Incarceration and Sexual Risk: Examining the Relationship Between Men’s Involvement in the Criminal Justice System and Risky Sexual Behavior

In this study, we used data from Add Health Waves II and III to compare men who had been incarcerated to those who had not, and examined whether incarceration was associated with increased numbers of sexual partners and increased odds of concurrent partnerships. We used multivariate regression and propensity-score matching to compare sexual behavior of Wave III male respondents who had been incarcerated with those who had not, and compared sexual behavior at Wave II to identify differences in sexual behavior prior to incarceration. Incarceration was associated with an increased rate of lifetime sexual partnership, but this was attenuated by substance use. Criminal justice involvement was associated with increased odds of having partners who report concurrent partnerships, but no further increase was seen with incarceration. There were no significant sexual behavior differences prior to incarceration. These results suggest that the criminal justice system and substance use may interact to shape sexual behavior.     

Author Index to Volume 10

A 67-yr-old woman presented to a free-standing medical center with respiratory distress of 1 day's duration. She was found on evaluation to have asthma associated with “dipping” the ends of polyurethane-coated wire into molten solder in the production, in her home, of components for the electronics industry. This process has been known to result in the evolution of isocyanates. The patient's sister had also developed cough and wheeze after she performed similar home piecework. Neither the manufacturer nor the distributors of the wire had provided a warning of its potential respiratory hazards. This episode emphasizes the importance of the occupational history, and of following-back thoroughly on cases of occupational disease. In addition, this episode reminds us that home pieceworkers are unlikely to have benefit of advice from industrial hygienists or others skilled in recognizing potentially hazardous situations.     

A Global Vision of Prehospital Care

Abstract

Background. Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills of the intubator. Unfortunately, the limited number of outcome studies adds to the controversy. New technology, the video laryngoscope, has been introduced to facilitate tracheal intubation. At least one model of video laryngoscope (GlideScope Ranger) has been designed for out-of-hospital use. In an effort to assess the effect this technology might have on out-of-hospital intubation, a study comparing traditional laryngoscopy (TL) versus video laryngoscopy (VL) was performed. The study endpoint was the number of attempts to achieve intubation. Data were also collected on time to intubate, nonventilated periods, unrecognized misplaced tubes, and complications of the procedure. Methods. Data were collected on 300 consecutive patients, 6 years of age or older, weighing at least 20 kg, who were intubated using TL. They were compared with data on 315 patients who were intubated using VL. All intubations were confirmed by visualization where possible, auscultation, misting, and capnography. In addition, all were continuously monitored by capnography. Results. The average time to intubate in the VL group was 21 seconds (range 8–43 seconds) versus 42 seconds (range 28–90 seconds) in the TL group. The average number of attempts was 1.2 (range 1–3) in the VL group versus 2.3 (range 1–4) in the TL group. Successful intubation was 97%% in the VL group versus 95%% in the TL group. There were no unrecognized misplaced tubes in either group. For failed intubations, an alternative airway was successful in 99%% of the VL group and 99%% of the TL group. Maximum nonventilated time during any one intubation attempt was 37 seconds in the VL group and 55 seconds in the TL group. Conclusions. The numbers of attempts were significantly reduced in the VL group. This suggests that the use of VL has a positive effect on the number of attempts to achieve tracheal intubation.     

The practitioner as policy analyst: a study of student reflections of an interprofessional course in higher education

Health and welfare practitioners in the United Kingdom have experienced and continue to experience considerable turbulence as services and occupational boundaries undergo restructuring. To a significant extent such turbulence is driven by policies that promote interprofessional agendas. This paper reports on an evaluation of a higher education programme that adopted a social policy approach to the analysis of interprofessional working. The retrospective views were sought of nursing, midwifery, social work and community and youth work post-qualifying students with use of semi-structured questionnaires and focus groups. Although difficulties were encountered with the political science focus to the programme, overall the participants very positively evaluated the opportunity to engage in policy analysis in a shared learning environment. Given the highly politicised, complex and shifting environment of interprofessional working, it is suggested that the study lends support to the argument that 'policy acumen' is a central skill for contemporary health and welfare practitioners. The paper, therefore, starts to explore issues of particular relevance for educationalists involved in developing frameworks for interprofessional programmes particularly in higher education.     

