This study examines drug acquisition and multiperson use of paraphernalia, drugs, and needles/syringes. Ethnographers observed 54 injection episodes in which IDUs were linked by HIV risk behaviors, and developed a typology of higher-risk, lower-risk, and nonsharing-risk networks. Multiperson use of injection paraphernalia or drug solution occurred in most injection events (94%). Serial use of syringes/needles occurred infrequently (14%) relative to "backloading" (37%) and reuse of paraphernalia (cookers 84%, cotton 77%, water 77%). Higher-risk injection networks were characterized by larger size and pooling of resources for drugs. Prevention messages must include avoiding reuse of injection paraphernalia and transfer of drug solution.
Memory impairment is among the most common cognitive deficits in people with multiple sclerosis (MS). To remediate this problem, recent research has evaluated the benefits of self-generated encoding. These nascent investigations reveal that people with MS who have mild memory impairment demonstrate a significant memory benefit from self-generated encoding compared with didactic learning. To extend prior research, the present experiment included MS patients with moderate-severe, rather than just mild, memory impairment. Additionally, the experiment evaluated whether self-generated encoding improves memory for activities of daily living instead of abstract words. Specifically, the experiment determined whether self-generated encoding enhanced memory for names, appointments, and object locations. In agreement with and extending prior research, MS patients remembered more information if it was self-generated rather than didactically presented, and this finding occurred despite moderate-severe memory impairment. Furthermore, compared with didactic encoding, self-generation enhanced recall of activities of daily living. Implications of these findings for cognitive rehabilitation and the nature of memory impairment in MS are discussed.
Although cognitive deficits are common in persons with multiple sclerosis (MS), the relationship between subjective complaints and objective impairment is sometimes obscured. To elaborate this issue, the present study examined the relationship between subjective complaints of dysexecutive syndrome, neuropsychological performance, and self-reported activities of daily living in 42 people with MS and 13 control participants. Regression analyses revealed that subjective complaints of impairment, measured by the Frontal Systems Behavior Scale (FrSBe), emerged as a significant predictor of neuropsychological deficit and poor adaptive function. Accordingly, subjective complaints of dysexecutive function in MS may serve as a potent indicator of cognitive and functional impairment. Implications for research and clinical practice are discussed.
This article presents a preliminary ethnographic decision tree model of the needle sharing and HIV risk decision-making processes common to injection drug users (IDUs) in Houston, Texas. Ethnographic tree decision modeling is a rigorous qualitative method used to understand and predict how and why people in certain groups do things the way they do. The model was developed from data collected from focus group and individual interviews and naturalistic observations. The research participants were White, African-American and Latino male and female IDUs. The model presents IDUs' needle-sharing routines or scripts based on several prioritized criteria. The model supports other researchers' findings that social roles play an important part in shaping IDUs' needle sharing. Yet, the model attempts to specify the different kinds of roles and relationships. The model suggests that social roles IDUs play and the status hierarchy between roles are the translation mechanisms that organize IDUs' social relationships into drug and HIV risky activities.
Ability to make decisions about medical treatment is compromised in significant numbers of people with neurological and psychiatric illness, and this incapacity frequently corresponds with compromised neuropsychological function. Although cognitive deficits occur often in people with multiple sclerosis (MS), no research has studied decisional capacity in that disease. The present investigation examined ability to understand treatment disclosures, which is a core component of decisional capacity, in 36 people with MS and 16 normal controls. MS patients with diminished neuropsychological function showed poor understanding of treatment disclosures compared to the control group, and diminished new-learning and executive function correlated with poorer understanding. Nonetheless, with sufficient cueing, the MS patients with diminished neuropsychological function were able to display understanding that was equivalent to the control group. Implications of these results for clinical practice and medical research involving people with MS are discussed.
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