Sexual Behavior Latent Classes Among Men Who Have Sex With Men: Associations With Sexually Transmitted Infections

Men who have sex with men (MSM) are at disproportionate risk of acquisition of sexually transmitted infections (STIs). We used latent class analysis (LCA) to examine patterns of sexual behavior among MSM and how those patterns are related to STIs. We examined patterns of sexual behavior using behavioral and clinical data from a cross-sectional study of 235 MSM who presented to an urban sexual health clinic for STI testing. Analyzed data were collected using a combination of interviewer- and self-administered surveys and electronic health records. We used LCA to identify underlying subgroups of men based on their sexual behavior, described the demographics of the latent classes, and examined the association between the latent classes and STI status. We identified three latent classes of sexual behavior: Unprotected Anal Intercourse (UAI) Only (67%), Partner Seekers (14%), and Multiple Behaviors (19%). Men in the Multiple Behaviors class had a 67% probability of being STI positive, followed by men in the UAI Only class (27%) and men in the Partner Seekers class (22%). Examining the intersection of a variety of sexual practices indicates particular subgroups of MSM have the highest probability of being STI positive.     

Neighborhood Priority or Desegregation Plans? A Spatial Analysis of Voting on San Francisco’s Student Assignment System

In 2011, San Francisco held an unprecedented citywide vote on its public schools’ student assignment policy. Proposition H provides a unique opportunity to learn more about the public’s desire for “neighborhood schools,” as compared to their interest in maintaining districtwide desegregation efforts. This paper takes the approach of applying geographic information system tools and regression analysis to understand the relationships between neighborhood, race, income, and attitudes toward student assignment systems. By comparing the election results with demographics and school quality data, we identify patterns of support for the narrowly defeated proposition. Support for a shift toward neighborhood-based schools was higher in census tracts with high-performing schools, more school age children, high median income, or a large fraction of foreign-born residents, and lower in tracts with a high percentage of Latinos. The shifting race- and class-based politics of the city foreshadow expected demographic shifts in the US.     

Community and Individual Factors Associated with Cigarette Smoking Among Young Men Who Have Sex With Men

Young men who have sex with men (YMSM) have higher rates of cigarette smoking than their heterosexual counterparts, yet few studies have examined factors associated with cigarette smoking among YMSM. The present study sought to understand how different types of gay community connection (i.e., gay community identification and involvement, gay bar/club attendance) were associated with smoking among YMSM recruited through venue-based sampling in Los Angeles, California (N = 526). Structural equation modeling was used to isolate direct and indirect effects of gay community connection on smoking through cognitive and psychological mediators (i.e., psychological distress, health values, internalized homophobia). Findings indicate YMSM cigarette smoking prevention and intervention must be tailored to address the direct and indirect influences of the gay community.     

Capitation funding in the public sector

A fundamental requirement of government at all levels—national and local—is to distribute the limited funds that it wishes to spend on particular public services between geographical areas or institutions, which are effectively competitors for such funds. Increasing use is now being made of capitation methods for such purposes, in which a standard estimate of expected expenditure is attached to a citizen with given characteristics. Statistical methods are playing an important role in determining such capitations, but they give rise to profound methodological problems. This paper examines the rationale for capitation and discusses the associated methodological issues. It illustrates the issues raised with two examples taken from the UK public sector: in personal social services and hospital care. Severe limitations of the data mean that small area data are used as the unit of observation, giving rise to considerable complexity in the model to be estimated. As a result, a range of methodologies including two-stage least squares and multilevel modelling methods are deployed. The paper concludes with a suggestion for an approach which would represent an improvement on current capitation methods, but which would require data on individuals rather than on small areas.     

Comparing the effectiveness of behavioral interventions in adults with co-occurring tobacco and substance use disorders: a systematic review of literature

ABSTRACT

This systematic literature review compares the e?ectiveness of various behavioral interventions delivered to persons with co-occurring tobacco and substance use disorders. It examines ?ndings of six randomized trials and three secondary analyses from randomized trials. Based on the ?ndings of this literature review, support is given to the following: (1) The consequences of tobacco use and smoking are deadly, costly, and can have an inhibitory e?ect on the progress of people in substance abuse treatment, (2) tobacco cessation options are a preventive intervention that can be easily incorporated into a treatment facility’s standard of practice and should be made available within the context of all substance abuse treatment facilities, and (3) concurrently treating tobacco use disorder and substance use disorder(s) is an e?ort that will help meet the social work profession’s Grand Challenge to ‘Close the Health Gap.’     

