Maternal Gambling, Parenting in the Home Environment, and Child Outcomes in Native American Families.

This mixed method study examined the relations between and among women's casino gambling,parenting in the home environment, parenting self-efficacy beliefs, social supports, and childbehavior problems in a sample of 150 Native American mothers with a child between 6 and 15 years of age. Respondents were recruited from a tribal casino on a Great Lakes Indian Reservation. Hypotheses were: 1) higher scores on measures of gambling frequency among Native American mothers will be associated with more behavior problems in their children; 2) greater access to emotional and instrumental support, higher parenting self-efficacy, and more adequate parenting in the home environment among Native American mothers will be associated with fewer behavior problems in their children; and 3) greater access to social support, higher parenting self-efficacy, and more adequate parenting in the home environment among Native American mothers will moderate the relationship between maternal gambling and child behavior problems. As expected, correlational analyses indicated that pathological gambling was associated positively and significantly with child behavior problems, while greater access to instrumental support, higher parenting self-efficacy, and more adequate parenting in the home environment were each associated significantly with fewer child behavior problems. Multiple regression analyses revealed that greater maternal financial strain and less adequate parenting in the home environment together explained 9 percent of the variance in child behavior problems and that access to social support from family moderated the relationship between maternal gambling frequency and child behavior problems. Social support from family explained an additional 5 percent of the variance in child behavior problems. Boys were more negatively affected by their mothers' frequent gambling than girls in this study. Qualitative themes were: Mothers' concerns regarding spending money and time at the casino, and guilt and remorse over how these affect their children and families; mothers' reports of the positive economic benefits of the jobs and educational opportunities now available to them; mothers' concerns that while there are increased opportunities to socialize and reduce their stress while gambling, that there is no culturally appropriate gambling treatment program on the reservation

The association of at-risk, problem, and pathological gambling with substance use, depression, and arrest history

We examined at-risk, problem, or pathological gambling co-occurrence with frequency of past-year alcohol, tobacco, and marijuana use; depressive symptoms; and arrest history. Data included the responses of over 3,000 individuals who participated in a 2006 telephone survey designed to understand the extent of at-risk, problem, and pathological gambling; comorbidity levels with substance use; mental health; and social problems among Southwestern U.S. residents. Data were analyzed with multinomial and bivariate logistic regression. Respondents at risk for problem gambling were more likely to use alcohol, tobacco, and marijuana than those respondents not at risk. Pathological gamblers were no more or less likely to consume alcohol or tobacco than were non-gamblers or those not at risk. A dose-response relationship existed between degree of gambling problems and depressive symptoms and arrest history. Interventions for at-risk or problem gamblers need to include substance use treatment, and the phenomenon of low levels of substance use among pathological gamblers needs further exploration

Demographics and Fracture Patterns of Patients Presenting to US Emergency Departments for Intimate Partner Violence

Orthopaedic surgeons are in a position to assist in identifying intimate partner violence (IPV) patients. It was the purpose of this study to analyze the demographics and fracture patterns of IPV patients in the United States

Urban Dwelling American Indian Adolescent Girls’ Beliefs Regarding Health Care Access and Trust

Indigenous people, specifically American Indians (AI), have historically had a greater mistrust of the medical system compared to their White counterparts. The purpose of this paper is to explore the perceptions of AI adolescent girls living in an urban

‘This Tobacco Has Always Been Here for Us,’ American Indian Views of Smoking: Risk and Protective Factors

We utilized eight talking circles to elicit American Indian views of smoking on a U.S. reservation. We report on (1) the historical context of tobacco use among Ojibwe Indians; (2) risk factors that facilitate use: peer/parental smoking, acceptability/availability of cigarettes; (3) cessation efforts/ inhibiting factors for cessation: smoking while pregnant, smoking to reduce stress , beliefs that cessation leads to debilitating withdrawals; and (4) protective factors that inhibit smoking initiation/use: negative health effects of smoking, parental and familial smoking behaviors, encouragement from youth to quit smoking, positive health benefits, “cold turkey” quitting, prohibition of smoking in tribal buildings/homes. Smoking is prevalent, but protective behaviors are evident and can assist in designing culturally sensitive prevention, intervention and cessation programs

