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It remains unclear if China's current HIV antibody testing algorithm misses a substantial number of HIV infected individuals. Of 196 specimens with indeterminate or negative results on HIV western blot (WB) retrospectively examined by HIV-1 nucleic acid test (NAT), 67.57% (75/111) of indeterminate WB samples, and 16.47% (14/85) of negative WB samples were identified as NAT positive. HIV-1 loads in negative WB samples were significantly higher than those in indeterminate WB samples. Notably, 86.67% (13/15) of samples with negative WB and double positive immunoassay results were NAT positive. The rate of HIV-1 infections missed by China's current HIV testing algorithm is unacceptably high. Thus, China should consider using NAT or integrating fourth generation ELISA into current only antibodies-based HIV confirmation. J. Med. Virol. 88:1462-1466, 2016. © 2016 Wiley Periodicals, Inc.

In China, the rate of human immunodeficiency virus (HIV) testing is increasing among men who have sex with men. The purpose of the present study was to describe HIV-related biomarkers and selected demographic variables of persons with newly diagnosed HIV/AIDS, among men who have sex with men in particular, in Wuhan China. Demographic indicators, and CD4+ T cell counts and HIV-1 viral load were collected from individuals newly identified as HIV-1 antibody positive during 2011. Of 176 enrolled patients, 132 (75.0%) were men who have sex with men. This group was significantly younger and had higher CD4+ T cell counts than patients who were likely infected through heterosexual contact. Most men who have sex with men (56.6%) were discovered by initiative investigation. Among heterosexual patients CD4+ T cell counts and HIV-1 viral load were significantly correlated; among the group of men who have sex with men, no such association was found. J Med. Virol. 85:1687–1691, 2013. © 2013 Wiley Periodicals, Inc.

To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.

It remains unclear if China's current HIV antibody testing algorithm misses a substantial number of HIV infected individuals. Of 196 specimens with indeterminate or negative results on HIV western blot (WB) retrospectively examined by HIV-1 nucleic acid test (NAT), 67.57% (75/111) of indeterminate WB samples, and 16.47% (14/85) of negative WB samples were identified as NAT positive. HIV-1 loads in negative WB samples were significantly higher than those in indeterminate WB samples. Notably, 86.67% (13/15) of samples with negative WB and double positive immunoassay results were NAT positive. The rate of HIV-1 infections missed by China's current HIV testing algorithm is unacceptably high. Thus, China should consider using NAT or integrating fourth generation ELISA into current only antibodies-based HIV confirmation. J. Med. Virol. 88:1462-1466, 2016. © 2016 Wiley Periodicals, Inc.

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.

The objective of this study was to examine, for a population of 8,258 adult injection drug users (IDUs) who all had entered a Massachusetts licensed methadone maintenance treatment program (MMT) between 1996 and 2002, client factors associated with remaining in MMT for a minimum of 1 year after program entry. Two binomial logistic regression models were developed. The first model examined the association between age, sex, race/ethnicity, parental status, employment status, educational status, health insurance status, homelessness status, having injected drugs in the past month, residential treatment use, number of overall treatment admissions, and whether a client’s longest consecutive stay in MMT had lasted for 1 year or more. Second, to examine the stability of the statistical relationships identified in the first logistic regression model, a second logistic regression model examined whether there were significant differences in client level characteristics between those who used MMT for 6 months or less compared with their counterparts. Those who were older, women, those who were not homeless, those who resided with their children, those who had public health insurance, and those who had not used residential treatment were significantly more likely to have stayed in MMT for at least 1 year or more. In contrast, those who were younger, males, homeless, did not live with children, had no insurance, and had used residential treatment were significantly more likely to have stayed in MMT for 6 months or less compared with their counterparts. Those who stayed in MMT for 1 year or more were more likely to have stable lives compared with those who dropped out of MMT before a year. Providing services to improve MMT clients’ employment, housing, and family stability may help improve MMT retention rates. Second, clients with a history of having used residential substance abuse treatment were more likely to stay in MMT for a shorter time period compared with their counterparts. The extent to which treatment bifurcation is a matter of choice or related to other factors needs to be further explored.

