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1.
World Neurosurg ; 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32147550

RESUMO

OBJECTIVE: For adult patients undergoing surgical decompression for Chiari malformation Type 1 (CM-1), the patient-level factors which influence extended length of stay are relatively unknown. The aim of this study was to investigate the impact of patient-baseline comorbidities, demographics and post-operative complications on extended LOS following intervention after adult CM-1 decompression surgery. METHODS: A retrospective cohort study using the National Inpatient Sample years 2010 - 2014 was performed. Adults (≥18 years) with a primary diagnosis of CM-1 undergoing surgical decompression were identified. Weighted patient demographics, comorbidities, complications, LOS, disposition and total cost were recorded. A multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. RESULTS: A total of 29,961 patients were identified for which 6,802 (22.7%) patients had extended LOS. The Extended LOS cohort had a significantly greater overall complication rate (Normal LOS: 10.6% vs. Extended LOS: 29.1%, p<0.001) and total cost (Normal LOS: $14,959 ±6,037 vs. Extended LOS: $25,324±21,629, p<0.001) compared to the Normal LOS cohort. On multivariate logistic regression, Black race, income quartiles, private insurance, obstructive hydrocephalus, lack of coordination, fluid and electrolyte disorders, and paralysis were all independently associated with extended LOS. Additional duraplasty (p=0.132) was not significantly associated with extended LOS after adjusting for other variables. The odds ratio for extended LOS was 2.07 (95%CI: 1.59-2.71) for patients with 1 complication and 9.47 (95%CI: 5.86-15.30) for patients with >1 complication. CONCLUSIONS: Our study demonstrates that extended length of stay after adult CM-I decompression surgery may be influenced by multiple patient-level factors.

2.
Nat Rev Neurol ; 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152460

RESUMO

Hydrocephalus is the most common neurosurgical disorder worldwide and is characterized by enlargement of the cerebrospinal fluid (CSF)-filled brain ventricles resulting from failed CSF homeostasis. Since the 1840s, physicians have observed inflammation in the brain and the CSF spaces in both posthaemorrhagic hydrocephalus (PHH) and postinfectious hydrocephalus (PIH). Reparative inflammation is an important protective response that eliminates foreign organisms, damaged cells and physical irritants; however, inappropriately triggered or sustained inflammation can respectively initiate or propagate disease. Recent data have begun to uncover the molecular mechanisms by which inflammation - driven by Toll-like receptor 4-regulated cytokines, immune cells and signalling pathways - contributes to the pathogenesis of hydrocephalus. We propose that therapeutic approaches that target inflammatory mediators in both PHH and PIH could address the multiple drivers of disease, including choroid plexus CSF hypersecretion, ependymal denudation, and damage and scarring of intraventricular and parenchymal (glia-lymphatic) CSF pathways. Here, we review the evidence for a prominent role of inflammation in the pathogenic mechanism of PHH and PIH and highlight promising targets for therapeutic intervention. Focusing research efforts on inflammation could shift our view of hydrocephalus from that of a lifelong neurosurgical disorder to that of a preventable neuroinflammatory condition.

3.
World Neurosurg ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32014543

RESUMO

BACKGROUND: Research experience is believed to be an important component of the neurosurgery residency application process. One measure of research productivity is publication volume. The preresidency publication volume of U.S. neurosurgery interns and any potential association between applicant publication volume and the match results of top-ranked residency programs have not been well characterized. OBJECTIVE: In this study, we sought to characterize the preresidency publication volume of U.S. neurosurgery residents in the 2018-2019 intern class using the Scopus database. METHODS: For each intern, we recorded the total number of publications, total number of first or last author publications, total number of neuroscience-related publications, mean number of citations per publication, and mean impact factor of the journal per publication. Preresidency publication volumes of interns at the top-25 programs (based on a composite ranking score according to 4 different ranking metrics) were compared with those at all other programs. RESULTS: We found that 82% of neurosurgery interns included in the analysis (190 interns from 95 programs) had at least 1 publication. The average number of publications per intern among all programs was 6 ± 0.63 (mean ± standard error of the mean). We also found that interns at top-25 neurosurgery residency programs tended to have a higher number of publications (8.3 ± 1.2 vs. 4.8 ± 0.7, P = 0.0137), number of neuroscience-related publications (6.8 ± 1.1 vs. 4.1 ± 0.7, P = 0.0419), and mean number of citations per publication (9.8 ± 1.7 vs. 5.7 ± 0.8, P = 0.0267) compared with interns at all other programs. CONCLUSIONS: Our results provide a general estimate of the preresidency publication volume of U.S. neurosurgery interns and suggest a potential association between publication volume and matching in the top-25 neurosurgery residency programs.

