Minority Stressors and Attitudes Toward Intimate Partner Violence Among Lesbian and Gay Individuals.

Sexual minority individuals experience more intimate partner violence (IPV) than those in heterosexual relationships. Issues of mistrust, stigma, and anticipation of abuse contribute to these rates. Lesbian and gay IPV victims have distinct experiences from their abuses with exposure to homophobia, heterosexism, discrimination, and threats of sexual disclosure, among others. These unique and additive minority stressors can lead to adverse health concerns, increase vulnerability to victimization, and elevate abuse perpetration. This study aimed to investigate whether experiences of minority stressors are associated with attitudes toward intimate partner violence among a sample of 240 lesbian and gay Filipinos (155 lesbian and 85 gay participants) aged 20 to 40. Through convenience sampling, lesbian and gay Filipinos completed the Sexual Minority Stress Scale (SMSS) and Intimate Partner Violence Attitude Scale-Revised (IPVAS-Revised). Comparing the minority stressors levels among the participants, lesbians expressed higher expectations of rejection, while gay men experienced more sexual minority adverse events. Lesbians also reported higher satisfaction with outness. Regarding IPV, gay men expressed slightly more favorable attitudes toward abuse, which could make them at risk of becoming victims or perpetrators. Internalized homophobia was associated with more favorable attitudes toward abuse and control, indicating its contribution to more favorable IPV attitudes, although the explanatory power was modest.

Access to US primary care physicians for new patients concerned about smoking or weight.

Tobacco smoking and obesity are leading causes of preventable morbidity and mortality in the US, and primary care physicians are the main source of preventive care. However, it is not known whether access for new patients is affected by an expression of interest in preventive care. In a 2015 audit, we called US primary care physicians' offices to request appointment information regarding new patient physicals for simulated patients. Simulated patients were differentiated by smoking concerns (N = 907), weight concerns (N = 867), or no health concerns ("healthy" patients; N = 3561). Additionally, patient profiles varied by race/ethnicity, sex, and insurance type. We also examined whether access differed in states that expanded Medicaid under the Affordable Care Act. We found that physicians' offices were no more likely to offer appointments to patients with smoking concerns than to healthy patients (54% vs. 55%; p-value = 0.56), and patients with smoking concerns were offered fewer appointments than patients with weight concerns (54% vs. 62%, p-value < 0.01). In analyses adjusted for covariates, smoking concerns did not improve appointment offers for any patient group, and reduced Medicare patients' offers in Medicaid expansion states by 9 percentage points relative to healthy patients (95% CI: -16, -2). Health concerns did not statistically significantly affect waits-to-appointment. Our results suggest that patients with smoking concerns are no more likely to be offered new patient appointments than those with no health concerns. The greater likelihood of appointment offers for some patients with weight concerns is encouraging for obesity prevention and management.

Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education.

In the US, deaths from prescription opioids have quadrupled since 1999, prompting authorities to declare an "opioid abuse" crisis. Rising overdose deaths were attributed to trends in the overprescription of opioids, specifically the strength and duration of the initial prescription. We describe educational interventions designed to control healthcare professionals' (HCPs) opioid prescribing in the wake of this crisis. A review of relevant programs for practicing providers, medical residents, and medical students reveals a focus on educational interventions that we describe, borrowing from sociologist John McKinlay's metaphor for public health interventions, as "downstream." These downstream interventions concentrate on regulating and educating practicing HCPs rather than transforming the training environment for medical students and residents. We draw on theories of behavior change to call for the development of complementary "upstream" educational programs for future practitioners that focus on structural and psychosocial factors and may contribute to more sustainable behavior change outcomes.

Squaring Up: Experiences of Transition from Off-Street Sex Work to Square Work and Duality--Concurrent Involvement in Both--in Vancouver, BC.

