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Biomedical subjects

L Miller

Publications and source records attributed to L Miller.

At least 37 records · Page 2Linked to original sources

Using the Colorado birth defects monitoring program to connect families with services for children with special needs.

BACKGROUND AND METHODS: The Community Notification and Referral Program (CNRP), which operates from within the state's birth defects monitoring and prevention program, links children and their families with local public health and early childhood agencies, which then inform families of services and resources in their home communities. In Colorado, many communities have developed systems for identifying, screening, evaluating, and providing services to children with developmental delays or other special needs. CNRP uses the existing infrastructure of services for children with special needs by notifying local community programs of children reported to the birth defects program with birth defects, developmental disabilities, or risks for developmental delay. Children to be referred to local agencies are identified from the birth defects registry on the basis of diagnosis and residence. Minor or lethal conditions are excluded from referral. CNRP provides the child's name, date of birth, address, phone, guardian, diagnoses, date and source of diagnosis, and length of stay to the local agency. A parental consent process is used under some circumstances. RESULTS: CRCSN analyzed data from 1621 children referred to local agencies in 1998. The local agencies contacted 34.1% of the families and referred 46.9%. of those contacted to early intervention, developmental, evaluation, or other services. They determined that 29.5% could definitely or moderately benefit from developmental services. In a telephone survey of families, 65.4% said they had learned about services, resources, or developmental screening about which they had not been aware. CONCLUSION: CRCSN has developed a notification and referral program to link families with services for children with special needs that could serve as a model for other birth defects registries.

Adolescent↗

Differential effects of unilateral lesions on language production in children and adults.

We present the first direct comparison of language production in brain-injured children and adults, using age-corrected z scores for multiple lexical and grammatical measures. Spontaneous speech samples were elicited in a structured biographical interview from 38 children (5-8 years of age), 24 with congenital left-hemisphere damage (LHD) and 14 with congenital right-hemisphere damage (RHD), compared with 38 age- and gender-matched controls, 21 adults with unilateral injuries (14 LHD and 7 RHD), and 12 adult controls. Adults with LHD showed severe and contrasting profiles of impairment across all measures (including classic differences between fluent and nonfluent aphasia). Adults with RHD (and three nonaphasic adults with LHD) showed fluent but disinhibited and sometimes empty speech. None of these qualitative or quantitative deviations were observed in children with unilateral brain injury, who were in the normal range for their age on all measures. There were no significant differences between children with LHD and RHD on any measure. When LHD children were compared directly with LHD adults using age-corrected z scores, the children scored far better than their adult counterparts on structural measures. These results provide the first systematic confirmation of differential free-speech outcomes in children and adults and offer strong evidence for neural and behavioral plasticity following early brain damage.

Adult↗

Increased depot medroxyprogesterone acetate use increases family planning program pharmaceutical supply costs.

To measure the use rates of depot medroxyprogesterone acetate and oral contraceptives and compare the costs between the two methods to see whether these trends had impacted the pharmaceutical acquisition costs for a family planning program, we compared vendor invoice costs over three time periods, 1992, 1994, and 1999. Visit types and client demographic statistics were tabulated from existing encounter record data sources. A local pharmaceutical chain was queried about their acquisition costs for similar products. Since 1992, depot medroxyprogesterone acetate use has increased from 3 to 17% while oral contraceptive use has decreased from 45 to 40% of contraceptive clients. The cost to our program for depot medroxyprogesterone acetate is $4.75 for 28 days and the average pill package is purchased for $1.35. The cost to our program is 4 times greater for the injection contraceptive user than for the oral contraceptive user. Approximately 80% of our clients have household incomes less than 200% of the poverty level and obtain their services from our program for free. This combination of increasing popularity and the high cost of depot medroxyprogesterone acetate has resulted in a great increase in the pharmacy acquisition cost. The oral contraceptive manufacturers make their products available at large discounts (20-fold reduction), but depot medroxyprogesterone acetate is not provided at a similar discount (2.8-fold reduction). We believe this is because there is no generic or competing product. The high cost of depot medroxyprogesterone acetate could jeopardize our ability to offer this highly effective method of birth control to all women.

Community Health Services↗

Internet availability of contraceptives.