4.
World Neurosurg ; 136: e347-e354, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31917315

RESUMO

OBJECTIVE: The aim of this study was to evaluate regional variations in the management, complications, and total cost of admission for adolescent idiopathic scoliosis (AIS) treated by elective posterior spinal surgery (PSF, ≥4 levels). METHODS: The Kids' Inpatient Database year 2012 was queried and adolescent patients (age 10-17 years old) with AIS undergoing elective PSF (≥4 levels) were selected. The primary outcome was regional variations for intraoperative and postoperative complications, length of surgery, and total cost of admission after elective PSF intervention. RESULTS: In our cohort of 3759 adolescent patients identified, 704 (18.7%) patients were treated in the Northeast, 917 (24.4%) in the Midwest, 1329 (35.4%) in the South, and 809 (21.5%) in the West (Northeast: n = 704; Midwest: n = 917; South: n = 1329; West: n = 809). The Northeast had the greatest complication rate, followed by the Midwest, South, and West region cohorts (Northeast: 27.7% vs. Midwest: 24.5% vs. South: 23.0% vs. West: 17.2%, P < 0.001). On average, length of surgery was shortest in the South (Northeast: 5.3 ± 2.7 days vs. Midwest: 5.3 ± 3.1 days vs. South: 4.9 ± 3.1 days vs. West: 5.3 ± 2.1 days, P < 0.001), while the total cost of admission was greatest in the West (Northeast: $51,760 ± $25,177 vs. Midwest: $55,201 ± $23,750 vs. South: $58,847 ± $28,227 vs. West: $60,636 ± $29,372, P < 0.001). CONCLUSIONS: Our study suggests that there may be regional variations in health care resource utilization in AIS patients undergoing multilevel posterior spinal fusions. Further study is warranted to determine the specific factors contributing to disparities in regional outcomes.

5.
Front Cell Neurosci ; 13: 515, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31803025

RESUMO

Epilepsy is a common neurological disorder characterized by recurrent and unprovoked seizures thought to arise from impaired balance between neuronal excitation and inhibition. Our understanding of the neurophysiological mechanisms that render the brain epileptogenic remains incomplete, reflected by the lack of satisfactory treatments that can effectively prevent epileptic seizures without significant drug-related adverse effects. Type 2 K+-Cl- cotransporter (KCC2), encoded by SLC12A5, is important for chloride homeostasis and neuronal excitability. KCC2 dysfunction attenuates Cl- extrusion and impairs GABAergic inhibition, and can lead to neuronal hyperexcitability. Converging lines of evidence from human genetics have secured the link between KCC2 dysfunction and the development of epilepsy. Here, we review KCC2 mutations in human epilepsy and discuss potential therapeutic strategies based on the functional impact of these mutations. We suggest that a strategy of augmenting KCC2 activity by antagonizing its critical inhibitory phosphorylation sites may be a particularly efficacious method of facilitating Cl- extrusion and restoring GABA inhibition to treat medication-refractory epilepsy and other seizure disorders.

6.
Transl Neurosci ; 10: 233-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31497319

RESUMO

Timely dissemination of results from clinical studies is crucial for the advancement of knowledge and clinical decision making. A large body of research has shown that up to half of clinical trials do not publish their findings. In this study, we sought to determine whether clinical trial publication rates within neurology have increased over time. Focusing on neurology clinical trials completed between 2008 to 2014, we found that while the overall percentage of published trials has not changed (remaining at approximately 50%), time to publication has significantly decreased. Our findings suggest that clinical trials within neurology are being published in a more timely manner.

