Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: implications for intervention development.

This study examined the prevalence of consistent condom use among inner-city women at risk for HIV, measured the distribution of these women across the stages of change for condom use, determined psychosocial factors associated with the stages, and suggested intervention strategies based on the results. The 5-city sample of women aged 15-34 years consisted predominantly of African Americans. Only 18% reported consistent condom use with main partners and 45% with other partners. Logistic regressions compared women in each stage of change with those in higher stages for each partner type. Results indicated that women who practice or intend to practice consistent condom use were more likely to talk with others about condoms, acknowledge the advantages of condoms, have higher self-efficacy for condom use, and indicate that people important to them favored condom use. Intervention approaches are suggested for women in different stages of change for condom use.

PIP: This cross-sectional study examines the prevalence of consistent condom use among inner-city women at risk for HIV and measured the distribution of these women across the stages of change for condom use. It further determined the psychosocial factors that could be used by program planners to design interventions for these women in different stages of change. The study sample was composed of women aged 15-34 years who were mostly African-Americans (79%). In the results, only 18% reported consistent condom use with main partners and 45% with other partners. The results further indicated that women who practice or intend to practice consistent condom use were more likely to talk with others about condoms, acknowledge the advantages of condoms, have higher self-efficacy for condom use, and state that people important to them favored condom use.

Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities.

OBJECTIVE: To compare outcomes from pediatric intensive care in hospitals with different levels of resources. DESIGN: Prospective, blinded comparison of outcome and care. SETTING: Tertiary (n = 3) and nontertiary (n = 71) hospitals in Oregon and southwestern Washington. PATIENTS: All critically ill children admitted with respiratory failure and head trauma for 6 months. MEASUREMENTS AND MAIN RESULTS: Severity of illness adjusted mortality rates were determined using admission day, physiologic profiles (Pediatric Risk of Mortality score) and care modalities were assessed daily. The crude mortality rate of the tertiary patients was four times higher than for the nontertiary patients (23.4% vs. 6.0%, p less than .0001). In the tertiary patients, the numbers of outcomes were accurately predicted by physiologic profiles (observed: 30 deaths and 98 survivors; predicted: 29.3 deaths and 98.7 survivors, z = -.25, p greater than .4). However, for the nontertiary patients, the number of the deaths were significantly different than predicted (observed: 20 deaths and 315 survivors; predicted: 14.4 deaths and 320.6 survivors, z = -2.08, p less than .05). The odds ratios of dying in a nontertiary vs. a tertiary facility were about 1.1, 2.3, and 8 (p less than .05) for mortality risk groups of less than 5%, 5% to 30%, and greater than 30%. Patients in tertiary facilities received more (p less than .05) invasive (e.g., arterial catheters) and complex (e.g., mechanical ventilation) care, whereas patients in nontertiary facilities received more (p less than .05) labor-intensive care (e.g., hourly vital signs). CONCLUSIONS: Care of the most seriously ill children in tertiary pediatric ICUs could improve their chances of survival.