Intellectual disability and patient activation after release from prison: a prospective cohort study.

BACKGROUND: Intellectual disability and patient activation may be important drivers of inequities in health service access and health outcomes for people with intellectual disability transitioning from prison to the community. We assessed the association between intellectual disability and patient activation after prison release and examined whether this association varied, depending on whether intellectual disability was identified prior to prison release. METHODS: Overall, 936 prisoners were screened for intellectual disability by using the Hayes Ability Screening Index and completed the Patient Activation Measure (PAM) within 6 weeks of prison release and again at 1, 3 and 6 months post-release. We estimated the association between intellectual disability status and PAM scores by using a multilevel linear model, adjusting for sociodemographic, behavioural, health and criminogenic factors. We used propensity score matching to estimate the impact of being identified with intellectual disability prior to release from prison on the change in mean PAM score after prison release. RESULTS: Compared with those who screened negative for intellectual disability, ex-prisoners who screened positive, both with and without prior identification of intellectual disability, had significantly decreased mean PAM scores [(B = -4.3; 95% CI: -6.3, -2.4) and (B = -4.5; 95% CI: -6.8, -2.3), respectively] over 6 months of follow-up. Among those who reported being identified with intellectual disability prior to release from prison, a significant increase in PAM score at the 6-month follow-up interview (B = 5.89; 95% CI: 2.35, 9.42; P = 0.001) was attributable to being identified with intellectual disability prior to release. CONCLUSIONS: Ex-prisoners screening positive for possible intellectual disability have decreased patient activation for at least 6 months after release from prison. However, individuals whose possible intellectual disability is unidentified appear to be particularly vulnerable. Incarceration is a pivotal opportunity for the identification of intellectual disability and for initiating transitional linkages to health and intellectual disability-specific community services for this marginalised population.

A longitudinal prospective study of health-related quality of life in breast cancer patients following high-dose chemotherapy with autologous blood stem cell transplantation.

This prospective longitudinal study examined both short- and long-term changes in health-related quality of life (HRQL) in 52 breast cancer patients with poor prognosis receiving high-dose chemotherapy (HDC) treatment with autologous blood stem cell transplantation (ASCT). HRQL was measured seven times from baseline to 2 years post enrollment with the Functional Living Index-Cancer (FLIC), the EuroQol (EQ-5D), and a quality of life visual analogue scale. The percentage of questionnaires returned at each assessment time ranged from 80 to 92%. All three measures showed a similar pattern of change, with HRQL decreasing following administration of HDC, and returning to baseline levels 8 weeks post HDC. A repeated-measures analysis of variance showed that the FLIC at 2 years was significantly better than baseline (P=<0.0001). Difficulty sleeping, headaches, and decreased sexual interest were the most common symptoms reported in the longer term. Our results have implications for early psychosocial intervention in the care of breast cancer patients with poor prognosis undergoing treatment with HDC and ASCT because such interventions can further improve the quality of their survival.

Evaluation of bacteriological swabs and transport media in the recovery of group B streptococci on laboratory media.

The survival of group B streptococci on a variety of swabs, held either in their containers or in transport media for periods of up to 48 hours, at room temperature and at 4 degrees C, has been assessed. Results indicated that holding swabs in transport media did not favour prolonged survival of the streptococci and that the yield of organisms was much greater from swabs held in their ordinary plastic tubes. A holding temperature of 4 degrees C rather than room temperature is recommended if any delay in plating out swabs is anticipated.

Use of the Streptosec test for grouping beta-haemolytic streptococci.

The Streptosec test, which embodies the coagglutination principle for grouping beta-haemolytic streptococci, was used against 72 streptococci previously grouped by precipitin methods. Only two of the 72 strains failed to react. The test is easy to manipulate, represents a considerable saving in time and effort, and produces results with an acceptable degree of accuracy.

Swabs and swab-transport media kits in the isolation of upper respiratory bacteria.

