Alcoholism treatment and the relationship of Native American cultural values to recovery

Native American alcoholics, Native American nonalcoholics, Anglo alcoholics, and Anglo staff were compared on demographics and the Rokeach Value Survey. The subjects were from an inpatient alcohol treatment program of a rural community mental health center located 1 mile from the boundary of a large southwestern Indian reservation. Results from this study provide evidence which supports the poorer prognostic rates of alcoholism recovery for Native American alcoholics. Evidence is also presented which suggests that Native Americans' values are measurable and significantly different from Anglo values. While the relationship between values and recovery was difficult to discern, it is suggested that the disparity in values between the two cultures is one reason why so few Native American alcoholics remained in treatment.     

Microscopic-observation drug susceptibility assay provides rapid and reliable identification of MDR-TB.

BACKGROUND: Liquid culture systems are more rapid and sensitive for both the detection and drug susceptibility testing (DST) of Mycobacterium tuberculosis. SETTING: St Peter's TB Specialised Hospital and public health laboratory, Addis Ababa. OBJECTIVE: To compare the microscopic-observation drug susceptibility (MODS) assay with the BACTEC-MGIT 960 system for isoniazid and rifampicin DST (i.e., multidrug-resistant tuberculosis [MDR-TB] identification) of M. tuberculosis. DESIGN: The evaluation was based on 58 smear- and culture-positive sputum samples from patients diagnosed in Addis Ababa, Ethiopia. BACTEC-MGIT was used as the reference standard. RESULTS: For the detection of MDR-TB, MODS has a sensitivity, specificity and accuracy rate of respectively 95%, 100% and 98.3% (kappa 0.981, concordance 98.3%). Concurrent culture detection and DST results are obtained in a median of 9 days with MODS, while indirect DST results with BACTEC-MGIT are obtained in a median of 8 days (this does not include time to primary isolate). CONCLUSION: MODS is an accurate, rapid and relatively inexpensive method for the identification of MDR-TB.     

Genetic evidence for different male and female roles during cultural transitions in the British Isles

Human history is punctuated by periods of rapid cultural change. Although archeologists have developed a range of models to describe cultural transitions, in most real examples we do not know whether the processes involved the movement of people or the movement of culture only. With a series of relatively well defined cultural transitions, the British Isles present an ideal opportunity to assess the demographic context of cultural change. Important transitions after the first Paleolithic settlements include the Neolithic, the development of Iron Age cultures, and various historical invasions from continental Europe. Here we show that patterns of Y-chromosome variation indicate that the Neolithic and Iron Age transitions in the British Isles occurred without large-scale male movements. The more recent invasions from Scandinavia, on the other hand, appear to have left a significant paternal genetic legacy. In contrast, patterns of mtDNA and X-chromosome variation indicate that one or more of these pre-Anglo-Saxon cultural revolutions had a major effect on the maternal genetic heritage of the British Isles.     

Comparisons of alcohol and other drugs: experience from the WHO collaborative cross-cultural applicability research (CAR) study

Current psychiatric classificatory systems commonly provide similar criteria for the identification of disorders relating to the use of alcohol and other drugs. However, since cultural views of substance use disorders are influenced by prevailing norms in the society, it is unlikely that a given culture wiH have identical threshold for the identification of disorders relating to the use of alcohol, commonly socially approved, and those relating to the use of other mood-altering substances, commonly socially disapproved. Using data derived from the WHO nine-country Cross-Cultural Applicability Research (CAR) study, we studied the cultural views on the use and abuse of alcohol and other drugs. Our observations suggest that, viith a few notable exceptions, any use of addictive substances other than alcohol is commonly considered socially aberrant. Most cultures set a much lower threshold for the identification of disorders relating to these substances than they do for alcohol-related ones.     

Acculturation, drinking, and alcohol abuse and dependence among Hispanics in the Texas-Mexico border