Many studies of exit from sex work are inspired by role theory, where people experience a lack of attachment to a role; are faced with individual, interactional, and structural challenges; contemplate transition and exit a role; and then struggle to establish postrole identities and new lives. This framework has been used to explicate the factors and experiences of those who leave or attempt to leave the sex industry; however, it is limited because studies present sex work as a harmful and dangerous profession that people are trapped in, escaping, or have survived. In this paper, I discuss Vancouver's history of violence against sex workers and I review research on sex work exiting and bring forward recommendations for the design of exit program based on the experiences of 22 active and former off-street sex workers from Vancouver, British Columbia. I describe study participants who include Sex-Work-No-More participants who would not return to the industry, Sex-Work-Maybe participants who consider reinvolvement, and Dual-Life participants who are employed in sex work and conventional work simultaneously. These participants uniquely challenge narrow, binary understandings of involvement and transition because they discuss their use of deception to obtain resources needed to make change; the support that clients have provided; their strategic engagement in sex work as a means to exit; their considerations of reentry; and for some, their dual employment. In light of new legislation that criminalizes activities related to sex work-the Protection of Communities and Exploited Persons Act-and the Federal government announcement of $20 million dollars for the creation of exit services nationwide, hearing from sex workers is essential to advancing agendas in this area.

Idiopathic necrotizing dermatitis: current management.

OBJECTIVES: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. METHODS: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. RESULT: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. CONCLUSION: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

Epidemiology of facial injury in female blunt assault trauma cases.

BACKGROUND: Etiology of trauma in the female population differs from that of the male population. To date, domestic violence has been researched extensively, but little has been published about the epidemiology of facial injury in the female population. OBJECTIVES: To analyze the differences in the circumstances under which males and females are injured, to identify gender-specific patterns of injury, and to assess whether differences in the demographics, health status, and drug-use profile exist between female and male assault cases and whether these factors lead to a difference in outcome. METHODS: A cohort of 91 female assault cases was compared with a control group of 706 males with similar injuries resulting from blunt assault trauma. Information was gathered by retrospective review of 797 consecutive cases requiring admission for facial injuries resulting from blunt assault trauma. Fisher exact, chi 2, and t tests were used to assess statistically significant differences between the male and female cohorts. RESULTS: The female cohort comprised 12% of all cases admitted for blunt assault facial trauma. One third of female blunt assault facial trauma patients were subjects of domestic violence. Statistically significant differences were found between males and females for the type of assault (rape, domestic violence, altercation, etc) with P < .0001. Females were more likely to be admitted with soft tissue injury only but no fracture (P < .05), less likely to be assaulted with a weapon, and unlikely to be involved in an altercation, gang violence, arrest, or robbery. Females were also less likely than males to be injured while intoxicated (P < .05). Incidence of specific injury patterns and outcomes, however, were similar between the 2 groups. CONCLUSION: The present data support the hypothesis that the female blunt assault facial trauma population represents a distinct epidemiological entity, with significant differences in the circumstances of injury, mechanism of assault, and role of intoxication in the incidence of injury. The prevalence of facial trauma in female assault cases makes it critical for the facial plastic surgeon to be vigilant in the evaluation and treatment of these patients.

Funnel-web spider (Hadronyche infensa) envenomations in coastal south-east Queensland.

Five patients with confirmed funnel-web spider bites (Hadronyche infensa) presented to Nambour General Hospital, in south-east Queensland, between 1992 and 1998. Two patients required antivenom; low doses of antivenom were effective. Patients were bitten in spring and early summer. In areas such as this, where funnel-web spider bites are reported less frequently than in New South Wales, clinicians and the community should be aware of the risks and immediate management of these bites.

An anatomical approach to glabellar rhytids.

OBJECTIVE: To identify surface landmarks that can serve as reference points to the underlying musculature in the treatment of glabellar rhytids. METHODS: Fifty cadaver hemibrows were dissected to assess the location, disposition, and relationships of the brow muscles, along with their variations at each of several consistent locations. Particular attention was paid to the corrugator supercilii, frontal belly of the frontalis, and procerus muscles. CONCLUSIONS: The information gained here may be applied to the pharmacological or surgical treatment of glabellar rhytids. Knowledge of the frequent location of the muscles involved, relative to easily identifiable surface landmarks, allows a more precise approach.

Surgical management of subclavian-vein effort thrombosis as a result of thoracic outlet compression.

