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Hypotheses concerning possible correlates of sexual satisfaction in marriage were tested using the replies of 797 married women and men of diverse ages to a 70-item mailed questionnaire that contained seven Likert-type sub-scales measuring different sexual and non-sexual variables. Multiple regression analysis, using sexual satisfaction as the dependent variable, yielded a five-variable model that accounted for a significant portion of the variation in sexual satisfaction (Adjusted R Squared = .602). The variable 'overall satisfaction with marriage' had the highest correlation with sexual satisfaction (r = .622), followed by 'satisfaction with non-sexual aspects of the relationship' (r = .609), frequency of spouse/partner orgasm per sexual encounter (r = .529), frequency of sexual activity (r = .370), and 'sexual uninhibitedness' (r = .230). None of three measures of religiosity made a significant contribution to explaining the variation on self reported sexual satisfaction. Men and women did not differ in level of sexual satisfaction, and adding gender to the regression model did not increase the level of explained variation. The results indicate that sexual satisfaction in these married respondents could not be compartmentalized to their sexual interactions, but was strongly associated with non-sexual aspects of the overall marital relationship as well.

PURPOSE: African-, Hispanic-, and Native Americans are underrepresented in the field of epidemiology including degree programs. As part of the assessment component of its mandate, the American College of Epidemiology Committee on Minority Affairs conducted a survey of minority recruitment activities of U.S. epidemiology degree programs. METHODS: The survey, containing questions related to marketing activities, institutional infrastructure, financial support, academic offerings, and receptive/supportive environment, was mailed to all programs identified in Episource as offering epidemiology degrees. Separate responses were requested concerning activities at the department and school levels. RESULTS: Fifty- two completed questionnaires were received (response rate of 79%). All but two institutions had at least one activity conducted by either the department or the school. However, all activities were more common at the school- than at the department-level. Indeed, some activities [a written minority student recruitment plan (6% of departments and 52% of schools), personnel with minority recruitment responsibilities (4% of departments and 73% of schools] were almost exclusively school-sponsored. Although marketing-type activities were the most common minority recruitment tool used by departments, only 21% made visits to minority schools, 17% visited other colleges specifically to recruit minorities, and 12% produced materials targeted to ethnic/racial minorities. Six percent of the departments and 19% of the schools offered financial support (grants, fellowships, scholarships) to almost all underrepresented minority students. CONCLUSIONS: Even though individual epidemiology degree programs may not see a need for general recruitment activities in order to maintain the size of their applicant pool, minority- specific recruitment activities should be undertaken to enhance and diversify that pool. We recommend that epidemiology departments develop, adopt, and implement comprehensive written plans for the recruitment of underrepresented minority students into their programs.

Increasing emphasis on the need for medical student education about substance abuse has led to the development of a variety of training efforts through faculty development. The Yale University School of Medicine Faculty Development Program or CADRE (Clinical Alcohol and Drug Research and Education) was instituted in 1992 for the purpose of enhancing substance abuse teaching in the Yale medical student curriculum. CADRE faculty were identify in internal medicine, pediatrics, and psychiatry. Prior to the program, there was limited formal teaching about substance abuse in the Yale curriculum and no coordinated effort across disciplines. The enhancement of teaching activities occurred primarily within four required “core”; clinical clerkships for third‐and fourth‐year medical students. Student evaluations of this new teaching activity were positive. The CADRE program was successful at developing a multidisciplinary core faculty group with expertise in substance abuse teaching and resulted in the development of a coordinated, multidisciplinary substance abuse curriculum for Yale medical students.

Comparisons of service use and treatment outcomes for 145 black and 236 white homeless veterans with mental disorders showed few differences. A greater improvement in psychiatric symptoms and alcohol problems among white than black veterans did not hold true when black veterans had participated in the residential treatment component of the program. The implications of the findings for the successful treatment of homeless black veterans are discussed.

Objective: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. Methods: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. Results: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. Conclusion: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.

