Barriers and facilitators to implementing an evidence-based woman-focused intervention in South African health services

BACKGROUND

Since the beginning of the HIV epidemic, numerous behavior change, risk-reduction, and biomedical interventions have been developed and tested. While some of these interventions have shown to be efficacious in randomized trials, it often takes almost two decades for an intervention to be translated into practice. Meanwhile, South Africa continues to have among the highest prevalence of HIV globally, with women of childbearing age bearing the burden of the epidemic. Given the urgency of the HIV epidemic among vulnerable women in South Africa, it is imperative that evidence-based interventions be implemented rapidly into practice. This study presents a first step toward examining the acceptability and feasibility of implementing the Women's Health CoOp (WHC) in clinics and substance abuse rehab settings in Cape Town, South Africa.

METHODS

We conducted focus group discussions with women who use substances and with service providers, we also conducted in-depth interviews with health service planners. Our goal was to examine implementation and clinical outcomes associated with delivery of the WHC across clinics and substance abuse rehab programs.

RESULTS

All participants agreed on the need for the WHC. Perceived facilitators to implementing the WHC included the recognizable need for programs to empower women and to build the capacity of staff to address issues of substance use, sexual risk, and intimate partner violence. Participants also identified potential barriers to women engaging with this program, including the stigma women experience when seeking services and the lack of person-centered care at healthcare facilities.

CONCLUSIONS

In a country with the largest number of women of childbearing age living with HIV, an evidence-based woman-focused intervention that comprehensively addresses women's risk for suboptimal antiretroviral adherence may be essential for reducing HIV incidence. However, potential barriers to implementing the WHC successfully must be addressed before the program can be fully integrated into the services delivered by healthcare facilities.

TRIAL REGISTRATION

Clinical trials NCT02733003 . Date of Registration: January 21, 2016, registered retroactively after participant enrollment.

Brief school-based interventions and behavioural outcomes for substance-using adolescents

BACKGROUND

Adolescent substance use is a major problem in and of itself, and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.

OBJECTIVES

To evaluate the effectiveness of brief school-based interventions in reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.

SEARCH METHODS

We conducted the original literature search in March 2013 and performed the search update to February 2015. For both review stages (original and update), we searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to February 2015. We also contacted authors and organisations to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.

MAIN RESULTS

We included six trials with 1176 adolescents that measured outcomes at different follow-up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. We generally found moderate-quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short-, medium-, or long-term follow-up. They also did not have a significant effect on delinquent-type behaviour outcomes among adolescents. When compared to assessment-only controls, we found low- or very low-quality evidence that BIs reduced cannabis frequency at short-term follow-up in one study (standardised mean difference (SMD) -0.83; 95% confidence interval (CI) -1.14 to -0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD -0.91; 95% CI -1.21 to -0.61, n = 242), alcohol abuse (SMD -0.38; 95% CI -0.7 to -0.07, n = 190) and dependence (SMD -0.58; 95% CI -0.9 to -0.26, n = 190), and cannabis abuse (SMD -0.34; 95% CI -0.65 to -0.02, n = 190) at medium-term follow-up in one study. At long-term follow-up, BIs also reduced alcohol abuse (SMD -0.72; 95% CI -1.05 to -0.40, n = 181), cannabis frequency (SMD -0.56; 95% CI -0.75 to -0.36, n = 181), abuse (SMD -0.62; 95% CI -0.95 to -0.29, n = 181), and dependence (SMD -0.96; 95% CI -1.30 to -0.63, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long-term follow-up on these outcomes in the assessment-only comparison was significant (SMD -0.78; 95% CI -1.11 to -0.45).

AUTHORS' CONCLUSIONS

We found low- or very low-quality evidence that brief school-based interventions may be more effective in reducing alcohol and cannabis use than the assessment-only condition and that these reductions were sustained at long-term follow-up. We found moderate-quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high-quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes - a randomised controlled trial protocol

Background

Little research has examined whether alcohol reduction interventions improve antiretroviral therapy (ART) adherence and HIV treatment outcomes. This study assesses the efficacy of an intervention for reducing alcohol use among HIV patients on ART who are hazardous/harmful drinkers. Specific aims include adapting a blended Motivational Interviewing (MI) and Problem Solving Therapy (PST) intervention for use with HIV patients; evaluating the efficacy of the intervention for reducing alcohol consumption; and assessing counsellors’ and participants’ perceptions of the intervention.

