Are Stressful Life Events (SLEs) Associated with the Utilization of Substance Use Treatment-Related Services?

OBJECTIVE: This study described herein explored the association of stressful life events with the utilization of substance use treatment-related services among substance users living in Puerto Rico. METHODS: A secondary data analysis was conducted using data collected by a research project entitled Puerto Rico Drug Abuse Research Development Program II (PRDARDP II). The study population consisted of 378 individuals from 18 to 35 years of age who were residents of the San Juan metropolitan area and who presented evidence of substance use in the 30 days prior to the interview. The analysis considered demographic data, information on patterns of substance use, substance use treatment history, stressful events, and depression and anxiety symptomatology. RESULTS: As the number of stressful life events increased, substance users were more likely to report having utilized substance use treatment-related services (OR = 1.11, 95% CI [1.06, 1.17], p < 0.001). Relapsing, the inability to afford drugs, and poor working conditions were statistically significant stressful life events associated with the utilization of substance use treatment-related services. CONCLUSION: Despite the structural limitations associated with access to and with the quality of the services in the substance use treatment-related system of Puerto Rico, findings suggest that stressful life events play a significant role in the utilization of those services. Researchers and clinicians should consider screening for stressful life events in outreach and engagement strategies. At the same time, the assessment of stressful life events should be integrated into the treatment planning stage to support the recovery process of people with substance use disorders.

Radon-contaminated drinking water from private wells: an environmental health assessment examining a rural Colorado mountain community's exposure.

In the study discussed in this article, 27 private drinking water wells located in a rural Colorado mountain community were sampled for radon contamination and compared against (a) the U.S. Environmental Protection Agency's (U.S. EPA's) proposed maximum contaminant level (MCL), (b) the U.S. EPA proposed alternate maximum contaminate level (AMCL), and (c) the average radon level measured in the local municipal drinking water system. The data from the authors' study found that 100% of the wells within the study population had radon levels in excess of the U.S. EPA MCL, 37% were in excess of the U.S. EPA AMCL, and 100% of wells had radon levels greater than that found in the local municipal drinking water system. Radon contamination in one well was found to be 715 times greater than the U.S. EPA MCL, 54 times greater than the U.S. EPA AMLC, and 36,983 times greater than that found in the local municipal drinking water system. According to the research data and the reviewed literature, the results indicate that this population has a unique and elevated contamination profile and suggest that radon-contaminated drinking water from private wells can present a significant public health concern.

Antibiotic Based Phenotype and Hospital Admission Profile are the Most Likely Predictors of Genotyping Classification of MRSA.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is associated with increased morbidity, mortality, and financial burdens. Phenotyping methods are used to classify MRSA as either health care MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA). Recent studies suggested the phenotyping methods are not always reliable, based on a lack of concordance with genotyping results. OBJECTIVE: In this study, concordance of classification methods based on clinical characteristics or antibiotic susceptibility compared to the gold standard genotyping was assessed in the classification of MRSA. METHODS: We compared the genotypes and phenotypes of MRSA in 133 samples taken from patients in Saudi Arabia. Statistical analyses included concordance, specificity and sensitivity, and logistic regression modeling. RESULTS: There was fair a definite agreement between the health care risk and infection type methods (p < .001), but no statistically significant agreement between the susceptibility pattern and health care risk methods (p = 243), and between susceptibility pattern and infection type methods (p = .919). Reduced multiple regression modelling suggested the potential of a phenotyping-based method of antibiotic susceptibility pattern (OR = 15.47, p < .001) in conjunction with hospital admission profile(OR = 2.87, p = .008) to accurately identify MRSA as HA-MRSA and CA-MRSA. CONCLUSION: The use of a standardized phenotyping technique, using susceptibility pattern and hospital admission profiles to classify MRSA infections as either HA-MRSA or CA-MRSA, would facilitate diagnosis, infection control efforts, prevention, and assignment of appropriate therapies. The ability to use phenotyping in the classification of these strains would improve efforts to contend with this adept and evolving bacterial organism.

A comprehensive review of clinical trials on the efficacy and safety of drugs for the treatment of low back pain.

A systematic review involving 50 randomized controlled trials (4,863 patients) published since 1980 was undertaken with the objective of assessing efficacy and safety of low back pain (LBP) medications. The methodological quality of each trial was evaluated based on a standardized system. Quality scores ranged from 26 to 82 points on a 100-point scale (from 0 to 100), indicating an overall moderate quality of the trials reviewed. Limited evidence was found regarding the effectiveness of drug treatments for LBP and current studies focused on short-term usage of the therapies. Available evidence supported the effectiveness of non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) in acute and chronic LBP, of muscle relaxants in acute LBP, and of antidepressants in chronic LBP; safety results were heterogeneous. More rigorously designed trials should be implemented to establish comparative efficacy and safety of drugs used to treat chronic and acute LBP.

HIV-positive parents, HIV-positive children, and HIV-negative children's perspectives on disclosure of a parent's and child's illness in Kenya.

