Patterns of smoking, quit attempts and services for a cohort of 15- to 19-year-olds

OBJECTIVES

To establish patterns of smoking among 15-to 19-year-olds within mixed urban and suburban area and explore preference for the nature of services to assist quitting.

DESIGN

Postal survey and depth interviews with focus group validation.

SETTING

People registered with health services in the Borough of Solihull, UK. The borough has a diverse population with areas of high deprivation to the north and a range of prosperity elsewhere.

PARTICIPANTS

Questionnaires were sent to 50% of those registered and 20 people interviewed aged from 15 to 19 years.

MAIN OUTCOME MEASURES

The survey contained demographic questions relating to educational attainment and family, smoking status, history and quit attempts, use of facilities for quit attempts. Qualitative themes explored attitudes and experience of quitting, utilization of cessation services, barriers to access and nicotine replacement therapy.

RESULTS

Total survey response rate was 32.6%. Three in five reported smoking a cigarette sometime, 17.2% current regular smokers, 7.2% current occasional smokers. Median age of starting smoking was significantly lower (P = 0.004) for current regular smokers, distinguishable in two groups; weekend smokers and all week smokers. More quit attempts had been made or planned by current regular smokers but were often short lived. Weekend smokers had a slightly longer duration of quitting (P = 0.03). Eight-two per cent were optimistic about quitting in the future although the majority (80%) had already made one quit attempt. Knowledge and use of existing services was poor, with concerns about privacy and confidentiality. Models based on autonomy were identified as potentially useful.

CONCLUSION

Teenage smoking is characterized by optimism about quitting despite the failure of many quit attempts, lack of regard for existing services and barriers to uptake.

Health and risk behaviors over time among youth living with HIV

Health practices and transmission behaviors were examined over time among 25 disabled youth living with HIV (YLH) living in a comprehensive residential care program. YLH were aged 19-24 years (M=23.4 years); 89 per cent of males were gay, bisexual, or transgendered (60% Caucasian); all had physical and mental health problems, as well as substance abuse disorders. YLH were assessed at least four times at 3-month intervals and reported high lifetime rates of sexual and substance-use risk acts. Over four assessments, YLH improved their nutrition and hygiene and decreased their worry about their health status. YLH evidenced no decrease in the frequency of substance use and sexual risk. Depression, self-esteem, and health status also were stable over time. YLH who have a lifetime history of multiple problem behaviors are likely to change slowly over time, even when receiving comprehensive residential care.

Perceived barriers to receiving HIV services in groups of traditionally underserved individuals: empirical models

Persons living with HIV/AIDS face many issues that make them highly vulnerable to a number of health and social problems. As the demographics of the epidemic have shifted in recent years, many members of traditionally underserved groups have encountered barriers to entering the services system. This article uses data from seven national demonstration projects funded to enroll persons with HIV/AIDS who tend to "fall through the cracks" and help them access needed services. Data on the initial perceptions of the participants about barriers to accessing services were related to 17 indicators of traditionally underserved status including demographic characteristics and behavioral variables using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Through the modeling methods, the groups most likely to experience a large number of barriers to service participation are identified. Having children needing care is particularly predictive of the level of barriers to care.

Satisfaction with innovative community and university health clinic programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models

As the demographics of the populations of affected individuals have changed, systems of care have needed to adapt to be responsive to client needs. This article examines client satisfaction data from seven national demonstration projects funded to enroll individuals from traditionally underserved groups and help them access services using different strategies. Data on client satisfaction ratings were related to indicators of traditionally underserved status, including demographic characteristics, behaviors, and other risk factors using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Client groups that were most likely to experience relatively higher and lower levels of satisfaction with services are identified. Overall, all client groups were highly satisfied with the innovative HIV/AIDS services received. The findings illustrate the success of these innovative HIV care models in being responsive and sensitive to the needs of their target populations.

Finding the Underserved: Directions for HIV Care in the Future

The demographic, behavior, and background characteristics of 4,804 participants in 17 national demonstration projects for HIV medical and/or psychosocial support services were coded for an index of "service need" or possible under-representation in the traditional healthcare system. Fifteen items were coded including status as a person of color, lack of private insurance, unemployment/disability, problem drinking, crack cocaine use, heroin use, other illicit drug use, less than 12 years of education, criminal justice system involvement, children requiring care while the patient receives services, sex work, being the sex partner of an injection drug user, unstable housing, primary language not English, and age less than 21 or over 55 years. Most (87.7%) of the program participants had four or more of these factors present. Through CHAID modeling, those groups with the highest levels of service need and vulnerability were identified. These data suggest that these projects, designed to attract and serve individuals potentially underrepresented in the health services system, had in fact achieved that goal. Implications of the changing demographics of the HIV epidemic for the health service delivery system are discussed.