Background:  Acculturation has been linked to an increased prevalence of alcohol‐related problems. However, most of the research has been conducted with Hispanic populations in metropolitan areas of the United States, none of which is on the U.S.–Mexico border. This study examines the association between acculturation, heavy episodic drinking, and DSM‐IV alcohol abuse and dependence among Hispanics in the Texas–Mexico border. Methods:  The study used data from a survey conducted (2002 to 2003) along the Texas–Mexico border and included 472 male and 484 female Hispanic adults from El Paso, the Rio Grande Valley, and colonias. Based on the Acculturation Rating Scale for Mexican Americans‐II scale, respondents were coded into 4 acculturation categories: “very Mexican oriented,”“Mexican bicultural,”“Anglo bicultural,” or “very Anglo/Anglicized.”. Results:  Acculturation was related to lower rates of alcohol use disorders among men and a higher frequency of heavy episodic drinking among women. Multivariate analyses indicate that men who report heavy episodic drinking and those who are “very Mexican,”“bicultural Mexican,” or “bicultural Anglo” are more at higher risk for alcohol abuse and/or dependence compared with “very Anglo/Anglicized” men. For women, acculturation level did not predict alcohol disorders. Statistical analyses included testing for bivariate associations and multivariate logistic regression predicting heavy episodic drinking alcohol abuse or dependence. Conclusions:  This study suggests that acculturation has different effects on drinking for men and women. This finding needs some attention as literature also indicates that women drink more and may develop more alcohol‐related problems as they acculturate. This increase in women’s drinking is probably because of U.S. society’s more liberal norms governing female drinking. The “bimodal” distribution of risk, in which only men in “very Anglo” group are at a lower risk than the others, may be unique to the Border. The association between acculturation and alcohol use disorders does not appear to be linear and the effect of acculturation is not uniform on individuals’ drinking behavior.     

Outcomes of an inner-city HIV mental health programme integrated with primary care and emphasizing cultural responsiveness

Effectiveness of HIV-related mental health practice in inner cities has not been adequately documented despite an urgent need for interventions for populations disproportionately affected by the epidemic. Practices must take into account and respond to cultural issues of people of colour and the needs of those infected through injection drug use or heterosexual sex with IDUs. We report the effectiveness of an HIV mental health programme integrated with primary care and emphasizing cultural responsiveness. A sample of 47 of 188 patients who received psychiatric and psychotherapy services was compared with other subjects. The 47 had an average of 8.34 encounters over an average of 36.23 weeks. Consumers of project services used mental health care at a higher rate than did comparison subjects. Regression analyses indicated that utilization was related to reduction in reported mental health problems, HIV-related physical symptoms, and use of alcohol and powdered cocaine, as well as to improvement in social functioning. Our clients, individuals often viewed as not likely to avail themselves of or benefit from mental health care, were highly motivated for self-improvement and, given access to competent, convenient and culturally respectful services, improved their well-being in significant domains.     

Repeated learning makes cultural evolution unique

Although genetic information is acquired only once, cultural information can be both abandoned and reacquired during an individual''s lifetime. Therefore, cultural evolution will be determined not only by cultural traits'' ability to spread but also by how good they are at sticking with an individual; however, the evolutionary consequences of this aspect of culture have not previously been explored. Here we show that repeated learning and multiple characteristics of cultural traits make cultural evolution unique, allowing dynamical phenomena we can recognize as specifically cultural, such as traits that both spread quickly and disappear quickly. Importantly, the analysis of our model also yields a theoretical objection to the popular suggestion that biological and cultural evolution can be understood in similar terms. We find that the possibility to predict long-term cultural evolution by some success index, analogous to biological fitness, depends on whether individuals have few or many opportunities to learn. If learning opportunities are few, we find that the existence of a success index may be logically impossible, rendering notions of “cultural fitness” meaningless. On the other hand, if individuals can learn many times, we find a success index that works, regardless of whether the transmission pattern is vertical, oblique, or horizontal.     

Rapid identification of Mycobacterium tuberculosis in BACTEC MGIT960 cultures by in-house loop-medicated isothermal amplification

Definitive diagnosis of tuberculosis (TB) by conventional culture, followed by bacterial identification based on biochemical tests is time-consuming and tedious. Simple loop-mediated isothermal amplification (LAMP) specific for Mycobacterium tuberculosis complex, targeting the M. tuberculosis 16S ribosomal RNA gene, termed TB-LAMP, was evaluated as an alternative for rapid culture confirmation. TB-LAMP was assessed for its ability to detect M. tuberculosis complex in BACTEC MGIT 960-positive cultures. Of the 103 cultures evaluated, 100 were identified to contain M. tuberculosis complex by TB-LAMP and had concordant results with standard biochemical tests of niacin accumulation, nitrate reductase, lack of heat-stable catalase, and susceptibility to para-nitrobenzoic acid. These results indicate that TB-LAMP in combination with BACTEC MGIT 960 is a specific, reliable, and technically feasible method for rapid and accurate identification of M. tuberculosis complex.     