Methods/Design

A randomised controlled trial will evaluate the intervention among ART patients in public hospital-based HIV clinics in Tshwane, South Africa. We will recruit patients who are HIV-positive, on ART for at least 3 months, and classified as harmful/hazardous drinkers using the AUDIT-3. Eligible patients will be randomly assigned to one of three conditions. Patients in the experimental group will receive the MI-PST intervention to reduce harmful/hazardous alcohol use. Patients in the equal-attention wellness intervention group will receive an intervention focused on addressing health risk behaviours. Patients in the control condition will receive treatment as usual. Participants will complete an interviewer-administered questionnaire at baseline and 3, 6 and 12 months post-randomisation to assess alcohol consumption, ART adherence, physical and mental health. We will also collect biological specimens to test for recent alcohol consumption, CD4 counts and HIV RNA viral loads. The primary outcome will be reduction in the volume of alcohol consumed. Secondary outcomes include reduction in harmful/hazardous use of alcohol, reduction in biological markers of drinking, increase in adherence rates, reductions in viral loads, and increases in CD4 T-cell counts. A process evaluation will ascertain counsellors’ and participants’ perceptions of the acceptability and effectiveness of the interventions.

Discussion

We have obtained ethical approval and approval from the study sites and regional and provincial health departments. The study has implications for clinicians, researchers and policy makers as it will provide efficacy data on how to reduce harmful/hazardous alcohol consumption among HIV patients and will shed light on whether reducing alcohol consumption impacts on HIV treatment adherence and other outcomes.

Trial registration

Pan African Clinical Trials Register Number: PACTR201405000815100.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-500) contains supplementary material, which is available to authorized users.

Brief school-based interventions and behavioural outcomes for substance-using adolescents

BACKGROUND

Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.

OBJECTIVES

To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.

SEARCH METHODS

We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.

MAIN RESULTS

Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n = 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants' delinquent or problem behaviours.

AUTHORS' CONCLUSIONS

There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.

The relationship between substance use and delinquency among high-school students in Cape Town, South Africa

Research has shown a positive relationship between substance use and delinquent-type behaviours among adolescents. The aim of this study is to explore the temporal relationships between these outcomes through secondary data analysis of a longitudinal study of high-school students' risk behaviours. Two regression models were compared and gender, socioeconomic status and repeating a grade were found to be consistent predictors of delinquent-type behaviour. Alcohol (OR: 1.26, CI: 1.02-1.55, p = 0.03) and drug use (OR: 1.10, CI: 1.03-1.16, p = 0.002) in the ordinal regression models were significantly associated with delinquent-type behaviours at Time 2 only. A transition model use was then used to measure delinquent-type behaviours as predicted by the previous time period, and results indicated that gender and delinquency were predictive of delinquency. Smoking also significantly interacted with delinquent-type behaviour to increase future risk of this behaviour. The findings point to the need for intervening early with adolescents who show delinquent-type behaviour.

Inequitable access to substance abuse treatment services in Cape Town, South Africa

BACKGROUND

Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa.

METHODS

This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization.

RESULTS

Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization.

CONCLUSIONS

Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services.

Methamphetamine ("tik") use and its association with condom use among out-of-school females in Cape Town, South Africa

BACKGROUND

Little is known about the association between methamphetamine use and sexual risk behaviors among young South African women between 13 and 20 years of age.

OBJECTIVE

To examine the association between methamphetamine use and condom use among out-of-school South African female adolescents.

METHODS

Black and Coloured female adolescents were interviewed and categorized into methamphetamine user (n = 261) or non-user (n = 188) groups.

