Neighborhood effects on drug reporting

Aims To examine whether neighborhood racial characteristics are associated with the under reporting of life time cocaine/crack use. Design A household survey of high‐risk communities with above‐average admissions to state‐supported drug and alcohol treatment programs. Setting Chicago, Illinois, USA. Participants A total of 303 adults. Measures Self‐reported use of cocaine/crack during a respondent's life time, hair test assays for cocaine use and level of neighborhood diversity measured using the Simpson Index. Findings Respondents from more segregated neighborhoods were more likely than those from diverse neighborhoods to under report life time cocaine/crack use. Conclusions Neighborhood racial characteristics should be considered as an important factor in household surveys on illicit substance use.     

Durable effects of concentrated disadvantage on verbal ability among African-American children

Disparities in verbal ability, a major predictor of later life outcomes, have generated widespread debate, but few studies have been able to isolate neighborhood-level causes in a developmentally and ecologically appropriate way. This study presents longitudinal evidence from a large-scale study of >2,000 children ages 6-12 living in Chicago, along with their caretakers, who were followed wherever they moved in the U.S. for up to 7 years. African-American children are exposed in such disproportionate numbers to concentrated disadvantage that white and Latino children cannot be reliably compared, calling into question traditional research strategies assuming common points of overlap in ecological risk. We therefore focus on trajectories of verbal ability among African-American children, extending recently developed counterfactual methods for time-varying causes and outcomes to adjust for a wide range of predictors of selection into and out of neighborhoods. The results indicate that living in a severely disadvantaged neighborhood reduces the later verbal ability of black children on average by approximately 4 points, a magnitude that rivals missing a year or more of schooling.     

Trauma history in African-American women living with HIV: effects on psychiatric symptom severity and religious coping

Women living with HIV (WLHIV) have rates of post-traumatic stress disorder (PTSD) up to 5 times higher than the general population. Individuals living with HIV and a concurrent diagnosis of PTSD have poorer HIV-related outcomes; however, the prevalence and impact of PTSD on African-American WLHIV seeking mental health treatment is unknown. The aim of this study is to examine the associations between PTSD symptoms with psychiatric symptom severity and psychological/religious coping strategies in African-American WLHIV who are seeking mental health treatment. This is a cross-sectional study of 235 African-American WLHIV attending an urban community mental health clinic. Bivariate analyses were conducted to evaluate associations between a PTSD symptoms scale (PSS ≥ 21 versus PSS < 21) and (1) psychiatric severity, (2) coping strategies, and (3) religious coping strategies. Thirty-six percent reported symptoms consistent with PTSD (PSS ≥ 21). These women were significantly more likely to have worse mental health symptoms and were more likely to employ negative psychological and religious coping strategies. On the contrary, women with a PSS < 21 reported relatively low levels of mental health symptoms and were more likely to rely on positive psychological and religious coping strategies. Over one-third of African-American WLHIV attending an outpatient mental health clinic had symptoms associated with PTSD. These symptoms were associated with worse mental health symptoms and utilization of dysfunctional religious and nonreligious coping strategies. Untreated PTSD in WLHIV predicts poorer HIV-related health outcomes and may negatively impact comorbid mental health outcomes. Screening for PTSD in WLHIV could identify a subset that would benefit from evidence-based PTSD-specific therapies in addition to mental health interventions already in place. PTSD-specific interventions for WLHIV with PTSD may improve outcomes, improve coping strategies, and allow for more effective treatment of comorbid mental health disorders.     