Objectives: This study examined the clinical significance of non-complexed (free) prostate-specific antigen (PSA) in the differential diagnosis of prostate cancer with an emphasis on patients with total PSA values between 4.0 and 10.0 ng/mL (the diagnostic gray zone). Methods: Serum samples were obtained from three specimen banks. Patient samples consisted of 55 untreated historically confirmed primary cancer, 62 men with untreated benign prostatic disease histologically confirmed by 6 negative sextant biopsies, and 64 asymptomatic healthy male controls with normal digital rectal examinations and PSA values less than 4.0 ng/mL. All patients were between the ages of 50 and 75 years. Total PSA levels were determined using the PA immunoassay performed on the TOSOH AIA-1200 automated immunoassay instrument. Free PSA levels were determined using a monoclonal-polyclonal antibody sandwich radioimmunoassay. The proportion of free to total PSA was calculated by dividing the patient's free PSA value by the total PSA value. Results: When all subjects were included, both total PSA and the proportion of free to total PSA significantly differentiated between patients with prostate cancer and patients with benign histologic conditions (P< 0.0001). However, in men with total PSA values between 4.0 and 10.0 ng/mL, the proportion of free to total PSA significantly differentiated between patients with benign and malignant histologic conditions (P = 0.0004), whereas the total PSA did not (P = 0.13). Among this subgroup of patients, the analysis of sensitivity and specificity showed that the proportion of free to total PSA had a clearly higher specificity compared with that of the total PSA at the same level of sensitivity. Conclusions: Measurement of the free PSA level in a patient's serum and calculation of the proportion of free to total PSA enhances the ability to distinguish benign histologic conditions from cancer while retaining high sensitivity for detecting cancer in men who present with total PSA levels between 4.0 and 10.0 ng/mL. A large-scale population-based study is currently in progress to confirm this preliminary finding. © 1995.

Objective: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Methods: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of Clinical need and to participation in the outreach program. Results: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Conclusions: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.

Pigeons were presented with a concurrent-chains schedule in which terminal-link entries were assigned to two response keys on a percentage basis. The terminal links were fixed delays that sometimes ended with food and sometimes did not. In most conditions, 80% of the terminal links were assigned to one key, but a smaller percentage of the terminal links ended with food for this key, so the number of food reinforcers delivered by the two alternatives was equal. When the same terminal-link stimuli (orange houselights) were used for both alternatives, the pigeons showed a preference for whichever alternative delivered more frequent terminal links. When different terminal-link stimuli (green vs. red houselights) were used for the two alternatives, the pigeons showed a preference for whichever alternative delivered fewer terminal links when terminal-link durations were long, and no systematic preferences when terminal-link durations were short. This pattern of results was consistent with the predictions of Grace's (1994) contextual choice model. Preference for the alternative that delivered more frequent terminal links was usually stronger in the first few sessions of a condition than at the end of a condition, suggesting that the conditioned reinforcing effect of the additional terminal-link presentations was, in part, transitory.

The present study compared compliance, noncompliance strategies, and the correlates in 5-year old Japanese and American children were observed during three standardized laboratory procedures. Compliance, noncompliance strategies, and negative affect were coded during Toy Pick Up procedure. Maternal directiveness and mother-directed behaviors were coded during Mother-Child play and Free-play procedures, respectively. A baseline level of play was also obtained during the Free Play procedures to ensure that the children's willingness to engage in the Toy Pick Up procedure would not be confounded with their level of involvement with the toys. Consistent with predictions derived from a review of cross-cultural research on socialization practices, Japanese children showed longer latencies to begin picking up toys in response to maternal requests and were also more likely to engage in the `less skilled' noncompliance strategies of direct defiance and passive noncompliance than American children. The two groups of children did not, however, differ in their level of negative affect during the Toy Pick Up procedure. Contrary to expectations, maternal directiveness was not associated with compliance in either group of children. However, approach behavior to mother during Free Play was inversely correlated with compliance in Japanese, but not American children.