Helping homeless men begin a new life. A program on Chicago's West Side provides substance abuse rehabilitation and job training

The MARSEPH program, named for the two principal program collaborators--the Marillac Social Center and Saint Joseph Health Centers and Hospital--provides life and work skills to homeless men who visit a day shelter operated by the Marillac Social Center. Participants gain work experience at Saint Joseph. One of the most important aspects of the MARSEPH program is the removal of obstacles to the newly employed. Each MARSEPH participant receives housing assistance, a uniform, transportation to Saint Joseph Health Centers and Hospital, and a meal pass to the hospital's cafeteria. Through this assistance, the men can get off the streets, get to their jobs, be nourished, and look presentable. The MARSEPH program carefully monitors each participant's progress, to ensure his success. Case workers meet weekly with the men to discuss problems and concerns. Every week case workers also visit each participant's residence to monitor his living conditions and offer emotional support. At the end of the six-month training program, MARSEPH helps graduates find employment.     

A review of 'traditional' aboriginal health beliefs

ABSTRACT: Western health professionals often experience difficulties in service delivery to Aboriginal people because of the disparity between Aboriginal and Western health belief systems. This article reviews the literature which considers 'traditional' Aboriginal health beliefs and medical systems. The traditional Aboriginal model of illness causation emphasises social and spiritual dysfunction as a cause of illness. Supernatural intervention is regarded as the main cause of serious illness. There are gender divisions in Aboriginal society that impact on the delivery of Western healthcare. Management strategies such as preventative care, bush medicine, and the role of traditional healers are discussed. These belief systems are considered with particular reference to their interactions and implications with regard to the Western medical system. This information provides a framework to allow improved understanding by health professionals of the health-related decisions made by Aboriginal people.     

Stratification techniques to explore genotype environment interactions

Linkage analysis was performed on the GAW11 Problem 2 data set using stratification to explore the effects of the environmental risk factors and the differences between mild and severe phenotypes. Analysis of the four study populations stratified by the two risk factors identified regions on chromosomes 3 and 5 with significant evidence for linkage. Other loci were sought by removing families consistent with linkage to the chromosome 3 locus. Our studies identified a locus on chromosome 3 (markers 43-46) associated with the mild phenotype in the presence of risk factor 1 and with the severe phenotype independent of risk factor 1. This suggests that distinct allelic variants at the chromosome 3 locus may cause different forms of disease. The locus identified on chromosome 5 (markers 36-39) was linked to the severe phenotype, but exposure to factor 1 or 2 may have a protective effect. The regions on chromosomes 3 and 5 appeared to have independent roles in disease etiology. Evidence for two loci on chromosome 1 linked to the mild form was found. The methods successfully identified linkages and interaction consistent with the generating model.     

Pay Status as a Predictor of Outcome in Surgical Treatment of Obesity

Background: Higher complication rates and lower success in surgery for severe obesity have been reported for patients with government pay status. We examined the effect of pay status upon outcome in surgical treatment of obesity. Methods: This was an observational study from an aggregate data set of individual patient information. Government pay status (G) was defined as full or partial medical care payment through Medicare, Medicaid, or Veterans Administration. Payment entirely by private insurance was defined as private (P). Operations were classified as either simple (S, gastric restriction) or complex (C, gastric restriction with small bowel bypass). Two measures of outcome, perioperative complication rate and weight loss success (≤50% excess weight), were examined to determine pay status effect. Results: More G than P patients were treated with simple procedures (79% vs 51%, p < 0.05). Perioperative complication rates were more common for G than P patients (14.4% vs 9.1%, p < 0.05). One-year weight loss success was higher for P than G, regardless of operation type. Conclusion: Pay status should be included in characterization of patient groups and in the analysis of results when effectiveness of surgical treatment for severe obesity is reported.     

Health care in-depth. Tuberculosis and HIV

Tuberculosis (TB) probably did not become a problem in sub-Saharan Africa (SSA) until around the 1850s. Poverty, inadequate TB control activities, and the HIV epidemic contribute to SSA having the world's highest TB case notification rate. HIV infection is responsible for a marked increase in TB in 15-45 year olds. In some parts of SSA, up to 70% of TB patients have HIV infection. A healthy immune system controls infection with Mycobacterium tuberculosis and prevents progression to TB but does not rid the body of dormant TB bacilli. HIV infection lowers immunity, therefore increasing susceptibility to TB. 25% of new TB cases each year in SSA are attributable to HIV infection. TB is the leading cause of death in HIV-infected individuals in SSA. The median CD4 count in HIV-infected adult TB patients is 200-250. Many persons in late stage HIV infection with TB are sputum smear negative. HIV-infected persons are more likely to have disseminated and extrapulmonary TB than HIV-negative persons. HIV infection sometimes reduces the skin test response to tuberculin. It is best to avoid anti-TB treatment as a diagnostic test for TB. Clinicians should not treat HIV-infected TB patients with thiacetazone but rather ethambutol. Thiacetazone can induce a severe, and sometimes fatal, skin reaction in HIV-infected persons. Many National TB Programs recommend ethambutol in place of streptomycin due to the problems associated with inadequate sterilization of needles and syringes and the pain associated with streptomycin injections in wasted HIV-infected TB patients. HIV-infected TB patients are more likely to die within 12 months after anti-TB treatment has begun than HIV-negative patients. Active TB may boost HIV replication. The World Health Organization does not yet recommend widespread isoniazid preventive therapy for HIV-positive persons in high TB prevalence countries.     

An evaluation system for school-community prevention programs

A management-oriented system for the evaluation of school-community prevention programs is described and examples of how the system has been applied to serve program management decisions with primary, secondary, and tertiary prevention programs are provided. The approach, termed Program Analysis and Review System (PARS), emphasizes a cooperative relationship between a program evaluator and prevention program manager in order that informed judgments can be made about program development and improvement. PARS, which was developed by the author in response to a perceived need for management-oriented approaches to prevention program evaluation, has been field tested with school-community prevention programs in Bergenfield, New Jersey, and Somerville, New Jersey, and has been adapted for use in other communities. PARS consists of three interrelated steps: Program Specification, Program Documentation, and Program Outcome Determination.Charles A. Maher is affiliated with the Department of School Psychology, Rutgers University. Reprint requests should be sent to the author, Graduate School of Applied and Professional Psychology, Rutgers University, P.O. Box 819, Piscataway, NJ 0–354.     

Kinds and locations of mutations arising spontaneously in the coding region of theHPRT gene of finite-life-span diploid human fibroblasts

Spontaneous thioguanine-resistant mutants were derived from populations of finite-life-span, diploid human fibroblasts by means of a fluctuation analysis. cDNA was prepared from mutantHPRT mRNA and amplified by the polymerase chain reaction, and the sequence of the product was analyzed. Exon deletions, which very likely arose from mutations in the intron splice site consensus sequences, were found in 10 of the 37 mutants examined (27% of the total). Among the 28 mutations in the coding sequence, base pair substitutions predominated (89%). With the exception of one base pair involved in a tandem mutation, all base pair substitutions resulted in alterations in the predicted amino acid sequence of the protein. In addition there were three frameshift mutations, consisting of the deletion of one or two base pairs. Although mutations occurred throughout the coding sequence, 50% (14/28) were found in the 5 portion of exon 3.