Social correlates of drinking in contrived situations

This chapter reviews the literature on experimentally created drinking situations with humans. In these experiments, social factors have been alternatively investigated as the dependent and independent variables. The findings of several studies assessing the impact of elements in the drinking environment are summarized. The effects of solitary drinking vs. group drinking have been covered and illustrate the quantitative and qualitative responses elicited. An aspect of this review examines studies that attribute behaviorally integrating effects to alcohol when the beverage is incorporated into certain therapeutic settings. Also illustrated are studies that have attempted to influence drinking behavior in alcoholics by using social contingencies.

Influenza B virus infections in the community and the family. The epidemics of 1976-1977 and 1979-1980 in Houston, Texas

Influenza B virus epidemics occurred in Houston, Texas, in 1976-1977 and 1979-1980. Among families with young children followed longitudinally in the Houston Family Study, 112 infections were detected during 511 person-years of observation. The infection rates for the two epidemics were similar--24 per cent and 20 per cent--although the two epidemics differed greatly in the community. The first epidemic was much more intense with a mid-winter peak that produced school absentee rates above 12 per cent for four consecutive weeks. The indolent epidemic of 1979-1980 smoldered from late September to mid-April with a peak during the second week of March for which school absenteeism did not exceed 8 per cent. In the Houston Family Study population, the combined infection rate for the two outbreaks was highest at 35 per 100 person-years for school children aged 6-19 years. Preschool children aged 7 months-5 years and adults had infection rates of 31 and 16 per 100 person-years, respectively. Preexisting neutralizing antibody titers greater than or equal to 3.5 log2 protected against influenza B infection and illness. Preschool children above 6 months of age, school age children, and parents introduced infection into the family at rates of 15, 15, and 9 per 100 person-years, respectively. Three second introductions were observed. The secondary infection rate was highest among school aged children at 61 per 100 persons at risk.

Breast-feeding and respiratory virus infection

Thirty-nine breast-fed and 42 bottle-fed infants were followed up from birth over a four-year period. Virus infection was documented by culture and serologic testing, and history and physical examination were recorded for all episodes of respiratory illness. There were no statistically significant differences in rates or distributions of infection with individual viruses or with all viruses over the first three or six months or during the second six months of life in the two groups, nor were there statistically significant differences in rates or distributions of disease of the upper and lower respiratory tract or total respiratory disease, except for decreased disease of the lower respiratory tract in bottle-fed infants in the second six months. There were trends to decreased morbidity in breast-fed infants in the first three and six months and more episodes of pneumonia and bronchiolitis in bottle-fed infants in the first six months (P less than .05) but similar use of medical care by both groups. High cord blood titers to two viruses were not associated with evidence of breast-feeding protection from infection with those two agents. Breast-fed babies do not have fewer respiratory virus infections or illnesses but may experience less severe illness.

Patterns of shedding of myxoviruses and paramyxoviruses in children

In the Houston Family Study, young children were cultured for virus weekly or biweekly and during acute respiratory illnesses. The interval between the onset of illness and positive culture was examined for 179 infections during 1975-1979. In week 1 after onset, 73%, 73%, and 66% of cultures were positive for influenza A virus, respiratory syncytial virus (RSV), and parainfluenza virus type 3, respectively. Pooled data from influenza B virus infections in 1977 and 1980 showed that 73% of cultures were positive in week 1. Influenza A virus in week 2 or RSV in weeks 2 and 3 was isolated from very few children. However, 37% of cultures were positive for influenza B virus during week 2, and 17% of cultures were still positive for parainfluenza virus type 3 during week 3. Shedding of parainfluenza virus type 3 on days 29-38 was also observed. Parainfluenza virus type 3, RSV, and influenza A virus were isolated up to six days before the onset of illness.