OBJECTIVE: To measure the accessibility of contraceptive supplies over the Internet. METHODS: We performed an Internet search with the use of search engines and key words. We posed as consumers purchasing both prescription and over-the-counter contraceptive supplies. The number of clicks or web pages accessed, costs, shipping time, barriers to access, and prescription requirements were compared for selected birth control supplies. RESULTS: More than 200 web sites were visited to locate at least one site where we could purchase each selected product. Contraceptive supplies, including male and female condoms, spermicides, vaginal sponges, intrauterine devices (IUDs), diaphragms, and cervical caps, were easily obtained without a prescription from foreign web sites. Oral contraceptive pills (OCs) were readily available online in November 1999; some sites had discontinued sales by February 2000, but OCs could still be purchased with no prescription in August 2000. None of the four prescription sites supplied physician or prescriber credentials. The contraceptive costs varied by vendor and product. A type of copper IUD could be purchased for less than $50.00, whereas a single package of emergency contraceptive pills cost $141.00 from one vendor because of prescription and shipping fees. Some emergency contraceptive pills ordered arrived after 72 hours or did not arrive and the purchase was not refunded. A levonorgestrel IUD was shipped without difficulty in December 1999, but a second device, ordered in February 2000, was temporarily impounded by United States Customs. CONCLUSION: This method of contraceptive purchase is accessible, expensive, erratically regulated, and rapidly changing.

Contraceptive Agents↗

Fruit size as a model for teaching first trimester uterine sizing in bimanual examination.

OBJECTIVE: To examine a commonly used fruit-comparison model for teaching uterine sizing by bimanual examination, to compare the sizes of actual fruits with published first trimester uterine ultrasound measurements, and to estimate the degree of provider agreement with this model. METHODS: Actual fruits (pears, juice oranges, navel oranges, and grapefruits) were measured. Published ultrasound measurements of first trimester pregnant uteri were compared with the fruit measurements. A questionnaire was developed and sent to a community-based sample of 300 women's healthcare providers selected from a local medical society roster of obstetrician-gynecologists and a local reproductive healthcare provider list. RESULTS: One hundred twelve (37%) of 300 questionnaires were returned. Of these respondents, 55% were medical doctors, 41% nurse-practitioners, and 4% midwives. Overall, 75% of respondents agreed (responded either "Agree" or "Strongly agree") that a nonpregnant or 5-week pregnant uterus feels like a small, unripe pear. Sixty-one percent agreed that a 6-week pregnant uterus feels like a small (juice) orange. Eighty percent agreed that an 8-week pregnant uterus feels like a large (navel) orange. Eighty-one percent expressed agreement that a 12-week pregnant uterus feels like a grapefruit. CONCLUSION: The degree of provider agreement with the fruit-based teaching model indicates potential utility of the model.

Data Collection↗

Menstrual reduction with extended use of combination oral contraceptive pills: randomized controlled trial.

OBJECTIVE: To compare a traditional 28-day cycle to an extended 49-day cycle of the 30 microg ethinyl estradiol (E2)/300 microg norgestrel monophasic birth control pill regimen. METHODS: Ninety subjects randomized to either 28-day cycles with 21 active pills or 49-day cycles with 42 active pills for a prospective open label trial over four 84-day reference periods or trimesters. Bleeding, pill taking, and symptom diaries were completed. The sample size with 80% power to detect a 40% reduction in bleeding days required 24 subjects in each arm. RESULTS: Of the 90 women, 24 subjects (54.5%) on the 28-day cycle and 29 (63%) on the 49-day cycle completed the entire study (P =.41). There were no statistically significant differences between the two groups in demographics or continuation rates. There was a significant reduction in bleeding days in the experimental arm beginning in the first trimester (28-day = 10.9, 49-day = 6.4 mean days of bleeding, P <.001) and continuing to the fourth trimester (28-day = 11.3, 49-day = 5.8 mean days, P =.005). The number of spotting days was similar between both schedules in the first trimester (28-day = 4.8, 49-day = 3.7 mean days, P =.24) and continued into the fourth trimester (28-day = 3.4, 49-day = 2.9 mean days, P =.30). Annual expenditure for hygiene products was significantly less for extended use subjects (28-day = $41.45, 49-day = $17.54 spent, P <.001). CONCLUSION: Extension of the 28-day oral contraceptive (OC) cycle to a 49-day cycle resulted in fewer bleeding days and no increase in mean spotting days or bleeding episodes.

Adult↗

Religiousness and substance use in children of opiate addicts.

