HIV in Africa: Challenges and Directions for the Next Decade

Africa carries a disproportionate burden of the global HIV endemic, accounting for two thirds of the global 33.3 million people living with HIV. While tremendous advances have been made in addressing the HIV epidemic in Africa, considerable challenges remain. Testing for HIV increased by 86% from 2007 to 2009 but more than 75% of people 15–49 years remain unaware of their HIV status. CD4 count at diagnosis tends to be low and linkage to care and treatment is suboptimal. The scale-up of antiretroviral therapy is ongoing but is hampered by the lack of diagnostic capability to monitor response to therapy and a substantial healthcare workforce shortage. Prevention strategies such as male circumcision, pre-exposure prophylaxis, and antiretroviral therapy for prevention have generated great excitement but cost and healthcare infrastructure deficiencies may limit their widespread applicability. Operational research to validate and inform treatment decisions, health care policies, and prevention strategies is sorely needed.     

Alcohol and Illicit Drug Use as Precipitants of Atrial Fibrillation in Young Adults: A Case Series and Literature Review

Background

Atrial fibrillation in young patients (≤45 years) is uncommon. There is the perception that the precipitant in such cases is alcohol, but we also have noted cases related to illicit drug abuse. There are no clear guidelines on the treatment of atrial fibrillation in patients presenting with “lone atrial fibrillation” precipitated by alcohol or illicit drugs.

Methods

We retrospectively analyzed young (defined as ≤45 years) patients with “lone” atrial fibrillation who were admitted to the hospital with electrocardiographically confirmed diagnosis of atrial fibrillation or atrial flutter, precipitated by either alcohol or illicit drugs, over a 6-year period.

Results

Eighty-eight patients aged ≤45 years were admitted with atrial fibrillation or atrial flutter. In 22 patients, (mean [SD] age 33.6 [8.4] years; 20 male), alcohol (n = 19) and/or illicit drugs (n = 3) were found to be the precipitant. One patient required electrical cardioversion, with the remaining patients cardioverting back to sinus rhythm either pharmacologically or spontaneously. Twelve (54.5%) were investigated for atrial fibrillation burden by 24-hour Holter monitoring and the majority also underwent a transthoracic echocardiogram (81.8%). At discharge, 14 (63.6%) patients were treated with anti-arrhythmic drugs and 10 received either antiplatelets or anticoagulants. Most (85%) patients were followed-up for at least 12 months, during which time 6 had further paroxysms; all of whom continued to abuse either alcohol or illicit drugs.

Conclusions

Alcohol and illicit drugs are arrhythmogenic and are associated with atrial fibrillation. Apart from abstinence, the optimal management of such patients and the long-term effects of these substances on the heart and atrial fibrillation recurrences are still unclear.     

Fraternity and Sorority Leaders and Members: A Comparison of Alcohol Use,Attitudes, and Policy Awareness

Background: Studies have documented that members of college fraternities and sororities (i.e., Greeks) drink more heavily and experience more alcohol-related consequences than other students. Few studies have examined the role of Greek leaders in the socialization of Greek members. Objectives: The present study investigated how alcohol-related attitudes and behaviors among Greek leaders differ from the attitudes and behaviors of members. Methods: At a single university, two anonymous surveys were conducted in 2006 and 2007 (N = 726 and 757, respectively) at fraternity and sorority chapter meetings. All individuals present at the meetings were invited to participate. One-way analyses of covariance (ANCOVAs), controlling for age and sex, were conducted to examine the effect of leadership status on alcohol-related attitudes and behaviors. Zero-inflated negative binomial regression was used to analyze the effect of leadership status on alcohol-impaired driving. Results: Few differences were found between Greek leaders and members. In both years, leaders perceived alcohol control policies as stricter than did members. Notably, leaders and members did not significantly differ in reports of alcohol use or consequences. Conclusion: With this additional study, the literature suggests that alcohol-related attitude and behavioral differences between Greek leaders and members may be highly variable across college and university campuses. Scientific Significance: The socialization process among Greek leaders and members warrants further investigation. The current findings suggest that future research should examine the roles that campus climate and on-campus initiatives may play in the Greek socialization process.     

Alcohol and Other Drug Dependency Treatment:

No abstract available for this article.     

Intoxicants and suicidal behaviour among adolescents: changes in levels and associations from 1992 to 2002

AIMS: To assess whether a substantial increase in substance use over a 10-year period has had an impact on the level of, or associations with, non-fatal suicidal behaviour among Norwegian teenagers. DESIGN, SETTING AND PARTICIPANTS: Two cross-sectional school surveys applying identical procedures and measures in 1992 and 2002, using national samples comprising 11 000 and 12 000 13-19-year-old students. FINDINGS: A significant proportion of the increase in the prevalence of attempted suicide among girls could be attributed to the increase in substance use, taking into account other risk and protective factors. Among boys no net increase in the prevalence of attempted suicide was observed, and the impact of substance use on suicidal behaviour was lower in 2002 than in 1992. Yet, it also appeared that unobserved protective factors may have countered the impact of increased substance use among boys. For both genders a larger fraction of attempted suicides was attributable to alcohol intoxication than to use of any other substance. CONCLUSIONS: A significant increase in use of alcohol and drugs may not necessarily be reflected in changes in the level of suicidal behaviour. Further studies applying other data sources and designs are warranted to supplement and validate the present findings.     