Objectives: Social workers will increasingly be required to attend to the cost-effectiveness of practices, programs, and policies. In the area of substance abuse, there is little evidence to suggest that social workers'decisions are based on evidence of either effectiveness or costs. Method: This article provides an overview of existing evidence on the effectiveness, costs, and benefits of methadone maintenance in the treatment of opiate addiction. Results: Methadone maintenance is a demonstrably cost-effective treatment for heroin dependence. Conclusions: As yet, social workers do not appear to be aware of either the effectiveness or the cost advantages of methadone. Because findings supporting the cost-effectiveness of methadone are stronger than in most areas of social work practice, the extent to which social workers appropriately refer and advocate for clients who can benefit from this treatment can be seen as a bellwether of how the profession will perform in the emerging era of cost-effectiveness.

The substance abuse field has identified a range of evidence-based substance abuse treatment approaches. Evidence-based approaches are those that have been shown, through carefully controlled and replicated research, to be efficacious or effective. These approaches have been articulated in National Institute on Drug Abuse (NIDA, 2000b) publications and on the NIDA Web site. Research literature, newsletters, and editorials aimed at providers of substance abuse treatment services have also articulated evidence-based approaches. Organizations serving large populations of substance-abusing clients need to be aware of evidence-based practices and use them when developing client service plans. One of the largest social services systems working with substance-abusing clients is the child welfare system. Child welfare agencies have become knowledgeable about substance abuse treatment, but relatively little is known about the extent to which child welfare practice remains current with advances in substance abuse practice. This study examines the extent to which methadone maintenance (MM) is discussed in the child welfare literature and broader social work literature, and the extent to which child welfare policies mention and recommend this treatment method. Why focus on MM as an evidence-based drug treatment practice? Briefly, we know that heroin-dependent women who are parents are likely to provide inadequate care to their children and may expose their family to drug-related violence (Schilling, Mares, & El-Bassel, 2003). The American Public Health Association (1997), NIDA (2000a, 2000b), the World Health Organization (WHO) (2001), Stimson, Des Jarlais, and Ball (1998), the Center for Substance Abuse Treatment (CSAT) (1999), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (1999) identify MM as an effective treatment for heroin dependence. Many studies have shown that opiate-dependent individuals on MM are likely to exhibit reductions in HIV risk behavior and crime and violence and improvements in child rearing and employment (Kott, Habel, & Nottingham, 2001; see Sorensen & Copeland, 2000, for a review). Child welfare is arguably the practice arena most widely recognized as the domain of social workers. Social workers recognize the importance of their state-sanctioned roles in protecting children (Barth & Jonson-Reid, 2000). In this capacity, social workers are required to investigate the well-being of children who are thought to be in danger, make judgments about levels of risk, and recommend courses of action. Social workers who find evidence of abuse or neglect usually recommend some corrective action by parents. In most instances, family court judges accept all or some of these recommendations and stipulate that court sanctions, including removal of the child from the home, remain in effect until the parents at least partially complete a recommended course of action. Wielding considerable power in such matters, social workers make the initial judgment that a child is in danger. Social workers then make recommendations to the court based on their determination, through their own investigation and through assessments of mental health consultants, of the family deficits contributing to child maltreatment. Critical is the social worker's knowledge of optimal and available resources, services, supports, and treatments. In recent decades, parental substance abuse has been shown to be a large contributing factor in child maltreatment (Bays, 1990; Olsen, Allen, & Azzi-Lessing, 1996; Wolack & Magura, 1996). A National Institute of Mental Health (NIMH)-funded study found that substance abusers had three times the odds of committing physical abuse and neglect after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). Another study found that more than three-quarters of state child protection administrators across the country reported substance abuse as one of the top two problems presented by their caseloads (Wiese & Daro, 1995). …

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.

HIV may be transmitted in the process of sharing injected drugs, even if all participants have their own syringes. In an effort to gain understanding of the extent and predictors of drug sharing, data were obtained via personal interviews with 1,024 injection drug users from four neighborhoods in the South Bronx. The relationship between drug-sharing and demographic, sexual, and drug-related variables was first examined in a bivariate analysis, and then via multiple logistic regression. Individuals who split drugs were more likely to be female, have had sex with a casual partner, exchanged sex for drugs or other needs, recently smoked crack cocaine, and shared needles. They were less likely to live or inject at their own home or have used a new needle the last time they injected. In a final logistic model, correlates of drug sharing included trading sex, injecting outside one's home, and using borrowed, rented or shared needles. Despite the lack of significance for gender in the final logistic model, females were at high risk of drug sharing because they constituted the great majority of those who exchanged sex. Continuing research is needed to understand how drug-sharing contributes to the spread of HIV and other infections, as are studies of approaches to reducing drug sharing. Prevention strategists and outreach organizations should be aware of the HIV risks inherent in the widespread practice of drug sharing.

