Long-Term Consequences of Adolescent Gang Membership for Adult Functioning

Objectives. We examined the possible public health consequences of adolescent gang membership for adult functioning.Methods. Data were drawn from the Seattle Social Development Project, a longitudinal study focusing on the development of positive and problem outcomes. Using propensity score matching and logistic regression analyses, we assessed the effects of adolescent gang membership on illegal behavior, educational and occupational attainment, and physical and mental health at the ages of 27, 30, and 33 years.Results. In comparison with their nongang peers, who had been matched on 23 confounding risk variables known to be related to selection into gang membership, those who had joined a gang in adolescence had poorer outcomes in multiple areas of adult functioning, including higher rates of self-reported crime, receipt of illegal income, incarceration, drug abuse or dependence, poor general health, and welfare receipt and lower rates of high school graduation.Conclusions. The finding that adolescent gang membership has significant consequences in adulthood beyond criminal behavior indicates the public health importance of the development of effective gang prevention programs.Research has consistently shown that gang membership has proximal adverse consequences during adolescence that, in turn, lead to significant social and economic costs.1–3 Active gang members are much more likely than their nongang peers to engage in criminal behavior,2,4,5 especially serious and violent offending6; in addition, they are more likely to be involved in drug use and selling,5 have more difficulties in school,4 and are more likely to be violently victimized.3 However, with few exceptions, there is scant research on possible broader, long-term public health consequences of gang membership.7–9Levitt and Vankatesh,8 in a 10-year follow-up of a sample of Chicago youths, found that those who reported being in a gang during adolescence were more likely to be arrested and incarcerated as adults, were more likely to rely on illegal income, and had obtained less formal education than their nongang peers. When they controlled for background characteristics such as home environment and early school performance, only the relationship between adolescent gang membership and illegal income in adulthood remained significant.In an ethnographic study, Hagedorn10 conducted follow-up interviews of 228 Milwaukee-based founding male gang members several years after his initial study. Two thirds of the sample did not have a high school diploma or general equivalency diploma (GED), fewer than 32% were employed, and more than 63% had been incarcerated.In a quantitative study involving a community sample, Thornberry et al.9 examined the extent to which gang membership negatively affected the timeliness of developmental transitions into adulthood, such as completion of schooling and establishment of a career. They found that, after control for individual and environmental risks, male respondents who had been short-term or long-term gang members in adolescence had a greater likelihood of cohabitation before marriage at the age of 22 years than male respondents who had not been gang members. Long-term gang members also had significantly higher rates of unstable employment, school dropout, early pregnancy, and teenage parenthood at the follow-up. Female gang members were more likely to experience untimely or problematic transitions, including unstable employment, teenage pregnancy, and early motherhood. Both male and female former gang members were more likely to report adult arrests.Recently, Krohn et al.11 found that there was an indirect positive relationship between adolescent gang membership and engagement in street crime and arrest in adulthood. Specifically, gang membership was related to precocious transitions into adulthood that then predicted disrupted family relationships and economic instability. They found that this path eventually led to criminal behaviors at the age of 30 years. In our study, we extended these investigations by assessing the effects of gang membership on adult functioning holistically, examining possible later adult outcomes.Life course theory12–14 provides a framework to understand how gang membership in adolescence may affect illegal behavior, educational and occupational attainment, and physical and mental health in adulthood. This theory emphasizes the strong connection between childhood events and experiences in adulthood (trajectories), as well as significant events that create a disruption in a trajectory (turning points). Although we did not directly test a trajectory change model in this study, life course theory would suggest that joining a gang during adolescence may initiate a negative developmental cascade into both criminal and noncriminal domains, including decreased educational and occupational attainment and poor physical and mental health.15,16 Indeed, Melde and Esbensen reported that “youth who join gangs experience noteworthy changes in their emotions, attitudes, and behavior,”17^(p539) suggesting that gang membership may serve as a significant turning point in an individual’s life course.One such life course theory, the social development model,18 provides specific mechanisms through which these consequences may operate. This model articulates the mechanisms of socialization and identifies parallel but separate causal paths for prosocial and antisocial processes consisting of opportunities for involvement, actual involvement, skills, rewards, bonding, and adoption of beliefs. Participation in the prosocial path is seen to increase subsequent positive outcomes and decrease risk behaviors. By contrast, participation in the antisocial path is seen to decrease positive outcomes and increase problem behaviors. From the perspective of this model, gang membership in adolescence may serve as a turning point, drastically changing the opportunity structure for young people. As gang-involved youths move through subsequent cycles of socialization, they are likely to experience reduced prosocial functioning across several domains and escalated problem behaviors as they transition into adulthood, even if they are no longer members of a gang.According to Krohn and Thornberry,