The recovery of upper respiratory tract bacteria on laboratory media from a variety of swabs and swab-transport media kits was examined. Organisms studied included strains of Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus, Neisseria meningitidis and Haemophilus influenzae. Although a wide range of results was obtained with regard to variables such as the type of swab or swab-transport media kit used, the time of plating, the temperature of storage of swab-transport media kits, and the nature of the suspension of the organisms, it was generally noted that recovery of organisms was better from swabs held in their plastic containers prior to plating than from swabs held in transport medium.

Survival of gram positive anaerobic cocci on swabs and their isolation from the mouth and vagina.

The survival of Gram positive anaerobic cocci on plain cotton wool and albumin coated swabs held in various transport media was investigated. Results suggested that in most cases Amies', Stuart's and VMGII media do not offer any more protection to the bacteria than storing swabs dry in their containers. A technique was developed for the isolation and identification of Gram positive anaerobic cocci from the mouth and vagina, incorporating bicozamycin in the medium as a selective agent. Few strains were recovered from the oral cavity, but larger numbers were isolated from the vagina. Using a minimum number of antibiotic sensitivity and biochemical tests, including analysis of end products by gas-liquid chromatography, most isolates were identified to species level.

Grouping of beta-haemolytic streptococci by enzyme-linked immunosorbent assay.

A method of grouping beta-haemolytic streptococci serologically by enzyme-linked immunosorbent assay is described. A comparison of this method with double diffusion in agar gel showed complete correlation of results when highly absorbed grouping sera were used.

The isolation and immunochemical characterisation of a cell-wall carbohydrate and a membrane lipocarbohydrate antigen of group B streptococcus, type II.

Two distinct carbohydrate antigens were isolated from the cell surface of group B streptococcus, type II. One antigen was extracted from SDS-purified cell walls by cold trichloroacetic acid and contained galactose, glucose, rhamnose, glucosamine and sialic acid in the approximate molar proportions 1.7:1.0:3.4:0.9:0.21 respectively. The serological activity of this polymer indicated that it is the group-specific antigen common to all group B streptococci. The second antigen was extracted by phenol from cell membranes and contained galactose, glucose, glucosamine, phosphorus and fatty acid in a molar ratio of 1.6:1.0:0.35:2.6:0.016 respectively. This antigen was shown to be specific for type II, group B streptococcus.

Psychological well-being and coping patterns in infertile men.

OBJECTIVE: To determine whether differences existed in mood and coping styles among fertile men, oligoasthenospermic men, or euspermic men whose wives were undergoing ovulation stimulation with clomiphene and IUI. DESIGN: A cross-sectional research design. SETTING: Hospital-based academic fertility clinic. PATIENT(S): 30 fertile men with currently pregnant wives, 30 euspermic and 30 oligoasthenospermic men in couples undergoing ovulation stimulation with clomiphene and IUI. INTERVENTION(S): Measures of psychological well-being and coping were administered. MAIN OUTCOME MEASURE(S): Biodemographic information, and psychometric measures of mood and coping. RESULT(S): There were no significant differences among the groups on any of the measures except the Family Inventory of Life Events (FILE), in which fertile men reported higher stress levels. FILE scores in all groups were moderate, indicating typical levels of family stress. CONCLUSION(S): Mood and coping in the three groups were similar. This study suggests that men's psychological adjustment to their own infertility and to unexplained infertility is generally healthy.

Estrogen replacement therapy and female athletes: current issues.

Physicians commonly recommend estrogen replacement as treatment for exercise-associated amenorrhoea. While the evidence shows that the basis of the amenorrhoea is estrogen deficiency, it is not clear that it is the only factor in the development of lowered bone density found in oligo-amenorrhoeic female athletes. Nutritional factors, significant in the development of the reproductive dysfunction, could also contribute to bone loss. No randomised, controlled studies of estrogen replacement in athletes have been published. However, one nonrandomised study of a small group of athletes does suggest that there are significant gains in bone density to be made by the initiation of estrogen therapy. More research is clearly needed.

Intermenstrual affect in women with symptomatic premenstrual change.

