Knowledge and attitudes about AIDS: A comparison of public high school students,incarcerated delinquents,and emotionally disturbed adolescents

This study compared AIDS knowledge and attitudes in public high school students (N=167), incarcerated delinquents (N=166), and emotionally disturbed (SED) adolescents (N=151). The response measure was a 50-item Acquired Immunodeficiency Syndrome (AIDS) questionnaire that was previously used by Bell et al., in their 1991 study of learning disabled adolescents. Although AIDS knowledge was moderately high in all three groups, widespread misunderstandings about disease transmission and awareness of high-risk groups and practices were noted. Knowledge scores were significantly higher in the public school sample than in the SED adolescents; moreover, they tended to be slightly higher (p<0.10) than the delinquent group as well. Teenagers with the severest emotional problems were by far the least informed. Age and race were also predictive of AIDS knowledge. Other results showed that delinquents were more permissive in their attitudes about sex, more inclined to disdain safe sex practices, and more likely to feel threatened by high-risk groups as well as powerless to protect themselves against AIDS. Generally speaking, the findings extend the work of other investigators on the needs for AIDS education in adolescents. The need is especially urgent in delinquent and emotionally disturbed youth who may require a more comprehensive intervention because of their greater knowledge deficits, propensity for high-risk practices, and tendency to deny or underestimate their own vulnerability.Received Ph.D. in clinical psychology from the University of Utah in Salt Lake City. Research interests include health behavior change and the treatment of anxiety and habit disorders. To whom correspondence should be addressed.Received M.A. degree in psychology from the University of the Pacific. Research interests include health behavior change and medical epidemiology.Received Ph.D. in psychology from the University of Auckland, Auckland, New Zealand. Research interests are in child and adolescent psychiatry and the delivery of mental health services.Received Ph.D. in biostatistics from the Medical College of Virginia. Research interests are in general linear models.     

Budgeting Rights: The Case of Jail Litigation

Judicial decisions are one element in the erosion of local government budgetary discretion. For example, litigation concerning constitutional rights forces local government officials to allocate resources toward the rights-based population. While rights-based allocation decisions may narrow the budgetary discretion of public officials, some managers may, paradoxically, be "better-off"—defined as the ability to protect and defend their budgets — when discretion is reduced. This thesis is tested through a case study of jail overcrowding litigation in a county government.     

Developing economics expertise for the evaluation of primary health care

Given that government budgets are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the costs and benefits of public sector investments. Nowhere is this need greater than in the health field, where the benefits of programmes are typically difficult to measure. Within the health sector a key area of interest is primary health care, which is generally regarded as a central function and the most important means by which the health of the population can be improved. This paper reports the results of a recent survey of Commonwealth countries which sought to establish the extent of economic evaluation of PHC programmes, the impact on decision-making and the level of health economics expertise available in Third World countries. Based on the results of the survey, suggestions are made for improving the commissioning and conduct of economic evaluations, for interpreting and implementing evaluation results, and for developing government expertise in economic evaluation.     

State Lotteries for Public Revenue

Lotteries, the state fiscal gimmick of the eighties, operate in jurisdictions encompassing substantially more than half the nation's population and enjoy considerable public acceptance. The revenue they generate is small, rarely more than two percent of state general revenue, it is subject to major year-to-year swings, and it is very expensive to generate, particularly when vendor commissions are recognized as part of cost. Furthermore, lotteries bear a high implicit excise tax rate and, because of the pattern of play across income classes, appears to worsen the overall equity of the revenue system. Their economic impact appears to be that of an internal transfer, although states with major lottery equipment suppliers have most to gain, particularly if they do not operate their own lottery. Lotteries are not destined to become mainstays of government finance, although their spread is likely, even with the fiscal questions they raise.     

Sudden death in an infant resulting from torsion of the uterine adnexa

A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.     

Utilizing the urinary 5-HTOL/5-HIAA ratio to determine ethanol origin in civil aviation accident victims

Specimens from fatal aviation accident victims are submitted to the FAA Civil Aerospace Medical Institute for toxicological analysis. During toxicological evaluations, ethanol analysis is performed on all cases. Care must be taken when interpreting a positive ethanol result due to the potential for postmortem ethanol formation. Several indicators of postmortem ethanol formation exist; however, none are completely reliable. The consumption of ethanol has been shown to alter the concentration of two major serotonin metabolites, 5-hydroxytryptophol (5-HTOL) and 5-hydroxyindole-3-acetic acid (5-HIAA). While the 5-HTOL/5-HIAA ratio is normally very low, previous studies using living subjects have demonstrated that the urinary 5-HTOL/5-HIAA ratio is significantly elevated for 11-19 h after acute ethanol ingestion. Recently, our laboratory developed and validated an analytical method for the simultaneous determination of both 5-HTOL and 5-HIAA in forensic urine samples using a simple liquid/liquid extraction and LC/MS/MS and LC/MS/MS/MS. In this previous work a 15 pmol/nmol serotonin metabolite ratio cutoff was established in postmortem urine, below which it could be conclusively determined that no recent antemortem ethanol consumption had occurred. In the current study this newly validated analytical method was applied to five ethanol-positive aviation fatalities where the origin of the ethanol present could not previously be conclusively determined. In four of the five cases examined the detected ethanol was demonstrated to be present due to postmortem microbial formation, and not consumption, even though some indication of ethanol consumption may have been present.     

A coffee can, factor analysis, and prediction of antisocial behavior: the structure of criminal risk

The predictive accuracy of the Psychopathy Checklist-Revised, Level of Service Inventory-Revised, Violence Risk Appraisal Guide, and the General Statistical Information on Recidivism were compared to four instruments randomly generated from the total pool of original items. None of the four original instruments better predicted post-release failure than the four randomly generated instruments. These results suggest two conclusions: (a) the instruments are only measuring criminal risk, and (b) no single instrument has captured sufficient risk assessment theory to result in better prediction than randomly derived instruments measuring criminal risk. A two-stage factor analysis was completed on 1614 cases. This analysis of the risk items indicated a 4-factor solution and all 4 factors were equal to the original instruments in predicting post-release failure. Thus, the original instruments did not improve prediction over randomly structured scales, nor did the restructuring of items improve risk assessment, suggesting substantial deficiencies in the conceptualization of risk assessment and instrumentation. We argue that developing a risk-based construct, which involves hypothesis testing and an explanation of behavior, is the optimal method to advance risk assessment within the criminal justice and mental health systems. Such an approach would provide targeted areas for clinical intervention that are salient to risk.