Trauma-informed Approaches to Substance Use Interventions with Indigenous Peoples: A Scoping Review.

Indigenous Peoples experience disproportionately higher rates of problematic substance use. These problems are situated in a context of individual and intergenerational trauma from colonization, residential schools, and racist and discriminatory practices, policies, and services. Therefore, substance use interventions need to adopt a trauma-informed approach. We aimed to synthesize and report the current literature exploring the intersection of trauma and substance use interventions for Indigenous Peoples. Fourteen databases were searched using keywords for Indigenous Peoples, trauma, and substance use. Of the 1373 sources identified, 117 met inclusion criteria. Literature on trauma and substance use with Indigenous Peoples has increased in the last 5 years (2012-2016, n = 29; 2017-2021, n = 48), with most literature coming from the United States and Canada and focusing on historical or intergenerational trauma. Few articles focused on intersectional identities such as 2SLGBTQIA+ (n = 4), and none focused on veterans. There were limited sources (n = 25) that reported specific interventions at the intersection of trauma and substance use. These sources advocate for multi-faceted, trauma-informed, and culturally safe interventions for use with Indigenous Peoples. This scoping review illuminates gaps in the literature and highlights a need for research reporting on trauma-informed interventions for substance use with Indigenous Peoples.

Recent activities of EC4 in the harmonization of clinical chemistry in the European Union.

This article describes the recent activities of the European Communities Confederation of Clinical Chemistry (EC4). Main goal of EC4 is harmonization of clinical chemistry in the European Union and Europe. EC4's actions connected to that are training and registration of professionals, and accreditation of laboratories. The 35000 professionals practising clinical chemistry in the EU have different backgrounds (medical, pharmaceutical, science-oriented, veterinary, or microbiological). Thus, for the harmonization of training of clinical chemists, EC4 has published a European Syllabus for Postgraduate Training, and instituted a European Union Register for Clinical Chemists. The Syllabus is an indication of the level of requirements in postgraduate training. The EC4 initiative to implement the European Register for Clinical Chemists is based on the 8 years vocational training necessary to obtain sufficient knowledge in clinical chemistry according to the European Syllabus. A guide to the EC4 Register has been published; registration leads to the title European Clinical Chemist (EurClinChem). The accreditation of laboratories must be based on a total quality management system. EC4 has described guidelines (essential criteria) which it judges appropriate for establishing the quality of medical laboratory service; it does not wish to fulfil the role of an accrediting body. Moreover, a working group has been set up to seek to harmonize the work of national accrediting bodies. Therefore, it is logical that EC4 monitors the activities of the different standardizing bodies that might influence the practice of clinical chemistry in the EU. Finally, some aspects concerning the future strategy of EC4 are brought forward.

New Zealand general practice computerisation; attitudes and reported behaviour.

AIMS: To gather information from general practitioners regarding aspects of computerisation including whether certain tasks should be computerised and whether those tasks were in fact computerised at their practice. METHODS: Five hundred general practitioners randomly selected throughout New Zealand were sent a postal survey in May 1995. Results were then collated and analysed. RESULTS: The response rate was 54% (268). Computerisation is becoming a necessity according to 85% of responders and a computer was used for at least one task by 84% of doctors. Computer use during consultation interfered unduly with doctor-patient communication according to 43% of responders. Privacy issues had not been dealt with adequately for 33% of responders. The five most frequently computerised tasks were; maintaining an age-sex register (81% of responders), recalls (80%), administration (77%), making appointments (50%) and word processing (49%). The number of doctors in a practice and responders' RNZCGP membership status appeared predictive of task computerisation. Responders' gender, year of graduation and their membership on the Indicative General Practitioners Register were not statistically significant factors for determining attitudinal and behavioural responses. CONCLUSIONS: The low response rate limits generalisation but the trends in the results are important. Reported tasks with greatest potential for computerisation were doctor education; checking drug interactions/contraindications; patient education; tasks relating to interfacing with laboratories; and database enquires of patients. Significant concerns among responders were perceived interference with doctor patient communication and privacy issues. Eighty-four percent of responders use the computer for at least one task.

General practitioners' opinions of continence care training.

