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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
PubMed2001

Differences among out-of-treatment drug injectors who use stimulants only, opiates only or both: implications for treatment entry.

The goal of this study was to compare drug and alcohol use, psychological symptoms and substance abuse treatment entry among 583 street-recruited, out-of-treatment injection drug users (IDUs) who used stimulants only, opiates only or both stimulant and opiate. Data analyzed from structured interviews indicated that stimulant-only users had the most severe alcohol problems and the highest psychological symptom scores for hostility, paranoia and psychoticism. In the 2 months following their interview only 3% of the stimulant-only users entered substance abuse treatment, as compared to nearly half of the participants in the other two groups. Even after controlling for variables that differed among the groups by logistic regression analysis, stimulant only users were still 24-25 times less likely than opiate only or both stimulant and opiate users to enter treatment. Researchers and clinicians are challenged to better understand and address the unique needs of stimulant users, including potential psychological problems and alcohol abuse, in order to attract them to treatment and serve them through a comprehensive treatment approach.

Adult↗
PubMed2001

Evidence for essential histidines in human pituitary glutaminyl cyclase.

Glutaminyl cyclase (QC, EC 2.3.2.5) catalyzes the formation of the pyroglutamyl residue present at the amino terminus of numerous secretory peptides and proteins. Treatment with diethyl pyrocarbonate inactivated recombinant human QC with the apparent modification of three essential histidine residues. Comparisons of the protein sequences of QC from a variety of eukaryotic species show four completely conserved histidine residues. Mutation of each of these residues to glutamine resulted in two mutant enzymes that were inactive (H140Q and H330Q), suggesting a role in catalysis, and two that exhibited increased Km values (H307Q and H319Q), suggesting a role in substrate binding. Consistent with these results is the prediction that QC possesses a zinc aminopeptidase domain in which the four histidines identified here are present in the active site. Mammalian glutaminyl cyclases may, therefore, have structural and catalytic similarities to a family of bacterial zinc aminopeptidases.

Amino Acid Sequence↗
PubMed2001

Methadone maintenance as HIV risk reduction with street-recruited injecting drug users.

OBJECTIVE: To compare changes in HIV risk behaviors between street-recruited opiate injectors who entered and remained in methadone maintenance treatment and those who did not. METHODS: Three hundred sixteen participants were interviewed at baseline, received outreach interventions, and were interviewed again 6 months later. RESULTS: Significant (p <.001) reductions in HIV-related risk behaviors, including frequency of injecting, injecting with used (dirty) needles, and sharing injection paraphernalia, were demonstrated. Participants (31%) who entered and remained in methadone maintenance treatment for at least 90 days before follow-up showed a significantly greater reduction in heroin injections than those who did not. They did not show a greater reduction in using dirty needles or sharing other injection paraphernalia. CONCLUSIONS: These findings suggest that although methadone maintenance may reduce injection frequency, it does not reduce other HIV-related risk behaviors above and beyond what can be accomplished through outreach interventions. Treatment facilities and outreach intervention programs should collaborate to provide a comprehensive approach to reducing HIV risk behaviors among drug injectors both in and out of drug treatment.

Adult↗
PubMed2000

Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack.

This study was designed to assess differences in sex-related risk behaviors between drug injectors who did not smoke crack cocaine, crack smokers who did not inject drugs, and drug users who both injected drugs and smoked crack. Current drug users (i.e. used within the past 30 days) from 22 cities were recruited and assessed. The sample (n = 26,982) included 28% who injected only, 42% who smoked crack only, and 30% who both injected and smoked crack. Results showed that active drug users were at risk of HIV infection through sexual transmission: in the 30 day period prior to their interview, 28% reported sex with two or more individuals, 23% had an IDU sex partner, and 24% had exchanged sex for drugs or money. In addition, more than 80% did not use a condom during sex. Crack only smokers and crack smoking injectors were more likely than injectors only to report multiple sex partners and exchanging sex. Because of these high risk behaviors, condom use was of particular importance. The number of days of alcohol use and having an IDU sex partner were independently associated with not using a condom. Crack smoking injectors reported the highest average number of days of alcohol consumption and were the most likely to have had an IDU sex partner.

Adult↗
PubMed2000

The effects of offering free treatment to street-recruited opioid injectors.