Infection with influenza A/Victoria virus in Houston families, 1976

In 1976, an epidemic caused by infections with an influenza virus antigenically similar to A/Victoria/75 (H3N2) occurred in Houston, Texas. During this outbreak, 37 families (155 members) enrolled in the Houston Family Study were under observation. The families lived throughout the metropolitan area (Houston, Texas), and were representative of low income groups. The overall frequency of infection in family members was 27.7%. The frequency of infection was the highest for infants under one year of age and for their older siblings, 14 (37.8%) of 37 and 17 (33.3%) of 51, respectively. Eighteen (48.6%) of the 37 families had at least one infected member. Twelve of the 18 'infected' families had school aged children, whereas only three of the 19 'non-infected' families had school aged children (P less than 0.01). These infected families were also larger and had increased household density (persons/rooms). The levels of pre-existing HI antibodies to A/Victoria/75 and A/Port Chalmers/73 were inversely related to frequencies of infection and illness associated with A/Victoria/75 virus. Three children required hospitalization as direct consequence of their infection with this H3N2 influenza virus. Antibody response to infection was related to previous experience with antigenically-related influenza A (H3N2) viruses according to Francis', 'doctrine of original antigenic sin.'

Risk of respiratory syncytial virus infection for infants from low-income families in relationship to age, sex, ethnic group, and maternal antibody level

The risk for hospitalization with respiratory syncytial virus infection during the first year of life was about five per 1,000 live births per year for infants born to low-income families in Houston from 1975 to 1979. The risk varied depending upon the intensity of the epidemic for a given season, the month of birth of the infant, and the level of passively acquired maternal antibody at the time of birth. Over 80% of the children hospitalized were less than 6 months of age; thus, most were born during the six months preceding the peak of RS virus activity. The neutralizing antibody titers in cord sera of 68 infants with culture-proven infections before 6 months of age were significantly lower than those of 575 randomly selected cord samples of infants born during the same period. The level of antibody at the time of birth was directly correlated with age at the time of infection. In addition, infants with more severe illnesses had lower levels of antibody in serum collected near onset of illness than did infants with milder illnesses. These observations demonstrate protection against RS infection in early infancy that is correlated with the level of maternal antibody, but it is not known if this protection is mediated directly by the passively acquired antibody or by some other mechanism.

Influenza in children. Relationship to other respiratory agents

During the 1975-1976 respiratory disease season, influenza A/Victoria virus exceeded respiratory syncytial (RS) virus as a cause of lower respiratory tract disease (LRD) in children admitted to the hospital. This was a reversal of their usual roles in the etiology of LRD; however, the importance of influenza viruses in causing serious disease in children has been underestimated because of failure to appreciate the full spectrum of disease associated with influenza virus infections. In addition to those with LRD, several children were hospitalized with nonspecific febrile illnesses or CNS involvement. Furthermore, in the ambulatory care setting, influenza viruses were the most important cause of illness that necessitated children's being brought for medical care during a three-year period. During the peak of epidemics, influenza viruses appeared to interfere with the spread of other major respiratory viruses--particularly RS virus.

Epidemiologic observations of influenza B virus infections in Houston, Texas, 1976-1977

Influenza B virus infections were documented in Houston, Texas, in 726 patients with febrile respiratory illnesses who presented to representative primary care facilities during the 1976-1977 respiratory disease season. This epidemic followed a "herald wave" of illness associated with influenza B during the preceding spring. Over one-half the virus isolates were from children aged 5-19 years, and school absenteeism rates indicated that about 40 per cent of the students in the Houston area were ill enough to miss school during the epidemic. The rapid rise in the number of cases among students after the school holiday recess demonstrated the importance of school attendance for the rapid dissemination of influenza viruses. During the later phase of the epidemic, most of the cases were preschool children and adults. In addition to disease of the respiratory tract, the epidemic was accompanied by cases of Reye's syndrome at a rate expected for an urban area.

Reinfection with influenza A (H3N2) virus in young children and their families

The frequency and consequences of reinfection with influenza A virus were studied by longitudinal observation of families for a three-year period in which two epidemics of influenza A (H3N2) occurred. Seven children followed from birth were reinfected 10-25 months after their first infection. Two children were reinfected by the same H3N2 virus while the others were reinfected with a closely related variant. At least five of these reinfections were accompanied by respiratory illness. Reinfection illness was similar to that accompanying primary infection. For children in the second and third year of life during the 1978 epidemic, the rate of infection was the same for those who had been previously infected (seven of 12) as for those who had not been previously infected (22 of 40). Reinfection was detected in 26% of older siblings and 6% of parents. The occurrence of reinfection may have important implications for elucidation of the protective immune response and for development of prophylaxis for influenzal infections.