Objective: This study tested a motivational intervention designed to enhance the likelihood that detoxified alcohol users will seek and participate in any form of aftercare. Method: After a baseline interview, 96 clients (76 men and 20 women) in a hospital inpatient detoxification unit were randomly assigned to either a standard care condition or a motivational interviewing condition, consisting of three motivational sessions conducted by master’s-level therapists. Results: Two months after discharge, participants in the motivational condition did not differ from controls in the areas of sustained abstinence, typical drinking, or entry into formal treatment. However, clients receiving motivational interviewing were more likely to participate in 12-step groups. Conclusions: Motivational interviewing is a potentially useful strategy to encourage detoxification clients to initiate participation in self-help and may show promise as a strategy for helping alcohol users remain abstinent during the critical initial period following discharge from detoxification.

This study examined the relationship between sex trading and psychological distress among a nonrandom sample of women recruited from 3 methadone maintenance clinics in New York City. Face-to-face interviews with 280 women (M age = 40.7) revealed that 32% had traded sex for money or drugs in the previous year. Compared to other participants, these women reported less education and higher rates of incarceration in the past year, sexually transmitted diseases, childhood sexual abuse, partner abuse, and current regular crack/cocaine and alcohol use. Hierarchical multiple regression analysis indicated that sex traders scored 0.41 units higher than non-sex traders on the General Severity Index of the Brief Symptom Inventory after controlling for all relevant covariates. The findings emphasize the need to consider the interrelation of psychological distress, abuse, and addiction in designing public health interventions addressing methadone maintained women.

The challenging context of social work interventions require that most intervention studies will be derived from nonexperimental research designs. Two evaluation studies in this special issue employed nonrandomized designs to examine the efficacy of two programs—a police crisis intervention team designed to enhance officers’ responses to mental health crisis and a program for pregnant incarcerated women. Each is a laudable effort to examine important intervention outcomes in insular settings. The design and execution problems explicated in both studies are familiar to researchers who venture into such practice arenas. Disappointing outcomes, as in these two studies, can sometimes be attributed to the problems of nonequivalent comparison designs or to unanticipated events. Intervention researchers must also recognize that programs often fail to demonstrate differences and can even result in adverse outcomes.

This article examines the relationship between sex trading and psychological distress and assesses sexual human immunodeficiency virus (HIV) risk behaviors and HIV seroprevalence in a sample of young men recruited from the streets of Harlem. The authors interviewed 477 men, aged 18 to 29 years, of whom 43 (9.0%) had received money or drugs in exchange for sex in the preceding 30 days and were categorized as sex traders. Psychological distress was measured by using the Brief Symptom Inventory (BSI). Sex traders scored significantly higher than non-sex traders on the General Severity Index and on all nine subscales of the BSI. According to multivariate analysis after adjusting for perceived HIV risk, current regular crack cocaine use and homelessness, sex traders scored 0.173 units higher on the General Severity Index than non-sex traders (p.001). More of the sex traders tested positive for HIV (41% versus 19%, p.001). The alarmingly high HIV seroprevalence rate in sex traders in this sample underscores the need to redouble HIV prevention efforts for this population. The high levels of psychological distress and crack cocaine dependence among sex traders may undermine their ability to adopt safer sex behaviors and should be considered in intervention designs.

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.

To examine associations between recent partner violence and sexual HIV risk behaviors and their implications for HIV prevention among women in methadone treatment, we conducted structured interviews covering demographics, drug use, trauma history, partner violence, and sexual risk behavior with 147 sexually active women who were at risk of HIV infection. Almost one third (30.5%) of the women reported that they had been physically or sexually abused by a spouse or boyfriend during the previous year. Multiple logistic regression analysis indicated that after adjusting for potential confounders, recently abused women were less likely to report using condoms (OR = 0.41, CI = 0.17, 0.99) and more likely than non-recently abused women to report having contracted a sexually transmitted disease (STD) (OR = 3.6, CI = 1.6, 8.5), exchanged sex for money (OR = 2.4, CI = 1.1, 5.4), and having had sex with an HIV-infected partner (OR = 2.5, CI = 1.0, 6.1). The study findings underscore the importance of developing HIV-risk reduction strategies that target the specific needs of abused women in drug treatment.

