Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty.

BACKGROUND: Extra-large uncemented components provide several advantages for acetabular revision, but limited information is available on the results of their use. The purpose of this study was to evaluate, at a minimum of five years, the results associated with the use of an extra-large uncemented porous-coated component for acetabular revision in the presence of bone loss. METHODS: Eighty-nine extra-large uncemented hemispherical acetabular components were used for revision after aseptic failure of a total hip arthroplasty in forty-six men and forty-three women (mean age at revision, fifty-nine years; range, thirty to eighty-three years). The revision implant (a Harris-Galante-I or II cup fixed with screws) had an outside diameter of > or = 66 mm in men and > or = 62 mm in women. Seventy-nine patients had a segmental or combined segmental and cavitary acetabular bone deficiency before the revision. Particulate bone graft was used in fifty-four hips and bulk bone graft, in nine. RESULTS: One patient died with the acetabular component intact and two patients were lost to follow-up within five years after the operation. At the time of the last follow--up, four acetabular components had been removed or revised again (two for aseptic loosening). All of the remaining patients were followed clinically for at least five years (mean, 7.2 years; range, 5.0 to 11.3 years). In the hips that were not revised again, only two sockets had definite radiographic evidence of loosening. All four of the sockets that loosened were in hips that had had combined cavitary and segmental bone loss preoperatively. In the hips that were not revised again, the mean modified Harris hip score increased from 56 points preoperatively to 83 points at the time of the most recent follow-up. The most frequent complication, dislocation of the hip, occurred in eleven patients. The probability of survival of the acetabular component at eight years was 93% (95% confidence interval, 85% to 100%) with removal for any reason as the end point, 98% (95% confidence interval, 92% to 100%) with revision for aseptic loosening as the end point, and 95% (95% confidence interval, 88% to 100%) with radiographic evidence of loosening or revision for aseptic loosening as the end point. CONCLUSIONS: This study demonstrates that extra-large uncemented components used for acetabular revision in the presence of bone loss perform very well and have a low rate of aseptic loosening at the time of intermediate-term follow-up.

Cultural mistrust of white mental health clinicians among African Americans with severe mental illness.

This study examined the association between cultural mistrust and beliefs about white mental health clinicians among African-American patients recently admitted to a psychiatric hospital. Self-report and clinician-rated measures of cultural mistrust predicted patients' beliefs about white mental health clinicians. Implications for mental health services to African Americans are discussed.

Differential risk perceptions for unintended pregnancy, STDs, and HIV/AIDS among urban adolescents: some preliminary findings.

Two pilot studies tested the hypothesis that adolescents perceive differential risks for unintended pregnancy (UP), sexually transmitted diseases (STDs), and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 1st study used a college sample consisting of 14 adolescents (21 years or younger) and 64 adults (over 21) who rated the likelihood that they and others would experience 15 health problems. The 2nd study used a community sample of 48 adolescents between 16 and 21 years of age who rated 11 health problems in a similar manner. Optimistic bias and uniqueness of risk in adolescents' perceived susceptibility to adverse sexual outcomes were examined. Optimistic bias is the difference between ratings of risk to self and risk to others, reflecting lower risk to self. Uniqueness of risk is the difference between ratings of risk and a baseline risk estimate (i.e., the mean rating for all non-sex-related health problems). Consistent with the hypothesis, adolescents perceived differential risks for UP, STDs, and HIV/AIDS. Implications for adolescent prevention programs are discussed.

Sociocultural differences in the developmental consequences of the use of physical discipline during childhood for African Americans.

Given the diverse cultures that can shape parenting behavior, some basic assumptions regarding the links between parenting styles and developmental outcomes may not be universal. Although a positive correlation between the use of physical discipline (i.e., spanking) and disruptive disorders in children is found in studies of European American families, research on African American families has found a negative association or none at all. Moreover, a review of the literature indicates that the positive association between spanking and child behavior problems is bidirectional for White families, whereas it is the product of reverse causation (i.e., negative child behaviors result in spanking) in Black families. The implications of these sociocultural differences for parent training programs and the family study of disruptive behaviors are discussed.

Preventing the high-risk sexual behavior of adolescents: focus on HIV/AIDS transmission, unintended pregnancy, or both?

Adolescents are at high risk for negative health outcomes associated with unprotected sexual intercourse including infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and unintended pregnancy. That unprotected sexual intercourse is the risk behavior common to both problems has not been fully capitalized on in prevention programs. Limited knowledge about the effects of type-of-outcome expectancy (i.e., disease vs. pregnancy) on the association between risk perceptions and precautionary or health-protective sexual behavior makes it difficult to determine what preventive approach would be most effective with adolescents. The literature suggests that pregnancy prevention is a greater concern for adolescents than disease prevention. This review focuses on the implications of these differential risk perceptions for HIV/AIDS prevention programs targeting adolescents.

Multidimensional scaling analysis of paranoid symptoms in the context of depressive and psychotic disorders.

The present study examined a continuum of paranoid symptoms in the context of depressive and psychotic disorders from a multidimensional perspective on psychopathology. Based on the self-ratings of 404 community residents, 96 depressed patients, and 65 psychotic patients, similarities or dissimilarities among multiple measures of paranoia (i.e. mild, moderate, and severe types), along with 16 other psychiatric symptom scales taken from the Psychiatric Epidemiology Research Interview (PERI; Dohrenwend, Shrout, Egri & Mendelsohn, 1980, Dohrenwend, Levav & Shrout, 1986b, were analysed using multidimensional scaling supplemented by cluster analysis. Four hypotheses were tested. Only one hypothesis was fully supported and two were partially supported. No distinct dimension for the continuum of paranoia emerged, but a global dimension of severity of psychopathology was pervasive and stable across diagnostic subgroups. The latter finding replicated and extended previous multidimensional studies of psychopathology.