7.
J Neurosurg ; : 1-11, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277071

RESUMO

OBJECTIVE: Intracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR. METHODS: The authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models. RESULTS: Overall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008). CONCLUSIONS: STR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.

9.
Int J Sex Health ; 27(1): 1-15, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25767648

RESUMO

In 2008, we conducted online interviews with 65 self-identified adult heterosexual men and women and gay/bisexual men to explore perceptions and experiences with meeting people online. Reasons for meeting people online, desired partner characteristics, and the process of connecting for sex paralleled those observed in real-life; but the Internet allowed people to identify more partners and specific partner characteristics. "Background checks" of online partners, even though often believed to be false, increased familiarity and trust leading to reduced perceived need for condom use. Participants said online condom use negotiation was easier, but usually occurred in face-to-face contexts in practice. (99).

10.
Couple Family Psychol ; 3(3): 193-206, 2014 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-25512880

RESUMO

Although the sexual transmission of HIV occurs in the context of an intimate relationship, preventive interventions with couples are scarce, particularly those designed for Hispanics. In this article, we present the effect of a pilot intervention directed to prevent HIV/AIDS in heterosexual couples in Puerto Rico. The intervention was theory-based and consisted of five three-hour group sessions. Primary goals included increasing male condom use and the practice of mutual masturbation as a safer sex method, and promoting favorable attitudes toward these behaviors. Twenty-six couples participated in this study. Fifteen were randomly assigned to the intervention group and eleven to a control group. Retention rates at post-intervention and follow-up were 82% for the whole sample. Results showed that there was a significant increase in the use of male condoms with main partners in the intervention group when compared with the control group. Couples in the intervention group also had better scores on secondary outcomes, such as attitudes toward condom use and mutual masturbation, HIV information, sexual decision-making, and social support. We found that these effects persisted over the three month follow up. A significant effect was also observed for the practice of mutual masturbation, but not for sexual negotiation. These results showed that promoting male condom use in dyadic interventions among heterosexual couples in Puerto Rico is feasible. Our findings suggest that because vaginal penetration has been constructed as the sexual script endpoint among many Hispanic couples, promoting other non-penetrative practices, such as mutual masturbation, may be difficult.

11.
BMJ Clin Evid ; 20142014 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-25263284

RESUMO

INTRODUCTION: Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. It leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper airway obstruction can, rarely, lead to respiratory failure and arrest. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in children with mild croup and moderate to severe croup? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 19 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids (dexamethasone, intramuscular and oral), nebulised budesonide, oral prednisolone, heliox, humidification, and nebulised adrenaline (racemate and L-adrenaline [ephinephrine]).


Assuntos
Tosse/etiologia , Tosse/terapia , Crupe/complicações , Crupe/terapia , Corticosteroides/uso terapêutico , Budesonida/uso terapêutico , Tosse/tratamento farmacológico , Crupe/tratamento farmacológico , Epinefrina/uso terapêutico , Hélio/uso terapêutico , Humanos , Umidade , Oxigênio/uso terapêutico , Prednisolona/uso terapêutico
12.
J Correct Health Care ; 18(2): 96-104, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22419643

RESUMO

Men's risk behavior during a 3-month period prior to parole revocation was assessed. Frequent alcohol use was higher among men who had more children, were homeless, or had a history of alcohol and other drug abuse treatment. The use of drugs was greater among men who were younger or had a history of sexually transmitted infection (STI). The use of hard drugs was higher among men who had history of injection drug use. Unprotected vaginal or anal sex was increased among men who were younger, single, or had a history of STIs. Sex with a high-risk partner was greater among men who were older, used hard drugs, or had a history of STIs. Findings highlight the importance of developing risk-reduction programs for men on parole.