Religious involvement,social support,and health among African-American women on the east side of detroit

BACKGROUND: A significant body of research suggests that religious involvement is related to better mental and physical health. Religion or spirituality was identified as an important health protective factor by women participating in the East Side Village Health Worker Partnership (ESVHWP), a community-based participatory research initiative on Detroit's east side. However, relatively little research to date has examined the mechanisms through which religion may exert a positive effect on health. OBJECTIVE: The research presented here examines the direct effects of different forms of religious involvement on health, and the mediating effects of social support received in the church as a potential mechanism that may account for observed relationships between church attendance and health. DESIGN: This study involved a random sample household survey of 679 African-American women living on the east side of Detroit, conducted as part of the ESVHWP. MAIN RESULTS: Results of multivariate analyses show that respondents who pray less often report a greater number of depressive symptoms, and that faith, as an important source of strength in one's daily life, is positively associated with chronic conditions such as asthma or arthritis. Tests of the mediating effect of social support in the church indicated that social support received from church members mediates the positive relationship between church attendance and specific indicators of health. CONCLUSIONS: These findings are consistent with the hypothesis that one of the major ways religious involvement benefits health is through expanding an individual's social connections. The implications of these findings for research and practice are discussed.     

Correlates of requesting home HIV self-testing kits on online social networks among African-American and Latino men who have sex with men

High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07–6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2–3.12), uncertain HIV status (4.29, 1.37–14.4), and having sex under the influence of alcohol (2.46, 1.06–5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02–6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56–0.92). By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions.     

Common and drug-specific genetic influences on subjective effects to alcohol, tobacco and marijuana use

Aim To examine variation in positive and negative subjective effects to alcohol, tobacco and marijuana and covariation between these three drugs and each effect. Design Retrospective self‐reports of subjective effects were collected to estimate the genetic and environmental influences and the extent of their specificity across three drugs. Participants Data were drawn from 1299 adolescent and young adult same‐ and opposite sex twin‐ and sibling‐pairs participating in the Colorado Center for Antisocial Drug Dependence (CADD). Setting A large, collaborative, longitudinal study of substance use and antisocial behavior in community and clinical adolescents. Measurement Subjective effects were assessed using a 13‐item questionnaire that included positive and negative responses to alcohol, tobacco and marijuana. Findings Heritable influences contributed moderately (additive genetic effects 16–56%) to positive and negative subjective effects to all three drugs and did not differ for males and females. Genetic and environmental contributions to positive and negative subjective effects are largely non‐overlapping for tobacco and marijuana. Multivariate genetic modeling indicated that subjective effects to alcohol, tobacco and marijuana share a common, heritable etiology and that drug‐specific genetic influences were an important contributor to individual differences in drug response. Conclusions Results from our genetic analyses suggest that subjective effects to these commonly used and misused drugs are heritable and that the genetic and environmental influences on effects to one drug also influence subjective effects to other drugs.     

Influence of acute bupropion pre-treatment on the effects of intranasal cocaine

Aims The aim of this experiment was to determine the influence of acute bupropion pre‐treatment on subject‐rated effects and choice of intranasal cocaine versus money. Design A randomized, within‐subject, placebo‐controlled, double‐blind experiment. Setting An out‐patient research unit. Participants Eight cocaine‐using adults. Measurements Subjects completed nine experimental sessions in which they were pre‐treated with 0, 100 or 200 mg oral immediate release bupropion. Ninety minutes later they sampled an intranasal cocaine dose [4 (placebo), 15 or 45 mg] and made six choices between that dose and an alternative reinforcer (US$0.25), available on independent, concurrent progressive ratio schedules. Subjects also completed a battery of subject‐rated, performance and physiological measures following the sample doses of cocaine. Findings After 0 mg bupropion, the high dose of cocaine (45 mg) was chosen five of six times on average compared to 2.25 of six choices for placebo cocaine (4 mg) (P < 0.05). Active bupropion reduced choice of 45 mg cocaine to 3.13 (100 mg) or 4.00 (200 mg) out of six drug choices on average. Bupropion also consistently enhanced positive subject‐rated effects of cocaine (e.g. good effects; willing to take again) while having no effects of its own. Conclusions The atypical antidepressant, bupropion, acutely appears to reduce preference for intranasal cocaine versus a small amount of money but to increase reported positive experiences of the drug.     

