Barriers to effective cross-cultural counseling.

Many mental health professionals have noted that racial and ethnic factors may act as impediments to counseling. Misunderstandings that arise from cultural variations in verbal and nonverbal communication may lead to alienation and/or an inability to develop trust and rapport. An analysis of the generic characteristics of counseling reveals 3 variables that interact in such a way as to seriously hinder counseling with 3rd-world groups: (a) language variables—use of standard English and verbal communication; (b) class-bound values—strict adherence to time schedules, ambiguity, and seeking long-range solutions; and (c) culture-bound values—individual centered, verbal/emotional/behavioral expressiveness, client to counselor communication, openness and intimacy, cause–effect orientation, and mental and physical well-being distinction. These generic characteristics are contrasted with value systems of various ethnic groups. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of rubella screening in pregnant women

BACKGROUND: The rationale for rubella vaccination in the general population and for screening for rubella in pregnant women is the prevention of congenital rubella syndrome. The objective of this study was to evaluate the effectiveness of the prenatal rubella screening program in Quebec. METHODS: A historical cross-sectional study was designed. Sixteen hospitals with obstetric services were randomly selected, 8 from among the 35 "large" hospitals in the province (500 or more live births/year) and 8 from among the 50 "small" hospitals (fewer than 500 live births/year). A total of 2551 women were randomly selected from all mothers of infants born between Apr. 1, 1993, and Mar. 31, 1994, by means of stratified 2-stage sampling. The proportions of women screened and vaccinated were ascertained from information obtained from the hospital chart, the physician's office and the patient. RESULTS: The overall (adjusted) screening rate was 94.0%. The rates were significantly different between large and small hospitals (94.4% v. 89.6%). Five large hospitals and one small hospital had rates above 95.0%. The likelihood of not having been screened was statistically significantly higher for women who had been pregnant previously than for women pregnant for the first time (4.8% v. 1.4%; p < 0.001). Of the 200 women who were seronegative at the time of screening (8.4%), 79 had been vaccinated postpartum, had a positive serological result on subsequent testing or did not require vaccination, and 59 had not been vaccinated postpartum; for 62, subsequent vaccination status was unknown. INTERPRETATION: Continued improvement in screening practices is needed, especially in small hospitals. Because vaccination rates are unacceptably low, it is crucial that steps be taken to address this issue.     

Emergency department screening for syphilis in pregnant women without prenatal care

STUDY OBJECTIVE: To determine if there is a high seroprevalence of syphilis in pregnant women without prenatal care presenting to an urban emergency department. DESIGN: Prospective, nonblinded sampling of pregnant women without prenatal care with a comparison group of pregnant women with prenatal care from the obstetrics clinic. Patients in the ED setting were asked about such associated risk factors as previous syphilis and drug use. SETTING: Urban ED. TYPE OF PARTICIPANTS: Pregnant women without prenatal care. INTERVENTION: Patients were screened for syphilis using the automated reagin test. Reactive automated reagin tests were confirmed by the fluorescent treponemal antibody absorption. In addition, 44 patients with nonreactive automated reagin tests had confirmatory tests done. New cases were verified by the state health department. MEASUREMENTS AND MAIN RESULTS: Seventy-two patients were included in the study. The average age was 25 years. Eight patients (11.1%) were diagnosed with previously undetected syphilis. Four patients (5.6%) had previously treated syphilis. The laboratory cost of screening was $248 per new case of syphilis detected. The study group was compared with 118 patients matched for age and race who presented to the obstetrics clinic for routine prenatal care. Two new cases of syphilis were discovered in the clinic population (1.7%). CONCLUSION: A high rate of syphilis infection was detected in this inner-city ED population presenting without prenatal care. This was higher than that found in the patients presenting for obstetrics care in the clinic. Patients can be screened effectively in the ED.     

