Determinants of condom use among intravenous drug users

OBJECTIVE: To examine the factors associated with condom use among a cohort of sexually active intravenous drug users (IVDU). DESIGN: Data were collected via personal interview at the fourth-month assessment point of a longitudinal study monitoring HIV infection and risk behaviors among IVDU. SETTING: A community-based methadone clinic. PARTICIPANTS: A total of 158 sexually active heterosexual male and female IVDU, including both methadone patients and out-of-treatment individuals with a history of opiate abuse. MAIN OUTCOME MEASURES: We describe a new approach to identify the determinants of condom use. Previous studies have described subjects as either 'condom users' or 'condom non-users', using an individual's overall behavior as the unit of analysis. By analyzing condom use during the most recent sexual encounter, we avoided the problem of interpreting inconsistent condom use. Data were analyzed using forward stepwise logistic regression. RESULTS: Thirty-four per cent of the heterosexual subjects (n = 160) reported using a condom during their last sexual encounter. Being HIV-positive and having either a causal or commercial partner were each associated with increased probability of using a condom (odds ratio, 10.6, 4.4 and 12.1, respectively). No interactions with sex were found. CONCLUSIONS: Our results suggest that knowing that one is HIV-positive is an important determinant of condom use; HIV testing may therefore increase the use of condoms. In addition, interventions to change sexual behaviors may need to focus on the type of sexual partner.     

Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis

OBJECTIVE: To evaluate the efficacy, pharmacokinetics, immunogenicity, and safety of multiple infusions of a chimeric monoclonal anti-tumor necrosis factor alpha antibody (cA2) (infliximab; Remicade, Centocor, Malvern, PA) given alone or in combination with low-dose methotrexate (MTX) in rheumatoid arthritis (RA) patients. METHODS: In a 26-week, double-blind, placebo-controlled, multicenter trial, 101 patients with active RA exhibiting an incomplete response or flare of disease activity while receiving low-dose MTX were randomized to 1 of 7 groups of 14-15 patients each. The patients received either intravenous cA2 at 1, 3, or 10 mg/kg, with or without MTX 7.5 mg/week, or intravenous placebo plus MTX 7.5 mg/week at weeks 0, 2, 6, 10, and 14 and were followed up through week 26. RESULTS: Approximately 60% of patients receiving cA2 at 3 or 10 mg/kg with or without MTX achieved the 20% Paulus criteria for response to treatment, for a median duration of 10.4 to >18.1 weeks (P < 0.001 versus placebo). Patients receiving cA2 at 1 mg/kg without MTX became unresponsive to repeated infusions of cA2 (median duration 2.6 weeks; P=0.126 versus placebo). However, coadministration of cA2 at 1 mg/kg with MTX appeared to be synergistic, prolonging the duration of the 20% response in >60% of patients to a median of 16.5 weeks (P < 0.001 versus placebo; P=0.006 versus no MTX) and the 50% response to 12.2 weeks (P < 0.001 versus placebo; P=0.002 versus no MTX). Patients receiving placebo infusions plus suboptimal low-dose MTX continued to have active disease, with a Paulus response lasting a median of 0 weeks. A 70-90% reduction in the swollen joint count, tender joint count, and C-reactive protein level was maintained for the entire 26 weeks in patients receiving 10 mg/kg of cA2 with MTX. In general, treatment was well tolerated and stable blood levels of cA2 were achieved in all groups, except for the group receiving 1 mg/kg of cA2 alone, at which dosage antibodies to cA2 were observed in approximately 50% of the patients. CONCLUSION: Multiple infusions of cA2 were effective and well tolerated, with the best results occurring at 3 and 10 mg/kg either alone or in combination with MTX in approximately 60% of patients with active RA despite therapy with low-dose MTX. When cA2 at 1 mg/kg was given with low-dose MTX, synergy was observed. The results of the trial provide a strategy for further evaluation of the efficacy and safety of longer-term treatment with cA2.     

Hypnotic amnesia and the paradox of intentional forgetting.

