Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis.

BACKGROUND: Posterior spinal instrumentation and fusion for correction of adolescent idiopathic scoliosis (AIS) typically requires lengthy operating time and may be associated with significant blood loss and subsequent transfusion. This study aimed to identify factors predictive of duration of surgery, intraoperative blood loss and transfusion requirements in an Irish AIS cohort. METHODS: A retrospective review of 77 consecutive patients with AIS who underwent single-stage posterior spinal instrumentation and fusion over a two-year period at two Dublin tertiary hospitals was performed. Data were collected prospectively and parameters under analysis included pre- and postoperative radiographic measurements, intraoperative blood loss, surgical duration, blood products required, laboratory blood values and perioperative complications. RESULTS: Mean preoperative primary curve Cobb angle was 62.3°; mean surgical duration was 5.6 h. The perioperative allogeneic red blood cell transfusion rate was 42.8 % with a median requirement of 1 unit. Larger curve magnitudes were positively correlated with longer fusion segments, increased operative time and greater estimated intraoperative blood loss. Preoperative Cobb angles greater than 70° [Relative Risk (RR) 4.42, p = 0.003] and estimated intraoperative blood loss greater than 1400 ml (RR 3.01, p = 0.037) were independent predictors of red blood cell transfusion risk. CONCLUSION: Larger preoperative curve magnitudes in AIS increase operative time and intraoperative blood loss; preoperative Cobb angles greater than 70(o) and intraoperative blood loss greater than 1400 ml are predictive of red blood cell transfusion requirement in this patient group.

Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function.

BACKGROUND: Surgical procedures to correct larger curve magnitudes >70° in patients with adolescent idiopathic scoliosis (AIS) are still common; despite their increased complexity, limited research has assessed the effect of preoperative curve severity on outcomes. AIM: This study aimed to examine the impact of preoperative curves >70° vs. those ≤70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF). METHODS: Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to preoperative function was reported. Preoperative curves >70° vs. ≤70° were analysed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient. RESULTS: Severe preoperative curves >70°, identified in 21 patients (27.3 %), were associated with significantly longer surgical duration (median 6.5 vs. 5 h, p = 0.001) and increased blood loss (median 1250 vs. 1000 ml, p = 0.005)-these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, CI 1.4-2.7, p = 0.004). Curves >70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 vs. €28,620, p < 0.0001). CONCLUSION: Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves >70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.

Psychosocial correlates of heterosexual condom use: a meta-analysis.

Despite increasing incidence of HIV/AIDS, there has been no systematic review of correlates of condom use among heterosexual samples. To rectify this, the present study used meta-analysis to quantify the relationship between psychosocial variables and self-reported condom use. Six hundred sixty correlations distributed across 44 variables were derived from 121 empirical studies. Variables were organized in terms of the labeling, commitment, and enactment stages of the AIDS Risk Reduction Model (Catania, Kegeles, & Coates, 1990). Findings showed that demographic, personality, and labeling stage variables had small average correlations with condom use. Commitment and enactment stage variables fared better, with attitudes toward condoms, behavioral intentions, and communication about condoms being the most important predictors. Overall, findings support a social psychological model of condom use highlighting the importance of behavior-specific cognitions, social interaction, and preparatory behaviors rather than knowledge and beliefs about the threat of infection.

Elevated cytokine concentrations in the nasopharyngeal and tracheal secretions of children with respiratory syncytial virus disease.

