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Summary. Background: It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8–17.2; venous, HR 3.3, 95% CI 1.1–9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.

The 100% Condom Use Program (100% CUP) was evaluated in Wuhan, China. The program sought to increase knowledge of STI/HIV transmission, increase condom use rates, and reduce the prevalence of sexually transmitted infections (STIs) among sex workers (commercial sex workers (CSWs)), via condom availability and use policies in entertainment establishments and STI services including education and counseling. Entertainment establishment owners and CSWs participated in educational sessions and multiple community sectors were involved in the program. At baseline, 170 female CSWs were assessed, and 102 CSWs were assessed at the final 21-month follow-up. At 6-month follow-up, 95% of entertainment establishments were in compliance with 100% CUP policies. At 15 months, condoms were readily available in retail outlets, and condom use rates rose by 94.5%. Refractive rates of chlamydia and methodological limitations of the evaluation leave unanswered questions about the effectiveness of the program. Nonetheless, outcomes suggest that the 100% CUP may be a promising approach to HIV prevention in China.

Opiate addiction is a major problem in our society in terms of its impact on children and families. Families affected by opiate addiction are often among the most vulnerable and exhibit many of the most challenging problems faced by child welfare workers. However, there are medications, such as Methadone and Buprenorphine shown to be effective in reducing opiate dependency. This manuscript is a comprehensive review of the evidence base on the consequences of maternal use of medication assisted drug treatment (MADT) on child well-being. An extensive literature search was conducted via Medline (Pub Med), Sociological Abstracts, Social Services Abstracts, and PsycINFO for the years 1980–2005. Over 200 studies were reviewed. Of these, findings from more than 100 studies are summarized in this review, leading to key recommendations for child welfare practitioners, policy makers and researchers concerned with protecting the safety and well-being of children of opiate-dependent parents.

Conducted in hospital-based clinics in New York City, this study is the first to depict the living circumstances of children of women in detoxification. Structured interviews were conducted with 160 African American and 96 Latina female patients who had at least one child under age 18. Virtually, all participants had used heroin or crack cocaine in the 30 days prior to entry into detox. High-risk drug use was common, including injection, frequenting crack houses, overdosing and trading sex for drugs. Fewer than half of the mothers had a high school education, and few received income from wages or child support. Mothers, with a mean age of 36, reported an average of 2.84 minor children. Only 34% of children were in the guardianship care of their mothers alone or mothers and their partners. Only 21% of mothers indicated that they were the guardians of all of their minor children. Rates of guardianship and custody were somewhat higher for Latina mothers compared to African American mothers. The most important sources of care for the children were grandparents, other relatives and foster parents. Of the children of detoxifying mothers, 21% were living with a non-relative, whereas in a national comparison sample of African American and Latino households, only 2% of children were living with non-relatives. A logistic equation determined that women who did not live in their own home, had less education and used multiple drugs were more likely to have lost guardianship of one or more children. Study findings expand understanding of the detrimental effects of parental drug abuse on children's life opportunities.

The present study sought to determine whether proximity to a needle exchange program (NEP) was associated with lower levels of HIV-related risk behavior among 587 injection drug users (IDUs) in East Harlem. Three neighborhood samples were compared: IDUs recruited at a NEP; those recruited within 10 blocks (‘proximal access’) of the NEP site; and those recruited more than 10 blocks away (‘distal access’). Most respondents were Puerto Rican or African American single men, and receiving public assistance. Levels of HIV risk behavior—both injection- and sexual-related—reported by the three comparison groups were lower than in similar samples obtained in many earlier studies. Participants recruited at the NEP were less likely to share syringes and other injection paraphernalia, and more likely to use condoms with main sex partners. After adjusting for age, gender, ethnicity, education and injection frequency, analyses of covariance revealed that IDUs located at the NEP were less likely than other IDUs to inject with a syringe that someone else had squirted drugs into, use dirty needles by themselves, or share a cooker; and were more likely to use new sterile needles and use a condom with a steady partner and during vaginal sex. Although 90% of IDUs recruited within 10 blocks of the NEP were NEP attendees, this group had injection- and sexual-risk levels similar to the distal access group. However, lending support to the plausibility of NEPs as referral providers, IDUs with access to the NEP site were more likely to participate in drug abuse treatment at present and in the past six months. The substantially lower rates of risk-taking among respondents located at the NEP is consistent with existing evidence that such programs are important elements in the array of strategies to slow the spread of HIV.

