Sex and Drug Risk Behavior Pre- and Post-Emigration Among Latino Migrant Men in Post-Hurricane Katrina New Orleans

High rates of sex and drug risk behaviors have been documented among Latino migrant men in the US. Whether these behaviors were established in the migrants’ home countries or were adopted in the US has not been described and has implications for prevention strategies. Quarterly surveys were conducted to gather information on selected sex and drug risk practices of Latino migrant men who arrived in New Orleans after Hurricane Katrina seeking work. Both kappa scores and McNemar’s tests were performed to determine if practice of these behaviors in home country was similar to practice post-emigration to the US. Female sex worker (FSW) patronage, same sex encounters (MSM), and crack cocaine use was more likely to occur post- rather than pre-emigration. Of those who ever engaged in these selected behaviors, most adopted the behavior in the US (i.e., 75.8 % of FSW patrons, 72.7 % of MSM participants, and 85.7 % of crack cocaine users), with the exception of binge drinking (26.8 %). Men who were living with a family member were less likely to adopt FSW patronage OR = 0.27, CI = 0.10–0.76, whereas men who earned >$465 per week were more likely to adopt crack cocaine use OR = 6.29 CI = 1.29, 30.57. Interventions that facilitate the maintenance of family cohesion and provide strategies for financial management may be useful for reducing sex and drug risk among newly arrived migrants.     

Early Loss Experiences in Psychotherapists,Church of England Clergy,Patients Assessed for Psychotherapy,and Scientists and Engineers

An Inventory of Early Loss (IEL) has been developed for retrospective use with adults comprising loss events in childhood and unempathic parental responses to the child. Overall early loss is described by a severity score of mild, moderate, severe, or very severe. Four studies using the Inventory are described: (1) 100 Church of England clergy participating in a larger study of early loss, personality, and religious experience; (2) 114 psychotherapist members of the Society of Psychotherapy Research (UK) surveyed in a postal questionnaire; (3) 201 patients assessed for psychotherapy in Hertfordshire; and (4) 84 scientists and engineers from the faculty of Brunel University, Uxbridge. Among the clergy, 46% had overall early loss scores of very severe; for psychotherapists this figure was 27%; for NHS patients, 47%; and for scientists and engineers, only 4%. Implications for career choice in the helping professions are discussed.Ein Inventar zur Erfassung früher Verluste wurde entwickelt, um Erwachsene im Hinblick auf Verlustereignisse in der Kindheit und unempathische elterliche Reaktionen gegenüber dem kind retrospektiv zu befragen. Aus dem Inventar resultiert ein Indikator für den frühen Verlust, der sich mit einem Schwerescore (von gering bis sehr schwer) ausdrücken lässt. Vier Befragungen, die auf dem Inventar basieren, werden beschrieben: a) 100 Geistliche der Church of England, die an einer grösseren Studie zum Zusammenhang früher Verluste, Persönlichkeitsmerkmale und religiöser Erfahrungen teilnahmen; b) 114 Psychotherapeuten, Mitglieder der Society for Psychotherapy Research in Grossbritannien, die postalisch befragt wurden; c) 201 Patienten, die in Hertfordshire psychotherapeutisch untersucht wurden sowie d) 84 Wissenschaftler und Techniker aus der entsprechenden Fakultät der Brunel Universität in Uxbridge. Unter den Geistlichen gaben 46% schwere frühe Verlusterfahrungen an, bei den Psychotherapeuten waren es 27%, bei den Psycho-therapiepatienten 47%, dagegen bei den Wissenschaftlern und Technikern nur 4%. Implikationen für die Berufswahl unter den helfenden Berufen werden auf der Basis der Ergebnisse diskutiert.Un Inventaire de Perte Précoce (Inventory of Early Loss - IEL) a été développé pour l'utilisation rétrospective sur des adultes ayant eu à la fois des situations de perte pendant l'enfance et des réponses parentales non-empathiques envers les enfants. En générl, la perte précoce est décrite par un score de sévérité de léger, modéré, sévère ou trés sévère. Quatre études au moyen de l'Inventaire sont décrites. (a) 100 membres du clergé anglican participent à une large étude sur la perte précoce, la personnalité et l'expérience religieuse; (b) 114 psychothérapeutes membres de la Society of Psychotherapy Research (UK) enquêtés par un questionnaire postal, (c) 201 patients évalués pour psychothérapie à Hertfordshire; et (d) 84 scientifiques et ingénieurs de la faculté de l'Université Brunel, Uxbridge. Parmi les membres du clergé, 46% ont eu, en général, des scores de perte précoce de très sévères; pour les psychothérapeutes ce fait était 27%; les patients NHS, 47%; et les scientifiques et ingénieurs, seulement 4%. Les implications pour le choix de carrière en profession d'aide sont discutées.     

