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S Molde

Publications and source records attributed to S Molde.

11 recordsLinked to original sources
PubMed1997

Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England.

OBJECTIVES: To determine whether changes in injecting drug use and sexual behavior over a 12-month follow-up are associated with HIV counseling and testing (C and T) of injecting drug users in methadone maintenance treatment programs (MMTP) in Massachusetts and Connecticut. METHODS: Clients were invited to participate in a longitudinal study involving five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were number of drug injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episodes. Data analyses included multiple regression, odds ratios, and quantitative analysis of text-based data. RESULTS: Subjects reported reductions in both injecting drug use and sexual behavior Primary associations with reduced injecting drug use were remaining in the MMTP and attending HIV-positive support groups. A reduction in high-risk sexual behavior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associated with an HIV-positive test result. Inconsistent condom use was associated with enrollment in the MMTP where condoms were available only upon request and abstinence and monogamy between uninfected partners were promoted. CONCLUSIONS: Injecting drug users who self-select to participate in MMTP and HIV C and T, two public health HIV-prevention interventions, reduce their HIV-risk behaviors. Clients should be encouraged to remain in MMTP and HIV-infected clients should attend support groups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.

Adult↗
PubMed1992

Human immunodeficiency virus infection in intravenous drug users: a model for primary care.

PURPOSE: Intravenous drug users (IVDUs) often encounter barriers to primary care. To improve access, we developed a primary care clinic--Central Medical Unit (CMU)--for substance abusers in drug treatment. We report outcomes for services offered to IVDUs with human immunodeficiency virus (HIV) infection. PATIENTS AND METHODS: During 1990, 24% (120 of 509) of IVDUs eligible for CMU were HIV positive. Diagnostic therapeutic and preventive goals for IVDUs with HIV infection were evaluated for acceptance and compliance by chart review for these 120 patients. RESULTS: On admission, 65% (78 of 120) of patients reported having no source of primary care, 64% (77 of 120) were male, and 77% (92 of 120) were in methadone maintenance. All were screened for tuberculosis, syphilis, and hepatitis; 94% (15 of 16) of eligible patients accepted tuberculosis prophylaxis and 83% (5 of 6) accepted syphilis treatment, but only 36% (5 of 14) accepted hepatitis B vaccine. Of those who accepted therapy, 87% (13 of 15) were compliant with tuberculosis prophylaxis, and 100% (5 of 5) were compliant with syphilis treatment. Influenza vaccine was accepted by 49% (59 of 120) and pneumococcal vaccine by 81% (97 of 120). Ninety-eight percent (118 of 120) accepted T-cell testing: 61% had T-helper counts less than 500/mm3 and 25% were less than 200/mm3. Of those eligible, 89% (70 of 79) accepted antiretroviral therapy, and 100% (35 of 35) accepted Pneumocystis carinii pneumonia prophylaxis. Six-month compliance rates for these therapies were 84% (59 of 70) and 77% (27 of 35), respectively. CONCLUSION: By offering primary care services with drug treatment, the CMU model may be an effective way of providing access to primary care for HIV-infected IVDUs and for facilitating compliance.

Adult↗
PubMedDate not supplied

Retention in methadone maintenance treatment programs, Connecticut and Massachusetts, 1990-1993.

The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.

Adult↗
PubMedDate not supplied

Complexity of ambulatory care: nurse practitioner and physician caseloads.

The case mix of patient caseloads of nurse practitioners (NPs), faculty attending physicians (F/MDs), and resident housestaff in an inner-city teaching hospital was examined. Social and demographic variables as well as diagnoses, medications, risks, and functional status were used to define complexity. Charts of 111 patients (37 per group) were analyzed. Patients of NPs and F/MDs were essentially equally complex, but residents' patients were somewhat less complicated. Differences in styles of practice were seen, with NPs attending more to symptoms of nonpathological conditions, comfort, and comprehensiveness of care. Scope of practice, complexity, and system of care are suggested as important variables to consider in future studies of NPs and in studies relating case mix to productivity and resource consumption.

Ambulatory Care↗
PubMedDate not supplied

Nurse practitioner research: selected literature review and research agenda.

Selected literature is reviewed to illustrate current conceptual and methodological issues in nurse practitioner research. Concepts of style of practice, acceptance, satisfaction, and outcome are discussed. Methodological issues are linking process to outcome, complexity measures, use of existing data, and the effect of nurse practitioner education and experience on interpretation of findings. A research agenda with two objectives is proposed: studies designed to improve rather than evaluate practice and studies designed with a policy framework in mind.

Clinical Competence↗