Acupuncture and Traditional Chinese Medicine for Survivors of Torture and Refugee Trauma: A Descriptive Report

Refugees with trauma histories are a difficult medical population to treat. Acupuncture care has gained acceptance in many mainstream hospitals in the United States, but research on acupuncture and refugee populations is limited. Herein, we report our experiences with 50 refugees (total acupuncture treatments = 425) at a major tertiary teaching hospital. Patients often reported extreme trauma including physical torture, rape and witnessing the same in family members. Patients represented 13 different countries, with about half the patients being Somali. The primary complaint of all patients was pain (100%). Using the Wong-Baker Faces Pain scale, 56% patients reported pain decreases. Patient acceptance of acupuncture was high. We provide three case histories as illustrative examples. Further research is warranted.     

A Monte Carlo investigation of factors influencing latent class analysis: an application to eating disorder research

Objective:

Latent class analysis (LCA) has frequently been used to identify qualitatively distinct phenotypes of disordered eating. However, little consideration has been given to methodological factors that may influence the accuracy of these results.

Method:

Monte Carlo simulations were used to evaluate methodological factors that may influence the accuracy of LCA under scenarios similar to those seen in previous eating disorder research.

Results:

Under these scenarios, the aBIC provided the best overall performance as an information criterion, requiring sample sizes of 300 in both balanced and unbalanced structures to achieve accuracy proportions of at least 80%. The BIC and cAIC required larger samples to achieve comparable performance, while the AIC performed poorly universally in comparison. Accuracy generally was lower with unbalanced classes, fewer indicators, greater or nonrandom missing data, conditional independence assumption violations, and lower base rates of indicator endorsement.

Discussion:

These results provide critical information for interpreting previous LCA research and designing future classification studies. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)     

Piloting a Nationally Disseminated,Interactive Human Subjects Protection Program for Community Partners: Unexpected Lessons Learned from the Field

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA‐supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers of the program and the collaborators who participated in the pilot across the United States describe 10 important lessons learned that align with four major themes: The distribution of the program, the implementation of the program, the involvement of community engagement in the program, and finally lessons regarding the content of the program. These lessons are relevant to anyone who anticipates developing or improving a training program that is developed in a central location and intended for local implementation.     

Sexual Partnerships, Risk Behaviors, and Condom Use Among Low-Income Heterosexual African Americans: A Qualitative Study

The purpose of the current investigation was to contextualize the sexual relationships and risk behaviors of heterosexually active African Americans. A total of 38 participants (20 females and 18 males) aged 18–44 years were recruited in a large city in the southeastern U.S. to participate in focus group discussions exploring sexual partnerships, general condom perceptions, and condom negotiation. Results indicated that participants distinguished among at least three partner types—one-night stand, “regular” casual partner, and main partner. Partner types were found to shape and influence types of sexual behaviors, perceptions of risk and condom use, and condom negotiation. Participants also shared general perceptions about condoms and elucidated situations in which intentions to use condoms were not realized. Gender differences emerged in many of these areas. Implications of these findings are discussed and directions for future research on sexual partnerships and risk behavior are offered.     

Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa

We investigated the effects of reduction in left ventricular mass on cavity geometry, afterload, pump function, and exercise performance in 17 patients with anorexia nervosa and in 10 age-and sex-matched normal subjects. Left ventricular mass index determined by two-dimensional echo-cardiography was significantly lower than that in normal subjects (53 +/- 15 vs 79 +/- 18 g/m2; p less than .005). Left ventricular end-diastolic and end-systolic volume indexes were also reduced in patients with anorexia nervosa compared with normal subjects (49 +/- 11 vs 65 +/- 17 ml/m2, p less than .005; 14 +/- 5 vs 19 +/- 4 ml/m2, p less than .025). In spite of the reductions in left ventricular mass and volume indexes, left ventricular chamber architecture described as h/R ratio, mass to volume ratio, and short/long left ventricular axis ratio were normal. Left ventricular afterload assessed as end-systolic meridional and circumferential wall stress was normal (59 +/- 18 vs 79 +/- 19 dyne/cm2 X 10(3) and 170 +/- 26 vs 167 +/- 23 dyne/cm2 X 10(3)). Ejection fraction, percent fractional shortening, and the relationship between end-systolic wall stress and ejection fraction were all within normal limits. In seven patients restudied after a 15% to 20% weight gain, left ventricular mass and volume indexes increased significantly but end-systolic wall stress and ejection fraction did not change. Ten patients with anorexia nervosa and resting heart rates and systolic blood pressures significantly lower than control values underwent treadmill testing. Exercise duration, peak heart rate, peak systolic blood pressure, and peak oxygen consumption in these patients were all significantly lower than normal. The hypotensive effect of fasting resulted in an initial decrease in afterload, which was the stimulus for reduction in left ventricular mass. The left ventricular remodeling associated with the mass reduction occurred in such a way that (1) orthogonal, meridional, and circumferential wall stresses were normalized, (2) normal chamber shape and architecture were maintained, and (3) chamber function and stress-shortening relationships were preserved. Thus down-regulation of left ventricular mass per se, like up-regulation of left ventricular mass, is not associated with abnormal left ventricular function.     

Proliferative lymphocyte responses to virus antigens homologous to GAD65 in IDDM

Summary Virus infection has been proposed as an initiating factor in the aetiology of insulin-dependent diabetes mellitus (IDDM). We have examined lymphocyte proliferation to virus proteins which demonstrate sequence similarity to the beta-cell autoantigen glutamic acid decarboxylase (GAD)65. The magnitude and frequency of response to coxsackie B viruses and adenovirus in a T-cell proliferation assay was significantly higher in a group of recently diagnosed IDDM subjects than in non-diabetic control subjects. The frequency of positive response to the coxsackie B viruses was also significantly higher in IDDM subjects expressing the DRB 1^*04 major histocompatibility complex (MHC) haplotype than the DRB 1*03 haplotype. There was no evidence that non-aspartate residue at position 57 of DQB 1 genes influenced virus responses in the IDDM group. The coxsackie homology was in amino acids 258–266 and the adenovirus homology was in amino acids 509–524 of GAD65. Both these regions are suspected to be T-cell epitopes in IDDM. These results indicate a disease and MHC class II association between coxsackie B virus infection and IDDM and an association between adenovirus infection and IDDM. [Diabetologia (1996) 39: 1318–1324] Received: 1 February 1996 and in revised form: 6 May 1996     

Slips, breaks and 'falls': condom errors and problems reported by men attending an STD clinic

The objective was to comprehensively assess the prevalence of condom-use errors and problems among male clients attending a public sexually transmitted disease (STD) clinic. Men (n = 278) attending an STD clinic completed an anonymous questionnaire. Seven errors and six problems were assessed. Summative scores were tested for associations with three key variables. Of 834 condom-protected events: 19% were associated with 'fit and feel' problems, 15% involved breakage, 14% involved lost erection, 9% were associated with lost erection while applying condoms, 8% involved slippage during withdrawal and 7% involved slippage during sex. A mean of 6.4 errors/problems were observed. None of these summative variables (total errors, total problems or total of errors and problems) were significantly associated with age, minority status or whether men indicated they had ever been taught how to use condoms. Multiple types of condom-use errors and problems may be highly prevalent among high-risk men attending public STD clinics.