AIMS: The goal of this investigation was to assess the treatment entry impact of offering free treatment to street-recruited injecting opioid users, and to determine which variables differentiated subjects who entered treatment when it was free, compared to those who entered when they had to pay for treatment. DESIGN: Three hundred and sixty-two out-of-treatment opioid injectors, recruited through street outreach, were randomly assigned to receive or not receive a coupon for 90 days of free substance abuse treatment. Demographics, desire for treatment, drug use and HIV risk behaviors were assessed prior to assignment. FINDINGS: Subjects were characterized by frequent and long-term drug use, numerous arrests, a variety of behaviors that placed them at risk for HIV, and ambivalence about entering substance abuse treatment. Offering free treatment led to significantly greater treatment entry (53% vs. 33%) and retention (155 days vs. 83 days). Entry into free treatment was particularly high, compared to those who had to pay for treatment, among subjects who had never been in treatment (43% vs. 23%) and those who reported that they did not want to enter treatment (24% vs. 6%). Subjects who entered free treatment were significantly less likely to have family problems than those who paid for their treatment. CONCLUSIONS: Opioid addicts recruited on the street and offered free methadone maintenance treatment are likely to enter and remain in treatment, even if they have never been in treatment before or claim not to want treatment. Different treatment approaches may be necessary if such subjects are motivated more by the removal of financial obstacles than other factors, such as family problems.

Adolescent↗
PubMed1999

Health-related service utilization and HIV risk behaviors among HIV infected injection drug users and crack smokers.

This study was designed to assess utilization of health-related services and HIV risk related behaviors by HIV infected drug users one year prior to and two years following the availability of Ryan White Title I funding. Using a cross-sectional design, a total of 777 drug injectors and crack smokers from five US cities were surveyed, over three waves of data collection, about their use of drug treatment, medical services, housing, mental health, and case management and about their sex and drug-related risk behaviors. For all service categories and in each wave, including the year prior to Title I funding, HIV risk behaviors were lower among those who used health-related services, with the exception of housing. Use of services did not increase significantly following the disbursement of Title I funds except for housing and case management. These findings suggest that it may be necessary to increase the attractiveness of health-related services, not just funding for services, for HIV infected substance abusers.

Adult↗
PubMed1999

Predictors of increased condom use following HIV intervention with heterosexually active drug users.

Research with injection drug users (IDUs), at risk for acquiring and transmitting HIV, has focused primarily on their risky drug practices, with far less attention paid to their risky sex behaviors. The purpose of this study was to determine what variables were associated with an increase in condom use following an HIV intervention with 3357 IDUs in nine cities. Participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention, and during 22% of their sexual encounters six months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive (odds ratio OR = 2.49), to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). Discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Substance abuse treatment for high-risk adolescents.

Adolescent substance abuse is rising dramatically in the United States. This observation is especially troubling given the association between substance use and HIV, as well as other sexually transmitted diseases. Surprisingly, there have been few carefully constructed, controlled studies examining different treatment approaches with adolescent substance abusers. In our review of the literature, we note that family therapy and, to a lesser extent, cognitive behavioral therapy, received the most attention as intervention strategies with adolescents. Both approaches appear to have some success, although further research is necessary. In addition, developing and assessing strategies to improve family involvement in treatment requires additional investigation.

Adolescent↗
PubMed1999

The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents.

OBJECTIVE: To assess HIV-related drug and sex risk behaviors and evaluate factors associated with change in risk behaviors among runaway and homeless adolescents, 244 street youth were recruited from a community drop-in center serving high-risk youth. METHOD: Using a cross-sectional design, approximately half of study participants received training in a peer-based intervention that included principles derived from the health belief model, while the remaining subjects received no intervention. Subjects were interviewed at baseline, immediately following the intervention (for those receiving the training) and 3 months later. Logistic regression and analysis of covariance were used to analyze intervention effects. RESULTS: Compared to youth in the control condition, runaways receiving the intervention significantly increased their knowledge about HIV. Contrary to the health belief model, in multivariate analyses knowledge and greater perceived chance for HIV were associated with high risk behavior. On the other hand, lower concern about HIV infection was also associated with high risk behavior, supporting the health belief model. CONCLUSIONS: Despite the intervention's success in increasing knowledge of HIV and AIDS, the association between knowledge, perceived likelihood of infection and high risk behaviors suggest that, without other alternatives, runaways will maintain their risks. The association noted between lower concern and high risk behaviors underscores the challenge faced in developing effective interventions with this population.

