Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature.

Adherence to antiretroviral medications is central to reducing morbidity and mortality among people living with HIV/AIDS. Relatively few studies published to date address HIV adherence among special populations. The purpose of this article is to review the existing literature on HIV antiretroviral adherence, with an emphasis on studies among the triply diagnosed population of people living with HIV/AIDS, mental illness, and chemical dependency. In order to reflect the most current information available, data from conference proceedings, federally funded studies in progress, and the academic literature are presented for consideration.

Management of spinal cord injured patients by indwelling suprapubic catheterization.

PURPOSE: We review the urological complications in spinal cord injury patients treated with suprapubic catheterization. MATERIALS AND METHODS: Suprapubic catheterization was used in 44 spinal cord injury patients. Followup ranged from 12 to 150 months (mean 58). The catheters were irrigated weekly and changed every 2 weeks. Patients were followed annually with urodynamic studies and ultrasound. RESULTS: No patient had renal deterioration, vesicoureteral reflux or bladder carcinoma. The incidences of incontinence, urinary tract infections and calculi were acceptable. CONCLUSIONS: Suprapubic catheterization is an effective and safe alternative form of bladder management in select patients with spinal cord injury.

Indicators of poor dietary habits in a high risk population.

OBJECTIVE: This study was conducted to determine whether individuals attending an urban outpatient clinic met the National Health Promotion and Disease Prevention nutritional objectives and to assess factors associated with poor dietary habits. METHODS: Individuals who attended the general medicine outpatient clinic at the State University of New York Health Science Center in Syracuse were interviewed using an expanded version of the Health Habits and History Questionnaire. Usual dietary intake, medical history, occupation, stress, physical activity, tobacco use and other life-style factors were recorded. Of particular interest were the percentage of calories from fat in the diet and whether individuals consumed the daily requirements of the base-foods in the USDA Pyramid (grains, vegetables and fruits). Unconditional logistic regression was used to determine odds ratios (OR) and 95% confidence intervals for variables associated with high fat consumption and low consumption of vegetables, fruit and high-fiber grains. RESULTS: None of the patients met the minimal recommended daily servings for the three base-food categories combined (grains, vegetables and fruits) and 84% of subjects had fat intakes which constituted over 30% of daily energy intake. Individuals with less education, who were disabled or unemployed, and who participated in little physical activity were twice as likely to have poor dietary habits (i.e. low consumption of vegetables, fruit, and/or high-fiber grains) as other subjects (p < 0.05). Younger patients (20-49 years of age), especially those who were nonsmokers and who reported little physical activity were more likely to consume fat and less likely to consume fruit than older patients (> or = 50 years of age). Nonwhite subjects were less likely to consume high-fiber grains and whole-wheat breads than white patients (p = 0.04). CONCLUSIONS: Nutritional screening should be considered for all patients attending similar inner-city general medicine clinics, regardless of the primary diagnosis in order to provide early dietary intervention. In particular, young adults, the unemployed, and the disabled should not be overlooked.