AIMS: To examine general practitioners' confidence in the diagnosis and management of urinary incontinence, to define their unmet continence training and educational needs, and to evaluate the current provision of continence care in general practice, including the role of practice nurses. METHODS: A pre-tested postal questionnaire was sent to 600 general practitioners throughout New Zealand to obtain information about their demography and training in incontinence management, their confidence in diagnosis and treatment, and their perceptions of met and unmet educational needs in continence care. They were also asked about current provision of continence promotion in their practice and their views on the role of practice nurses in caring for incontinent patients. Confidence data were recorded on five point scales and analysed using chi square tests. Cluster analysis was used to describe groups with different opinions on practice nurses' roles. RESULTS: The response rate from eligible contacts was 81.3%. Although most respondents provide continence care, only 2.6% offered special clinics for continence promotion. Fewer than half felt confident to diagnose the causes of incontinence. Confidence in managing incontinence in children was consistently lower than for other incontinence presentations. There was no difference by sex in confidence in caring for incontinent patients although female respondents were more likely to consider management of continence care part of a practice nurse's role (chi 2 = 47.5, p < 0.01) and to routinely ask well women about incontinence (chi 2 = 243.6, p < 0.01). Most respondents (71.9%) could not remember having had any formal training in the management of incontinence at either undergraduate or postgraduate level. Recall of postgraduate education was associated with greater levels of confidence in management of continence problems. There was general agreement that it was appropriate to include training in continence management in vocational and continuing medical education. CONCLUSION: A substantial proportion of general practitioners perceive a lack of adequate medical training in incontinence care at both undergraduate and postgraduate levels. There is a need for improved education for both general practitioners and practice nurses.

Pravastatin and risk factor modification in patients with moderate primary hypercholesterolaemia.

AIM: To evaluate the efficacy and safety of pravastatin 20mg at night, versus placebo, in combination with dietary, smoking cessation, and other lifestyle advice in general practice. METHODS: This was a multicentre, randomised double blind placebo controlled trial carried out in thirty general practices in three New Zealand centres. Patients with moderate primary hypercholesterolaemia (5.2-6.7 mmol/L) and two or more risk factors for coronary heart disease were enrolled. After a minimum of 6 weeks lifestyle changes, 95 patients (aged 18-70 years) were randomised to active or placebo therapy. They continued to receive advice and encouragement in maintaining dietary, exercise or smoking cessation changes. RESULTS: Seventy eight patients, pravastatin (n = 39) and placebo (n = 39), completed the treatment phase of the study. After 6 weeks on 20 mg pravastatin, total cholesterol decreased by 18% (0.9 mmol/L, p < 0.0001), triglycerides decreased by 6% (0.1 mmol/L ns), LDL-cholesterol decreased by 23% (1.1 mmol/L, p < 0.0001), and HDL-cholesterol increased by 8% (0.1 mmol/L, ns). A similar effect was also observed after 26 weeks of therapy. These effects were also significant when compared with the placebo group. In 61% of patients treated with pravastatin there was a reduction in cholesterol to less than 5.2 mmol/L, and no real change in lipid levels in patients receiving placebo. No significant differences were observed between the active and placebo groups with regard to patient withdrawal, compliance, or adverse reactions. CONCLUSIONS: In general practice pravastatin is a well tolerated and safe drug that induces a favourable effect on lipid profile in patients with primary moderate hypercholesterolaemia and two or more other risk factors for coronary artery disease.

Changes in payments for general practice consultations 1989-93.

AIMS: Information generated by the computer systems of general practitioners was examined to determine whether general practitioners fee structures during 1993 were different from those reported in 1989. METHODS: Copies of the general medical services (GMS) claims and actual consultation charges to patients were examined to determine whether patients had been charged the doctors' regular fee or an amount greater or less than this, in 1993. These data were compared with results from a previous study describing charging data in 1989. RESULTS: Information on 59,215 consultations was collected in 1993 and compared with information on 97,869 consultations collected in 1989. The proportion of consultations which resulted in a regular fee being charge had reduced from 47.0% in 1989 to 34.1% in 1993 (p < 0.001). The proportion of cases in which a less than normal fee was charged had risen 7.9 times from 3.5% in 1989 to 27.5% in 1993 (p < 0.001). The contribution of Accident Compensation (ACC) funding for general practitioner consultations had reduced from 17.5% of consultations in 1989 to 10.1% of 1993 consultations (p < 0.001). Excluding consultations in which a maternity or immunisation claim was made, 19.4% of consultations in 1993 generated no fee to the patient. CONCLUSION: In the 4 years between these two data collections, changes in the contribution of different agencies funding general practice care is marked. Public agencies have diminished input and both patients and practitioners are carrying more of the financial burden for access to primary care.

