Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community.

Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.

Meta-analysis of the effectiveness of HIV prevention interventions for women.

The present study is a meta-analysis of the effectiveness of HIV prevention interventions for women in the USA. Twenty-four articles from 1989-1997 were included. We evaluated five ethnic groupings (All Ethnicities Combined, African-American, White, Hispanic and a Mixed Ethnicity group) over four time periods (post-test, less than two months after the intervention, 2-3 months after the intervention and 6-24 months after the intervention) on three HIV-related sexuality outcome variables (HIV/AIDS knowledge, self-efficacy and sexual risk reduction behaviour). The HIV interventions appear effective at improving knowledge about HIV/AIDS and increasing sexual risk reduction behaviours for all ethnicities examined at all follow-up periods, with one exception. The findings for self-efficacy are less consistent. The interventions were less consistently effective for African-American women, for whom significant improvements in feelings of self-efficacy were only seen six months or longer after the intervention. The present analysis elucidates ethnic differences which may have previously been obscured while demonstrating convincingly that HIV interventions are generally effective for women of many different ethnicities.

Improving safer sex measures through the inclusion of relationship and partner characteristics.

This article describes the development of a safer sex algorithm, which considers the characteristics of a woman's relationship and the HIV risk profile of herself and her primary partner. A sample of 306 low-income, predominantly African American women was recruited to participate in a study of the effectiveness of a sexual health seminar. These women were interviewed three times, at one month prior to seminar administration, three months after the seminar and again nine months after the seminar. Data from these women indicate that using an algorithm that considers the probability of HIV transmission between partners decreases the measured prevalence of unsafe sex in this population by about 17% and lowers the estimate of the average number of unsafe incidents by about four incidents in three months. The algorithm results in measures with adequate levels of temporal stability, which are similar to the more commonly used measure, vaginal or anal intercourse without a condom.

Physician confidence and interest in learning more about common geriatric topics: a needs assessment.

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics. DESIGN: Written survey. SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). PARTICIPANTS: Seven hundred and fifty-eight physicians (547 ACP members, 211 AAFP members). MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five-point Likert scale. RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee-for-service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r =.44, P <.0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified. CONCLUSIONS: These findings provide useful information on the physician-learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.

Fat phobia scale revisited: the short form.

OBJECTIVE: To develop a shortened form of the original 50-item fat phobia scale. METHOD: The first factor from the original fat phobia scale-undisciplined, inactive and unappealing-was identified as a potential short form of the scale. A new sample of 255 people completed the original 50-item scale. The reliability of a shortened 14-item version of the scale was tested and compared to that of the full scale using both the new sample and the original sample of 1135 study participants. RESULTS: The fat phobia scale-short form demonstrated excellent reliability in both samples and was strongly correlated with the 50-item scale. Mean and 90th percentile scores are given for both the long and short versions of the scale. CONCLUSION: The shortened fat phobia scale is expected to increase the utility of the measure in a diverse array of research and clinical settings. Future research should focus on developing scale norms for the general population and conducting research on fat phobia in males and among different ethnic groups.

Criterion-related validity of the Marital Disaffection Scale as a measure of marital estrangement.

The Marital Disaffection Scale was administered, along with measures of positive feelings towards spouse, problem-drinking behavior of spouse, workaholic behavior of spouse, and marital status, to 323 female members of the American Counseling Association. Scores on the Marital Disaffection Scale showed significant inverse correlations (r = -.94) with positive feelings towards spouse and (rpb = -.63) with marital status. Scores on the Marital Disaffection Scale showed significant positive relationships (r = .36) with spouse's problem drinking behavior and (r = .48) with workaholic behavior of spouse. The results support the use of the Marital Disaffection Scale as a measure of emotional estrangement in marriage.

Postgraduate educational opportunities in the military services.

The three branches of the service provide advanced training to about 450 dentists each year. Approximately one-third of these positions are in post-doctoral general dentistry and the remainder in specialties, distributed as needed by the various services.

Assessing the offspring of workaholic parents: the Children of Workaholics Screening Test.