Ethnic and sex bias in primary care screening tests for alcohol use disorders

BACKGROUND: The use of self-report screening tests for alcohol use disorders in the primary care setting has been advocated. OBJECTIVE: To test for ethnic and sex bias in three self-report screening tests for alcohol use disorders in a primary care population. DESIGN: Cross-sectional study with patients randomly selected from appointment lists. SETTING: University-based family practice clinic. PATIENTS: Probability sample of 1333 adult family practice patients stratified by sex and ethnicity. MEASUREMENTS: Patients completed 1) a diagnostic interview to determine the presence of a current alcohol use disorder and 2) three screening tests: the CAGE questionnaire, the Self-Administered Alcoholism Screening Test (SAAST), and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The areas under the receiver-operating characteristic (ROC) curves for the CAGE questionnaire and the SAAST ranged from 0.61 to 0.88 and were particularly poor for African-American men and Mexican-American women. For the AUDIT, the area under the ROC curves was greater than 0.90 for each patient subgroup. The sensitivity of the CAGE questionnaire and the SAAST at standard cut-points was lowest for Mexican-American women (0.21 and 0.13, respectively). Positive likelihood ratios for the AUDIT were similar to or higher than those for the other screening tests, whereas negative likelihood ratios were lowest for the AUDIT (<0.33), indicating the superiority of this test in ruling out a disorder. CONCLUSIONS: A marked inconsistency in the accuracy of common self-report screening tests for alcohol use disorders was found when these tests were used in a single clinical site with male and female family practice patients of different ethnic backgrounds. The AUDIT does not seem to be affected by ethnic and sex bias.     

Barriers and pathways to testing among HIV-infected women

N-acetylcysteine (NAC), the acetylated variant of the amino acid L-cysteine, is an excellent source of sulfhydryl (SH) groups, and is converted in the body into metabolites capable of stimulating glutathione (GSH) synthesis, promoting detoxification, and acting directly as free radical scavengers. Administration of NAC has historically been as a mucolytic agent in a variety of respiratory illnesses; however, it appears to also have beneficial effects in conditions characterized by decreased GSH or oxidative stress, such as HIV infection, cancer, heart disease, and cigarette smoking. An 18-dose oral course of NAC is currently the mainstay of treatment for acetaminophen-induced hepatotoxicity. N-acetylcysteine also appears to have some clinical usefulness as a chelating agent in the treatment of acute heavy metal poisoning, both as an agent capable of protecting the liver and kidney from damage and as an intervention to enhance elimination of the metals.     

Coexisting mental illness and alcohol and other drug dependencies in pregnant and parenting women

1. To determine whether dexfenfluramine is a substrate of cytochrome P450 2D6 (CYP2D6), its disposition has been studied in nine extensive (EM) and eight poor metabolizers (PM) of debrisoquine. 2. Following a 30 mg dose of dexfenfluramine hydrochloride, urine was collected in all subjects for 96 h post-dose and plasma samples were collected in 11 subjects (six EMs and five PMs). Dexfenfluramine and nordexfenfluramine were measured in urine by h.p.l.c. and in plasma by g.c. 3. Urinary recovery of dexfenfluramine was greater in PMs than EMs (4136 +/- 1509 micrograms vs 1986 +/- 792 micrograms; 95% CI of difference 926-3374; P < 0.05) whereas that of nordexfenfluramine was similar in both phenotypes (PM: 1753 +/- 411 micrograms vs 1626 +/- 444 micrograms). 4. Dexfenfluramine AUC was higher in PMs (677 +/- 348 micrograms l-1 h) than EMs 359 +/- 250 micrograms l-1 h). The apparent oral clearance of dexfenfluramine was greater in EMs than PMs (93.6 +/- 42.4 l h-1 vs 45.6 +/- 19.5 l h-1; 95% CI of difference 1.2-94.7; P < 0.05). The renal clearance was similar in both phenotypes (EMs: 5.88 +/- 2.83 l h-1; PMs 6.60 +/- 2.01 l h-1), indicating that the higher urinary recovery of dexfenfluramine in PMs reflects higher plasma concentrations, rather than phenotype differences in the renal handling, of dexfenfluramine. 5. The apparent nonrenal clearance of dexfenfluramine was substantially lower (P < 0.05; 95% CI of difference 3.0-94.1) in PMs (39.0 +/- 19.5 l h-1) than EMs (87.6 +/- 41.2 l h-1). 6. There was a significant inverse correlation (rs = 0.776 95% CI-0.31-0.94; n = 11; p = 0.005) between the debrisoquine metabolic ratio and the apparent nonrenal clearance of dexfenfluramine. 7. PMs had a higher incidence of adverse effects (nausea and vomiting) than EMs. 8. In conclusion, the metabolism of dexfenfluramine is impaired in PMs. Thus CYP2D6, the isoenzyme deficient in poor metabolizers of debrisoquine, must catalyse at least one pathway of dexfenfluramine biotransformation.     