HIV disclosure from parent to child is complex and challenging to HIV-positive parents and healthcare professionals. The purpose of the study was to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Sixteen HIV-positive parents, seven HIV-positive children, and five HIV-negative children completed semistructured, in-depth interviews. Data were analyzed using the Van Kaam method; NVivo 8 software was used to assist data analysis. We present data on the process of disclosure based on how participants recommended full disclosure be approached to HIV-positive and negative children. Participants recommended disclosure as a process starting at five years with full disclosure delivered at 10 years when the child was capable of understanding the illness, or by 14 years when the child was mature enough to receive the news if full disclosure had not been conducted earlier. Important considerations at the time of full disclosure included the parent's and/or child's health statuses, number of infected family members' illnesses to be disclosed to the child, child's maturity and understanding level, and the person best suited to deliver full disclosure to the child. The results also revealed it was important to address important life events such as taking a national school examination during disclosure planning and delivery. Recommendations are made for inclusion into HIV disclosure guidelines, manuals, and programs in resource-poor nations with high HIV prevalence.

Comparison of two clinical severity scoring systems in two multi-center, developing country rotavirus vaccine trials in Africa and Asia.

BACKGROUND: Clinical severity scoring systems are used in rotavirus vaccine efficacy and effectiveness studies to define the primary endpoint, severe rotavirus gastroenteritis (RVGE). Understanding how scoring systems perform in diverse settings is critical for proper design and interpretation. This investigation aims to understand how the Vesikari scoring system (VSS) and Clark scoring system (CSS) categorize severe disease among children under 2 years of age using data from two Phase III efficacy trials conducted in five developing countries in Africa and Asia. METHODS: Signs and symptoms were collected on trial participants who presented to a medical facility with study-defined gastroenteritis. Severity scores were calculated using pre-established VSS and CSS criteria and compared to identify differences in the proportions of severe RVGE within regions and sites, and by gender and age. RESULTS: In Africa and Asia, 40.6% and 56.0% of rotavirus-positive episodes were severe according to the VSS, while 9.5% and 6.3% of episodes were severe according to the CSS (Fisher's Exact, p ≤ 0.001). Using the mean scores in these trials (VSS: ≥ 10 Africa, ≥ 11 Asia; CSS: Africa and Asia ≥ 10) as the severity thresholds, agreement between scoring system severity classifications improved substantially within each region (Africa: kappa = 0.67; Asia: kappa = 0.78) as compared to the original severity classification (Africa: kappa = 0.27; Asia: kappa = 0.10). Using the mean score, 17.1% and 9.5% of severe VSS cases in Africa and Asia, respectively, were classified as not severe according to the CSS and 14.7% and 9.5% of severe CSS cases in Africa and Asia were classified as not severe according to the VSS. CONCLUSION: The two scoring systems performed differently among developing country populations in Africa and Asia, with the VSS classifying more cases as severe in both regions. One accurate and reliable scoring system should be developed and implemented for all trials so that results may be more comparable.

State capacity influences on the epidemiology of neglected tropical and vector-borne diseases in Sub-Saharan Africa.

Many neglected tropical and vector-borne diseases continue to emerge and reemerge in Africa where a significant number of governments have limited state capacity. The reasons these diseases resurface are numerous and this problem remains unsolved. This study contributes to existing research by examining how economic and sociopolitical attributes of state capacity influence the transmission of disease in a population. This ecological study examined relationships between state capacity and the epidemiology of five neglected tropical and vector-borne diseases in a sample of 33 African countries. Regression analyses were used to examine the relationships between state capacity, i.e., economic and sociopolitical attributes, and disease burden, incidence, prevention/control and mortality. Results revealed statistically significant relationships between state capacity and the following dependent variables: all disease-burden variables; insecticide-treated-nets prevention and control; and all age-related and human African trypanosomiasis mortalities. A broad range of effect sizes (R(2) = 0.02-0.59) were observed and the economic and sociopolitical attributes of state capacity made different contributions to these effects. Future studies should explore the economic and sociopolitical attributes of state capacity that influence disease transmission by examining different populations or diseases, and by using different research methods.

Human Salmonella infections linked to contaminated dry dog and cat food, 2006-2008.

OBJECTIVE: Human Salmonella infections associated with dry pet food have not been previously reported. We investigated such an outbreak of Salmonella Schwarzengrund and primarily affecting young children. PATIENTS AND METHODS: Two multistate case-control studies were conducted to determine the source and mode of infections among case-patients with the outbreak strain. Study 1 evaluated household exposures to animals and pet foods, and study 2 examined risk factors for transmission among infant case-patients. Environmental investigations were conducted. RESULTS: Seventy-nine case-patients in 21 states were identified; 48% were children aged 2 years or younger. Case-households were significantly more likely than control households to report dog contact (matched odds ratio [mOR]: 3.6) and to have recently purchased manufacturer X brands of dry pet food (mOR: 6.9). Illness among infant case-patients was significantly associated with feeding pets in the kitchen (OR: 4.4). The outbreak strain was isolated from opened bags of dry dog food produced at plant X, fecal specimens from dogs that ate manufacturer X dry dog food, and an environmental sample and unopened bags of dog and cat foods from plant X. More than 23 000 tons of pet foods were recalled. After additional outbreak-linked illnesses were identified during 2008, the company recalled 105 brands of dry pet food and permanently closed plant X. CONCLUSIONS: Dry dog and cat foods manufactured at plant X were linked to human illness for a 3-year period. This outbreak highlights the importance of proper handling and storage of pet foods in the home to prevent human illness, especially among young children.