Pathogen identification of abscesses and cellulitis

The goal of culturing abscesses and/or cellulitis is to identify the offending pathogen in order to understand and treat the infection. Abscesses respond to incision and drainage. Antibiotics are not indicated in the patient with normal host defense, and thus in these patients cultures and Gram stains are not indicated. In immunocompromised patients, in patients with abscesses of the central face, and in those with abscesses that contain gas or involve muscle or fascia, Gram stain, culture, and antibiotics are necessary. The Gram stain is a reliable indicator of sterile abscesses, abscesses in pure culture (especially Staphylococcus aureus), and those in mixed anaerobic culture. Location and odor of abscesses are clues to offending bacteria. Cultures of tissue or blood in patients with cellulitis usually are positive in less than 40% of cases, regardless of the technique used. Hemophilus influenzae cellulitis in pediatric patients is an exception; blood cultures are positive in more than two-thirds of cases. Although not specific, certain types of cellulitis show different clinical characteristics. Treatment with elevation, warm soaks, and antibiotics is still the mainstay of therapy. Gram stain and culture are limited to those patients who do not respond to initial therapy or who are immunocompromised.     

Confronting the AIDS epidemic among i.v. drug users: does ethnic culture matter?

The AIDS education and prevention literature contains numerous calls for the development of culturally relevant efforts to reach members of ethnic minority populations. In the AIDS literature on IV drug users (IVDUs), however, this issue finds less emphasis despite the disproportionate rate of human immunodeficiency virus (HIV) infection in minority IVDUs. The reason appears to be the sense in the drug field that the primary culture of the IVDU is drug culture rather than ethnic culture. This paper explores this issue in light of a review of recent research on IVDUs, ethnicity, and AIDS risk behavior. Specifically, this review covers literature on 6 topics in light of ethnic differences: changing patterns of IV drug use prevalence, AIDS prevalence among IVDUs, needle-related AIDS risk, polydrug use, sexual risk among IVDUs, and the drug subculture. Finding that ethnic culture does matter in infection patterns and risk behavior, this paper examines a typology for the analysis of discontinuities in intercultural communication and presents a framework for comparing alternative models for overcoming cultural barriers to effective AIDS education with IVDUs.     

Sex differences in addict careers. 1. Initiation of use

Five-hundred-sixty-seven heroin addicts admitted to methadone maintenance treatment programs in southern California were included in the present analysis. Systematic comparisons were made between women and men for Anglo and Chicano subpopulations. The behaviors compared focused on initial drug use and other antecedent behaviors during the year prior to initiation of heroin use including interpersonal relationships, other substance use, drug dealing, legal income, and various criminal behaviors. Unlike men, the initial use of heroin by women was highly influenced by a man, especially by a sex partner who is often a daily heroin user. On the other hand, many women (like men) reported self-initiation of heroin use, multiple drug use, and drug dealing, thus demonstrating that they took an active role in their drug involvement. Other differences between men and women for antecedent behaviors prior to narcotics use appear to be related to traditional expectations about gender roles in American society.     

Sex Differences in Addict Careers. 1. Initiation of Use

Abstract

Five-hundred-sixty-seven heroin addicts admitted to methadone maintenance treatment programs in southern California were included in the present analysis. Systematic comparisons were made between women and men for Anglo and Chicano subpopulations. The behaviors compared focused on initial drug use and other antecedent behaviors during the year prior to initiation of heroin use including interpersonal relationships, other substance use, drug dealing, legal income, and various criminal behaviors. Unlike men, the initial use of heroin by women was highly influenced by a man, especially by a sex partner who is often a daily heroin user. On the other hand, many women (like men) reported self-initiation of heroin use, multiple drug use, and drug dealing, thus demonstrating that they took an active role in their drug involvement. Other differences between men and women for antecedent behaviors prior to narcotics use appear to be related to traditional expectations about gender roles in American society.     

Bacterial identification methods

In clinical microbiology the identification of bacteria has been, and continues to be, based on traditional classical taxonomy of their phenotypic characteristics such as morphology, appearance in culture media, physiological and biochemical properties, macromolecular degradation, type of respiratory enzyme, nutritional requirements, chemotaxonomic characteristics, inhibition by various substances and reaction to antibodies. Simple techniques are used for their identification such as microscopic examination before or after staining and cultures, as well as more complex procedures, some of which are automated. The future of microbiology applied to the identification of bacteria causing human infections is directed toward the preservation of clinical data as the basis of the entire process and to maintaining microscopy, cultures and simple techniques, that is, to conserving the best of classical methods while at the same time incorporating new technological knowledge and developing techniques of rapid diagnosis. Microbiologists, as well as clinicians, should prepare themselves for the changes represented by conserving traditional methods and applying new technologies.     

Blood cultures have limited value in predicting severity of illness and as a diagnostic tool in ventilator-associated pneumonia.

