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Biomedical subjects

J McCusker

Publications and source records attributed to J McCusker.

At least 73 records · Page 4Linked to original sources
PubMed1992

Time trends in high-risk injection practices in a multi-site study in Massachusetts: effects of enrollment site and residence.

Time trends in needle sharing and bleach use were examined among needle users enrolled at drug abuse treatment and nontreatment sites in greater Worcester, MA, from 1987 through 1989. Substantial declines in high-risk behavior were found, with different trends at drug treatment versus nontreatment sites. The percentage of individuals sharing needles declined at treatment facilities but not at nontreatment sites. Among those sharing, the proportion using bleach increased at both drug treatment and nontreatment sites. The bleach distribution program in Worcester appears to be associated with increased bleach use among residents. Bleach use was associated with residence in Worcester, after controlling for age, gender, race, enrollment site, time period, and frequency of sharing. Risk reduction in the subpopulation of needle users entering treatment was greater than that among those not in treatment. As avoidance of sharing is likely to be more effective than bleaching for the prevention of human immunodeficiency virus (HIV) transmission, the subpopulation not in treatment should be targeted for prevention programs.

Adolescent↗
PubMed1990

Racial/ethnic differences in HIV-1 seroprevalence and risky behaviors among intravenous drug users in a multisite study.

Differences in human immunodeficiency virus type 1 (HIV-1) seroprevalence and patterns of drug-use and sexual behaviors were examined among Hispanic, black, and white intravenous drug users recruited at multiple sites in Worcester, Massachusetts. A total of 1,092 (786 males, 306 females) intravenous drug users were interviewed, and HIV-1 antibody test results were available for 874 (80.0%). After adjustment for demographic differences, black males were significantly less likely to report risky drug-use behaviors (ever sharing needles and recently visiting shooting galleries) compared with white males. In contrast, Hispanic males were significantly more likely to report recent risky drug-use behaviors (sharing needles in New York City, daily needle-sharing, and visiting shooting galleries). Both groups were less likely to report risky sexual behaviors compared with whites. The odds ratios for HIV-1 seropositivity remained significantly greater than 1 for Hispanics compared with whites (odds ratio = 4.5) and maintained marginal significance for blacks compared with whites (odds ratio = 2.1) when adjusted for risky behaviors and demographic variables. The different patterns of drug-use and sexual behaviors by race/ethnicity indicate the need for interventions targeted to specific populations.

AIDS Serodiagnosis↗
PubMed1990

Demographic characteristics, risk behaviors, and HIV seroprevalence among intravenous drug users by site of contact: results from a community-wide HIV surveillance project.

We investigated differences in behaviors important for human immunodeficiency virus (HIV) transmission and HIV antibody status among 927 recent needle users enrolled in a multi-site HIV surveillance project in Worcester, Massachusetts. Subjects were enrolled at drug abuse treatment centers reported less risky injection practices unexplained by demographic variables. Risky sexual practices were in general reported more frequently by men at the jail than men at other sites. However, HIV status showed little relation to enrollment site. These results have implications both for targeting of acquired immunodeficiency syndrome (AIDS) prevention programs to needle users not in drug abuse treatment and for potential selection bias in studies of intravenous drug users.

Adult↗
PubMed1990

Use of drugs and alcohol by homosexually active men in relation to sexual practices.

The use of alcohol and recreational drugs in relationship to sexual practices was investigated longitudinally and cross-sectionally in a cohort of homosexually active men at a Boston community health center. Use of marijuana, nitrite inhalants, and cocaine decreased by approximately 25-48% during 42 months of follow-up, whereas use of alcohol showed little change. Men who initially reported both high-risk sexual practices and some use of alcohol or marijuana and who subsequently stopped using marijuana or reduced their frequency of alcohol use were significantly more likely to stop those unsafe sexual practices than were those who continued to use these substances. Men who at their most recent visit reported impaired judgement during sexual activity due to substance use, and particularly due to drug use, had significantly higher levels of perceived susceptibility to AIDS and barriers to behavior change, and lower levels of self-efficacy, which were independent of their unsafe sexual practices.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Predictors of AIDS-preventive behavior among homosexually active men: a longitudinal study.

Predictors of adoption of safer sexual behaviors were examined in a cohort of 278 homosexually active men with stable HIV-antibody status followed over 12 months at a Boston community health center. The behaviors examined included: (1) restriction of partners to one monogamous or steady relationship and (2) among men who maintained multiple or non-steady partners, the avoidance of unprotected receptive and insertive anogenital contact. For each behavior, men who adopted consistently safer behavior were compared with those who remained unsafe, using bivariate analyses and multiple logistic regression modelling. The strongest predictor of all behaviors was the initial level of the unsafe behavior. After controlling for this, weak effects of several health beliefs were found, including perceived susceptibility and medical efficacy. Men who became aware of a positive HIV-antibody test result and who reported greater effort to change their behavior were more likely to adopt safer insertive anogenital contact. In this generally well-educated cohort with high levels of knowledge about AIDS, adoption of safer sexual behaviors is best predicted from previous levels of unsafe behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Outcomes of a geriatric rehabilitation program in a long-term care facility.