Assuntos
Prisões/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Assunção de Riscos , Doenças Sexualmente Transmissíveis/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
13.
AIDS Behav ; 16(6): 1560-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22012148

RESUMO

Factors associated with gay male couples' concordance on aspects of sexual agreements remain understudied. The present study examined which relationship factors, self-reports of UAI, and patterns of HIV testing may be associated with men who were concordant about having a sexual agreement, the same type of sexual agreement, and adhering to their sexual agreement with their main partner. Various recruitment strategies were used to collect dyadic data from 142 gay male couples. Concordance on aspects of sexual agreements varied within the sample. Results indicated that relationship satisfaction was significantly associated with couples who were concordant about having and adhering to their sexual agreement. Predictability and faith of trusting a partner, and value in one's sexual agreement were also positively associated with couples' adhering to their sexual agreement. More research is needed to better understand how relationship dynamics, including sexual agreements, affect HIV risk among gay male couples in the U.S.


Assuntos
Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Relações Interpessoais , Negociação , Parceiros Sexuais/psicologia , Adulto , Estudos Transversais , Tomada de Decisões , Características da Família , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Oregon , Inquéritos e Questionários , Confiança , Washington
14.
J Health Care Poor Underserved ; 21(3): 977-85, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20693739

RESUMO

Institutional policies, practices, and norms can impede the delivery of ethical standard-of-care treatment for people with HIV in correctional settings. In this commentary, we focus on the fundamental issues that must be addressed to create an ethical environment in which best medical practices can be implemented when working with correctional populations. Thus, we consider ethical issues related to access to services, patient privacy, confidentiality, informed consent for testing and treatment, and issues related to the provision of services in an institutional setting in which maintenance of security is the primary mission. Medical providers must understand and navigate the dehumanization inherent in most correctional settings, competing life demands for incarcerated individuals, power dynamics within the correctional system, and the needs of family and significant others who remain in the community.


Assuntos
Assistência à Saúde/ética , Infecções por HIV/terapia , Política Organizacional , Prisioneiros , Confidencialidade/ética , Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde/ética , Humanos , Consentimento Livre e Esclarecido/ética , Prisões/organização & administração
15.
AIDS Behav ; 12(1): 27-40, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17345144

RESUMO

An A-CASI survey of 197 men with a history of incarceration, ages 18-29, revealed that 50% and 17% of participants, respectively, had used substances or had sex while confined. Univariate regression analyses indicated that these two behaviors were correlated and both were associated with being older, having spent more years incarcerated, being sexual abused, and being involved with gangs and violence during incarceration. Multiple regression analyses showed that the likelihood of any substance use during incarceration was higher for men who were affiliated with a gang. Men were more likely to have had sex during incarceration if they reported having had a male sex partner in the community. The prevalence of sexual behavior also differed across sites. Findings document the occurrence of substance use and sexual behavior among incarcerated men, and highlight the need for continued research into the context of these behaviors.


Assuntos
Prisioneiros , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Coleta de Dados , Infecções por HIV/prevenção & controle , Hepatite/prevenção & controle , Humanos , Masculino , Prevalência , Análise de Regressão , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/prevenção & controle
17.
Curr Opin Psychiatry ; 18(5): 530-5, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16639113

RESUMO

PURPOSE OF REVIEW: To summarize articles related to HIV/AIDS and correctional populations that were published from January 2004 through March 2005. In all, 43 empirical and seven non-empirical articles are summarized, about two-thirds of which are focused on correctional populations in the USA. The majority of the studies were descriptive; only two articles presented evaluation data for HIV prevention interventions. RECENT FINDINGS: Published studies during the review period documented elevated rates of HIV, STIs, and hepatitis among correctional populations--often associated with injection drug use, mental illness, and infectious-disease co-morbidity. These studies highlighted a global public-health need for comprehensive HIV risk-reduction programs that address not only disease prevention but also the factors enabling disease transmission. Research further demonstrated the detrimental effects of release from prison on medication adherence and disease progression among HIV-positive people, underscoring the need for transitional treatment and health-care services. SUMMARY: HIV-related research is urgently needed to document the global scope of HIV disease prevalence and correlates among incarcerated populations, to examine the impact of incarceration and release from prison on HIV risk behavior, to identify optimal treatment programs for HIV-positive individuals, and to rigorously evaluate HIV risk-reduction interventions for incarcerated people--particularly those focused on the period of community re-entry. Finally, research and activism are needed to impact structural factors impeding HIV-prevention efforts with correctional populations.

