Descriptors and accounts of alcohol consumption:methodological issues piloted with female undergraduate drinkers in Scotland

Excessive drinking among young women continues to attract adverse media attention and is the target of UK government-led initiatives. Reliable research on alcohol consumption is needed to inform/evaluate public health interventions. This pilot study, investigating descriptors of alcohol drinking in female Scottish undergraduate students, comprised: (i) self-completed questionnaire survey (n=95); (ii) interview plus test pouring of a ‘drink’ (n=19). Self-reports by 70% of drinkers (n=90) indicated alcohol consumption for the ‘week past’ meriting classification as ‘binge’ drinking, and 83% of this group reported drinking in this fashion at least fortnightly. However, binge-drinking may be under-estimated, since poured drinks were measured to be on average double the alcohol content for a standard drink, drinking often occurred outwith licensed premises, and respondents preferred to quantify consumption in (fractions of) bottles, rather than glasses. Qualitative analysis showed that interviewees oriented to drinking as an accountable practice but were unaware of the clinical definition of binge drinking. They defined it in terms of the effect of alcohol consumed on individual behaviour, not in absolute quantities. Given the unreliability of self-reported consumption, future health surveys and initiatives should consider ‘quantifying’ alcohol in a way more meaningful to the population of interest, in terms of effect

Predictors of Drug Court Client Graduation

Background: Substance use disorder in the United States adversely effects society by burdening the justice system with offender incarceration for drug-related crimes, it also strains in the healthcare system with costs in excess of $216 billion dollars for treatment of drug-related mental and physical illnesses. Many offenders of nonviolent crimes with substance use disorder have been diverted to Drug Court (DC) for year-long supervised community-based drug addiction treatment as an alternative to incarceration for non-violent drug-related crimes. Drug Court program outcomes, however, have been studied as a criminal justice intervention, rather than a primary care mental health intervention. The majority of DC program evaluation has focused on admission data and outcomes using univariate and bivariate analyses, rather than longitudinal data using multivariate analyses to identify multivariate predictors of DC graduation. Objective: The purpose of this study is to: (a) describe the Sample Severity for DC clients; (b) discuss the differences between Drug Court graduates and dropouts for Sample Severity, Drug Court Practices, and In-Program Behavior; and (c) develop a prediction model for Drug Court graduation. Methods: This is a descriptive longitudinal design using secondary data analysis of existing DC Shelby County DC data. Data were analyzed from January 1, 2009 through March 17, 2011 for clients admitted to Shelby County DC, and either graduated or dropped out of DC. The MultiSite Adult Drug Court Evaluation (MADCE) Model guided the data selected at three points in time: (a) admission to the DC program (Sample Severity data); (b) during the DC program (DC Practices and In-Program Behavior data); and (c) end of DC program (graduation or dropout data). Results: The sample consisted of 310 Shelby County DC clients, predominately male (80.0%), and African American (60.3%) with a mean age of 29.9 years. Most DC clients had a high school diploma or GED (54.5%) or no high school diploma or GED (41.9%). Thirty-four percent were employed at DC admission and worked an average of 10.4 hours per week. Marijuana (56.1%) and alcohol (15.5%) were the top two primary drugs of choice. To compare differences between DC graduates and dropouts, data were analyzed using t-tests or Chi-squared, as appropriate. There were (48.1%) graduates and fewer male graduates (Χ² = 4.19, p = .041), and fewer African American graduates (Χ² = 4.26, p = .039). There were more graduates who had a high school diploma/GED or a college degree than dropouts (Χ² = 5.21, p = .022), and more DC graduates were employed at DC admission (Χ² = 23.09, p = .001). Of the seven primary drugs of choice, there was only one significant difference with more graduates listing alcohol as their primary drug of choice than dropouts (Χ² = 14.05, p = .002). Of the six DC programs, there were significant differences for four programs. There were fewer graduates who participated in the Outpatient program (Χ² = 4.04, p = .039) and Residential program (Χ² = 8.00, p = .004), more graduates in the Outpatient DUI program (Χ² = 27.5, p = .001), and no graduates in the Early Assessment Intervention Treatment program (Χ² = 5.66, p = 017). Graduates spent more days in DC programs (t-test = 15.17, p = .001), and participated in fewer DC programs (t-test = 2.17, p = .031). Of the ten treatment agencies, there were significant differences for only on agency that had no graduates (Χ² = 4.70, p = .030). Of the 27 candidate predictor variables, there were six significant predictors. Having more diluted urine drug screens (OR = 5.081, p = .002) and greater number of days in the DC programs (OR = 1.019, p = .001) were positive predictors of graduation. Male gender (OR = 0.373, p = 0.47), no high school diploma/GED (OR = 0.214, p = .004), rearrests (OR = 0373, p = .002), and number of jail sentencing sanctions (OR = 0.439, p = .001) were negative predictors of graduation. The Hosmer and Lemeshow Goodness of Fit statistic (Χ² = 11.3724, df = 8, p = .182) documented that the model predicts the data well. The c statistic (0.949) documented highly acceptable predictive ability of the model with 94.9% of all possible pairs of graduates and dropouts predicted correctly. Discussion: The final prediction model suggests that males with no high school education diploma or GED, greater rearrests, and more jail sentencing sanctions are at-risk for not graduating from the Shelby County DC. Education is the only modifiable factor for DC graduation which has implications for DC practice changes and future health literacy research with the DC client population. Drug Court practice changes include: (a) evaluate client literacy and health literacy after drug detoxification; (b) develop and evaluate low literacy DC materials and programs; (c) integrate and require adult reading and GED classes; (d) evaluate need for and design and evaluate programs for men; (e) evaluate and refine exiting programs for women. Future research will: (a) validate the prediction model using cross-validation statistics; (b) develop separate prediction models for men and women; (c) develop a unified data base with continuous variables and MADCE Model variables for DC program reports and evaluation; and (d) use the MADCE Model and Social-Ecological Model to examine Offender Perceptions and Post-Program Outcomes in clients