BACKGROUND: Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract disease in infants. The role of inflammatory mediators in the pathogenesis of RSV disease is not well-understood. The present study was designed (1) to determine whether RANTES (regulated on activation, normal T cell expressed and presumably secreted), macrophage-inflammatory protein-1-alpha (MIP-1-alpha), interleukin (IL)-6, IL-8 and IL-10 can be detected in respiratory secretions of children with RSV infection and (2) to assess whether the concentrations of these cytokines in respiratory secretions correlate with white blood cell (WBC) counts and RSV concentrations and with disease severity. METHODS: During the 1996 to 1997 RSV season, we studied prospectively 14 intubated and 14 nonintubated children hospitalized with RSV disease. Nasal wash (NW) and tracheal aspirate (TA) samples were obtained from intubated patients on Hospital Days 1, 3 and 5. NW samples were obtained from nonintubated patients on hospital days 1 and 3. Seven healthy children undergoing elective surgery served as controls. All samples were analyzed for: (1) WBC and differential counts; (2) concentrations of RANTES, MIP-1-alpha, IL-6, IL-8 and IL-10; and (3) quantitative RSV cultures, except in control patients. RESULTS: RANTES, MIP-1-alpha, IL-6, IL-8 and IL-10 were detected in NW and TA samples from all children with RSV infection. The concentrations of these cytokines in samples obtained from children with RSV infection were significantly greater than those in samples obtained from control children. NW WBC counts significantly correlated with NW RANTES, IL-6, IL-8 and IL-10 concentrations, whereas TA WBC counts significantly correlated with TA IL-6, IL-8, IL-10 and MIP-1-alpha concentrations. NW RSV concentrations correlated with NW WBC counts and with NW cytokine concentrations. Among children with RSV infection nonintubated patients had greater NW WBC counts and NW RANTES concentrations than intubated patients. TA RANTES, IL-8 and IL-10 concentrations inversely correlated with clinical markers of RSV disease severity. CONCLUSION: The presence of cytokines in NW and TA samples of children with RSV infection suggests that they have a role in mediating the respiratory tract inflammation induced by RSV. These observations could have implications for designing new therapeutic strategies directed at immunomodulation of RSV disease.

Using implementation intentions to increase attendance for cervical cancer screening.

This article evaluates an intervention based on P. M. Gollwitzer's (1993) concept of implementation intentions. Women registered at a medical practice in rural England (N = 114) completed measures of the theory of planned behavior variables before a manipulation that induced one half of the sample to form implementation intentions specifying when, where, and how they would make the appointment. Subsequent attendance was determined from medical records. Findings show that the theory of planned behavior variables and previous delay behavior provided good prediction of attendance. However, despite equivalent motivation to attend, participants who formed implementation intentions were much more likely to attend for screening compared with controls (92% vs. 69%). Evidence also suggests that implementation intentions attenuated the relationship between previous delay behavior and subsequent attendance.

Can the theory of planned behavior explain patterns of health behavior change?

This article tested the ability of the theory of planned behavior (TPB) to predict patterns of behavior change associated with health screening. Attitudes, subjective norms, perceived behavioral control, and intentions were used to predict objective measures of attendance 1 month and 13 months later among participants who had never previously been screened (N = 389). Findings showed that the TPB predicted attendance on each occasion and also predicted frequency of attendance. However, the model was unable to reliably distinguish among consistent attendees, participants who delayed attending, and participants who initially attended but relapsed. Thus, the TPB needs to be extended to understand behaviors that must be performed promptly and repeatedly for health benefits to accrue.

Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective.

Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.

PIP: Beliefs relating to the spread of HIV and preventive behaviors were explored in a sample of 351 sexually active, 16-18 Scottish teenagers from Dundee, Scotland, who responded to a postal questionnaire. Specifically, the questionnaire investigated the relation between health belief model (HBM) measures and reported endorsement of HIV-preventive intentions. 38% reported 1 previous sex partner, 71% reported 1-3, and 5% reported 10. 70% of respondents reported having used a condom during sexual intercourse. It was found that respondents generally intend to use condoms with new sexual partners, with the majority intending to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8 to 24.3% of variance in reported preventive intentions. Moreover, perceived barriers to preventive behaviors were important predictors. The pattern of results, however, called into question the adequacy of the HBM to HIV-preventive intentions. The authors, therefore, discuss the need for an extended model. The relevance of findings to HIV-preventive campaigns is also considered.

Exploring the relationship between different psychosocial determinants of depression: a multidimensional scaling analysis.

BACKGROUND: The psychological literature concerned with the aetiology and maintenance of depression has generally been considered too diverse to allow for integration of concepts into a single comprehensive review. Moreover, there is little understanding of the original theorists' conceptualisation of the key themes underlying psychosocial theories of depression. This study aims to create a single framework of psychosocial depression concepts based on the opinions of key original theorists. METHOD: A quantitative integration of depression factors was conducted. Ninety-nine factors were identified from 27 theories. Fourteen of the original theorists sorted the factors into groups using a card sort task. RESULTS: Three-way multidimensional scaling (MDS) produced a four-dimensional solution with high explained variance and low stress. Dimension one describes cognitions resulting in a lack of positive intrapersonal and interpersonal communication. Dimension two emphasises behaviours and the impact of environmental stressors. Dimension three describes the individual's pursuit of unrealistic goals and a perceived lack of control. Finally, Dimension four describes concepts relating to self-focus and self-reinforcement. LIMITATIONS: future research could examine clinicians and depressed individuals' understandings of the literature. CONCLUSIONS: the MDS solution identifies the original theorists' collective understanding of the literature. Clinicians could usefully employ the framework to identify the underlying psychosocial themes involved in depression. Moreover the study highlights the need for clinicians to consider the relationships between different conceptual areas in order to challenge the chronic nature of the depressive experience and the high rates of relapse.