To determine whether women seeking treatment for symptomatic premenstrual change have ongoing psychological disturbance, we undertook a cross-sectional, comparative study across four groups of reproductive-age women. Subjects were 35 patients with symptomatic premenstrual change and no psychiatric history, 35 women without symptomatic premenstrual change, 35 patients with affective disorders, and 35 women from the community at large. All women except those in the community sample were tested in the intermenstrual phase (after menses but before the 12th cycle day). Psychological tests administered were Profile of Mood States, State-Trait Anxiety Inventory, Institute for Personality and Ability Testing (IPAT) Anxiety Scale, IPAT Depression Scale, General Health Questionnaire and the Family Inventory of Life Events (FILE). Demographic data and information concerning present and past stresses were also collected. Women with symptomatic premenstrual change were distinguishable from psychiatric patients on assessment of intermenstrual mood state. They were no different from women within the community at large or from non-symptomatic women. When symptomatic women reported on time periods, which include the premenstrual phase of the cycle, we found results at variance with those obtained in relation to current state mood. While not unlike the women from the community at large in longer term affective characteristics, they were consistently different from non-symptomatic women and sometimes indistinguishable from psychiatric patients. Women with symptomatic premenstrual change also reported higher levels of past external stresses than women taken from the community at large.

Towards a definition of PMS: a factor analytic evaluation of premenstrual change in non-complaining women.

Symptomatic premenstrual change remains enigmatic and much disputed. To establish baselines in a non-complaining population, we administered the Premenstrual Assessment Form (PAF) to 133 volunteers not seeking or using treatment for premenstrual symptoms. The PAF, a 95-item self report questionnaire, provides categorical, bipolar and quantitative data on a wide range of premenstrual symptoms. Only 27 women (20.3%) failed to meet criteria for at least one of the negative PAF syndromes suggesting that the criteria are lax for clinical investigative purposes. Most common syndromes were minor and major depressive syndromes (87, 65%) with atypical and hostile subtypes most common, general physical discomfort syndrome (82, 61.7%) and fluid retention syndrome (71, 53.4%). Factor analysis was used with the quantitative data to group symptoms. The analysis suggested three factors: a physiological depression (depression with physical change), an anxiety-volatility, and an increased well-being unrelated to other changes. The clearer delineation of premenstrual changes in non-complaining women will define the control group in research with premenstrually symptomatic complainers.

Towards a definition of PMS.II: A factor analytic evaluation of premenstrual change in women with symptomatic premenstrual change.

We have examined the value of the Premenstrual Assessment Form (PAF) in 109 women with prospectively validated symptomatic premenstrual change. Results were compared with those of non-complaining women previously published (J Psychosom Res 1990; 34: 439-446.), there was considerable overlap in categorical and numerical scales so that selection of homogeneous populations of complainers could not be achieved. However, fewer than 7% of complainers had a total PAF numerical score in the normal range (defined as 2 SD above the mean total score of controls). Factor analysis of numerical scores in women with symptomatic premenstrual change suggested three factors similar to but not identical with those of non-complaining women. These were physiological depression, anxiety-volatility and increased well-being. While the negative syndromes are compatible with clinical experience, prospective investigation will be required to assess their homogeneity.

The prevalence of hepatitis B serological markers in dental personnel.

There is a need to assess the risk to members of the dental profession in the U.K. of acquiring hepatitis B from patients. Towards this end a study was performed in order to determine the degree of carriage of serological markers of hepatitis B in a sample of dental workers in and around Edinburgh. Of a total of 88 persons tested only one, a dental assistant, was positive. She had evidence of past infection but did not give a history of previous jaundice. We conclude that in the Edinburgh area the risk of dental personnel acquiring hepatitis B from patients is very small and that routine active immunisation is not necessary. Those who volunteer to treat known hepatitis B virus (HBV) carriers should be offered immunisation and the recommendations of the expert group of the Health Departments of Great Britain on the treatment of HBV carriers should be implemented.

Oral hygiene habits, denture plaque, presence of yeasts and stomatitis in institutionalised elderly in Lothian, Scotland.

