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Biomedical subjects

R E Booth

Publications and source records attributed to R E Booth.

At least 19 recordsLinked to original sources
PubMed1997

Conduct disorder and HIV risk behaviors among runaway and homeless adolescents.

This study was designed to assess the prevalence of conduct disorder (CD) among runaway and homeless adolescents and to investigate associations between CD and HIV risk behaviors. The Diagnostic Interview Schedule for Children and a standardized HIV risk assessment questionnaire were administered to 219 runaway and homeless adolescents recruited from a drop-in center serving high-risk youth. One-half of the males and 60% of the females were diagnosed with CD. In multivariate analyses, CD was the strongest predictor of lifetime use of heroin and/or cocaine and exchanging sex for money, drugs, food or shelter, as well as the number of drugs used and the number of sex partners in the 3 months preceding the interview. The high rate of CD in this population, and the association between CD and both drug and sex-related HIV risk behaviors, indicate a need for interventions that consider the influence of this psychiatric diagnosis on high-risk behaviors.

Adolescent↗
PubMed1997

Prevalence of sexual risk behaviour and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City.

We aim to assess the prevalence of HIV sexual risk behaviours and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City. Survey data were examined from 775 runaway and homeless adolescents recruited from street settings and youth agencies during 1992/1993. Nearly all (98%) reported having engaged in sexual intercourse, of whom 49% first had intercourse by the age of 13. Condom use during all vaginal intercourse in the previous 3 months was reported by 42%. Among males, 23% indicated that they had exchanged sex for money, as did 14% of the females. Ninety-seven per cent had used alcohol or drugs and 21% had injected drugs. Overall, 75% reported having had sex while under the influence of alcohol or drugs. Systematic epidemiological studies of this population and the development of innovative interventions are essential to reduce the threat of HIV among runaway and homeless youth.

Adolescent↗
PubMed1997

Simultaneous bilateral versus unilateral total knee arthroplasty. Outcomes analysis.

One hundred consecutive, primary simultaneous bilateral total knee arthroplasties were prospectively compared with 100 consecutive, primary unilateral total knee arthroplasties in reference to relative risk, complications, cost, and need for rehabilitation. All procedures were performed using identical preoperative, intraoperative, and postoperative protocols. Postoperative confusion was approximately four times greater in the simultaneous bilateral total knee arthroplasties group (29% versus 7%), which was thought to represent an increased incidence of fat embolism. Cardiopulmonary complications were approximately three times greater after simultaneous bilateral total knee arthroplasties (14% versus 5%), and most commonly involved arrhythmias. The increased stress on the cardiopulmonary system with simultaneous bilateral total knee arthroplasties may make this procedure contraindicated in certain patients with preexisting disease. There was an approximately 17 times greater need for banked blood in the simultaneous bilateral total knee arthroplasties group (17% versus 1%), which is alarming given the persistent concerns of transfusion related disease transmission. Although the length of hospitalization was similar (6.4 days simultaneous bilateral total knee arthroplasties versus 6 days unilateral total knee arthroplasty), 89% of the patients in the simultaneous bilateral total knee arthroplasties group required a rehabilitation stay versus 45% of the patients in the unilateral total knee arthroplasty group. Total hospital charges averaged $53,168 for simultaneous bilateral total knee arthroplasties versus $32,598 for unilateral total knee arthroplasty. Total rehabilitation charges were similar. The relative cost savings implicit by doing simultaneous bilateral total knee arthroplasties seem to be at least partially offset by the approximately two times greater need for rehabilitation in this group. The true safety, efficacy, relative risk, and total cost analysis of simultaneous bilateral total knee arthroplasties demands further critical evaluation.

Adult↗
PubMed1996

The prevalence of additional injection-related HIV risk behaviors among injection drug users.

SUMMARY: This study assesses the prevalence of injection-related behaviors that may facilitate HIV transmission even when syringes are not directly shared. Subjects who self-reported practicing these "indirect sharing" behaviors are described, the prevalence of these behaviors are compared with the direct sharing of syringes, and variables independently associated with indirect sharing are determined. Injection-related risks were assessed among 585 injection drug users (IDUs) in Denver, Colorado. Respondents were classified into three groups based on their self-reported injection behaviors: IDUs who directly and indirectly share syringes, IDUs who indirectly share only, and IDUs who neither directly or indirectly share. Indirect sharing was twice as prevalent as direct sharing. IDUs who injected heroin or speedballs were less safe in their injection behavior than those who did not. Drug treatment did not protect against injection-related risk behaviors; however, exposure to community HIV prevention efforts was protective. Indirect sharing behaviors are common, yet their link to HIV transmission remains unrecognized by many IDUs. IDUs must be informed about these additional risk behaviors.

Adolescent↗
PubMed1996

Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users.