RESULTS

Methamphetamine use was reported by 58% of the total sample. Higher methamphetamine rates were found among young Coloured females (87%) than among young Black females (11%). In a multiple logistic regression analysis that adjusted for relevant confounders and included an interaction term for race and methamphetamine use, Coloured female methamphetamine users were over six times more likely than other participants to report not using a condom the last time they had sex (OR = 6.21; 95% CI = 1.21, 31.94).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Efforts are needed to reduce methamphetamine use and related sexual risk among adolescent females in Coloured communities and to prevent the spread of methamphetamine use in Black African communities.

Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

Background

Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries. This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa.

Methods

Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in poor communities in Cape Town, South Africa who had accessed substance abuse treatment in 2006.

Results

Multiple regression analyses revealed that therapeutic alliance, treatment perceptions, abstinence-specific social support, and depression were significant partial predictors of treatment completion.

Conclusions

Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i) improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii) strengthening clients' abstinence-oriented social networks and, iii) strengthening the counselor-client therapeutic alliance.

Heroin treatment demand in South Africa: trends from two large metropolitan sites (January 1997-December 2003)

Accurate prevalence data on heroin use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of heroin use in South Africa. Data were collected from 41 specialist alcohol and other drug treatment centres in two metropolitan sites (Cape Town and Gauteng Province) between January 1997 and December 2003. Treatment indicators point to a substantial increase in heroin use over time. Most heroin users in treatment tend to be white, male, between the ages of 21 and 24 years and tend to smoke rather than inject the substance. However, this profile is changing. These emerging trends point to the possibility of heroin use becoming a serious health and social issue in South Africa and demonstrate the need for continued monitoring of heroin use patterns in the future and the development of a strategic plan for intervening before the situation deteriorates further.

Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: implications for public health

INTRODUCTION AND AIMS

In the past decade, methamphetamine has become increasingly a drug of concern globally. The purpose of this study is to describe the changing trends in treatment admissions for methamphetamine abuse in Cape Town, South Africa and to highlight the implications of these changes for policy, practice and research.

DESIGN AND METHODS

Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance and information on prior treatment.

RESULTS

The results indicate that between 2004 and 2006 a dramatic increase in treatment admissions for methamphetamine abuse occurred, a large proportion of the methamphetamine patients are adolescents and that the drug is almost exclusively smoked.

DISCUSSION AND CONCLUSIONS

The rapid increase in admissions for methamphetamine abuse is of great concern, particularly as the drug has a number of serious, often chronic, side effects and that a large proportion of the patients are adolescents. The implications for public health are discussed.

Cocaine treatment admissions at three sentinel sites in South Africa (1997-2006): findings and implications for policy, practice and research

BACKGROUND

Accurate prevalence data on cocaine use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of problematic cocaine use in South Africa.

METHODS

Data were collected between January 1997 and December 2006 on admissions for drug abuse treatment through a regular monitoring system involving 56 drug treatment centres and programmes in Cape Town, Gauteng Province (Johannesburg and Pretoria) and the Eastern Cape every six months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance, and information on prior treatment.

RESULTS

Treatment indicators point to a significant increase in cocaine related admissions over time in all sites, but with substantial inter-site variation, particularly in recent years. The data indicate high levels of crack cocaine use and high levels of daily usage among patients, most of whom were first time admissions. Patients with cocaine related problems continue to be predominantly male, with a mean age of around 30 years. Substantial changes in the racial profile of patients have occurred over time. Poly drug use is high with cocaine often used with alcohol, cannabis and other drugs.

CONCLUSION

These trends point to the possibility of cocaine use becoming a serious health and social issue in South Africa and demonstrate the utility of continued monitoring of cocaine treatment admissions in the future. They also highlight the need to address cocaine use in national and provincial policy planning and intervention efforts. In terms of treatment, the findings highlight the need to ensure that treatment practitioners are adequately trained to address stimulant problems, poly drug use, and HIV and other risk behaviour related to crack cocaine use. Possible gaps in access to treatment by certain sectors of the population should be addessed as a matter of urgency.