Adolescent↗
PubMed1999

Extensor mechanism allografts in total knee arthroplasty.

Forty knees in 40 patients who had a chronic extensor mechanism disruption after knee arthroplasty underwent extensor mechanism allograft placement to restore extensor function. Thirteen knees were infected previously and 11 knees did not respond to previous attempts at direct extensor repair or reconstruction. Two patients died and two patients underwent above the knee amputation because of recurrent infection. The final group of 36 patients was studied for a mean followup of 3.6 years (range, 2-10 years). Clinical evaluations were performed using a modified Knee Society scoring system. The average range of motion in the entire group of patients was 1.4 degrees extension to 98 degrees flexion. The average extensor lag was 13 degrees in 15 of 36 patients. There were eight extensor allograft ruptures, which were treated by repeat extensor allograft placement. The average knee scores for function improved from 37 points preoperatively to 68 points postoperatively. Despite these initial ruptures, 34 of 36 patients had a successful clinical result. These results support the use of this technique for complete extensor mechanism loss after knee arthroplasty when direct repair is unfavorable.

Aged↗
PubMed1999

Arthroscopic treatment of patellar clunk.

Excellent results have been reported with posterior stabilized total knee arthroplasty. A common complication relating to patellofemoral articulation is patellar clunk syndrome. Patellar clunk syndrome occurs when a fibrous nodule develops just proximal to the patellar button. At approximately 30 degrees to 45 degrees from full extension, the nodule catches the anterior flange of the femoral prosthesis, resulting in the clunk and a painful range of motion. The present study examines the use of arthroscopic debridement for this disorder. Thirty consecutive patients (32 knees) with the diagnosis of patellar clunk syndrome were evaluated at 1 year after arthroscopic debridement. All patients were evaluated clinically and radiographically according to the Knee Society score. In addition, patients were questioned specifically regarding anterior knee pain and patellofemoral symptoms. Radiographs were evaluated further regarding patella and component position. Patients were diagnosed with patellar clunk at an average of 12 months after their latest knee arthroplasty, with a range of 3 to 47 months. All patients complained of anterior knee pain and the clunk. All patients had a hypertrophic nodule at the junction of the proximal pole of the patella and quadriceps tendon and underwent arthroscopic debridement through a superolateral portal. All patients were free of patellar clunk postoperatively; one patient reported persistent anterior knee pain. Knee Society scores increased from an average of 64 points preoperative to 93 points postoperative. Radiographs showed patella alta in eight knees, patella baja in two. Four femoral components were in 5 degrees flexion. The present study represents the largest collection of data regarding patellar clunk syndrome. The data appear to support arthroscopic debridement as a successful treatment of patellar clunk syndrome.

Aged↗
PubMed1998

Suicidal behavior and sexual/physical abuse among street youth.

OBJECTIVE: To examine the relationship between home life risk factors and suicide attempts among homeless and runaway street youth recruited from both shelters and street locations in Denver, CO; New York City; and San Francisco, CA. METHOD: Street youth 12-19 years old (N = 775) were recruited by street outreach staff in Denver, New York City and San Francisco in 1992 and 1993 and interviewed. Cross-sectional, retrospective data were analyzed to examine the relationship between suicide attempts and antecedent home life variables. Logistic regression was used to identify factors predicting suicide attempts. RESULTS: Forty-eight percent of the females and 27% of the males had attempted suicide. The mean number of suicide attempts was 6.2 (SD = 12.9) for females and 5.1 for males (SD = 7.6). Among females, 70% reported sexual abuse and 35% reported physical abuse. Among males, 24% reported sexual abuse and 35% reported physical abuse. Sexual and physical abuse before leaving home were independent predictors of suicide attempts for females and males. Other home life factors hypothesized to be risk factors for suicide attempts were not significant. Interaction terms were not significant. Among street youth who were sexually or physically abused in this sample, the odds of attempting suicide were 1.9 to 4.3 times the odds of attempting suicide among those not sexually or physically abused. CONCLUSIONS: Interventions attempting to reduce risky behaviors in this population must include assessments of suicidal behaviors as well as components for assisting youth in dealing with the behavioral and emotional sequelae of physical and sexual abuse.

Adolescent↗