Screening women for gonorrhea: demographic screening criteria for general clinical use

OBJECTIVES: The purpose of this analysis was to derive potential gonorrhea screening criteria for women. METHODS: Data corresponding to 44,366 gonorrhea cultures from women 15 through 44 years of age in Columbus, Ohio, were analyzed. RESULTS: Characteristics that were associated with gonococcal infection and were suitable for screening decisions included patient's age and marital status and previous prevalence of gonorrhea at provider site. Probabilities of infection ranged from .001 for married women 25 through 44 years of age at low-prevalence provider sites to .078 for unmarried women 15 through 19 years of age at high-prevalence sites. CONCLUSIONS: Patient's age and marital status and prevalence of gonorrhea at provider site can be used as indicators to ensure testing of high-prevalence groups.     

Moral and social issues regarding pregnant women who use and abuse drugs

Pregnant women who abuse drugs, such as alcohol, cocaine, and marihuana may face a variety of legal and social responses, including involuntary commitment, forced treatment, and criminal sanctions. These programs are intended to remedy apparent maternal-fetal conflicts but paradoxically may encourage some women to avoid beneficial medical and social services or to seek abortion. Although pregnant women have ethical duties to give due consideration to their offspring, these moral obligations fail to justify coercive and punitive programs regarding substance abuse. Coercive fetal protection policies may undermine pregnant women's trust and cooperation, violate their autonomy, weaken our civil liberties, and raise a host of ethical problems relating to race, gender, and class prejudice. Education and drug treatment programs, rather than punitive and coercive measures, may better help pregnant women fulfill their moral duties to refrain from abusing substances.     

Marihuana use by pregnant women: neurobehavioral effects in neonates

In a prospective study of 291 mothers-to-be, 20 per cent reported some use of marihuana before and/or during pregnancy. A significant increase in symptoms associated with nervous system abnormalities was observed among babies born to heavy regular marihuana users and visuals responses were affected in two- to three-day-old infants in a dose-related fashion. No relationship between marihuana use and maternal weight again, length of gestation, duration of labor or birthweight was found.     

Determinants of binge drinking and alcohol use by young Australian women

The modern views on the distribution, morphological and functional characteristics of Langerhans cells (LCs) and their role in the immunological defense system in female genital tract are summarised. Within this tract, LCs are situated mainly in the mucosal epithelia of vagina and uterine cervix. They are surrounded by hormone-dependent and cyclically changing epithelium and are highly sensitive to hormonal and deleterious factors. LCs function as a component of afferent limb of the local immune system. which has special properties as it is modulated by the changing hormonal levels, provides the antimicrobial immunity and is tolerant to multiple immunization with sperm antigens. Perspectives in the study of LCs in female genital tract are discussed.     