Pulmonary Blastoma Presenting as a Solitary Lip Metastasis: Case Report and Review of the Literature

Abstract

Pulmonary blastoma (PB) is an uncommon primary lung malignancy. This neoplasm was first described by Barrett and Barnard in 1945. The tumor is composed of immature epithelial and mesenchymal tissues which may recapitulate early embryological lung development. Under the microscope, the globular component resembles immature bronchus and connective tissue as seen in embryonic lung. More than one hundred cases have been reported in the literature. PB is more frequent in older people and in males and tends to affect blacks at younger ages. Symptomatology varies from asymptomatic to symptoms of a non-specific pulmonary disease. Cough, hemoptysis, dyspnea, chest pain, respiratory distress, fever, anorexia and weight loss are the most common presenting features. The most common roentgenologic pattern is a well-demarcated peripheral lesion, encapsulated by compression or atelectatic lung tissue, although in some cases there is a tendency to lobulation and cavitation. The size of the mass varies from a small peripheral nodule to a mass occupying the entire lobe or hemithorax. The treatment of choice has been surgical excision, radiation and, in selected cases, a combination of chemotherapy with radiation. The prognosis of this malignancy is poor; overall five-year survival is approximately 16 percent. No correlation has been established between histopathologic criteria and survival. The factors that indicate poor prognosis are tumor recurrence, metastasis at initial presentation, tumor size over 5 cm and lymph node metastasis. Liver, central nervous system and bones are the most frequent location of distant metastases. A rare case is presented of a pulmonary blastoma with an upper lip metastasis occurring in a paraplegic male. Diagnosis was confirmed by autopsy findings. To our knowledge, this is the first documented case of a pulmonary blastoma metastasis to the upper lip. (J Spinal Cord Med; 18:203–207)     

Elevated maternal serum-free β-human chorionic gonadotropin (β-hCG) and reduced risk of spontaneous preterm delivery*

Objective: To evaluate the relationship between first and second trimester maternal serum-free β-hCG and the risk of spontaneous preterm delivery (PTD).

Study design: This was a case-control study of women evaluated and delivered at our institution from 2011 to 2015. Spontaneous PTD was defined as delivery before 37 weeks due to spontaneous preterm labor or premature rupture of membranes. Patient with multifetal gestation and those with medically indicated term or PTD were excluded.

Results: Of 877 women meeting the inclusion criteria, 173 delivered preterm and 704 delivered at term, and 8.1% had high free β-hCG in one or both trimesters. High maternal first and/or second trimester free β-hCG (≥95th percentile) was associated with lower rates of PTD. Thirty-two women with high free β-hCG in both first and second trimesters delivered at term. Gestational age at delivery and birth weights were lower in women who did not have high free β-hCG in any trimester. Low free β-hCG (≤5th percentile) in either trimester was not associated with an increased or decreased likelihood of PTD. Logistic regression demonstrated an independent association of high free β-hCG (≥95th percentile) with a reduced likelihood of PTD. Stratified analysis revealed a stronger impact of this association in women with no prior history of PTD.

Conclusions: High free β-hCG, in the absence of risk factors for medically indicated PTD, is associated with a reduced likelihood of spontaneous PTD and may represent a marker indicating lower risk.     

A dyadic genotype–phenotype approach to diagnostic criteria for Proteus syndrome

Phenotype‐based diagnostic criteria were developed for Proteus syndrome in 1999 and updated in 2006. Subsequently, the causative mosaic gene alteration was discovered, the c.49G>A p.E17K variant in AKT1. As well, a number of overlapping overgrowth disorders attributable to mosaic PIK3CA variants have now been characterized, leading to the designation of PIK3CA‐related overgrowth spectrum (PROS). Finally, ongoing work to better characterize Proteus syndrome has led to identification of additional features of that disorder that could be useful in diagnostic criteria. We have taken the opportunity of these discoveries to re‐evaluate the Proteus syndrome diagnostic criteria. Here we propose a new set of diagnostic criteria that establishes a weighted, point‐based system for the phenotypic attributes and then integrates that with the potential molecular test results to result in one of two designations: AKT1‐related Proteus syndrome or AKT1‐related overgrowth spectrum. A patient whose only manifestation is an AKT1 c.49G>A‐positive tumor would receive neither of these designations. Here we review the rational basis of diagnostic criteria and argue that a unitary diagnostic entity is a distinct gene‐phenotype dyad and that this should be the model for all mendelian disorders. The gene‐alone or phenotype‐alone approach is inadequate to rigorously delineate a unitary diagnostic entity.