Correlates of nonparticipation in an HIV prevention program for MSM.

Providing HIV prevention services to high-risk individuals remains challenging. We assessed factors associated with nonparticipation among high-risk, sexually active MSM found eligible to participate in a brief, telephone-delivered HIV prevention trial designed to evaluate the efficacy of motivational enhancement therapy (the Sex Check). Two levels of nonparticipation are evaluated: eligible participants who did versus those who did not complete their baseline/enrollment interview, and enrolled participants who did versus those who did not attend any of their counseling sessions. Nonenrollers were younger, less educated, more closeted, and were more likely to report sex with an injection drug using partner. Enrolled participants who did not engage in their counseling session(s) were less educated, reported greater use of alcohol and drugs during sex and use of injection drugs. Innovative methods to reduce barriers to engaging high-risk, sexually active MSM in risk reduction counseling are needed.     

Alcohol-induced heart rate response dampening during aversive and rewarding stress paradigms in subjects at risk for alcoholism.

Individuals with a family history of alcoholism (FH+) are at risk to develop alcohol problems. In several studies, psychophysiological stress responses were more attenuated by alcohol in FH+ than in FH- subjects. However, it is not clear from these studies, if this stronger stress-response dampening effect of alcohol (SRD) in FH+ subjects is confined to aversive stimuli, or would hold for nonaversive stress conditions as well. Also, male and female FH+ subjects seem to respond differently to the alcohol challenge, but have rarely been directly compared in a SRD paradigm. Participants were 54 female and 63 male healthy adults; 31 women were daughters (DOAs) and 40 men were sons (SOAs) of alcohol-dependent fathers. The remaining 23 women (DONAs) and 23 men (SONAs) had no FH of any alcohol use disorder. The participants took part in two laboratory sessions, one with and one without alcohol. In each session, three stressor procedures were presented. Heart rate is the main dependent variable in this report. SOAs, but not SONAs showed a tendency towards SRD. Among female participants, a strong SRD occurred, but contrary to our expectation only in controls. Stress responses and SRD effects were somewhat stronger in the aversive than in the rewarding task. The extent of alcohol induced SRD was strongly influenced by BAL and the amplitude of the stress response in the no-alcohol condition (multiple regression analysis). Thus, aversive tasks might have the advantage of eliciting stronger stress responses than rewarding tasks, thereby providing better conditions for observing differences in alcohol induced SRD between FH+ and FH- subjects.     

Psychiatric aspects of epilepsy.

Patients who have epilepsy face many challenges resulting from their illness and have frequent psychiatric comorbidities. Recognition of these disorders is increasing and is having a positive impact on patients' quality of life. Recent recommendations about a new classification system for psychiatric disorders related specifically to epilepsy and based on the relationship of symptoms to seizures, antiepileptic medications, and EEG changes should further research and treatment. Especially insofar psychiatric syndromes specific to epilepsy can be identified, correlation of clinical phenomena with relatively well-understood pathophysiology in epilepsy will allow advances in the understanding of psychiatric illness. This progress should move the treatment of patients who have epilepsy toward a comprehensive biopsychosocial model that focuses on the whole person rather than simply on the disease process.     

Concurrent Validation of Substance Abusers Self-Reports Against Collateral Information: Percentage Agreement VS. k Vs. Yule's Y

The ability for chemical users to give an accurate self-report of (ubrbnce use vs. abstinence has been questioned. This study hatlgated its concurrent validity, against collateral ratings. The results indicated that validity of reports of chemical use must be evaluated in the context of the validity of other types of information. Chemical use items were corroborated about as often as such nonchemical use items as reports of emergency room visits, arrests, md hospitalizations, thus arguing against the presence of a specific denlal syndrome or overarching tendency toward self-misrepresenletion. Relative concurrent validities seemed more a function of such factors as item salience and specificity. No consistent trend in patient over-or underreporting of chemical use was found. The choice of concurrent validation statistic is important and can influence interpretation of results. Current standards such as percentage agreement and K were seen as flawed; comparisons of results based on these two measures, as well as Yule's Y led to the conclusion that Yule's Y is the statistic of choice.     

Peripheral Blood Lymphocyte Surface Antigen Expression and Prognosis in Myeloma: Australian Leukaemia Study Group Study

The Australian Leukaemia Study Group myeloma study (MM1) aimed to determine the prognostic significance of clinical and immunophenotypic markers in patients with multiple myeloma. All patients were treated with standard dose melphalan and prednisone. Seventy-four patients were entered and the median survival was 27 months. Serum beta 2-microglobulin (βM) and albumin levels were the only significant clinical factors influencing survival (p = 0.007 and p = 0.008, respectively). Patients with raised levels of CD38+ lymphocytes at presentation had a significantly shorter survival than patients with normal levels (p = 0.01, logrank test, median 19 months vs 33 months). CD38 antigen expression was independent of β2M but patients with raised levels of CD38 had significantly lower levels of albumin than patients with normal levels (p = 0.001) which may explain their poorer survival. Salmon and Durie stage was not associated with antigen expression. No other B-cell antigens (CD10, CD19, CD20, CD21, CD22, CD23, FMC1 or FMC7) or plasma cell antigens tested (PCA-1) were found to be associated with prognosis. Patients who achieved plateau phase had a better prognosis than those who did not (p = 0.04 in a landmark analysis). Patients who achieved plateau phase following an objective response appeared to have a better prognosis than those who were in plateau phase at presentation (p = 0.09 in a landmark analysis). Light chain isotype suppression (LCIS) was not associated with a significant survival advantage and did not correlate with any known prognostic indicator. We conclude that phenotypic analysis of peripheral blood lymphocytes for CD38 antigen at diagnosis may be useful as a prognostic indicator in patients with myeloma.     

Aetiology of neonatal septicaemia in Qatif, Saudi Arabia

Neonatal septicaemia (NNS) is a major cause of neonatal morbidity and mortality. Neonatal septicaemia was studied to determine the incidence, common bacterial aetiology and antibiotic susceptibility in Qatif Central Hospital, Saudi Arabia. Of 1,797 babies admitted into the unit over a 3 year period, 144 (8.0%) had documented neonatal septicaemia consisting of 94 (65%) late onset and 50 (35%) early onset septicaemia. The incidence was 8.2/1000 of the total live births in the hospital.

Gram negative bacteria were encountered in 66.2%, gram positive bacteria in 29.2% and Candida albicans in 4.4% of the case. Klebsiella spp., E. coli, and Pseudomonas accounted for 81.8 % of the gram negative while Staphylococcus epidermidis, Staphylococcus aureus and group B Beta haemolytic Streptococcus accounted for 73.9% of the gram positive bacteria.

Most of Gram negative bacteria had a high sensitivity to Aminoglycosides and third generation Cephalosporins. Coagulase negative staphylococci were frequently resistant to most antibiotics but always sensitive to Vancomycin. The overall mortality rate was 18.7%.     

Can people with severe mental retardation consent to mutual sex?

One of the most pressing issues confronting service providers who work with people with severe mental retardation is how to negotiate mutual sex behaviors which occur among this population. Uncertainty surrounding whether individuals have the capacity to consent, fear of legal repercussion, and staff not understanding what their responsibilities and roles should be, each contribute to the difficulty which the service provider experiences. This article examines in detail all aspects of consent and ways for determining consent as well as the responsibilities an interdisciplinary team has for managing mutual sex behaviors.