Recidivism among high-risk youths: study of a cohort of juvenile detainees.

We report some results from an ongoing, longitudinal study of juvenile detainees. Analyses were directed toward determining whether the youth's alcohol or other drug use and their emotional/psychological problems at entry into the detention center predicted subsequent arrests for new offenses. Statistically significant relationships were found between the youths' demographic characteristics (age, race, gender), referral history, reason for placement in the detention center, and cocaine use (as measured by urinalysis) and recidivism. However, the magnitudes of these relationships were low to moderate in value, suggesting that a longer follow-up period is needed to more meaningfully study this issue.

Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A double-blind, placebo-controlled trial.

BACKGROUND: Preliminary reports suggest that patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia may benefit from the addition of corticosteroid treatment to antibiotic therapy. METHODS: We conducted a double-blind, placebo-controlled trial to assess the efficacy of adjunctive corticosteroids in patients with AIDS and severe P. carinii pneumonia. Patients with marked abnormalities in gas exchange who had been treated with antibiotics for less than 72 hours were randomly assigned to receive either methylprednisolone (40 mg) or placebo every 6 hours for 7 days, in addition to treatment for 21 days with trimethoprim-sulfamethoxazole. The primary outcome measures were survival until hospital discharge and the development of respiratory failure. RESULTS: Twenty-three patients were enrolled in the study; there were no significant differences in base-line clinical or laboratory measures between the two treatment groups. Of 12 patients treated with corticosteroids, 9 (75 percent) survived until hospital discharge, as compared with only 2 of 11 placebo recipients (18 percent) (P less than 0.008). Respiratory failure developed in nine placebo recipients, as compared with only three patients treated with corticosteroids (P less than 0.008). No patient required the interruption or discontinuation of corticosteroid or antibiotic treatment because of toxicity or a complicating event. Because of the marked difference in survival, it was deemed unethical to continue the trial, and the study was terminated. CONCLUSIONS: Early adjunctive corticosteroid therapy can improve survival and decrease the occurrence of respiratory failure in patients with AIDS and severe P. carinii pneumonia.

A longitudinal study of the relationships among alcohol use, marijuana/hashish use, cocaine use, and emotional/psychological functioning problems in a cohort of high-risk youths.

There is increasing recognition that children involved in the justice system often have serious, multiple problems in the areas of physical abuse, sexual exploitation, and alcohol/other drug use (ADM). Using data collected in a longitudinal study of detained juveniles, we test a model of the relationships of these problems. Significant over-time interrelationships are found among these problems. Research and policy implications of these important findings are drawn.

Physical abuse, sexual victimization, and illicit drug use: replication of a structural analysis among a new sample of high-risk youths.

Mounting evidence of serious adverse consequences of childhood physical and sexual abuse has important implications for public health officials and care providers. Given the potential impact on social policy of this area of inquiry, programmatic research is needed for the validation of theoretical models across populations and over time. This study, based on a sample of high-risk youths, replicates a structural model that specified the influence of child physical and sexual abuse on self-derogation and drug use. Results suggest that for male and female youths, physical abuse and sexual victimization had a direct effect on self-derogation and illicit drug use, and an indirect effect on drug use that was mediated by self-derogation. Moreover, structural coefficients for the model were found to be identical across gender. Subsequent analyses demonstrated the equivalence of the structural model of child physical and sexual abuse on drug use across two study cohorts. Implications for the identification and treatment of youths in high-risk groups are discussed.

Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS.

The safety and efficacy of sulfamethoxazole and trimethoprim in the prevention of Pneumocystis carinii pneumonia associated with the acquired immunodeficiency syndrome (AIDS) were evaluated. Sixty patients with a new diagnosis of Kaposi's sarcoma and no history of opportunistic infections were randomly assigned to receive 800 mg of sulfamethoxazole and 160 mg of trimethoprim twice per day or no therapy. None of the 30 patients receiving sulfamethoxazole and trimethoprim developed P carinii pneumonia. Sixteen of the 30 patients receiving no suppressive therapy developed P carinii pneumonia. Development of P carinii pneumonia was associated with the stage of Kaposi's sarcoma, B subtype disease, and the presence of 0.20 X 10(9)/L (200/mm3) or fewer CD4 cells at study entry. The proportion of patients surviving and the mean length of survival were significantly greater in the treatment group compared with the control group. Adverse reactions occurred in 15 patients (50%).

Physical abuse, sexual victimization and illicit drug use: a structural analysis among high risk adolescents.

The relationships between child physical and sexual abuse and illicit drug use are relatively unexplored and obscure. Data gathered from a sample of youths in a juvenile detention center permitted an examination of this important issue. A structural model, specifying the influence of child physical and sexual abuse variables on the youths' illicit drug use, directly and as mediated by self-derogation, was estimated among male and female detainees. Results suggest that for both gender groups, sexual victimization had a primarily direct effect on drug use, whereas physical abuse had both a direct and an indirect effect on drug use. The indirect effect of physical abuse on drug use was mediated by self-derogation. Further analysis indicated race did not affect the results. The implications of these results for theory and research on the etiology of drug use and the identification of youths in high risk groups who are likely to become seriously involved in drug use are discussed.

Perception of the etiology of illness: causal attributions in a heart patient population.

This study examined perceived causes of myocardial infarction in a patient population of 345 men previously free from significant medical problems. Investigation of their perceptions following the life-threatening illness crisis indicated that stress and tension factors were the causes most commonly cited. Possible social and psychological correlates are analyzed using an attribution theory framework, and their implications are discussed.