Contingency management interventions for HIV-related behaviors

Contingency management (CM) is a scientifically based treatment approach typically employed in substance abuse treatment settings to reinforce drug abstinence, counseling attendance, completion of activities, or other treatment goals. Although the application of CM to HIV management has few published studies, it shows promise as an intervention for HIV-related behaviors. CM interventions such as voucher reinforcement, prize systems, and cash incentives can be used to reduce HIV risk behaviors and to improve HIV medication adherence. CM programs have wide applicability to HIV prevention and management in clinical and community settings and can be implemented as stand-alone techniques or in combination with other interventions.     

A process evaluation of tobacco-related outcomes from a telephone and print-delivered intervention for motor freight workers

Interventions are needed to address the high prevalence of tobacco use among blue-collar, motor freight workers in the United States. In the present study, we conducted an evaluation of the Gear Up for Health study to evaluate which intervention components associated with this print- and telephone counseling-based tobacco intervention were associated with affecting psychosocial indicators of future quitting, number of quit attempts, and quitting tobacco. The sample is comprised of 64 baseline tobacco users. The intervention components evaluated were receipt of nicotine replacement therapy (NRT), aspects of the counseling calls, the targeted and tailored print materials, and goal setting. The results indicated that several intervention components were related to tobacco cessation, and less frequently related to psychosocial indicators (i.e. intention and self-efficacy) and quit attempts. A higher percentage of those who quit using tobacco, versus not quitting, thought the number of calls were just right (100% vs. 75%), received NRT (87% vs. 56%), read most or all of the materials (100% vs. 70%), found the materials to be very helpful (87% vs. 30%), set tobacco goals (93% vs. 58%) and met these goals (100% vs. 44%) (p ≤ 0.05 for all). These results may be used in planning future interventions and indicated that perceptions of materials, call number, and call content may be more important than absolute call number or duration. Thus, the number and duration of counseling calls may be flexible and determined in response to the needs of participants.     

Disclosing clinical adverse events to patients: can practice inform policy?

Objectives To understand patients’ and health professionals’ experience of Open Disclosure and how practice can inform policy. Background Open Disclosure procedures are being implemented in health services worldwide yet empirical evidence on which to base models of patient–clinician communication and policy development is scant. Design, setting and participants A qualitative method was employed using semi‐structured open‐ended interviews with 154 respondents (20 nursing, 49 medical, 59 clinical/administrative managerial, 3 policy coordinators, 15 patients and 8 family members) in 21 hospitals and health services in four Australian states. Results Both patients and health professionals were positive about Open Disclosure, although each differed in their assessments of practice effectiveness. We found that five major elements influenced patients’ and professionals’ experience of openly disclosing adverse events namely: initiating the disclosure, apologizing for the adverse event, taking the patient’s perspective, communicating the adverse event and being culturally aware. Conclusions Evaluating the impact of Open Disclosure refines policy implementation because it provides an evidence base to inform policy. Health services can use specific properties relating to each of the five Open Disclosure elements identified in this study as training standards and to assess the progress of policy implementation. However, health services must surmount their sensitivity to revealing the extent of error so that research into patient experiences can inform practice and policy development.     

Diffusionsgewichtete MRI: Isch?mische und traumatische Verletzungen des Zentralnervensystems

Die diffusionsgewichtete Magnetresonanz Tomografie (DWI) stellt ein neues Verfahren dar, welches die Bildgebung von der einfachen Darstellung der Neuroanatomie um das Feld der funktionalen und physiologischen Prozesse erweitert. Im Gegensatz zur konventionellen MRT mi?t die DWI einen vollkommen anderen physiologischen Parameter. Der Bildkontrast h?ngt von Unterschieden in der Mikrobewegung (Diffusion) der Wassermoleküle im Hirngewebe ab. Daher kann die DWI pathologische Prozesse aufzeichnen, wo konventionelle T1- und T2-gewichtete MR Bilder unauff?llig bleiben. In der klinischen Routine hat sich die DWI bei der Diagnostik des akuten Schlaganfalls und des Traumas bew?hrt. durch die M?glichkeiten zwischen L?sionen mit zytotoxischem Oedem (verminderte Diffusion) und L?sionen mit vasogenem Oedem (vermehrte Diffusion) zu unterscheiden. Cerebrale Verletzungen k?nnen so früher nachgewiesen werden. Die Messung der Diffusion in verschiedenen Raumrichtungen erlaubt es eine Vielzahl funktionaler Karten zu erstellen. Die am h?ufigsten verwendeten Karten sind die des apparent diffusion coefficients (ADC) und der isotropen Diffusion. Zus?tzlich k?nnen Karten über anisotrope Diffusion berechnet werden. Diese sollen Auskunft über die Integrit?t und Lokalisation von Nervenbahnen geben. Diese funktional-anatomische Information wird wahrscheinlich in der Fühdiagnostik von prim?ren und sekund?ren Gewebeverletzungen unterschiedlicher Ursachen eine immer wichtigere Rolle spielen und k?nnte bestehende und zukünftige neuroprotektive Behandlungen leiten und validieren.     