This study aims to (1) describe rates of lifetime and current partner abuse among women on methadone; (2) examine the relationship between partner violence and demographics, substance abuse, and drug risk behaviors; and (3) explore the association between a victim's current use of crack/cocaine, heroin, marijuana, and drug risk behavior after controlling for demographics, household composition, history of victimization and sex trading. Approximately three-fourths of the women ever experienced physical, sexual, or life-threatening abuse and slightly less than one-third experienced at least one type of abuse during the previous year. A history of childhood victimization was reported by more than half of the women and one-third witnessed her mother being abused. Risk of partner violence was associated with victim's current drug and alcohol use, visiting shooting galleries, and living with someone with drug or alcohol problems. The study discusses the implications of the findings for research and intervention.

Medical providers are called upon to address a wide range of psychosocial issues, under increasing time constraints. Spiritual/existential distress was one of 18 issues covered in a survey of oncologists’ (n=94) and oncology nurses’ (n=267) attitudes and practices regarding psychosocial issues. The survey included patient vignettes at good, moderate and poor prognosis levels, and questions regarding attitudes toward patient care, typical and ideal services, and expectation for impact. A substantial proportion of both oncologists (37.5%) and nurses (47.5%) identified themselves as primarily responsible for addressing spiritual distress in their setting. However, over 85% of both MDs and RNs felt that ideally a chaplain should address such issues. Working in an inpatient setting predicted that nurses, but not doctors, would confer with chaplains. When ranking spiritual distress as important to address in comparison to 17 other issues, only 11.8% of MDs and 8.5% of RNs ranked it in the top three for the poor prognosis vignette, with yet lower values with better prognoses. For the poor prognosis, younger MDs were more likely to address spirituality (r=−0.26) and were also more likely to address anxiety or depression (r=0.25) and family distress (r=0.20). For RNs, no such relationships appeared. Perceived impact was also a predictor of whether spirituality issues were addressed. These results suggest that spiritual distress experienced by cancer patients may be under-addressed due to time constraints, lack of confidence in effectiveness, and role uncertainty. Copyright © 1999 John Wiley & Sons, Ltd.

This objective of this study was to examine the association between a women's HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondent's demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.

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.

Background and Objectives:Small ethnographic and clinic-based studies indicate that crack-smoking sex workers are at high risk for human immunodeficiency virus (HIV) and sexually transmitted diseases (STD).Study Goals:To examine the prevalence of risky sexual behaviors and HIV and STD in a large sam

The Alcohol Use Disorder Identification Test (AUDIT), developed by the World Health Organization, was administered to 400 incarcerated, drug-using women in order to assess its utility, validity, and reliability. Principal component factor analysis and reliability tests were conducted. Sensitivity and specificity for all possible AUDIT cutoff points were computed, and a Receiver Operating Characteristics (ROC) curve was plotted to suggest an AUDIT cutoff point for identifying problem drinkers. This cutoff point was then assessed as to its concurrent and discriminant validity. Principal component factor analysis identified one factor that accounted for a substantial portion (67.3%) of the total variance of the AUDIT, a result that indicated that the AUDIT could be used as a consistent and summated screening tool for identifying problem drinkers. Internal consistency was high (Alpha = 0.94). The ROC curve, sensitivity, and specificity tests suggest that a total AUDIT score of 10 or more is a reliabl...

This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1 %, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.

Despite the scope of the HIV/AIDS epidemic among female offenders, little is known about the risk behaviors of these women and even less about ways in which to reduce HIV/AIDS among this population. This article describes the development of an eight-session group cognitive-behavioral and social support enhancement intervention that aims to reduce HIV risk among drug-using female offenders. The intervention is based on social-cognitive theory and informed by other skills-training approaches with demonstrated efficacy at reducing HIV risk. Both current and former offenders were involved in the development of this intervention. Help-seeking and social support skills are unique to this intervention, as is an eight-session booster conducted after release from jail to enhance transfer of skills to the community.

