Concurrent sexual partnerships among African Americans in the rural south

PURPOSE: To investigate concurrent sexual partnerships among heterosexual African Americans, 18 to 59 years old, in rural North Carolina. METHODS: Household interviews with persons randomly selected from the NC driver's license file were conducted to identify overlap among the 3 most recent sexual partnerships. RESULTS: Concurrency prevalence in the past 5 years was 53% (men) and 31% (women). Most (61%) respondents believed that a recent partner had had a concurrent partnership. Multivariate analysis revealed strong associations between concurrency and male gender, being unmarried, age of sexual debut, and incarceration of a sex partner. CONCLUSIONS: Concurrent partnerships may increase rates of heterosexual HIV among blacks in the rural Southeastern United States. Future research should examine the context that supports this network pattern.     

Pregnant women with significant medical conditions: anaesthetic implications

Anaesthetic assessment plays a vital role in the successfulmanagement of the pregnant patient with coexisting medical diseases.This has been highlighted by successive reports of the ConfidentialEnquiries into Maternal Deaths (CEMD). Advances in medical carehave resulted in an increasing number of women with concomitantdiseases becoming pregnant. The effects of the physiologicalchanges of pregnancy on the disease must be given due considerationin patient evaluation and management. In this review, some ofthe common problems will be discussed.     

How not to do it: restrictive thoracic dystrophy after pectus excavatum repair

The purpose of our paper is to call attention to acquired restrictive thoracic dystrophy (ARTD), an iatrogenic disease. The condition may occur following correction of pectus excavatum in young patients and is characterized by a reduced and restricted rib cage, usually with some recurrence of the deformity. The authors personal experience with five such patients includes analysis of their operative notes, radiographs, and long-term follow up. These, as well as literary, data indicate that the cause of ARTD is not that the operation is performed at an early age, but that inappropriate surgical technique was performed that may include radical chondrocostal resection, extirpation of growth centers, and suturing together of the perichondrial strips retrosternally, consequentially causing cartilaginous growth behind the sternum. A well-designed, conservative operation may be safely performed at any age, including in children less than 4 years old.     

Back for more: a qualitative study of emergency department reattendance for asthma

OBJECTIVE: To explore the reasons why individuals recurrently present with asthma to hospital emergency departments. DESIGN: A predominantly qualitative study in which participants were interviewed in-depth about their asthma. Data on medication use, respiratory health and asthma knowledge were also collected, and asthma severity was determined from medical records. SETTING: A tertiary teaching hospital and a suburban hospital emergency department (ED) from 1 March to 30 April 2000, and a rural hospital ED from 1 July to 31 August 2000. PARTICIPANTS: The participation rate was 32% of an initial 195 ED attendees (183 of whom were eligible) aged 18-70 years: 32 had presented to an ED for asthma care on more than one occasion over the preceding 12 months (reattendees), and 29 were non-reattendees. RESULTS: Two-thirds (22/32) of reattendees had chronic severe asthma and presentation to ED was deemed appropriate for 18 of these, indicated by recurrent severe asthma attacks despite seeking prior medical intervention. Reasons for re-presentation identified in a third of all reattendees included poor asthma knowledge, and financial and other barriers to medication use. CONCLUSIONS: We identified potentially preventable issues in about a third of patients (most of whom had mild to moderate asthma) who recurrently presented to EDs for treatment. The remainder of the participants sought emergency asthma treatment appropriately after failing to respond to medical care, and this was frequently in accordance with their asthma management plans.     

Randomised controlled trial of health assessments for older Australian veterans and war widows

OBJECTIVE: To assess the effect of home-based health assessments for older Australians on health-related quality of life, hospital and nursing home admissions, and death. DESIGN: Randomised controlled trial of the effect of health assessments over 3 years. PARTICIPANTS AND SETTING: 1569 community-living veterans and war widows receiving full benefits from the Department of Veterans' Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942). INTERVENTION: Annual or 6-monthly home-based health assessments by health professionals, with telephone follow-up, and written report to a nominated general practitioner. MAIN OUTCOME MEASURES: Differences in health-related quality of life, admission to hospital and nursing home, and death over 3 years of follow-up. RESULTS: 3-year follow-up interviews were conducted for 1031 participants. Intervention-group participants who remained in the study reported higher quality of life than control-group participants (difference in Physical Component Summary score, 0.90; 95% CI, 0.05-1.76; difference in Mental Component Summary score, 1.36; 95% CI, 0.40-2.32). There was no significant difference in the probability of hospital admission or death between intervention and control groups over the study period. Significantly more participants in the intervention group were admitted to nursing homes compared with the control group (30 v 7; P < 0.01). CONCLUSIONS: Health assessments for older people may have small positive effects on quality of life for those who remain resident in the community, but do not prevent deaths. Assessments may increase the probability of nursing-home placement.