STUDY OBJECTIVES: To define the usefulness of blood cultures for confirming the pathogenic microorganism and severity of illness in patients with ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study using BAL and blood cultures collected within 24 h of establishing a clinical diagnosis of VAP. SETTING: A 15-bed medical and surgical ICU. PATIENTS: One hundred and sixty-two patients receiving mechanical ventilation hospitalized for > 72 h who had new or progressive lung infiltrate plus at least two of three clinical criteria for VAP. INTERVENTIONS: BAL and blood culture performed within 24 h of establishing a clinical diagnosis of VAP. MEASUREMENTS AND RESULTS: Ninety patients were BAL positive (BAL+), satisfying a microbiological definition of VAP (>/= 10(4) cfu/mL), 72 patients were BAL negative (BAL-). Bacteremia was diagnosed when at least two sets of blood cultures yielded a microorganism or when only one set was positive, but the same bacteria was present at a concentration >/= 10(4) cfu/mL in the BAL fluid. Bacteremia was significantly more frequent in the BAL+ than in the BAL- group (22/90 patients vs 5/72 patients; p = 0.006). In 6 of 22 BAL+ patients with bacteremia, an extrapulmonary site of infection was the source of bacteremia. Sensitivity of blood culture for disclosing the pathogenic microorganism in BAL+ patients was 26%, and the positive predictive value to detect the pathogen was 73%. Factors associated with mortality were age > 50 years, simplified acute physiology score > 14, prior inadequate antibiotic therapy, PaO(2)/fraction of inspired oxygen < 205, and use of H(2) blockers. By multivariate analysis, only the use of prior inadequate antimicrobial therapy (odds ratio [OR], 6.47) and age > 50 years (OR, 5.12) were independently associated with higher mortality. The rate of complications was not different in patients with bacteremia. CONCLUSIONS: Blood cultures have a low sensitivity for detecting the same pathogenic microorganism as BAL culture in patients with VAP. The presence of bacteremia does not predict complications, it is not related to the length of stay, and it does not identify patients with more severe illness. Inadequacy of prior antimicrobial therapy and age > 50 years were the only factors associated with mortality in a multivariate analysis. Blood cultures in patients with VAP are clearly useful if there is suspicion of another probable infectious condition, but the isolation of a microorganism in the blood does not confirm that microorganism as the pathogen causing VAP.     

Detection and identification of bacterial DNA in serum from patients with acute pancreatitis

BACKGROUND AND AIMS: Bacterial infections are common complications in patients with acute pancreatitis, and translocation of bacteria from the intestinal lumen is probably the first step in the pathogenesis of these infections. As blood cultures in afebrile patients are usually negative, more sensitive methods to investigate this hypothesis in patients are needed. Our group has recently developed a method to detect the presence of bacterial DNA in biological fluids, and we aimed to detect bacterial DNA in patients with acute pancreatitis, as molecular evidences of bacterial translocation. METHODS: Samples of blood were obtained on three consecutive days within the first six days after admission. Bacterial DNA was detected using a polymerase chain reaction based method, and an automated DNA nucleotide sequencing process allowed identification of bacteria species. RESULTS: Thirty one consecutively admitted patients with acute pancreatitis were studied. Bacterial DNA was detected in six patients (19.3%), and the sequencing process allowed identification of Citrobacter freundii and Pseudomonas aeruginosa. In two patients the same bacteria detected at admission was detected 24 hours later (above 99.9% homology of nucleotide sequence). Basic clinical and biochemical characteristics were similar among patients with or without the presence of bacterial DNA. CONCLUSION: Detection of gram negative bacteria derived bacterial DNA in our series supports the contention that bacterial translocation is a systemic process in approximately 20% of patients with acute pancreatitis that does not seem to be related to the severity of the episode or immediate development of infection.     

PCR identification of the group A Neisseria meningitidis gene in cerebrospinal fluid

The aim of this study was to develop a PCR method for direct identification of Neisseria meningitidis serogroup A in cerebrospinal fluid. The assay makes use of unique sites within the gene cassette responsible for expression of the (alpha1 --> 6)-linked N-acetyl-D-mannosamine-1-phosphate serogroup A capsule. A total of 67 different N. meningitidis strains and 12 clinical samples of CSF, culture positive for N. meningitidis, were examined. All the strains and samples of N. meningitidis serogroup A were correctly identified by an amplified PCR product of 519 bp. The PCR method for identification is specific for the group A gene of N. meningitidis. The assay may contribute to reducing recurrent, devastating epidemics of meningococcal infection by providing a diagnostic tool for grouping in developing countries where problems with false negative cultures are common and vaccination against serogroup A meningococci may be required.     