Hypnotic amnesia is often interpreted as a deliberate effort to avoid thinking of ideas or thoughts targeted for amnesia. However, as D. M. Wegner (1989) showed, nonhypnotized individuals who deliberately attempt to suppress certain thoughts or images paradoxically suffer intrusions of the proscribed material. The authors replicated Wegner's findings in 2 separate investigations. However, they also found that hypnotic amnesia did not have such paradoxical effects. Indeed, the great majority of high-hypnotizable individuals administered suggestions for amnesia showed no such intrusions whatsoever, indicating that thought suppression and hypnotic amnesia represent quite different processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marginal gap of crowns made with a phosphate-bonded investment and accelerated casting method

BACKGROUND: Most patients undergoing in-hospital cardiac resuscitation will not survive to hospital discharge. OBJECTIVE: To derive a decision rule permitting the discontinuation of futile resuscitation attempts by identifying patients with no chance of surviving to hospital discharge. PATIENTS AND METHODS: Patient, arrest, and outcome data for 1077 adult patients undergoing in-hospital cardiac resuscitation was retrieved from 2 randomized clinical trials involving 5 teaching hospitals at 2 university centers. Recursive partitioning was used to identify a decision rule using variables significantly associated with death in hospital. RESULTS: One hundred three patients (9.6%) survived to hospital discharge. Death in hospital was significantly more likely if patients were older than 75 years (P<.001), the arrest was unwitnessed (P = .003), the resuscitation lasted longer than 10 minutes (P<.001), and the initial cardiac rhythm was not ventricular tachycardia or fibrillation (P<.001). All patients died if there was no pulse 10 minutes after the start of cardiopulmonary resuscitation, the initial cardiac rhythm was not ventricular tachycardia or fibrillation, and the arrest was not witnessed. As a resuscitation rule, these parameters identified all patients who survived to hospital discharge (sensitivity, 100%; 95% confidence interval, 97.1%-100%). Resuscitation could have been discontinued for 119 (12.1%) of 974 patients who did not survive, thereby avoiding 47 days of postresuscitative care. CONCLUSIONS: A practical and highly sensitive decision rule has been derived that identifies patients with no chance of surviving in-hospital cardiac arrest. Prospective validation of the rule is necessary before it can be used clinically.     

Public policy, ethics, government, and law.

Contends that public policy reflects doubt about the effectiveness of professional self-regulation. Alternatives to professional self-regulation have come to the fore, as documented by increased governmental (licensing) regulation and escalation of legal (malpractice) actions. Endorsement of actions (e.g., through allocation of resources) and proactive efforts to circumvent the development of problems (e.g., planning and prevention) are preferred to legislative regulation. A recommendation of macrointervention (focusing on the child but accepting that he/she is part of the human system) is outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with families: A school psychology training perspective.

Considers the implications for school psychology training of the position of J. C. Hansen et al (see record 1990-18461-001) concerning the ethical issues facing school psychologists who work with families. It is suggested that the evolution of practice models leads to a contemporary socioeducational action practice model, which will require faculty shifts and curriculum revisions. Professional defensiveness can be expected, and financial and family privacy reasons are analyzed. Recommendations are made for accommodating modern-day public policy expectations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combination endovascular and open treatment of peripheral arterial occlusive disease performed by surgeons

The endovascular treatment of peripheral arterial occlusive disease has historically been performed by interventional radiologists and cardiologists. With additional training in endovascular techniques, surgeons become uniquely suited to manage arterial lesions with both endovascular and conventional surgical techniques. Over a 14-month period, 13 patients underwent combination endovascular and open reconstruction on limbs with peripheral arterial occlusive disease. There were 10 males and 3 females. The mean age was 66 years. All procedures were performed in the operating room by surgery residents under the direct supervision of vascular surgeons. After intraoperative angiography, 26 arterial lesions underwent percutaneous transluminal angioplasty (aorta, 1; common iliac, 14; external iliac, 10; superficial femoral, 1). Twenty-five of 26 lesions were further treated with intraluminal stent placement, the lone exception being a case of superficial femoral artery angioplasty. Concomitant open reconstruction was performed on all limbs, 14 as outflow and 1 as inflow. There were two cases of procedural morbidity and one perioperative death secondary to myocardial infarction. There were no wound-related complications. The mean ankle-brachial index of the affected lower extremity improved from 0.41 (+/- 0.15) to 0.74 (+/- 0.14) at 30 days. Mean follow-up was 8 months (range, 2-14). Based on our early experience, simultaneous combination endovascular and open reconstruction of multisegment arterial occlusive disease can be performed safely and efficiently by surgeons.     

The "stuff" of hypnotic performance: A review of psychometric approaches.

Reviews psychometric investigations into the nature of the processes that underlie hypnotic performance and examines issues that underlie psychometric investigations of hypnosis scales, such as the Stanford Hypnotic Susceptibility Scale. The issues addressed are dimensionality and the problem of difficulty factors, the interpretation of factorial dimensions, and componential alternatives to the factor analytic approach. It is argued that hypnotic performances are most likely overdetermined in that they reflect the combined influence of a plurality of processes. The relevance of various componential models, each reflecting a different contemporary theoretical perspective toward hypnosis, and some of the implications of such models for future research are discussed. (77 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)