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PubMed2001

Sexually transmitted infections among HIV infected and HIV uninfected high-risk youth in the REACH study. Reaching for Excellence in Adolescent Care and Health.

OVERVIEW: This review presents the findings of published research in the Reaching for Excellence in Adolescent Care and Health (REACH) Project on sexually transmitted infections (STIs) within the context of the project's scientific agenda. Methods employed in the study for specimen collection, management, and laboratory analysis are presented. This review presents published analyses of cross-sectional data; longitudinal analyses are underway. In addition, baseline prevalence data on selected STIs and sexual risk profiles of the subjects in REACH are presented. High STI rates were evident in both human immunodeficiency virus (HIV) infected and uninfected youth of both genders regardless of sexual orientation. High infection rates at baseline suggest that prevention-oriented programs for risk reduction among adolescents should focus on both HIV infected and at-risk, uninfected youth.

Adolescent↗
PubMed2002

Comparison of neural activity preceding reaches to auditory and visual stimuli in the parietal reach region.

We examined the responses of neurons in the parietal reach region (PRR) during reaches to the remembered locations of auditory or visual stimuli. We found that the firing rate of PRR neurons contained information about the location of auditory and visual stimuli. For neurons tested with visual stimuli, the amount of information remained constant throughout the task. In contrast, for neurons tested with auditory stimuli, the amount of target-location information increased as the trial evolved. During the reach period of the task, the amount of information that was carried by neurons tested with auditory stimuli was not statistically different from the amount carried by neurons tested with visual stimuli. We interpret these data to suggest that the type of information that PRR neurons encode evolves throughout a task.

Acoustic Stimulation↗
PubMed2003

Recruitment and retention of adolescent participants in HIV research: findings from the REACH (Reaching for Excellence in Adolescent Care and Health) Project.

PURPOSE: To evaluate the importance of 13 items in the recruitment and retention of HIV-positive and HIV-negative adolescent participants in a longitudinal study (REACH study). METHODS: A confidential, self-administered, visual analog, cross-sectional survey was offered to active participants (November 1999-August 2000) with 438 subjects (86%) participating. Sixty-six percent of the cohort were HIV-positive and 34% were HIV-negative with a mean age of 17 years, and 76% were female. Subjects were asked to recall the importance they placed on 13 items in deciding to join the REACH study (recruitment) and to remain on study (retention). Factors that might explain the judgment placed on the items were analyzed using the nonparametric Wilcoxon Rank-Sum test or the Kruskall-Wallis test. RESULTS: The five most important factors for study recruitment were identical to those chosen for retention by participants. The factors were: (a) quality medical care, (b) caring staff, (c) health education, (d) privacy/confidentiality, and (e) altruism. Items judged least important were social activities, compensation, transportation, and food/meals. Subject characteristics (gender, age, HIV status) were not associated with statistically different mean judgment scores at recruitment and retention, although clinical site showed significant variation. Factors that could render subjects vulnerable (health insurance, family finances) were not associated with related items. CONCLUSIONS: Adolescents found quality health care and care team characteristics critically important in considering research participation. Attention to privacy and the opportunity to be altruistic were also important. Compensation for participation was not a significant factor for recruitment and retention of this adolescent cohort. This study demonstrates that adolescents apply sound criteria in evaluating research participation and do not appear to be unduly affected by compensation.

Adolescent↗
PubMed1987

Infant safety seat use. Reaching the hard to reach.

We crafted an interactive video infant safety seat (ISS) education program for presentation to postpartum mothers. This program was designed to reach all socioeconomic groups with the message that consistent, correct ISS use is important. The program was further designed to be physically portable, versatile, and affordable and to narrow previously observed differences in correct ISS use between groups of high and low socioeconomic status exposed to the same educational message. Observed ISS use at an examination after four months confirmed the utility of this program in meeting the experimental goals. While also reaching other program goals, the interactive video program (64.6% correct use) was found to be at least as effective as a control education program (63.9% correct use).

Health Promotion↗
PubMed1993

Correction processes in early reaching: reaches by infants to prismatically displaced targets.

