Increasing condom use among adolescents with coalition-based social marketing.

OBJECTIVES: This study evaluated a multimodal social marketing intervention to reduce the sexual transmission of HIV infection among adolescents in Sacramento, California, USA. DESIGN: Five rounds of a cross-sectional random sample telephone survey were conducted from December 1996 to October 1998. The total number of respondents was 1402. RESULTS: A statistically significant, increasing trend in exposure to the intervention was detected. The number of channels through which an adolescent had been exposed to the intervention was associated with condom use at last sex with main partner [odds ratio (OR) 1.26, P < 0.01] and with psychosocial determinants of this behavior. After statistical adjustments for sex, age, and race/ethnicity to make the survey rounds comparable, the proportion of adolescents who had used a condom at last sex increased 4.3 percentage points over the 1 year intervention period. CONCLUSION: Social marketing can be combined with behavioral science to reduce the risk of HIV infection and other sexually transmitted diseases (STD) among adolescents in a large geographical area. Such a reduction can exceed expectations based on national secular trends.

The effect of tailoring a model HIV prevention program for local adolescent target audiences.

In five U.S. sites (Nashville, Tennessee; Newark, New Jersey; northern Virginia; Phoenix, Arizona; and Sacramento, California), HIV risk-reduction workshops were mounted as a part of the Prevention Marketing Initiative (PMI). In four of the five sites, the workshop curriculum was a version of Be Proud! Be Responsible! (Jemmott, Jemmott, & McCaffree, 1996) that had been tailored to fit the needs of local target audiences. This article describes the evaluation of the PMI workshops. Protective effects on several behavioral determinants and behavioral outcome measures were observed 1 month after the workshops. Based on the overall pattern of results, it was concluded that the PMI workshops reduced the likelihood of unprotected sex among participants. The intervention developed by Jemmott and colleagues appears to have retained its effectiveness after it was tailored to meet perceived local needs.

Symptom self-management and relapse in schizophrenia.

The purpose of this descriptive study was to examine the relationships among 4 variables that are hypothesized to be associated with relapse in schizophrenia; insight, symptom recognition, symptom self-management, and perceived effectiveness of symptom self-management. The theoretical framework was derived from self-management theory and the vulnerability-stress model of schizophrenia. Pearson's correlation coefficients for the variables in the model detected 2 significant relationships; between symptom recognition and symptom self-management and between symptom self-management and perceived effectiveness of symptom self-management. Insight was not found to be significantly related to the other variables. Results of the study indicate that individuals with schizophrenia do recognize symptoms associated with relapse and use a wide range of management methods, regardless of the degree of insight present.

Lessons learned from the PMI case study: the community perspective.

PIP: This summary report presents the lessons learned during the two-part qualitative case study on the efficacy of the Prevention Marketing Initiative (PMI) in its implementation of an HIV prevention program. About 179 community participants were included in the PMI program, which discussed topics ranging from organizing initial planning committees to financially sustaining federal demonstration programs. One of the successes observed was the development of rapport with schools and churches; however, during the course of its implementation, the program realized the necessity of 1) approaching the program as an ongoing process; 2) going beyond studying the target population through formative research; 3) changing the role of a community coalition as the project matures; 4) reexamining the composition of coalition in the light of the target audience; 5) advocating the project as a community resource that promotes collaboration; 6) attending the needs of coalition members; and 7) using the media in the campaign. Likewise, several lessons were also learned in the areas of youth involvement, intervention development, program implementation, and maintenance of PMI activities.^ieng

Reproductive health needs: comparing women at high, drug-related risk of HIV with a national sample.

Women who inject drugs or have injection drug-using sex partners are at high risk of acquiring human immunodeficiency virus (HIV) infection and of transmitting HIV perinatally. Many of these women need standard reproductive health care services, specialized HIV care, pre- and postnatal care, and drug treatment, but the extent of the unmet need for such health services is unknown. Large-scale national surveys that estimate drug use do not include reproductive health topics and vice versa. In addition, such surveys typically employ a household sampling method that tends not to include drug-using women. This paper presents evidence from three convenience samples that a high-risk population of women who use drugs has limited access to reproductive health services, and that this population is not represented in the National Survey of Family Growth (NSFG), the national survey that informs public policy regarding reproductive health care in the United States. Policy makers would be well served by regular surveillance of the multiple service needs of women with HIV-risk-related behaviors.

HIV prevention in prisons and jails: obstacles and opportunities.

High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of injection drug use, and other high-risk behaviors among inmates create a prime opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the opportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have differing approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or segregated by HIV serostatus, and whether condoms, bleach, or clean needles should be made available to the prisoners, are questions hotly debated by public health and correctional officials. Even accurate assessment of risk-taking within the institutions leads to controversy, as asking questions could imply acceptance of the very behaviors correctional officials are trying to prevent. Education and risk-reduction counseling are the least controversial and most widely employed modes of prevention, but the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined.

Behavioral responses and self-reported pain in postoperative patients.

