Risk factors for dengue infection during an outbreak in Yanes, Puerto Rico in 1991

In November 1991, during a five-month dengue outbreak, we performed epidemiologic and serologic surveys linked to an earlier entomologic study in a community of 425 houses in Yanes (Florida), Puerto Rico. We obtained a household response rate of 95% (98 of 103) and blood samples from 84% (345 of 410) of the participants. Dengue incidence, as volunteered by the respondents, was 5% (21 of 410), but serologic diagnosis (immunoglobulin M and IgG-enzyme-linked immunosorbent assays [ELISA]) indicated a recent infection rate of 18% (59 of 331). The presence of anti-dengue antibodies was detected in 277 (84%) of 331 persons tested. In our final sample of 65 households and 112 persons, we analyzed (by univariate and multivariate logistic regression methods) the association of 12 entomologic, environmental, and behavioral variables with the proportion of household members with laboratory-confirmed recent dengue. The number of female Aedes aegypti per person was the only significant (P = 0.02) household risk factor. The results of our study underscore the importance of intradomiciliary mosquito populations in dengue transmission, and may serve as a guide for mosquito control efforts.     

Optometric manpower needs in Puerto Rico

We report an intradiploic epidermoid cyst of the skull responsible for transverse sinus compression and presenting with nonpulsatile tinnitus. Plain films and CT both demonstrated the tumour. Cerebral angiography showed best the degree of narrowing of the right transverse sinus, accompanied with turbulent flow probably leading to tinnitus. MRI demonstrated accurately both the tumour and the dural sinus compression. The tumour was totally removed, cranioplasty was performed, and the patient was discharged free of symptoms.     

HIV/AIDS risk in heterosexual college students. A review of a decade of literature

Empirical studies dealing with the psychosocial correlates of HIV risk among heterosexual college students are reviewed, including findings related to such theoretical variables as HIV/AIDS-related knowledge, personal and partner's attitudes toward condom use, perceived susceptibility, communication with sex partners, and sexual self-efficacy. Although college students are highly knowledgeable about basic HIV/AIDS facts, they retain some misperceptions about disease transmission. They hold neutral-to-negative hedonistic and practical attitudes about using condoms: those who have engaged in risky behavior accurately perceive their greater susceptibility to infection and experience anxiety regarding transmission of HIV infection. Heterosexual college students communicate infrequently with their partners about safer sex, but they often agree to a partner's suggestion that they use condoms. Higher levels of sexual self-efficacy among college students have been associated with a lower risk for HIV transmission. Limitations and clinical implications of the findings and recommendations for future interventions are discussed.     

AIDS/HIV and university students in Delhi, India: knowledge, beliefs, attitudes and behaviors

Eight hundred eighty-seven students in social work, nursing, and humanities from two major universities in Delhi were compared regarding their knowledge about AIDS/HIV and attitudes toward PWAs and homosexuals. Their scores on the 20-item knowledge test indicate fair degree of knowledge; however, they lacked information in crucial areas of AIDS prevention and human sexual anatomy. Unmarried, female and older students and those in social work and nursing disciplines scored significantly higher on correct answers. Social work students were likely to be more positive in their attitudes toward AIDS victims than those in nursing or humanities. Knowledge was positively related to attitudes and perception of risk. Despite their awareness of personal risks only four in ten used condoms sometimes during intercourse. Educational strategies to increase cognitive and affective understanding of AIDS and its victims are discussed.     

Incidence of IDDM in children living in Puerto Rico. Puerto Rican IDDM Coalition

OBJECTIVE: To determine incidence, geographic distribution, and seasonal variation of IDDM in children 0-14 years of age living in Puerto Rico. Because these data have been collected through the infrastructure of the World Health Organization's DiaMond project, these results are directly comparable with incidence data from other population worldwide involved in this study. RESEARCH DESIGN AND METHODS: Beginning in 1990, new cases of IDDM were registered retrospectively from 1985 and prospectively to 1994 by review of medical records from island hospitals. Included in the hospital registry are 1,527 cases of IDDM. Validation of the primary source was by three secondary lists of cases obtained through diabetic camps, surveys of schools, and a government registry. Long linear modeling (capture-recapture) was used to correct incidence. RESULTS: Mean incidence of IDDM from 1985-1994 was 18.0 cases/100,000 children per year (95% CI 17.6-18.3). There was a slight female rather than male predominance: 51% of the cases were girls, and 49% were boys. Although Puerto Rico has marked variation in rainfall, altitude, and genetic markers, no significant differences are found in the incidence rates of different areas or seasons of the island. CONCLUSIONS: This registry of Puerto Rican children is the largest IDDM registry of minority children in the U.S. The results of this study indicate that the annual incidence of IDDM of children living in Puerto Rico is higher than the incidence of other multiracial ethnic groups living in the U.S.     