Improving knowledge and perception of HIV/AIDS among English language speaking children in rural areas through educational digital storytelling

Background/Objective:Previous research efforts have shown the need for improvement of knowledge and perception of HIV/AIDS among English Language speaking children in rural areas. Hence, the study at hand was designed to investigate the effect of using educational digital storytelling intervention to satisfy this need of English Language children in rural areas in Nigeria.Method:The study adopted a randomized control design involving a pretest, post-test, and follow-up measures. Eight-four children (n = 84) took part in the study. The HIV Knowledge Questionnaire (HIV-KQ-18) and the Perceived Risk of HIV Scale (PRHS) were used for data collection. Data were analyzed using t test statistics.Result:The educational digital storytelling intervention in appreciably improved knowledge and perception of English language children in rural areas who participated in the intervention concerning HIV/AIDS compared with their peers in the no-intervention control group. The improvement in knowledge and perception gained was also maintained throughout the follow-up evaluation period.Conclusion:The present study showed that the use of educational digital storytelling could improve knowledge and perception of HIV/AIDS among English Language speaking children in rural areas. Educational digital storytelling intervention effectively improved knowledge and perception of HIV/AIDS among children in rural areas. In return, we recommend that rural sociologists, counselors, language and communication experts, child educators, and other professionals involved in public health especially, as it concerns children be skilled in the use and application of educational digital storytelling intervention procedures to facilitate the move towards adopting the method in their professional practices.     

抗结核药物引起的副作用604例临床分析

目的 了解抗结核药物副作用发生情况。方法 对1990～1998年住院肺结核患者1848例进行临床分析。结果 抗结核药物副作用604例 (32.7%),以肝损害、位听神经损害、血液学异常及胃肠反应为主 (82.1%),因副作用致终止治疗率14.6%。77%的副作用出现于给药的2个月内,血液学异常的50%以上在用药的3个月后出现。结论 抗结核药物引起的副作用常见,分布较广,应引起临床工作者高度重视。     

Effect of awareness of language law on language access in the health care setting

BACKGROUND: Federal law obligates health care providers receiving federal funding to ensure language access to limited English-proficient (LEP) individuals who cannot communicate with their provider. OBJECTIVE: To determine whether LEP individual awareness of this law improved language access through interpreter utilization. DESIGN, SETTING, AND PARTICIPANTS: In June 2003, a telephone survey of 1,200 Californians was conducted in 11 non-English languages. MEASUREMENTS: The survey included items on English proficiency, awareness of language law, health care utilization, and communication methods. Language access was defined as having a provider who speaks the individual's language (language-concordant) or utilizing an interpreter. RESULTS: There were 1,000 LEP participants, of whom 371 (37%) were aware of the language law. Four hundred and ninety-one (49%) of LEP participants had a language-concordant provider. Of the remaining 509 LEP participants without a language-concordant provider, 111 (22%) reported interpreter utilization in the health care setting. After controlling for age, gender, education, income, insurance status, years in the United States, health care utilization, and level of English proficiency, awareness of law was not associated with interpreter utilization (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.38, 1.17; P=.16), but was associated with having a language-concordant provider (OR 1.64; 95% CI 1.19, 2.26; P=.003). CONCLUSION: Awareness of language law is not sufficient to resolve language barriers for LEP individuals. Provider and organization level barriers to language access must be addressed.     