Pain has been difficult to assess because of its multidimensional nature. The primary purpose of this study was to investigate the relationship between the nurse's assessment of behavioral cues to pain and self-reports of pain made by patients using patient controlled analgesia (PCA). This descriptive-correlational study used the PACU Behavioral Pain Rating Scale (BPRS), patient's self-report, and hospital's PCA pain-rating scale to investigate pain measurement. The convenience sample consisted of 36 postoperative, gynecological surgery patients. Pain assessments for this study were completed during the first 6 postoperative hours on patients who did not have complications. Five pain assessments were collected for each patient. Pain scores were highest during the immediate postoperative period and continued over 2 hours. Significant relationships (rs = 0.56 to 0.80; P < 0.05) were found between the BPRS scores and the self-reports of pain. The relationship between the hospital's PCA pain rating scores and self-reported pain was significant only during the second assessment (rs = 0.45; P < 0.05). The BPRS consistently showed a moderate to high relationship with the patient's self-report of pain and had a stronger relationship with the patient's self-reported pain than with the hospital's pain scale.

Relationship between psychiatric diagnosis and patient aggression.

Patient aggression is a common problem on psychiatric units. Recent research has focused on the relationship between aggressive behavior and various patient characteristics, including psychopathology. The purpose of this study was to examine the relationship between diagnostic groups and particular types of patient aggression in a state psychiatric hospital. A secondary analysis was performed on existing data. There was no significant difference noted among DSM III diagnoses in total patient aggression. However, there was a significant difference between individuals with organic disorders and individuals with paranoid schizophrenia in the category of physical aggression against other people. Improved ability to identify a particular diagnostic group with the potential for aggression will strengthen efforts to decrease the risk of patient aggression in psychiatric facilities.

Dealing with violent patients in flight.

Prevention is the key to minimizing the dangers in aeromedical transport of violent patients. Complete patient evaluation, identification and treatment of underlying causes of the behavior, anticipation of possible behavior changes, and thorough preparation are needed to ensure a safe transfer.

Functional precursors to language and its lateralization.

An adequate account of language evolution must reconcile the propositions that language is unique but has precursors. The paper of Bellman and Goldberg and that of Tzeng and Wang each neglects one of these propositions. We suggest that the uniqueness of language lies primarily in its dualistic structure which has a frame-content mode of organization: at the phonological level, consonant and vowel elements are inserted into syllabic frames; and at the morphological level, stem forms of content words are inserted into syntactic frames. We suggest that the morphological level evolved from the phonological level and that the frame-content mode of organization in phonology had a precursor in the form of bimanual coordination in which the nonpreferred (frame) hand holds an object operated on by the preferred hand (content). It is argued that lateralization of cortical function evolved first for bimanual coordination, then for language. Old World monkey hand preferences may be consistent with both the putative left-hemisphere specialization for bimanual coordination and the human right-hemisphere specialization for spatial functions.

Anaesthetic experience using a standard technique for laryngeal surgery in infants and children.

A 12 year review is presented of 1922 anaesthetic experiences on 285 patients presenting for microlaryngeal operations at the Hospital For Sick Children, Toronto. The lesions treated were laryngeal growths, 198 cases (69.5 per cent): subglottic stenosis, 81 cases (28.4 per cent); and posterior laryngeal cleft, 6 cases (2.1 per cent). The anaesthetic technique consisted of topical analgesia with lidocaine spray (3 mg kg-1) and pharyngeal insufflation of halothane and methoxyflurane both 1-1.5 per cent in oxygen through a special channel in the blade of a Jako Pilling microlaryngoscope in spontaneously breathing patients. Arterial blood gases sampled after 15 and 40 minutes of anaesthesia showed Paco2 = 6.29 +/- 0.31 kPa (47.1 +/-2.39 torr) and 6.44 +/- 0.16kPa (278 +/- 36.2 torr) respectively. Surgical exposure of the larynx was good allowing for a shorter operative time with minimal perioperative complications, in only 94 (4.89 per cent) of the 1922 anaesthetics.

Use of technetium ( 99m Tc) as a bacterial label in lung clearance studies.

The suitability of technetium ((99m)Tc), a gamma emitter, for labeling of Diplococcus pneumoniae in studies of lung bacterial clearance was examined. A killed bacterial slurry with high specific activity was obtained with a ferric ascorbate reducing system. Approximately 5.5% of radioactive counts dissociated from labeled bacteria in 6 h. Rats were exposed to a uniformly mixed aerosol of untagged, viable pneumococci and killed, (99m)Tc-tagged pneumococci. The aerodynamic behavior of labeled and unlabeled pneumococci was similar. Viable bacterial counts and radioactive counts were determined in lung homogenates at intervals following exposure, and rates of bacterial killing and disappearance of radioactive counts were plotted. Radioactive counts did not increase in the liver during the period of observation, suggesting that the decrease in lung radioactivity represents mucociliary clearance and not release of isotope to the systemic circulation. The use of (99m)Tc for bacterial labeling provides advantages of technical simplicity and personnel safety compared to the use of beta-emitting isotopes.