/tail cancers is rising. Despite higher survival rates among patients with pancreatic head cancer compared with those with pancreatic body/tail cancers in several variables, patients with local-stage pancreatic body/tail cancers had higher survival rates compared with local-stage pancreatic head cancer.

Research paper thumbnail of Birleşik Devletlerde İntrahepatik Kolanjiokarsinomanın Risk Faktörleri: Bir Vaka-Kontrol Çalışması

Gastroenterology, 2005

Giriş & Amaçlar: Birleşik Devletlerde intrahepatik kolanjiokarsinomanın insidansı son zamanla... more Giriş & Amaçlar: Birleşik Devletlerde intrahepatik kolanjiokarsinomanın insidansı son zamanlarda artmaktadır. Bu vaka-kontrol çalışmasında, intrahepatik kolanjiokarsinoma için bilinen risk faktörlerini değerlendirmek ve diğer potansiyel risk faktörlerini araştırmak için Gözetim, Epidemiyoloji ...

Research paper thumbnail of VHA pharmacy use in veterans with Medicare drug coverage

The American journal of managed care

To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VH... more To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VHA) pharmacy services. Retrospective analysis of veterans dually enrolled in the Veterans Health Administration and Medicare healthcare systems. We used VHA and Medicare administrative data for calendar year 2002 to examine the effect of Medicare HMO pharmacy benefit levels on VHA pharmacy use. In 2002, 64% of the VHA and Medicare dually enrolled veterans in our study sample received medications from the VHA. Use of VHA pharmacy services varied monotonically by the level of pharmacy benefits among Medicare HMO enrollees, with veterans enrolled in plans with both low and high pharmacy benefit levels significantly less likely to use VHA pharmacy services than veterans in plans with no pharmacy benefits (odds ratios = .83 and .53, respectively, versus plans with no benefits). Among VHA pharmacy users, enrollment in plans with high levels of benefits was associated with significantly lower an...

Research paper thumbnail of Self-reported pain in persons with dementia predicts subsequent decreased psychosocial functioning

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2009

Pain self-report is the assessment gold standard in cognitively intact populations but has been d... more Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia. Longitudinal. Patients and caregivers were assessed eve...

Research paper thumbnail of The impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. Population-based study

The American journal of gastroenterology, 2007

Pancreatic cancer is the fourth leading cause of cancer death in the United States. Curative inte... more Pancreatic cancer is the fourth leading cause of cancer death in the United States. Curative intent surgery (CIS) is presumed to be the only curative option in the treatment of pancreatic cancer. The determinants and the outcomes of surgical resection are not clear at the population level. Using data from nine registries of the Surveillance Epidemiology and End Results (SEER) program, we examined the predictors of receiving CIS as well as the survival of patients receiving CIS between 1987 and 2001. The definition of CIS in SEER is accurate and has been previously validated and found to be highly accurate. Cox proportional hazard model was used to examine the effect of potential determinants on survival. We identified 32,348 cases of pancreatic cancer. Of those, 3,545 (10.9%) received CIS. The proportion of patients receiving CIS decreased significantly with age (P < 0.0001), was similar across all racial groups (10.8% in whites, 11.4% in blacks, 11.5% in Asians, and 11.2 % in Hi...

Research paper thumbnail of Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma

Journal of oncology practice / American Society of Clinical Oncology, Jan 2, 2014

Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often ... more Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often provided through a tumor board (TB) forum; this standard is limited by oncology workforce shortages and lack of a TB at every institution. Virtual TBs (VTBs) may help overcome these limitations. Our study aim was to assess the impact of a regional VTB on the MDE process for patients with HCC. A retrospective cohort study was conducted, including patients with HCC referred to a tertiary cancer center from regional facilities (2009 to 2013). Baseline characteristics and outcomes were compared based on the referral mechanism: VTB versus subspecialty consultation (non-VTB). The primary outcome was comprehensive MDE (all required specialists present and key topics discussed). Secondary outcomes included timeliness of MDE and travel burden to complete MDE. Univariable and multivariable logistic regressions were performed to examine the association of a VTB with comprehensive MDE. A total of 11...