A comparison of substance use and injury among Mexican American emergency room patients in the United States and Mexicans in Mexico

BACKGROUND: Emergency room (ER) studies have found differences in the association of alcohol with injury (intentional and unintentional) across cultures. These differences may be due to differences in drinking patterns across cultures. Few comparative data have been reported on associations of alcohol and injury between Mexican American ER patients and ER patients living in Mexico, and general population studies suggest that Mexican Americans may adopt more frequent heavy drinking patterns after migrating to the United States. METHODS: A comparative analysis of drinking, drug use, and injury was performed in probability samples of 550 ER patients from Santa Clara County (San Jose, CA) and 1417 ER patients in Pachuca (Hidalgo), Mexico. RESULTS: Both injured and uninjured (i.e., medical conditions) patients in Pachuca were less likely to report heavy drinking, drug use, drunkenness, or alcohol-related problems compared with those in Santa Clara. Those scoring high on level of acculturation in Santa Clara were more likely to report both drinking and drug use before the event, and heavy drinking, drug use, and consequences related to drinking in the last year compared with those scoring lower. Those scoring low on acculturation were similar on substance use variables to those in the Pachuca sample. CONCLUSIONS: Findings suggest that alcohol's association with injury may not just reflect typical drinking patterns in a culture. Among Mexican Americans, this association my vary by acculturation, and those migrating to the United States may be at increased risk for alcohol-related injury as their drinking patterns undergo change to those of the dominant culture. The ER, in this context, may take on increasing importance as a site for health services providers to implement intervention and prevention services for alcohol-related consequences in this ethnic group.     

Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients

The incidence of bacteremia related to transesophageal echocardiography was studied in 140 consecutive patients (71 women and 69 men with a mean age of 53.7 +/- 15 years). Thirty-four patients had one or more prosthetic heart valves. Blood cultures were obtained from each patient through separate venipuncture sites immediately before and after transesophageal echocardiography. An additional late blood culture was obtained in 114 patients 1 h later. The skin was cleaned with povidone-iodine and venipunctures were performed with separate butterfly needles with use of sterile gloves and drapes. Blood samples were drawn into separate syringes, transferred to aerobic and anaerobic culture bottles and processed with use of a semiautomated system. The overall incidence of blood cultures positive for bacteremia was 2% (8 of 394 bottles) and all positive cultures grew in a single blood culture bottle. Positive cultures occurred in 4 (1.4%) of 280 bottles before the procedure, in 2 (0.7%) of 280 bottles immediately after the procedure and in 2 (0.9%) of 228 late (1-h) blood culture bottles. Bacterial isolates were coagulase-negative staphylococci (n = 5), Propionibacterium (n = 2) and Moraxella (n = 1). All were considered contaminants. Mean endoscopic time in these patients was not significantly different from that in the other patients. Follow-up of patients with a blood culture positive for bacteremia revealed no clinical evidence of systemic infection. It is concluded that 1) the incidence of bacteremia related to transesophageal echocardiography is very low, and 2) the incidence of blood cultures positive for bacteremia after transesophageal echocardiography is indistinguishable from the anticipated contamination rate.     

Diagnosis of plague and identification of virulence markers in Yersinia pestis by multiplex-PCR

We have developed a procedure for the rapid diagnosis of plague that also allows the identification of prominent virulence markers of Y. pestis strains. This procedure is based upon the use of a single polymerase chain reaction with multiple pairs of primers directed at genes present in the three virulence plasmids as well as in the chromosomal pathogenicity island of the bacterium. The technique allowed the discrimination of strains which lacked one or more of the known pathogenic loci, using as template total DNA obtained from bacterial cultures and from simulated blood cultures containing diluted concentration of bacteria. It also proved effective in confirming the disease in a blood culture from a plague suspected patient. As the results are obtained in a few hours this technique will be useful in the methodology of the Plague Control Program.     

Heroin use in Slovenia - a consequence or a vehicle of social changes

Slovenia is a country in transition with a relatively successful record both in the economic and social spheres. It has not escaped all the adverse consequences of transition (high unemployment, especially among youths, changes in values). Massive heroin use has also started in the 90s, and there are approximately 450 intravenous drug users or 900 regular users per 100,000 inhabitants. Those groups that were uprooted in the process of transition (young people, males, immigrants) are vulnerable to problematic use. The HIV prevalence is extremely low, while that of hepatitis C is relatively substantial. Difficulties with employment, housing shortage and severed social ties are all the result of problematic heroin use as well as the factor that promotes it along with the changes in youth culture and social values. Poverty is probably one of the most important vectors towards destructive outcomes while postindustrial hedonistic individualism is an important cultural vehicle toward the increase in drug use.