Cultural similarities and differences between a sample of Black/African and colored women in South Africa: convergence of risk related to substance use, sexual behavior, and violence

South Africa is one of the six southern African countries where the HIV levels for childbearing women are 20% or higher. We conducted two focus groups aimed at developing an understanding of the intersections of substance abuse, sexual behavior, and violence affecting the lives of women of color in Cape Town, South Africa. Both Colored and Black/African participants reported using cannabis, methaqualone, and alcohol, although they differed on other drugs used. Black/African women also used heroin, and crack cocaine, whereas Colored women used methamphetamines. For participants in both groups, relationships with men affected sexual and substance use risk behaviors. Although the Black/African women did not trust men to use condoms, the Colored women in the study believed that almost all men use condoms. Both groups of women reported high rates of violence, with Colored participants reporting more gang violence and woman-on-woman violence compared with Black/African participants. The paper discusses these issues, as well as the implications for adapting a culturally specific, brief woman-focused HIV prevention intervention for the South African context.

Nematodes transmitted to man by fish and aquatic mammals

Zoonotic nematodes may cause disease in man through migrating larva (larva migrans), through direct infection or possibly through allergic responses. The parasitic genera Ancylostoma, Uncinaria, Bunostomum and Toxocara can cause larva migrans. The cod worm (Phocanema decipiens) a parasite found in fish and seals, can infect man, as can Anisakis, Dioctophyme renale and Gnathostoma hispidium larvae obtained from eating raw fish.

The discovery of indoxacarb: oxadiazines as a new class of pyrazoline-type insecticides

The evolution of the insecticidal pyrazoline moiety that was originally discovered in 1972 has led to the discovery of a new crop insecticide, indoxacarb, which is the first commercialized pyrazoline-type sodium-channel blocker. Both monocyclic and fused-tricyclic pyrazolines and pyridazines, as well as structurally related semicarbazones were examined prior to the discovery of analogous tricyclic oxadiazines which had similarly high activity as well as favorable environmental dissipation rates and low toxicity to non-target organisms. The eventual leading candidate, DPX-JW062, was originally obtained as a racemic molecule, but a chiral synthesis was developed which produces material that is 50% ee in the insecticidal (+)-S-enantiomer (DPX-MP062, indoxacarb).

Total synthesis of (+)-amphidinolide P. [corrected]

The convergent enantiocontrolled total synthesis of the 15-membered macrolactone (-)-amphidinolide P is reported. Key transformations include a Sakurai allylation, a Stille coupling for the formation of a fully functionalized acyclic precursor, and intramolecular transesterification.

Drug-using and nonusing women: potential for child abuse, child-rearing attitudes, social support, and affection for expected baby

Eighty pregnant women (25 substance using, 55 nonusing) from an American prenatal clinic serving lower-income to working-class women responded to questionnaire measures of child-rearing attitudes. The drug users' primary substance of misuse was cocaine (68%), alcohol (16%), amphetamines (12%), or sedatives (4%); polydrug use was documented for 80% of the women. The two (user and nonuser) groups were not different on demographic (age, race, marital status, education, SES, source of income) or obstetrical factors (number of pregnancies, number of children). Drug-using women scored significantly higher on a measure of child abuse potential; more than half scored in the range of clinical criterion for extreme risk. As their babies were not yet born, no actual physical abuse was documented, only a higher potential for abuse. The subgroup who were both drug users and had lower social support scored higher on child abuse potential than all other subgroups. The drug users also had lower self-esteem scores than the nonusers. The two groups did not differ on measures of overall social support, authoritarian/democratic child-rearing beliefs, or affection for the expected baby.

Social support and anxiety in pregnant drug abusers and nonusers: unexpected findings of few differences

Drug-abusing (n = 25) and nonusing (n = 55) pregnant women from a publicly supported prenatal clinic were tested for level of social support and of pregnancy anxiety during the last half of pregnancy. Differences found between the groups were fewer than expected. Drug abusers did not differ from nonusers in overall level of social support or in Appraisal, Belonging, or Tangible subscales. Abusers were found to report lower levels of self esteem; lower self esteem was predicted by drug abuse, having more children and lower socioeconomic status. Drug abusers did not differ from nonusers in their overall feelings of pregnancy anxiety, but they did indicate higher fears for themselves and for the baby, and there was a tendency for higher depression and withdrawal.