Although investigators have studied HIV-related behavior and attitudes in prisons, little is known about HIV/AIDS phenomena in work release or other alternative forms of incarceration. This study examined the sexual- and drug-risk behavior of 270 male drug users in three work-release facilities located in New York City, comparing their self-reported risk profiles to findings from studies of related high-risk samples in other settings. The respondents reported lower rates of current drug use (heroin, crack cocaine, and alcohol), injection drug use, sexual risk taking, and sexually transmitted diseases than did these comparison groups, and the respondents reported comparable rates of condom use. The rates of most HIV-related risk behaviors in this sample were substantially lower than those reported in other studies of comparison populations. Explanations for these unexpectedly low rates of self-reported risk behavior are offered, and ways in which to overcome practical and methodological challenges that arise in conducting HIV/AIDS research in transitional correctional settings are suggested.

The purpose of this study was to determine the utility and assess the psychometric properties of the Drug Abuse Screening Test (DAST) in a sample of persons receiving services from an employee assistance program (EAP). Study participants (N = 176) were union members, including identified drug users and nonusers. As in other studies, the DAST was found to have a high internal consistency, test-retest reliability, and item-total scale correlation. Also consistent with previous reports, factor analysis identified 5 factors. The multifactor solution of the DAST underscores the importance of measuring and assessing substance use along a continuum of early recognition to its more advanced stages. DAST scores were correlated with family, financial status, job performance, mental health problems, and alcohol abuse. Study findings lend support to the DAST as a practical screening tool for use by human resource workers who provide services for substance-using individuals who are receiving services in an EAP setting.

This study examines the relationship between childhood abuse and partner abuse among a sample of predominantly African-American and Hispanic women, who were patients in methadone clinics in Harlem and the South Bronx. A structured questionnaire addressing demographics, psychosocial and physical health characteristics, depression, childhood abuse, and domestic violence was administered to 151 women. Over half of the women (60%, n = 98) reported lifetime physical, life-threatening, or sexual abuse by a spouse or boyfriend. Multiple logistic regression analysis was used to assess the associations between childhood physical abuse and abuse by a spouse or boyfriend and between childhood sexual abuse and abuse by a spouse or boyfriend. After controlling for potential confounders, women who reported childhood physical abuse were almost nine times more likely to report having been abused by a spouse or boyfriend (OR = 8.74, CI, = 3.25 to 23.57). Women who reported childhood sexual abuse were almost four times more likely to report having been abused by a spouse or boyfriend (OR = 3.93, CI = 1.46 to 10.59). Depression and need for social support were significantly associated with partner abuse, while current heroin use was inversely associated with partner abuse. The high rate of domestic violence and the strong association between childhood and partner abuse found in this study suggest areas for intervention in chemical dependency among women.

The move from elementary to junior high school is a significant change in the lives of young adolescents. Rates for depression, academic failure, and a variety of problem behaviors escalate after this transition. Few studies in the field of primary prevention have addressed this transition. The investigators conducted a three-part study with 6th grade students to establish an empirical base for preventive intervention aimed at reducing problems associated with entry into junior high school. The study assessed students' perceptions of the transition, their beliefs about the junior high school environment, and their readiness for it. Recommendations for preventive programming are made based on students' responses.

Logistic regression analysis was used to examine the likelihood of either entering residential treatment, methadone treatment or solely entering detoxification programs for 32,173 injection drug users (IDUs) using drug treatment in Massachusetts, 1996–1999. Those IDUs who were employed, more educated, health-insured, not homeless and who resided with their children were less likely to solely enter detoxification programs. This population, with more human capital and lower levels of institutional disaffiliation, was also more likely to enter methadone maintenance programs. These results were consistent for two groups of drug users: those who reported having injected in the past year and those with a history of injecting who had not injected in the past year. Overall, the findings demonstrate a need for more complex drug treatment program planning efforts that also respond to issues of employment, education and social isolation.

This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack uses. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.

Neurologic damage may become permanent when the disorder is mistaken for multiple sclerosis or diabetic neuropathy—hence the need for prompt parenteral B12 in patients with pernicious anemia. The need for B12 injections is questionable for patients with achlorhydria and for those with a marginal or low serum B12 level but no signs or symptoms of deficiency.