PURPOSE: To investigate among children of opiate addicts a potential protective effect of religiousness (broadly defined in the literature to include religious beliefs, practice, and tradition) against onset of substance use. METHODS: Subjects were 161 opiate-addicted biological parents recruited from methadone maintenance programs in the New York metropolitan area, their 279 children, and 63 non-opiate-addicted parents with whom the child had daily contact. Childhood onset of substance use was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS); parental DSM-III-R diagnosis of opiate addiction was assessed using the SADS-Lifetime Version (SADS-L). RESULTS: Religiousness in children of opiate addicts was associated with a substantially decreased likelihood of onset of substance use. Parent-child concordance of religiousness showed additional protective qualities with respect to religious denomination in opiate-addicted parent and with respect to the personal importance of religion and frequent attendance of religious services in non-opiate-addicted parents. CONCLUSION: Religiousness protects against substance use among children of opiate addicts.

Adolescent↗

Role of vascular remodeling in the pathogenesis of early transplant coronary artery disease: a multicenter prospective intravascular ultrasound study.

BACKGROUND: Luminal narrowing in transplant coronary artery disease is thought to be primarily caused by intimal proliferation, and the role of vascular remodeling is less certain. METHODS AND RESULTS: We studied cardiac allografts from 83 prospectively recruited patients immediately and 1 year after transplant using intravascular ultrasound in a multicenter study. We measured coronary artery dimensions in 310 angiographically matched segments (175 were also fully matched by ultrasound criteria). At 1 year, lumen area changed by -1.8 +/- 3.7 mm(2) (p < 0.0001, 14% of baseline lumen area). Thirty-three percent of this luminal loss was due to intimal thickening and 67% to vessel shrinkage. Shrinkage also occurred (-0.9 +/- 3.2 mm(2), 7% of baseline total area) in segments free of detectable intimal disease at baseline and at 1 year. Using the mean baseline total vessel area (13.9 mm(2)) as the cutoff, we divided the cohort into the large and the small coronary-segment groups. The large-segment group (n = 176) shrank more (-2.6 +/- 4.4 vs. -0.03 +/- 2.8 mm(2), p < 0.0001), but intimal growth was similar in both groups (0.8 +/- 2.2 vs. 0.4 +/- 1.3 mm(2), p = not significant). Analysis of the 175 fully ultrasound matched sub-cohort showed similar results. Changes in intimal area, total vessel area, and lumen area were similar in segments with (n = 132) and segments without (n = 178) pre-existing donor disease. Despite overall shrinkage, change in total vessel area positively correlated with change in intimal area (r = 0.29, p < 0.0001). CONCLUSION: In large coronary segments, coronary artery shrinkage plays an important role in the loss of luminal diameter early after cardiac transplantation, whereas new intimal growth occurs in both large and small segments. Pre-existent donor disease does not aggravate these processes. Compensatory remodeling with increasing intimal growth retards the rate of lumen loss. As is intimal thickening, shrinkage and compensatory remodeling are important pathogenic mechanisms in transplant coronary artery disease.

Adult↗

Effect of training with the american college of radiology breast imaging reporting and data system lexicon on mammographic interpretation skills in developing countries.

RATIONALE AND OBJECTIVES: The authors evaluated the effect of training in the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) lexicon on the interpretive skills of radiologists evaluating screening mammograms in Ukraine. MATERIALS AND METHODS: As part of a program to improve breast cancer detection and treatment in Ukraine, a series of training sessions was given to a group of radiologists across Ukraine to improve their interpretive skills in screening mammography. The training sessions focused on the use of the lexicon and assessment categories developed by the ACR BI-RADS committee. Participants (n = 14) evaluated 30 test screening mammograms before and after the training sessions. The test sets were randomly selected from a larger collection of training sets containing normal, benign, and abnormal mammograms. False-positive, false-negative, true-positive, and true-negative evaluations were determined, and sensitivity, specificity, and positive predictive values were calculated for each participant before and after training. RESULTS: The mean baseline sensitivity, specificity, and positive predictive values were 50%, 77%, and 43%, respectively. Each of these measures of interpretive skills improved significantly after training in the use of the lexicon, to 87%, 89%, and 78% (P < .0001, P < .01, and P < .0001, respectively). CONCLUSION: As the use of mammography spreads throughout developing countries, it is essential to address training and educational needs, as well as equipment needs. The ACR BI-RADS lexicon provides a systematic and efficient method for training radiologists to interpret screening mammograms. Educating radiologists on the use of this lexicon proved an effective way to improve their interpretive skills in screening mammography.