Couples with an elderly parent with Alzheimer's disease: perceptions of familial relationships

This study examined family relationships in families with and without an elderly parent with Alzheimer's disease. Spouses (29 pairs with an Alzheimer's diseased parent; 29 pairs with a healthy elderly parent) completed questionnaires regarding their perceived relationships with each other, their parent, and one of their own children (aged 8-18). In addition, they completed surveys that inquired about feelings of burden regarding the target parent. Couples perceived a poorer relationship with parents with Alzheimer's disease when contrasted to couples who had a healthy elderly parent. In addition, wives with an Alzheimer's parent also tended to have a more negative relationship with their husbands than wives who had a healthy parent. Perceptions of burden were associated with poorer spousal relationships for wives but not husbands.

Water stress and seedling growth of two eucalypt species from contrasting habitats

Seedlings of Eucalyptus maculata Hook (mesic environment) and E. brockwayi C.A. Gardn. (arid environment) were supplied 100, 70 or 40% of their water requirements estimated from leaf area and the water used by well-watered seedlings. Restricting water supply caused large differences in growth rates, which were related to large differences in total leaf area. There was a fivefold range of variation in number of leaves per plant, and a reduction of up to 20% in average leaf size as a consequence of restricting water supply. Eucalyptus maculata seedlings produced more dry matter than E. brockwayi seedlings, but net assimilation rate was higher in E. brockwayi seedlings. Transpiration rates were also higher in E. brockwayi than in E. maculata. Leaf expansion was analyzed as a function of water stress integral (S(Psi)), which is the cumulative integral over time of predawn water potential below a datum. The leaf area achieved at any stress level was not uniquely dependent on total S(Psi), there was a secondary effect associated with reduced leaf growth caused by previous stress. At any value of S(Psi), reductions in leaf growth of water-stressed seedlings relative to leaf growth of well-watered control seedlings were greater in E. maculata seedlings than in E. brockwayi. Treatment differences in both species showed that, within the levels of stress applied, a moderate water stress over a long period of time was more detrimental to dry matter production than a severe stress for a short time.

Water stress integral-a link between short-term stress and long-term growth

Water stress integral (S(Psi)), the cumulative integral of pre-dawn leaf water potential over any chosen period of time, was estimated from measurements of pre-dawn water potential made every two weeks in a Pinus radiata D. Don plantation near Canberra, Australia. Also measured were final length of current-season needles and annual stem basal area increment. Data were gathered over a 4-year period from a control plot, a fertilized plot, an irrigated plot, and two plots that were both fertilized and irrigated. Among years and treatments, annual basal area increment varied over a threefold range. Of this variation, 91% was accounted for by variation in S(Psi) for the entire year, during every month of which stem diameter growth occurred. Of variation in annual needle elongation, 90% was accounted for by variation in S(Psi) from late August to late February, which was the period of needle growth. In dry years, the annual value of S(Psi) in non-irrigated plots was mainly determined by soil water content, but in wet years in non-irrigated plots, and in all years in irrigated plots, it was closely correlated with tree nutrient status (r(2) = 0.81).

Leaf water relations and anatomy of a tropical rainforest tree species vary with crown position

Leaf water potentials, osmotic properties and structural characteristics were examined in the Australian tropical rainforest tree species, Castanospermum australe. These features were compared for individuals growing in the understorey and canopy of the undisturbed forest and in an open pasture from which the forest had been cleared. Leaf water potentials during the day declined to significantly lower values in the open-grown and canopy trees than in the understorey trees. During most of the day the opengrown tree experienced the lowest water potentials. These differences were paralleled by significant differences in tissue osmotic properties. The tissue osmotic potential at full hydration was lowest in the open-grown tree (-1.80 MPa), intermediate in the canopy trees (-1.38 MPa), and highest in the understorey trees (-0.80 MPa). As a result, the degree to which high and positive turgor pressures were maintained as water potentials declined was highest in the open-grown tree, intermediate in the canopy trees, and lowest in the understorey trees. The differences in tissue osmotic properties between individuals in the three crown positions were paralleled, in turn, by differences in leaf structual characteristics. Relative to leaves of the canopy and open-grown trees, leaves of the understorey trees had significantly larger epidermal cells with thinner cell walls, larger specific leaf areas and turgid weight: dry weight ratios, and a higher proportion of intercellular air space.