HIV infection among male prisoners in South Australia, 1989 to 1994

The prevalence of human immunodeficiency virus (HIV) in male prisoners in South Australia from July 1989 to June 1994 was ascertained from a repeated cross-sectional study. We also compared the criminological and demographic characteristics and histories of drug use of 39 HIV-infected prisoners and a randomly selected sample of 86 uninfected prisoners admitted at the same time. The numbers of HIV-infected prisoners in prison in any month ranged from 4 to 12. Prevalence among the total prison population ranged from 0.4 per cent to 1.4 per cent, and among the subpopulation of injecting drug users from 1.25 per cent to 4.36 per cent. Many HIV-infected prisoners continued after their diagnosis to have lifestyles that resulted in imprisonment. Infected prisoners were significantly older, had spent longer in prison and were more likely to be users of heroin (OR = 13.1) and methadone (OR = 25.4) than controls. Infection with HIV among South Australian prisoners has been continuous since at least the mid-1980s. The recidivism among many of the infected prisoners contributes to the variation in prevalence but also raises concerns about their management. Greater effort to minimise the recidivism of the HIV-infected prisoners could reduce the prevalence of HIV in the prison population.     

Alcohol-involved sexual risk behavior among heavy drinkers living with HIV/AIDS: Negative affect, self-efficacy, and sexual craving.

Evidence of the effects of negative affect (NA) and sexual craving on unprotected sexual activity remains scant. We hypothesized that NA and sexual craving modify the same day association between low self-efficacy to use condoms and unprotected anal or vaginal sex, and the same-day association between alcohol use during the 3 hours prior to sexual activity and unprotected sex. We used an electronic daily diary, drawing on a sample of 125 men and women recruited from an agency serving economically disadvantaged persons living with HIV/AIDS. Casual or steady partner type designation and perceived partner HIV serostatus were also examined. Findings support the hypothesized moderating effects of high NA and sexual craving on the association between low self-efficacy and unprotected sex, and the association between alcohol use and unprotected sex. Implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social networks and patterns of use among the poor with mental health problems in Puerto Rico

OBJECTIVES: This study uses the recently developed Network-Episode Model (NEM) to examine the nature and correlates of utilization among Puerto Ricans reporting mental health problems. The NEM highlights two issues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability and content of social networks influences patterns of care. METHODS: Using data from the 1989 Mental Health Care Utilization Among Puerto Ricans Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlates of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year. RESULTS: A combination of clustering and multinomial logit techniques indicates that there are six unique care patterns. Two patterns include the use of mental health providers and are associated with different contingencies. CONCLUSIONS: In general, patterns of use are shaped by age, education, gender, and illness severity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direct entry into the mental health sector. These results are in line with NEM's predictions for lower class populations and help clarify inconsistencies in previous research on social networks. The implications of this perspective for health services research and treatment are discussed.     

Attitudes of medical students to HIV and AIDS

OBJECTIVE--To assess the knowledge and attitudes of medical students to HIV/AIDS and whether attitudes correlate with knowledge and clinical experience. To determine if students felt adequately prepared to deal with medical and psychological aspects of HIV/AIDS. SUBJECTS AND METHODS--The subjects consisted of 190 London and 99 Cambridge medical students at the end of their genitourinary medicine attachment, plus 230 Cambridge medical students at the end of their second pre-clinical year. Between March 1991 and February 1992 all were asked to complete an anonymous questionnaire, covering factual knowledge and attitudes towards HIV/AIDS. MAIN RESULTS--Cambridge genitourinary medicine students, despite spending less time studying HIV infection than their London counterparts gave more correct answers to the factual questions, although this difference did not reach significance (52.4% vs. 47.5%, p = 0.14). One third of students believed that many health care workers were at high risk of acquiring HIV at work and one fifth thought doctors should have the right to refuse to treat people with HIV. Fourteen percent of Cambridge genitourinary medicine students indicated that most British people with HIV have only themselves to blame, by comparison with 4% of London students (p = 0.003). Thirty-nine per cent of Cambridge genitourinary medicine students expressed reluctance to care for someone with AIDS by comparison with 10% of London students (p = 0.0001). CONCLUSIONS--It is important that medical educators convey accurate information about HIV, including the actual risks posed by occupational exposure and try to ensure that medical students spend sufficient time seeing patients with HIV/AIDS during their training.     

Characterizing and improving HIV/AIDS knowledge among cocaine-dependent outpatients.

