An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection

The purpose of this study was to assess the efficacy of brief group interventions, the positive choices intervention (PCI) and a standard intervention (SI), to increase condom use and intention to use condoms and to change condom use attitudes and beliefs. The design of the study was a randomized comparative trial. Participants were 347 heterosexual African American crack cocaine users living with HIV infection. Data were collected at intake and at three and nine months after intake. Behavioral and sociocognitive data were collected. Although both brief interventions achieved positive results, there were significant differences in outcomes between the interventions groups. The mean number of sex partners was significantly lower in the PCI group at three months. The proportion of those assigned to the PCI reporting sex with a paid partner significantly decreased, while the proportion disclosing their serostatus to their partners increased. There were no significant differences on these measures in the SI group. Significant time effects were found on measures of condom use, condom use attitudes, and self-efficacy beliefs. These measures significantly increased from intake to one month for both groups. One significant time-by-group effect was found. The measure of situational self-efficacy significantly increased in the PCI group, but not the SI group. Results also showed significant time-by-time effects. Mean condom use, intention to use condoms, attitudes, and condom use self-efficacy beliefs showed significant difference between three and nine months. However, there was no clear pattern of change. Findings suggest that brief group interventions designed to reduce HIV can help heterosexual drug users living with HIV infection increase condom use and intention to use condoms and change condom use attitudes and beliefs. A significant time-by-group effect was observed only for situational self-efficacy, suggesting limited additional efficacy of the PCI intervention. Given similar positive findings between groups, more research is needed to determine which components of brief interventions produce changes in motivations and risk behaviors.     

Adoption of new antiglaucoma drugs in Finland: impact of changes in copayment

BACKGROUND: Copayments are common measures intended to control drug expenditures and promote rational prescribing. In Finland, new antiglaucoma drugs start with a high copayment, but once sufficient clinical experience is available, they are reevaluated and can receive a lower copayment status. OBJECTIVE: This study assessed the effect of changes in copayment level on the adoption of 2 antiglaucoma drugs. METHODS: A retrospective analysis was performed from 1997 to 2001 using the Finnish national register of reimbursed drug purchases, which covers approximately 98% of all antiglaucoma drug purchases in the country. There were 172,293 purchases of dorzolamide (plain or combined with timolol) and 281,377 purchases of latanoprost. An interrupted time-series design from approximately 30 months before and 20 months after the change in copayment was used in the analysis. The main outcome measures were the numbers of defined daily doses (DDDs) purchased and the monthly numbers of patients who purchased the study drugs for the first time before and after the change in copayment. RESULTS: A substantial increase in consumption of both dorzolamide and latanoprost was seen immediately after the introduction of the lower copayment. The monthly consumption of dorzolamide was 60,713 DDDs higher and the monthly consumption of latanoprost was 49,330 DDDs higher than expected according to the utilization trend during the higher copayment period. Twelve months later, the observed consumption of dorzolamide was 109% higher and that of latanoprost was 21% higher than if the copayment had remained the same. The number of new patients using the study drugs peaked within 2 months of the lower copayment, but the amount consumed per patient per day remained quite stable. CONCLUSIONS: Decreasing the copayment of a new antiglaucoma drug to the same level as the copayments of alternative drugs accelerated the adoption of these new products in Finland.     

HCV carriers with normal alanine aminotransferase levels: Healthy persons or severely ill patients?: Dealing with an everyday clinical problem

Approximately 30% of patients with chronic HCV infection show persistently normal ALT levels. Although formerly referred to as ‘healthy’ or ‘asymptomatic’ HCV carriers, and thus historically excluded from antiviral treatment, it has now become clear that the majority of these patients have some degree of histological liver damage that may be significant in up to 20% of patients and might progress toward a more severe degree of liver fibrosis. A significant proportion of patients (≥ 20%) experience periods of increased serum ALT (flare) associated with enhanced disease progression. However, controversies still exist in clinical practice regarding the definition of ‘persistent’ ALT normality, the virological and histological features of these subjects, the need for liver biopsy, the role of non invasive tools for the assessment of liver fibrosis (transient hepatic elastography, fibroscan), and the natural history and optimal management of chronic hepatitis C with normal ALT. The advent of new therapeutic options (pegylated interferons plus ribavirin) has shifted treatment targets toward eradication of underlying infection, with therapy decision based on age, severity of disease and likelihood of response rather than on aminotransferase levels. This review does approach the main unresolved issues on this topic in the form of a dialog between a hepatologist and a patient with HCV infection but normal alanine aminotransferase levels, trying to give evidence-based answers to the more frequently asked questions from patients and their physicians.     

