ABSTRACT
Background: Hispanic/Latino (H/L) heritage civilians out-number all other non-White ethnic groups in the United States. When studied as one group, H/L diversity is ignored, including rates of drug misuse. This study's aim was to examine H/L diversity regarding drug dependence by disaggregating how the burdens of active alcohol or other drug dependence (AODD) might change if we were to address syndromes drug by drug. Method: Studying non-institutionalized H/L residents from the National Surveys on Drug Use and Health (NSDUH) 2002-2013 probability samples, we utilized online Restricted-use Data Analysis System variables to identify ethnic heritage subgroups and active AODD via computerized self-interviews. We estimated case counts of AODD with analysis-weighted cross-tabulations and variances from Taylor series. Radar plots disclose AODD variations when we simulate the reductions of drug-specific AODD one by one. Results: For all H/L heritage subgroups, the most substantial AODD decline might be achieved by reducing active alcohol dependence syndromes, followed by declines of cannabis dependence. The burdens due to active syndromes attributed to cocaine and pain relievers vary somewhat across subgroups. For the Puerto Rican subgroup, our estimates reveal potentially important burden reduction if active heroin dependence can be decreased. Conclusion: A sizeable reduction in the H/L population health burden attributable to AODD syndromes might be achieved via the effective decline of alcohol and cannabis dependence among all subgroups. Future research includes a systematic replication with recent NSDUH survey data, as well as various stratifications. If replicated, the need for targeted drug-specific interventions among H/L will become unequivocal.
ABSTRACT
OBJECTIVE: Orthostatic intolerance (OI) and autonomic dysfunction (AD) are common in adolescents and young adults. Patients experience multisystem symptoms including gastrointestinal (GI), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), or only symptoms of OI (SOI) without significant findings on 70-degree head-up tilt testing (HUT). We hypothesize that patients with POTS, OH, and SOI show differences in GI symptoms and motility test and that heart rate (HR) changes on HUT predict severity of GI dysmotility. STUDY DESIGN: From medical records of patients (<18 years) with OI, we collected demographics, presenting symptoms, GI manifestations, and GI motility testing. Data were compared between the 3 groups (POTS, OH, and SOI). We assessed changes in HR on HUT with changes on GI motility evaluation. RESULTS: Two hundred twenty-nine patients were included (73% females). Abdominal pain (65%), nausea (49%), vomiting (18%), and constipation (24%) were the most common GI symptoms. In patients who had motility evaluation, there were 27% (53/193) with delayed gastric emptying (GE) at 4 hours, 35% (32/92) with delayed colonic transit (CT), 55% (17/31) with reduced gastric accommodation (GA), and 75% (21/28) with dyssynergic defecation (DD). Among 100 POTS, 34 OH, and 95 SOI patients, no significant differences in GI symptoms or motility tests were identified and HR changes on HUT were not associated with changes on motility tests. CONCLUSION: GI symptoms are frequent in adolescents with OI and are associated with delayed GE, reduced GA, delayed CT, and presence of DD.