Clinical Competence↗

Determination of 4,4'-dinitrocarbanilide (DNC), the active component of the antifertility agent nicarbazin, in chicken, duck, and goose plasma.

4,4'-Dinitrocarbanilide (DNC) was extracted from chicken, duck, and goose plasma and isolated by reversed-phase high-performance liquid chromatography. DNC was detected by ultraviolet absorbance at 347 nm and quantified by comparison to a calibration standard. Recovery data were determined by analyzing DNC-fortified control plasma. The mean recovery of DNC in fortified chicken plasma samples was 99.7 +/- 1.9% for 0.18 and 9.1 ppm DNC, and in fortified duck and goose plasma samples was 99.5 +/- 4.9% and 101.4 +/- 4.5%, respectively, for 0.18, 9.1, and 18 ppm DNC.

Animals↗

A multivariate analysis of the revised Conners' Teacher Rating Scale with low-income, urban preschool children.

The present investigation addressed the utility of the revised Conners' Teachers Rating Scale (CTRS-28) with low-income urban preschool children. CTRS-28 ratings for a large sample of preschool children from an urban Head Start program were analyzed using exploratory factor analysis. Analyses yielded a 3-factor structure: Conduct problems, Hyperactivity, and Passivity. Further analyses cross-validated this structure for males and females and supported its integrity. Multimethod, multisource validity analyses substantiated the CTRS-28 dimensions. The Play Disruption factor of the parent and teacher Penn Interactive Peer Play Scales (PIPPS) provided convergent validity for the Conduct and Hyperactivity factors of the CTRS-28, whereas the Play Interaction factor revealed divergent validity. The Play Disconnection factor of the PIPPS validated the CTRS-28 Passivity factor. The Q-Sort Emotional Regulation scale provided divergent validity for the Conduct and Hyperactivity factors and likewise the Q-Sort Autonomy scale provided divergent validity for the Passivity factor. Age and sex differences were assessed across the 3 factors of the derived preschool structure. A main effect was found for sex and age indicating that boys displayed higher levels of Hyperactivity and Passivity problems than girls did. Similarly, 4-year-old children demonstrated higher levels of Passivity problems than did 5-year-old children.

Black or African American↗

Oral administration of naturally occurring coumarins leads to altered phase I and II enzyme activities and reduced DNA adduct formation by polycyclic aromatic hydrocarbons in various tissues of SENCAR mice.

Several naturally occurring coumarins, to which humans are routinely exposed in the diet, were previously found to inhibit P450-mediated metabolism of benzo[a]pyrene (B[a]P) and 7,12-dimethylbenz[a]anthracene (DMBA) in vitro, block DNA adduct formation in mouse epidermis and inhibit skin tumor initiation by B[a]P and/or DMBA when applied topically to mice. The present study was designed to investigate the effects of two of these compounds, of the linear furanocoumarin type, when given orally (70 mg/kg per os, four successive daily doses), on P450 and glutathione S-transferase (GST) activities and DNA adduct formation by B[a]P and DMBA in various mouse tissues. Imperatorin and isopimpinellin significantly blocked ethoxyresorufin O-deethylase (EROD) and pentoxyresorufin O:-dealkylase (PROD) activities in epidermis at 1 and 24 h after oral dosing. Imperatorin and isopimpinellin modestly inhibited EROD activities in lung and forestomach at 1 h and significantly inhibited PROD activities in lung and forestomach at 1 h after the final oral dose. Twenty-four hours after the final oral dose of imperatorin or isopimpinellin EROD and PROD activities remained inhibited in epidermis and lung. However, forestomach P450 activity had returned to control levels. Interestingly, imperatorin and isopimpinellin treatment inhibited liver EROD activity at 1 h, had no effect on PROD activity at this time point, but elevated both these enzyme activities at 24 h. Elevated EROD and PROD activities coincided with elevated hepatic P450 content. Imperatorin and isopimpinellin treatment also increased liver cytosolic GST activity at both 1 and 24 h after the final oral dose by 1.6-fold compared with corn oil controls. Oral administration of imperatorin and isopimpinellin also had a protective effect against DNA adduct formation by B[a]P and DMBA. Imperatorin pretreatment decreased formation of DNA adducts by DMBA in forestomach. Pretreatment with isopimpinellin led to reduced DNA adduct levels in liver (B[a]P), lung (B[a]P) and mammary epithelial cells (DMBA). These results suggest that imperatorin and isopimpinellin may have potential chemopreventive effects when administered in the diet.

