Chancroid: results from an outbreak in Houston, Texas

A recent (and continuing) epidemic of chancroid in Houston has included morphologic variation in the disease, including so-called dwarf, classic, giant, transient, follicular, phagedenic, and pseudogranuloma inguinale types. Most cases were clearly acquired by unprotected sexual encounters with local prostitutes. The strain of Haemophilus ducreyi responsible for this outbreak was relatively easily cultured on routine media; unexpected sensitivity of this strain to vancomycin rendered the recommended "selective" growth medium much less optimal for isolation. Therapeutic success uniformly followed the use of intramuscular ceftriaxone sodium; one case responded to oral ciprofloxacin hydrochloride.     

Antimicrobial Susceptibilities of Shigellae Isolated in Houston, Texas, in 1974

One hundred seventy-three strains of shigellae (113 Shigella sonnei, 56 S. flexneri, and four others) isolated in Houston during 1974 were tested for susceptibility to commonly used and newer antimicrobial agents. Forty-five percent of S. sonnei strains were susceptible to ampicillin, whereas 93% of S. flexneri strains were susceptible to that agent. S. sonnei and S. flexneri strains were equally susceptible to tetracycline (35 and 33%, respectively). All 173 strains were uniformly susceptible to quinoline drugs (cinoxacin, oxolinic acid, and nalidixic acid) and to trimethoprim-sulfamethoxazole. This study supports recent suggestions that the initial therapy of bacillary dysentery no longer should be ampicillin or tetracycline. It remains for field testing to determine whether quinoline agents or trimethoprim-sulfamethoxazole will be the treatment of choice.     

A comparison of HIV risk behaviors between early and late initiators of injection drug use in Houston,Texas

Abstract

Background: Injecting drug use accounts for 10% of new HIV cases worldwide. Younger injecting drug users are more likely to engage in HIV risk behaviors. Objectives: To assess the association between the age at initiation of injecting drugs and HIV risk behaviors. Methods: Houston data from the National HIV Behavioral Surveillance System were analyzed. The primary exposure variable was the self-reported age at injecting drug initiation. This study assessed whether individuals who initiated injecting drugs before and after the age of 21 differ by selected socio-demographic characteristics and high risk behaviors. Results: Black race and lower education level were shown to be the only statistically significant factors with those self-reported to initiate injecting drugs before turning 21. The group initiating use before the age of 21 was found to be more likely to share needles. Conclusions: This study highlights that race and education are positively associated with younger injecting drug initiation and younger injectors tend to engage in HIV risk behaviors such as needle sharing.     

Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective

OBJECTIVES: Investigations of the association between chronic pain conditions and suicidal ideation (SI) and suicide attempts (SA) have rarely taken the effect of mental disorders into account and have been limited by nonrepresentative samples. The present study used a large population-based sample to investigate the association between chronic pain conditions and SI and SA. METHODS: Data were from the Canadian Community Health Survey Cycle 1.2 public use file conducted by Statistics Canada from 2001 to 2002 (N=36,984; response rate 77%). Respondents were asked if they had been diagnosed with the following painful conditions: migraine, back problems, arthritis, and fibromyalgia. Respondents were assessed for past 12-month SI and SA. The Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders-IV. RESULTS: After adjusting for sociodemographics, Axis I mental disorders and comorbidity (3 or more mental disorders), the presence of 1 or more chronic pain conditions was associated with both SI and SA. Among respondents with a mental disorder, comorbidity with 1 or more chronic pain conditions was also associated with SI and SA. In models adjusting for other painful conditions, migraine had the strongest link with SI and SA. DISCUSSION: This is the first study to demonstrate the association between several chronic pain conditions and SI and SA while adjusting for mental disorders in a nationally representative sample. Moreover, this study demonstrates that among individuals with a mental disorder, having a chronic pain condition significantly increased the association with SI and SA.     

African Americans' perceptions of access to workplace opportunities: a survey of employees in Houston, Texas

Although increasing numbers of African Americans are employed in predominantly white organizations, anecdotal and scholarly evidence suggests that they still must overcome barriers to have similar career trajectories as their white counterparts. This study is motivated by other studies pertaining to racial discrimination and inequalities at the workplace as experienced by blacks. We examined how African Americans perceive their own access to workplace opportunities and rewards, their views of other minority employees' work remuneration and career trajectory, as well as gender bias in their organizations. The findings indicated that many respondents believed that in crucial areas of job advancement (e.g., advanced training, mentoring, and promotion), they do not receive what they consider to be a fair share of opportunities from their organizations. Some respondents felt that other minority employees receive more attention and favorable treatment at work than they do. Considering gender bias, many thought that women of all ethnicities had more access to work benefits than their male counterparts.     

