A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA

As AIDS becomes more prevalent among late middle-aged and older adults, mental health support services that facilitate the coping and adjustment efforts of this group are increasingly needed. The current article: (1) outlines a coping improvement group intervention for HIV-infected older adults; and (2) examines the efficacy of the intervention utilizing a small sample (N = 16) of older adults living with HIV/AIDS in Milwaukee, Wisconsin and New York City. The intervention focused on enabling HIV-infected older adults to accurately appraise sources of stress, develop adaptive coping responses and access social support resources to facilitate coping efforts. An evaluation of this pilot intervention, conducted using a pretest-posttest, no control group design, revealed that the intervention increased participants' perceptions of social support, produced higher perceptions of social wellbeing and enabled participants to engage in more planful problem solving, confrontive coping and future optimism. Intervention participants also experienced less stressor burden associated with AIDS-related loss and health concerns. While the current intervention showed potential to facilitate the adjustment efforts of HIV-infected older adults, randomized clinical trials of this intervention with larger samples are needed before its appropriateness for this population can be determined.     

International spinal cord injury quality of life basic data set

Study design:Survey of expert opinion, feedback, and development of final consensus.Objective:Present the background, purpose, development process and results for the International Spinal Cord Injury (SCI) Quality of Life (QoL) Basic Data Set.Setting:International.Methods:A committee of experts was established to select and define data elements to be included in an International SCI QoL Basic Data Set. A draft data set was developed and disseminated to appropriate organizations for comment. All suggested revisions were considered, and a final version of the QoL data set was completed.Results:The QoL data set consists of 3 variables: ratings of satisfaction with general quality of life, satisfaction with physical health, and satisfaction with psychological health. All variables are rated on a scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied).Conclusion:Collection of the International SCI QoL Basic Data Set variables should be a part of all future studies of SCI QoL to facilitate comparison of results across published studies from around the world. Additional standardized instruments to assess other aspects of QoL can be administered based on the purpose of a particular study.     

Prevention Needs of HIV-Positive Men and Women Awaiting Release from Prison

Greater understanding of barriers to risk reduction among incarcerated HIV+ persons reentering the community is needed to inform culturally tailored interventions. This qualitative study elicited HIV prevention-related information, motivation and behavioral skills (IMB) needs of 30 incarcerated HIV+ men and women awaiting release from state prison. Unmet information needs included risk questions about viral loads, positive sexual partners, and transmission through casual contact. Social motivational barriers to risk reduction included partner perceptions that prison release increases sexual desirability, partners’ negative condom attitudes, and HIV disclosure-related fears of rejection. Personal motivational barriers included depression and strong desires for sex or substance use upon release. Behavioral skills needs included initiating safer behaviors with partners with whom condoms had not been used prior to incarceration, disclosing HIV status, and acquiring clean needles or condoms upon release. Stigma and privacy concerns were prominent prison context barriers to delivering HIV prevention services during incarceration.     

The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients

BACKGROUND: The spinal cord independence measure (SCIM) is a newly developed disability scale specific to patients with spinal cord lesions (SCL). Its sensitivity to functional changes in a whole cohort of SCL patients was found to be better than that of the functional independence measure (FIM). OBJECTIVE: o compare the sensitivity to functional changes of the SCIM and the FIM in SCL subgroups. DESIGN: A comparative self-controlled study. SETTING: The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. SUBJECTS: 22 SCL inpatients. INTERVENTIONS: Monthly SCIM and FIM assessments of the subgroups. MAIN OUTCOME MEASURES: Functional change detection rate (FDR) and mean differences between consecutive scores (DCS). RESULTS: The outcome measures of the SCIM were higher than those of the FIM for tetraplegia and paraplegia, complete and incomplete lesions (the FIM missed 25-27% of the functional changes detected by the SCIM; DSC 8.2-11.4 vs 5.2-9; P<0.05 in most comparisons). The SCIM did not exhibit this advantage, however, in the functional areas of self-care and mobility in the room and toilet. Further subgrouping yielded similar results. CONCLUSIONS: The SCIM is more sensitive than the FIM to functional changes in the subgroups studied, and has the potential to serve as a universal tool for disability assessment of SCL patients.     

Transdermal Delivery of Levonorgestrel. V. Preparation of Devices and Evaluation in Vitro

Transdermal devices were prepared and evaluated for their ability to codeliver levonorgestrel and the permeation enhancers ethyl acetate and ethanol in vitro. The 24-hr devices were prepared with membranes composed of ethylene vinyl acetate (EVAc) copolymers. The vinyl acetate (VAc) content of the membranes (50 ± 10 or 100 ± 10 µm thick) was varied from 12 to 25% to give a range of permeabilities toward the enhancers. The reservoir used was ethyl acetate/ethanol (7:3, v/v; 0.5 ml) containing excess solid levonorgestrel and gelled with 2% hydroxypropyl cellulose. The higher VAc content membranes (18 and 25%) exhibited relatively high release rates of EtAc and EtOH leading to depletion of ethyl acetate and ethanol from the reservoir by the end of 24 hr. As a result, the transdermal flux of levonorgestrel, evaluated using rat skin, reached a maximum at about 8 hr and thereafter diminished to zero by 24 hr. The less permeable membranes (12 and 15% VAc content) led to a more sustained release of enhancers, but due to lower solvent delivery to the skin, levonorgestrel flux was substantially lower. There was a direct relationship between drug delivery through skin and the amount of solvent delivered until release of the enhancers had diminished. The potential use of ethyl acetate in transdermal drug delivery is also discussed.