Dating violence: a comparison of rural, suburban, and urban teens.

This study analyzed rural, suburban, and urban differences in teen dating violence using the 1996 Teen Assessment Project data. Teens in rural school districts were more likely to be victims of dating violence than their suburban and urban counterparts; males reported being slapped, hit, or kicked more frequently than females. The findings of this study indicate that students in rural school districts are at greater risk for participating in dating violence than suburban and urban students, with rural female students at greatest risk.

Integrative research review of risk behaviors among adolescents in rural, suburban, and urban areas.

PURPOSE: The purpose of this integrative review was to describe the state of the science regarding adolescent risk behaviors, with particular emphasis on comparisons among rural, urban, and suburban populations. METHOD: The review was done at two levels, moving from the major national survey studies which included data collected in the late 1980s up to 1993, to more focused topical areas including studies with data collection and publication between 1990 and 1996 within each identified category of adolescent health issues. A total of 137 published works across several disciplines were reviewed. Suggestions for clinical practice were drawn from the significant research findings. In addition, risk behaviors were compared to national baseline data and objectives. RESULTS: The level of research in this topic area was primarily descriptive. Currently, only a small portion of the national objectives for decreasing adolescent risk behaviors have been met. Successful intervention programs, although few in number, usually included not only topical education but also adolescent interaction with peers and support systems to raise awareness and change behaviors. CONCLUSIONS: The risk behaviors for the adolescent population as a whole have been well described. Education alone is not sufficient to change behaviors. Objective outcomes must be identified and health care providers need to use research findings in their practice with adolescents. It is time to intervene with developmentally and culturally appropriate strategies. There was a large gap in the literature regarding risk behaviors and protective factors for rural adolescents. The few studies that included subjects from rural settings indicated that the view that rural adolescents are engaged in fewer or less severe risk behaviors is misleading.

Lisinopril use in a large military medical center.

The results of a drug use evaluation of lisinopril at a large teaching military medical center are reported. Indicators and thresholds were developed and approved by the Pharmacy and Therapeutics Committee. The medical charts of 227 patients for whom lisinopril was prescribed from June 1991 to June 1992 were reviewed for appropriateness of prescribing, appropriateness of monitoring, occurrence of any adverse drug reactions, and detection of drug interactions. Prescribing was appropriate in 97% and monitoring was appropriate in all reviewed cases. The most common adverse drug reactions detected were cough (7%), hypotension (3%), and rash (2%). Patients were also prescribed several drugs that may interact with lisinopril. Lisinopril appeared to be well tolerated and efficacious. Forty patients (18%) experienced adverse drug reactions related to lisinopril. There did not appear to be any major deficiencies with lisinopril prescribing and no corrective action needed to be taken other than educational activities for the appropriate use of lisinopril. Information from this drug use evaluation is useful in formulary decision making.

Effect of a combination of gemfibrozil and niacin on lipid levels.

To determine the effect of the combination of niacin and gemfibrozil on the lipid profile, a retrospective review was conducted of 161 patients who were prescribed a combination of gemfibrozil and niacin for 6 to 12 months at a community-based lipid clinic. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, ratio of total cholesterol to HDL, alanine aminotransferase (ALT), and weight were measured at entry to the clinic, 2 months after dietary instruction, during single-agent therapy, and during combination therapy. Mean doses of niacin and gemfibrozil were 1,229 mg/day and 1,200 mg/day, respectively. Patient weight decreased significantly after dietary instruction and after institution of combination therapy. There were no significant changes in ALT levels with either single-agent therapy or with combination therapy. The combination of niacin and gemfibrozil produced marked and significant changes in lipid levels: total cholesterol and LDL decreased by 14%, HDL increased by 24%, the ratio of total cholesterol to HDL decreased by 30%, and triglycerides decreased by 52%. The combination of niacin and gemfibrozil in the setting of dietary instruction has a marked beneficial effect on serum lipid levels, and was most effective in patients with initial levels of HDL < 40 mg/dL, triglycerides > 250 mg/dL, and LDL > 160 mg/dL. No episodes of ALT elevation or symptomatic myositis were seen.

Early markers of HIV infection and subclinical disease progression.

Human immunodeficiency virus (HIV) infection in US Air Force personnel between 1985 and 1989 was examined through a mandatory serological survey, and through annual examination of infected patients. CD4+ cell counts were determined by flow cytometry; beta 2 microglobulin and neopterin were measured by immunoassay. During this period 933 cases were found, of which 161 were documented seroconversions, giving an incidence rate of 15.6/100,000 person-years. For patients with > 400 CD4 cells microliters-1, the rate of initial occurrence of opportunistic infection was 1 and 4% at 1 and 2 years, respectively. HIV-infected persons with < 400 CD4+ cells microliters-1, in contrast, had rates of 21% at 1 year and 36% at 2 years. In a cross-sectional study, beta 2 microglobulin concentration was shown to increase in both the serum and spinal fluid of patients infected with HIV as their blood CD4 numbers declined. Neopterin levels in serum and spinal fluid showed a similar trend, with significantly lower neopterin concentrations in the group that had > 1000 CD4+ T cells compared to the 0-600 CD4+ cell group. Longitudinal studies included correlation of HIV p24 antigen with CD4 counts over a 1 year period. The p24 antigen-positive group had a 21% decline in CD4+ T cells, while the antigen-negative group had a 14% decline. Specific helper T-cell subsets were also examined over a 6 month period. A significant decline was seen in the CD4+/CD29+, CD4+/CD45R+, and overall CD4+ subsets which was not seen in AZT-treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)