The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico.

During the last decade, the veterinary anesthetics have gained popularity as recreational drugs. The aim of this study was to document the use of "anestecia de caballo" (xylazine) and its consequences among drug users in Puerto Rico. The study combined a cross-sectional survey with 89 drug users and two focus groups conducted in Mayagüez with frontline drug treatment providers. Drug users were recruited from communities of the San Juan metropolitan area using a variety of ethnographic and outreach strategies. A short questionnaire developed for the study collected information on sociodemographics, xylazine use, and its consequences. The two focus groups were conducted to discuss the details related to xylazine use, its consequences, and utilization awareness. The sample comprised 63 males (70.8%) and 26 females with a mean age of 37.2 years. The mean number of years of drug use was 14.3, with a mean frequency of drug use of 5.9 times daily. More than 65% reported speedball as the principal drug of use. The prevalence of xylazine use was 80.7%. More than 42% of the sample used xylazine in a mixture with speedball. The main route of administration of xylazine was injection but 14% reported the use of xylazine by inhalation. More than 35% of the sample reported skin lesions and 21.1% reported at least one overdose episode. Multiple logistic regression analysis revealed that males (OR = 3.47, CI = 1.10-12.00) and those who reported speedball as their main drug of use (OR = 9.34, CI = 2.51-34.70) were significantly more likely to be xylazine users. Focus groups revealed that drug users claimed to recognize the presence of xylaxine in a mixture of speedball based on its effects, taste, the color of the drug (dark brown), and its odor. In conclusion, the use of xylazine among drug users in Puerto Rico seems to be an emerging trend with potentially serious health consequences.

Canine infection and the possible role of dogs in the transmission of American tegumentary leishmaniosis in Salta, Argentina.

Some Leishmania species affect humans in two principal forms: visceral and cutaneous leishmaniosis (CL). Several studies have identified dogs as the main reservoirs of the visceral leishmaniosis (VL) caused by Leishmania infantum. The purpose of this work was to carry out a survey of the canine population associated with human cases of American tegumentary leishmaniosis (ATL), in order to establish the clinical, parasitological, serological and immunological characteristics of the canine disease, in an endemic region for both ATL and Chagas' disease in the province of Salta, in northwestern Argentina. Two hundred and eight dogs from the endemic area were examined and 41 (19.7%) of them presented lesions compatible with leishmaniosis. In order to investigate the presence of antibodies against Leishmania spp. and Trypanosoma cruzi, sera were screened by ELISA using two complex antigens from these parasites and, because of cross-reactions between them, a specific antigen for diagnosis of T. cruzi infection. Sixty-two (29.8%) of 208 dogs were positive for the complex antigen F45 from Leishmania and 50 (24%) were positive for the complex antigen F105 from T. cruzi. Nine dogs (4.3%) were positive for the specific Ag163B6-cruzipain suggesting that these dogs were truly infected with T. cruzi. Furthermore, three of these nine dogs presented Leishmania sp. in their skin lesions and therefore were considered as infected by both, T. cruzi and Leishmania parasites. The prevalence of Leishmania infection detected by lesions and/or positive serology was 27.4% (57/208). On the basis of previous observations regarding the clustered appearance of human ATL, the dog population was divided into two groups: zone A, dogs living within a 100 m radius from houses with human cases, and zone B, dogs living beyond this limit. The prevalence of ATL in dogs was significantly higher in zone A (34.6%) than in zone B (7.3%), suggesting a strong correlation between canine and human cases. The average time required for a parasitological diagnosis by microscopy was six times longer for dog samples than human ones, and the average number of parasites per 100 microscopic fields was 14-fold lower in canine samples. The high prevalence of Leishmania infection and the close association with human cases, demonstrated that dogs are a very susceptible host for Leishmania infection, but the scarcity of parasites in their lesions suggests that they may not be the main reservoir of the parasite in this endemic area.

Countertransference in working with victims of political repression.

The countertransferential reactions of psychotherapists working in a threatening environment with victims of political repression are described. Via case studies based on clinical consultation and direct testimony, this paper examines the effects on Chilean therapists living and working in that country. It is suggested that these clinical observations may have application to therapeutic work with victims in other stressful settings.

Mexican-American adolescent sexuality and sexual knowledge: an exploratory study.