This study reports initial stages in the development of a self-report instrument that measures offsprings' mental disposition toward their parents' work habits. In an initial sitting, a battery of tests was administered to 207 young adults to assess the reliability and validity of the Children of Workaholics Screening Test. After a 2-wk. interval, the test was administered again. Test-retest reliability, split-half reliability, and concurrent validity are reported. The findings provide strong support for the utility of the Children of Workaholics Screening Test for assessing the offspring of workaholic parents.

Cognitive predictors of resistiveness in dementia patients.

Resistiveness to physical care among patients with dementia is a common and burdensome problem. Forty-nine nursing home residents with dementia were administered the Mini-Mental State Exam (MMSE) and the Royall Executive Interview (EXIT), a specific test of frontal-subcortical function. Nurses rated resistiveness on every shift for 3 days. Correlation with resistiveness ratings was stronger for the EXIT (r=0. 73) than for the MMSE (r=-0. 46); logistic modeling found the EXIT to be a strong independent predictor of resistiveness. Executive dysfunction as measured by the EXIT is a major determinant of resistiveness to care in long-term care residents with dementia, possibly as a result of such patients' tendency toward inertia.

Factors associated with the prevalence of myopia in 6-year-olds.

PURPOSE: To describe the frequency of and risk factors associated with myopia in grade one children. METHODS: Refractive error was measured by static retinoscopy, without cycloplegia, for 10,616 children in the first year of a province-wide vision-screening program. Information on factors that might be associated with myopia was collected from parents or guardians by self-administered questionnaires distributed before the vision screening. These factors were evaluated by a case-control method. RESULTS: The prevalence of myopia, greater than -0.25 D, was 6%. The estimated relative risk of myopia was increased significantly among children whose birth weight was <2500 g and whose mothers had a history of early spectacle use. CONCLUSIONS: Results suggest that the prevalence of myopia in 6-year-old children is associated with both hereditary and nonhereditary factors. In accord with prior work, the results argue that low birth weight has a permanent influence upon eye development.

Therapeutic uses of sexually explicit materials in the United States and the Czech and Slovak Republics: a qualitative study.

This study investigates the reflections of 279 U.S. and Czech and Slovak mental health and health professionals about their use of sexually explicit materials. Professionals were 2.6 times as likely to cite specific instances when their use of sexually explicit materials was useful with their clients and students than they were to cite instances when such materials were not useful. In addition, no significant differences were observed between the ways in which U.S. and Czech and Slovak mental health and health professionals evaluated these materials. The article presents several suggestions for the judicious and efficacious use of sexually explicit materials in therapy or in the classroom in either Western or Central European settings.

The Work Addiction Risk Test: development of a tentative measure of workaholism.

The development and analyses of the psychometric characteristics of a tentative self-report measure of work addiction are reported. A total of 363 college students completed a battery of tests including the Work Addiction Risk Test. Internal consistency of the scores was .88. Also, these scores were compared with those on the Type A Self-rating Scale and the Jenkins Activity Survey, which give self-reports of Type A behavior and the State-Trait Anxiety Inventory. That scores on the work addiction risk test were reliable and showed concurrent validity supported psychometric utility for research and clinical practice.

Transgender HIV prevention: a qualitative needs assessment.

Although clinical experience and preliminary research suggest that some transgender people are at significant risk for HIV, this stigmatized group has so far been largely ignored in HIV prevention. As part of the development of HIV prevention education targeting the transgender population, focus groups of selected transgender individuals assessed their HIV risks and prevention needs. Data were gathered in the following four areas: (1) the impact of HIV/AIDS on transgender persons; (2) risk factors; (3) information and services needed; and (4) recruitment strategies. Findings indicated that HIV/AIDS compounds stigmatization related to transgender identity, interferes with sexual experimentation during the transgender 'coming out' process, and may interfere with obtaining sex reassignment. Identified transgender-specific risk factors include: sexual identity conflict, shame and isolation, secrecy, search for affirmation, compulsive sexual behaviour, prostitution, and sharing needles while injecting hormones. Community involvement, peer education and affirmation of transgender identity were stressed as integral components of a successful intervention. Education of health professionals about transgender identity and sexuality and support groups for transgender people with HIV/AIDS are urgently needed.