This study was designed to assess the effect of client characteristics and community interventions on treatment entry and retention, and to evaluate the relative effectiveness of treatment, compared to other interventions, in reducing drug use and crime among out-of-treatment opiate injectors. Subjects (N = 2973) from 15 cities were randomly assigned to: standard intervention (SI)-HIV testing and counseling; or enhanced intervention (EI)-SI plus additional educational sessions stressing responsible drug use. EI in some cities included staff assistance with treatment admission (i.e. "active' referral). All locations provided intervention by community outreach workers. Factors positively associated with treatment entry included: prior treatment, intervention by community workers, assignment to the EI, not injecting cocaine, injecting opiates, and fewer program interventions received. Sites where the EI included active referral achieved significantly higher treatment entry rates than sites where the EI did not. Findings supported the efficacy of treatment over other interventions in reducing drug use and arrests, the addition of staff assistance to facilitate clients' entry into treatment, and the involvement of community outreach workers in achieving treatment entry.

Adult↗
PubMed1996

Radiographic cost reduction strategy in total joint arthroplasty. A prospective analysis.

A consecutive series of 222 patients who underwent cemented total knee arthroplasty (124) and uncemented total hip arthroplasty (98) were evaluated prospectively. The purpose of this study was to determine if routine radiologic interpretation of postoperative total hip and total knee radiographs is cost effective. Also, the study was designed to determine if routine predischarge radiographs, in conjunction with recovery room radiographs, are worthwhile. There were no changes in postoperative patient management based on orthopaedic or radiologic review of either radiograph. No additional information was gained from review of the radiologic evaluations. Therefore, obtaining one series of routine inpatient postoperative total joint radiographs and eliminating postoperative radiologic consultation will significantly reduce costs without compromising patient care.

Cost Savings↗
PubMed1996

The Coventry Award. Polymerase chain reaction detection of bacterial infection in total knee arthroplasty.

Synovial fluid aspirates from 50 patients with symptoms after total knee arthroplasty were analyzed by means of the polymerase chain reaction for the presence of bacterial deoxyribonucleic acid indicative of infection. Synovial fluid specimens were processed using a rapid bacterial lysis and extraction protocol, subjected to polymerase chain reaction amplification using universal bacterial primers, and polymerase chain reaction products analyzed by deoxyribonucleic acid hybridization methodology. Polymerase chain reaction testing on preoperative aspirates yielded 32 specimens positive for bacterial infection. Standard microbiologic culturing assays performed on the same samples gave 6 positive bacterial infection tests; intraoperative culturing identified 9 additional infected specimens. All culture positive specimens were polymerase chain reaction positive; in contrast, there were no false polymerase chain reaction positives in 21 negative control specimens obtained from aseptic joints. The synovial fluid processing protocol and polymerase chain reaction analysis can be performed with a minimum of time and may provide greater sensitivity than standard diagnostic tests. In view of the high incidence of false negative test results from standard microbiologic assays of synovial fluid specimens, the use of molecular biology based bacterial detection methodology should provide an additional, or alternative, assay to identify infected patient specimens.

Awards and Prizes↗
PubMed1996

Severe aggression and related conduct problems among runaway and homeless adolescents.

OBJECTIVE: The study assessed the prevalence of severe aggressive behavior and conduct disorder in a population of runaway and homeless adolescents and examined relationships between aggression, conduct disorder, other problem behaviors, and background characteristics. METHODS: A total of 219 runaway and homeless youths recruited through a urban drop-in center were surveyed using the Adolescent Health Survey, a questionnaire about background and mental health experiences, and the revised version of the Diagnostic Interview Schedule for Children. RESULTS: More than half of study participants met criteria for conduct disorder, and 62 percent reported a history of severe aggressive behavior. Although these constructs were related to each other, a third of the subjects met criteria for only one. Childhood sexual abuse was associated with conduct disorder, while living in a home where drugs were used was associated with aggression. Severe aggressive behavior was associated with other problem behaviors, including attempted suicide, behavior that precipitated residential psychiatric treatment, pregnancy, arrests, and convictions. CONCLUSIONS: The assessment and systematic treatment of conduct disorder and aggression among runaway and homeless youths is urgently needed to reduce the effects of the disorder and associated problem behaviors.

Adolescent↗
PubMed1996

Comparative risk of early postoperative pulmonary embolism after cemented total knee versus total hip arthroplasty with low-dose warfarin prophylaxis.

