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Inconsistencies exist among Air Force commanders when disciplining spouse abuse offenders, possibly owing to inadequate training, unclear role expectations, conflicting policy statements, or personal biases. This situation may lead to inappropriate decisions, further endangering victims and negatively impacting mission readiness. A sample of 624 Air Force squadron commanders was surveyed to measure how their perceived role and operations tempo affect their disciplinary decisions on two abuse scenarios. The study tested role and decision-theory concepts. Statistical results supported role theory in the predicted direction, and decision theory, but in the opposite direction hypothesized. Implications for theory, practice, and policy development for the military are discussed. [ABSTRACT FROM AUTHOR]

The authors identified the number, type, and frequency of protective behaviors that undergraduate college students who consume alcohol use to prevent alcohol-related consequences. Their hypothesis was that students who engage in more types of protective behaviors with greater frequency would be less likely to experience alcohol-related consequences. Participants consisted of a randomly selected sample of 1,355 undergraduates aged 18 years and older at a large public university. Students completed a mailed questionnaire on alcohol and health behaviors in spring 2002. The findings (after adjustment for covariates) indicated that self-protective behaviors are inversely associated with alcohol-related problems for women but not for men. The influences of gender and racial and ethnic differences are considered in relation to prevention and intervention programs aimed at reducing alcohol-related consequences on college campuses. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop and empirically evaluate a model that delineated the processes whereby clinical social workers experience burnout and job dissatisfaction in their workplaces. First, on the basis of an array of relevant variables as stress-strain (burnout)--outcome (job dissatisfaction), the proposed model specified interrelationships among work stressors and burnout, the intervening factors between burnout and job satisfaction, and the final outcome variable, job satisfaction. Then the theoretical model was translated into an empirically testable model. Finally, the model was tested with a sample of 165 clinical social workers in Florida by using linear structural relation (LISREL) techniques. The results of analysis of components fit indicated that role conflict did intensify the amount of burnout and job dissatisfaction. Social support acted as an intervening and moderating factor between burnout and job dissatisfaction. lmplications for social work practice are provided. [ABSTRACT FROM AUTHOR]

Finding effective ways to prevent adolescent pregnancy is a concern of public health officials, educators, social workers, parents, and legislators. Numerous programs exist, but there is debate as to whether it is the specific program itself or other factors that are responsible for participants' successful outcomes. Using a quasi-experimental design, this study sought to determine which factors predicted changes in knowledge and beliefs among middle school students (N = 1,450) after exposure to Postponing Sexual Involvement (PSI), the curricular component of Education Now and Babies Later (ENABL), a pregnancy prevention program. It was found that the single most important predictor of improvement in knowledge and beliefs about pregnancy prevention was PSI itself, not background variables. The findings contradict some of the previous studies on factors impacting teenage pregnancy and lend support for the continued examination of ENABL as a promising component of pregnancy prevention efforts. [ABSTRACT FROM AUTHOR]

As the HIV/AIDS epidemic has evolved, heterosexual behaviors have come to be an increasingly important mode of transmission and rates of infection have increased faster among women generally and minority women in particular. Most of what we known about heterosexual risk taking is based on survey data collected from either women or men. These data have been useful for helping to understand different levels and types of risk taking by women and men. However, they provide little information about the levels of risk taking that exist for paired partners in main partner relationships, the types of risks each partner brings to the relationship and how the contribution of partner risks varies. Using data from the pretest of a pilot project designed to test a behavioral intervention to reduce HIV/AIDS transmission among main sex partners, the authors developed four subscales of sexual risk taking for each partner. The association between subscales within and between genders are examined and the subscales are combined to obtain measures of couple risks. Particular attention is given to the gender contribution of partners to couple risk and the differential contribution of types of risk to total risk. The data suggest that, even though men bring relatively higher risks to their main partner relationship than women, this varies inversely with the level of couple risk.

Context: Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use., Methods: Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms., Results: Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently., Conclusions: HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Context: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors., Methods: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use., Results: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1)., Conclusions: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.

Previous investigators have reported ethnic differences in the expression of sexual decision making and sexual behaviors in women. In a sample of women of low socioeconomic status between ages 18 and 45, we examined the influence of ethnicity and other variables (age, education, marital status, and comfort in discussing sex) on (i) who makes decisions on the timing and type of sex, (ii) whether a woman engages in vaginal, oral, and anal sex, (iii) the frequencies of each type of sex, and (iv) whether or not a woman has multiple partners. Multivariate analyses showed that, independent of other independent variables, ethnicity had little direct effect on most variables. The notable exception was that ethnicity influenced joint decision making regarding the timing and type of sexual activities for Hispanic but not for African American women. We conclude that ethnicity contributes to differences in sexual behaviors but that other variables are equally important.

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

The development and implementation of a culturally and gender sensitive, cognitive behavioral-intervention program aimed at preventing high-risk sexual and drug-use behaviors among culturally diverse women at risk for HIV/AIDS is described. The intervention stressed education, cultural/social barriers to change, and assertiveness/negotiation skill building. Methodological problems and their solutions are presented. The article stresses ways to recruit poor at-risk women, how to reduce attrition using incentives such as providing transportation, having food and child care at the intervention sessions, financial rewards, and a tracking system that includes many friends and family members of the participant. Preliminary findings indicated that the intervention was successful in promoting knowledge about HIV/AIDS. At the end of the six-week intervention protocol, the intervention group compared to the control group showed significant improvements in HIV/AIDS knowledge items dealing with clinical aspects of the disease, transmission knowledge, and partner risk knowledge. Knowledge, along with motivation to reduce risk and negotiation skills are essential in changing behaviors that put one at risk.

