Effectiveness of psychosocial interventions in preventing HIV risk behaviour in injecting drug users.

OBJECTIVE: To consider evidence for the effectiveness of psychosocial interventions in reducing the risk of infection with HIV of injecting drug users. METHOD: We reviewed 19 published studies of the effectiveness of individual counselling, HIV testing, group interventions, street outreach, and a 'social' intervention designed to change norms for safer behaviours. RESULTS: Eight of 15 studies that examined behavioural outcomes provided evidence of the effectiveness of an experimental intervention, compared with a control or comparison group. In four of these studies, however, serious design limitations made results difficult to interpret. In the other four studies without design limitations, the success of the experimental interventions may have been due to their greater length and intensity as well as to having been conducted with stable and well-motivated populations. Nine of the 15 studies showed evidence of marked behaviorial changes in both experimental and comparison group(s), with the changes in many cases being sustained for upwards of 12 months. CONCLUSIONS: A close examination of the evidence and competing hypotheses for the pattern of results suggests that participating in evaluation research may itself be a valuable intervention. Implications for the development of interventions include the potential efficacy of health risk assessment. Implications for evaluation of interventions include the need for developing unobtrusive measures and for assessing the impact of behavioural assessments. Despite the large behavioural changes reported in most of the studies, a substantial proportion of subjects receiving interventions reported unacceptably high levels of risk behaviours. New, more potent interventions are needed, such as those designed to change the norms of entire communities of drug users concerning safer injection and safer sex.

Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior.

An unprecedented number of human sexuality studies have been initiated in response to the acquired immune deficiency syndrome (AIDS) epidemic. Unfortunately, methodological developments in the field of sex research have been slow in meeting the demands of AIDS investigations focusing on the diverse populations at risk for infection with the human immunodeficiency virus (e.g., adolescents, gay men, intravenous-drug users, ethnic minorities, elderly transfusees). In this article, we review and integrate current literature on measurement error and participation bias in sex research, with an emphasis on collecting sexual information in the context of AIDS. The relevance of these findings for AIDS-related sex research is discussed, and recommendations are made to guide future investigations.

Coupons attract high-risk untreated heroin users into detoxification.

This study examined the degree that the distribution of coupons brought drug users at risk of HIV infection into outpatient detoxification treatment. Demographic characteristics and outcome indicators were compared for patients recruited through coupon redemption (n = 238) versus other referral channels (n = 1129). Significantly more coupon subjects had no previous drug treatment, compared with non-coupon subjects (28% vs. 13%), had shared needles in the previous 30 days (39% vs. 31%) and more were ethnic minorities and men. Length of treatment stay and program completion rates did not differ between the groups. Within a year of the coupon project's end 43% of coupon subjects returned to the treatment program. Results suggest untreated heroin users will utilize drug treatment if more is available.

A preparative method for the isolation of genetic variant forms of glucosephosphate isomerase and a study of five variants.

A method has been developed for the rapid, quantitative separation of normal and abnormal glucosephosphate isomerase allozymes from individuals heterozygous for genetic variant forms of the enzyme. The method utilizes a substrate gradient elution of the enzyme from carboxymethyl Biogel and is far superior in terms of resolution and recovery to methods based on electrophoresis and isoelectric focusing. Five different genetic variant forms of the enzyme were isolated and subjected to a systematic comparison of their physical, catalytic and stability properties. While the physical and catalytic properties of most of the variants were similar, clear differences in the stability of the allozymes were apparent. In order to detect mutations affecting the stability, a series of different stability tests are required.

Personality correlates of logical and sociomoral judgment.

This study examined the relation of the California Psychological Inventory (CPI) to stages of logical and sociomoral judgment. Logical judgment was measured using adaptations of the pendulum and correlations tasks of Inhelder and Piaget; moral judgment was scored using the standard Kohlberg interview. In a sample of 143 adults, logical and sociomoral judgment were correlated .30 to .50 with most of the Class I (Factor 2) CPI scales, those capturing social poise and interpersonal adequacy, and Class III (Factor 3) CPI scales, those capturing achievement potential and intellectual efficiency. The findings offer support for a cognitive interpretation of competence and ego development.

Relation of socioeconomic status to logical and sociomoral judgment of middle-aged men.

Empirical links between socioeconomic status and logical and sociomoral judgment were studied. Logical judgment was measured with adaptations of the pendulum and correlations tasks devised by Inhelder and Piaget (1958); sociomoral judgment was scored with the standard Kohlberg interview. Measures of socioeconomic status (SES) were status of family of origin and subject's educational attainment and occupational prestige. In a sample of 83 middle-aged men, the 3 measures of SES accounted for 25% and 12% of the variance in logical and sociomoral judgment, respectively. Adult occupational prestige accounted for 6% of the variance in logical judgment beyond that explained by family status and education, suggesting that adult cognitive functioning may be related to occupational placement, occupational experience, or both.

