BART to HIVEd: adapting an HIV education prevention program.

One of the fastest growing segments of the population infected with HIV is the nation's youths. Thus, prevention in this high-risk population is vital. The authors detail the process of adapting an evidence-based HIV/AIDS educational program (HIVEd) to the unique needs of high-risk youths in adjudicated and detained facilities and alternative high schools. The HIVEd program derives from St. Lawrence's Becoming A Responsible Teen (BART) curriculum. This article describes the modification of BART into HIVEd, identifies the challenges encountered and lessons learned, and suggests future directions for HIVEd as a useful tool for prevention of HIV/AIDS and sexually transmitted infection in high-risk youths.

Psychological impact of self-image dissatisfaction after orthognathic surgery: a case report.

AIMS: The number of patients who need treatment for dentofacial abnormalities has increased over the past 30 years. Facial alterations can influence both the patient's self-confidence and his interpersonal relationships, possibly generating emotional or physical handicaps. This qualitative study discusses a patient's psychological dissatisfaction with a postoperative outcome, despite the esthetic and functional success of the treatment. METHODS: The Oral Health Status Questionnaire, Post Surgical Satisfaction Questionnaire, Illness Behavior Questionnaire, and a clinical interview were used for the research methodology. RESULTS: Oral surgeons are encouraged to identify, presurgery, the patient's true motivation. An efficacious behavioral model is proposed that might help the patient transition through the consequences stages of the psychosocial changes associated with facial reconstructive surgery. CONCLUSION: Orthognathic surgery involves more than the correction of a physical problem. The psychological needs of the patient must be recognized and acknowledged, and communication between surgeons and patients is essential. It is important to understand that any surgical treatment that modifies body image could generate psychological disorders for some patients. Early surgical intervention and a referral for psychological counseling may reduce long-term morbidity. This case report should alert attending surgeons and orthodontists to possible unfavorable psychological sequelae.

Psychoemotional assessment changes in patients treated with orthognathic surgery: pre- and postsurgery report.

AIM: To evaluate a sample of patients treated with orthognathic surgery, establishing the emotional and self-perception differences between the pre- and postsurgical assessment. MATERIAL AND METHODS: Several questionnaires (Body Dysmorphic Disorder Examination, State Trait Anxiety Inventory, Self-Rating Depression Scale, Oral Health Status Questionnaire, Post-Surgical Satisfaction Questionnaire) were administered to the sample of 30 patients; these were used to study the data related to body image, level of anxiety, eventual depressive status, quality of life, and postsurgical satisfaction. RESULTS: The longitudinal study results outline the impact of orthognathic surgery on the psychological and emotional well-being of the patient and the need for the specialist to understand the emotional status and expectations of the patient.

Condom access in San Antonio, Texas: the "three A's" and HIV/STI incidence.

Condoms are highly effective at reducing STI transmission. Access is a critical precursor to use. This socio-ecologic study operationalizes the concept of condom access by defining it in terms of availability, affordability, and affect, and explores the relationship between these and STI incidence. Three pairs of zip codes, each with similar demographics but different Chlamydia and HIV incidence rates, were identified. Supermarkets, convenience stores, and pharmacies (N = 102) were evaluated for the three A's. Nonparametric methods were used to compare the moderate-Chlamydia areas to the high-incidence areas. High-Chlamydia areas were significantly less likely to have 12-packs available compared to moderate-Chlamydia areas. Prices averaged over $1 per condom and did not vary by incidence. High-incidence areas were significantly less likely to allow patrons to select condoms unassisted. High-HIV areas placed more positively-connoted items near condoms. Improving these factors may improve condom acquisition and in turn reduce STI and HIV incidence rates.

Adapting an HIV prevention intervention for high-risk, incarcerated adolescents.

This study examined the effectiveness of an adapted 4-session HIV prevention program. Participants included 490 adolescents who participated in either the 8- or the adapted 4-session HIVEd program. Analyses to identify mean changes in HIV-related knowledge, attitudes, self-efficacy, and behavioral intentions between participants in either the 4- (n = 274) or 8-session (n = 216) programs were completed. Findings indicate participants in both programs had positive changes at post interview across all study outcomes. No significant differences in changes between participants in the 4- and 8-session programs were found except that male adolescents in the 4-session program had significantly higher mean changes in condom knowledge (p < .01). The adaptation of the 8-session HIVEd program was undertaken to better reach and accommodate the needs of a high risk incarcerated adolescent population. Findings demonstrate that HIV prevention interventions for high risk populations may be successfully adapted and condensed when based on rigorously evaluated and theoretically driven programs.

Lead hazards for pregnant women and children: part 2: more can still be done to reduce the chance of exposure to lead in at-risk populations.

In the United States the risk of lead exposure is far higher among poor, urban, and immigrant populations than among other groups. And even slightly elevated blood lead levels increase children's risk of significant neurobehavioral problems extending through adolescence. Research has shown that blood lead levels in pregnant women well below the Centers for Disease Control and Prevention's "level of concern" of 10 micrograms per deciliter can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers of lead exposure, routine prenatal lead screening and education is not a standard of care in the United States. Part 1 of this two-part article (October) presented the case of a pregnant woman with lead poisoning and described the epidemiology of lead exposure in the United States, the main sources of it, and its effects on a pregnant woman and her developing fetus and child. Part 2 describes recommendations for prenatal screening and strategies for dealing with lead exposure when it occurs: education, reduction in environmental exposure, treatment options, and developmental surveillance.

Lead hazards for pregnant women and children: part 1: immigrants and the poor shoulder most of the burden of lead exposure in this country. Part 1 of a two-part article details how exposure happens, whom it affects, and the harm it can do.

Poor, urban, and immigrant populations are at far greater risk for lead exposure than are other groups in the United States. Children with even slightly elevated blood lead levels are at increased risk for significant neurobehavioral problems that can extend through adolescence. Research has shown that elevated blood lead levels in pregnant women, even those well below 10 micrograms per deciliter-the Centers for Disease Control and Prevention's "level of concern"-can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers, routine prenatal lead screening and lead education is not a standard of care. Part 1 of this two-part article presents a short case example of a pregnant mother with lead poisoning and describes the epidemiology of lead exposure in the United States, the main sources of lead exposure, and the effects of lead on the pregnant mother and the developing fetus and child. Prevention is crucial. Treatment options such as chelation must be used selectively and will not reverse damage once it's occurred. Part 2 will describe recommendations for screening, education, nutrition, reducing environmental exposures, and treatment.