Health care workers and HIV/AIDS: a critical review of the literature.

This paper reviews the extensive literature which looks at the impact of HIV/AIDS on health care workers (HCWs). The knowledge and attitudes of HCWs toward people with HIV/AIDS and other relevant attitudes, for example those regarding male homosexuality have been widely studied whereas attitudes to intravenous drug use are perhaps under-investigated. Three major themes of the literature are examined. These are fear of infection, beliefs about the right to refuse care and the stresses associated with caring for HIV positive people. A number of educational interventions which attempt to change HCWs attitudes and beliefs are reviewed. Some notable gaps in the literature are identified. Neglected areas include attitudes to women, people of colour and consideration of the organizational and societal factors mediating the impact of HIV upon healthcare workers. Limitations of the research techniques used are identified and future implications for health care workers are considered.

Modelling and modifying young heterosexuals' HIV-preventive behaviour; a review of theories, findings and educational implications.

Studies applying social cognitive frameworks such as the health belief model and the theory of reasoned action to HIV-prevention are reviewed. These models suggest that appropriate beliefs, attitudes, social norms, intentions and perceived self-efficacy are sufficient psychological conditions for safer sexual behaviour. Limitations inherent in these accounts are identified and additional factors which need to be incorporated in psychological models and health education programmes are highlighted. These include, the motivational complexity of sexual behaviour, the emotional and arousal states in which it is enacted, the difficulties of planning what is regarded as spontaneous interaction and contextual factors which can undermine HIV-preventive intentions. Health education interventions aimed at individual, group and community levels are examined in light of this theoretical review and action-focused, empowering interventions grounded in youth culture are recommended.

Measurement of condom use in 72 studies of HIV-preventive behaviour: a critical review.

Ninety-four distinct measures of condom use were identified in a review of 72 psychosocial studies of HIV-prevention. A coding scheme was developed which characterised each measure in terms of: (1) type of measure (e.g. frequency of use, use at last intercourse), (2) response alternatives (e.g. Likert scale), (3) recall period (e.g. lifetime, last month), (4) partner specification (e.g. 'new' partner), and (5) activity specification (e.g. vaginal or anal intercourse). Results show a great deal of inconsistency in measurements of condom use across studies. Single-item frequency or consistency measures were most common. Several difficulties with measures employed to date were identified. These included indeterminate reliability and validity of measures, lack of attention to the epidemiological significance of different types of use and terminological and self-presentational problems with items assessing use. Implications of extant measurement approaches for the accumulated knowledge base on predictors of 'safer' sex and suggestions for future research in this area are outlined.

The development and validation of the Visual Analogue Self-Esteem Scale (VASES).

OBJECTIVES: To develop a visual analogue measure of self-esteem and test its psychometric properties. DESIGN: Two correlational studies involving samples of university students and aphasic speakers. METHOD: Two hundred and forty-three university students completed multiple measures of self-esteem, depression and anxiety as well as measures of transitory mood and social desirability (Study 1). Two samples of aphasic speakers (N = 14 and N = 20) completed the Visual Analogue Self-Esteem Scale (VASES), the Rosenberg (1965) self-esteem scale and measures of depression and anxiety. (Study 2). RESULTS: Study 1 found evidence of good internal and test-retest reliability, construct validity and convergent and discriminant validity for a 10-item VASES. Study 2 demonstrated good internal reliability among aphasic speakers. CONCLUSION: The VASES is a short and easy to administer measure of self-esteem that possesses good psychometric properties.

An evaluation of short-term group therapy for people with aphasia.