This study investigated outcomes of geriatric rehabilitation and predictors of success among 81 consecutive admissions to a 40-bed rehabilitation unit in a long-term care facility. Predictors measured at admission included sociodemographic variables, functional status (both current and prior to illness), social contact, and self-motivation. In all, 62 patients (77%) successfully completed the rehabilitation program; 76% of the successes were discharged home. Failure to discharge successfully rehabilitated subjects was mainly due to placement problems and patient and family preference. Both of the success groups showed significant improvement in functional status (Barthel Index), while failures had poorer initial functional status, and showed no improvement on average. At six-month follow-up, functional status (measured by the Sickness Impact Profile) was similar in the two success groups. No predictors other than functional status were associated with rehabilitation success. Among the successes, better functional status at six months was predicted by aspects of self-motivation.

Aged↗
PubMed1988

Behavioral risk factors for HIV infection among homosexual men at a Boston community health center.

Social and behavioral factors associated with human immunodeficiency virus (HIV) infection were analyzed using cross-sectional data from homosexual and bisexual male clients of a Boston community health center. Partners from California, and a previous period of greater sexual activity (a "high period"), were independently associated with positive HIV antibody status, as were the frequency of receptive anogenital contact, both during the "high period" and during the last six months.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men.

This study assesses the effects of HIV (human immunodeficiency virus) antibody testing on subsequent (one year) sexual behavior among 270 homosexual men at a Boston community health center, 21 per cent of whom were unaware of their test result. Except for the number of steady partners, the levels of all sexual activities of all groups of study participants declined over time. No effects of test awareness of antibody status were found on protective behavior for receptive anogenital contact. Elimination of unprotected insertive anogenital contact (by elimination of the practice or by condom use) was reported somewhat more often among seropositive men who became aware of their test result. Increased negative emotional reactions were reported by HIV seropositive men who were aware of their test result. These results suggest some behavioral impact of HIV antibody test knowledge in this cohort, but may not be generalizable to other populations.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Association of electronic fetal monitoring during labor with cesarean section rate and with neonatal morbidity and mortality.

Data from the 1980 National Natality Survey by the National Center for Health Statistics were used to assess the relation of electronic fetal monitoring (EFM) during labor with cesarean section rates and neonatal morbidity and mortality. In univariate analyses, EFM was associated with higher cesarean section rates, lower five-minute Apgar scores, and a higher rate of respiratory distress. Logistic regression analysis controlling for other risk factors for poor neonatal outcome indicated that the association of EFM with higher cesarean section rates persisted (odds ratio 1.45, 95% CI 1.16, 1.81), except in certain pregnancies at very high risk for cesarean section. EFM was associated with an Apgar score less than 6 at five minutes only if delivery was by cesarean section. EFM was not found to be independently associated with respiratory distress. Neither univariate nor multivariate analyses found an association of EFM with neonatal mortality. These results suggest that EFM may identify hypoxic infants, who are frequently delivered by cesarean section. The lack of association of EFM with beneficial neonatal outcomes is consistent either with lack of effect of EFM or with uncontrolled selection bias.

Apgar Score↗
PubMed1988

Do HMOs reduce hospitalization of terminal cancer patients?

The ability of health maintenance organizations to contain the costs of their members' health care, largely through reduced hospitalization, has been documented. There are, however, no studies to investigate whether HMOs realize cost savings specifically for their terminally ill members. In this study, we examined hospital utilization and costs in a matched-pair comparison of HMO members and nonmembers under the age of 65 in Monroe County, New York, who died of cancer during 1976-1982. We found that the HMO members used somewhat fewer hospital days and had lower hospital costs than nonmembers, but the differences were not statistically significant. We also found significantly greater variance in the costs of care for nonmembers than for HMO members.

Costs and Cost Analysis↗
PubMed1987

Correlation of enzyme-linked immunosorbent assays for serum human immunodeficiency virus antigen and antibodies to recombinant viral proteins with subsequent clinical outcomes in a cohort of asymptomatic homosexual men.

A cohort of asymptomatic homosexual men at a Boston community health center was screened for the presence of human immunodeficiency virus (HIV) serum antigen and antibodies to recombinant proteins containing portions of the envelope and the gag (core) gene products. Of 196 asymptomatic men screened, 149 were antigen-negative/antibody-negative, 41 were antigen-negative/antibody-positive, and six were antigen-positive/antibody-positive. All three men in whom the acquired immune deficiency syndrome (AIDS) developed over the next year were antigen-positive at enrollment. Although a larger portion of the men who were antigen-positive and did not demonstrate progression to AIDS after one year had thrush, zoster, or generalized lymphadenopathy, the associations were not statistically significant. Whereas all of the seropositive men had antibody to viral envelope antigens, about a quarter did not have detectable antibodies to recombinant core antigens. However, all of these men had detectable antibody to core antigens by Western blot. Titers to recombinant core and envelope antigens tended to be lower in the men with AIDS. HIV-infected persons who are more likely to have enhanced immuno-compromise may be identified by these newer tests, but further longitudinal studies will be necessary to fully understand their prognostic value.