Four hundred thirteen cemented total hip arthroplasties and 852 cemented total knee arthroplasties were evaluated prospectively for postoperative pulmonary embolism. Inclusion criteria were a diagnosis of osteoarthritis, age 50 to 75 years old, cemented primary arthroplasty, and prophylaxis with low-dose warfarin (Coumadin, DuPont Pharma, Wilmington, Delaware). All patients underwent a preoperative perfusion scan and postoperative ventilation perfusion scan with all moderate probability scans evaluated with arteriogram. The overall incidence of pulmonary embolism was 3.8% after cemented total hip arthroplasty and 5.6% after cemented total knee arthroplasty. Because of a weight bias, patient age, weight, and gender-matched comparison was performed. Two hundred eighty-two patients from each group were matched with identical age, weight, and gender. The incidence of postoperative pulmonary embolism was 4.3% for total hip arthroplasty and 4.6% for total knee arthroplasty. These results do not support the contention that pulmonary embolism is higher after total hip arthroplasty than after total knee arthroplasty.

Aged↗
PubMed1995

Development of a novel, rapid processing protocol for polymerase chain reaction-based detection of bacterial infections in synovial fluids.

We describe the development of a molecular detection system designed for use with synovial fluid (SF)-based infections. The methodology employs a lysis/extraction procedure that effectively disrupts microorganisms allowing for release of the microbial DNA and its amplification by polymerase chain reaction (PCR). We tested the effectiveness of adding a mixed-bed, ion-exchange resin to the extract to remove PCR inhibitory components present in the SF. After centrifugation to separate the resin, DNA contained in the supernatant is subjected to PCR using oligonucleotide primers designed for broad-spectrum microorganism detection. Amplification products are analyzed by agarose gel electrophoresis and/or DNA hybridization methodology. We report here the detection sensitivity and specificity of the protocol using SF inoculated with Escherichia coli and Staphyloccocus aureus. We have applied this new methodology to clinical SF specimens with results superior to standard laboratory culturing assays.

Bacterial Infections↗
PubMed1995

Postoperative blood salvage in total knee arthroplasty using the Solcotrans autotransfusion system.

One hundred forty-four patients who underwent primary total knee arthroplasty were examined in a prospective controlled study to determine the efficacy and safety of a postoperative wound drainage autotransfusion system (Solcotrans, Smith & Nephew Richards, Memphis, TN). The patients were divided into two groups: control group 1 comprised 88 (61%) patients who either received a Hemovac disposable drainage system (63 patients) or the Solcotrans system and had inadequate drainage for autotransfusion (25 patients). Experimental group 2 comprised 56 (39%) patients who received a Solcotrans drainage system and were autotransfused. The Solcotrans proved itself safe. No sepsis, transfusion reactions, or coagulopathies were associated with autotransfusion, which averaged 524 mL. There were no significant differences between groups 1 and 2 when comparing preoperative and postoperative hemoglobins and hematocrits. The Solcotrans system did not lower homologous blood requirements. Only 1.6% (2 patients) of all patients who autodonated at least 2 units of autologous blood (122 patients) were in need of a homologous blood transfusion in the postoperative period. Thus, although safe, the Solcotrans system was not proven effective in the management of primary total knee arthroplasty patients.

Blood Transfusion, Autologous↗
PubMed1995

Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties.

A consecutive series of 36 patients underwent primary cemented total hip arthroplasty followed by primary cementless total hip arthroplasty of the contralateral hip. Clinical pain scores between the cementless and cemented hips were not different. Subjectively, patients either had no preference or preferred the cementless side. Comparison of results in the same patient eliminates variability introduced by differences in sex, weight, comorbidities, bone quality, and activity level. Control of these factors permits more meaningful comparison of the type of fixation.

Adult↗
PubMed1995

Gender differences in high-risk sex behaviours among heterosexual drug injectors and crack smokers.

This study was designed to assess gender differences in high-risk sex behaviors related to the transmission of HIV among injection drug users (IDUs) and crack smokers. Using a standard national survey instrument, 593 verified drug users were questioned about their sexual activities and drug use in the 30 day period prior to the interview. High-risk sex behaviors included nonuse of condoms, exchanging sex for drugs or money, sex with an IDU, and sex with more than one partner. Results showed that IDUs who engaged in needle risk practices were more likely report nonuse of condoms than IDUs who practiced safer needle use. African-American ethnicity was a more powerful determinant of exchanging sex than smoking crack cocaine. Sex with more than one partner in the previous 30 day was reported by 11% of married males and 15% of married females. Independently, marital status was found to be a marker for high-risk sex behaviors, in particular, sex with an IDU and nonuse of condoms, behaviors reported more often by married than unmarried respondents. Needle risk, more common among females than males, was associated with sex with an IDU. Approximately one-fourth of the injectors reporting sex with only non-IDUs also reported needle risk, sex with more than one partner, and nonuse of condoms. These findings show the dual threat drug injectors face for HIV infection, through sex and needle risk behaviors, and the pivotal role IDUs play in the heterosexual transmission of HIV to noninjectors.

Adolescent↗