A comparison was made between trajectories of reaches to visual targets by 6-months-old infants, with and without lateral prismatic displacement. In the No Prism condition, the major element of the movement veered towards the target, confirming the results of Mathew and Cook (1990). In the Prism condition, the prism did not affect hand position or movement direction at the beginning of the major element, but a lateral displacement was evident by the end of the element. This is taken as evidence that shifts in trajectory during the element were not due to visual guidance. It is suggested instead that these shifts may reflect correction based upon somatic feedback about position in relation to the visually specified goal of the movement. Evidence that the hand approached the virtual target supports the suggestion that any visual guidance was confined to the approach phase of the reach. Nevertheless, it appears that visual guidance was operating at this stage, since movement direction was displaced away from the virtual target and towards the real target.

Attention↗
PubMedDate not supplied

An examination of adolescents who were and were not exposed to "Teens Stopping AIDS": reaching the hard-to-reach.

Teens Stopping AIDS (TSA) was an HIV prevention project in Sacramento, California, that involved coalitions of volunteers in designing and launching a social marketing intervention. Mounted in 15 zip codes where teen sexually transmitted disease (STD) and pregnancy rates were high, TSA delivered HIV prevention messages for one year through various communication channels (e.g., radio spots, posters, skills-building workshops). Sixty-seven percent of 521 sexually active adolescents surveyed in a random sample phone interview reported exposure to TSA. To inform future refinements in the intervention, logistic regression was used to identify factors associated with exposure to the program. Eighteen-year-olds were less likely than their younger counterparts to report exposure to TSA (OR [odds ratio] = .54, p <.05). Adolescents living in zip codes where a concentrated effort had been made to hold workshops, display posters, and organize peer outreach were more likely than adolescents living outside of these zip codes to report any program exposure (OR= 2.57, p <.01). Adolescents traditionally viewed as "hard to reach" (i.e., males, minorities, and those with a history of high-risk behavior) were no less likely than other adolescents to report exposure to TSA. Characterizing the members of the unexposed segment of the target audience made it possible to offer practical suggestions for expanding the reach of the program.

Adolescent↗
PubMed1997

Prism adaptation of reaching movements: specificity for the velocity of reaching.

Accurate reaching toward a visual target is disturbed after the visual field is displaced by prisms but recovers with practice. When the prisms are removed, subjects misreach in the direction opposite to the prism displacement (aftereffect). The present study demonstrated that the severity of the aftereffect depends on the velocity of the movements during and after the visual displacement. Trained subjects were required to reach with one of four movement durations (<300, approximately 800, approximately 2000, and approximately 5000 msec) from a fixed starting point to a target that appeared at a random location on a tangent screen (400 mm away). The size of the aftereffect was largest when the movement after the removal was performed with the same duration as that performed with the prisms. It became smaller as the difference in velocity became larger. When the contralateral arm was used after visual displacement, the aftereffect was never significant. Because the adaptation does not generalize across velocities or to the other arm, we infer that the underlying changes occur at a later stage in the transformation from visual input to motor output, in which not only the direction but also the time-dependent parameters of movements, such as velocity, acceleration or force, are represented.

Adaptation, Physiological↗
PubMed1993

Characteristics of target-reaching in cats. II. Reaching to targets at different locations.

Trajectory formation of unrestrained forelimb target-reaching was investigated in relation to the effect of a change in target location. Sagittal displacement of the target (6 cm in each direction) gave a selective change of velocity in the x direction (protraction) with an increase or decrease at larger and shorter distances, respectively. In the case of a double-peaked x velocity profile, the change was mainly with respect to the first major component. The shape of the y (sideways) and of the z (lifting) velocity profiles were both almost unchanged, but the onset of the movement in the z direction changed with the x distance. Vertical displacement (4 cm up or 5 cm down) gave increased velocity in the z direction (lifting) when the target was above the normal mid-position and decreased velocity when the target was lower. The velocity was changed with constant rate of rise, so that the rise time increased when the target was elevated and shortened when the target was lowered (pulse width control policy). The change in the z velocity was not selective. In cats with a double-peaked x velocity profile, the second component decreased when the target was elevated and increased when it was lowered. With excessive lowering of the target (14 cm down), the first x velocity component was very much reduced in amplitude so that protraction depended mainly on the second x velocity component. In the cat with a unimodal x velocity profile, a second component appeared in the x and net velocity profiles when the target was excessively lowered.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Target selection in eye-hand coordination: Do we reach to where we look or do we look to where we reach?