All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.

This article reports results from a survey of culturally diverse women at risk for HIV infection in south Florida. Data concerning their substance use and its association with HIV risk behaviors are presented. Results indicate levels of consumption which exceed expectations based on general estimates of female substance use. Further, substance use was associated with specific behaviors and lifestyles which placed the women at increased risk for HIV infection.

One hundred and four larynges removed from infants registered as dying from Sudden Infant Death Syndrome (SIDS) and 20 control larynges from infants of matching ages, were examined histologically. Excessive amounts of subglottic submucosal glandular tissue had reduced the available airway by more than half in 35 per cent of the SIDS larynges within the age group two of four months. In 30 per cent of this group the airway reduction was more than 60 percent. It is suggested that hyperplasia of subglottic mucous glands is one cause of fatal hypoxia in sudden unexpected infant death.

This article reports results from a survey of women at risk for HIV infection. The sample (n = 620) included black (50.6%), white (28.7%), Hispanic (13.4%), and Haitian (5.0%) adult women from south Florida. Data concerning their AIDS knowledge, prevalence of risk behaviors, and perceived vulnerability are presented. Results indicate differences in certain knowledge areas and risk behaviors by race/ethnicity and a consistent incidence of unprotected sex with their main partners across all racial/ethnic groups.

Seventy-four larynges removed at death from children who died of sudden infant death syndrome (SIDS) have been studied by serial sectioning in the transverse plane. An increase in subepithelial glandular tissue is seen in many specimens, and the reduction in the available subglottic area has been measured with the Measuremouse Image Intensifying system. This preliminary report confirms that in some of these children with SIDS, particularly around the age of 3 months, there is a potentially lethal reduction in subglottic airway secondary to an increase in mucus-secreting glands, possibly from an associated mild upper respiratory tract infection. Accepting that adequate control infants within this age group who have not had any trauma to the laryngotracheal area are not available, these findings offer a possible explanation for what are always tragic events.

The results of 58 consecutive cases of pharyngolaryngo-oesophagectomy and pharyngogastric anastomosis are presented. The Grey Turner technique is used, but modified by adding bilateral chest drainage established by guidance from below the diaphragm and a jejunostomy. The immediate postoperative therapy management of hypocalcaemia with calcium gluconate and long term control with calciferol is described. An overall 3-year survival rate of 29 per cent has been obtained. Seven patients survived longer than 7 years, the longest living over 10 years. The authors conclude that, with careful management this technique is within the compass of competent surgeons with good facilities and should be the surgical treatment of choice for these difficult tumours.

Fifty-eight patients with osseous or fibro-osseous conditions affecting the craniofacial bones are reviewed in order to determine difficulty of diagnosis, natural history, and management. In many patients separation into individual categories is possible on clinical grounds alone. However, by correlating clinical examination with radiological and histological findings, it is clear that each of the pathological conditions discussed is a separate entity and not merely part of a broad spectrum of bony disorders.

The combined approach for resection of tumors of the nose and paranasal sinuses is well established. The technique has been considerably modified, resulting in an operation that combines good access, sound oncologic resection with excellent cosmesis, and a low postoperative morbidity rate for conditions that have been associated hitherto with an extremely poor prognosis. A 9 year experience with 92 patients is presented. Long follow-up confirmed the initial results, suggesting an improved survival rate in patients with potentially curable disease. An increasing number of large benign tumors, which would previously have been considered inaccessible, are now being resected. Herein, the role and accuracy of preoperative investigations such as computerized tomography and magnetic resonance imaging are evaluated, and the cosmetic implications associated with long-term survival, particularly in children, is considered. The many advantages of craniofacial resection recommend it as the treatment of choice for tumors of the nose and paranasal sinuses, and the versatility of the technique allows its application to tumors arising in adjacent areas.

The linchpin of oncologic statistics might well be thought to be classification based upon the hope that comparisons of natural history and treatment regimes could be compared and controlled worldwide. Many such systems exist for sites within the head and neck; all possess varying degrees of intrinsic error--usually unquantified! A review of three sites by an experienced clinician highlights some of these deficiencies together with their likely significance. The conclusion is reached that although encouraging better recording of clinical and radiologic assessment, cancer statistics based upon existing classification systems can best be compared with a pyramid perched precariously upon its apex!

Most recent publications dealing with surgical repair following pharyngolaryngectomy or pharyngolaryngoesophagectomy appear to be based upon limited surgical experience of the most differing operations now available. An up to date review of 162 patients, including 68 gastric "pull up" procedures, has the advantage of being a personal series as well as a critical evaluation of each technique based upon personal evaluation.

Bullet wounds involving larynx or trachea frequently prove fatal unless the airway is maintained soon after injury. With modern high-velocity bullets tissue damage is severe and injuries may be multiple. Six cases of high-velocity bullet wounds survived initial injury. The sequelae of the damage to larynx or trachea is discussed and in three patients total laryngectomy was necessary.