304 research outputs found

    Intergenerational associations between a consensual childhood sexual experience and adult substance abuse among Latina mothers and daughters

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    Purpose: Early onset of sexual activity has been linked to later substance abuse. Our study aimed to further describe the associations between Latina mothers’ and daughters’ early sexual activity and adult substance abuse. Methods: A survey was conducted with 92 Latina mother–daughter dyads whose members never experienced sexual abuse. Childhood sexual experience was defined as the occurrence of a consensual sexual encounter at the age of 15 years or younger. Substance abusers were identified by the extent of substance use during the 12 months prior to the interview. Path analysis was used to fit our conceptual models to the data. Main findings: Daughters’ current, adult substance abuse was associated independently with: their own childhood sexual experience (odds ratio [OR] = 6.0) and mothers’ current, adult substance abuse (OR = 2.0). Compared with daughters who first experienced sex after the age of 19, the odds of using substances were 17.7 times higher among daughters who had childhood sexual experience and 3.8 times higher among daughters who first experienced sex between the age of 16–19 years. Explicitly, sexual experiences between the ages of 16–19 years were also risk factors for later adult substance abuse. Mothers’ childhood sexual experience (OR = 7.3) was a strong predictor for daughters’ childhood sexual experience. Conclusions: Our study supported a link between mother and daughter childhood sexual experience among Latinas, and indicated it is a correlate of adult substance abuse. Family based substance abuse prevention efforts and future longitudinal studies should consider maternal childhood sexual experience as a potential indication of risk for Latina daughters

    Neighborhood Latino ethnic density and mortality among HIV- positive Latinos by birth country/region, Florida, 2005–2008

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    OBJECTIVE: Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos. METHODS: Florida HIV surveillance data for 2005–2008 were merged with 2007–2011 American Community Survey data using zip code tabulation areas. Hazard ratios (HR) were calculated using multi-level weighted Cox regression and adjusted for individual-level factors and neighborhood poverty. RESULTS: Of 4649 HIV-positive Latinos, 11.8% died. There was no difference in mortality risk across categories of Latino ethnic density for Latinos as a whole. There were subgroup effects wherein mortality risk differed by ethnic density category for Latinos born in some countries/regions. Residing in an area with ≥50% Latinos compared with <25% was associated with increased mortality risk for Latinos born in Puerto Rico (HR 1.67; 95% CI [1.01–2.70]). Residing in an area where Mexicans were the majority Latino group was associated with increased mortality risk for Latinos born in Mexico (HR 3.57; 95% CI [1.43–10.00]). CONCLUSIONS: The survival advantage seen among the Latino population in high Latino density areas was not seen among HIV-positive Latinos. Research is needed to determine if this may be related to stigma or another mechanism

    Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000–2011

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    BACKGROUND: The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors. METHODS: Florida surveillance data for persons diagnosed with HIV 2000–2008 were merged with 2007–2011 administrative data from the American Community Survey. Hazard ratios (HR) were calculated using multi-level weighted Cox regression adjusting for individual and neighborhood (ZCTA-level) factors. RESULTS: Of 10,989 HIV-positive Latinos, 10.3% had IDU history. Latinos with IDU history were at increased mortality risk compared with Latinos without IDU history after controlling for individual and neighborhood factors (adjusted HR [aHR] 1.61, 95% confidence interval [CI] 1.43–1.80). Factors associated with mortality for those with IDU history included: being 40–59 (aHR 6.48, 95% CI 1.41–121.05) and ≥60 years (aHR 18.75, 95% CI 3.83–356.45) compared with 13–19 years of age; being diagnosed with AIDS within 3 months of HIV (aHR 2.31, 95% CI 1.87–2.86); residing in an area with ≥50% Latinos compared with <25% Latinos (aHR 1.56, 95% CI 1.19–2.04); and residing in a rural compared with an urban area at the time of diagnosis (aHR 1.73, 95% CI 1.06–2.70). Race and neighborhood poverty were not predictors among those with IDU, but were among those without. CONCLUSION: HIV-positive Latinos with IDU history are at increased mortality risk and have unique contributing factors. Tertiary prevention strategies should target those who are older, diagnosed at later stages, and those who live in predominantly Latino and rural areas

    Ischaemic stroke, haemorrhage and mortality in elderly patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population-based study from UK primary care

