The intersections of HIV and violence: directions for future research and interventions

The purpose of this paper is to review the available literature on the intersections between HIV and violence and present an agenda for future research to guide policy and programs. This paper aims to answer four questions: (1) How does forced sex affect women's risk for HIV infection? (2) How do violence and threats of violence affect women's ability to negotiate condom use? (3) Is the risk of violence greater for women living with HIV infection than for noninfected women? (4) What are the implications of the existing evidence for the direction of future research and interventions? Together this collection of 29 studies from the US and from sub-Saharan Africa provides evidence for several different links between the epidemics of HIV and violence. However, there are a number of methodological limitations that can be overcome with future studies. First, additional prospective studies are needed to describe the ways which violence victimization may increase women's risk for HIV and how being HIV positive affects violence risk. Future studies need to describe men's perspective on both HIV risk and violence in order to develop effective interventions targeting men and women. The definitions and tools for measurement of concepts such as physical violence, forced sex, HIV risk, and serostatus disclosure need to be harmonized in the future. Finally, combining qualitative and quantitative research methods will help to describe the context and scope of the problem. The service implications of these studies are significant. HIV counseling and testing programs offer a unique opportunity to identify and assist women at risk for violence and to identify women who may be at high risk for HIV as a result of their history of assault. In addition, violence prevention programs, in settings where such programs exist, also offer opportunities to counsel women about their risks for sexually transmitted diseases and HIV.     

Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: a critical evaluation of 117 patients with complex tibial shaft fractures

In the 1978-1986 period, 117 patients with 119 fresh and complex fractures of the lower leg were secured primarily with a Hoffmann-Vidal-Adrey external fixation device. Ninety-five fractures could be followed until bony consolidation. In 12 fractures (12.7%) a pseudarthrosis developed, and a deep infection in four (4.2%). The external fixation device was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3%), minor pin-tract infection in nine (9.4%), and major pin-tract infection in three patients (3.1%). Fourteen fractures needed a secondary internal fixation; in 17 other fractures a secondary transplantation of cancellous bone autografts without internal fixation was carried out. After healing of the soft tissues, the tibial fracture can be regarded as a closed one and other therapeutic procedures to accelerate bony consolidation should be taken into account. The advantages and disadvantages of a second internal stabilization should be evaluated for every fracture with bone healing problems. The alteration from external to internal fixation makes an early removal of the external fixator possible and prevents in this way the intrinsic problems combined with this fixation type such as delayed union, nonunion, pin loosening, or pin-tract infection.     

Disparities in Use of Mental Health and Substance Abuse Services by Asian and Native Hawaiian/Other Pacific Islander Women

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n = 491) and not at-risk (n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.     

Comparison of the effects and disposition kinetics of lidocaine and (+/-)prilocaine in patients undergoing axillary brachial plexus block during day case surgery

OBJECTIVE: The aim of this investigation was to compare the clinical effects and pharmacokinetics of lidocaine and prilocaine in two groups of 15 patients undergoing axillary brachial plexus anaesthesia. METHODS: The study had a randomised design. Patients were allocated to one of the two groups of 15. Each group received either lidocaine (600mg = 2.56 mmol/L + 5 mg/L adrenaline) or prilocaine (600mg = 2.72 mmol/L + 5 mg/L adrenaline), injected over a period of 30 seconds. Onset of the surgical analgesia was defined as the period from the end of the injection of the local anaesthetic to the loss of pinprick sensation in the distribution of all three nerves. RESULTS: The mean onset time of surgical analgesia of both lidocaine and prilocaine was 10 minutes. Lidocaine was biexponentially eliminated with a rapid elimination phase half-life (t((1/2)alpha)) of 9.95 +/- 14.3 minutes and a terminal elimination phase half-life (t((1/2)beta)) of 2.86 +/- 1.55 hours. Lidocaine was metabolised to MEGX (monoethylglycylxylidide); time to reach maximum plasma concentration (tmax) 2.3 +/- 0.8 hours; maximum plasma concentration (C(max)) 0.32 +/- 0.13 mg/L; t((1/2)beta) 2.4 +/- 2.4 hours. Lidocaine total body clearance was 67.8 +/- 28.8 L/h. Prilocaine was rapidly and biexponentially eliminated with a t((1/2)alpha) of 9.4 +/- 18.4 minutes and a t((1/2)beta) of 2.12 +/- 1.28 hours. The total body clearance of prilocaine (150 +/- 53 L/h) was higher than that of lidocaine (p = 0.0255). Both compounds demonstrated a comparable volume of distribution (Vd), while the volume of distribution at steady-state (V(ss)) and the volume of distribution in the second compartment (V(beta)) values of prilocaine were a factor of 1.6 higher than those of lidocaine (p < 0.001). Both compounds showed a comparable t((1/2)alpha) (p > 0.8) and a comparable t((1/2)beta) (p = 0.26). CONCLUSION: Following axillary administration, lidocaine and prilocaine demonstrated similar pharmacokinetic behaviour and could therefore be used as the clinical preference for this regional anaesthesia technique.     

