The role of individual and neighborhood factors: HIV acquisition risk among high-risk populations in San Francisco.

We examined socioeconomic status and social and sexual network factors and their relationship to HIV acquisition risk among HIV-negative Black MSM (BMSM), White MSM (WMSM) and transfemales (male to female transgenders). Geographic analysis examined residential patterns and neighborhood patterns of HIV prevalence in San Francisco. Factors associated with engaging in more episodes of potentially HIV serodiscordant unprotected receptive anal intercourse were analyzed. Transfemales and BMSM were more likely to live in areas of higher HIV prevalence and lower income compared to WMSM. BMSM and transfemales had lower socioeconomic scores (SES) scores compared to WMSM. BMSM were more likely to report serodiscordant partnerships and higher numbers of potentially serodiscordant unprotected sex acts. Decreasing individual SES did not predict serodiscordant partnerships in any group. Increasing neighborhood HIV prevalence predicted an increase in the number of potentially serodiscordant unprotected sex acts among transfemales and BMSM but only significantly so for transfemales. Prevention interventions must consider neighborhood HIV prevalence, and HIV prevalence in social/sexual networks, in addition to considering individual level behavior change or poverty reduction.

A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study.

Forty-eight patients with acute acromioclavicular dislocation were assessed clinically and radiologically before random allocation to non-operative management (28) or open reduction and coracoclavicular screw fixation (20) and followed for a minimum of 4 years. In 6 patients, late salvage surgery was required, the results of which were inferior to early operative intervention. Early surgery also gave better results than non-operative treatment in severe disruptions which could be identified in the acute stage. Three types of acromioclavicular dislocation which have predictable clinical outcomes could be distinguished on radiographs. When treated non-operatively, type A dislocations (19 per cent) may develop painful subluxation, type B (68 per cent) remain dislocated but retain sufficient muscle attachment to avoid fatigue on activity, and type C (12 per cent) leave a weak and unsightly shoulder. In type C dislocations, the clavicle is displaced 2 cm or more from the acromion on plain anteroposterior radiographs and the attached origin of the anterior deltoid is avulsed. Type C dislocations may benefit from early operative reconstruction.

The management of acute acromioclavicular dislocation. A randomised prospective controlled trial.

In a prospective study, 60 patients with acute acromioclavicular dislocation were randomly allocated to treatment with a broad arm sling or to reduction and fixation with a coracoclavicular screw. Of these 54 were followed for four years. Conservatively-treated patients regained movement significantly more quickly and fully, returned to work and sport earlier and had fewer unsatisfactory results than those having early operation. For severe dislocations, with acromioclavicular displacement of 2 cm or more, early surgery produced better results. Conservative management is best for most acute dislocations, but younger patients with severe displacement may benefit from early reduction and stabilisation.

Bone scintigraphy in the assessment of spondylolysis in patients attending a sports injury clinic.

Thirty-three patients attending the Nottingham Sports Injury Clinic in whom a clinical diagnosis of a stress fracture of the pars interarticularis was made were evaluated with both radiography and bone scintigraphy. This was done in an effort to distinguish a recent stress fracture which would produce a positive scintigram from an established 'incidental' spondylolysis giving a normal scintigram. Nine patients demonstrated abnormal radiography with a normal scintigram. A further nine patients had a positive scintigram. Six were associated with a spondylolysis indicating a recent stress fracture but two had normal radiography suggesting a stress fracture in the 'sub-radiological' phase. One patient had increased uptake in relation to degenerative changes of the lower lumbar facet joints. Oblique views of the scintigram helped in localisation of the abnormal uptake to the pars interarticularis.

Cast-brace treatment of ankle sprains.

Forty-two severely sprained ankles treated by a cast-brace have been reviewed. This method was devised to avoid the disadvantages of immobilization. Diagnosis was based on the history and clinical signs. Strain films were taken in 31 patients but it is submitted that this investigation may be misleading unless general anaesthesia is used. The results of the treatment by cast-brace compare favourably with those by other methods and it is considered that patients were able to return to sport in a shorter time.

A double-blind study comparing ibuprofen 1800 mg or 2400 mg daily and placebo in sports injuries.

In a double-blind, placebo-controlled study of forty-six patients with acute ligamentous damage of the knee, ibuprofen in dosages 1800 mg and 2400 mg produced significant improvements in joint mobility, weight bearing ability and match fitness. Joint effusion, pain on stress and pain severity was significantly improved by all three treatments. Only two patients reported side-effects (one while taking placebo and one taking ibuprofen 2400 mg). The study confirmed the efficacy and excellent tolerance to ibuprofen in patients with sports injuries to the knee.

Temazepam and the perceptual-motor performance of professional footballers.

The use of benzodiazepines to overcome the possible debilitating effects of travel on football performance is a recent phenomenon and indicative of current usage of such drugs. Contemporary psychological theory is critical of many of the measures used to monitor such drugs. This study has created a battery of tests which include some measures which are deemed more ecologically valid and, for purposes of comparison, some traditional indices. On a sample of First Division professional Association footballers temazepam (40 mg) was compared with placebo on these measures and testing occurred on the afternoon following night time medication. The findings suggest that on such a protocol, perceptual-motor performance is not impaired.

Medical implications of ultra marathon running: observations on a six day track race.

Medical records were kept of the injuries and illnesses sustained by competitors in a six day running race held in Nottingham in August 1982. The overall rate of injuries sufficiently severe to affect running performance was 60 per cent. These injuries are itemised and discussed with particular reference to the problems raised by this ultra distance race.

Injuries to the lateral ligament of the ankle: assessment and treatment.

Initial assessment of severity of injury to the lateral ligament of the ankle is by clinical examination. If it is thought that there is a possibility of either lateral or anterior instability, patients are investigated radiologically by anterior and inversion stress films. If instability is demonstrated a peroneal tenogram is carried out to exclude damage to the calcaneo-fibular ligament. Treatment is by means of a cast brace if instability is present. The advantages of this are preservation of calf power and improved joint function. The early results are reported in relation to the improvement in stability and early return to sporting activity.