Psychoeducational group approach: HIV risk reduction in drug users.

In two trials of a small-group AIDS prevention approach, 50 methadone maintenance patients and 98 heroin abusers in outpatient detoxification were randomly assigned to experimental or comparison conditions. Experimental condition subjects received a 6-hour, small-group intervention that aimed to improve their knowledge and attitudes about AIDS, skills in syringe sterilization and condom use, and changing high-risk needle use and sexual behaviors. Comparison subjects received a set of written materials about AIDS. At posttest and 3-month follow-ups, experimental condition subjects in both maintenance and detoxification demonstrated greater knowledge of AIDS and risk reduction practices and improved skill in demonstrating condom use. Although outpatient detoxification subjects displayed considerably more risk behaviors at study outset, the intervention's effect appeared to be more robust in methadone maintenance patients. The relative lack of impact on subjects' behaviors points out that more potent, sustained interventions need to be developed to slow the spread of HIV among injecting drug users.

PIP: In two trials of a small-group AIDS prevention approach in the programs of Substance Abuse Services, Department of Psychiatry, at San Francisco General Hospital, 50 methadone maintenance patients and 98 heroin abusers in outpatient detoxification were randomly assigned to experimental, psychoeducational groups or information-only comparison groups employing a pre-post-follow-up design. The 50 methadone maintenance subjects included 33 men and 17 women with a mean age of 40.7 years, mean education of 11.8 years, a mean of 6 previous years in methadone maintenance, and 8.6 previous detoxification attempts. Both groups of subjects received a packet of education brochures about AIDS. Experimental subjects also received a 6-hour intervention to improve their knowledge and attitudes about AIDS, syringe sterilization and condom use skills, and changing high-risk sexual behaviors. Comparison subjects received only the packet of brochures about AIDS. The interaction of Condition (experimental versus comparison) with the contrast between pretest and posttest was significant for knowledge about AIDS (p .001), knowledge of AIDS sexual risk-reduction practices (p .01), drug-related self-efficacy (p .05), sex-related self-efficacy (p .05), and the condom use demonstration (p .001). The 98 heroin abusers in outpatient detoxification included 64 men and 34 women with a mean age of 37.2 years, mean education of 11.5 years, a mean of 1.8 previous years in methadone maintenance, and 9.5 previous detoxification attempts. 60 subjects who participated in all three interviews revealed that the interaction of Condition with the contrast between pretest and posttest was significant for knowledge about AIDS (p .05), knowledge of AIDS sexual risk-reduction practices (p .05), and the condom use demonstration (p .001). The interaction for drug-related self-efficacy was significant (p .05), the comparison condition showed a large increase. The interaction for the syringe demonstration was marginally significant in the expected direction (p .10). The interaction between Condition and the contrast between pretest and the follow-up was significant for knowledge of AIDS sexual risk reduction practices (p .05), perceived susceptibility to AIDS (p .01), and the condom use demonstration (p .05).

Character structure and performance on the MMPI.

In a sample of 74 normal adults, a typology of character structure based on the developmental theory of Piaget was used to predict performance on the MMPI. The typology's validity was assessed by examining its empirical relationship to 11 clinical scales of the MMPI. Significant differences among the character types were noted for 5 of the 11 scales examined (Hypochondriasis, Depression, Masculinity/femininity, Psychasthenia, and Ego strength). There were significant differences on three additional scales (Hysteria, Psychopathic deviate, and Hypomania) between subtypes of the most numerous character type, which included two-thirds of the subjects studied. Differences among the character types and subtypes were generally consistent with expectations.

Promoting effective teaching and learning: hospital consultants identify their needs.

OBJECTIVES: The aim of this study was to help hospital consultants identify their needs in relation to teaching skills, leading to the development of a teacher training programme. DESIGN: The study was directed at all 869 consultants in the region and initially involved a postal questionnaire which had a 60.5% response rate. SETTING: Hospitals throughout Northern Ireland. SUBJECTS: Hospital consultants. RESULTS: Results from this questionnaire indicated that while the majority of respondents were interested teachers, only 34% had received any teacher training. The questionnaire was followed by a focus group study involving three groups of consultants drawn randomly from those who had responded to the questionnaire. Participants in these groups identified the following key areas of hospital education: qualities of hospital teachers; selection procedures; problems of teaching in hospitals; the need for teacher training and how it should be provided. CONCLUSION: The study highlighted that hospital teachers need to acquire and update their teaching skills through attending courses that should include basic teaching and assessment/appraisal skills. These courses should last 1 or 2 days and be provided at a regional or subregional level. As a result of this study, teacher training courses have been developed in this region.