Primary care: detection of women with alcohol use disorders

DNA damage of human leukemia (HL-60) cells caused by methyl tert-butyl ether (MTBE), a new gasoline additive, and its metabolites tert-butyl alcohol (TBA), a-hydroxyisobutyric acid (HIBA) and formaldehyde was determined by single cell gel electrophoresis (SCGE), with release of lactate dehydrogenase as an indicator for evaluating its cytotoxicity. Results showed that MTBE, TBA and HUBA at levels of 1 to 30 mmol/L could cause DNA damage in a dose-dependent pattern. Formaldehyde at level of 5 mumol/L could cause DNA damage, but at a higher level could decrease DNA migration. It suggested that MTBE and its metabolites could have genotoxicity, however, with doses causing genotoxic effects, no cytotoxic effect by MTBE, TBA and HIBA was observed, but formaldehyde presented obvious cytotoxic effect.     

Serum screening of pregnant women reveals Down syndrome. Analysis of biochemical markers for earlier detection

Second trimester maternal serum screening for fetal Down's syndrome (DS), using the AFP (alpha-fetoprotein), hCG (human chorionic gonadotrophin) and uE3 (unconjugated oestriol) triple test, is as well documented procedure associated with a DS-detection rate of about 70 per cent, for an amniocentesis rate of about 7 per cent. The triple test is relatively little used in the Nordic countries, though its wider use would result in more efficient diagnosis of DS and various fetal malformtions. The maternal age indication currently used leaves gravidae under 35 years of age without prenatal diagnostics, although it is in just this age group that the majority (70 per cent) of cases of fetal DS occur. In Denmark, where 12 per cent of gravidae undergo invasive diagnostic procedures, the proportion of induced abortions due to the procedures is far too high, in relation to the DS detection rates obtained. Maternal serum screening yields a much better ratio between the risk of abortion after amniocentesis and the likelihood of DS detection than does maternal age alone. Maternal serum screening at 7-14 weeks of gestation, using pregnancy-associated plasma protein A and free hCG beta subunit concentrations, will become available within the next few years, thus reducing the incidence of some of the psychological and technical problems associated with second trimester screening, especially that of third trimester abortion. Irrespective of whether it is performed in the first or the second trimester, maternal serum screening will be the cornerstone of prenatal DS diagnosis in the future.     

Self-reported alcohol use among women of childbearing age and their knowledge of alcohol warning labels and signs

OBJECTIVE: To examine the prevalence of self-reported alcohol use among women of childbearing age and their ability to recall information about pregnancy risk contained in warning labels on alcoholic beverage containers and warning signs posted in places where liquor is sold. DESIGN: A telephone survey was conducted with adults using a dual-frame procedure. Specifically, approximately one third of the total sample were contacted by random-digit dialing, and the remainder were obtained from listed residential telephone numbers. Also, poststratification weighting was done using estimates of age, ethnic, and sex groups to approximate the 1990 adult population of Illinois. SETTING: A total of 4987 adults with known residence (excluding those without residences and/or telephones and those living in institutions or group quarters) in Illinois participated in a survey during the spring and summer of 1990. PARTICIPANTS: A total of 1515 women of childbearing age (18 through 45 years old) participated in the survey. A random subsample of approximately half were asked questions regarding warning labels and signs; the other half were omitted from the investigation, which yielded the final sample of 748. MAIN OUTCOME MEASURES: The two main outcome measures were self-reported alcohol use and ability to recall information about pregnancy risk contained in warning labels and signs. RESULTS: Pregnant women were significantly less likely than nonpregnant women to report using alcohol in the past 30 days. Approximately one fourth of all women were able to recall information about pregnancy risk contained in warning labels and signs. CONCLUSIONS: Alcohol warning labels and signs seem to be reaching a minority of women; this was uniform across several sociodemographic subpopulations, with few exceptions.     