Research paper thumbnail of Secular Trends in the Incidence of Cholangiocarcinoma in the USA and the Impact of Misclassification

Digestive Diseases and Sciences, 2014

It has been reported that the incidence of intrahepatic cholangiocarcinoma (ICC) has increased in... more It has been reported that the incidence of intrahepatic cholangiocarcinoma (ICC) has increased in the USA, while extrahepatic cholangiocarcinoma (ECC) has decreased or remained stable. However, neither the recent trends nor the effects of the misclassification of Klatskin tumors are known. Using the Surveillance, Epidemiology, and End Results program databases, we calculated the average annual age-adjusted incidence rates (AA-IRs) of ICC and ECC in 4-year time periods (1992-1995, 1996-1999, 2000-2003, 2004-2007). These AA-IRs were calculated with misclassified as well as correctly classified Klatskin tumors. AA-IRs were also calculated based on age, sex, and race. Multivariable Poisson regression models were used to evaluate the secular trends of ICC and ECC. The AA-IR of ICC was 0.92 in 1992-1995 and 0.93 in 2004-2007, while the AA-IR of ECC increased from 0.70 in 1992-1995 to 0.95 in 2004-2007. There was no significant trend in AA-IR of ICC (p = 0.07), while there was a significant increase in ECC across the 4-year time periods (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Klatskin tumors comprised 6.7% of CCs with approximately 90 and 45% misclassified as ICC during 1992-2000 and 2001-2007, respectively. Adjusted Poisson models showed no significant differences in the temporal trend of ICC or ECC due to misclassification of Klatskin tumors. The incidence of ICC has remained stable between 1992 and 2007 with only slight fluctuations, while the incidence of ECC has been increasing. Misclassification of Klatskin tumors does not appear to play a significant role in the trends of CCs.

Research paper thumbnail of How to Find and Apply Large Databases for Epidemiologic Research

Diseases and Clinical Methodology, 2014

Research paper thumbnail of HIV Testing Implementation in Two Urban Cities: Practice, Policy, and Perceived Barriers

PLoS ONE, 2014

Background: Although funding has supported the scale up of routine, opt-out HIV testing in the US... more Background: Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

Research paper thumbnail of Treatment Outcomes in Undocumented Hispanic Immigrants with HIV Infection

PLoS ONE, 2013

Objective: Little is known about the treatment outcomes of undocumented Hispanic immigrants with ... more Objective: Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care.

Research paper thumbnail of Incidence and Survival of Pancreatic Head and Body and Tail Cancers

Pancreas, 2010

Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No s... more Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No studies have examined whether the demographics, disease characteristics, and patient survival with pancreatic body/tail cancers are different from pancreatic head tumors. We used the Surveillance, Epidemiology, and End Results (SEER) registry to identify 43,946 cases of pancreatic cancer. The yearly incidence and survival rates were calculated. Cox proportional hazards model examined temporal trends in survival. The incidence rate for pancreatic head cancer has remained at 5.6% per 100,000, whereas the rate for pancreatic body/tail cancers has increased by 46% between 1973 and 2002. The 3-year survival rate has increased slightly for both groups. The Cox proportional hazards model analysis confirms this improvement. The 3-year survival rate for local-stage pancreatic body/tail cancer is 20.0% compared with 9% for local-stage pancreatic head cancer. This study indicates that the incidence of pancreatic head cancer has remained stable, whereas the incidence of pancreatic body/tail cancers is rising. Despite higher survival rates among patients with pancreatic head cancer compared with those with pancreatic body/tail cancers in several variables, patients with local-stage pancreatic body/tail cancers had higher survival rates compared with local-stage pancreatic head cancer.

Research paper thumbnail of Utilization and Determinants of Adjuvant Therapy Among Older Patients Who Receive Curative Surgery for Pancreatic Cancer

Pancreas, 2009

We conducted a population-based study to describe the utilization, determinants, and survival eff... more We conducted a population-based study to describe the utilization, determinants, and survival effects of adjuvant therapies after surgery among older patients with pancreatic cancer. Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients older than 65 years who received surgical resection for pancreatic cancer during 1992-2002. We constructed multiple logistic regression models to examine patient, clinical, and hospital factors associated with receiving adjuvant therapy. Cox proportional hazards models were used to examine the effect of therapy on survival. Approximately 49% of patients received adjuvant therapy after surgery. Patient factors associated with increased receipt of adjuvant therapy included more recent diagnosis, younger age, stage II disease, higher income, and geographic location. Hospital factors associated with increased receipt of adjuvant therapy included cooperative group membership and larger size. Adjuvant treatments associated with a significant reduction in 2-year mortality (relative to surgery alone) were chemoradiation or radiation alone but not chemotherapy alone. Our findings suggest that adjuvant chemoradiation and, to a lesser degree, radiation only are associated with a reduction in the risk of mortality among older patients who undergo surgery for pancreatic cancer. However, receipt of adjuvant therapy varied by period and geography as well as by certain patient and hospital factors.