Benefit--cost methodology in the evaluation of therapeutic services for alcoholism

Benefit--cost analysis as a form of "social profitability analysis" can be a powerful tool in the overall evaluation of alcoholism treatment efforts. Alcoholism treatment potentially leads to a multiplicity of benefits in addition to sobriety. Benefit--cost analysis provides a methodology for converting many of these diverse benefits into a common metric (dollars), thereby allowing the comparison of aggregate benefits and treatment costs. The analysis thus leads to the expression of treatment outcome in terms of the return on investment. A benefit--cost analysis conducted on 3034 clients from the Oklahoma data base indicated a return to society of $1.98 for every $1 invested in alcoholism treatment. Such data may represent a critical portion of the information required for responsible resource allocation decisions.

The role of acetaldehyde in mediating reactivity to an acute dose of ethanol among different racial groups

Physiologic changes after ingestion of alcohol were monitored in Chinese and white volunteers, and absorption rate, acetaldehyde concentration, facial flushing, and heart rate increases were correlated.

Drinking behavior, remission, and relapse: the Rand Report revisited

Utilizing the Armor, Polich, and Stambul 1976 criteria, the clinical course of patients from 26 treatment programs was studied, with relapse analyses differing from the data reported by Armor et al. The overall rate of remission at 6 mo follow-up was considerably lower (54%) in this study. The data suggest that those alcoholics who chose to reduce their drinking, as an option, experienced a substantial risk of relapse.

The relative accuracy of U.S. British, and Mexican raters in judging the emotional displays of schizophrenic and normal U.S. women

Asked U.S., British, and Mexican male students of college age to discriminate among three affective displays presented by 10 schizophrenic and 10 normal U.S. women. Significant main effects for diagnostic category, nationality of judge and for the interaction of nationality and diagnostic category were obtained. Furthermore, U.S. judges did significantly better in judging normals as compared to schizophrenics, British judges tended in the same direction, and Mexican judges did not. Co-nationality and national similarity confer an advantage in judging normals as compared to schizophrenics. The data have relevance for questions about the effects of sending and receiving nonverbal emotional messages on communications or miscommunications between doctor and patient, doctors from different cultures and people including conference negotiators, from different national backgrounds.

Tribal affiliation and prevalence of alcohol problems

Differences in tribal culture, history and settlement may explain why Indians in eastern Oklahoma have lower rates of alcohol-related arrests and deaths than do Indians in the western part of the state.

Racial differences in circadian variation of ethanol metabolism

In two experiments, independent groups of male social drinkers were administered equal doses of ethanol per unit of body weight (0.66 ml/kg) at different times during the day. Peak blood alcohol concentration (BAC) was achieved, and the time taken to return to a BAC of 20 mg/100 ml and the rate of ethanol metabolism per hour were determined.

Reactogenicity and immunogenicity of bivalent influenza A and monovalent influenza B virus vaccines in high-risk children

Seventy-nine high-risk children were immunized with either commercial, bivalent, split-product influenza A vaccine or purified hemagglutinin-neuraminidase bivalent influenza A vaccine, and 78 of these subjects were immunized with commercial, monovalent, influenza B split-product vaccine. The reactogenicity of all three vaccines was low, and there were no severe reactions. Twenty-nine subjects who received hemagglutinin-neuraminidase vaccine as their initial dose and commercial split-product vaccine as a booster dose had significantly lower antibody responses to influenza A/New Jersey/76 virus than subjects who received two doses of commercial split-product vaccine. The responses of the two groups to influenza A/Victoria/75 virus were comparable. Twenty-four subjects with malignancy who were receiving chemotherapy were compared with a group of subjects matched for age and vaccine preparation. Patients with cancer had significantly lower antibody responses to A/New Jersey/76 virus than patients without cancer. The ultimate responses of patients with cancer to A/Victoria/75 and B/Hong Kong/72 viruses were comparable to those of other patients, but early responses were lower.