Local labor unions' positions on worksite tobacco control

OBJECTIVES: This report describes local unions' positions on tobacco control initiatives and factors related to these positions. METHODS: A national random sample of local union leaders was surveyed by telephone. RESULTS: Forty-eight percent of local unions supported worksite smoking bans or restrictions, and only 8% opposed both a ban and a restriction. CONCLUSIONS: Support for tobacco control initiatives among local unions was higher than might be expected on the basis of previous evidence. Engaging unions in smoking policy formation is likely to contribute to the larger public health goal of reducing smoking and exposure to second-hand smoke among workers.     

Characterisation of a human small-cell lung cancer cell line resistant to the DNA topoisomerase I-directed drug topotecan.

Camptothecins are DNA topoisomerase I-directed anti-tumour drugs with a novel mechanism of action. Topotecan (TPT), a hydrophilic derivative of camptothecin, is currently undergoing phase II clinical trials in small-cell lung cancer (SCLC). Human SCLC OC-NYH cells were made more than 6-fold resistant to topotecan by stepwise drug exposure and resistance was stable for 70 passages without drug. NYH/TPT cells had half the topoisomerase I level and activity of wild-type cells. However, no difference in camptothecin or topotecan inhibition of topoisomerase I-mediated DNA relaxation was found, indicating that the enzyme itself was unchanged in the resistant cell. In NYH/TPT cells, topoisomerase II alpha and beta levels were increased approximately 2-fold. Accordingly, the topoisomerase II-directed drug etoposide (VP-16) induced an increased number of DNA single-strand breaks in NYH/TPT cells. However, sensitivity to different topoisomerase II-targeting agents in NYH/TPT cells varied from increased to decreased, indicating a role for as yet unidentified factors acting on the pathway to cell death after topoisomerase II-induced DNA damage has occurred. Of 20 anti-cancer agents tested, only hydroxyurea showed marked collateral hypersensitivity in NYH/TPT cells.     

Bronchopulmonary dysplasia and pulmonary insufficiency of prematurity. Lack of correlation of outcome with gas exchange abnormalities at 1 month of age

A review of all infants admitted to the two intensive care nurseries in Seattle from July 1, 1980, through Dec 31, 1981, was performed to evaluate the outcome of infants still requiring supplemental oxygen and/or mechanical ventilation at 1 month of age. Sixty-three infants were identified. Fifty-six infants survived to at least 2 years of age, including 11 of 13 in the subgroup of infants requiring 40% or more oxygen at 1 month of age. Eight (14%) of the 56 survivors have required prolonged rehospitalization for pneumonia or other respiratory illnesses in the first two years following birth. We conclude that the degree of gas exchange impairment assessed at 1 month of age does not predict ultimate outcome from neonatal chronic lung disease.     

Short-term carcinogenicity testing of 2-amino-1-methyl-6-phenylimidazo[4, 5-b]pyridine (PhIP) and 2-amino-3-methylimidazo[4, 5-f]quinoline (IQ) in E{micro}-pim-1 transgenic mice

The usefulness of transgenic Eµ-pim-1 mice over-expressingthe pim-1 oncogene in lymphoid tissues, as sensitive test organismswas studied in a short-term carcinogenicity study. The micewere fed standard diet Altromin 1314 supplemented either with0.03% 2-amino-1-methyl-6-phenylimidazo[4, 5-b]pyridine (PhIP)for 7 months or with 0.03% 2-amino-3-methylimidazo[4, 5-f] quinoline(IQ) for 6 months. PhIP and IQ are heterocyclic amines formedduring cooking of meat and fish and are mutagenic to bacteriaand cultured mammalian cells. PhIP is a potent mouse lymphomagen,while IQ is a liver carcinogen and also causes lung tumors andtumors of the forestomach in mice. We found that transgenicEµ-pim-1 mice are highly susceptible to PhIP induced lymphomagenesisbut do not respond to the IQ treatment. PhIP feeding of Eµ-pim-1mice not only increased the total number of T-cell lymphomasbut also decreased the latency time compared to either transgenicor wild-type controls. The effect was most pronounced in thetreated female Eµ-pim-1 mice, which showed a higher incidenceof PhIP induced T-cell lymphomas than transgenic males and astrongly reduced latency period after PhIP treatment comparedto non-transgenic mice. Our results suggest that the transgenicEµ-pim-1 mouse may be a useful model for short-term carcinogenicityscreening of potential genotoxic carcinogens having the lymphoidsystem as target tissue. The carcinogen IQ which does not havethe lymphoid system as a target was not recognized in this model.     

Verrucous carcinoma of the female genital tract: Report of a case and review of the literature

Verrucous carcinoma (VC) of the female genital tract is a rare lesion, primarily affecting postmenopausal women. A case of VC of the vulva is reported, bringing the total number of VC of the female genital tract to 89. VC is a slowly growing, locally "pushing" tumor with a rather benign histologic appearance, and the clinical and histologic characteristics are described on the basis of the present report and a review of the literature. The treatment of VC is still a matter of discussion. It seems logical to treat the tumor by wide local excision, taking the lack of proof of spontaneous metastasis into consideration. Radiation therapy should be contraindicated, and local application of podophyllin, bleomycin therapy, and cryosurgery are ineffective methods in the treatment of VC.