Survey of drug and alcohol use by lesbian women in New Zealand

A newly identified herpesvirus has been associated with Kaposi's sarcoma. We determined risk factors for Kaposi's-sarcoma-associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8) seropositivity and incidence of infection over time in a cohort of Danish homosexual men followed from 1981 to 1996. Antibodies to a latent nuclear (LANA) and a structural (orf65) antigen of KSHV/HHV-8 were measured by immunofluorescence and ELISA/WB respectively. Through linkage with the national AIDS registry, all cohort members diagnosed with AIDS as of September 1996 were identified and their hospital records were scrutinized to record all diagnoses of KS. Overall, 21.1% (52/246) of the men were KSHV/HHV-8-seropositive in 1981. Among the initially seronegative, the rate of KSHV/HHV-8 seroconversion was highest between 1981 and 1982 and declined steadily thereafter. In a multivariate analysis of the status at enrollment in 1981, KSHV/HHV-8 seropositivity was not associated with age but was independently associated both with number of receptive anal intercourses (OR = 2.83; p = 0.03) and with sex with US men (OR = 2.27; p < 0.05). In a multivariate analysis of follow-up data, risk of KSHV/HHV-8 seroconversion was independently associated with having visited homosexual communities in the United States, and current HIV-positive status. More than 5 years' homosexual experience was associated with an insignificantly increased risk (RR = 2.68). KS occurred only in HIV-positive men who were KSHV/HHV-8-positive at or prior to their KS diagnosis. In conclusion, KSHV/HHV-8 appears to be sexually transmitted, probably by receptive anal intercourse, and may have been introduced to Danish homosexual men via sex with US men. The epidemic of KSHV/HHV-8 is now declining. These findings are concordant with the view that KSHV/HHV-8 may have been actively spread simultaneously with and by the same activities that lead to the spread of HIV.     

A study on the boundary value of hemoglobin concentration for screening iron deficiency anemia in pregnant women

To evaluate whether a pregnant woman is in anemia or there exist the needs to replenish iron is usually based on the measurement of hemoglobin (HB) concentration, because the evaluation of iron nutritional status has not yet been used widely in our country. Blood specimens were collected from 258 pregnant women, and concentrations of Hb, serum ferritin (SF) and free erythrocyte protoporphyrin (FEP) were determined to find out a reasonably boundary value of Hb concentration from the two different ones set by our country and WHO, respectively, and the one averaged the former two, i.e, 100g/L, 110g/L and 105g/L. False positivity and false negativity in diagnosis of iron deficiency anemia (IDA) for pregnant women were evaluated based on the measurement of SF and FEP concentrations as gold standards. Results showed that the optimal Hb concentration for preliminary diagnosis of IDA was 105g/L with maximizing Yorden index.     

Psychometric evaluation of the Multidimensional Assessment of Fatigue Scale for use with pregnant and postpartum women.

Although fatigue is a common experience for pregnant women and new mothers, few measures of fatigue have been validated for use with this population. To address this gap, the authors assessed psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale, which was used in 2 independent samples of pregnant women. Results indicated that the psychometric properties of the scale were very similar across samples and time points. The scale possesses a high level of internal consistency, has good convergent validity with measures of sleep quality and depression, and discriminates well from a measure of social support. Contrary to previous evaluations of the MAF, data strongly suggest that the scale represents a unidimensional construct best represented by a single factor. Results indicate that the MAF is a useful measure of fatigue among pregnant and postpartum women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting positive attitudes about quitting drug and alcohol use among homeless women.

Two separate path models for alcohol and drugs were tested in which psychosocial, environmental, and sociodemographic variables predicted behavioral and substance abuse related factors as well as the key outcome of positive attitudes about quitting drugs (N = 620) or alcohol (N = 526) in a sample of 709 homeless women. A positive attitude about quitting alcohol was predicted by more Addiction Symptoms, fewer Positive Effects from using alcohol, and not having a partner who uses alcohol. A positive attitude about quitting drugs was predicted by more Drug Problems, greater Drug Use in the Past 6 Months, more Active Coping, more education, less Emotional Distress, not having a partner who uses drugs, and fewer Addiction Symptoms. Implications of the results for drug and alcohol interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)