Sonia A. Alemagno

Brief Motivational Intervention to Reduce HIV Risk and to Increase HIV Testing Among Offenders Under Community Supervision

Risky drug- and sex-related behaviors put criminal offenders at high risk for HIV. Intervening with this population under supervision can potentially reduce risk. This study reports a randomized trial that examines the efficacy of brief negotiation interviewing (BNI) compared to usual education activities. BNI is a computerized, self-directed intervention that combines a short structured interview with a brief counseling session. The study examined whether BNI could decrease HIV risks and increase testing for HIV in a cohort of criminal-justice-involved clients. The trial randomly assigned 212 participants to experimental (108) and control (104) conditions. Interview data were collected at baseline and at 2-month follow-up. Results indicate that the BNI intervention group had a significantly higher rate of HIV testing and was more likely to consider behavioral changes.

Suicidal Behaviors among Adolescents in Juvenile Detention: Role of Adverse Life Experiences

Purpose The purpose of this study was to assess the influence of multiple adverse life experiences (sexual abuse, homelessness, running away, and substance abuse in the family) on suicide ideation and suicide attempt among adolescents at an urban juvenile detention facility in the United States. Materials and Methods The study sample included a total of 3,156 adolescents processed at a juvenile detention facility in an urban area in Ohio between 2003 and 2007. The participants, interacting anonymously with a voice enabled computer, self-administered a questionnaire with 100 items related to health risk behaviors. Results Overall 19.0% reported ever having thought about suicide (suicide ideation) and 11.9% reported ever having attempted suicide (suicide attempt). In the multivariable logistic regression analysis those reporting sexual abuse (Odds Ratio = 2.75; 95% confidence interval  = 2.08–3.63) and homelessness (1.51; 1.17–1.94) were associated with increased odds of suicide ideation, while sexual abuse (3.01; 2.22–4.08), homelessness (1.49; 1.12–1.98), and running away from home (1.38; 1.06–1.81) were associated with increased odds of a suicide attempt. Those experiencing all four adverse events were 7.81 times more likely (2.41–25.37) to report having ever attempted suicide than those who experienced none of the adverse events. Conclusions Considering the high prevalence of adverse life experiences and their association with suicidal behaviors in detained adolescents, these factors should not only be included in the suicide screening tools at the intake and during detention, but should also be used for the intervention programming for suicide prevention.

The US Cancer Moonshot initiative

Correspondence avoid surgery in rapidly progressive or chemo-insensitive disease. 4 Genotyping of pancreatic tumours via fine needle aspiration could influence the clinical management of pancreatic cancer. Fine-needle aspiration sequencing was used to identify subgroups of patients with specific actionable mutations related to resectable or locally advanced tumours. 5 In patients with radiologically resectable or borderline resectable tumours, preoperative fine-needle aspiration sequencing could distinguish between patients with a genetic pattern associated with micrometastatic tumours, who should undergo neoadjuvant therapy, and those with a truly localised disease that would be amenable to a surgery-first strategy. Michele Reni has served as a consultant for or on the advisory boards of Celgene, Boehringer-Ingelheim, Lilly, Genentech, Baxalta, Novocure, Astra-Zeneca, Pfizer, and Merck-Serono, and has received honoraria from Celgene. Massimo Falconi has received honoraria from Celgene, Ipsen and Novartis. The other authors declare no competing interests. *Stefano Crippa, Michele Reni, Gianpaolo Balzano, Claudio Doglioni, Massimo Falconi crippa1.stefano@hsr.it Division of Pancreatic Surgery, IRCCS San Raffaele Hospital, Milan, Italy (SC, GB, MF); Medical Oncology Department, IRCCS San Raffaele Hospital , Milan, Italy (MR); Department of Pathology, IRCCS San Raffaele Hospital , Milan, Italy (CD); Clinical and Translational Research Program on Pancreatic Cancer, IRCCS San Raffaele Hospital, Milan, Italy (SC, MR, GB, CD, MF) e178 Barreto SG, Windsor JA. Justifying vein resection with pancreatoduodenectomy. Lancet Oncol 2016; 17: e118–24 Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I. Meta-analysis of benefit of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg 2016; 103: 179–91. Bapat AA, Hostetter G, Von Hoff DD, Han H. Perineural invasion and associated pain in pancreatic cancer. Nat Rev Cancer 2011; Sohal DP, Walsh RM, Ramanathan RK, Khorana AA. Pancreatic adenocarcinoma: treating a systemic disease with systemic therapy. J Natl Cancer Inst 2014; 106: dju011 Valero V, Saunders TJ, He J, et al. Reliable detection of somatic mutations in fine needle aspirates of pancreatic cancer with next-generation sequencing: implications for surgical management. Ann Surg 2016; Author’s reply Stefano Crippa and colleagues, in responding to our manuscript, 1 agree that increasing the radicality of surgery for pancreatic ductal adenocarcinoma, including synchronous vein resection, is suspect. Indeed, a recent meta-analysis 2 indicates that synchronous vein resection, as reported, increases mortality and decreases survival. Crippa and colleagues put forward two interesting ideas that warrant further discussion. The first is that the surgery-first approach for pancreatic ductal adenocarcinoma might ultimately be retired, given that pancreatic ductal adenocarcinoma is usually systemic at presentation, local treatments have little effect, and neoadjuvant therapy has possible benefits. For now, the absence of high-level evidence for neoadjuvant therapy leaves largely theoretical benefits; namely that neoadjuvant therapy will reveal the biology (ie, those patients that can progress on neoadjuvant therapy will avoid futile surgery), or alter the biology (ie, those patients that are downstaged will become resectable). The preliminary results of the ALLIANCE trial 3 damages the lustre of these purported benefits with no improvement in the number of resections (10 [50%] of 20 patients who completed all preoperative therapy), and no rescue of aggressive tumour biology. This leads to the second idea, in which Crippa and colleagues suggest a biological (rather than radiological) basis for selecting patients for neoadjuvant therapy with a view to reduce the number of synchronous vein resections. Endoscopic ultrasonography- guided genotyping is a possible way to select subgroups of patients with heterogenous pancreatic ductal adenocarcinoma 4 who will benefit from neoadjuvant therapy. In support of this method, Hruban and colleagues 5 suggested that an intact SMAD4/DPC4 gene might be used to select surgery because there is lesser risk of distant metastases for this genotype. 6 In the future, we hope to more accurately select a subgroup of patients in whom a surgery-first approach, and even synchronous vein resection, is justified, but it is much more likely that precision neoadjuvant therapy will ultimately result in less radical surgery and the introduction of non-surgical techniques to support the response to neoadjuvant therapy. We declare no competing interests. Savio G Barreto, *John A Windsor j.windsor@auckland.ac.nz Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India (SGB); Hepatobiliary Pancreatic and Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand (JAW) Barreto S, Windsor J. Justifying vein resection with pancreatoduodenectomy. Lancet Oncol 2016; 17: e118–24. Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I. Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg 2016; Varadhachary G, Fleming J, Crane C, et al. Phase II study of preoperation mFOLFIRINOX and chemoradiation for high-risk resectable and borderline resectable pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 2015; 33 (suppl 3): abstr 362. Killock D. Pancreatic cancer: a problem quartered—new subtypes, new solutions? Nat Rev Clin Oncol 2016; 13: 201. Hruban RH, Adsay NV. Molecular classification of neoplasms of the pancreas. Hum Pathol Iacobuzio-Donahue CA, Fu B, Yachida S, et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol 2009; The US Cancer Moonshot initiative We recently sent the following letter to Vice President of the USA, Joe Biden, to state that we, as Deans and Directors of Public Health schools and programmes around the USA, strongly support the goals of the Cancer Moonshot initiative to www.thelancet.com/oncology Vol 17 May 2016