Affinity labeling and characterization of the active site histidine of glucosephosphate isomerase. Sequence homology with triosephosphate isomerase.

N-Bromoacetylethanolamine phosphate was found to act as a specific affinity label for the active center of glucosephosphate isomerase. The inactivation process followed pseudo-first order kinetics, was irreversible and exhibited rate saturation kinetics with minimal half-lives of inactivation of 4.5 and 6.3 min for the enzyme isolated from human placenta and rabbit muscle, respectively. The pH dependence of the inactivation process closely paralleled the pH dependence of the overall catalytic process with pKa values at pH 6.4 and 9.0. The stoichiometry of labeling of either enzyme, as determined with N-bromo[14C2]acetylethanolamine phosphate, was 1 eq of the affinity label/subunit of enzyme. After acid hydrolysis and amino acid analysis of the radioactive affinity-labeled human enzyme, only radioactive 3-carboxymethyl histidine was found. In the case of the rabbit enzyme, the only radioactive derivative obtained was 1-carboxymethyl histidine. Active site tryptic peptides were isolated by solvent extraction, thin layer peptide fingerprinting, and ion exchange chromatography before and after removal of the phosphate from the active site peptide. Amino acid analysis of the labeled peptides from the two species were very similar. Using high sensitivty methods for sequence analysis, the primary structure of the active site was established as Val-Leu-His-Ala-Glu-Asn-Val-Asp (Gly,Thr,Ser) Glu-Ile (Thr-Gly-His-Lys-Glx)-Tyr-Phe. Apparent sequence homology between the catalytic center of glucosephosphate isomerase and triosephosphate isomerase suggest that the two enzymes may have evolved from a common ancestral gene.

Families are helped by drug treatment.

Twenty-six pairs of heroin addicts applying for methadone maintenance treatment and their family members were interviewed before being admitted to a drug treatment program and 3 months after entry into treatment to determine whether treatment resulted in changes in family or individual functioning. Results revealed a considerable lessening of family and patient problems in the first months of drug treatment. Family members and patients reported significantly fewer family crises and family difficulties with the patient. Both family members and patients reported improvement on several mood indicators and significant lessening of the patient's family/social problems and drug problems.

National estimates of nonfatal firearm-related injuries. Beyond the tip of the iceberg.

OBJECTIVE: To describe the magnitude and characteristics of nonfatal firearm-related injuries treated in hospital emergency departments in the United States and to compare nonfatal injury rates with firearm-related fatality rates. DESIGN: Data were obtained from medical records for all firearm-related injury cases identified using the National Electronic Injury Surveillance System (NEISS) from June 1, 1992, through May 31, 1993. SETTING: NEISS comprises 91 hospitals that are a stratified probability sample of all hospitals in the United States and its territories that have at least six beds and provide 24-hour emergency service. MAIN OUTCOME MEASURES: Numbers and population rates for nonfatal and fatal firearm-related injuries. RESULTS: An estimated 99,025 (95% confidence interval [CI], 56,325 to 141,725) persons (or 38.6 per 100,000 population; 95% CI, 22.0 to 55.2) were treated for nonfatal firearm-related injuries in US hospital emergency departments during the study period. The rate of nonfatal firearm-related injuries treated was 2.6 (95% CI, 1.5 to 3.7) times the national rate of fatal firearm-related injuries for 1992. CONCLUSIONS: Nonfatal firearm-related injuries contribute substantially to the overall public health burden of firearm-related injuries. NEISS can be useful to monitor the number of nonfatal firearm-related injuries in the United States. A national surveillance system is needed to provide uniform data on firearm-related injury morbidity and mortality for use in research and prevention efforts.

Psychosocial predictors of needle sharing among intravenous drug users.

This study examined the relationship between health beliefs and needle sharing in a sample of 226 heroin detoxification clients. Zero-order correlations revealed that needle sharing was positively associated with perceived susceptibility and AIDS anxiety, and negatively associated with self-efficacy and communication skill in negotiating safe needle practices. Logistic regression analysis showed that demographic and situational factors also play a role in needle sharing. White race and injection of drugs in shooting galleries or other public places increase the odds of sharing a "dirty" needle, while that probability decreases sharply as a function of drug users' self-efficacy. This last finding suggests that preventive clinical interventions such as counseling or psychoeducational groups maybe needed to help drug users develop confidence in resisting needle sharing.