This paper reports an evaluation of a group therapy intervention conducted with aphasic people (n = 6). The intervention comprised 10 sessions of approximately 90 min duration and included two participants with stuttering difficulties. The therapy programme consisted of communication activities within the group which encouraged sharing of personal experiences, videotaping of role-play activities for self- and group-evaluation and practice tasks completed outside the group. Measures of functional communicative ability, attitudes to communication and psychological adjustment were obtained before and after the intervention. Findings showed significant improvements in communicative competence and attitudes to communication over the course of the intervention. Before the intervention self-esteem and communicative competence were highly intercorrelated. By the end of the therapy sessions the correlation between self-esteem and communicative competence was significantly smaller and was non-significant. This indicates that communicative function was not related to feelings of self-worth by the end of the intervention. Improvements in attitude to communication, greater attendance and completion of assignments were each predictive of reduced levels of depression. There was also evidence that stronger beliefs about the role of personal effort in improving speech were predictive of improvements in communication attitudes. A measure of satisfaction showed extremely positive evaluation of the intervention by participants. It is concluded that shortterm group therapy can produce improvements in communicative abilities and attitudes, and have psychological benefits for participants. Several suggestions for future research are outlined.

'Inclined abstainers': a problem for predicting health-related behaviour.

A longitudinal test of the association between motivation to undertake a precautionary health action and subsequent behaviour was conducted on women's uptake of the cervical screening test. A sample of never-screened women (N = 166) completed measures derived from protection-motivation theory (PMT; Rogers, 1983). One year later, screening uptake was reliably determined from medical records. While regression analyses demonstrated that PMT variables predicted both motivation to undergo cervical screening and screening uptake, there was, nonetheless, a good deal of inconsistency between protection motivation and screening behaviour. Fifty-seven per cent of those who indicated they were willing to undergo the test did not do so within a one-year period. Discriminant analysis was therefore used to test the ability of cognitions specified by PMT to distinguish four patterns of association between motivation and behaviour: inclined actors, inclined abstainers, disinclined actors and disinclined abstainers. While PMT variables could successfully classify the four groups, it was not possible to derive a reliable discriminant function which distinguished between inclined actors and inclined abstainers. The results suggest that PMT provides a useful account of choice motivation but does not address the psychological processes by which intention is translated into action. Recent calls for the development of a social psychology of volition are discussed in the light of these findings.

Do intentions predict condom use? Meta-analysis and examination of six moderator variables.

This study used meta-analysis to quantify the relationship between intentions and behaviour in prospective studies of condom use. The effects of six moderator variables were also examined: sexual orientation, gender, sample age, time interval, intention versus expectation and condom use with 'steady' versus 'casual' partners. Literature searches revealed 28 hypotheses based on a total sample of 2532 which could be included in the review. Overall, there was a medium to strong sample-weighted average correlation between intentions and condom use (r+ = .44), and this correlation was similar to the effect sizes obtained in previous reviews. There were too few studies of gay men to permit meaningful comparison of effect sizes between homosexual versus heterosexual samples. Gender and measurement of intention did not moderate the intention-behaviour relationship. However, shorter time intervals, older samples and condom use with 'steady' rather than 'casual' partners were each associated with stronger correlations between intentions and condom use. Factors which might explain the significant effects of moderator variables are discussed and implications of the study for future research on intention-behaviour consistency are outlined.

Temporal stability as a moderator of relationships in the Theory of Planned Behaviour.

Temporal stability of behavioural intentions and perceived behavioural control (PBC) within the Theory of Planned Behaviour were examined as moderators of the cognition-behaviour relationships in two studies. Study 1 (N = 201) examined attendance at health screening appointment (infrequently performed behaviour) using an objective measure of attendance. The impact of intentions and past behaviour on behaviour was moderated by intention stability. In addition, stable intentions were more strongly related to attitudes and past behaviour. Study 2 (N = 407) examined eating a low-fat diet (frequently performed behaviour) using a self-report measure of behaviour. The impact of intentions on behaviour was moderated by intention stability, while the impact of PBC and past behaviour on behaviour was moderated by PBC stability. Stable intentions were more strongly related to attitudes, subjective norms and PBC. Stable PBC was more strongly related to attitudes and past behaviour. The discussion considers the implications of the findings for furthering the understanding of the proximal determinants of behaviour and emphasizes the importance of temporal stability as a key measure of the strength of intentions and PBC.

Social judgements of sex and blame in the context of AIDS: gender and linguistic frame.