Background and Methods The smoking of “crack” cocaine is thought to be associated with high-risk sexual practices that accelerate the spread of infection with the human immunodeficiency virus (HIV). We studied 2323 young adults, 18 to 29 years of age, who smoked crack regularly or who had never smoked crack. The study participants, recruited from the streets of inner-city neighborhoods in New York, Miami, and San Francisco, were interviewed and tested for HIV. This report presents the findings for the 1967 participants (85 percent) who had never injected drugs. Results Of the 1137 crack smokers, 15.7 percent were positive for HIV antibody, as compared with 5.2 percent of the 830 nonsmokers (prevalence ratio adjusted for the city, 2.4; 99 percent confidence interval, 1.7 to 3.6). The prevalence of HIV was highest among the crack-smoking women in New York (29.6 percent) and Miami (23.0 percent). In these two cities, of the 283 women who had sex in exchange for money or drugs, 30.4 percent were infected with...

There can be no doubt that chart reviews, clinical experiences, and other forms of retrospective data-gathering over the past century have contributed significantly to progress in medical science a...

This study identified predictors of reported sexual risk reduction among 109 female injection drug users enrolled in methadone clinics. Univariate analyses were used to examine the individual effects of each variable on the outcome of sexual behavior change over the past 6 months. Multiple logistic regression was then used to identify which of these variables were independently associated with such a change. Women with more than one sexual partner were more likely than women with one or no sexual partner to report changing their sexual behavior. African-American women were less likely than White Anglo or Latina women to report changing their sexual behavior. Women who held stronger beliefs that luck plays the largest role in getting AIDS were less likely to report changing their sexual behavior. Change in sexual behavior was associated with feeling comfortable asking partners to use condoms, higher depression scores, and loss of friends or family to AIDS. The observed relationship between personal susceptibility and depression suggests that risk reduction interventions should also address the depressive symptomatology associated with feelings of vulnerability.

In recent years many groups have become interested in the potential cost savings and efficacy of outpatient treatment for chemical dependency. This study was originally conceived to answer questions of both patients and staff concerning graduation and attrition rates in an evening outpatient alcohol treatment program. Of particular interest were gender effects, rates of attrition across two progressive program levels, and whether alcohol-only users and self-initiated clients fared better in treatment than did polysubstance users and patients who were referred by others. Medical records were available for 103 of the 107 treated patients, and of these, 27 remained in the program until graduation. Women were more likely to graduate and remain in the program longer than men. Alcohol users were more likely to graduate than subjects with additional substance use disorders. Graduation rates did not differ significantly between contact initiators and noninitiators; however, the former dropped out of treatment more quickly. The study is an example of the potential use of data obtained from an existing agency data base.

Since crack cocaine appeared in urban areas in the United States in the mid-1980s, reports have suggested that crack smokers may be at increased risk of sexually transmitted diseases (STDs), including infection with HIV, because they have multiple sex partners, trade sex for money or drugs, and rarely use condoms. A cross-sectional survey is being conducted in urban neighborhoods in Miami, New York and San Francisco--where crack use is common--to explore these issues. Indigenous street outreach workers are recruiting men and women who are either current regular crack smokers or who have never smoked crack; each group is further stratified according to whether participants had ever injected drugs. Participants were interviewed about their sexual and drug-use practices. Overall, crack smokers, whether injectors or not, engaged in higher-risk sexual behaviors than nonsmokers, reported greater numbers of sex partners than nonsmokers, and were more likely than nonsmokers to have exchanged sex for money or drugs or to have had an STD. Differences between crack smokers and nonsmokers were generally greater among non-injectors than among injectors, and generally greater among women than among men. Condom use, although somewhat more common with paying than nonpaying partners, was infrequent overall. Most of the subjects had not been in substance abuse treatment in the preceding 12 months, and a majority had never been in substance abuse treatment. Education and prevention programs specifically targeted at crack smokers not currently in substance abuse treatment are needed to reach these high-risk persons.

