Participation in HIV Behavioral Research: Unanticipated Benefits and Burdens.

HIV behavioral research has provided an invaluable knowledge base for effective approaches to behavioral challenges along the HIV care cascade. Little attention has been paid to tracking unanticipated effects of research participation, whether negative or positive. We used qualitative methods to elicit impressions of unanticipated effects of participation in behavioral research. An instrument was developed and piloted to assess positive (emotional gains, practical gains, HIV prevention knowledge and skills gains) and negative (emotional stress, discomfort with research) unanticipated effects. Participants (N = 25) from five projects, including men who have sex with men, adults who use substances, and youth, reported multiple positive unanticipated effects (sexual and drug risk reduction, goal setting, improvements in self-esteem and mood, relationship gains, health care behavior gains, knowledge and introspection gains) and rare unanticipated negative effects. Developing a systematic tool of unanticipated positive and negative effects of participation in behavioral research is a crucial next step.

Medical and Mental Health Status Among Drug Dependent Patients Participating in a Smoking Cessation Treatment Study.

Substance Abusers have a large number of medical and psychiatric problems, and 70-90% are smokers. The aim of this analysis was to examine the prevalence and correlates of medical and psychiatric problems in this sample of drug dependent patients who were participants in a multi-site study of smoking cessation interventions while engaged in substance abuse treatment. Descriptive analyses showed at baseline, 72.8% of participants had at least one medical problem and 64.1% had at least one psychiatric diagnosis. Medical problems correlated strongly with age, smoking severity, and pack-years; Psychiatric problems correlated with gender and ethnicity. Smoking cessation treatment was associated with a moderate reduction in the ASI Medical composite score. More research is needed on the possible effects of combined treatment of substance abuse and concurrent medical and psychiatric problems. Offering smoking cessation in conjunction with primary care may be a way to address the health needs of this population.

Factor concentrate usage in persons with hemophilia in New York State.

BACKGROUND: Persons with a congenital deficiency of FVIII or F IX (hemophilia A and hemophilia B, respectively) receive factor concentrate to treat or prevent bleeding. STUDY DESIGN AND METHODS: A population-based study of all persons with hemophilia residing in New York State at any time during 1993 through 1998 was conducted. All available medical records for each patient were reviewed to determine type of therapy. RESULTS: Case finding yielded 1160 cases, for a prevalence of 63.9 per 1 million population in 1998. Recombinant factor concentrates were used by 56 percent of patients. Patients with severe disease used more (158,234 IU/patient) factor concentrate than did patients with moderate disease (46,315 IU) or mild disease (5794 IU). Over half (57%) of all factor concentrate was prescribed for patients with severe disease on prophylactic therapy. Patients undergoing immune tolerance therapy used the most per person-455,116 IU each. Hemophilia treatment centers provided factor concentrate for 62 percent of all patients who used factor and 73 percent of patients with severe disease. CONCLUSION: Hemophilia patients, especially patients with severe disease, use large amounts of expensive factor concentrates to prevent and to treat bleeding episodes. Specialized hemophilia treatment centers play a key role in the care of these patients.