Developing services for substance-abusing HIV-positive youth with mental health disorders

Models of program development have primarily focused on the internal organizational processes needed to plan, implement, and evaluate new service programs. However, creating an external demand for new programs by policy makers, administrative bureaucracies, public health officials, and funders is critical to establishing new programs. A series of deaths of seropositive youth and an absence of local service settings with staff trained to address the needs of youth living with HIV provided the impetus for Larkin Street Youth Center. In particular, the agency had to overcome stigma associated with having both substance use and mental health disorders to establish service programs to recruit and mobilize staff within the agency and the local community and to establish a comprehensive housing program for symptomatic HIV-infected adolescents. This article examines how a residential assisted care facility for HIV-seropositive adolescents was established using organizational strategic planning processes, problem solving, and social marketing frameworks.

Quantification and characterisation of arteries in retinal images

A computerised system is presented for the automatic quantification of blood vessel topography in retinal images. This system utilises digital image processing techniques to provide more reliable and comprehensive information for the retinal vascular network. It applies strategies and algorithms for measuring vascular trees and includes methods for locating the centre of a bifurcation, detecting vessel branches, estimating vessel diameter, and calculating angular geometry at a bifurcation. The performance of the system is studied by comparison with manual measurements and by comparing measurements between red-free images and fluorescein images. In general an acceptable degree of accuracy and precision was seen for all measurements, although the system had difficulty dealing with very noisy images and small or especially tortuous blood vessels.

Fractionated high dose rate brachytherapy moulds--a precise treatment for carcinoma of the pinna

BACKGROUND AND PURPOSE

The aim of this paper is to describe a fractionated high dose rate brachytherapy procedure for the treatment of small superficial cancers of the pinna and to report the outcome in a small series of patients.

MATERIALS AND METHODS

Thirteen patients with superficial cancers of the pinna, not invading cartilage, have been treated and in the majority of cases the tumour thickness was determined by a transdermal ultrasound measurement. For the single-plane moulds the prescribed surface dose was 45 Gy in eight fractions over 5 days and the moulds were constructed such that the full thickness of the disease, as determined by the ultrasound measurement, would lie within the 80% isodose surface. One case was treated with a sandwich mould and in this case the dose was reduced to 42.5 Gy. The treatment machine was a high dose rate microselectron, which contains a single stepping iridium source.

RESULTS

The radiation reactions were of moderate severity, but were limited to the high dose volume. In all cases there was complete tumour resolution and rapid healing occurred leaving a barely perceptible scar. There were no recurrences over a minimum follow-up time of 18 months and there were no late radiation complications in this period.

CONCLUSIONS

The treatment of superficial carcinoma of the pinna by means of HDR moulds is a safe and reliable technique. In this small series of patients there was total tumour control with excellent cosmesis.

Expansion rates of small abdominal aortic aneurysms

BACKGROUND

The present study was carried out in order to examine those factors that influence the rate of expansion of small abdominal aortic aneurysms.

METHODS

A retrospective study was undertaken of 112 patients who attended the St George Vascular Laboratory between 1987 and 1997. These patients had abdominal aortic aneurysms that were considered to be too small to warrant surgical repair at the time of presentation. Sequential ultrasound examinations were used to measure maximal anteroposterior aneurysm diameter. From these data, annual growth rates were calculated. Growth rate per annum was then compared with gender, age, initial aortic aneurysm diameter, presence of hypertensive disease, cardiac disease, family history of aneurysmal disease, diabetes mellitus, smoking, beta-adrenergic blockade and lipid lowering drugs.

RESULTS

Univariate analysis showed that three factors were significantly related to growth rate: the initial size of the aortic aneurysm, the presence of cardiac disease and the presence of beta-adrenergic blockade.

CONCLUSIONS

The presence of beta-adrenergic blockade appeared to have an independent effect on aneurysm growth rate, and suggests a possible role for beta-adrenergic blockade as a therapeutic strategy in controlling expansion rates of small abdominal aortic aneurysms. A controlled double-blind clinical trial is required to demonstrate this conclusively.

Retinal vascular network architecture in low-birth-weight men

BACKGROUND

Low birth weight is associated with hypertension and increased cardiovascular mortality, but the mechanism of this association is not known. Hypertension is accompanied by abnormalities of the microvasculature including rarefaction.

OBJECTIVE

To test the hypothesis that low birth weight is associated with an alteration in microvascular architecture.

DESIGN

A stratified random sample of 100 men aged 64-74 years was selected from a cohort of men whose birth weights were known. They were of relatively high or low birth weight ('high' > or = 3700 g, 'low' < or = 3200 g) and high or low systolic blood pressure (high > or = 160 mmHg, low < or = 140 mmHg).

METHODS

Retinal arteriolar geometry was defined in terms of arteriolar bifurcation angles and junction exponents (a measure of the relative diameters of parent and daughter vessels), measured from photographic diapositives using operator-directed image analysis.

RESULTS

Members of low-birth-weight groups had significantly narrower bifurcation angles than did members of high-birth-weight groups (74 +/- 1 degree versus 78 +/- 1 degree, P= 0.017 by analysis of variance). There was no significant difference between angles in members of groups with high and low blood pressures. Neither birth weight nor blood pressure grouping affected junction exponents.