During a goal-directed movement of the hand to a visual target the controlling nervous system depends on information provided by the visual system. This suggests that a coupling between these two systems is crucial. In a choice condition with two or more equivalent objects present at the same time the question arises whether we (a) reach for the object we have selected to look at or (b) look to the object we have selected to grasp. Therefore, we examined the preference of human subjects selecting the left or the right target and its correlation to the action to be performed (eye-, arm- or coordinated eye-arm movement) as well as the horizontal position of the target. Two targets were presented at the same distance to the left and right of a fixation point and the stimulus onset asynchrony (SOA) was adjusted until both targets were selected equally often. This balanced SOA was then taken as a quantitative measure of selection preference. We compared these preferences at three horizontal positions for the different movement types (eye, arm, both). The preferences of the 'arm' and 'coordinated eye-arm' movement types were correlated more strongly than the preferences of the other movement types. Thus, we look to where we have already selected to grasp. These findings provide evidence that in a coordinated movement of eyes and arm the control of gaze is a means to an end, namely a tool to conduct the arm movement properly.

Adult↗
PubMed2005

Modification of the functional reach test: analysis of lateral and anterior functional reach in community-dwelling older people.

The purpose of this study was to evaluate the validity and reproducibility of the modified lateral functional reach (FR), and to examine the associations between a variety of functional variables and the FR in community-dwelling older people (>65 years of age). A total of 383 aged Japanese participated in this study at the rural district Kahoku, Kochi, Japan, in 2002. The average age of the subjects was 78.6 years. The activity of daily living (ADL) and mental status were measured as outcomes. FR (anterior and lateral) and timed up and go (TUG) were measured as predictors. The test-retest reliability of lateral FR between the first and second measurement was very consistent. Subjects with greater lateral FR had higher basic and instrumental ADL (IADL) scores than did those with shorter lateral FR. However, there was no significant relationship between anterior FR and ADLs. The lateral FR of participants with depression was shorter than in those without depression, while the anterior FR did not correlate with the participants' scores on the geriatric depression scale (GDS). Lateral FR should be considered as a new, alternative means of assessing geriatric social activity and mental status in the elderly.

Activities of Daily Living↗
PubMed2006

Reaching hard-to-reach migrants by letters: an HIV/AIDS awareness programme in Nepal.

We assessed the impact of an HIV/AIDS programme for Nepalese migrants to India that involved writing letters. The programme created opportunities for sending HIV/AIDS-related messages to the migrants in India, and encouraging them practicing safer sex. Initially, they received the messages only from the programme, but later from their colleagues, spouses or other family members. They discussed the messages in groups, disseminated them, and sought more knowledge in their destinations. These findings indicated that using letters could be an effective way to reach inaccessible migrants at their destinations, and help them to improve their HIV/AIDS-related knowledge, and safer sex practices.

Adolescent↗
PubMed1997

Evaluation of a worksite injury and illness prevention program: do the effects of the REACH OUT training program reach the employees?

In this article the authors report the findings of a 2-year study evaluating the effectiveness of REACH OUT, a train-the-trainer program developed to assist small businesses comply with California legislation, Senate Bill 198 (1989), requiring employees to implement a worksite Injury and Illness Prevention Program. Data from a case study sample of 8 companies, drawn from 151 Southern California small businesses participating in the larger study, are reported. Diagnostic walk-throughs were performed, and employee surveys collected at the case study companies approximately 2 months before the treatment group received the intervention and again 1 year later. Results indicate that greater corporate compliance led to employees' perceptions of increased health and safety meetings and training sessions, which led to greater employee health and safety knowledge and improved employee health outcomes.

Accidents, Occupational↗
PubMed1975

Reaching the hard-to-reach: illicit drug use among high school absentees.