Beyond “Happily Ever After”: Family Recovery from Alcohol Problems

SUMMARY

Based on the findings of the Family Recovery Project, stages and domains of family recovery from alcoholism are described, illustrated by an ongoing hypothetical family case example. The characteristics of each stage are presented, along with major principles of treatment for each stage. The stages of family recovery parallel the stages of individual recovery from alcoholism, and therapists use different approaches in each recovery stage. Families benefit from understanding the process of recovery and knowing what to expect in each stage. Recovery is traumatic as the alcoholic family system collapses. Outside supports, especially Twelve-Step programs, are essential to allow families to negotiate this trauma. The care of children is a special challenge as families go through recovery.     

The Role of Social Support in Collegiate Recovery Communities: A Review of the Literature

In the past decades one response to the increase of college drinking is the growing prevalence of Collegiate Recovery Communities (CRC). Numerous publications on these programs exist, yet a review does not. With a growing need for evidence-based model programs to address the concerns of alcohol abuse and dependence on college campuses, the importance of a collection on the effectiveness of CRCs exists. The goal of this article is to compile a thorough overview of data on CRCs in the United States, focusing specifically on the role of social support in recovery maintenance. Recommendations for future directions are discussed.     

Cannabis and crime: findings from a longitudinal study

Aim   To examine the association between cannabis use during adolescence and young adulthood, and subsequent criminal charges.
Methods   Data were obtained from the Young in Norway Longitudinal Study. A population-based sample ( n  = 1353) was followed from 13 to 27 years of age. Data were gathered on cannabis use, alcohol consumption and alcohol problems, and use of other illegal substances such as amphetamines, cocaine and opiates. In addition, extensive information on socio-demographic, family and personal factors was collected. This data set was linked to individual-level information from official Norwegian crime statistics.
Findings   We found robust associations between cannabis use and later registered criminal charges, both in adolescence and in young adulthood. These associations were adjusted for a range of confounding factors, such as family socio-economic background, parental support and monitoring, educational achievement and career, previous criminal charges, conduct problems and history of cohabitation and marriage. In separate models, we controlled for alcohol measures and for use of other illegal substances. After adjustment, we still found strong associations between cannabis use and later criminal charges. However, when eliminating all types of drug-specific charges from our models, we no longer observed any significant association with cannabis use.
Conclusions   The study suggests that cannabis use in adolescence and early adulthood may be associated with subsequent involvement in criminal activity. However, the bulk of this involvement seems to be related to various types of drug-specific crime. Thus, the association seems to rest on the fact that use, possession and distribution of drugs such as cannabis is illegal. The study strengthens concerns about the laws relating to the use, possession and distribution of cannabis.     

Inhaled Insulin: Promises and Concerns

Since the introduction of Pfizer Exubera® in the early 1990s, a number of other inhaled insulin solutions have been developed. This article provides an overview of inhaled insulin systems developed by Pfizer, Novo Nordisk, MannKind, and Lilly, three of which are currently in phase 3 trials. The strengths and weaknesses of each product, as well as the general technologies (liquid vs dry powder), are evaluated. Results of clinical studies conducted by Pfizer and corroborated by other studies are summarized. Although inhaled insulin promises much, a greater body of controlled studies is necessary to draw firm conclusions about its safety and efficacy.     

Classification of alcohol use disorders among nightclub patrons: associations between high-risk groups,sociodemographic factors and illicit drug use

Background: Nightclubs are favorable environments for alcohol abuse and the use of other drugs among patrons. Objective: To identify patterns of alcohol use in a high-risk population and their relationship with sociodemographic factors and illicit drug use. Methods: A portal survey technique was used to recruit patrons in 31 nightclubs in the city of São Paulo, Brazil. A two stage sampling method allowed the selection of nightclubs and patrons within a nightclub. A total of 1057 patrons answered to a three stages-survey (nightclub entrance and exit face-to-face interviews and a day-after online questionnaire). Entrance survey offered information on sociodemographic data and history of drug use. The day-after survey used the Alcohol Use Disorders Identifications Test (AUDIT) that identified patterns of alcohol abuse disorders. Data were modeled using an ordered logit regression analysis, considering sample weights. Results: Almost half of the nightclub patrons presented any alcohol use disorder (AUDIT score ≥8). Being male (OR?=?1.68; 95% CI?=?1.09–2.60) and single (OR?=?1.71; 95% CI?=?1.05–2.76) increased the chances for more severe alcohol use disorders. Having a graduate degree (OR?=?0.57; 95% CI?=?0.38–0.87) and age ≥35 years (OR?=?0.48; 95% CI?=?0.27–0.85) decreased the chances of patrons’ alcohol use disorders. The prevalence rates of past-year marijuana, cocaine and inhalants use increased with the increased level of alcohol use disorders. Conclusions: Patrons of nightclubs show higher prevalence rates for any alcohol use disorders than the general population. Patrons could benefit from governmental brief intervention or referral to treatment for alcohol used disorders disclosed in nightclubs.     

