The influence of integrated tuberculosis and human immunodeficiency virus service delivery on patient outcomes.

SETTING: Public health clinics in Cape Town, South Africa. OBJECTIVE: To examine the influence of integrated tuberculosis (TB) and human immunodeficiency virus (HIV) service delivery on mortality, TB cure and successful treatment completion and loss to follow-up of TB-HIV co-infected patients on concurrent anti-tuberculosis and antiretroviral treatment (ART). DESIGN: A survey instrument was used to measure the degree to which TB and HIV services were jointly delivered, and patient data were collected retrospectively from clinic sites and the Department of Health. Six domains measuring integrated TB and HIV service delivery were modelled to assess their relationship with patient outcomes. RESULTS: Two domains, integrated TB and ART service delivery and the delivery of TB and HIV care by one clinical team, were associated with lowered odds of death. Care by the same clinical team was also associated with reduced loss to follow-up. CONCLUSION: Overall, these findings show that the organization and delivery of health services are important factors that influence health outcomes. These findings strongly support efforts by local governments to integrate TB and ART services, and may help to alleviate concerns that restructuring of TB programs could have a negative impact on long-standing gains.

Sexual behavior problems and psychopathology symptoms in sexually abused girls.

OBJECTIVE: This study contrasted a group of sexually abused girls, aged 6 to 12 years, with two demographically comparable control groups, girls from a child psychiatry outpatient department, and girls from a general pediatric clinic to determine whether differences in sexual behavior and psychopathology symptoms could be demonstrated. METHOD: All girls and their mothers underwent an evaluation protocol composed of two parent-report inventories, the Child Behavior Checklist and the Child Sexual Behavior Inventory. RESULTS: Sexually abused girls and psychiatric controls manifested more psychopathology symptoms, including internalizing and externalizing behaviors, than the nonpsychiatric controls. Relative to both control groups, sexually abused girls manifested more sexual behavior problems: masturbating openly and excessively, exposing their genitals, indiscriminately hugging and kissing strange adults and children, and attempting to insert objects into their genitals. Abuse by fathers or stepfathers involving intercourse was associated with particularly marked sexual behavior disturbances. There was a subgroup of sexually abused girls who tended to force sexual activities on siblings and peers. All of these girls had experienced prolonged sexual abuse (more than 2 years) involving physical force which was perpetrated by a parent. CONCLUSIONS: Findings suggest that sexual abuse in preadolescent girls is associated with sexual behavior problems.

The sugar scoring system for the Bender-Gestalt test: an objective approach that reflects clinical judgment.

Although several objective scoring systems have been developed for use with the abbreviated form of the Bender-Gestalt test of visuomotor development (Figures A, 1, 2, 4, 6, and 8), each has been criticized as being inadequate in some way or other. This paper reviews the inadequacies of these systems as described in the literature and presents the results of a small study designed to investigate the psychometric properties of a new objective scoring system, recently proposed by Sugar, which incorporates both quantitative and qualitative perspectives. The new system is shown to be psychometrically sound in validity and reliability. Additional advantages are described. The new system is recommended as a good, if not better, alternative to other, existing methods for scoring the Bender-Gestalt test.

Care and Justice Moral Reasoning: A Multidimensional Scaling Approach.

In contrast to Kohlberg's (1969) universal model of moral development, Gilligan's (1982) model posits the existence of separate patterns of moral development for men and women. The pattern for men, termed the "justice ethic," is based on abstract concepts of justice, reciprocity, and individual rights. The pattern for women, termed the "care ethic," is based on responsibility toward others and the preservation of relationships. The purpose of this article is to utilize a recently developed multidimensional scaling methodology to explore the underlying structure of moral reasoning responses to 12 moral dilemmas, developed on the basis of Gilligan's theory, and to relate that structure to individual difference characteristics. Results of findings and implications for future research are discussed.