9,10-Dimethyl-1,2-benzanthracene↗

Effect on polymorphonuclear cell function of a human-specific cytotoxin, intermedilysin, expressed by Streptococcus intermedius.

Streptococcus intermedius is a member of the normal flora of the mouth but is also an opportunistic pathogen associated with purulent infections at oral and nonoral sites. Intermedilysin (ILY) has been shown to be a cytolysin capable of generating pores in the cell membrane of erythrocytes demonstrable by electron microscopy. This effect has been shown to be specific for human cells. Since polymorphonuclear cells (PMNs) are the main cell involved in innate immunity we investigated the effect of purified intermedilysin from Streptococcus intermedius on PMN function. Active ILY at a concentration of 40 ng/microl caused a significant decrease in the number of intact PMNs after 60 min. The active cytolysin, when compared with heat-inactivated ILY, did not appear to be chemotactic for the PMNs but did cause an increase in intracellular calcium, with increased cell surface CD11b expression, metabolic burst, and phagocytosis of Staphylococcus aureus. These findings may have implications for the role of ILY in deep-seated abscesses.

Bacterial Proteins↗

Papillomavirus type 16 oncogenes downregulate expression of interferon-responsive genes and upregulate proliferation-associated and NF-kappaB-responsive genes in cervical keratinocytes.

Infection with high-risk human papillomaviruses (HPV) is a major risk factor for development of cervical cancer. Expression of the HPV E6 and E7 oncoproteins increases in differentiating keratinocytes, resulting in inactivation of the p53 and retinoblastoma proteins, two important transcriptional regulators. We used cDNA microarrays to examine global alterations in gene expression in differentiating cervical keratinocytes after infection with retroviruses encoding HPV type 16 (HPV-16) E6 and E7. Expression of 80 cellular genes (approximately 4% of the genes on the array) was altered reproducibly by E6 and/or E7. Cluster analysis classified these genes into three functional groups: (i) interferon (IFN)-responsive genes, (ii) genes stimulated by NF-kappaB, and (iii) genes regulated in cell cycle progression and DNA synthesis. HPV-16 E6 or a dominant negative p53 protein downregulated multiple IFN-responsive genes. E6 decreased expression of IFN-alpha and -beta, downregulated nuclear STAT-1 protein, and decreased binding of STAT-1 to the IFN-stimulated response element. E7 alone was less effective; however, coexpression of E6 and E7 downregulated IFN-responsive genes more efficiently than E6. The HPV-16 E6 protein also stimulated expression of multiple genes known to be inducible by NF-kappaB and AP-1. E6 enhanced expression of functional components of the NF-kappaB signal pathway, including p50, NIK, and TRAF-interacting protein, and increased binding to NF-kappaB and AP-1 DNA consensus binding sites. Secretion of interleukin-8, RANTES, macrophage inflammatory protein 1alpha, and 10-kappaDa IFN-gamma-inducible protein were increased in differentiating keratinocytes by E6. Thus, high-level expression of the HPV-16 E6 protein in differentiating keratinocytes directly alters expression of genes that influence host resistance to infection and immune function.

Cell Cycle↗

Knowledge and use of folic acid supplementation: a study of Colorado women whose pregnancies were affected by a fetal neural tube defect.

OBJECTIVES: To determine whether women who have ha da pregnancy in which the fetus is affected by a neural tube defect (NTD) know of current folic acid recommendations; whether the recommendations are followed before or during the pregnancy associated with an NTD and subsequent pregnancies; and to insure that women who have had an NTD-affected pregnancy have access to proper information about NTDs and folic acid recommendations. METHODS: Women living in Colorado who had a pregnancy in 1996 or 1997 in which the fetus had an NTD were interviewed in 1998 about their knowledge and use of folic acid supplementation. RESULTS: Twenty-one of 42 eligible women were interviewed. All women first learned of the folic acid recommendations either during or after their affected pregnancy. Only 23.8% of the women took vitamins containing folic acid during the 1 to 3 months before becoming pregnant. None who had a subsequent pregnancy followed the recommendation to consume 4.0 mg/d of folic acid, beginning at least 1 month before conception. Women who had subsequent pregnancies became pregnant on average of 9 months after their affected pregnancy ended. CONCLUSIONS: Most women who have an NTD-affected pregnancy are unaware of the national folic acid recommendations and do not follow these recommendations for subsequent pregnancies. However, such women are receptive to information about folic acid supplementation. Health care providers and public health officials should consider their role in assuring that education is provided in an effective and timely manner to women with NTD-affected pregnancies.