Research paper thumbnail of Assessing HIV Testing and Linkage to Care Activities and Providing Academic Support to Public Health Authorities in Houston, TX

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Background-Health departments often have little knowledge of HIV testing and linkage activities o... more Background-Health departments often have little knowledge of HIV testing and linkage activities outside of those they directly fund. Many health departments also have limited access to outside academic expertise. Methods-We conducted a survey of health organizations in the Houston/Harris County region to determine the number of HIV tests completed in 2011, activities that organizations conducted to promote linkage to care for persons newly diagnosed with HIV, and barriers to linkage to care. We also convened a Scientific Advisory Council to advise the local health department on HIV prevention activities. Results-In 2012, 55 of 84 organizations (65.5%) completed the survey, and 43 of those 55 organizations reported conducting HIV testing, so were included in this analysis. Organizations reported conducting 210,565 HIV tests in 2011, 50.9% under health department contract. The median number of tests per organization was 1045 (IQR 159 and 3520). Over 90% of the organizations used active linkage to care methods, but only 46.5% had written linkage to care protocols. Barriers to linkage to care most often reported were client refusal, followed by staff capacity and funding limitations. The Scientific Advisory Council provided valuable informal expertise to the local health department.

Research paper thumbnail of Epidemiology of Hepatocellular Carcinoma in Hispanics in the United States

Archives of Internal Medicine, 2007

Background: To our knowledge, no detailed analysis exists of the incidence and mortality of hepat... more Background: To our knowledge, no detailed analysis exists of the incidence and mortality of hepatocellular carcinoma (HCC) among Hispanics in the United States. In previous studies, the rates for Hispanics have not been reported separately from other racial or ethnic groups. Methods: We used information on patients diagnosed as having HCC from 13 registries in the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute to calculate race-specific, ageadjusted incidence rates (AIR) between 1992 and 2002. We also used California and Texas state death records from between 1979 and 2001 to calculate race-specific, age-adjusted mortality rates for liver cancer excluding intrahepatic cholangiocarcinoma. For Hispanics and Asians/ Pacific Islanders, the rates were calculated for nativeborn subjects and immigrants separately. Results: In SEER, the yearly AIRs were higher by 1.2fold in Hispanics than in blacks (6.3 vs 5.0 per 100 000 person-years of the underlying US population) and by 2.7-fold than in non-Hispanic whites (2.4 per 100 000 personyears) but lower than in Asians/Pacific Islanders (10.8 per 100 000 person-years). The median age at HCC diagnosis in Hispanics (64 years) was intermediate between whites (the oldest) and blacks (the youngest). Between the periods 1992-1995 and 2000-2002, there was a 31% increase in the incidence of HCC in Hispanic men and a 63% increase in Hispanic women. The race-specific, ageadjusted mortality rates were remarkably similar in California and Texas and were highest in immigrant Asian/ Pacific Islanders followed by native Hispanics. The rates for native Hispanic men were more than twice as high as those for immigrant Hispanic men. For Texas, the rates for native Hispanic men were 65% higher than those for immigrant Hispanic men. Conclusion: Hispanics in the United States have high rates of HCC that are second only to Asians/Pacific Islanders.

Research paper thumbnail of Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome

The American Journal of Medicine, 2008

Research paper thumbnail of A randomized trial to test a peer mentor intervention to improve outcomes in persons hospitalized with HIV infection

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 23, 2016

Few interventions have been shown to improve retention in HIV care, and none have targeted the h... more Few interventions have been shown to improve retention in HIV care, and none have targeted the hospitalized patient. Peer mentoring has not been rigorously tested. We conducted a randomized, controlled clinical trial of a peer mentor intervention. Eligible adults were hospitalized, and were either newly diagnosed with HIV infection or were out of care. The intervention, based on the information, motivation, and behavioral skills model, included two in-person sessions with a volunteer peer mentor while hospitalized, followed by 5 phone calls in the 10 weeks after discharge. The control intervention provided didactic sessions on avoiding HIV transmission on the same schedule. The primary outcome was a composite of retention in care (completed HIV primary care visits within 30 days and between 31 and 180 days after discharge) and VL improvement (≥1 log10 decline) 6 months after discharge. We enrolled 460 participants in 3 years; 417 were in the modified intent-to-treat analysis. The...