Premenstrual tension syndrome symptom clusters. Statistical evaluation of the subsyndromes

Premenstrual symptoms were evaluated in a group of women with severe premenstrual tension syndrome. Factor analysis was performed in order to establish the nature of symptom clusters in this sample. Similar to clinical observations reported on before, the results revealed two distinct clusters of emotional/behavioral symptoms and two of physical symptoms.

Early intervention using Brazelton training with middle-class mothers and fathers of newborns

The purpose of this study was to test the effectiveness of the Brazelton exam as a parent education tool for mothers and fathers. 42 middle-class families with firstborn, healthy, full-term infants were randomly assigned to one of three groups: father treatment, mother treatment, and control. The target parents in the treatment groups were taught to perform the Brazelton exam on their own infant, with attention being drawn to the infant's most positive interactive and physical abilities. Questionnaire and observational data were collected in the hospital and at 4 weeks postpartum. These included measures of knowledge of infant behavior, confidence in parenting ability, satisfaction with the infant, and behavior with the infant. The results showed that treatment parents scored higher in knowledge about infants, at both the early and the 4-week periods. Also, treatment fathers were more involved in caretaking with their infants at 4 weeks than were control fathers. More modest treatment effects were shown for confidence and satisfaction measures. No behavioral treatment effects were found during a 10-min observation of parent-infant interaction.

Calcification of the bladder and papillary tumours of the bladder and ureters in gibbons (Hylobates lar) infected with Schistosoma haematobium (Iran)

Many species of nonhuman primates have been employed to find parasite-definitive host combinations which would allow for investigations on different aspects of schistosomiasis haematobia. Gibbons (Hylobates lar), exposed to moderate numbers of Schistosoma haematobium cercariae, have demonstrated some of the basic features of schistosomiasis haematobia in man. Calcification in schistosomiasis haematobia is variable. Radiologically evident calcification of the bladder was noted in one gibbon. Radio-opaque areas in the bladder corresponded to dense deposits of calcified eggs observed on histological examination. Thus, it seems, bladder calcification, thought to be a later complication of schistosomiasis, can develop fairly rapidly. One of two gibbons killed 11 months after infection had small papillary transitional cell tumours in both ureters. The other had papillary transitional cell tumours covering most of the urinary bladder surface. No invasion of muscle by tumour was present and no metastases were seen.

Schistosoma haematobium infection in the opossum (Didelphis marsupialis): involvement of the urogenital system

Investigations of experimental schistosomiasis haematobia have suffered for want of satisfactory mammals in which schistosome infections would establish host-parasite situations more or less comparable with those seen in man. As a consequence, mammals representing different major groups have been exposed to infection by Schistosoma haematobium (Iran strain) to determine their potential use as models for more detailed investigations. In preliminary studies, 8 American opossums (Didelphis marsupialis) were exposed to 1000 or 2000 cercariae. Macroscopic involvement of the urogenital tract was noted in 3 animals, one of which had a 1-cm fibrous plaque in the bladder. In another animal, multiple transitional cell papillomas were present in the bladder and in one ureter.

Helminths of vertebrates and leeches taken by the U.S. Naval Medical Mission to Yemen, Southwest Arabia

Helminths are listed for amphibians, reptiles, and mammals from vertebrates captured and examined in the Yemen, Southwest Arabia. Two species of leeches were collected, one of which is reported from man.

Nematode parasites of fishes taken on Taiwan (Formosa) and its offshore islands

The present report is one of a series concerned with the helminths of vertebrates taken on Taiwan and its Offshore Islands. Nematodes are listed for fishes (mostly marine) examined over a 5-year period (1957–1962).