A quasi-experimental evaluation design was employed in order to determine whether community outreach efforts would result in reductions in drug- and sexual-related HIV risk behavior among injection drug users, and to gain insight into the potential effect of enhanced outreach on increased client participation in drug abuse treatment and STD/HIV services. Interviews were conducted with 1943 randomly selected drug users in two control neighborhoods and two experimental neighborhoods in the South Bronx. The sample was largely indigent males in their mid 30s, most with less than a high school education, of Hispanic or African American background. Data were gathered before and after enhanced outreach was instituted in the two experimental communities. Needle sharing decreased and bleach cleaning increased in both pairs of neighborhoods; however, sharing of cookers, cotton, and rinse water increased. Unprotected vaginal and anal sex decreased over time, but no between-condition differences in reductions in drug- or sex-related risk behaviors were found. Over time, an increasing proportion of drug users in both study conditions reported having attended substance abuse treatment, but longitudinal outcomes did not favor the enhanced outreach neighborhoods with respect to exposure to outreach messages or acceptance of referrals to chemical dependency treatment or STD/HIV services. In sum, HIV risks declined over time in both conditions, but there were no apparent differences in behavior change or treatment/services entry between the control and enhanced outreach neighborhoods. The study underscores the difficulty of interpreting cross-community comparisons of intervention outcomes in an environment of changing risks and neighborhood dynamics.

This study investigated the utility and psychometric properties of the University of Rhode Island Change Assessment Scale (URICA) in a sample of 257 female inmates from a large urban prison. It addressed three major issues: (a) whether URICA captures stages of change among female offenders with a recent history of drug abuse; (b) whether distinct, reliable subgroup profiles would emerge from a cluster analysis of the URICA scale; and (c) whether women in these clusters would differ in their demographic characteristics, drug-use patterns, or psychological symptoms. Results indicate that the URICA is a useful, reliable, and valid tool to assess stages of change in drug-using incarcerated women. Consistent with other studies conducted with different populations, the scale yielded five distinct stages: precontemplation, contemplation, preparation, action, and maintenance. Cluster analysis using the hierarchical agglomerate method classified the subjects into five clusters, which correlated with subjects' psychological symptoms. Intervention implications of URICA are discussed.

Conventional practice wisdom has long shielded alcohol treatment center clients from social and medical pressures to quit smoking. But, recent findings of increased cancer risk are forcing a re-examination of traditional practices. Detailed case histories of 14 recovering alcoholics who successfully quit smoking suggest the feasibility of cessation efforts even in the face of severe substance abuse histories.

The relationship between hypocholesterolemia and anemia has been recognized in humans. However, no metabolic studies in humans have been reported, nor has an animal model been developed to investigate the effects of anemia on cholesterol metabolism. We have identified an animal model, the 'sex-linked anemic' (gene symbol, sla) mouse, characterized by iron deficiency anemia, to study the relationship between anemia and cholesterol metabolism. Results from our studies showed that the serum cholesterol was significantly lower in anemic male SLA mice compared to non-anemic littermates. The lower serum cholesterol observed in anemic SLA mice was related to a decreased in vivo hepatic cholesterol synthesis. However, the decreased hepatic cholesterol synthesis in anemic SLA mice was not due to a block at the primary regulatory site, the hydroxymethylglutaryl-CoA reductase, nor at one of the secondary regulatory sites: the acetoacetyl-CoA thiolase and hydroxymethylglutaryl-CoA synthase.

This study evaluated cigarette smoking prevention methods with a sample of adolescent females and males. Arranged by school, 331 informed and consenting sixth graders were randomly divided into four groups: 1) pretest, skills-building methods, posttest; 2) pretest, discussion methods, posttest; 3) pretest and posttest; and 4) posttest only. All subjects were followed for 6 and 15 months after the posttest. Outcome results on measures of non-smoking intentions, attitudes, predictions, problem-solving abilities, and peer interactions favored subjects in the skills-building group when compared with subjects in the discussion and pretest-posttest control groups. Smoking rates at posttest and at both follow-ups were lower in the skills-building group than in the other three groups. Results from posttest-only subjects did not support pretest reactivity. The study's strengths and limits are discussed along with directions for future smoking prevention research.

This paper considers coping styles of mothers and fathers of handicapped children. Cautioning against stereotyping, the authors find that mothers and fathers differ in how they appraise and cope with the stress of rearing a developmentally disabled child. The need for systematic investigation of gender-related coping styles in families with handicapped children is discussed.

This paper proposes a new definitional model and improved methods for human services prevention research with youth and families. The proposed model defines prevention as knowledge-based, group intervention aimed at helping at-risk youth and families build skills and social supports to enhance interpersonal and environmental competence and to manage stress. Based on this definition, the authors suggest methods for improving prevention research. Those methods begin with risk assessment. Risk assessment, in turn, provides a basis for three levels of preventive intervention: universal, selective, and indicated. Each intervention level is discussed, with particular attention given to selective and indicated interventions because of their relevance for human services with youth and families. Finally, the paper notes the implications and future research directions for new models and levels of human services prevention with youth and families.

Human services workers have long recognized that parents of handicapped children experience inordinate stresses. In recent years investigators have examined how such families deal with stress. This paper discusses stress in families of developmentally disabled children and how parents of special needs children draw on personal and social coping strategies to manage daily challenges. An overview of existing research is followed by a prescription for research on stress, personal coping, and social support. The authors call for prevention strategies to prevent stress-related maltreatment of special needs children.