BACKGROUND: There is considerable variability and controversy in the current management of subclavian-vein effort thrombosis. The purpose of this study was to determine the long-term effectiveness and the functional outcome of our preferred treatment strategy of early thrombolysis/recanalization and prompt extensive supraclavicular decompression. PATIENTS AND METHODS: Thirty-three patients who ranged in age from 15 to 60 years underwent operative decompression of 34 primary subclavian-vein thromboses, one of which was bilateral. There were 21 patients with acute thrombosis 7 of whom had had prior unsuccessful balloon venoplasty, 1 with stent placement and 8 patients with chronic/recurrent thrombosis 5 of whom had had 9 unsuccessful prior operations for attempted decompression. Four patients had high-grade symptomatic stenosis and positional occlusion. A supraclavicular approach was used in 32 cases and, in 23 cases, was complemented by an infraclavicular (n = 21) or transaxillary (n = 2) incision. Complete subclavian-vein decompression was achieved by first-rib resection (n = 31), scalenectomy (n = 33), and circumferential venolysis (n = 34). RESULTS: Follow-up was obtained in 30 patients at a mean of 31 months. Twenty of the 21 patients with acute thrombosis had a complete resolution of symptoms with a return to full activity; the other patient was lost to follow-up. Four of the 8 patients with chronic thrombosis reported a mild relief of symptoms but still had limitations of activities of daily living. All of the patients with high-grade symptomatic stenosis with positional occlusion had a complete relief of symptoms and a return to full activity. CONCLUSION: The optimal management of acute effort thrombosis of the subclavian vein includes anticoagulation therapy, thrombolysis/recanalization, confirmatory positional venography, and early supraclavicular decompression of the subclavian vein. In the patients with chronic subclavian-vein thrombosis and positional venographic evidence of compression of first-rib bypass graft collaterals, the initial anticoagulation therapy should be followed by the surgical decompression of the collaterals. The supraclavicular approach alone or with an infraclavicular incision provides optimal exposure for scalenectomy, total first-rib resection, and circumferential venolysis.

Epidemiology of facial injury in blunt assault. Determinants of incidence and outcome in 802 patients.

BACKGROUND: Facial assault trauma has reached epidemic proportions. While the biomechanics of injury, methods of repair, and general demography of blunt facial trauma are well known, statistical associations between epidemiological factors, incidence, and outcome are poorly understood. OBJECTIVES: To provide a comprehensive epidemiological survey of this patient population. To assess factors determining outcome and pattern of injury. DESIGN: Retrospective review of 802 patients admitted with blunt assault facial trauma. Statistical analysis of associations between epidemiological factors, incidence, and outcome with chi 2 test, 2-tailed t test, and Fisher exact test. SETTING: Urban university and county hospital. RESULTS: Statistically significant associations are demonstrated between gender and the context of assault, incidence of armed assault, presence of fracture, and rate of intoxication at injury. Poor prognostic indicators for outcome include use of tobacco and presence of a mandible fracture. Open reduction and internal fixation were found to bear a higher complication rate only in mandible fractures. CONCLUSIONS: While choice of treatment carries a statistically significant association with outcome, social variables, including gender, tobacco use, intoxication, and low socioeconomic status, produce dramatic worsening of both injury incidence and outcome.

Attitudes, knowledge, and practices of otolaryngologists treating patients infected with HIV.

The AIDS epidemic has become one of the most important public health problems of this century. As the prevalence of HIV infection continues to rise, health care practitioners in all geographic regions can expect greater clinical exposure to patients infected with HIV. We conducted an anonymous survey of all practicing otolaryngologists in Ohio and California to investigate regional differences in attitudes, knowledge, and practices regarding the care of patients infected with HIV. We also examined the data with respect to year of completion of residency training to identify differences in attitudes or practices among otolaryngologists who trained in the era of AIDS (post-1982 graduates) in comparison with their predecessors (pre-1982 graduates). In comparison with Ohio otolaryngologists, California otolaryngologists reported more frequent clinical encounters with HIV-infected patients and displayed significantly better knowledge regarding the otolaryngologic aspects of HIV infection. Californians were more likely to support the right of an HIV-infected physician to maintain an unrestricted practice and would be less likely to disclose their HIV status to their patients and hospital if they were to become infected with HIV. Post-1982 graduates had more frequent encounters with HIV-infected patients than did pre-1982 graduates and demonstrated a better fund of knowledge. Although Californians were more likely than Ohioans to routinely double glove in surgery, the overall double gloving rate was low at 21%. Californians were no more likely than Ohioans to routinely use protective eyewear, water-impervious gowns, or indirect instrument-passing techniques in surgery. No differences were observed in prevalence of protective surgical precautions between pre-1982 and post-1982 graduates.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium current and tension generation in immature mammalian myocardium: effects of diltiazem.