A Randomized Controlled Trial Using Insinuated Standardized Patients to Assess Residents' Domestic Violence Skills Following a Two-Hour Workshop

Background: Residents feel inadequately trained to treat domestic violence victims.

Purpose: The purpose was to assess clinical skills of residents participating in a domestic violence workshop.

Methods: Twenty-seven internal medicine residents were randomized to receive one of two workshops (domestic violence or control workshop). Standardized patients were trained to two domestic violence cases (depressed; injured). The two cases were randomized and insinuated into each resident's continuity clinic at either 1 to 3 months or more than 3 months after the workshops.

Results: The domestic violence workshop residents did not identify the standardized patients as domestic violence victims any more often than residents participating in the control workshop; 16/25 (64%) versus 13/23 (56%), p = .86. However, domestic violence workshop residents were more likely to score 75% or higher on the domestic violence checklist items compared to control workshop residents; 9/25 (36%) versus 2/23 (9%), p = .04.

Conclusions: Once a standardized patient was identified in clinic as a domestic violence victim, domestic violence workshop participating residents demonstrated better clinical skills than a control group.     

Immunophotoelectron microscopy: the electron optical analog of immunofluorescence microscopy.

The electron optical analog of immunofluorescence microscopy combines three developments: (i) photo-electron microscopy to produce a high-resolution image of exposed components of the cell, (ii) site-specific antibodies, and (iii) photoemissive markers coupled to the antibodies to make the distribution of sites visible. This approach, in theory, provides a way to extend the useful immunofluorescence microscopy technique to problems requiring much higher resolution. The resolution limit of fluorescence microscopy is limited to about 200 nm by the wavelength of the light used to form the image, whereas in photoelectron microscopy the image is formed by electrons (current resolution: 10-20 nm; theoretical limit: 5 nm or better depending on the electron optics). As a test system, cytoskeletons of CV-1 epithelial cells were prepared under conditions that preserve microtubules, and the microtubule networks were visualized by both indirect immunofluorescence and immunophotoelectron microscopy using colloidal gold coated with antibodies. Colloidal gold serves as a label for immunophotoelectron microscopy, providing enhanced photoemission from labeled cellular components so that they stand out against the darker background of the remaining unlabeled structures. In samples prepared for both immunofluorescence and immunophotoelectron microscopy, individual microtubules in the same cells were visualized by both techniques. The photoemission of the colloidal gold markers is sufficiently high that the microtubules are easily recognized without reference to the immunofluorescence micrographs, indicating that this approach can be used, in combination with antibodies, to correlate structure and function in cell biological studies.     

Flecainide: electrophysiologic and antiarrhythmic properties in refractory ventricular tachycardia

Twenty-two patients with coronary artery disease and spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent intracardiac electrophysiologic evaluation and, when possible, ambulatory monitoring before and after therapy with flecainide (mean dose 418 +/- 87 mg [mean +/- standard deviation]). An average of 4 antiarrhythmic agents were used and were unsuccessful before therapy with flecainide was begun. During 64 +/- 16 hours of control Holter monitoring in 16 patients, all had 1 or more salvos of VT, as well as ventricular premature complexes (VPCs). Programmed stimulation during the control period induced VT in 17 of 22 patients. After flecainide therapy, Holter monitoring showed elimination of all forms of VT in all but 1 patient, as well as significant reduction of paired VPCs by 95% (p less than 0.03) and single VPCs by 70% (p less than 0.005). Electrophysiologic study during flecainide therapy showed significant increases in AH, HV, PR, QRS and QTc intervals, and the ventricular effective refractory period. Programmed stimulation in 17 patients taking flecainide, with a mean plasma level of 1,075 +/- 521 ng/ml, showed ablation of inducible VT in only 2 patients, a worsening in 5 and continued VT inducibility in 10. Adverse effects that required drug withdrawal were infrequent and encountered in patients who received higher drug levels: 1 patient with congestive heart failure and 1 with severe sinus bradycardia. Thus, although flecainide suppresses complex ventricular arrhythmias on Holter recordings, it rarely alters the response to programmed stimulation. Caution is recommended in its use for recurrent sustained VT or VF and in the interpretation of electrophysiologic studies until the predictive value of programmed stimulation with flecainide therapy is established.