How many chaplains per 100 inpatients? Benchmarks of health care chaplaincy departments.

Reports the results of a questionnaire survey of a sample of chaplaincy departments directors (N = 370) designed to answer the following questions: How many chaplains do various types of hospitals employ per 100 inpatients? What is the relationship between the number of employed chaplains and departmental Clinical Pastoral Education (CPE) programs? How much effort do departments give to outpatient ministry? What percentage of ministry do volunteer chaplains provide? Provides tentative answers to inform the strategic planning processes of chaplains and administrators.

Factors associated with HIV-infected women's delay in seeking medical care.

Data from an investigation of HIV-infected African-American, Puerto Rican and non-Hispanic white women's treatment behaviour and decision-making are presented. Findings are based on a thematic analysis of the narrative accounts of 31 women who exhibited significant delay in seeing a physician about their HIV infection after testing positive for HIV antibodies. Analysis of the women's qualitative interview data indicated that a variety of barriers impeded them from actively pursuing treatment. The women's psychological responses to learning their serostatus were the most pervasive factors associated with delaying seeking care. Implications of the analysis for informing the design of secondary prevention efforts to move women into treatment earlier are discussed, such as the need to develop interventions or supportive services designed to assist women in coming to terms with their infected status.

Barriers and pathways to testing among HIV-infected women.

Through in-depth interviews the testing experiences of HIV-infected women were examined. The barriers that impeded the women from recognizing their at-risk status and from seeking testing once their vulnerability was acknowledged are discussed. Also described are the pathways that led women into testing. The data reveal that lack of understanding about risk behaviors, ignorance of their partner's risk practices, lack of information about HIV-related symptoms, and perceived invulnerability to infection were the principal barriers to women recognizing their at-risk status. The women's accounts also indicate that psychological factors--fear and denial--are the principal barriers to seeking testing once one acknowledges vulnerability. Finally, the data show that few women made a thoughtful proactive decision to be tested but rather seemed to be led by circumstances to learn their status, sometimes unwittingly.

HIV-infected women: barriers to AZT use.

AZT has become a mainstay drug in efforts to slow disease progression in HIV-infected individuals. Further, recent evidence indicates that AZT use by pregnant infected women and their neonates may reduce the risk of vertical transmission. In a study of HIV-infected women's treatment-related behavior, attitudes toward the use of this drug were examined. Data were gathered through unstructured interviewing techniques. The data from the first 71 women accrued revealed that negative attitudes towards its use were widely prevalent. Women viewed the drug as highly toxic, prescribed indiscriminately, inadequately tested in women and minorities, promoted for the wrong reasons and inappropriate while they were feeling well. The findings suggest that removing attitudinal barriers to the use of AZT will be important to both primary and secondary prevention efforts.

Childhood bereavement due to parental death from acquired immunodeficiency syndrome.

Numerous articles stress the unique problems of mourning an acquired immunodeficiency syndrome (AIDS)-related death and suggest psychotherapeutic interventions. However, no studies have been conducted that identify what differs in the grief process when the death was AIDS-associated and whether the extensive clinical and research literature on bereavement can be generalized to AIDS. This paper focuses on a bereaved population that has suffered AIDS-related loss--the uninfected children of mothers who die of AIDS, a group that has been referred to as "AIDS orphans." We begin with a brief discussion of factors that complicate the grief process among those who lose a significant other to AIDS. Next we discuss the factors that the extant clinical and research literatures suggest may influence adjustment to parental death in childhood. Then we apply this literature to parental loss in childhood from an AIDS-associated death. Finally we recommend directions for future research.

Sepsis due to Rhodotorula related to use of indwelling central venous catheters.

With increased use of surgically implanted silastic central venous catheters, there has been an increase in the recovery from blood cultures at Memorial Sloan-Kettering Cancer Center (New York) of environmental and skin organisms including the red yeast Rhodotorula. From 1985 through 1989, 23 patients had catheter-related Rhodotorula sepsis. All 23 patients had indwelling central venous catheters that had been in place from 1 to 22 months (average, 9.3 months) prior to the detection of fungemia. All patients had blood drawn both through the catheter and from a peripheral source, and only one patient had a peripheral blood culture positive for Rhodotorula. Colony counts of yeast from the catheter cultures often exceeded 100 (15 patients) and even 1,000 (seven patients) cfu/mL of blood. Thirteen of the patients were treated with antifungal therapy and had the catheter removed, and five patients received antifungal therapy without catheter removal (suggesting that compulsory removal of the catheter may not always be required). Five patients had the catheter removed without antifungal therapy. All patients survived the fungemic episode and experienced no recurrence of the infection.