Antiproliferative effects of carbon monoxide on pancreatic cancer

BackgroundCarbon monoxide, the gaseous product of heme oxygenase, is a signalling molecule with a broad spectrum of biological activities. The aim of this study was to investigate the effects of carbon monoxide on proliferation of human pancreatic cancer.MethodsIn vitro studies were performed on human pancreatic cancer cells (CAPAN-2, BxPc3, and PaTu-8902) treated with a carbon monoxide-releasing molecule or its inactive counterpart, or exposed to carbon monoxide gas (500 ppm/24 h). For in vivo studies, pancreatic cancer cells (CAPAN-2/PaTu-8902) were xenotransplanted subcutaneously into athymic mice, subsequently treated with carbon monoxide-releasing molecule (35 mg/kg b.w. i.p./day), or exposed to safe doses of carbon monoxide (500 ppm 1 h/day; n = 6 in each group).ResultsBoth carbon monoxide-releasing molecule and carbon monoxide exposure significantly inhibited proliferation of human pancreatic cancer cells (p < 0.05). A substantial decrease in Akt phosphorylation was observed in carbon monoxide-releasing molecule compared with inactive carbon monoxide-releasing molecule treated cancer cells (by 30–50%, p < 0.05). Simultaneously, carbon monoxide-releasing molecule and carbon monoxide exposure inhibited tumour proliferation and microvascular density of xenotransplanted tumours (p < 0.01), and doubled the survival rates (p < 0.005). Exposure of mice to carbon monoxide led to an almost 3-fold increase in carbon monoxide content in tumour tissues (p = 0.006).ConclusionThese data suggest a new biological function for carbon monoxide in carcinogenesis, and point to the potential chemotherapeutic/chemoadjuvant use of carbon monoxide in pancreatic cancer.     

非心血管药物对心血管系统的不良影响

本文评价了一系列非心血管药物对心血管系统的众多不良影响及其特点,其引起的问题之多几乎涵盖了各种常见心血管疾病范围,为此,特提醒临床医师应高度重视非心血管药物对心血管系统的不良影响,并将其影响减少到最小。     

湖南省6558例HIV/AIDS病人HAART疗效及不良反应分析

目的了解湖南省开展艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）高效抗反转录病毒治疗（HAART）的疗效、不良反应及耐药等情况。方法采用回顾性研究,对湖南省2003年9月至2012年12月间接受HAART的病例进行分析。结果共有6558例HIV/AIDS病人接受了HAART：1）CD＋4T淋巴细胞（简称CD4细胞）计数随治疗时间的延长明显升高,按照基线CD4细胞水平划分为≤99个/μL、100~199个/μL、200~350个/μL三组,然后做两两比较,差异有统计学意义（P〈0.01）。2）在治疗后7-12个月,64%的病人体内病毒复制得到了完全抑制,病毒载量检测值〈50拷贝/mL;在治疗后7-12个月,病毒载量〈50拷贝/mL的比例及病毒载量常用对数值lgVL变化幅度最大,12个月以后下降趋势减缓,约3年后进入平台期。3）服药后较常见的不良反应是胃口改变、恶心呕吐、皮疹及疲倦等,因不良反应更换治疗方案的病例占总换药病例的70.1%（1719/2451）,因不良反应停药占总停药病例的33.6%（178/529）。4）最近一次病毒载量检测〈50拷贝/mL的2739例病人中,连续2次CD4细胞计数较基线水平增幅〈20%,或治疗一年以上未达200个/μL的共375例,免疫无应答比例13.7%。5）2011及2012连续两年耐药监测显示,总耐药率为2.6%,处于较低水平。结论湖南省艾滋病HAART在免疫学和病毒学方面均取得了较好的疗效,需进一步加强不良反应、免疫无应答及耐药情况的监测和处理。     