AIDS-Related Complex↗
PubMed1987

Effects of an expanding home care program for the terminally ill.

This study was a quasi-experimental time series design to test the hypothesis that an expanded program of home care for the terminally ill would reduce hospital utilization and costs of care during the last month of life. The data base was derived by comparing cancer deaths in persons less than 65 years of age over a 7-year period from a regional tumor registry against Blue Cross enrollment and claims files, to form claims histories for the last 6 months of life for 1,874 decedents who had made at least one claim during this period. Forty-six percent (46%) of the decedents had used home-care services, and a subgroup of high-intensity users was identified from daily home care charges during the last month of life. As the home care program expanded to provide more intensive home-hospice services, a trend was observed of greater cost savings among home-care users than among nonusers. These savings among users were achieved by a reduction in hospital days, and by a reduction in the mean daily cost of hospitalization. Home-care users also showed significantly less variability in costs than nonusers.

Adult↗
PubMed1986

Human T-lymphotropic virus type III in high-risk, antibody-negative homosexual men.

A cohort of 215 asymptomatic homosexually active men from a Boston community health center are being prospectively followed to assess the natural history of the human T-lymphotropic virus type III (HTLV-III) infection. To determine if certain asymptomatic persons who are HTLV-III antibody negative may be viremic, an algorithm was developed that defined high-risk characteristics (a sexual partner with the acquired immunodeficiency syndrome [AIDS]; more than 100 homosexual partners; or leukopenia, lymphopenia, neutropenia, or thrombocytopenia). Of 33 asymptomatic homosexual men who did not have antibody to HTLV-III and whose cases have not been previously reported, 2 had HTLV-III recovered from their lymphocytes. Clinical, behavioral, and hematologic data from seronegative persons did not distinguish between those with negative or positive viral cultures. Asymptomatic carriage of HTLV-III in high-risk seronegative persons underscores the need to base preventive educational strategies and behavioral modification on the assessment of risk factors and not solely on the results of HTLV-III antibody screening.

Acquired Immunodeficiency Syndrome↗
PubMed1985

A randomized controlled study of a home health care team.

This report describes the findings of a randomized study of a new team approach to home care for homebound chronically or terminally ill elderly. The team includes a physician, nurse practitioner, and social worker delivering primary health care in the patient's home, including physician house calls. Weekly team conferences assure coordination of patient care. The team is available for emergency consultation through a 24-hour telephone service. The team physician attends to the patient during necessary hospitalizations. This approach was evaluated in a randomized experimental design study measuring its impact on health care utilization, functional changes in patients, and patient and caretaker satisfaction. The team patients had fewer hospitalizations, nursing home admissions, and outpatient visits than the controls. They were more often able to die at home, if this was their wish. As expected, they used more in-home services, measured in weighted cost figures; their overall cost was lower than their controls, but the difference was not statistically significant. Their functional abilities did not change differently from the controls, but they, and especially their informal caretakers in the home, expressed significantly higher satisfaction with the care received.

Aged↗
PubMed1984

The terminal period of cancer: definition and descriptive epidemiology.

There is considerable current interest in the care of the terminally ill. This study provides information on the incidence, prevalence and duration of terminal cancer, and examines patient characteristics and patterns of care during the terminal care period (TCP). The data were derived from a retrospective study of 144 cancer deaths, utilizing information from physicians, medical records, and interviews with surviving relatives. It was estimated that 90% of all cancer deaths had a TCP, of average duration 94 days. Better functional status was associated with a longer TCP, and with spending a greater proportion of the TCP at home. Several areas of concern were noted in patterns of care, including use of a tumor-directed therapy during the TCP (in 18% of patients with a TCP) and the lack of face-to-face contact with the physician outside institutions, particularly as death approached.

Adult↗
PubMed1984

Lack of significant person-to-person spread of swine influenza-like virus following fatal infection in an immunocompromised child.

In February 1982, a four-year-old Nevada girl with acute lymphoblastic leukemia in remission was hospitalized with fulminant pneumonia and died eight days later at a hospital in California. An influenza virus was the only pathogen detected, and was present in both antemortem and postmortem specimens. The virus was closely related antigenically to A/New Jersey/8/76 (H1N1) and had a genome very similar to a contemporary enzootic swine influenza virus. The patient had had no known contact with swine, and the source of infection could not be determined. Only five possible secondary cases could be detected by retrospective investigation of 62 contacts, and there was no evidence of spread to the general community. Swine influenza viruses circulate among pigs in the United States annually, and it is likely that sporadic transmissions to humans will continue to be detected. Nevertheless, person-to-person spread under these circumstances appears to be limited.

Adolescent↗