Central and Peripheral Catecholamine Levels after Pyrazole Treatment

Abstract: Pyrazole (50 to 300 mg/kg intraperitoneally) given to male rats produced a decrease in body weight. A dose dependent fall in the noradrenaline content of the brain was observed, but no changes occurred in the central levels of dopamine or 5-hydroxytryptamine. Even a single dose of pyrazole (100 mg/kg) decreased the noradrenaline content by 20 %. Successive doses had an additive effect which was maximal 24 hrs after the final dose. Recovery was quite rapid, but 3 days after the final administration the levels were still lower than in the controls. The noradrenaline content of the heart and spleen was also slightly reduced. The adrenaline content of the adrenals seemed unaffected by the treatment. It is concluded that pyrazole administration in the dose and time schedules used, markedly reduces the noradrenaline content of the central nervous system. This should be kept in mind when this substance is combined with ethanol in similar studies.     

Comparing the financial risk of bed-day and DRG based pricing types using parametric and simulation methods

The extent of random financial risk involved in the Finnish bed-day and Diagnosis Related Groups (DRG) based hospital pricing systems were estimated and compared using parametric and simulation methods. DRG based payment schemes were found to provide significantly better protection against financial risk for municipalities, but municipality's size was the main determinant of financial risk. Small municipalities should use longer contracts between hospitals or form bigger purchaser-organisations for risk pooling. In addition, the current risk management system proved to be ineffective in decreasing the random variation in total costs.     

DRG-related prices applied in a public health care system--can Finland learn from Norway and Sweden?

In the early 1990s, DRG based hospital financing was introduced into some hospital districts in Finland. The 1993 state subsidy reform decentralising all hospital financing to municipalities, and the aim of improving productivity, were the driving forces for introducing DRG. This study addresses the pros and cons of DRG in hospital financing in the Finnish health care system and puts forward several solutions to avoid potential problems. We consider the objectives and optimal features of hospital financing systems in the context of the public health care system, where the public sector owns and finances hospitals. We analyse impacts of introducing different types of DRG based hospital financing systems, taking into account earlier experiences in countries such as Sweden and Norway, as well as Finnish system specific features. DRG could assist the Finnish municipalities to compare quality, costs and prices of services between hospitals, and related cost information might help them budget expenditure more accurately. System specific features mean that traditional uses of DRG in hospital pricing are not feasible in Finland. But some benefits of DRG could be exploited, for instance in the controlled contracts between municipalities and hospitals.     

Geographical variation in incidence of primary total hip arthroplasty: a population-based analysis of 34,642 replacements

Background  

Considerable variation in total hip arthroplasty (THA) incidence between regions has been described. The aim of this study was to evaluate geographical variation in the incidence of primary THA for OA in Finland and to analyze variables associated with this variation.     

Smoking-related self-efficacy, beliefs, and intention: assessing factorial validity and structural relationships in 9th-12th grade current smokers

Smoking-related self-efficacy and beliefs about the benefits of smoking are consistently related to intention to continue smoking, a common proximal outcome in youth smoking cessation studies. Some measures of these constructs are used frequently in national and state youth tobacco surveys, despite little evidence of validity for high school smokers. Further, the association of the constructs with intention has not been demonstrated in this group. The factorial validity of the measures and the cross-sectional correlations among self-efficacy, beliefs, and intention were examined among 9th-12th grade current smokers (N=2,767, 13.8% reporting smoking >1 cigarette in the previous 30 days; mean age 16.2; 61.2% white, 6.2% Black, 17.8% Hispanic, 5.0% Asian, 3.5% other; response rate 70%) from a convenience sample of 22 Texas schools. Confirmatory factor analyses supported evidence of factorial validity for the scales in this sample. Structural equation modeling analyses suggested youth smokers have low confidence in their ability to avoid smoking, believe smoking offers emotional or social benefits, and intend to continue smoking. The scales assess smoking-related self-efficacy, beliefs, and intention in this sample. Prospective studies are needed before intervention development implications are suggested.