The present study was an experimental test of efficacy of a brief education intervention for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. Participants were randomly assigned to an HIV/AIDS education intervention (experimental condition) or a sham intervention (control condition). Control participants were subsequently crossed over to the HIV/AIDS education intervention. Experimental participants had higher scores on tests of HIV/AIDS knowledge after receiving the education intervention than did control participants. Further supporting the intervention's efficacy, control participant scores also increased once participants were crossed over and received the education intervention. Scores at follow-up were lower than at postintervention but remained higher than baseline scores. Results support the intervention's efficacy for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. This intervention is brief, inexpensive, and easily implemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes, beliefs, and practices of nursing students concerning HIV/AIDS: implications for prevention in women

Nursing students are a group of predominantly young women who may be sexually active but who are well educated and presumably health conscious. It might be expected, therefore, that they are not a population at risk for sexually acquired HIV infection. Recent studies indicate that heterosexual women constitute the fastest growing population of persons with AIDS in the United States and Canada (Health and Welfare Canada, 1993b; Wofsky, 1992) and that women and adolescents will constitute the next surge of the AIDS epidemic (Novello, 1993). First-year nursing students in a major Canadian city were surveyed regarding HIV-related knowledge, attitudes, beliefs, and behaviors. The women were highly knowledgeable about HIV transmission but 15% to 25% reported high risk sexual behavior. The results reinforce that knowledge is not enough to prevent HIV infection among young women and that interventions must be based on an understanding of the social context of women's lives.     

Prevalence and risk factors of problem gambling among college students.

College students from 2 Minnesota universities were surveyed about their gambling involvement. Gambling was reported to be a common experience, with 87% having participated at least once in the previous year. Most students reported gambling at fairly infrequent levels, and few identified financial, social, or personal consequences as a result of gambling. The odds of being identified as a probable pathological gambler was high for men, those indicating a positive parental history for gambling problems, regular (weekly plus) users of illicit drugs, and those with poor grades. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Present versus future time perspective and HIV risk among heterosexual college students.

Because safer sex behaviors require planning and forethought and their primary motivations lie in the future, the hypothesis that behaviors that might reduce exposure to HIV would positively correlate with future time orientation, whereas risky behaviors would correlate with present time orientation, was tested in a survey of 188 heterosexual college students. As expected, those high in future time orientation were less likely to be sexually experienced and had fewer sexual partners. In contrast, present time orientation positively related to those measures. Those high in future orientation were more likely to use alternate methods of reducing exposure to HIV (e.g., inquiring about partner's sexual history, delaying or abstaining from sex). Time perspective also interacted with both gender and fear of AIDS. The responses of women and individuals low in fear were more related to time orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in attitude, sexual behaviour and the risk of HIV/AIDS transmission in southwest Nigeria

This pilot study was carried out in southwest Nigeria to determine the current trends in sexual behaviours known to be associated with HIV transmission in Nigeria. Knowledge of AIDS in general and as an incurable disease was high (91.4% and 79.4% respectively). Knowledge of the means of AIDS transmission was also very high among both men and women. Overall, condom use was consistent at 25%, inconsistent at 55% and non-existent at 20% for all sexually active respondents. Over 60 per cent of sexually active respondents had two or more sexual partners, with significantly more males than females having this number of sexual partners (p < 0.01). Eighteen per cent of sexually active respondents had a history of sex with commercial sex workers while 25% had a history of at least one sexually transmitted disease. Using multiple logistic regression, the significant determinants of condom use among the sexually active group were: being in a stable sexual relationship, history of sex with commercial sex workers, self-perception of testing positive for HIV and self-perception of HIV/AIDS risk in Nigeria. Prevalence of condom use in this study was much higher than those reported in previous studies, suggesting a probable decline in high risk sexual behaviours among inhabitants of urban Southwest Nigeria since the advent of AIDS. Most sexually active respondents aged 19 years or below (adolescents) who perceived themselves at a high risk of testing positive for HIV had never used condoms. The non usage of condoms among this group of adolescents is disturbing, since they are at greatest risk of spreading the disease. Health education and promotion of safe sex practices need to be extensively targeted at adolescents.     

Ethnic conflict and the psychology of liberation in Guatemala, Peru, and Puerto Rico

Ethnic identity and conflict in Guatemala, Peru, and Puerto Rico are complexly embedded within dynamic systems of class- and race-based geopolitics. Whereas overt violence and terror have permeated both Guatemalan and Peruvian societies, overt conflict has undermined Puerto Rican nationhood. Despite similarities among these 3 countries of Hispano-America, there are important particularities that inform psychological theory and practice. This article explores selected contributions of a psychology of liberation informed by indigenous psychologies and reflexive praxis. The challenges these conflicts and their consequences pose to psychologists seeking to work with populations most deeply affected by these social inequalities are analyzed. It concludes with suggestions of how psychology can move toward the development of community-based responses to psychosocial oppression that foster enhanced individual and collective development in a context of social change.     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)