Research paper thumbnail of HIV Testing Implementation in Two Urban Cities

Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance i... more Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown. We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions. In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC. Given unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.

Research paper thumbnail of Utilization and Determinants of Adjuvant Therapy Among Older Patients Who Receive Curative Surgery for Pancreatic Cancer

Pancreas, 2009

We conducted a population-based study to describe the utilization, determinants, and survival eff... more We conducted a population-based study to describe the utilization, determinants, and survival effects of adjuvant therapies after surgery among older patients with pancreatic cancer. Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients older than 65 years who received surgical resection for pancreatic cancer during 1992-2002. We constructed multiple logistic regression models to examine patient, clinical, and hospital factors associated with receiving adjuvant therapy. Cox proportional hazards models were used to examine the effect of therapy on survival. Approximately 49% of patients received adjuvant therapy after surgery. Patient factors associated with increased receipt of adjuvant therapy included more recent diagnosis, younger age, stage II disease, higher income, and geographic location. Hospital factors associated with increased receipt of adjuvant therapy included cooperative group membership and larger size. Adjuvant treatments associated with a significant reduction in 2-year mortality (relative to surgery alone) were chemoradiation or radiation alone but not chemotherapy alone. Our findings suggest that adjuvant chemoradiation and, to a lesser degree, radiation only are associated with a reduction in the risk of mortality among older patients who undergo surgery for pancreatic cancer. However, receipt of adjuvant therapy varied by period and geography as well as by certain patient and hospital factors.

Research paper thumbnail of Self-Reported Pain in Persons With Dementia Predicts Subsequent Decreased Psychosocial Functioning

The American Journal of Geriatric Psychiatry Official Journal of the American Association For Geriatric Psychiatry, Oct 1, 2009

Objectives: Pain self-report is the assessment gold standard in cognitively intact populations bu... more Objectives: Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia. Design: Longitudinal. Patients and caregivers were assessed every 4 months for 24 months. Setting: Veterans Affairs Medical Center, Houston, TX. Participants: One hundred seventy-one patients over age 60 years diagnosed with dementia in the previous year and with no previous aggression were recruited from Veterans Administration clinics. Measurements: Pain, agitation, depression, involvement in pleasant events, caregiver burden, psychosis, and patient/ caregiver relationship quality (mutuality). Results: Pain scores at each time period were predictive of increased agitation and depression and decreased pleasant event frequency 4 months later. Conclusions: Our results suggest that persons with dementia who affirmatively respond to pain questions are at higher risk for developing negative psychosocial states. (Am J Geriatr Psychiatry 2009; 17:873-880)

Research paper thumbnail of Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

PLOS ONE, 2016

Poor retention in HIV medical care is associated with increased mortality among patients with HIV... more Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA) is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC). Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV.

Research paper thumbnail of Incidence and Survival of Pancreatic Head and Body and Tail Cancers: A Population-Based Study in the United States

Pancreas, 2010

Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No s... more Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No studies have examined whether the demographics, disease characteristics, and patient survival with pancreatic body/tail cancers are different from pancreatic head tumors. We used the Surveillance, Epidemiology, and End Results (SEER) registry to identify 43,946 cases of pancreatic cancer. The yearly incidence and survival rates were calculated. Cox proportional hazards model examined temporal trends in survival. The incidence rate for pancreatic head cancer has remained at 5.6% per 100,000, whereas the rate for pancreatic body/tail cancers has increased by 46% between 1973 and 2002. The 3-year survival rate has increased slightly for both groups. The Cox proportional hazards model analysis confirms this improvement. The 3-year survival rate for local-stage pancreatic body/tail cancer is 20.0% compared with 9% for local-stage pancreatic head cancer. This study indicates that the incidence of pancreatic head cancer has remained stable, whereas the incidence of pancreatic body/tail cancers is rising. Despite higher survival rates among patients with pancreatic head cancer compared with those with pancreatic body/tail cancers in several variables, patients with local-stage pancreatic body/tail cancers had higher survival rates compared with local-stage pancreatic head cancer.