Long-term effects of marijuana use on the brain

Questions surrounding the effects of chronic marijuana use on brain structure continue to increase. To date, however, findings remain inconclusive. In this comprehensive study that aimed to characterize brain alterations associated with chronic marijuana use, we measured gray matter (GM) volume via structural MRI across the whole brain by using voxel-based morphology, synchrony among abnormal GM regions during resting state via functional connectivity MRI, and white matter integrity (i.e., structural connectivity) between the abnormal GM regions via diffusion tensor imaging in 48 marijuana users and 62 age- and sex-matched nonusing controls. The results showed that compared with controls, marijuana users had significantly less bilateral orbitofrontal gyri volume, higher functional connectivity in the orbitofrontal cortex (OFC) network, and higher structural connectivity in tracts that innervate the OFC (forceps minor) as measured by fractional anisotropy (FA). Increased OFC functional connectivity in marijuana users was associated with earlier age of onset. Lastly, a quadratic trend was observed suggesting that the FA of the forceps minor tract initially increased following regular marijuana use but decreased with protracted regular use. This pattern may indicate differential effects of initial and chronic marijuana use that may reflect complex neuroadaptive processes in response to marijuana use. Despite the observed age of onset effects, longitudinal studies are needed to determine causality of these effects.The rate of marijuana use has had a steady increase since 2007 (1). Among >400 chemical compounds, marijuana’s effects are primarily attributed to δ-9-tetrahydrocannabinol (THC), which is the main psychoactive ingredient in the cannabis plant. THC binds to cannabinoid receptors, which are ubiquitous in the brain. Consequently, exposure to THC leads to neural changes affecting diverse cognitive processes. These changes have been observed to be long-lasting, suggesting that neural changes due to marijuana use may affect neural architecture (2). However, to date, these brain changes as a result of marijuana use remains equivocal. Specifically, although functional changes have been widely reported across cognitive domains in both adult and adolescent cannabis users (3–6), structural changes associated with marijuana use have not been consistent. Although some have reported decreases in regional brain volume such as in the hippocampus, orbitofrontal cortex, amygdala, and striatum (7–12), others have reported increases in amygdala, nucleus accumbens, and cerebellar volumes in chronic marijuana users (13–15). However, others have reported no observable difference in global or regional gray or white matter volumes in chronic marijuana users (16, 17). These inconsistencies could be attributed to methodological differences across studies pertaining to study samples (e.g., severity of marijuana use, age, sex, comorbidity with other substance use or psychiatric disorders) and/or study design (e.g., study modality, regions of interest).Because THC binds to cannabinoid 1 (CB1) receptors in the brain, when differences are observed, these morphological changes associated with marijuana use have been reported in CB1 receptor-enriched areas such as the orbitofrontal cortex, anterior cingulate, striatum, amygdala, insula, hippocampus, and cerebellum (2, 11, 13, 18). CB1 receptors are widely distributed in the neocortex, but more restricted in the hindbrain and the spinal cord (19). For example, in a recent study by Battistella et al. (18), they found significant brain volume reductions in the medial temporal cortex, temporal pole, parahippocampal gyrus, insula, and orbitofrontal cortex (OFC) in regular marijuana users compared with occasional users. Whether these reductions in brain volume lead to downstream changes in brain organization and function, however, is still unknown.Nevertheless, emergent studies have demonstrated a link between brain structure and connectivity. For example, Van den Heuvel et al. and Greicius et al. demonstrated robust structural connections between white matter indexes and functional connectivity strength within the default mode network (20, 21). Similarly, others have reported correlated patterns of gray matter structure and connectivity that are in many ways reflective of the underlying intrinsic networks (22). Thus, given the literature suggesting a direct relationship between structural and functional connectivity, it is likely that connectivity changes would also be present where alterations in brain volume are observed as a result of marijuana use.The goal of this study was to characterize alterations in brain morphometry and determine potential downstream effects in connectivity as a result of chronic marijuana use. To address the existing inconsistencies in the literature that may be in part due to methodological issues, we (i) used three different MRI techniques to investigate a large cohort of well-characterized chronic cannabis users with a wide age range (allowing for characterization without developmental or maturational biases) and compared them to age- and sex-matched nonusing controls; (ii) examined observable global (rather than select) gray matter differences between marijuana users and nonusing controls; and (iii) performed subsequent analyses to determine how these changes relate to functional and structural connectivity, as well as behavior. Given the existing literature on morphometric reductions associated with long-term marijuana use, we expected gray matter reductions in THC-enriched areas in chronic marijuana users that will be associated with changes in brain connectivity and marijuana-related behavior.