it is reasonable to expect that being a member of a gang during adolescence will be associated with disrupted transitions from adolescence to adulthood and, ultimately, will adversely impact life chances.7^(p149)

They noted that the challenge is to discover empirically to what extent gang membership contributes to negative outcomes in adulthood over and above general delinquency and other risk factors in adolescence. This was precisely the aim of our study.     

New diagnostic techniques for breast cancer detection

Breast imaging has made huge advances in the last decade, and along with newer techniques to diagnose primary breast cancer, many novel methods are being used and look promising in detecting distant metastasis, recurrent disease and assessing response to treatment. Full-field digital mammography optimizes the lesion-background contrast and gives better sensitivity, and it is possible to see through the dense tissues by altering computer windows; this may be particularly useful in younger women with dense breasts. The need for repeat imaging is reduced, with the added advantage of reduced radiation dose to patients. Computer-aided detection systems may help the radiologist in interpretation of both conventional and digital mammograms. MRI has a role in screening women at high risk for breast cancer. It also aids in cancer management by assessing response to treatment and can help in deciding appropriate surgery by providing accurate information on the extent of the tumor. Newer diagnostic techniques such as sestamibi scans, optical imaging and molecular diagnostic techniques look promising, but need more investigation into their use. Their roles will appear clearer in coming years, and they may prove to be of help in further investigating lesions that are indeterminate on standard imaging. Other upcoming techniques are contrast-enhanced mammography and tomosynthesis. These may give additional information in indeterminate lesions, and when used in screening they aid in reducing recall rates, as shown in recent studies. PET/computed tomography has a role in detecting local disease recurrence and distant metastasis in breast cancer patients.     

Breast MRI: Early experience with a 3-D fat-suppressed Gradient Echo Sequence in the evaluation of breast lesions

The early clinical experience with a 3-Dimensional Fourier Transform Gradient Echo sequence with fat suppression in the evaluation of breast masses is reported. Ten female patients with breast malignancies were pre-operatively evaluated with this sequence and the results compared with the pathological specimens. The scanning protocol included a noncontrast sequence followed by an immediate post-contrast sequence (completed 4.5 min after intravenous contrast injection) and a delayed sequence. Images were assessed for maximum lesion and parenchymal enhancement, lesion size and additional enhancing abnormalities. In six patients, malignant masses enhanced maximally on the immediate post-contrast sequence with parenchyma enhancing maximally on delayed images. In three cases, there was preferential enhancement of malignant lesions over normal parenchyma but to a similar degree on both post-contrast sequences. In one case, both the lesion and parenchyma enhanced maximally on the delayed sequence. Magnetic resonance assessed lesion size accurately and also detected satellite malignancies in one case. However, lesion grade, associated in situ carcinoma and lymphovascular invasion did not impact on lesion enhancement. In this small series, a contrast-enhanced, fat-suppressed 3-D Gradient Echo Sequence detected breast carcinoma with high sensitivity. The technique holds promise but further evaluation is required.     

Building Interdisciplinary Research Models Through Interactive Education

Background

Critical interdisciplinary research skills include effective communication with diverse disciplines and cultivating collaborative relationships. Acquiring these skills during graduate education may foster future interdisciplinary research quality and productivity.

Objective

The project aim was to develop and evaluate an interactive Toolbox workshop approach within an interprofessional graduate level course to enhance student learning and skill in interdisciplinary research. We sought to examine the student experience of integrating the Toolbox workshop in modular format over the duration of a 14‐week course.