Characterization of Renal Anionic Drug Transport Capacity in Kidney Transplant Recipients with Persistent BK Viremia: Pharmacokinetic and Pharmacodynamic Studies of Cidofovir

Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD), and drug therapy plays a significant role in the management of transplant recipients. A variety of commonly used drugs are actively secreted by transporters in the kidney, yet the functional expression and activity of these proteins in transplant patients has not been investigated. The first objective of this research was to characterize anionic tubular secretion capacity in kidney transplant recipients by evaluating the pharmacokinetics of cidofovir, a prototypical organic anion transporter substrate frequently used to treat BK virus infections in this patient population. A sensitive and specific analytical technique was developed to measure cidofovir concentrations in human plasma. Pharmacokinetic analysis of cidofovir in adult kidney transplant recipients suggested reduced OAT1-mediated secretion in these patients. The mechanistic basis of this observation was evaluated in a syngeneic rat model of kidney transplantation, which established that the transplant process itself leads to a sustained reduction in the expression of anionic transport proteins localized to the basolateral membrane of the renal proximal tubule. Additionally, apical anionic transporters were differentially regulated in this model. The next objective was to evaluate the pharmacodynamics of cidofovir in kidney transplant patients. This study demonstrated that cidofovir transiently reduced the degree of BK viremia and viruria in vivo, though the effect was not sustained, and viral loads returned to baseline by the next sampling period. A retrospective analysis employed serum creatinine-based estimates of cidofovir clearance in a large cohort of kidney transplant recipients to approximate aggregate cidofovir exposure, and correlated drug exposure with virologic response. Higher systemic exposure was significantly associated with a larger reduction in the degree of BK viremia. However, only 11% of the variance in the decline in the BK viral load could be explained by variation in cumulative cidofovir exposure, indicating that other factors, likely immune-mediated, play a major role in viral clearance. Collectively, this work broadens our understanding of drug disposition in kidney transplant recipients and provides fundamental knowledge that may improve the treatment of BK virus infections

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre‐existing interview data from 15 self‐identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community’s knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134173/1/ajcp12080.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134173/2/ajcp12080_am.pd

Enhanced Characterization of Drug Metabolism and the Influence of the Intestinal Microbiome: A Pharmacokinetic, Microbiome, and Untargeted Metabolomics Study.

Determining factors that contribute to interindividual and intra-individual variability in pharmacokinetics (PKs) and drug metabolism is essential for the optimal use of drugs in humans. Intestinal microbes are important contributors to variability; however, such gut microbe-drug interactions and the clinical significance of these interactions are still being elucidated. Traditional PKs can be complemented by untargeted mass spectrometry coupled with molecular networking to study the intricacies of drug metabolism. To show the utility of molecular networking on metabolism we investigated the impact of a 7-day course of cefprozil on cytochrome P450 (CYP) activity using a modified Cooperstown cocktail and assessed plasma, urine, and fecal data by targeted and untargeted metabolomics and molecular networking in healthy volunteers. This prospective study revealed that cefprozil decreased the activities of CYP1A2, CYP2C19, and CYP3A, decreased alpha diversity and increased interindividual microbiome variability. We further demonstrate a relationship between the loss of microbiome alpha diversity caused by cefprozil and increased drug and metabolite formation in fecal samples. Untargeted metabolomics/molecular networking revealed several omeprazole metabolites that we hypothesize may be metabolized by both CYP2C19 and bacteria from the gut microbiome. Our observations are consistent with the hypothesis that factors that perturb the gut microbiome, such as antibiotics, alter drug metabolism and ultimately drug efficacy and toxicity but that these effects are most strongly revealed on a per individual basis