FROM HOMEBOY TO AMERICAN ICON: IMAGE TRANSFORMATION OF MALCOLM X, 1965-1999.

This dissertation examines and analyzes the transformation of Malcolm X's image from the representation as the "Angriest Black Man in America," to the intellectual, political American leader of the 1990s. Malcolm was recognized for his outspoken defense of oppressed black and poor people, his leadership in Islam, and transformation from an ostracized political figure to an authority on the plight of black Americans. Recently, X has become a symbol of American individuality, a champion of human rights. Seen by contemporaries and future admirers as the quintessential black man, X's image has been appropriated to represent facets of black male identity to mainstream culture, rendering it consumable to a variety of groups. This dissertation contributes to the evaluation of Malcolm's work in the civil rights movement and his resulting image. It does so in two important ways; first, it positions X as a theoretician on the black diasporic experience and secondly, it significantly cites the importance of X's connection to the African diaspora and his work to connect blacks to that diaspora. By accounting for the images produced by Malcolm himself, it then chronicles the materialization of new images by black nationalists, scholars, black youth culture of the 1990s, Spike Lee, the Shabazz family, and mainstream popular culture beginning shortly after the assassination of Malcolm in 1965 and continuing until the end of the twentieth century. Unlike the images of other civil rights leaders, X's image was contested when appropriated by the mainstream. Analysis of major developments, (X, the postal stamp of 1999, material produced during the 1990s, etc.), will demonstrate how the image circulated from the sole possession of the black community to American mainstream culture. The battle for control over the representations of his image and its meanings can be construed as the struggle between retaining a black champion and creating an American icon. Ultimately, the goal was to establish Malcolm as the ideal black man, who not only predicted the trajectory of the movement, but also established and demonstrated racial pride in black American manhood, in spite of the toll that this position took on his life

Assessment of Metabolic Syndrome in a sample of Central and South Americans living in the Washington, D.C. area

The Central/South American population is growing rapidly in the U.S., but little is known about the health status. The purpose of this study was 1) to estimate the prevalence of MS and its individual components, 2) compare risk factors among Hispanic sub-groups, and 3) examine how metabolic syndrome (MS) prevalence estimates have changed from 1993–1994 to 2008–2009 in a sample of Central/South Americans living in the D.C. area. In this cross-sectional, medical record extraction survey, data from 1993–1994 were compared with data from 2008–2009 on 1,042 male and female adults collected by questionnaire. 28% of our subjects had MS. The most prevalent MS components were low HDL (43.2% men; 50.7% women), elevated triglycerides (37%), and high BMI ≥ 25 kg/m2 (75.6%). Among Central/South Americans, Salvadorans had the highest prevalence of MS (30.7%). MS prevalence was significantly greater for the 2008–2009 subjects (27.9%) compared with 1993–1994 subjects (19.7%) (p ≤ 0.05)

Acute Liver Failure Secondary to Hemophagocytic Lymphohistiocytosis during Pregnancy.

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive immune activation that mimics and occurs with other systemic diseases. A 35-year-old female presented with signs of viral illness at 13 weeks of pregnancy and progressed to acute liver failure (ALF). We discuss the diagnosis of HLH and Kikuchi-Fujimoto (KF) lymphadenitis in the context of pregnancy and ALF. HLH may respond to comorbid disease-specific therapy, and more toxic treatment can be avoided

Trade Union Perspectives on Diversity Management: A Comparison of the UK and Denmark

This article compares the viewpoints of trade union activists in the UK and Denmark on diversity management. While this concept is spreading rapidly across Europe, very different attitudes are revealed among equality activists and officials in the two countries. The article distinguishes between understandings of diversity management as a descriptor, theoretical approach, and policy approach. The main differences between the countries emerge with regard to diversity management as a policy approach, which is regarded with great scepticism in the UK and with great enthusiasm in Denmark. Explanations for these differences are offered, involving prior experiences of anti-discrimination activities, industrial relations approaches, and the wider political context

