The inappropriateness of psycho-social models of risk behaviour for understanding HIV-related risk practices among Glasgow male prostitutes.

Much the most common models of HIV-related risk behaviour are those psychosocial models derived from studies of health behaviour and tested on large interview samples of American gay men. These models were not appropriate for understanding risk behaviour among 32 Glasgow male prostitutes. Whereas psycho-social models conceive of risk behaviour as volitional and individualistic, ethnographic data indicate that the male prostitutes' risk practices were constrained and emergent from the immediate circumstances of the sexual encounter. Unsafe sex was associated with client control. Safer sex was associated with countervailing prostitute strategies of influence. These data confirm the utility of self-empowerment approaches to health education.     

Measurement of choriogonadotropin by chemiluminescence immunoassay and immunochemiluminometric assay: 1. Use of isoluminol derivatives

We have developed immunoassays, monitored by the detection of chemiluminescence, for measuring choriogonadotropin in human urine. These methods involve the use of derivatives of isoluminol and include: (a) a labeled antigen with a second antibody covalently linked to polyacrylamide beads as the solid-phase reagent (i.e., solid-phase chemiluminescence immunoassay); and (b) an excess concentration of a specific antibody passively adsorbed onto the walls of polystyrene tubes and a labeled antibody of different specificity (i.e., two-site immunochemiluminometric assay). After the respective binding reactions, the solutions are aspirated, the antigen- or antibody-bound fractions are washed twice with 500 microL of buffer, sodium hydroxide (2 mol/L; 200 microL) is added, and the mixture is incubated for 60 min at 60 degrees C. After cooling, the label is oxidized with microperoxidase/hydrogen peroxide and the resulting chemiluminescence signal is measured for 10 s. We have evaluated the methods in terms of their sensitivity, precision, and clinical utility, and we compare results with values obtained by radioimmunoassay.     

Preoperative patient assessment: a review of the literature and recommendations.

The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested.     

Modelling net expenditure of hospitals in the Cape Province

Modelling the net expenditure of provincial hospitals in the Cape Province during 1989/90 on the number of inpatient days and outpatient visits (emergencies included) showed that on average the cost of a single outpatient visit is equivalent to 43% of the cost of an inpatient day in small hospitals. In specialist and academic hospitals this proportion increases to 70%. The current proportion of 33% used in the standardisation of hospitals is therefore inadequate. Multiple regression can be used to estimate the expected net expenditure for each hospital, which can then be used as a reference value. The need for separate accounting and reporting of the expenditure on outpatients is identified.     

Visual processing and dyslexia

Book reviewed in this article: This review is concerned with the current theories surrounding the neurological basis of reading disability and although this has important implications for optometric management of vision-related learning problems, this review is not a practice management guide. Rather, it critically summarises research in this field, providing a logical foundation on which clinical management should be based. Evidence suggests that the great majority of dyslexics show transient sensory and temporal processing deficiencies in one or all of the senses. Clinical tests of transient visual function (such as flicker contrast sensitivity) and temporal processing speed, corresponding to an assessment of the magnocellular visual pathway, could discriminate pre-reading children at risk of reading difficulty. If attention mechanisms are affected by transient system temporal processing deficits, then treatments which enhance visual attention and binocular stability would be expected to produce the best prognosis.     

Twin-track studies of ifosfamide and mitoxantrone (I-M) in recurrent high grade non-Hodgkin's lymphoma and Hodgkin's disease. Yorkshire Regional Lymphoma and Central Lymphoma Groups.

Fifty-seven patients, initially diagnosed as having advanced high grade non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) refractory to first-line treatment or in relapse, were treated with ifosfamide 6 g/m2, infused over 48 h, followed by mitoxantrone 12 mg/m2. The regimen repeated at three-weekly intervals. Of 33 patients with NHL evaluable for response, 10 (30 per cent) achieved complete remission and six partial remission, giving an overall response rate of 48 per cent. Two patients subsequently went on to bone marrow transplant (BMT)--one allogeneic and the other autologous. Of 18 patients with HD evaluable for response, seven (39 per cent) achieved complete remission and six partial remission, giving an overall response rate of 72 per cent. Two of this group also went on to BMT (both autografts). The principal toxicity was neutropenia, though central nervous system changes were observed in 10 patients. The possibility of increasing the safety of the regimen by increasing the time of infusion to 72 h is discussed. Given the need to offer alternative treatment to patients in these categories, this combination (I-M) is of value in relapsed patients, especially where options are limited because of previous multi-drug treatment. Remissions may not be prolonged but allow the effective application of additional intensive treatment including bone marrow transplantation.     

Failure to thrive: a parent-infant interaction perspective.

The purpose of this study was to prospectively study inpatients admitted for failure to thrive during their first year of life. Twelve infants with failure to thrive were studied and compared with 17 healthy controls. Mothers and infants with nonorganic failure to thrive scored lower on the Nursing Child Assessment Feeding Scale, reported more change in their lives, and less social support. The need for further research is discussed and suggestions for beginning level interventions are made.