Research paper thumbnail of Birleşik Devletlerde İntrahepatik Kolanjiokarsinomanın Risk Faktörleri: Bir Vaka-Kontrol Çalışması

Gastroenterology, 2005

Giriş & Amaçlar: Birleşik Devletlerde intrahepatik kolanjiokarsinomanın insidansı son zamanla... more Giriş & Amaçlar: Birleşik Devletlerde intrahepatik kolanjiokarsinomanın insidansı son zamanlarda artmaktadır. Bu vaka-kontrol çalışmasında, intrahepatik kolanjiokarsinoma için bilinen risk faktörlerini değerlendirmek ve diğer potansiyel risk faktörlerini araştırmak için Gözetim, Epidemiyoloji ...

Research paper thumbnail of VHA pharmacy use in veterans with Medicare drug coverage

The American journal of managed care

To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VH... more To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VHA) pharmacy services. Retrospective analysis of veterans dually enrolled in the Veterans Health Administration and Medicare healthcare systems. We used VHA and Medicare administrative data for calendar year 2002 to examine the effect of Medicare HMO pharmacy benefit levels on VHA pharmacy use. In 2002, 64% of the VHA and Medicare dually enrolled veterans in our study sample received medications from the VHA. Use of VHA pharmacy services varied monotonically by the level of pharmacy benefits among Medicare HMO enrollees, with veterans enrolled in plans with both low and high pharmacy benefit levels significantly less likely to use VHA pharmacy services than veterans in plans with no pharmacy benefits (odds ratios = .83 and .53, respectively, versus plans with no benefits). Among VHA pharmacy users, enrollment in plans with high levels of benefits was associated with significantly lower an...

Research paper thumbnail of Self-reported pain in persons with dementia predicts subsequent decreased psychosocial functioning

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2009

Pain self-report is the assessment gold standard in cognitively intact populations but has been d... more Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia. Longitudinal. Patients and caregivers were assessed eve...

Research paper thumbnail of The impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. Population-based study

The American journal of gastroenterology, 2007

Pancreatic cancer is the fourth leading cause of cancer death in the United States. Curative inte... more Pancreatic cancer is the fourth leading cause of cancer death in the United States. Curative intent surgery (CIS) is presumed to be the only curative option in the treatment of pancreatic cancer. The determinants and the outcomes of surgical resection are not clear at the population level. Using data from nine registries of the Surveillance Epidemiology and End Results (SEER) program, we examined the predictors of receiving CIS as well as the survival of patients receiving CIS between 1987 and 2001. The definition of CIS in SEER is accurate and has been previously validated and found to be highly accurate. Cox proportional hazard model was used to examine the effect of potential determinants on survival. We identified 32,348 cases of pancreatic cancer. Of those, 3,545 (10.9%) received CIS. The proportion of patients receiving CIS decreased significantly with age (P < 0.0001), was similar across all racial groups (10.8% in whites, 11.4% in blacks, 11.5% in Asians, and 11.2 % in Hi...

Research paper thumbnail of Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma

Journal of oncology practice / American Society of Clinical Oncology, Jan 2, 2014

Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often ... more Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often provided through a tumor board (TB) forum; this standard is limited by oncology workforce shortages and lack of a TB at every institution. Virtual TBs (VTBs) may help overcome these limitations. Our study aim was to assess the impact of a regional VTB on the MDE process for patients with HCC. A retrospective cohort study was conducted, including patients with HCC referred to a tertiary cancer center from regional facilities (2009 to 2013). Baseline characteristics and outcomes were compared based on the referral mechanism: VTB versus subspecialty consultation (non-VTB). The primary outcome was comprehensive MDE (all required specialists present and key topics discussed). Secondary outcomes included timeliness of MDE and travel burden to complete MDE. Univariable and multivariable logistic regressions were performed to examine the association of a VTB with comprehensive MDE. A total of 11...