Cross-cultural perspective on paranoia: a focus on the black American experience.

A cross-cultural perspective on paranoia is developed, based on a synthesis of three distinct areas of research, with particular attention to the Black experience in America. This perspective is applied in a two-phase program of research. Phase I was the secondary analysis of data from an epidemiologic study of schizophrenia and depression: It examined differences in paranoid symptom expression among Black, Latino, and White Americans. Phase II, called the Culturally-Sensitive Diagnostic Interview Research Project, is currently underway and involves primary data collection, focusing exclusively on African Americans. Phase I results and some pilot data from the phase II study are reported. It is concluded that cultural mistrust among Black psychiatric patients should not be construed as psychopathology.

Self-evaluation processes of African American youth in a high school completion program.

In the present study, regression analyses were used to determine whether particular domains of perceived competence, alienation from school, and cultural mistrust of society in general predicted judgments of global self-worth and global self-discrepancy in a group of African American high school dropouts in a compensatory program. The participants were 31 African American high school dropouts between 16 and 24 years of age (M = 17.7 years, SD = 1.81) who were enrolled in a state-sponsored high school completion program. Perceived job competence and peer-related social competence were the most significant predictors of self-evaluations. Cultural mistrust of society was associated with students' self-evaluation and overshadowed alienation from school in the prediction of global self-worth. The implications of these results for interventions with African American high school dropouts in this type of program are discussed.

Racism in the provision of mental health services: a social-cognitive analysis.

A social-cognitive analysis is proposed as a framework for delineating the process by which racial bias operates in the provision of mental health services. The concept of aversive racism is used to explain how the behavior and attitudes of white clinicians toward black patients can lead to differences by race in treatment and outcomes, despite lower levels of self-reported prejudice among individuals. Implications for research, practice, and professional training are discussed.

Black psychiatric patients' reactions to the cultural mistrust inventory.

This pilot study examined African-American psychiatric patients' reactions to the Cultural Mistrust Inventory, a measure of blacks' mistrust of white society. Twenty-two black psychiatric patients were screened for the Culturally-Sensitive Diagnostic Interview Research Project. All patients were debriefed after the screening interview including queries about their reactions to the experience, whether they would be willing to participate in the next interview, and their reasons for participating or not. Patients' responses were recorded verbatim and were categorized in terms of their valence (positive, neutral, or negative) and affectivity (yes or no) by independent raters. Agreement between raters in terms of the valence of patients' reactions was very good, but it was poor to fair in terms of affectivity ratings. The majority of these black patients' responses were positive and nonaffective. Administration of the Cultural Mistrust Inventory to black psychiatric patients does not cause negative emotional reactions.

Ethnic and racial differences in perceptions of dangerousness of persons with mental illness.

Ethnic and racial differences in the stigma associated with mental illness in the general population were examined through secondary analysis of data from a survey of a nationally representative sample (N = 1,468) on attitudes toward homeless and homeless mentally ill people. American Indian (1 percent of the sample), Asian-Pacific Islander (1.5 percent), black (10 percent), and Hispanic respondents (4 percent) were compared with white respondents (82 percent) to determine if the groups differed in their perception of the dangerousness of mental patients and if contact with mentally ill persons moderated ethnic and racial differences in perceptions of dangerousness. Asian and Hispanic respondents perceived mental patients as significantly more dangerous than did white respondents. Increased contact with mentally ill people was associated with lower levels of perceived dangerousness among white respondents but not among black respondents.

A culturally sensitive approach to the prevention of interpersonal violence among urban black youth.

Black-on-black interpersonal violence is a major problem for black youth living in poor urban areas. Diverse lines of research converge to suggest that interpersonal violence among inner-city black youth may result from a combination of environmental stressors, racial identity problems, and health and mental health problems. A culturally sensitive approach to the prevention of interpersonal violence among black youth is described. It is concluded that insensitivity to the significant role of racial or cultural factors in black-on-black violence contributes to the relative inattention to the problem.

The effects of behavior modification vs lithium therapy on frontal lobe syndrome.

An A-B-BC-C single-subject design was used to evaluate the effects of behavior modification (i.e. a token economy program) and lithium therapy on the behavioral symptoms associated with frontal lobe damage in a 21-year-old woman. The design consisted of a baseline, token economy, token economy plus lithium, lithium alone and a 4 month follow-up. There was a significant decrease in inappropriate behaviors after treatment with the token economy program, but no additional change was noted in subsequent phases involving lithium therapy. There was evidence of generalization and maintenance in the home environment, even after lithium therapy was discontinued. The results do not support the use of a combined treatment approach.

Cognitive processes in adolescent drug use: the role of positivity bias and implications for prevention policy.

Recent investigations of the role of expectations about the effects of alcohol in drinking behavior suggest that there is a functional relationship between expectancies and alcohol use. Specifically, greater positive expectancies are related to heavier drinking patterns. In contrast, expectations about the negative consequences of alcohol use seem to be unrelated to drinking behavior. These differential roles of positive and negative expectancies as mediators of alcohol use reflect the robust phenomenon of positivity bias in human information processing. The theoretical and clinical implications of this phenomenon with respect to adolescent drug use are discussed.