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This study reports on observed interaction patterns between 20 children with autism and mixed intellectual disabilities (mean chronological age = 11:4 years; language age = 4:7 years) and their nine teachers working with a specially developed multimedia program aiming to increase literacy skills. An increase in verbal expression was found over time for the total group. Children with autism also showed increased enjoyment and willingness to seek help from their teachers. Teachers for both diagnostic groups reduced their instructions on how to handle the computer during the program but the decrease was greater in the teachers for children with autism. When the total group of children was subdivided according to language age (high versus low), it appears that those with a low language age showed an increase in verbal expressiveness from start to end of training. Those with a high language age showed increased enjoyment. It is concluded that more detailed studies of the interaction patterns between teachers and children are needed, and these should be related to children's language level as well as to diagnostic group. [ABSTRACT FROM AUTHOR]

Context: Hepatitis C virus (HCV) infection may resolve (viral clearance), persist without complications, or cause end-stage liver disease (ESLD). The frequency and determinants of these outcomes are poorly understood.Objective: To assess the incidence and determinants of viral clearance and ESLD among persons who acquired HCV infection from injection drug use.Design and Setting: Community-based prospective cohort study with enrollment in 1988-1989 and a median follow-up of 8.8 years.Subjects: A total of 1667 persons aged 17 years or older with a history of injection drug use and an HCV antibody-positive test result during follow-up.Main Outcome Measures: Viral clearance was assessed in a subset of 919 patients and defined as failure to detect HCV RNA in at least 2 consecutive samples collected 5 or more months apart. End-stage liver disease was assessed at semiannual visits and by review of medical records and death certificates and defined by the presence of ascites, esophageal varices, or hepatic encephalopathy, or when ESLD was stated as a cause of death.Results: Viral clearance was observed in 90 persons who were compared with 722 with persistent viremia, while the viremia of 107 was not resolved. Viral clearance occurred more often in nonblacks (adjusted odds ratio [OR], 5.15; 95% confidence interval [CI], 2.60-10.17) and those not infected with human immunodeficiency virus (HIV) (adjusted OR, 2.19; 95% CI, 1.26-3.47). Forty cases of ESLD were observed throughout follow-up (incidence, 3.1 per 1000 person-years). In a multivariate model, risk of ESLD was higher for persons aged 38 years or older at enrollment (adjusted relative incidence, 3.67; 95% CI, 1.96-6.88) and who reported ingestion of more than 260 g of alcohol per week (adjusted relative incidence, 3.60; 95% CI, 1.73-7.52). Of 210 patients without ESLD randomly selected for biopsy, only 2 had cirrhosis.Conclusions: Our results indicate that although HCV infection can be self-limited or associated with ESLD, the majority of adults have persistent viremia without clinically demonstrable liver disease. Further research is needed to explain the less frequent clearance of HCV infection among black persons and to improve utilization of treatment for those infected in the context of injection drug use. JAMA. 2000;284:450-456 [ABSTRACT FROM AUTHOR]

A cohort of Royal Thai Army (RTA) conscripts was followed in civilian life after completing 2 years of military service, to determine whether such a cohort might be suitable for HIV vaccine trials. Objectives were to identify correlates of participation and to determine the occurrence of risk behaviors for HIV infection after discharge from the military. The cohort was selected from among conscripts who had participated in HIV studies from 1991 to 1993. Risk factors were surveyed at 3, 9, and 15 months after discharge (1993-1995). Change in risk was evaluated based on deviations from expected distributions of risk categories for sentinel behaviors, assessed with chi-square analysis. HIV seroconversion rates (SR) and 95% confidence intervals (CI) were calculated. A total of 380 men returned after discharge. Seven men seroconverted after discharge; the SR (95% CI) was 2.02/100 person-years (0.81-4.17). Among changes in risk were reduced visits to commercial sex workers (CSWs), more condom use with CSWs, and less alcohol use prior to CSW visits. Behaviors associated with increased risk of HIV seroconversion declined after military service. Thus, sufficient numbers of outcome events for vaccine trials may not be attained with this type of cohort. Nonetheless, these findings provide data on the dynamics of the HIV epidemic in Thailand and the development of HIV vaccine cohorts. [ABSTRACT FROM AUTHOR]