Evaluation of a smoking cessation intervention for pregnant women in an urban prenatal clinic

A smoking cessation and relapse prevention intervention was tested in an urban, prenatal clinic serving predominantly low-income, African-American women. At their first prenatal visit, 391 smokers were randomly assigned to an experimental (E) group to receive usual clinic information plus a prenatal and postpartum intervention or to a control (C) group to receive only usual clinic information. The intervention consisted of individual skills instruction and counseling by a peer health counselor on the use of a self-help cessation guide and routine clinic reinforcement. Among the E group (n = 193), 6.2% were cotinine-confirmed quitters at third trimester and among the C group (n = 198) the quit rate was 5.6%. Quitters were light smokers at entry into prenatal care. Many had tried to quit smoking at least once prior to pregnancy.     

Benzo[a]pyrene metabolism in mouse liver. Association of both 7,8-epoxidation and covalent binding of a metabolite of the 7,8-diol with the Ah locus

The 7,8-epoxidation of benzo[a]pyrene, and the 9,10-epoxidation of benzo[a]-pyrene trans-7,8-dihydrodiol coupled with covalent binding of the highly reactive diol-epoxide, are two key P-450-mediated reactions believed to be important in cancer initiation, mutagenesis and teratogenesis. New assays for these two reactions were developed with mouse liver microsomes. These two activities have apparent Km values (approximately 6 microM) similar to that of aryl hydrocarbon hydroxylase activity. Twenty-six individual 3-methylcholanthrene-treated Ahb/Ahd and Ahd/Ahd progeny of the (C57BL/6N)(DBA/2N) F1 X DBA/2N backcross were studied. Both of the newly described activities appear to represent P-450 protein(s) that are responsible for aryl hydrocarbon hydroxylase activity and that are coordinately controlled by the Ahb allele.     

3-in-1 lumbar plexus block for muscle biopsy in malignant hyperthermia patients. Amide local anaesthetics may be used safely

A 3-in-1 lumbar plexus block with the aid of a nerve stimulator was performed in 32 patients and a psoas compartment block was performed in five patients for muscle biopsy of the upper leg for diagnosis of malignant hyperthermia (MH) susceptibility. Twenty-two patients were found to be MH susceptible by the in vitro contracture test. Twenty patients received 40 ml prilocaine 1.5% with epinephrine 1:200,000 and two received 40 ml bupivacaine 0.5% with epinephrine 1:200,000 without any untoward reaction. The 3-in-1 block provides a high success rate and excellent analgesia for muscle biopsy of the upper leg. Amide local anaesthetics are safe in MH-susceptible patients.     

Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial

Purpose. To study the effects of adding supervised group physical therapy to unsupervised individualized therapy in ankylosing spondylitis. Methods. One hundred forty-four patients were randomized to exercises at home, or the same plus weekly group physical therapy for 9 months. Endpoints were spinal mobility, fitness[maximum work capacity by ergometry], functioning (Sickness Impact Profile, Health Assessment Questionnaire for the Spondylar-thropathies, and Functional Index), and patient's global assessment of change on a 10-cm visual analogue scale. Results. Thoracolumbar flexion and extension increased by an average of 0.5 cm (9%) after home exercises, and by 0.9 cm (16%) after group therapy. Maximum load in ergometry decreased by 2 W (1%) after home exercises, but increased by 7 W (4%) after group therapy. Global assessment improved by 0.3 (6%)after home exercises, and by 1.7 (34%) after group therapy. These three differenceswere statistically significant. There were no significant differences in chest expansion, cervical rotation, or the self-assessments of functioning. Conclusions. Group physical therapy proved superior to individualized therapy in improving thoracolumbar mobility and fitness, and had an important effect on global health reported by the patients.