Review of Medicare's proposed hospice eligibility criteria for select noncancer patients.

Recent events have challenged our health system to increase access to and provide high quality care for patients near the end of life. Simultaneously, Medicare is developing review policies to determine eligibility for hospice patients with select noncancer diagnoses. The purpose of this study was to determine whether the proposed policies met one of their chief goals: accurate identification of patients with a less-than-six-months prognosis. Only 35 percent of 104 patients who died within six months of admission to the hospice used for this study, LifePath Hospice, met the Medicare proposed criteria for hospice eligibility. The median and mean survival time of the sample was 14 and 30 days respectively. Based on this review, it is recommended that Medicare alter their proposed review policies and not limit access to hospice eligible patients who desire and are in need of such services.

Diabetic ketoacidosis associated with cocaine use.

BACKGROUND: Multiple risk factors for diabetic ketoacidosis (DKA) have been described, including omission of insulin therapy and clinical conditions known to increase counterregulatory hormones. Recently, substance abuse has been identified in patients with DKA. We observed many cases of DKA in cocaine users, although the association between cocaine use and DKA has not been well described in the medical literature. METHODS: We performed a retrospective case-control study of admissions for DKA in cocaine users and non-user controls in an urban teaching hospital from January 1, 1985, to December 31, 1994. RESULTS: We identified 720 adult admissions for DKA. Twenty-seven cocaine users accounted for 102 admissions (14% of all DKA admissions). The users were compared with 85 nonuser controls who had 154 DKA admissions. Cocaine users had more admissions for DKA (mean, 3.78 vs 1.81; P = .03). Cocaine users were less likely than controls to have an intercurrent illness identified as a precipitating factor for DKA (14.7% vs 33.1%; P<.001) and were more likely to have missed taking insulin prior to admission (45.1% vs 24.7%; P<.001). Although cocaine users had higher serum glucose levels on admission (32.9 mmol/L [593.4 mg/dL] vs 29.5 mmol/L [531.1 mg/dL]; P =.03), no differences in intensity of illness or treatment outcome were detected. CONCLUSIONS: In this preliminary study, cocaine use was found in a significant number of adults admitted with DKA and was associated with more frequent omission of insulin therapy and the absence of precipitating systemic illness. Either because of its association with insulin therapy omission or its effects on counterregulatory hormones, cocaine use should be considered a risk factor for DKA, particularly in patients with multiple admissions.

Diagnosis of irreversible dementia: how extensive the evaluation?

Recommendations for managing the patient with irreversible dementia can be organized according to the results of the initial evaluation. The patient may have normal mental status and normal functional assessment, abnormal mental status and abnormal functional assessment, or mixed results (one normal, one abnormal). The extent of further investigations usually depends on initial clinical findings and on patient and/or family preferences. MRI imaging may be useful prior to referral if greater specificity in diagnosis is desired. Referral is suggested for illnesses of short duration, atypical features, or when the patient and family require precision in diagnostic labeling.

Guideline for initial evaluation of the patient with memory loss.

A practical and useful guideline for early identification of Alzheimer's disease and related dementias has been developed by the Agency for Health Care Policy and Research. By using the initial evaluation process described in this guideline, primary care physicians can identify and treat many "reversible" causes of memory problems, such as depression, delirium, and co-morbid medical conditions. The treatable causes of dementia may be structural, metabolic, toxic, infectious, nutritional, psychiatric, or drug-related. Initial evaluation includes patient history, physical examination, mental status testing, functional assessment, and some laboratory tests. Information from an informed family member can be very helpful in this process.

Risk of addiction to work and family functioning.

A total of 107 self-identified workaholics from across the United States and Canada responded to a set of inventories assessing their scores on the Work Addiction Risk Test and the correlations with current family functioning. Individuals in the High-risk group, compared to those in the Low- and Medium-groups, were significantly more likely to perceive their current families as having less effective problem-solving ability, worse communication, less clearly established family roles, fewer affective responses, less affective involvement, and lower general family functioning.