Guided by theory, empirical research, and clinical experience, this demonstration tested a 12-session group intervention for 38 inner-city children who had lost a caregiver. The design of the group intervention was guided by the psychodynamic tradition of the sponsoring agency, themes from the bereavement literature, and findings from intervention research on bereaved children and adults. Attendance for the group intervention was high among those 29 children who completed posttests. The loss of the parent figure often had an impact on caregiving and living arrangements. Children rated themselves as significantly more depressed at pretest than their caregivers rated them, but at posttest this difference diminished. However, the majority of children remained depressed throughout the study. Pretest and posttest comparisons suggest that the treatment intervention may have enabled children to develop a more mature concept of death. Mixed outcomes and the methodological limitations of the study allow for multiple interpretations. Nevertheless, modest results reported here may encourage other clinical researchers to build on this early effort. Better understanding of how to treat bereaved children must await controlled, longitudinal research.

Splenectomy is indicated in hereditary spherocytosis to relieve symptoms due to anaemia or splenomegaly, reverse growth failure or skeletal changes due to over-robust erythropoiesis, and prevent recurrent gallstones. A life-long risk of bacterial infection has been recognised for many years as a concomitant cost of splenectomy. The scope of this risk has expanded to include a number of organisms beyond the triad of pneumococcus, meningococcus, and haemophilus influenzae. Recently, it has been demonstrated that splenectomy also confers a significant risk of delayed adverse vascular events in patients with hereditary spherocytosis, just as it does in patients undergoing splenectomy for other indications. Further, these same studies demonstrated a benefit of avoiding splenectomy: hereditary spherocytosis patients with a spleen have significantly fewer adverse vascular events than unaffected family members, probably because of the protective effect of chronic, mild anaemia. Accordingly, this review marshals the evidence favouring a conservative approach to splenectomy in spherocytosis.

Female intravenous drug users are among the fastest growing segments of the population infected with the human immunodeficiency virus. This article, based on interviews with 91 African-American and Latina women in methadone clinics, describes respondents' drug use, sexual risk taking, and attitudes toward condom use and negotiation of safer sex; and examines relationships between sexual risk taking and demographic characteristics, length of time in treatment, current drug use, and attitudes toward negotiating safer sex and condoms. Forty-two percent of the sample reported that they had changed their sexual practices to reduce their risk of AIDS. Recovering IV drug users in long-term monogamous relationships tended to use condoms less frequently during sexual intercourse than those in casual relationships. Various drugs were differentially related to high-risk sexual activity. Frequent drug injectors admitted to having more sexual partners and to having sex more frequently, and used condoms with less frequently than women who used IV drugs less often. Attitudes toward negotiating safer sex and frequency of condom use varied by ethnicity. In addition, use of condoms appeared to be related more to attitudes toward negotiating safer sex and the degree of comfort with social skills in communicating with sexual partners than to perceptions about the properties of condoms. Findings have implications for developing interventions to reduce AIDS risks.

Heterosexual contact with drug users is a major route of AIDS transmission. This study of 135 male and 109 female methadone maintenance patients described subjects' sexual behavior, preventive practices and attitudes toward safer sex; explored ethnic-racial differences in high risk sexual behavior and attitudes; and examined the relationship between attitudes toward safer sex and frequency of condom use for men and women. Reported condom use was low, and it correlated with attitudes toward safer sex. Men tended to report higher rates of sexual risk-taking, although women reported more frequent sex with IV drug users. Study findings have implications for developing intervention strategies to reduce risk behavior associated with HIV transmission.

The University of Wisconsin Medical School established an alternative Independent Study Program (ISP) in the basic medical sciences in 1972. This program enabled class size to be increased without increasing laboratory teaching space, provided better education for students with diverse educational backgrounds, permitted individual progress, and promoted independent study. When compared to the most receptive oriented regular curriculum students (RCR) and those most discovery oriented (RCD), the preferred learning style of self-selected ISP students was more discovery or self-directed. They retained that style after graduation, while RCD students frequently became less discovery oriented. The ISP group was older, had more females, and had more advanced degrees. Although they had lower undergraduate grade point averages, they did well on the Verbal, General Information, Problem-Solving, and Quantitative sections of the MCAT. They also did well scholastically in Medical School, scored well on the National Boards Medical Examination, had the same distribution of residencies, and obtained the same quality of residency placement for medicine, surgery, and pediatrics. They have been very supportive of the program and feel that it was valuable in developing their abilities for continued self education.