Penicillin susceptibility of Streptococcus pneumoniae in a private pediatric hospital in Houston, Texas.

Of 493 isolates of Streptococcus pneumoniae, 14 were found to have decreased penicillin susceptibility as determined by the oxacillin disk test. Of these 14 isolates, 4 were relatively resistant by quantitative susceptibility studies and 1 was penicillin resistant (MIC, 2 micrograms/ml). This is the first confirmed penicillin-resistant isolate in the Houston, Tex., area.     

Prevalence and determinants of type 2 diabetes among Filipino-Americans in the Houston, Texas metropolitan statistical area.

OBJECTIVE: The few available studies suggest that Filipino-Americans have an increased risk for developing type 2 diabetes. The purpose of this study was to determine the prevalence of previously diagnosed type 2 diabetes and its major risk factors among Filipino-Americans. RESEARCH DESIGN AND METHODS: A cross-sectional survey was conducted in the Houston, Texas, metropolitan statistical area between September 1998 and March 2000. The convenience sample included 831 Filipino-American participants aged 20-74 years. The major risk factors assessed were age, sex, family history of diabetes, socioeconomic status, obesity (BMI >30), physical inactivity, acculturation, region of birth and, in women, history of gestational diabetes and delivery of a baby weighing > 9 lb. RESULTS: Overall prevalence was estimated to be 16.1% (95% CI 13.5-18.7). Multivariate logistic regression analyses identified independent risk factors: increasing age from ages 35-44 years (odds ratio [OR] 5.6, 95% CI 1.5-20.5) to 65-74 years (34.2, 7.2-163.0); male sex (1.8, 1.1-32.1); family history of diabetes (4.7, 2.6-8.5); obesity (3.6, 1.4-9.0); region of birth, Mindanao (3.2, 1.3-7.7); and, among women, gestational diabetes (21.7, 6.7-69.7) and low income (5.3, 1.4-20.2). CONCLUSIONS: The study observed a high prevalence of type 2 diabetes and supports earlier studies suggesting that Filipinos are at higher risk for type 2 diabetes than the U.S. non-Hispanic white population.     

The role of drugs and alcohol in urban minority adolescent suicide attempts

This study examined psychopathology and substance use in 15 African American adolescents who attempted suicide and 15 African American adolescents who did not attempt suicide (control group). Both groups of adolescents and their parents completed questionnaires that addressed depression, behavior problems, family functioning, and drug and alcohol use. On the basis of group means of the Children's Depression Inventory (Kovacs & Beck, 1977), the Youth Self-Report (Achenbach & Edelbrock, 1987), and the Child Behavior Checklist (Achenbach & Edelbrock, 1983), the suicidal youth were found to have a significant level of depression in addition to a variety of internalizing and externalizing behavior disorders. Similarly, on the Multigating Substance Use Evaluation System (Jurkovic & Bruce, 1991), the suicidal youth were at a high risk for alcohol and drug abuse. The suicidal group reported more alcohol and drug abuse than the control group. The results indicated that suicidal African American adolescents used significant amounts of drugs and alcohol, which may be associated with suicide attempts.     

Graphology for the diagnosis of suicide attempts: a blind proof of principle controlled study

To evaluate the ability of two graphologists and two practising internists not trained in graphology to differentiate letters written by subjects who have attempted to commit suicide by self-poisoning and healthy volunteers, we performed a maximal blind controlled study vs. healthy volunteers. Forty fully recovered patients who had attempted to commit suicide and 40 healthy volunteers wrote and signed a short letter or story not related to the parasuicide or their mental health status. The evaluators classified the 80 letters as 'suicide' or 'no suicide' in an intention-to-treat analysis. Letters expressing sadness were subsequently excluded for a per-protocol analysis. Correct diagnosis of suicide and of healthy controls was made in, respectively, 32 of 40 and 33 of 40 letters by the graphologists and in 27 of 40 and 34 of 40 letters by the internists. After the exclusion of 12 letters expressing sadness, the sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 73, 88, 81 and 82% for the graphologists and 53, 89, 80 and 71% for the internists. Both classified the letters with significantly more effectiveness than chance (p < 0.001) with no statistically significant difference between the two groups of evaluators. We concluded that graphological analysis is able to differentiate letters written by patients who attempt suicide from those written by healthy controls. This technique shows an acceptable degree of accuracy and could therefore become an additional discharge or decision-making tool in Psychiatry or Internal Medicine.     