NHLBI training workshop report: The vanishing pediatric pulmonary investigator and recommendations for recovery

The adequacy of the pipeline of advanced pulmonary fellows to supply appropriately trained and committed researchers to enter academic careers was the major topic of a recently held National Heart Lung and Blood Institute NHLBI Workshop: Respiratory Medicine‐Related Research Training for Adult and Pediatric Fellows. The special challenges and opportunities for the academic pediatric pulmonary trainee were discussed as part of this workshop and are discussed as a companion paper to the report by the full workshop. Surveys were conducted of pediatric chairs of academic departments and pediatric pulmonary training directors in the United States to examine the current status and opportunities for the pediatric pulmonary trainee. Strategies for recruitment and retention of talented young trainees and junior faculty are proposed. Pediatr Pulmonol. 2010; 45:25–33. © 2009 Wiley‐Liss, Inc.     

Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance

Aims The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated. Design Retrospective case–control study based on autopsy and toxicology. Settings Single faculty accepting referrals from Greater Athens and prefectures. Participants Consecutive pre‐hospital and in hospital fatalities. Measurements Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death. Findings Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4–90) years for the PTG and 45 (3–97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non‐preventable (ISS = 75). The frequency of severe trauma (ISS≥16) was comparable between PTG and NTG (P = 0.87). The PTG presented with a median ISS of 43 (6–75) versus 41 (2–75) of the NTG, hence without significant difference (P = 0.11). The pre‐hospital death rate was 77.8% for the PTG versus 58% of the NTG (P < 0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P < 0.001). Conclusions In the greater Athens region, almost a third of motor vehicle collision‐related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence‐based management protocols and reassessment of surveillance are required.     

Cannabis and social welfare assistance: a longitudinal study

Aims To investigate associations between cannabis use and subsequent receipt of social welfare assistance. Design, setting and participants The Young in Norway Longitudinal Study. A population‐based Norwegian sample (n = 2606) was followed‐up from adolescence to late 20s. Self‐report data were merged with data from national registers. Measurements Data were extracted on the use of alcohol, tobacco and cannabis and other illegal substances. Information was also retrieved on socio‐demographic and family factors, academic achievement, conduct problems and mental health. National registers provided data on social welfare assistance, educational level and crime statistics. Findings We observed prospective bivariate associations between increasing levels of cannabis use and subsequent social welfare assistance (P < 0.0001). The associations were reduced after adjusting for a range of potentially confounding factors, but remained significant. Frequent cannabis users were at highly increased risk for subsequently receiving social welfare assistance. At 28 years, those with 50+ times cannabis use during the previous 12 months and had an odds ratio of 9.3 (95% confidence interval: 4.3–20.1) for receiving social welfare assistance in the following 2‐year span. Users of cannabis also had longer periods of receiving social welfare assistance than others (P < 0.0001) and were less likely to leave the welfare assistance system (P < 0.0001). Conclusions In Norway the use of cannabis is linked with subsequent receipt of social welfare assistance whether the consequences are related to use of the substance per se, or to cultural factors and the illegal status of the cannabis. Future research should attempt to understand the interactions of factors behind these associations.     

Social Perception and Alcohol Use Disorder: Preliminary Findings

A growing literature suggests that social perception deficits are evident in individuals with alcohol use disorder. Recent studies suggest differences between users of alcohol and control participants may persist with abstinence and may be associated with treatment outcomes. However, measurement of social perception has been inconsistent across studies, and replication studies are needed. Moreover, prior studies of social perception in this population have not thoroughly evaluated psychiatric symptoms, which are commonly comorbid with alcohol use disorder. The present study measured social perception performance and psychiatric symptoms in patients during early alcohol abstinence. Participants were 30 patients (10 women, 20 men) participating in an inpatient treatment program for alcohol use disorder. Across the sample, the subjects performed significantly worse than the normative sample on the Affect Naming and Pairs subtests, but not on the Prosody subtest. Depression scores were negatively associated with scores on the Pairs subtest, but no other social perception measures. These findings are consistent with previous literature documenting social perception deficits among individuals with alcohol use disorders. Generally, psychiatric symptoms were not associated with social perception performance, with the exception of depression symptoms. Limitations of the study and implications for future studies are discussed.