Adolescent↗

Not just malingering: syndrome diagnosis in traumatic brain injury litigation.

When patients present with syndromes we mistrust or misunderstand, clinician are often quick to make a determination of malingering. However, the use of malingering as a default diagnosis neglects a variety of clinical possibilities that may be relevant for treatment and forensic disposition. In neuropsychology, the growing use of a malingering diagnosis has recently been fueled by the increasingly adversarial nature of forensic brain injury litigation in which the goal is often less to provide an objective evaluation of cognition and personality as to brand all personal injury claimants as manipulative frauds. Less maliciously, but still disturbing, neuropsychologists whose knowledge base and clinical experience involves mainly the administration and scoring of psychometric tests may ignorantly, if innocently, overlook alternative diagnoses and syndromes that their education and training have ill-prepared them to recognize. And some patients do indeed malinger, and it is important to identify them, if only to spare legitimately injured claimants from being tarred with the same brush. This paper describes some of the syndromes that may present in clinical and forensic practice with brain-injured patients. It is to be considered a first step toward a practice model of neuropsychology that encourages the role of knowledge and clinical judgement in guiding the meaningful clinical interpretation of tests and measures.

Brain Concussion↗

Electrochemically controlled hydrogen bonding. o-Quinones as simple redox-dependent receptors for arylureas.

9,10-Phenanthrenequinone and acenaphthenequinone are shown to act as simple redox-dependent receptors toward aromatic ureas in CH(2)Cl(2) and DMF. Reduction of the o-quinones to their radical anions greatly increases the strength of hydrogen bonding between the quinone carbonyl oxygens and the urea N-hydrogens. This is detected by large positive shifts in the redox potential of the quinones with no change in electrochemical reversibility upon addition of urea guests. Cyclic voltammetric studies with a variety of possible guests show that the effect is quite selective. Only guests with two strong hydrogen donors, such as O-H bonds or amide N-H bonds, that are capable of simultaneously interacting with both carbonyl oxygens give large shifts in the redox potential of the quinones. The electronic character and conformational preference of the guest are also shown to significantly affect the magnitude of the observed potential shift. In the presence of strong proton donors the electrochemistry of the quinone becomes irreversible indicating that proton transfer has taken place. Experiments with compounds of different acidity show that the pK(a) of the protonated quinone radical is about 15 on the DMSO scale, >4 pK(a) units smaller than that of 1,3-diphenylurea. This is further proof that hydrogen bonding and not proton transfer is responsible for the large potential shifts observed with this and similar guests.

Electrochemistry↗

Is 'knowing people with HIV/AIDS' associated with safer sex in men who have sex with men?

OBJECTIVE: To examine the sexually protective role of knowing person(s) with HIV/AIDS (PWHA) by conducting a multidimensional analysis distinguishing the number of PWHA known (by disease status and relationship category) and aspects of the relationship with the closest PWHA (emotional closeness, length of time known, disease status, type of relationship). DESIGN: Cross-sectional study of white, Latino, and African-American men who have sex with men recruited at street locations in West Hollywood, California, in 1997. METHODS: The analyses conducted with linear regression models focused on men (n = 334) who reported that they were seronegative or of unknown serostatus and thus at risk for HIV infection. Unprotected sex was defined as percentage of anal intercourse partners in the past 12 months with whom unprotected anal intercourse (UAI) occurred at least once. RESULTS: The number of PWHA known was not associated with the percentage of UAI partners in multivariate or univariate analyses. Greater emotional closeness to a person who was HIV-positive without AIDS was associated with reduced UAI in multivariate models even after excluding participants whose close PWHA was a lover or sex partner. Younger men (18-25 years) knew fewer PWHA, reported less emotional closeness to a PWHA, and had a higher level of UAI than did older men. CONCLUSIONS: Emotional closeness to a seropositive person without AIDS may be a sexually protective factor. The results suggest the possibility that lower levels of emotional closeness to a PWHA may partially underlie the elevated sexual risk behavior of younger men who have sex with men.

Adolescent↗