Diagnoses, prevalence, and state-based federal spending for HIV prevention and treatment in the United States, 2006–2009

BackgroundIn response to an article published in 2012 by officials at the US Department of Health and Human Services (DHHS), an independent analysis of state-based federal resource allocation for HIV was conducted to determine if the funding accurately reflected diagnosis and prevalence rates.MethodsTotal state-based federal funding for HIV, state-based funding for HIV prevention, and state-based funding for HIV treatment were compared to state-based HIV diagnosis and prevalence rates from 2006-2009.ResultsTotal state-based federal funding for HIV and funding for HIV prevention and treatment were highly correlated with HIV diagnosis and prevalence rates during the time horizon of the study; however, correlations between state-based HIV prevention funding and state-based HIV diagnosis rates were lower than the correlations between state-based HIV treatment funding and HIV prevalence.ConclusionsOur findings suggest that state-based federal resource allocation for HIV prevention and treatment may be better aligned with HIV diagnosis and prevalence rates than previously reported; however resource allocation for HIV prevention is less aligned than funding for HIV treatment signaling the need to reexamine state-based federal funding for HIV prevention.

Psychometric Properties of an HIV Knowledge Scale Administered With Populations at High Risk for HIV Infection

HIV prevention programs targeting men who have sex with men, Blacks, and young adults commonly use measures of HIV knowledge as an important component of demonstrating overall program effectiveness. These scales, however, are rarely subjected to repeated analysis to confirm reliability and validity and the results of psychometric analysis rarely include subpopulation variations. In this study, we administered an adapted version of a previously validated HIV knowledge scale to participants of a large, city-wide HIV prevention program (n = 5,027) and performed psychometric analysis to determine if differences existed across populations. Analysis showed that the HIV knowledge scale performed poorly for men who have sex with men, but very well for transgenders. Results were similar for Blacks, Hispanics, and Whites, very poor for 30- to 39-year-olds, but very well for 60+ year olds. Findings underscore the need for further research on the measurement of HIV knowledge among high-risk populations and the importance of culturally appropriate survey items tailored to each population.

History of Substance Abuse Research in the United States

Research on substance abuse has a long history in the United States. This chapter seeks to examine the development of the field, beginning with the latter part of the nineteenth century to present. While establishing an accurate historical timeline for the field’s development during this period is somewhat difficult, there are some clear chronological benchmarks that can be reasonably ascertained, with important methodological advancements generally mirroring methodological improvements shaping and advancing the field of epidemiology overall. Other factors have also influenced the science of addiction research. Specifically, the field of substance abuse research in the U.S. has been shaped by social and political understandings of addiction, which have shifted over time between more criminological standpoints to medical/disease orientations. Choice of orientation has had important implications for scholarly productivity, as well as the speed of advancement of the science. While not necessarily linear, historical advancements in research methods have built upon one another, greatly expanding our understanding of addiction and informing policy and practice solutions.