The purpose of the present study was to examine the relation between oral hygiene habits, denture plaque, presence of yeasts and stomatitis in institutionalised elderly. A sample of 201 residents, 48-99 yr of age (mean age 82 yr), was selected from four different institutions in Lothian, Scotland. Clinical recordings were carried out under standardised circumstances using well recognised indices. Information about oral hygiene habits was obtained through structured interviews conducted immediately before the clinical examination. A multivariate analysis, principal component, was carried out on the correlated five maxillary denture plaque scores and two components, accounting for 74% and 12% of the variation, were identified. Using these two independent variables, an analysis of variance was carried out testing for significance between the four effects: soaking habits, brushing habits, denture stomatitis and growth of yeasts in the palate together with their interactions. The analysis showed a significant relation between maxillary denture plaque, soaking habits and the presence of denture stomatitis. There was no relation between denture plaque and brushing habits or between denture plaque and growth of yeasts.

Prolonged cancer death. A family affair.

The frequency with which families have to deal with cancer death is increasing as the population ages. The prevalence of some cancers in younger people is also increasing. In this article the authors focus on helping families deal with the anticipated cancer death of a family member. The article includes a definition of those groups of people who form families in the 1990s and examines dimensions along which families vary such as belief systems. We discuss the needs of families when a family member has a terminal cancer diagnosis and outline coping strategies that are seen in families and ways in which nurses and other health care professionals can facilitate adaptive coping.

Relationship of oral disease to the presence of cytomegalovirus DNA in the saliva of AIDS patients.

Cytomegalovirus is an important pathogen in persons infected with human immunodeficiency virus. In this study a thorough oral examination was done and blood and urine cultures for cytomegalovirus were obtained from a group of 31 patients with acquired immunodeficiency syndrome with CD4 lymphocyte counts less than 150 cells/mm3. Whole saliva was also collected for detection of cytomegalovirus deoxyribonucleic acid (DNA) via the polymerase chain reaction. The presence of cytomegalovirus DNA in the saliva specimens was not related to the presence of cytomegalovirus in the urine, which suggests a local source of cytomegalovirus from salivary gland and kidney parenchyma. There was also a strong statistical relationship between salivary cytomegalovirus DNA and xerostomia (p = 0.0004), which suggests that cytomegalovirus may be a cause of salivary gland dysfunction in patients with acquired immunodeficiency syndrome with low CD4 counts.

Alteration of humoral responses to Candida in HIV infection.

The objectives of this preliminary study were to determine the prevalence of oral candidal carriage and infection in a group of HIV-positive individuals and compare the humoral immune responses in serum and saliva in this group with a control group of HIV-negative subjects. Patients were examined clinically with particular reference to the presence of candidal lesions and oral swabs taken to identify carriers. Venous blood and whole saliva were obtained for estimation of total and anti-Candida antibody levels. Pseudomembranous candidiasis was the commonest clinical variant in HIV-positive individuals. Candida albicans was the commonest species isolated in both groups. Increased levels of anti-Candida IgG were found in both serum and saliva of HIV-negative individuals who were either carriers of Candida species or had clinical candidiasis. This was associated with a reciprocal fall in anti-Candida IgA. Similar trends were seen in HIV-positive individuals in association with candidal carriage and infection, although the changes were more marked.

Optimal methods for the isolation of groups A, B, C and G streptococci.

The recovery of beta-haemolytic streptococci on laboratory media over a 48-hour period was studied from a variety of swabs held in plastic containers only, and from those held in transport media, stored either at room temperature or at 4 degrees C. The best results were obtained from swabs not held in transport medium and of these plain cotton-wool swabs consistently produced optimal results. The percentage recovery over 48 hours was maintained satisfactorily only when the swabs were kept at 4 degrees C.

Advocacy, prejudice, and role modeling in the deaf community.

Prejudiced attitudes toward deaf people are a well-established phenomenon (Higgins & Nash, 1982; Moores, 1982; Quigley & Kretschmer, 1982). In recent years, however, a new phenomenon has appeared, and some members of the deaf population now openly express prejudice against the hearing (Boros & Stuckless, 1982; Nash & Nash, 1981). The phenomenon may be an interesting example of Allport's (1954) classical analysis: The victims of the prejudice may tend to reciprocate and/or internalize the prejudice to which they have been exposed. The purpose of our analysis is to examine this phenomenon in more detail, particularly from the perspective of social learning theory as described by Bandura and Walters (1963), Walters (1966), and Bandura (1977).