Single sucrose gap and isolated myocyte voltage-clamp techniques were used to study the effects of diltiazem on calcium current (ICa) and tension generation in isolated ventricular myocytes and right ventricular papillary muscles from neonatal New Zealand White rabbits. Diltiazem was shown to significantly shorten the duration of isolated myocyte action potentials with no effect on overshoot potential or resting membrane potential. Diltiazem blocked but did not completely abolish ICa in these neonatal cells. Addition of diltiazem to the solution bathing papillary muscles resulted in a similar reduction in action potential duration accompanied by a reduction in twitch tension. When the duration of depolarization was controlled employing the single sucrose gap voltage clamp, the decrease in tension development caused by diltiazem was abolished despite a significant decrease in twitch tension in the same muscles. In another series of experiments it was demonstrated that the magnitude of developed tension in neonatal papillary muscles is dependent upon the duration of depolarization. Taken together, the results of this investigation suggest that in neonatal myocardium when ICa is blocked by diltiazem, the resulting reduction in developed tension is caused in part by reduction of action potential duration. The calcium carried into the neonatal heart cell by ICa does not appear to be the only source of extracellular Ca2+ for excitation-contraction coupling. Finally, the action potential appears to act as a gate for calcium movement into the neonatal heart cell.

Speech therapy for psychogenic voice disorder: a survey of current practice and training.

A survey of speech therapists in the United Kingdom showed that they usually undertook the treatment of psychogenic voice disorders. Their pre-qualification education had provided advice that was usually reflected accurately in the experience they gained in practice, though during their education about a third had lacked any opportunity to treat or observe psychogenic voice disorders. The appropriate duration of treatment appears to be in doubt. At present, speech therapists acquire many of the psychological skills required for treatment after qualification. There is a substantial need for post-qualification courses, although more practical instruction on psychological treatment might advantageously be incorporated in initial education.

Surgical oncology--theory and practice.

In viewing the broad imagery of oncology, it is seen as a multidisciplinary subject, and attention is focused initially on oncology philosophy, indicating major problems for solution. The position of surgical oncology is clearly delineated in clinical oncology as a major discipline with well-defined theory and practice, which is the main subject here. The foundations of the theory are the essential sciences for surgeons--surgical anatomy, physiology, and pathology, with surgical oncology now emerging as a multidisciplinary science. The basic sciences of surgical oncology, currently making valuable additions to oncology knowledge, are defined, and their relevance to the build-up of the theory is described. There must be a constant feedback of theory and practice. Major surgical operations are central in the practice component; the latter can be epitomized as rehabilitation and continuing care. Rehabilitation begins with diagnosis. The performance of oncological operations requires sound surgical judgment and superb technical ability. The surgical oncologist has an important role in rehabilitation and continuing care programmes. Education and training courses in the theory and practice of surgical oncology are developing for graduates who desire a career in this discipline.

Primary malignant nervous system neoplasms. Birth cohort effect in the elderly.

Current data indicate that mortality for primary malignant nervous system neoplasms (NSNs) provides a fairly accurate index of incidence. Average annual age- and sex-specific death rates among whites for primary malignant NSNs in the 48 contiguous United States from 1940 through 1975 showed a marked cohort effect among the elderly of either sex. For white men aged 60 through 64 years, mortality increased steadily from 5.3 per 100,000 per year for those born in 1880 to 16.1 per 100,000 per year for the 1910 cohort. No definite cohort effect was seen in the young. The increase in mortality could be due to better diagnosis and more complete case ascertainment for deaths due to primary malignant NSNs, but further studies are required to distinguish a real from an artifactual increase in mortality.