Investigating the Readiness of Hospital Social Workers to Respond to Domestic and Family Violence

ABSTRACT

Domestic and family violence (DFV) is recognised as a health care priority. Women experiencing DFV use health services at a higher rate than the general population. Hospital social workers are an important component of a public hospital response to domestic and family violence but how prepared are they for this role? This research study explored the readiness of social workers in a Melbourne metropolitan hospital setting to respond to DFV. Results indicated that although the social workers had a knowledge base highly relevant for responding to DFV, many lacked specific knowledge of risk assessment, safety planning, legislative responsibilities, and referral pathways for support, including legal support. As a result, it was likely that they were not adequately responding, either by not recognising when they needed to, or with knowledge and confidence when they did. They also identified a range of organisational enablers, including policy, time, and safe conversation spaces.

IMPLICATIONS

• Hospital social workers have a central role to play in responding to domestic and family violence.

• Hospital social workers need to be better prepared for domestic and family violence responses.

• Social workers require ongoing training and organisational support including practice protocols and guidelines, and the provision of time and private, safe spaces for sensitive conversations to occur.

• Universities should ensure that the role of hospital social workers is considered within curriculum addressing the area of domestic and family violence (DFV).

     

Methods and Rationale for Derivation of a Reference Dose for Methylmercury by the U.S. EPA

In 2001, the U.S. Environmental Protection Agency derived a reference dose (RfD) for methylmercury, which is a daily intake that is likely to be without appreciable risk of deleterious effects during a lifetime. This derivation used a series of benchmark dose (BMD) analyses provided by a National Research Council (NRC) panel convened to assess the health effects of methylmercury. Analyses were performed for a number of endpoints from three large longitudinal cohort studies of the neuropsychological consequences of in utero exposure to methylmercury: the Faroe Islands, Seychelles Islands, and New Zealand studies. Adverse effects were identified in the Faroe Islands and New Zealand studies, but not in the Seychelles Islands. The NRC also performed an integrative analysis of all three studies. The EPA applied a total uncertainty factor (UF) of 10 for intrahuman toxicokinetic and toxicodynamic variability and uncertainty. Dose conversion from cord blood mercury concentrations to maternal methylmercury intake was performed using a one-compartment model. Derivation of potential RfDs from a number of endpoints from the Faroe Islands study converged on 0.1 microg/kg/day, as did the integrative analysis of all three studies. EPA identified several areas for which further information or analyses is needed. Perhaps the most immediately relevant is the ratio of cord:maternal blood mercury concentration, as well as the variability around this ratio. EPA assumed in its dose conversion that the ratio was 1.0; however, available data suggest it is perhaps 1.5-2.0. Verification of a deviation from unity presumably would be translated directly into comparable reduction in the RfD. Other areas that EPA identified as significant areas requiring further attention are cardiovascular consequences of methylmercury exposure and delayed neurotoxicity during aging as a result of previous developmental or adult exposure.     

Safe patient handling curriculum in occupational therapy and occupational therapy assistant programs: A descriptive study of school curriculum within the United States of America

The purpose of this study was to identify safe patient handling (SPH) curricular content in accredited occupational therapy and occupational therapy assistant programs in the United States of America. A survey was emailed to 155 accredited occupational therapy and 137 accredited occupational therapy assistant programs. With a 39% response rate, most programs addressed SPH curricula by including lectures and lab-based experiences with gait belts, slide boards, and manual transfers while stressing ‘safe’ body mechanics. There were limited responses regarding curricular-based hands-on experience, evaluation of sit-to-stand lifts, how to safely transfer bariatric persons, and information on “no-lift” policies. While occupational therapists have a central role in teaching SPH to caregivers, it is important to enhance SPH curricula to reduce exposure to musculoskeletal risk, thereby, increasing the health and safety of the occupational therapy workforce as well those whom the profession serves.