As part of a large-scale survey of adolescent drug use in the State of New York, two absentee studies were carried out to estimate levels of drug use among school absentees. Students interviewed in households reported very little drug use. By contrast, absentees self-selecting themselves to participate in a group-administered questionnaire reported much higher illicit drug use than regular students from the same schools. However, comparison of students in the absentee sample with the total target absentee population, and the reverse association between drug use and selected background factors among absentees, suggest that most chronic absentees and heavy users, especially blacks and males, did not participate in the self-selected absentee sample. Attempts to identify factors related to higher drug use among absentees were unsuccessful. While poor school performance brings levels of illicit drug use among regular students to levels comparable to those of the absentees, poor school performances per se does not explain the higher rates of illicit drug use among the absentees. It is clear that school absentees who are generally excluded from school surveys are extremely hard to reach for research purposes.

Achievement↗
PubMed2001

Disclosure of serostatus by HIV infected youth: the experience of the REACH study. Reaching for Excellence in Adolescent Care and Health.

PURPOSE: To describe disclosure of HIV serostatus by infected youth to parents and sexual partners and to examine the association of disclosure with subject characteristics. METHODS: Baseline data on 317 HIV infected adolescents in national 15 site study were examined. Data sources included direct and computer-assisted interview, laboratory studies, and chart reviews. Examination of parental disclosure was restricted to subjects without parental permission requirements. Concordance in parental disclosure/support used McNemar's test. Associations between disclosure to parent(s) and subject characteristics were examined using logistic regression analysis. Repeated measure analysis was used for sexual partner disclosure. RESULTS: Subjects of both genders more often disclosed their HIV infection status to mothers than to their fathers (77% vs. 47%, p < .001). With disclosure, perceived support from either parent was high. In multivariate analyses, factors associated with maternal disclosure were length of time since diagnosis (OR = 1.43; 95% CI: 1.06-1.92), and Hispanic ethnicity (OR = .37; 95% CI: .15-.95). No factors were significantly associated with paternal disclosure in multivariate analysis, although length of time since diagnosis showed a trend (OR = 1.31; 95% CI: 1.00-1.74). Factors associated with disclosure to sexual partners were partner's HIV+ status (OR = 2.09; 95% CI: 1.11-3.93) and "main partner" status (OR = 3.17; 95% CI: 1.84-5.46). CONCLUSIONS: Although subjects were more likely to reveal their status to their mothers, parental support was perceived as high after disclosure to either parent. Since "time since diagnosis" was associated with parental disclosure, support systems are necessary for youth until such a disclosure can occur.

Adolescent↗
PubMed1999

Rural breast cancer treatment: evidence from the Reaching Communities for Cancer Care (REACH) project.

BACKGROUND: Research shows that rural populations are more likely than their urban counterparts to be diagnosed with late-stage cancer, but less is known about appropriateness of cancer treatment in rural locations after diagnosis. The objective of this analysis was to assess the degree to which rural breast cancer treatment was received in concordance with national recommendations. METHODS: Data came from 251 stage I and II breast cancer patients residing in rural North Carolina. State-of-the-art care was defined using the National Cancer Institute's (NCI) physician data query (PDQ) database, and cases were categorized into appropriate primary and/or adjuvant treatment. Chi-square and Fishers' exact tests were used to assess changes in appropriate treatment over time (1991-1996) and between stage. Multiple logistic regression was used to determine whether any patient or disease characteristics were associated with receipt of appropriate treatment. RESULTS: Most (81-90%) of the breast cancer cases received the appropriate primary therapy (mastectomy or lumpectomy followed by radiation therapy); of these, the majority received a mastectomy (66-72%). Fewer women received adjuvant therapy as recommended (27-61%), although significantly more stage II than stage I cases did so (p < or = 0.05). Regression showed that stage and estrogen-receptor (ER) status were associated with appropriate therapy. CONCLUSIONS: The findings suggest that there exist deviations from NCI established treatment recommendations among rural breast cancer patients. More research is needed to develop better methods for dissemination of state-of-the-art cancer information to rural physicians and patients, and to understand how treatment decisions are made.

Adult↗