Interrelationships of Violence and Psychiatric Symptoms in Women with Substance Use Disorders

Women's issues of violence, mental health problems, and substance abuse have been noted to cooccur, but few studies have examined the interrelationship among the three. A chart review of 198 women (primarily African American) at an inner city substance abuse treatment center was performed to collect data related to physical and sexual abuse experiences before and after age 13. There were significant associations among all forms of physical and sexual abuse before and after age 13 and most of the types of substances abused and almost all of the presenting mental health problems, but most of the independent relationships became nonsignificant in multivariate analyses. However, the experience of both physical and sexual assault increased the risk of suicide attempts by a factor of 6.04. Physical assault was a borderline (p = .07) predictor of depression, while sedative use was significantly predictive of depression, anxiety, and suicide attempts.     

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in today's urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff. University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.     

Long QTc and Torsades de Pointes in Human Immunodeficiency Virus Disease

Three patients with human immunodeficiency virus (HIV) infection presented with QT_c prolongation (> 440 ms) and torsades de pointes. We sought to evaluate the etiology of the long QT syndrome in these patients without previously identified causes for QT_c prolongation, and determine the prevalence among patients with HIV infection. The three index patients underwent: (1) left stellate ganglion block; (2) β-blocker challenge; and (3) electrocardiographic stress testing. QT_c interval was measured before and after intervention. We undertook a retrospective analysis of prevalence of QT_c prolongation among all patients with computerized ECGs over a 6-month period at one institution and compared it to the prevalence in hospitalized patients with HIV disease. Thirty-four thousand one hundred eighty-one patients with computerized ECGs were screened for QT_c prolongation. Forty-two hospitalized patients with HIV disease had computerized ECG during the same 6-month period. In the three index patients, the QT_c failed to shorten with left stellate ganglion blockade, β-blocker challenge, or stress testing, suggesting an acquired form of the long QT syndrome in these patients with HIV disease. None had previously recognized acquired causes of QT_c prolongation. Mexiletine hydrochloride was useful in preventing recurrences of torsades de pointes. We observed a 7.0% prevalence of QT_c prolongation among all patients screened. Hospitalized patients with HIV disease (n = 42) during this same period, demonstrated an increased prevalence of QT_c prolongation (28.6%, P = 0.002). Patients with HIV disease have a significantly higher prevalence of QT_c prolongation than a general hospital-based population, may have an unrecognized acquired form of the long QT syndrome, and are at risk for torsades de pointes.     

Acute Human Immunodeficiency Virus (HIV) Infection Presenting with Fever,Elevated Amylase/Lipase,and Hematologic Abnormalities

Background

Many cases of acute human immunodeficiency virus (HIV) infection (AHI) present to the Emergency Department (ED). Early diagnosis allows a patient to modify their behavior and seek early treatment. The Emergency Physician should know that the antibody response may be absent.

Objective

We report a case of AHI and review its presentation to increase the awareness of this important diagnosis.

Case Report

A 20-year-old black man who had a history of sex with men initially presented to the ED with a chief complaint of blood per rectum when he passed stool, and chills for the prior few days. His work-up was normal, including a rapid HIV screen, and he was discharged. He returned 2 weeks later with constipation, fatigue, myalgias, decreased urination, chills, and a productive cough. His physical examination was unremarkable, HIV antibody test was negative, but his laboratory tests showed an elevation of creatine phosphokinase, amylase, and lipase. His blood count showed a normal hematocrit and white blood cell count, but there were juvenile and vacuolated white cells and giant platelets reported. HIV viral load was reported as > 1,000,000 copies/mL.

Conclusions/Summary

This case illustrates that AHI can present as a non-specific illness. Patients at risk should be screened for HIV. However, AHI can occur before there is a significant antibody response. In such cases, a viral load test may help make the diagnosis, allowing for early treatment and patient counseling.     

Quality of Life and the Concept of "Living Well" With HIV/AIDS in Sub-Saharan Africa

PURPOSE: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in four countries in sub-Saharan Africa: Botswana, Lesotho, South Africa, and Swaziland. METHODS: Using a cross-sectional design and convenience sample, we administered a survey and collected data on demographic characteristics, measures of severity of illness, and perceptions of quality of life. The purposefully selected sample (N=743) consisted of community-based people living with HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality of life, a hierarchical multiple regression was conducted with quality of life as the dependent variable. RESULTS: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62 % of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2 % of the variance in life satisfaction. Those participants with higher life satisfaction scores were less educated, had worries about disclosure and finances, did not have an AIDS diagnosis or other comorbid conditions, had lower symptom intensity, had greater functioning, and had fewer health worries. None of these participants was taking antiretroviral medications at the time of this study. CONCLUSIONS: Several dimensions of the Wilson and Cleary model of quality of life were significantly related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this sample was primarily defined as overall functional ability and control over symptom intensity. These findings are similar to studies in developed countries that have shown the significant relationships among functional abilities, symptom control, and perceived quality of life. As antiretroviral medications become more available in these areas, community members and care providers can help clients realize the possibility of living well with HIV/AIDS, and can work with clients to improve functional ability and control symptom intensity to make living well a reality.     

Frequent Emergency Department Visits are More Prevalent in Psychiatric,Alcohol Abuse,and Dual Diagnosis Conditions than in Chronic Viral Illnesses Such as Hepatitis and Human Immunodeficiency Virus

Background

Repeat users of Emergency Departments (ED), so-called “frequent visitors,” place a substantial burden on limited ED resources. The illness features of frequent visitors have not been well defined, though chronic medical and psychiatric illness and substance abuse are implicated.

Study Objectives

This study assessed whether chronic conditions such as hepatitis C (HCV) and human immunodeficiency virus (HIV) are more prevalent in frequent ED users compared to a viral condition with relatively less disability, hepatitis B (HBV). As a comparison, psychiatric complaints and alcohol abuse were also compared in frequent and non-frequent visitors.

Methods

All visits to a university ED in a particular calendar year were retrospectively reviewed. Frequent visitors were defined as those who made four or more visits. Presenting complaints and past medical history were examined for HCV, HIV, HBV, psychiatric complaints, and alcohol abuse.

Results

Frequent visitors accounted for 28% of all ED visits. HCV, HIV, and alcohol abuse were more prevalent in frequent visitors than non-frequent visitors. People with HBV comprised a small proportion of both groups. Frequent visitors with psychiatric complaints were more prevalent than those with HBV or alcohol abuse. Psychiatric history comorbid with alcohol abuse and HCV with alcohol abuse were more prevalent in frequent vs. non-frequent visitors.

Conclusion

Although chronic hepatitis and psychiatric complaints are both implicated in frequent ED visits, patients with psychiatric complaints present to the ED more often. Patients with a “dual diagnosis” of psychiatric condition and alcohol abuse are likely to be frequent visitors. This population should be targeted for creative intervention strategies, both within and outside of the emergency system, that comprehensively screen for symptomatology and integrate mental health treatment with substance abuse interventions.     

环甲膜穿刺麻醉在AIDS病人/HIV感染者纤维支气管镜诊疗中的应用及护理

机会性感染已成为艾滋病病人就诊和死亡的重要原因,及时、准确地诊断和治疗机会性感染对降低艾滋病病人死亡率具有重要的意义,呼吸系统是机会性感染最常见部位。随着国家对艾滋病(AIDS)病人生活质量的关注度不断提高,AIDS病人/人类免疫缺陷病毒(HIV)感染者与其他公民享有同样的诊疗