18.
Health Educ Behav ; 31(6): 775-89, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15539547

RESUMO

The article describes men's perceptions of and experience with substance use and sexual behavior during incarceration. Grounded theory content analyses were performed on qualitative interviews conducted with 80 men, aged 18 to 29, in four U.S. states. Participants believed that drugs were easily available in prison. Half reported using substances, primarily marijuana or alcohol, while incarcerated. Key themes included the role of correctional personnel in the flow of substances in prison and the economic significance of substance trafficking. With regard to sexual behavior, most men acknowledged that it occurred but were hesitant to talk in-depth about it. There was a strong belief in "don't look, don't tell," and sex in prison was often associated with homosexual behavior or identity. Sex during incarceration was reported by 12 men, mostly with female partners. Participants were pessimistic about HIV/STD/hepatitis prevention efforts inside correctional facilities. These findings highlight the need for risk reduction programs for incarcerated men.


Assuntos
Alcoolismo/epidemiologia , Prisioneiros/psicologia , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Bebidas Alcoólicas/provisão & distribução , Alcoolismo/psicologia , Canabinoides/provisão & distribução , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Hepatite B/prevenção & controle , Hepatite B/psicologia , Hepatite B/transmissão , Humanos , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/psicologia , Prisioneiros/estatística & dados numéricos , Sexo Seguro/psicologia , Sexo Seguro/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/psicologia , Doenças Sexualmente Transmissíveis/transmissão , Transtornos Relacionados ao Uso de Substâncias/psicologia
19.
Arch Sex Behav ; 33(3): 211-22, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15129040

RESUMO

Although the male condom remains the most commonly used method of HIV prevention, sexual health promotion interventions directed toward heterosexuals in the United States have focused primarily on women. In this paper, we discuss limitations of the utility of various HIV-prevention-related sexual health promotion messages as they pertain to the sexual behavior of heterosexual men. We also present several key considerations for the development of sexuality-based HIV health promotion directed toward this population, including the importance of developing HIV risk reduction messages that are responsive to (1) their predominant sexual and safer sex behavioral patterns; (2) the societal gender roles, norms, and scripts that guide heterosexual interactions; and (3) developmental and cultural influences on sexual behavior. We conclude with recommendations for future research.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Promoção da Saúde/normas , Heterossexualidade , Educação Sexual/normas , Coito/psicologia , Preservativos/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Heterossexualidade/estatística & dados numéricos , Humanos , Masculino , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Parceiros Sexuais/psicologia , Estados Unidos/epidemiologia , Saúde da Mulher
20.
AIDS Behav ; 7(2): 131-41, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-14586198

RESUMO

Ninety-seven service providers, representing 83 agencies, were interviewed about sexual and drug use HIV/STD risk behaviors and their determinants among young men who have been released from prison. Providers believed that men frequently practiced sexual risk behavior, often in conjunction with substance use. Individual determinants of risk behavior primarily focused on "making up for lost time," being a man, degree of HIV/STD knowledge and vulnerability, desire to escape, and future orientation. Peers, partners, and family were portrayed as strong interpersonal influences on risk behavior, both positively and negatively. The dominant contextual determinant of risk behavior was the co-occurrence of sex and drug use. Structural determinants of reduced risk included stable housing, economic sufficiency, and positive community support for safer behavior (e.g., drug treatment access, needle exchange). The findings highlight the need for comprehensive, transitional case management for young men as they reintegrate into the community, including HIV/STD prevention.


Assuntos
Infecções por HIV/transmissão , Prisioneiros , Assunção de Riscos , Doenças Sexualmente Transmissíveis/psicologia , Adolescente , Adulto , Atitude , Relações Familiares , Pessoal de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Grupo Associado , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias
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