Biomedical subjects

J McCusker

Publications and source records attributed to J McCusker.

97 records · Page 6Linked to original sources

PubMedDate not supplied

Use of condoms by heterosexually active drug abusers before and after AIDS education.

This study identified variables associated with increased condom use among drug abusers in a randomized trial of three AIDS educational programs in a short-term inpatient detoxification program. Participants (n = 301) completed baseline and follow-up interviews and were heterosexually active on both occasions. At baseline, 10% always, 24% sometimes, and 66% never used condoms, and this distribution changed only slightly at follow-up. Among the latter two groups, 21% increased their use. There was no differential intervention effect on changes in condom use. Women, but not men, were more likely to initiate condom use than to increase to consistent use with all partners, and to initiate use if they had multiple partners. Although beneficial attitudes and beliefs about condoms were more common among women at baseline, positive changes in these attitudes/beliefs were associated with increased condom use among men only. Among men, personal attitudes and beliefs were associated with increased condom use, while among women, perceptions of the attitudes of sexual partners were more important.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Awareness and use of hepatitis B vaccine among homosexual male clients of a Boston community health center.

Factors associated with awareness and acceptance of hepatitis B vaccine were identified among 150 homosexual male clients of a Boston community health center. Five percent of the subjects were unaware of hepatitis B and 25 percent had a history of hepatitis. Among the remaining 106 men, 68 percent were aware of the vaccine, and 25 percent of these had been vaccinated. Awareness of vaccine was associated with education beyond the baccalaureate level. Factors associated with vaccination included at least one prior visit to the health center, having health insurance, and extent of knowledge of the effects of hepatitis B. Among those not vaccinated, 68 percent would like to be but were deterred by the perceived high cost of the vaccine. The predominant reason given by the 31 percent who have decided not to be vaccinated was the perception that they were not at risk because of monogamous sexual relationships, or "safer" sexual practices. Strategies for maximizing vaccine use among homosexually active men should focus on increasing both awareness of the vaccine and appropriate perceptions of risk.

Adult↗

PubMedDate not supplied

Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men.

This study was undertaken to determine the reliability of self-reported sexual behavior using the test and retest technique when used with self-reported sexual behavior. The subjects were 116 asymptomatic homosexual men who participated in another study (an examination of behavioral and demographic determinants of HIV antibody status). The subjects were asked to complete two questionnaires. The first contained demographic and sexual behavior questions. The second, administered an average of 6 weeks later, used a subset of the questions in the first questionnaire. The reliability of the test-retest procedure was measured by the Kappa statistic, which assesses the proportion of agreement between two data items, accounting for the amount of agreement expected by chance. The highest degree of reliability as measured by Kappa was found with demographic information, smoking history, and sexual orientation. Self-reported sexual behaviors for the previous 6 months generally had the next highest degree of reliability as measured by Kappa. Questions examining change over the previous 5 years had the lowest reliability. Behavior changes during the time between questionnaires, subjectivity of the answer categories, and social desirability of the answers are three factors that may result in a lack of reliability in this self-reported sexual behavior questionnaire. This raises methodological concerns about the measurement of behavioral risk factors for AIDS and the ability to assess meaningfully subjective reports of behavioral change.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

The use of home care in terminal cancer.

In order to identify factors associated with the use of home care services and satisfaction with those services, interviews were conducted with 72 percent of the surviving relatives and 92 percent of the physicians of a random sample of 133 patients from the Rochester, New York, area who had died of cancer and who had been diagnosed at least two weeks before death. These interviews included a self-administered attitude questionnaire from which ten attitude-scale scores were derived. Forty-one percent of the sample had used organized home care services, almost all under a home-hospice program. In comparison with nonusers, home care users tended to be younger, married, to have a longer terminal care period, and to spend more of it at home. Relatives of patients who had used home care services, in comparison with relatives of nonusers, were less satisfied with the availability of care and reported that the patient had experienced more pain. This study also highlights problems in communication, particularly between the physician and the patients and their families, and the effects of home care on the families, especially the primary care-giver. In order for home care and home death to be viable options for a larger number of terminal cancer patients, family members need to be assured of around-the-clock availability of care, adequate pain control, and respite care to provide temporary relief from the burden of home care.

Adult↗

PubMedDate not supplied

Where cancer patients die: an epidemiologic study.

In a sample of deaths among cancer patients, the relationship of place of death to age, sex, length of time between diagnosis and death, cancer site, and patients' socioeconomic status was investigated. The Rochester (N.Y.) Regional Tumor Registry provided these data for all cancer patients who died in Monroe County, N.Y., during 1976, 1977, and 1978. Patients who had not been residents of the county were excluded from the sample, as were patients under 15 years of age at death and those whose cancers had been diagnosed only at autopsy. Analysis with a logit model was used to estimate odds ratios that compared the probabilities of death in an acute care hospital and in a chronic care facility with the probability of death at home. Patients whose cancers had been diagnosed less than 1 month before their deaths were significantly more likely to die in a hospital than were patients whose cancers had been diagnosed earlier. Cancer sites, too, were significantly related to place of death: persons with leukemia or lymphoma were most likely to die in a hospital, followed by patients with lung, breast, and upper gastrointestinal tract cancers; persons with colorectal, genitourinary, and miscellaneous cancers were most likely to die at home. The patients whose deaths were studied were classified by socioeconomic area (SEA) ranking. Patients who had resided in higher level SEAs were more likely to die at home than those from lower level SEAs; however, this trend was reversed among patients from the lowest level SEAs, who had a relatively high rate of death at home and a low rate of death in chronic care facilities.

Adolescent↗

PubMedDate not supplied

Increased leukemia, lymphoma, and spontaneous abortion in Western New York following a flood disaster.

The New York State Department of Health was asked in September 1978 of investigate a cluster of leukemias and lymphomas in a rural town in western New York State of less than 1,000 people. Four cases of these diseases had been diagnosed in the town's population in the previous 10 months. Residents were concerned about environmental hazards such as background radiation and contamination of their water supply. A total environmental study of the area was not feasible or warranted, but certain environmental studies of the area were conducted. No environmental health hazards were identified. Incidence rates for towns in the four-county area (population 281,000) surrounding the study town were analyzed, based on data from the New York State Cancer Registry. These four counties had been severely affected by the flood following the 1972 Hurricane Agnes. Examination of annual leukemia and lymphoma incidence rates for these counties for 1966--77 revealed that the rates for towns in the river valley (population 102,000), but not for nonriver-valley towns, were 20 to 50 percent above the statewide rates for 1972--77. All other cancer rates remained level throughout both periods. An analysis of spontaneous abortion rates for the four counties for 1968--77 showed a significant peak in 1973, but not for the rest of upstate New York. The peak was concentrated in the towns in the river valley. The apparent time-space cluster of leukemias and lymphomas in conjunction with a marked increase in the spontaneous abortion rate suggests an unidentified flood-related environmental exposure.

Abortion, Spontaneous↗

PubMedDate not supplied

Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.

The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.

Adolescent↗