Provider-delivered,Theory-based,Individualized Prevention Interventions for HIV Positive Adults Receiving HIV Comprehensive Care

HIV prevention efforts are often difficult to emphasize in settings delivering comprehensive HIV care due to factors such as time constraints and differing priorities about the use of clinical time. To assist clinicians within dedicated HIV clinics to offer prevention strategies, investigators at two universities in the United States (Johns Hopkins University and the University of Alabama at Birmingham) have developed and implemented similar, audio-computerized-assisted, self-interviewing systems that have been programmed to assess individual patient risk factors and identify based on the patient’s self-assessment, the patient’s behavioral stage or, readiness for changing, each identified target behavior. Following the assessment, the systems provide printouts of key elements of this information along with individualized, theory-based intervention strategies to the medical provider. This paper will describe our efforts in developing provider-delivered, individualized, stage-based interventions intended to reduce high-risk behaviors among HIV-infected persons.     

Local Melanoma Recurrence: A Clarification of Terminology

Background. The current medical literature contains multiple different meanings for the term "local melanoma recurrence." Confusion regarding locally persistent and locally metastatic disease makes interpretation and analysis of previously published reports difficult if not impossible.
Objective. The objective was to present a more precise definition of local melanoma recurrence.
Methods. A case is reported and the literature is reviewed.
Conclusion. Owing to the myriad of different definitions that exist in the medical literature, the term "local melanoma recurrence" is ambiguous and at times misleading. Melanoma that recurs locally from persistence of tumor at the resection margins has a vastly different prognosis than recurrence developing from local (satellite) metastases adjacent to the surgical resection site. We propose the use of the terms "persistent melanoma" and "local metastasis" as more precise and predictive of a patient's prognosis.     

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.     

An electrophysiological investigation of the actions of some autonomic blocking drugs on transmission in the guinea-pig vas deferens

Membrane potentials have been recorded from the guinea-pig isolated vas deferens with intracellular and sucrose-gap electrodes during stimulation of the hypogastric nerve and of intramural nerve fibres. Atropine had no detectable effect on the excitatory junction potentials in response to nerve stimulation or on the spontaneous discharge of small potentials. High concentrations of adrenolytic drugs, acting on α-receptors were needed to block the response to nerve stimulation and the spontaneous discharge. During the onset and recovery from yohimbine blockade, junction potentials in response to repetitive stimulation were not sustained. Bretylium initially reduced both the junction potentials and the spontaneous discharge. However, after 30 min exposure, the spontaneous discharge increased in frequency although the response to nerve stimulation was abolished. Block of the junction potentials by procaine was rapid in onset compared with that by bretylium and guanethidine, but the spontaneous discharge was not abolished. These results are discussed in relation to the mechanism of transmission from sympathetic nerve to smooth muscle.     

Youth preferences for prenatal and parenting teen services

STUDY OBJECTIVE: Parenting teens served by a teen-tot program and teens from a prenatal clinic participated in focus groups to explore their perceptions of medical care, social services, and psycho-educational parenting groups. DESIGN: The teens met in four focus groups, two prenatal and two postnatal. SETTING: Teens receiving care from a teen-tot program and associated prenatal clinic in a large metropolitan area in New England. PARTICIPANTS: A total of 16 pregnant (n=6) and parenting (n=10) teens ages ranging from 16 to 21 years (13 African American, 2 Latina, and 1 Haitian) participated in the four focus groups. METHODS: A qualitative focus group study was performed. Structured, culturally sensitive questions guided the discussion based on a hypothetical case scenario. Themes were identified through grounded theory with three coders and differences were reconciled. RESULTS: The groups revealed prenatal and postnatal mothers valued medical and social services provided in a teen-focused hospital clinic. Prenatal teens looked to providers for health education services and group support. Parenting teens requested consistent doctors for their children and social supports for themselves. Both groups desired assistance with social services, education, housing, and finances as well as educational services for fathers. CONCLUSIONS: Teen parents' perceptions and suggestions for services are critical to program development that meets the needs of participants.