Jef St. De Lore

HIV Disclosure and Subsequent Sexual Behaviors Among Men Who Have Sex with Men Who Meet Online

To assess HIV disclosure discussions and related sexual behaviors among men who have sex with men (MSM) who meet sex partners online, 28 qualitative interviews with Seattle-area MSM were analyzed using grounded theory methods and themes and behavior patterns were identified. MSM found a greater ease in communicating and could prescreen partners through the Internet. However, no consistent relationship was found between HIV disclosure and subsequent behaviors: some were safer based on disclosure while perceived HIV status led others to risky behaviors. Interventions need to promote accurate disclosure while acknowledging its limitations and the need for men to self-protect.

Partner notification for gonococcal and chlamydial infections in men who have sex with men: success is underestimated by traditional disposition codes.

Background: Recent reports evaluating partner notification (PN) efforts among men who have sex with men (MSM) have observed relatively poor outcomes. However, the validity of traditional PN disposition codes is not known, possibly leading to overly pessimistic assessments of PN outcomes. Objectives: To evaluate PN practices among MSM with gonococcal or chlamydial infection, assess the utility of offering MSM PN assistance and compare patient self-reported PN outcomes with those recorded using Disease Intervention Specialist (DIS) disposition codes. Study Design: We reviewed the records of all MSM with gonococcal or chlamydial infection interviewed by Public Health—Seattle and King County for purposes of PN in 2004. Men were asked to indicate whether each of their sex partners were already notified or treated at time of interview and were offered PN assistance. Results: DIS interviewed 409 of 628 (65%) MSM reported with gonococcal or chlamydial infection. Three hundred thirteen of the 409 (76%) interviewed men provided information about their number of sex partners in the 60 days before diagnosis and specific information about 1 or more of their potentially exposed partners. These index cases reported a total of 1037 sex partners, but provided information about only 634 (61%). Two hundred thirteen of the 313 (68%) index cases reported notifying at least 1 partner. Index cases reported that 295 of all 1037 (28%) reported partners had been notified, and that 170 (16%) were treated; DIS disposition codes documented the treatment of 111 (11%) partners. Only 18 (6%) index cases requested DIS assistance contacting a partner; DIS notified and assured the treatment of 24 of the 35 (69%) partners reported by these 18 men. Conclusions: Although MSM with gonorrhea or chlamydia seldom accept assistance notifying partners, they report higher levels of partner treatment than suggested by DIS disposition codes, with 68% indicating that they had notified at least 1 sex partner and 46% reporting that at least 1 of their partners received treated.

Concussion treatment after combat trauma: Development of a telephone based, problem solving intervention for service members

Military service members (SMs) and veterans who sustain mild traumatic brain injuries (mTBI) during combat deployments often have co-morbid conditions but are reluctant to seek out therapy in medical or mental health settings. Efficacious methods of intervention that are patient-centered and adaptable to a mobile and often difficult-to-reach population would be useful in improving quality of life. This article describes a new protocol developed as part of a randomized clinical trial of a telephone-mediated program for SMs with mTBI. The 12-session program combines problem solving training (PST) with embedded modules targeting depression, anxiety, insomnia, and headache. The rationale and development of this behavioral intervention for implementation with persons with multiple co-morbidities is described along with the proposed analysis of results. In particular, we provide details regarding the creation of a treatment that is manualized yet flexible enough to address a wide variety of problems and symptoms within a standard framework. The methods involved in enrolling and retaining an often hard-to-study population are also highlighted.

Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized Clinical Trial.

Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).

Patient perspectives on quality and access to healthcare after brain injury

ABSTRACT Primary objective: To gather information about brain injury (BI) survivors’ long-term healthcare needs, quality, barriers and facilitators. Research design: Qualitative content analysis of data gathered in focus groups using semi-structured interviews. Methods: Forty-four community-dwelling adults participated at two clinical research centres in Seattle, Washington and New York, New York. Participants were asked open-ended questions about their experiences with healthcare in the community with regard to care needs, utilization, access, barriers and facilitators to health management. Results: Central themes emerged across three categories: 1) barriers to healthcare access/utilization, 2) facilitators to healthcare access/utilization, and 3) suggestions for improving healthcare after BI. The importance of communication as both a facilitator and barrier to care was mentioned by most participants. Compensatory strategies and external tools were identified as key facilitators of medical self-management. Finally, improving clinicians’ knowledge about BI emerged as a potential solution to address health needs of individuals with chronic BI. Conclusions: Additional efforts need to be made to improve access to appropriate healthcare and increase the ability for individuals to successfully navigate the healthcare system. Findings suggest several specific, low-cost modifications to healthcare delivery and strategies for improving medical self-management that can maximize long-term health maintenance for BI survivors.

Telephone Problem Solving Treatment for Active Duty Service Members with Mild Traumatic Brain Injury

Objective: To evaluate the efficacy of a personalized rehabilitation treatment for balance disorders based on visual, proprioceptive and vestibular deficits evaluated by CDP versus a traditional rehabilitation program. Design: Randomized, controlled study. Setting: Outpatient. Personalized balance disorders rehabilitation. Participants: The study involves the recruitment of 240 MS patients with balance disorders. Patients are evaluated with computerized dynamic posturography to identify subjects with prevalent visual or proprioceptive or vestibular deficits. Patients are randomly assigned to the control group (traditional rehabilitation program [TRG]) or study groups (visual [VRG], proprioceptive [PRG] or vestibular [VSRG] rehabilitation group). Each group is composed with 60 subjects. Interventions: Personalized rehabilitation treatments for balance disorders based on visual, proprioceptive and vestibular deficits evaluated by computerized dynamic posturography versus a traditional rehabilitation program. Each group received rehabilitation treatment for 20 sessions, 3 sessions/week, 1 hour/session. Main Outcome Measures: Clinical and instrumental evaluations are: BBS, TUGT, Mini best test, ABC scale, MFIS, T25W, TWT 6min, SOT Composite score and Subscores (Equitest), falls diary, FES-I and VAS. All participants are evaluated at T0 (start of rehabilitation treatments), T1 (end of rehabilitation treatments), T2 (one month follow up), T3 (three month follow up) and T4 (six month follow up). Results or Clinical Course: Preliminary results: 105 patients reached the end of rehabilitation treatments (T1) until now. 26 were assigned to VRG group, 25 to PRG group, 39 to VSRG group and 15 to TRG group. We performed multivariate analysis with RM ANOVA model. Preliminary results show marked improvement of BBS (P<.02). VSRG group shows greater improvement in BBS than the other groups. SOT Composite Score Equitest shows greater improvement in treatment groups without even enhancement of the statistical data. Conclusion: Personalized rehabilitation treatment for balance disorders have greater impact on both clinical outcomes (BBS) and instrumental (SOT Composite Score Equitest) compared to traditional treatment.