Butaclamol in newly admitted chronic schizophrenic patients: a modified fixed-dose dose-range design

In a double-blind placebo controlled study of newly admitted chronic schizophrenics, an attempt was made to further evaluate the safety, acceptability, and effectiveness of BT in doses of 10, 20, and 40 mg. Significant dose related responses occurred on several behavioral variables by the first week of treatment. Maximum clinical response appeared to be at the 20-40 mg. dose level. Extrapyramidal signs occurred at all doses, but with greater severity at higher doses. Excessive daytime drowsiness occurred in all groups but with longer duration and greater intensity in the 20 mg. group. Rebound insomnia occurred after the abrupt withdrawal of BT at all dose levels suggesting the desirability of further study of its hypnotic properties.

Evaluation of butaclamol in chronic schizophrenic patients

In a double-blind, placebo-controlled study, an attempt was made to evaluate butaclamol in chronic schizophrenic patients using chlorpromazine (CPZ) as the standard comparative drug. With doses up to 50 mg/day, butaclamol was shown to have significant antipsychotic activity comparable to CPZ but with a much higher incidence of extrapyramidal signs. A more reasonable maintenance dose may be in the range of 5 to 20 mg/day. Rebound insomnia was noted again with butaclamol, which warrants further study.

Quantitative determination of antibody to capsular polysaccharide in infection with type III strains of group B Streptococcus

The development of antibody in response to invasive infection with type III strains of group B Streptococcus was studied in sera from 31 infants and 4 adults by means of a quantitative radioactive antigen-binding assay. Low concentrations of antibody were consistently found in the acute sera of patients who developed clinical illness. Although adults with puerperal sepsis and infants with bone or joint infection uniformly demonstrated significant rises in serum antibody concentration after recovery, much lower levels of antibody were detected in convalescent sera from infants recovering from meningitis or sepsis. The median antibody concentration in sera from 43 parturients with type III strains of group B Streptococcus isolated from vaginal cultures whose neonates failed to develop symptomatic disease was significantly greater than that in sera from 29 mothers of infants with invasive, type III, group B streptococcal infection. Study of paired maternal and cord sera demonstrated a significant correlation between the antibody concentration in a mother's serum and that in her neonate.

Nosocomial transmission of group B Streptococci in a newborn nursery

Group B streptococcal colonization of normal newborn infants increased from 22.5% within 20 hours of birth to 65.4% at the time of hospital discharge (P less than .001). In contrast, colonization in mothers did not change significantly between the time of admission to labor and delivery (27.7%) and the time of discharge (31.1%). Epidemiologic data suggested but did not prove that the mode of nosocomial transmission of group B streptococci among infants was cross colonization via personnel contact.

Evaluation of two dose levels of loxapine succinate in chronic schizophrenia

In a double-blind, placebo controlled design in chronic schizophrenic inpatients using 50 mg. and 100 mg. LOX, an attempt was made to replicate the findings of a previous study and to establish the dose-level and duration of treatment optimal for this kind of patient. Multiple regression analysis adjusting for dose, age, duration of illness, and baseline values indicated that 100 mg. LOX was an effective dose as previously shown. In contrast to the previous study, significant response effects were found by the 4th week. In addition, the dose was linearly related to response on nearly all the variables. The principal side effects were drowsiness and extrapyramidal signs.

Prolonged pneumococcal meningitis due to an organism with increased resistance to penicillin

For more than 30 years, penicillin has been the agent of choice for pneumococcal infections. During this time the majority of strains of Streptococcus pneumoniae have been highly susceptible to penicillin. However, during the last ten years there have been sporadic reports of pneumococci with increased resistance to penicillin. The case report of an 18-month-old white boy with meningitis due to a strain of S. pneumoniae with increased resistance to penicillin is presented. The MIC of the organism to penicillin was 0.2 mug/ml and the MBC 0.39 mug/ml. The patient had normal immunity and no demonstrable sequestered focus of infection but failed to respond to appropriate doses of intravenous penicillin. Treatment with chloramphenicol caused a dramatic bacteriologic and clinical response. This experience reemphasizes the existence of pneumococcal strains of intermediate penicillin sensitivity and the importance of in vitro susceptibility tests.