A questionnaire study (N = 318) examined social judgements of sexually active males and females on positive and negative evaluative dimensions, as a function of the perceiver's gender, and the linguistic frame of judgement. This frame was manipulated by requiring respondents to rate themselves on a number of descriptive dimensions which evaluatively favoured either a 'liberal' or a 'conservative' approach to sex and personal relationships, before making their judgements. Female targets were rated more negatively than males on both evaluative dimensions. There were also significant interactions between the framing manipulation and both subject and target gender for the evaluatively positive measure. There was some evidence of females being perceived more positively in the liberal than the conservative frame and within the conservative frame they were judged less positively than male targets. Male subjects tended to rate targets more positively in the liberal frame whereas females did not. Judgements of blame and personal responsibility in the context of AIDS were examined as a function of the independent variables and also revealed gender differences. These factors, and particularly the importance of language in framing the context of self-perception and social judgement, are discussed.

Health beliefs and teenage condom use: a prospective study.

PIP: The authors investigated the extent to which Health Belief Model (HBM) measures can be used to predict subsequent sexual activity and consistency of condom use among teenagers, especially those who report having new sex partners. Results from a longitudinal survey of sex behavior and HIV-relevant cognitions among 258 sexually active 16 and 18 year olds in Dundee, Scotland, are reported. Participants responded to a confidential postal questionnaire on their demographic characteristics, previous sexual experience, prior condom use, beliefs specified by the HBM, peer norms regarding condom use, and condom use intentions. Measures of sexual behavior and condom use consistency were then included in a follow-up questionnaire 1 year later. Demographic and HBM measures, as determined through discriminant analysis, did not account for significant proportions of variance in the consistency of condom use or mediate the effects of prior sexual experience or demographic measures. The respondents who reported more frequent sexual intercourse were less likely to use condoms consistently while those who had used condoms previously reported more consistent use. Female respondents were less likely than the young men to follow through upon their intentions to consistently use condoms.^ieng

The postAIDS structure of students' attitudes to condoms: age, sex and experience of use.

PIP: A central aspect of health education campaigns designed to prevent the spread of HIV has been to encourage people to use condoms during sexual intercourse. Little research has, however, been carried out on attitudes towards condoms. The present study investigated the post-AIDS structure of students' attitudes to condoms and examined the association of subjects' age, sex, and experience of use with those attitudes. Subject were students attending a university and a polytechnic in Dundee, Scotland. Out of 600 questionnaires sent out 318 were returned after reminders, a response rate of 53%. Attitudes towards condoms were measured using 8 5-point Likert items. Principal component analysis with varimax rotation produced 3 orthogonal factors accounting for 61.0% of the variance. The factors were labelled Condom Effectiveness (26.3%), Condom Offensiveness (21.0%), and Condom Attractiveness (13.7%). Factor scores were computed by reversing the scoring of items with negative loadings and averaging across items within factors. Condoms were considered quite effective among the present sample (M=4.0, SD+0.6, range=1.5). Subjects also believed, however, that condoms were somewhat offensive (M=3.4, SD=0.6) and unattractive to use (M=2.7, SD=0.8). Women considered condoms more offensive than men (F 1273=11.06, p.001) and subjects who had previously used condoms during sex considered condoms more effective (F1273=4.85, p.05) and less offensive (F1273=12.18, p.001) than those who had never used them. Clearly these concerns about the condom on dimensions of effectiveness, offensiveness and attractiveness might be a barrier to intentions to change behavior and need to be addressed by health education campaigns. Such initiatives must, as Abrams, Abraham, Spears, and Marks (1990) and Abraham, Sheeran, Abrahams, and Spears (in press) point out, be targeted towards the concerns of particular groups such as those examined here. (full text)^ieng

Religiosity, gender, and the double standard.

Scottish teenagers (N = 690) participated in a survey concerning the relationship between religiosity, gender, and social judgments of sexual activity. Respondents estimated the number of sexual partners of 20-year old men and women and made evaluative judgments of sexually active men and women on positive and negative dimensions. On both tasks, evidence was obtained for the operation of a double standard. Women were expected to have fewer sexual partners than men, and their sexual activity was judged more negatively on evaluatively negative dimensions. Contrary to findings of previous studies in this area, gender differences in endorsement of the double standard were not found. Only moderate support was found for the view that religiosity contributes to different standards of sexual behavior for men and women, although religiosity had significantly greater influence on judgments made by women than on judgments made by men.