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American Indian and Alaska Native (AIAN) communities have higher rates of substance use than other racial and ethnic groups. Substance use disorder (SUD) is tied to the increased risk of experiencing homelessness. National policies have also led to the disproportionate rates of homelessness among AIAN communities. However, specific experiences related to the occurrence of SUD and homelessness among AIAN in California, as well as seeking and accessing SUD treatment, are not well understood. This study explored potential SUD risk and resilience factors for AIANs experiencing homelessness and their experiences when seeking services for SUD. Nineteen interviews were conducted in northern, central, and southern California. Thematic analysis was used for these data. The five primary codes were: (1) risk factors for SUD, (2) resilience related to SUD service seeking, (3) services available, (4) barriers accessing services, and (5) services needed. Based on the results, themes for risk were trauma, mental health, and community conditions. Themes for resilience were identified at individual and community levels and included personal motivation and community support and inclusiveness. Themes for services available were limited knowledge about service types and services' location. The themes for barriers accessing services were identified at internal and external levels, and included lack of readiness and transportation challenges, respectively. Themes for services needed included continuum of care, integrated care, and culturally sensitive services. Findings highlight the importance of addressing the potential risk factors and service needs of AIANs experiencing homelessness to provide comprehensive and culturally sensitive services to reduce substance use. [ABSTRACT FROM AUTHOR]

A family with Becker type muscular dystrophy is described, in which two females were severely affected, giving the family tree the appearance of dominant inheritance. [ABSTRACT FROM PUBLISHER]

Introduction: The surveillance of febrile neutropenia (FN) episodes in every center allows adapt the antibiotic therapy guidelines to local epidemiology., Aim: To characterize clinical features and compare the FN etiology between hematological cancer (HC) and solid organ cancer (SOC) in our center., Patients and Methods: Surveillance study in adult patients with FN admitted to Hospital Clinico Universidad Católica, in Santiago, Chile, from January 2004 to August 2007., Results: 154 FN episodes corresponding to 87 patients were included. Mean age: 47 +/- 6 years-old; 71% had HC and 29% SOC. A clinical and/or microbiologically documented infection was recognized in 76%. Gastrointestinal 31.5%, upper respiratory 30.3% and lower respiratory 16.9% were the more frequent clinical focus. In 30.5% blood culture resulted positive: gram negative rods 51%, gram positive cocci 41% and yeasts 8%; being Escherichia coli 22%, S. coagulase negative (SCoN) 20% and Klebsiella pneumoniae 12% most frequent bacteria; 22.2% Enterobacteriaceae were ESBL producers and 55.6% 5CoN were methicillin resistant. In 18.3% of FN episodes the etiology was not established. Highest mortality was observed in episodes with microbiologically documented infection (14.5% vs 1.3%, p < 0.005). A clinical observed focus and positive blood cultures were more frequently obtamed among HC than SOC associated episodes: 37.3% vs 13.6%; (p < 0.01) and 67.2% vs 50%; (p = 0.045), respectively., Conclusions: The etiological profile of FN in our center and the necessity to continue the surveillance was described. Future studies are needed regarding risk factors of invasive infection that have worst prognosis.

Objective: To assess objective and subjective evidence of sleep disorders in patients with systemic lupus erythematosus (SLE) and to examine correlations between parameters of lupus activity, depression, and sleep disturbances., Methods: Fourteen SLE patients and 11 normal control subjects of similar age underwent all-night polysomnography on 3 consecutive nights. The patients and controls were also evaluated for daytime sleepiness by the Multiple Sleep Latency Test and completed a sleep disorders questionnaire and the Beck Depression Inventory., Results: The polysomnographic data showed that sleep in SLE patients was characterized by respiratory and movement disorders. These intrinsic primary sleep disorders are related to the symptom of restless, poor sleep at night. Lupus patients were more sleepy during the day, and their sleepiness was related to sleep fragmentation, with more arousals and stage transitions than the control group. Disease activity was associated with decreases in sleep efficiency and delta sleep and with increases in sleep fragmentation. Depression was not correlated with the activity of the disease., Conclusion: There is an enhanced presence of sleep disorders in patients with SLE. The most frequent primary sleep disorders are respiratory and movement disorders.