CONCLUSIONS

Narrower bifurcation angles are associated with increased circulatory energy costs and may be related to a lower than normal microvascular density. Our finding of differences in retinal microvascular architecture might reflect a persistent alteration in vascular architecture as a result of an impairment of foetal development and could provide a mechanistic link between low birth weight and subsequently increased cardiovascular risk.

Outpatient angioplasty: 4-year experience in one practice

Angioplasty is often performed as an inpatient procedure after preliminary angiography. In order to increase efficiency and patient comfort we introduced a policy of performing angioplasty for chronic leg ischaemia as an outpatient whenever possible, using duplex scanning to select suitable lesions. This paper examines the safety and feasibility of this policy over a 4-year period. We prospectively assessed 168 consecutive cases which were planned for outpatient angioplasty from a total of 190 cases undergoing angioplasty and found full agreement between duplex scanning and angiography in 92%. Six patients (4%) developed complications of angioplasty requiring admission and another five were admitted for unexpected organisational reasons. Thus, the complication rate of outpatient angioplasty was 4%. All complications were noted at the time of angioplasty with no unexpected readmissions. Angioplasty for leg ischaemia is feasible and safe to perform as an outpatient using duplex scanning to select appropriate cases.

Are butter and cheese rich in monounsaturates beneficial in hyperlipidaemic patients?

BACKGROUND

Reduction in intake of dairy products has long been recommended to reduce blood lipids. The value of monounsaturated fatty acids is increasingly recognized.

METHODS

We evaluated the effects of a monounsaturate-rich butter and cheese (B) produced by modifying the bovine diet on blood lipid levels of patients with type IIa hyperlipidaemia. We compared their effects with those of normal butter and cheese (A) and polyunsaturate-rich spread and cheese (C). Using a double cross-over design, we studied 30 patients of mean age 56.4 years (23 men, one woman excluded) over 6-week periods.

RESULTS

Approximately 35.5 g/day butter/cheese were consumed; no changes in serum total cholesterol, triglycerides, low-density lipoprotein, lipoprotein (a) or cholesterol: high-density lipoprotein (HDL) ratio were observed. HDL levels were higher in B(1.31 mmol/l) than in C (1.22 mmol/l; P < 0.05) and similar to those in A (1.28 mmol/l). HDL2 levels were higher in patients fed diet A(0.23 mmol/l) than they were in those fed diet C (0.19 mmol/l; P < 0.05) and similar to those in patients fed diet B (0.20 mmol/l). Serum HDL3 was significantly higher in patients fed diet B (1.11 mmol/l) than in those fed diet C (1.03 mmol/l; P < 0.05) but similar to that in patients fed diet A (1.06 mmol/l).

CONCLUSIONS

Moderate intake of modified dairy products may be of value and deserves further evaluation.

Two cases of infected atherosclerotic aneurysms and a comparison with infective endocarditis

Two cases of infected atherosclerotic aneurysms thought to have arisen following haematogenous seeding of atheromatous lesions are described. Although infective endocarditis also arises by the haematogenous route, there are striking contrasts in both the range and therefore likely source of organisms, together with a perceived difference in the rate of blood-culture positivity. This case report provides a focus for discussion of these observations.

Comparison of Ifosfamide versus cyclophosphamide in combination with Cisplatin and Doxorubicin (adriamycin), as first-line therapy for advanced epithelial ovarian-cancer - report of a pilot-study

Cisplatin induction therapy followed by combination chemotherapy employing cisplatin, doxorubicin, and ifosfamide was administered to 25 consecutive patients with FIGO stage III:or IV epithelial ovarian cancer as first-line therapy following cytoreductive surgery. A median of seven (3-10) courses of combination chemotherapy were administered. Myelotoxicity necessitated dose attenuation in 20 (80%) patients. Microscopic hematuria was observed in one (4%) patient. Serious central neurotoxicity occurred in two (8%) patients. A surgically documentable response to therapy was observed in 16 of 19 (84%) patients who underwent second-look laparotomy. Thirteen (68%) patients had a surgical complete response, three (12%) patients had a surgical partial response, and three (12%) patients demonstrated progression of disease. The estimated two-year survival for the study population was 81%. The results observed in the current study were compared to those reported for a population of 40 patients with advanced ovarian cancer treated with cisplatin, doxorubicin, and cyclophosphamide (PAC). Patients treated with PAI had significantly (p=0.04) fewer episodes of sepsis, a significantly (p=0.02) greater percentage of patients requiring dose reduction secondary to myelotoxicity, and a significantly (p=0.02) higher surgical complete response rate. The two-year survival for patients treated with PAI of 81% and that for patients treated with PAC of 68%, do not differ significantly (p=0.39). The two-year disease-free survival for patients treated with PAI of 34% and the two-year disease-free survival of 55% for patients treated with PAC do not differ significantly (p=0.99). The combination of cisplatin, doxorubicin, and ifosfamide is effective as first-line therapy in the treatment of advanced epithelial ovarian cancer, but a significant advantage over the less costly standard regimen which employs cisplatin, doxorubicin and cyclophosphamide is not demonstrable in the current study.