PIP: This article reports the findings of a study designed to examine the sexual knowledge, attitudes, and practices of low-income Mexican- American adolescents. The participants in the study were all about to begin a sex education program in a community health organization in East Los Angeles. The study involved 84 adolescents aged 14-19, 97% of who identified themselves as Mexican-American (the remainder identified themselves as Latino). 51 of the subjects were female and 33 male. The participants completed a 43-item questionnaire concerning demographics, sexual experience and contraceptive use, knowledge of birth control methods, and attitudes towards sexuality and birth control. Only 18 (21%) of the subjects indicated ever having sex. But among this group, 83% reported not using contraception during their last intercourse, and 61% reported never using contraception. Only 22% reported using contraception regularly. Concerning the knowledge of different birth control methods,many of the participants were able to list several methods, but their responses indicated a lack of accurate and specific knowledge about contraceptive methods. In addition to the 43-item questionnaire, 27 of the subjects also completed a sexual and contraceptive knowledge questionnaire. The topics included contraceptive effectiveness, the menstrual cycle, and fertilization. The scores on the questionnaire were low, with an average score of 33% of correct answers. Finally, all 84 participants responded to a sexual attitude questionnaire, which revealed a generally traditional attitude toward the importance of have children, virginity, and the relationship between sex and love.^ieng

Health care utilization by low-income clients of a community clinic: an archival study.

PIP: An archival study was done of 500 medical records from a community clinic serving a low income predominantly Hispanic area of Los Angeles. The data collected included demographic characteristics and presented symptoms or reasons for visit, as well as diagnosis and treatment. The greatest number of patient visits were made for family planning services. A large porportion of the patients who received initial family planning services failed to return to the clinic for follow ups or additional supplies. A total of 208 pregnancy tests were performed in 151 of the 500 cases sampled. Of these, 152 were positive. The most frequently stated reason for requesting pediatric services was for physical exams, accounting for 30% of the visits. It should be noted that the discontinuity of care and insufficient utilization of preventive care seen in these results deserve serious attention by medical clinic administrators. The rate of patients who do not return for family planning after the initial visit is worrisome. A greater effort to attract women to family planning services at the time they request pregnancy verification could reduce the need for abortion of unwanted pregnancy. The data also indicate that changes in the wording of certain questions commonly asked of clients may be needed. This study allowed service providers to obtain important information about their performance, their needs, and the future direction that their services might take. This type of analysis is relatively low in cost and can yield important benefits, espicially if done on a periodical base in a search for policy implications.^ieng

Personality assessment and test interpretation of Mexican Americans: a critique.

Reviews the personality test assessment of Mexican Americans. Although there is a paucity of available research there are some indications that Mexican Americans differ in response patterning on projective devices. On objective instruments, problems involving fluency in English obscure the findings. Several recommendations are offered for increasing the efficiency of these instruments for use with Mexican American clients.

Personality structure of Mexican Americans using the Comrey Personality Scales.

The Comrey Personality Scales (CPS) were used to examine the personality structure of 176 Mexican American college students. A majority of the eight factors maintained substantial loadings and corresponded closely with Comrey's normative sample as well as with Brazilian and New Zealand samples. Two factors, Conformity and Orderliness, showed the weakest fit across all four groups. Overall, the CPS shows adequate measurement properties for "normal" personality assessment among Mexican Americans and is preferable to instruments such as the Minnesota Multiphasic Personality Inventory (MMPI). However, the external validity of the CPS with clinical populations must first be determined prior to its use to assess psychopathology among Mexican Americans.

An enzyme-linked antiglobulin test for assessing anti-D immunoglobulin preparations.

Two enzyme-linked antiglobulin tests (ELAT) for assessing anti-D IgG preparations are described; one is performed in tubes and the other in microtitre plates. An anti-human IgG alkaline phosphatase conjugate and the substrate p-nitrophenyl phosphate are used. Both methods were sensitive and reproducible, with variations coefficients of 7.8 and 8.6% for enzyme immunoassay in tubes and microplates, respectively. The linear relationship between the amount of red cell-bound anti-D and the optical density shows that the method is suitable for quantitative studies. Results obtained by the two methods show a very good correlation (r = 0.99) in 12 of the 14 samples assayed, and both give good agreement with results obtained in automated haemagglutination. Since microtitre plate ELAT has numerous advantages over the tube method, it could provide an alternative method for assessing anti-D activity of specific IgG preparations in control laboratories.

Ethnicity and life event cognitive appraisals and experiences.