Methods

The Toolbox Health Sciences Instrument includes six modules that were introduced in a 110‐minute dialogue session during the first class and then integrated into the course in a series of six individual workshops in three phases over the course of the semester.

Results

Seventeen students participated; the majority were nursing students. Three measures were used to assess project outcomes: pre–post intervention Toolbox survey, competency self‐assessment, and a postcourse survey. All measures indicated the objectives were met by a change in survey responses, improved competencies, and favorable experience of the Toolbox modular intervention.

Conclusion

Our experience indicates that incorporating this Toolbox modular approach into research curricula can enhance individual level scientific capacity, future interdisciplinary research project success, and ultimately impact on practice and policy.     

In Vitro Activity of Retapamulin and Antimicrobial Susceptibility Patterns in a Longitudinal Collection of Methicillin-Resistant Staphylococcus aureus Isolates from a Veterans Affairs Medical Center

Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin-resistant Staphylococcus aureus (MRSA), and the topical agent retapamulin may be a potential alternative therapy. The goal of this study was to determine the in vitro activity of retapamulin as well as a panel of 15 antimicrobial agents, including mupirocin, for 403 MRSA isolates collected longitudinally from a naive population at the Veterans Affairs Puget Sound Health Care System. The MICs for retapamulin had a unimodal distribution, ranging from 0.008 to 0.5 μg/ml. One isolate had an MIC of >16 μg/ml, was also resistant to clindamycin and erythromycin, and was recovered from the nares of a patient undergoing hemodialysis. Twenty-four isolates (6%) and 11 isolates (3%) demonstrated low-level resistance (MICs of 8 to 64 μg/ml) and high-level resistance (MICs of ≥512 μg/ml), respectively, to mupirocin. Isolates were recovered from 10 patients both before and after mupirocin therapy. Of those, isolates from 2 patients demonstrated MIC changes postmupirocin therapy; in both cases, however, strain typing demonstrated that the pre- and postmupirocin strains were different. A total of 386 isolates (96%) had vancomycin MICs of ≤1.0 μg/ml; 340 isolates (84%) were resistant to levofloxacin, 18 isolates (4.5%) were resistant to trimethoprim-sulfamethoxazole, and 135 isolates (33%) had elevated MICs of 4 μg/ml for linezolid. The baseline levels of resistance were low for mupirocin (9%) and even lower for retapamulin (0.25%) Although the use of mupirocin is currently the standard therapy for decolonization practices, the activity of retapamulin warrants its consideration as an alternative therapy in MRSA decolonization regimens.     

Candidate gene association studies of the alpha 4 (CHRNA4) and beta 2 (CHRNB2) neuronal nicotinic acetylcholine receptor subunit genes in Alzheimer's disease

Consistent deficits in the cholinergic system are evident in Alzheimer's disease (AD) patients, including selective loss of alpha4beta2 nicotinic acetylcholine receptors in the brains of AD patients. Knockout mice for the beta2 subunit have impaired neuronal survival in ageing. Accordingly, we have analysed polymorphisms in the genes that encode the alpha4 and beta2 subunits, CHRNA4 and CHRNB2 respectively, for genetic associations with late-onset AD. A significant association for disease was observed for a non-coding polymorphism in CHRNB2 (odds ratio=0.57, 95% confidence interval=0.35-0.95, P=0.024). Replication analysis was performed in two further sample sets. While these did not individually yield significant results, a significant association remained when all samples were pooled (odds ratio=0.70, 95% confidence interval=0.52-0.95, P=0.019). These data suggest that this variant warrants further examination in large case-control series.     

Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload

Background  

Icodextrin is a high molecular weight, starch-derived glucose polymer, which is capable of inducing sustained ultrafiltration over prolonged (12–16 hour) peritoneal dialysis (PD) dwells. The aim of this study was to evaluate the ability of icodextrin to alleviate refractory, symptomatic fluid overload and prolong technique survival in PD patients.