Differences between prescribed and dispensed medications.

AIMS: To describe differences between general practice prescribed and dispensed medications in terms of patient characteristics and category of drug. METHODS: Computerised prescribing records and prescriptions presented to pharmacies were retrospectively reviewed. All prescriptions generated from the computers of 13 practices over a 12 week period in 1992 were compared with prescriptions dispensed. Data from the two sources were matched and unmatched items were analysed to determine whether patient demography or category of drug prescribed influenced the rate of prescription dispensing. The nine most commonly prescribed drug categories were examined in detail. RESULTS: A total of 49 756 items were prescribed to 19 299 people and 43 302 (87.0%) of these were dispensed. Antibiotics were the most commonly prescribed category of the drug accounting for 17.6% of nondispensed items. There was no significant difference by gender in the proportion of people (9.8%) failing to claim prescribed items, nor in the number of items (13.0%) prescribed but not dispensed. Differences in dispensing rates by community services card (CSC) status of patients were statistically significant for both numbers of people failing to uplift their medications and for numbers of items not dispensed (p<0.001). There were also significant differences by high user health card (HUH) eligibility (p<0.005) and age (p<0.001). CONCLUSIONS: There is a high rate of nondispensing of medicines prescribed in general practice. Patients eligible for government subsidies are more likely than other patients to have their prescriptions filled. Current pharmaceutical subsidies may be inadequately targeted. There are no gender differences, while increasing age is associated with lower nondispensing rates. General practitioners need to be aware of these factors when making prescribing decisions.

New Zealand general practitioner referral patterns.

AIM: The aim of this study was to describe the referral patterns of general practitioners in New Zealand, for a defined list of medical conditions. METHODS: A postal questionnaire was sent to a random sample of 200 general practitioners, selected from the Medical Council of New Zealand list. Responses were made on five point scales to indicate general practitioners' views on the appropriateness of referral. For each medical condition, derived from An Educational Guide for General Practice, respondents also indicated favoured agencies for referral. Cluster analysis was used on an SPSSX dataset. RESULTS: A response rate of 87% (91.5% of eligible contacts) was achieved. The conditions for which referrals were least often made included mild hypertension, rheumatoid arthritis not requiring second line therapy, hypothyroidism, and obesity. Referral was common for rheumatoid arthritis requiring second line therapy, insulin dependent diabetes mellitus, altered bowel habit with rectal bleeding, multiple sclerosis, and postmenopausal bleeding. Seventy seven different referral agencies were indicated by respondents: the most common was the general physician (13% of all agencies indicated). CONCLUSIONS: Although there are a large number of conditions which are routinely managed only in general practice, general practitioners need to be able to refer patients to other health carers, even if only occasionally. There is a high degree of consensus as to the conditions for which referral is usually appropriate. They tend to be conditions requiring well defined investigation, treatment or management procedures which are commonly provided by centralised secondary or tertiary institutions.

Epitope-sharing between Mycoplasma arthritidis and chondrocytes demonstrated by monoclonal antibodies.

Polyclonal and monoclonal antibodies against Mycoplasma (M.) arthritidis membranes were investigated in the indirect immunofluorescence test (IIFT) and enzyme immunoassay (EIA) for their reactivity with rat and human chondrocytes as well as with rat skin fibroblasts. The monoclonal antibody A 79 gave positive reactions with rat chondrocytes in the IIFT up to a dilution off 1: 128 and in EIA up to a dilution of 1:16. In the EIA, the monoclonal antibodies A 31, A 32 and A 58 recognized M. arthritidis as well as rat and human chondrocyte membrane antigens up to dilutions of 1:128 and 1:256 and rat skin fibroblasts up to dilutions of 1:32/64. In the IIFT, the whole surfaces of the rat and human chondrocytes were strongly fluorescing after the treatment with the polyclonal antiserum against M. arthritidis. The monoclonal antibody A 79 caused weak fluorescence (rat chondrocytes) or no fluorescence (human chondrocytes) on the surface of the chondrocytes but a stronger fluorescence on areas around and between them. From these results it can be concluded that A 79 probably reacts with antigens of the chondrocyte matrix.