This study compared the cognitive appraisals and incident ratings of urban American Indians (N = 50), Anglo-Americans (N = 50), and Hispanics (N = 47) on a revised version of the Social Readjustment Rating Scale (SRRS). Results indicated no overall significant differences among the three ethnic groups. However, on comparison of individual life events items, the groups differed significantly on the cognitive appraisal of 8 items and on the incidence of 10 items. Of these items, only 2 overlapped between cognitive appraisals and actual incidence. Results are discussed in terms of potential use of the revised SRRS with these ethnic groups in future research on the relationship between life events and physical and psychological disorders.

Posttraumatic stress in immigrants from Central America and Mexico.

International migration has been associated with increased levels of psychological disturbance, particularly among refugees who have fled from war or political unrest. This study examined self-reported symptoms of depression, anxiety, somatization, generalized distress, and posttraumatic stress disorder (PTSD) in a community sample of 258 immigrants from Central America and Mexico and 329 native-born Mexican Americans and Anglo Americans. Immigrants were found to have higher levels of generalized distress than native-born Americans. Fifty-two percent of Central American immigrants who migrated as a result of war or political unrest reported symptoms consistent with a diagnosis of PTSD, compared with 49 percent of Central Americans who migrated for other reasons and 25 percent of Mexican immigrants. The authors call for more research to document the psychosocial aspects of migration.

Correlates and changes over time in drug and alcohol use within a barrio population.

Extent and determinants of use of alcohol, marijuana, inhalants, and PCP were explored in a group of 339 Mexican American youths from the East Los Angeles Housing projects. Results from this study were compared to those from a similar survey carried out in the same area 2 years ago. Use of inhalants has declined markedly compared with prevalence reported in the previous report. However, use of alcohol and marijuana have increased across all age and sex cohorts. Prevalence of PCP use, explored for the first time in this report, was shown to be extremely high. Use of all drugs was generally predicted by age, sex, and number of peers reporting use. Self-concept factors, especially one's self-evaluation with respect to others, were also significant predictors to use of marijuana, inhalants, and PCP. However, alcohol use was not related to any self-concept factors. Language (Spanish-English) used both in the home and with peers was related to use of all substances studied. Limitations in the generalization of this study as a result of sampling problems are discussed.

Inhalant, marijuana, and alcohol abuse among barrio children and adolescents.

Prevalence of inhalant, marijuana, and alcohol abuse was studied in a sample of 457 male and female Mexican-American children and adolescents between the ages of 9 and 17 years. Subjects interviewed resided in four housing projects located in East Los Angeles. All interviews were conducted by adolescents who resided in the same housing projects. Results indicated that compared to a national sample, Mexican-American adolescents were at least 14 times more likely to be currently abusing inhalants. The prevalence rate of marijuana was double the national rate, but the prevalence of alcohol was equal to that found nationally. Reasons for elevated substance abuse rates are explored.

Psychosocial and cognitive correlates of alcohol use in younger adult immigrant and U.S.-born Hispanics.

Hispanic groups, taken together, constitute nearly 9% of the U.S. population. Research undertaken in the last decade has demonstrated that segments of the Hispanic male population are particularly heavy drinkers and are at high risk for alcohol-related problems. This article reviews several of the most important studies of alcohol use and its consequences among Hispanics, and reports new data from a study of alcohol use and its correlates among 452 young adult men and women in Los Angeles. The findings show important differences between immigrants and U.S.-born Hispanics as well as clear gender differences in terms of alcohol use patterns, expectations about the benefits of alcohol consumption, and depressive symptomatology associated with the use of alcohol. These differences have implications for the design of prevention and treatment services for Hispanics and these are discussed.

[Migration and post-traumatic stress disorders: the case of Mexicans and Central Americans in the United States]. / Migración y estrés postraumático: el caso de los mexicanos y centroamericanos en los Estados Unidos.

The process of international migration has been associated with increased levels of psychological disturbance and recently investigators have noted the experience of PTSD symptoms among recent war refugees from Southeast Asia. This study sought to first examine the overall impact of migration in a large sample of immigrants from Central America and Mexico in terms of symptoms related to depression, anxiety, somatization and generalized distress. A second aim of the study was to note the existence of specific symptoms related to PTSD diagnoses as related to self-reported reasons for migration. Immigrants were found to have overall higher levels of generalized distress symptoms when compared to non-immigrants, and self-reported reasons for migration were highly related to PTSD diagnosis, with 52% of Central American war refugees in this sample meeting the DSM-III criteria for the disorder. Results are discussed in terms of sensitizing mental health professionals to the psychological sequelae of forced migration.