Research paper thumbnail of Secular Trends in the Incidence of Cholangiocarcinoma in the USA and the Impact of Misclassification

Digestive Diseases and Sciences, 2014

It has been reported that the incidence of intrahepatic cholangiocarcinoma (ICC) has increased in... more It has been reported that the incidence of intrahepatic cholangiocarcinoma (ICC) has increased in the USA, while extrahepatic cholangiocarcinoma (ECC) has decreased or remained stable. However, neither the recent trends nor the effects of the misclassification of Klatskin tumors are known. Using the Surveillance, Epidemiology, and End Results program databases, we calculated the average annual age-adjusted incidence rates (AA-IRs) of ICC and ECC in 4-year time periods (1992-1995, 1996-1999, 2000-2003, 2004-2007). These AA-IRs were calculated with misclassified as well as correctly classified Klatskin tumors. AA-IRs were also calculated based on age, sex, and race. Multivariable Poisson regression models were used to evaluate the secular trends of ICC and ECC. The AA-IR of ICC was 0.92 in 1992-1995 and 0.93 in 2004-2007, while the AA-IR of ECC increased from 0.70 in 1992-1995 to 0.95 in 2004-2007. There was no significant trend in AA-IR of ICC (p = 0.07), while there was a significant increase in ECC across the 4-year time periods (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Klatskin tumors comprised 6.7% of CCs with approximately 90 and 45% misclassified as ICC during 1992-2000 and 2001-2007, respectively. Adjusted Poisson models showed no significant differences in the temporal trend of ICC or ECC due to misclassification of Klatskin tumors. The incidence of ICC has remained stable between 1992 and 2007 with only slight fluctuations, while the incidence of ECC has been increasing. Misclassification of Klatskin tumors does not appear to play a significant role in the trends of CCs.

Research paper thumbnail of How to Find and Apply Large Databases for Epidemiologic Research

Diseases and Clinical Methodology, 2014

Research paper thumbnail of HIV Testing Implementation in Two Urban Cities: Practice, Policy, and Perceived Barriers

PLoS ONE, 2014

Background: Although funding has supported the scale up of routine, opt-out HIV testing in the US... more Background: Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

Research paper thumbnail of Treatment Outcomes in Undocumented Hispanic Immigrants with HIV Infection

PLoS ONE, 2013

Objective: Little is known about the treatment outcomes of undocumented Hispanic immigrants with ... more Objective: Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care.

Research paper thumbnail of Incidence and Survival of Pancreatic Head and Body and Tail Cancers

Pancreas, 2010

Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No s... more Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No studies have examined whether the demographics, disease characteristics, and patient survival with pancreatic body/tail cancers are different from pancreatic head tumors. We used the Surveillance, Epidemiology, and End Results (SEER) registry to identify 43,946 cases of pancreatic cancer. The yearly incidence and survival rates were calculated. Cox proportional hazards model examined temporal trends in survival. The incidence rate for pancreatic head cancer has remained at 5.6% per 100,000, whereas the rate for pancreatic body/tail cancers has increased by 46% between 1973 and 2002. The 3-year survival rate has increased slightly for both groups. The Cox proportional hazards model analysis confirms this improvement. The 3-year survival rate for local-stage pancreatic body/tail cancer is 20.0% compared with 9% for local-stage pancreatic head cancer. This study indicates that the incidence of pancreatic head cancer has remained stable, whereas the incidence of pancreatic body/tail cancers is rising. Despite higher survival rates among patients with pancreatic head cancer compared with those with pancreatic body/tail cancers in several variables, patients with local-stage pancreatic body/tail cancers had higher survival rates compared with local-stage pancreatic head cancer.

Research paper thumbnail of Utilization and Determinants of Adjuvant Therapy Among Older Patients Who Receive Curative Surgery for Pancreatic Cancer

Pancreas, 2009

We conducted a population-based study to describe the utilization, determinants, and survival eff... more We conducted a population-based study to describe the utilization, determinants, and survival effects of adjuvant therapies after surgery among older patients with pancreatic cancer. Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients older than 65 years who received surgical resection for pancreatic cancer during 1992-2002. We constructed multiple logistic regression models to examine patient, clinical, and hospital factors associated with receiving adjuvant therapy. Cox proportional hazards models were used to examine the effect of therapy on survival. Approximately 49% of patients received adjuvant therapy after surgery. Patient factors associated with increased receipt of adjuvant therapy included more recent diagnosis, younger age, stage II disease, higher income, and geographic location. Hospital factors associated with increased receipt of adjuvant therapy included cooperative group membership and larger size. Adjuvant treatments associated with a significant reduction in 2-year mortality (relative to surgery alone) were chemoradiation or radiation alone but not chemotherapy alone. Our findings suggest that adjuvant chemoradiation and, to a lesser degree, radiation only are associated with a reduction in the risk of mortality among older patients who undergo surgery for pancreatic cancer. However, receipt of adjuvant therapy varied by period and geography as well as by certain patient and hospital factors.