Solving the Problem of Organ Donation Shortage

Organ donation, a medically perfected procedure, affords a second chance at life for many people. Unfortunately, organ transplantation demonstrates the stark reality of supply and demand. Thousands of individuals are added to the transplant list each day, but many more die during the same time frame waiting for new organs. The solution to this dilemma seems simple: increase the supply. This article will discuss several ways to achieve this goal. First, through the HIV Organ Policy Equity Act, which allows for HIV-positive-to-HIV-positive transplants, more transplantable organs will hopefully be available in the future. Second, the supply of organs may increase by changing the standards of organ donation from irreversible loss of brain function to irreversible loss of cardiac function. Third, educating individuals, especially minorities, about donation and the regionally based system for transplants may result in a larger number of matching donors and a greater number of potential recipients on multiple transplant lists. Finally, efforts such as payments and advertising for organs, giving priority transplants to registered donors, and even confronting the disparate number of elderly donors whose organs are never transplanted, may result in an increase in the organ supply

Solving the Problem of Organ Donation Shortage

Organ donation, a medically perfected procedure, affords a second chance at life for many people. Unfortunately, organ transplantation demonstrates the stark reality of supply and demand. Thousands of individuals are added to the transplant list each day, but many more die during the same time frame waiting for new organs. The solution to this dilemma seems simple: increase the supply. This article will discuss several ways to achieve this goal. First, through the HIV Organ Policy Equity Act, which allows for HIV-positive-to-HIV-positive transplants, more transplantable organs will hopefully be available in the future. Second, the supply of organs may increase by changing the standards of organ donation from irreversible loss of brain function to irreversible loss of cardiac function. Third, educating individuals, especially minorities, about donation and the regionally based system for transplants may result in a larger number of matching donors and a greater number of potential recipients on multiple transplant lists. Finally, efforts such as payments and advertising for organs, giving priority transplants to registered donors, and even confronting the disparate number of elderly donors whose organs are never transplanted, may result in an increase in the organ supply

Preparing young people for future decision-making about cancer risk in families affected or at risk from hereditary breast cancer: A qualitative interview study

Purpose: Women carrying the mutated BRCA gene, have approximately an 80% life-time risk of developing breast cancer with 50% risk of their children inheriting the gene mutation. Many parents find it difficult to know when and how to disclose this information to their children and how such disclosure might affect their child's future decision-making. Method: This study explored the communication of genetic risk information in families using qualitative semi-structured interviews conducted with parents, children (7-11years) and young people (12-18years) affected or at risk from a BRCA gene mutation. Thematic analysis was applied to coded transcripts producing four themes; family communication, perception of cancer risks, risk management strategies and impact of genetic risk communication in children and young people's decision making. Results: Twenty-seven individuals from 11 families took part, recruited through purposive sampling techniques. Cancer risk caused by a BRCA gene mutation induced a sense of fear in parents about their children's future. As a result, parents with hereditary breast cancer disclosed limited information about the risks associated with prophylactic surgery and/or the psychological and emotional impacts of surgery on body image. This had implications to children and young people's perceptions of prophylactic procedures, which were already influenced by cultural understandings of the 'desirable body' and increasing acceptance and proliferation cosmetic surgery.Conclusion: Lack of risk management information and the acculturation of cosmetic surgery combined to limit children and young people's understanding of the impact of hereditary breast cancer; reducing their ability to actualise the physiological, psychological and emotional consequences of surgery

Exploring the baseline knowledge and experience of healthcare professionals in the United Kingdom on Novel Psychoactive Substances

Submitted 28 january 2020. Reviwers' comments received 11 February 2020. Accepted 26 February 2020. Published 2 March 2020.Objective: This survey aimed to explore knowledge and experience on novel psychoactive substances (NPS) of healthcare professionals (HCPs). The study also aimed to assess how HCPs would like to improve their knowledge of NPS. Methods: Seventy paper questionnaires were disseminated in 2017 within continuing education events to pharmacists, nurses and general practitioners (GPs). Additionally, 127 online surveys were completed using the Qualtrics platform by other HCPs and mental health nurses in six United Kingdom (UK) independent mental health hospitals long-stay in-patient rehabilitation services. Two educational sessions involving pharmacists and GPs were also held in late 2017 and mid-2018. Knowledge of NPS by HCPs was evaluated prior to the start of the educational events. Evaluation forms were handed out post-sessions to garner feedback, especially on areas for improvement for future sessions. Statistical analysis of data was undertaken using SPSS (V.25). Results: Most HCPs reported only 'basic' to 'intermediate' NPS knowledge. Substance misuse service staff felt more informed, were more often consulted and had greater confidence regarding NPS compared to hospital and primary care professionals. A negative association was found between the age of the HCP and knowledge of NPS. Most participants expressed a need for regular training and updates as insufficient NPS-related information is currently received. Conclusions: An improvement within the self-reported knowledge of HCPs on NPS is evident in comparison to previous studies. Continued education of HCPs on NPS is fundamental for the provision of improved harm reduction services, which can enhance overall care for NPS service users.Peer reviewedFinal Published versio