Background: The epidemic of Human Immunodeficiency Virus (HIV) infection led blood banks to initiate donation deferral criteria based on self-reported risk factors. However little information is available on the differences in reporting risk factors before and after HIV status is known.Methods: Between April and July 1994, blood donors in a provincial hospital in northern. Thailand were interviewed at the time of donation, about their demographic characteristics and risk factors. All donors had agreed to learn their test results and were called back for post-test counselling and reinterview.Results: HIV-positive blood donors were more likely to change from 'denying' to 'acknowledging' risk factors while HIV-negatives were more likely to change from 'acknowledging' to 'denying'. The differences between risk factors obtained before and after test results were known resulted in stronger, weaker or even opposite risk measures.Conclusion: The study results raise questions about the impact of the differences in reporting HIV-related risk factors by the donors on how effective donation deferral criteria can be developed. [ABSTRACT FROM AUTHOR]

This article reviews recent studies of family preservation and related family-strengthening programs, estimates the effect sizes of outcomes in studies with control or comparison conditions, and discusses the status of research on family preservation services. A set of core services that characterize innovative family preservation programs in child welfare, multisystemic family treatment in juvenile justice, and family-based psychoeducation in mental health is identified. Family preservation services may be useful in preventing youth violence; family-based psychoeducation in mental health may prevent or delay relapse and hospitalization; and aside from promising data on family reunification programs, the findings in child welfare are equivocal. [ABSTRACT FROM AUTHOR]

In a survey of 1,057 active intravenous drug users in Baltimore, MD, who were recruited through extensive community outreach, 12 reported endocarditis and 113 reported subcutaneous abscesses in the 6 months before being interviewed. Of all the persons surveyed, 556 reported cleaning their skin prior to injection at any time and 173 reported cleaning their skin all the time in the 6 months before the interview. The frequency of subcutaneous abscesses was lower among those who reported skin cleaning all the time; a similar trend was noted for frequency of endocarditis. The relatively simple procedure of encouraging intravenous drug users to clean their skin prior to injection will not eliminate but might reduce the frequency of these serious and expensive infectious complications of intravenous drug use. [ABSTRACT FROM AUTHOR]

A multiplex polymerase chain reaction (M-PCR) assay that simultaneously detects the three major causes of genital ulcer disease (GUD), Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus, was used to evaluate swab specimens for 38 sequential patients with GUD at a Thai sexually transmitted disease clinic. Subjects received clinical diagnoses and syndromic treatment. Swab specimens for H. ducreyi cultures and M-PCR were obtained. No H. ducreyi cultures were positive. Of 38 M-PCR specimens, 31 (81.6%) were positive for HSV, 1 (2.3%) for both HSV and T. pallidum, and none for H. ducreyi or T. pallidum alone; 6 (15.8%) were negative for all 3 pathogens. Clinical diagnoses corresponded poorly to M-PCR findings; none of 5 suspected cases of chancroid were positive by M-PCR and none of 1 for syphilis, but 21 of 24 suspected herpes lesions were confirmed by M-PCR. Human immunodeficiency virus infection status was known for 24 of 38 subjects; 11 (45.8%) were seropositive, and all 11 had HSV by M-PCR. HSV appeared to be the most common pathogen overall. [ABSTRACT FROM AUTHOR]

Although the concept of chronic neglect is used in child welfare practice, studies have not differentiated chronic cases of neglect from those of more recent onset. In this study three groups of families referred to a large metropolitan county child welfare agency for child neglect are considered: those known to the agency for three years or more (chronic group), those more recently referred and substantiated (newly neglecting group), and those in which neglect was not substantiated (unconfirmed group). Significant differences among the three study groups included family size and composition, numbers and kinds of problems, neighborhood characteristics, family relationships, parenting knowledge and expectations, and mental health. Findings demonstrate the need for changes in social policy and social services delivery systems to supplement intervention with individual families. [ABSTRACT FROM AUTHOR]