Psychosocial Issues in the Era of New AIDS Treatments from the Perspective of Persons Living with HIV.

In the past, HIV disease meant an almost invariably downward health course. New highly active antiretroviral therapy (HAART) regimens have improved the health outlook for many persons living with HIV/AIDS but may create new psychological and coping challenges. In this study, open-ended, in-depth interviews were undertaken with an ethnically diverse sample of 44 purposively selected men and women with HIV disease who were on HAART regimens. The interviews were transcribed and qualitatively coded to identify major themes. While patients responding well to the regimens held optimistic views for their future, some who continued to have detectable viral load exhibited depression and feelings of hopelessness. Many patients reported stress associated with the demands of adhering to complex HAART regimens. Other common themes emerging in the interviews involved concerns about employment, romantic and non-romantic relationship formation, sexual behavior and serostatus disclosure, whether to plan families, and experiences of AIDS-related discrimination. There continue to be critical roles for psychological services in the care of persons living with HIV.

Effects of serial percutaneous application of carbon dioxide in intermittent claudication: results of a controlled trial.

In a prospective, controlled clinical trial, serial application of carbon-dioxide-enriched water was compared with fresh water. Twenty-four patients with peripheral arterial occlusive disease (stable claudication) were randomly allocated to one of two serial intervention groups, lower extremities immersed in either fresh water or in CO2-enriched water (1000 mg CO2/kg) water under standardized conditions (temperature, 33 degrees C; depth, 40 cm; immersion time, 30 min; five times a week over 4 weeks). The serial application of carbon-dioxide-enriched water increased arterial peak flow (reactive hyperemia), transcutaneous oxygen tension (basal value and half-recovery-time), and pain-free walking distance. The serial fresh water application did not change these values. The authors conclude that serial carbon dioxide application can be clinically effective in patients with arterial obstructions in the lower extremities.

Effect of carbon dioxide-enriched water and fresh water on the cutaneous microcirculation and oxygen tension in the skin of the foot.

The effects of immersion of the lower leg and foot in fresh water and in carbon dioxide (CO2)-enriched water (1200 mg CO2 per kg water; succinate+sodium bicarbonate: Actibath, KAO Tokyo) on cutaneous circulation, vasomotion and oxygen tension (PO2) were measured by laser Doppler flowmetry and transcutaneous oximetry. On the first of two consecutive days patients were randomly assigned to have the lower extremities immersed in either fresh water or CO2-enriched water under standardized conditions (temperature, 34 degrees C; depth, 35 cm; immersion time, twenty minutes) with concurrent measurement. On the second day patients were switched to the other bath type. For both sets of measurements probes were attached symmetrically to the dorsum of each foot. Included in the study were 18 patients with mild, bilateral, peripheral, occlusive arterial disease (intermittent claudication, femoral or iliac type). During immersion in CO2-enriched water the Doppler laser signal and vasomotion amplitude rose by 300%, while PO2 increased by 10%. These increases were still apparent during the latter part of the measurement period, following withdrawal of the limbs from the bath, while patients were seated and supine. During immersion in fresh water and thereafter the Doppler laser signal was unchanged and the PO2 increase was considerably less marked. The authors were thus able to demonstrate vasodilation and increased oxygen utilization (Bohr effect) resulting from topical CO2 application, and hence, that the use of topical CO2 has an objective basis.

Physical therapy improves venous hemodynamics in cases of primary varicosity: results of a controlled study.

Physical factors are known to influence hemodynamics in the veins of the lower extremities. In a controlled, randomized study the authors investigated the effects of combined physical therapy on varicose veins. Over a twenty-four-week period a treatment group consisting of 12 persons exercised under the supervision of a therapist twice a week for sixty minutes. This included muscle and joint activation by means of externally applied compression and cold-temperature stimuli (ie, thermosteresis). They also exercised once a day without supervision for fifteen minutes. During the same period a control group of 12 persons underwent the same measurements but no treatment. In the treatment group venous capacity decreased by an average of 16% from 4.9 +/- 0.3 (sd) mL/100 mL tissue to 4.1 +/- 0.4 (P < 0.005, U-test) while in the control group it remained practically unchanged at 4.8 +/- 0.4 vs 5.0 +/- 0.3. Venous refilling time in the lower extremities also increased in the treatment group, half refilling time rising from 7.8 +/- 1.0 to 11.3 +/- 0.9 seconds (P < 0.001) and total refilling time from 17.0 +/- 1.4 to 25.7 +/- 2.1 seconds (P < 0.001); these parameters remained virtually unchanged in the control group, with half refilling time dropping slightly from 7.7 +/- 1.1 to 7.1 +/- 1.3 seconds and total refilling time from 18.3 +/- 1.7 to 16.3 +/- 1.9 seconds. Patient self-rating scores obtained by use of a standardized questionnaire administered at baseline and at the end of week 24 improved in the treatment group only. The combined physical therapy was thus shown to be of long-term therapeutic value, improving venous function and reducing patients' symptoms. These findings indicate that for the further development of this combined treatment regimen it would be useful to identify the individual factors contributing to its efficacy and evaluate them separately.

An investigation of cognitive style and alcohol/work-related problems among Naval personnel.

This study examines the relationship between cognitive style (i.e., information, normative, and diffuse orientation, and commitment) and alcohol/work-related problems. A random sample of Naval personnel (n = 2000) with less than two years of service toward their first enlistment was sent a questionnaire to assess cognitive style [1] and alcohol/work-related problems. A total of 899 respondents (45.0%) returned their questionnaires. Findings support prevention strategies that incorporate problem-solving, decision-making, and coping strategies, particularly among participants who employ diffuse problem-solving/coping strategies (lack of exploration and commitment, avoidance of problems). Correlations between cognitive style and alcohol/work-related problems are theoretically compatible. Diffuse orientation scores are positively related to both alcohol- and work-related problems, while norm and information orientation scores are negatively related to both measures. Collectively, cognitive style measures explain 11.4 percent of the variability in alcohol-related problems, and 14.0 percent of the variability in work-related problems.

Ego identity: developmental differences and experimental substance use among adolescents.

A total of 12,988 adolescents completed a questionnaire which assessed experience with cigarettes, inhalants, alcohol, marijuana, cocaine, and level of ego identity (EOM-EIS). Discriminant analyses of substance use, across the achievement, moratorium, foreclosure, and diffusion identity statuses, yielded significant functions for each grade comparison (7th to 12th). Frequencies of experience for diffused respondents were consistently higher than estimates for the achieved and moratorium respondents; and, foreclosed adolescents reported the lowest frequency of experience. Diffused adolescents were about twice as likely to have tried cigarettes and alcohol, three times as likely to have tried marijuana, four times as likely to have tried inhalants, and five times as likely to have used cocaine than their foreclosed peers. The achieved, moratorium, and unclassified respondents reported frequencies of experience that fell between the two extreme groups. Implications for identifying adolescents "at risk", and tailoring prevention/intervention efforts to address developmental differences are addressed.

An "economic" theory of addiction, hypomania, and sensation seeking.

Research into the relationship between mania, sensation seeking, and substance abuse has shown that hypomanics and sensation seekers use substances frequently and often for the purpose of adjusting their moods. This essay develops an "economic" theory of addiction that attempts to account for those phenomena. The theory also supports the notion that sensation-seeking behavior and variants of manic behavior share many of the characteristics of the addictive behaviors. Implications for the treatment of addictive behaviors are discussed. Data from drug users in the military (Navy) are presented to support the theory, and suggestions for future research are outlined.