The distribution of unsulphated and sulphated glycosaminoglycans in palmar fascia from patients with Dupuytren's disease and healthy subjects.

Eighty specimens from 20 patients with Dupuytren's disease and 7 biopsies of healthy palmar fascia were analysed for their glycosaminoglycan isomer patterns with a combined enzymatic/HPLC method. The diseased portions of palmar fascia tissue were characterized by elevated total glycosaminoglycans together with a relative increase in the sulphated fractions. The macroscopic stages of nodules, bands and unaffected tissue could be classified very well by multivariate statistical analysis on the basis of their glycosaminoglycan patterns. The biochemical analysis provided evidence of the pathological process even in those specimens that did not yet show any clinical symptoms of the disease.

In-vitro culture of human chondrocytes from adult subjects.

An agarose gel matrix was utilized to grow chondrocytes from human donors of various ages in cell culture. The chondrocytes produced the pericellular matrix characteristic for such cells and synthesized collagen type II as well as glyco-saminoglycans. The latter exhibit the typical distribution pattern of the respective articular cartilage matrix. The electron-microscopic appearance of the cultured chondrocytes closely resembles that of chondrocytes in sections of the original cartilage.

Proteoglycans from human articular cartilage: the effect of joint location on the structure.

Proteoglycan monomers from the articular cartilages of the knee, hip and shoulder of 3 subjects (21, 26 and 45 years old) were isolated and analysed. The proteoglycan monomers from the high weight-bearing knee and hip joints were smaller than those from the low weight-bearing shoulder joints and both had a lower chondroitin sulphate content. The proteoglycan monomers from knee joint cartilage had the lowest intra-individual chondroitin-4-sulphate content in each case. Hyaluronate binding capacity was not found to be dependent on joint location.

[Dupuytren contracture in childhood]. / Dupuytren'sche Kontrakturen im Kindesalter.

A two-year old boy suffered a contracture of the second and third digit beginning at the age of seven months. The clinical examination suggested a diagnosis of early Dupuytren's disease. A partial fasciectomy was performed. Histological examination showed a fibrosis palmaris similar to Dupuytren's disease. The biochemical examination (Glycans, hyaluronic acid, chrondroitinsulfat, dermatansulfat and heparansulfat) showed also changes in the extracellular proteoglycanmatrix similar to those found in adult Dupuytren's disease.

High performance liquid chromatographic assay of disaccharides and oligosaccharides produced by the digestion of glycosaminoglycans with chondroitin sulphate lyases.

In high performance liquid chromatographic procedures hitherto described, SiO2, NH2 and RP columns have been used for the analysis of disaccharides produced by the digestion of glycosaminoglycans with the chondroitin sulphate lyases AC and ABC. The use of a potent anion exchanger offers the following advantages over these columns: superior separation characteristics for non-sulphated disaccharides, and improved column performance, coupled with more stable analytical conditions. Elution with dilute saline solutions permits separation of the two non-sulphated disaccharides from chondroitin and hyaluronate. The sequential application of chondroitinase AC and ABC permits the determination of hyaluronate, the chondroitin sulphate isomers and the dermatan sulphate isomers by high performance liquid chromatographic separation of the products of enzymatic hydrolysis. In a previously described method, hyaluronate lyase was used for the determination of hyaluronate. It has been found, however, that omission of the hyaluronate lyase step results in superior accuracy in the high performance liquid chromatographic separation of the non-sulphated disaccharides. The enzymatic analysis of human articular cartilage glycosaminoglycans has repeatedly yielded a fraction which is not digestable by chondroitinase AC, but is completely digestable by chondroitinase ABC. More extensive characterization has disclosed that this fraction differs structurally from chondroitin sulphate. Enzymatic characterization indicates that it should presumably be assigned to dermatan sulphate.