HIV outreach for hard-to-reach populations: a cross-site perspective.

This article examines the effectiveness of outreach as a vehicle for moving hard-to-reach substance abusing clients into substance abuse treatment. These clients were recruited by and participated in one of twelve HIV Outreach Demonstration Projects funded by the Center for Substance Abuse Treatment (CSAT). The analysis combines data across projects to provide a cross-site perspective. Data from 1675 clients were analyzed in this study. In addition, a comparison group of 3704 subjects was generated from the National Treatment Improvement Evaluation Study (NTIES) data. The results supported the hypothesis that clients representing traditional hard-to-reach populations would be more likely to enter treatment for substance abuse through participation in HIV Outreach programs than would clients exposed to treatment-specific recruiting methods (e.g. NTIES). The findings from this cross-site study support the view that HIV Outreach, as an integrated approach to several behavioral constellations, is more effective in recruiting clients to substance abuse treatment than are approaches that focus exclusively on substance abusing behavior. The HIV Outreach model is especially effective in reaching substance abusers earlier in the cycle of abuse. This has importance clinically for developing and focusing more effective methods for treatment for younger substance abusers with shorter histories of abuse. It also has implications for policy to guide the effective use of scarce treatment resources. Targeting specific populations and affiliation with substance abuse treatment providers were also influential in facilitating access to substance abuse treatment for groups at increased risk for HIV.

Langerhans cells in verruciform xanthomas: an immunoperoxidase study of 10 oral cases.

Ten oral verruciform xanthomas were studied using an immunoperoxidase stain for S-100 protein. All cases exhibited positively stained dendritic cells among the mononuclear inflammatory cell infiltrate at the base of the lesions and to a lesser extent among the "foam cells". The foam cells were, however, negative for S-100 staining. We suggest that, based on these findings, verruciform xanthomas belong to a new category of "non-X histiocytoses" in which the presence of Langerhans cells suggests an immunologic pathogenesis.

Medical school education in hypertension management: a national survey.

Results of a survey of 90 medical schools in 44 states indicate that only 11 had specific hypertension sections, and that after completion of four years of medical school, students had received only 18 hours of instruction in the management of hypertension. Undergraduate students spent only an average of 1.5 weeks in clinics specifically designated for the treatment of hypertension, and small numbers of students were involved in each school at any one time. Specific instruction during residency training was also minimal. Even when ward round and general medical clinic teaching hours are included, instruction in the management of hypertension is limited for a disease that is the most common chronic illness in the United States and accounts for over 5 percent of all physician visits by adults. An increased emphasis should be placed on training for the management of hypertension within the undergraduate curriculum and within the existing general medical and hypertension clinics.

Is hypergastrinaemia associated with rheumatoid arthritis?

In an attempt to confirm the reported high incidence of raised serum gastrin levels in patients with rheumatoid arthritis (RA), gastrin concentrations were estimated in 54 patients. Only three patients (6%) had basal hypergastrinaemia. The heptadecapeptide (G17) and total carboxyl-terminal immunoreactive gastrin responses to a standard protein meal were measured by specific radioimmunoassay in these three patients and in nine normogastrinaemic RA patients displaying the same age range. The three hypergastrinaemic patients showed significantly greater and more prolonged G17 and total carboxylterminal immunoreactive gastrin responses to the meal compared with the normogastrinaemic RA patients (P less than 0.02). Two of these three patients agreed to have an acid output study (pentagastrin 6 microg/kg subcutaneously) and gastric mucosal biopsies taken for histology. Both were found to be achlorhydric and to have atrophic gastritis. This study suggests that basal hypergastrinaemia in RA patients is considerably less common than previously reported and, when present, is associated with achlorhydria. In addition, the incidence of achlorhydria in rheumatoid arthritis is similar to that found in a normal age-matched population.