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    Objective To assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all cause mortality in older people with atrial fibrillation and chronic kidney disease. Design Propensity matched, population based, retrospective cohort analysis from January 2006 through December 2016. Setting The Royal College of General Practitioners Research and Surveillance Centre database population of almost 2.73 million patients from 110 general practices across England and Wales. Participants Patients aged 65 years and over with a new diagnosis of atrial fibrillation and estimated glomerular filtration rate (eGFR) of <50 mL/min/1.73m2, calculated using the chronic kidney disease epidemiology collaboration creatinine equation. Patients with a previous diagnosis of atrial fibrillation or receiving anticoagulation in the preceding 120 days were excluded, as were patients requiring dialysis and recipients of renal transplants. Intervention Receipt of an anticoagulant prescription within 60 days of atrial fibrillation diagnosis. Main outcome measures Ischaemic stroke, cerebral or gastrointestinal haemorrhage, and all cause mortality. Results 6977 patients with chronic kidney disease and newly diagnosed atrial fibrillation were identified, of whom 2434 were on anticoagulants within 60 days of diagnosis and 4543 were not. 2434 pairs were matched using propensity scores by exposure to anticoagulant or none and followed for a median of 506 days. The crude rates for ischaemic stroke and haemorrhage were 4.6 and 1.2 after taking anticoagulants and 1.5 and 0.4 in patients who were not taking anticoagulant per 100 person years, respectively. The hazard ratios for ischaemic stroke, haemorrhage, and all cause mortality for those on anticoagulants were 2.60 (95% confidence interval 2.00 to 3.38), 2.42 (1.44 to 4.05), and 0.82 (0.74 to 0.91) compared with those who received no anticoagulation. Conclusion Giving anticoagulants to older people with concomitant atrial fibrillation and chronic kidney disease was associated with an increased rate of ischaemic stroke and haemorrhage but a paradoxical lowered rate of all cause mortality. Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation. There remains an urgent need for adequately powered randomised trials in this population to explore these findings and to provide clarity on correct clinical management

    Madness decolonized?: Madness as transnational identity in Gail Hornstein’s Agnes’s Jacket

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    The US psychologist Gail Hornstein’s monograph Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness (2009) is an important intervention in the identity politics of the mad movement. Hornstein offers a resignified vision of mad identity that embroiders the central trope of an “anti-colonial” struggle to reclaim the experiential world “colonized” by psychiatry. A series of literal and figurative appeals make recourse to the inner world and (corresponding) cultural world of the mad, as well as to the ethno-symbolic cultural materials of dormant nationhood. This rhetoric is augmented by a model in which the mad comprise a diaspora without an origin, coalescing into a single transnational community. The mad are also depicted as persons displaced from their metaphorical homeland, the “inner” world “colonized” by the psychiatric regime. There are a number of difficulties with Hornstein’s rhetoric, however. Her “ethnicity-and-rights” response to the oppression of the mad is symptomatic of Western parochialism, while her proposed transmutation of putative psychopathology from limit upon identity to parameter of successful identity is open to contestation. Moreover, unless one accepts Hornstein’s porous vision of mad identity, her self-ascribed insider status in relation to the mad community may present a problematic “re-colonization” of mad experience

    Collaboration scripts - a conceptual analysis

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    This article presents a conceptual analysis of collaboration scripts used in face-to-face and computer-mediated collaborative learning. Collaboration scripts are scaffolds that aim to improve collaboration through structuring the interactive processes between two or more learning partners. Collaboration scripts consist of at least five components: (a) learning objectives, (b) type of activities, (c) sequencing, (d) role distribution, and (e) type of representation. These components serve as a basis for comparing prototypical collaboration script approaches for face-to-face vs. computer-mediated learning. As our analysis reveals, collaboration scripts for face-to-face learning often focus on supporting collaborators in engaging in activities that are specifically related to individual knowledge acquisition. Scripts for computer-mediated collaboration are typically concerned with facilitating communicative-coordinative processes that occur among group members. The two lines of research can be consolidated to facilitate the design of collaboration scripts, which both support participation and coordination, as well as induce learning activities closely related to individual knowledge acquisition and metacognition. In addition, research on collaboration scripts needs to consider the learners’ internal collaboration scripts as a further determinant of collaboration behavior. The article closes with the presentation of a conceptual framework incorporating both external and internal collaboration scripts

    Multi-wavelength Observations of AT2019wey: a New Candidate Black Hole Low-mass X-Ray Binary

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    AT2019wey (ATLAS19bcxp, SRGA J043520.9+552226, SRGE J043523.3+552234, ZTF19acwrvzk) is a transient reported by the ATLAS optical survey in December 2019, but shot to fame upon detection, three months later, by the Spektrum-Roentgen-Gamma (SRG) mission in its on-going sky survey. Here we present our ultraviolet, optical, near-infrared and radio observations of this object. Our X-ray observations are reported in a separate paper. We conclude that AT2019wey is a newly discovered Galactic low-mass X-ray binary (LMXB) and a candidate black hole (BH) system. Remarkably, we demonstrate that from ~58950 MJD to ~59100 MJD, despite the significant brightening in radio and X-ray (more than a factor of 10), the optical luminosity of AT2019wey only increased by 1.3--1.4. We interpret the bright UV/optical source in the dim low/hard state (~58950 MJD) as thermal emission from a truncated disk in a hot accretion flow, and the UV/optical emission in the hard-intermediate state (~59100 MJD) as reprocessing of X-ray flux in the outer accretion disk. We discuss the power of combining current wide-field optical surveys and SRG in the discovery of the emerging population of short-period BH LMXB systems with low accretion rates
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