Benzodiazepine use of community-based violent offenders: a preliminary investigation

Objective: To explore the relationship between benzodiazepine use and violent crime in a sample of community-based offenders. Methods: Participants were recruited via drug diversion and treatment programs in Melbourne, Australia. Data regarding benzodiazepine and other substance use, mental health, personality characteristics, and crime involvement were collected through semistructured interviews conducted in 2011. Participants (n = 82, 79.3% male) were 21–56 years old, predominantly Australian-born (89%), with 14.6% identifying as Aboriginal or Torres Strait Islanders. Eligibility criteria were having been charged with a criminal offence in the previous six months and at least monthly benzodiazepine use. Group differences between violent (n = 11) and nonviolent offenders were assessed via independent samples t-tests (two-tailed) and nonparametric tests. Results: Individuals charged with violent index offences were significantly more likely to use higher average doses of alprazolam (p = 0.040) and exhibit benzodiazepine dependence (p = 0.037) as well as report high levels of sensation seeking, prior violence, and the diagnoses of depression and personality disorder than individuals charged with nonviolent index offences. Conclusions: The findings suggest the existence of a complex dynamic between mental health and violent offending that may be influenced by benzodiazepine use, in particular alprazolam. A core implication of these preliminary findings includes attending to the interpersonal skills and adaptive coping resources of violent offenders.     

Young riders: all-terrain vehicle use in north Texas.

Annually, there are more than 54,000 visits to nationwide emergency departments as a result of injuries sustained while riding all-terrain vehicles. Of those visits, nearly one-half involve children younger than 16 years. Children's Medical Center Dallas admitted 211 patients over a 5-year period from March 2002 until May 2007 as a result of all-terrain vehicle-related incidents with 207 of those patients aged 13 years or younger. The primary mechanisms of these injuries were secondary to collision with stationary objects, rolling of the vehicles, and falling from the vehicles.     

Risk factors for fecal colonization with trimethoprim-resistant and multiresistant Escherichia coli among children in day-care centers in Houston, Texas.

In a previous study, we found fecal colonization with multiresistant Escherichia coli exhibiting high-level trimethoprim resistance in 19% of diapered children attending six day-care centers in Houston, Tex. To examine the potential risk factors associated with this finding, we conducted cross-sectional studies among 203 children attending 12 day-care centers, 51 children attending a well-child clinic (controls), and 64 medical students. The prevalence of fecal colonization with trimethoprim-resistant E. coli among children attending day-care centers (30%) was higher (P less than 0.001) than among control children (6%) or medical students (8%). The prevalence of colonization among the children attending the 12 centers ranged from 0 to 59% and was correlated with the number of diapered children enrolled (r = 0.73; P less than 0.01). In a case control study among the day-care center children, significant risk factors were an age of less than 12 months and attendance at a center with an enrollment of over 40 diapered children (odds ratios of 2.2 and 3.5, respectively); ethnicity, duration of attendance, and prior antibiotic administration were not associated with colonization. Plasmid analysis of 60 of the day-care center strains revealed 22 profiles, each of which was unique to a given day-care center. Transmission and carriage of trimethoprim-resistant strains for as long as 6 months was documented in one center studied on three occasions. Given the documented transmission of enteric pathogens among diapered children attending day-care centers and their spread into family members, it is likely that day-care centers are an important community reservoir of plasmid-associated antibiotic-resistant E. coli.     

The need for improved operational definition of suicide attempts: illustrations from the case of street youth

The use of inadequate operational definitions of suicidal behavior is often a limitation of suicide research. In this article, the results of an exploratory qualitative study of street youth suicidality is contrasted with the existing literature to highlight the problems associated with defining suicidal behaviors. It is argued through the use of the case example of street youth that accurate and detailed assessment of suicidal history, context, and intent is necessary to avoid substantial threats to the validity and clinical use of research findings.     

Guns and dolls: an exploration of violent behavior in girls

As demonstrated by several studies, there is an increase in levels of female violence.This study attempts to more fully understand the increasing phenomenon of violence in girls by exploring motivations to engage in violent behavior. The hypothesis that a girl's perceived sense of competence is influenced by social and environmental variables that motivate her to engage in violent behavior is tested. Research studies of female adolescent violence have focused on the study of risk factors predisposing the individual to violent behavior. This study uses a health behavior framework (C.L. Cox, Advances in Nursing Science, October 1982, 41-56) to explore the links between perceived sense of competence and both the risk and protective factors that motivate girls to act violently.