Greater Drug Use Research Articles

Exposure to microplastics via hemodialysis: differences between women and men

Abstract Background Hemodialysis (HD) may contribute to microplastics (MPs) burden in dialysis patients. The aim of the study was to estimate any differences in exposure to MPs between cases (on dialysis patients) and controls (not on dialysis patients), investigating any sex differences. Methods We organized a case-control study. Both cases and controls were recruited at the Policlinic “G. Rodolico-San Marco” Hospital Nephrology Unit. Preparation and determination of MPs smaller than 10 µm in blood samples were carried out using a patented method (Italian Patent n. 102018000003337-07 March 2018, European Patent n.3788344 20 July 2022) and SEM-EDX electron microscopy analysis, respectively. Results A convenience sample was recruited including 15 dialysis (60.0% women) and 10 not on dialysis patients (60.0% women) with a median (IQR) age of 77.0 (59.0-83.0) in dialysis patients and 65.5 (49.3-79.0) in those not on dialysis. No significant differences were found between cases and controls on the consumption of bottled water (100% vs 80%, p = 0.07), bagged foods (93.3% vs 70%, p = 0.12) unlike the use of drugs (100% vs 70%, p = 0.02). Women in general declared a greater use of drugs than men (F 93.3%, M 80.0%, p = 0.32). Dialysis patients had higher MPs levels than non-dialysis patients [9132(4896-15847) vs 3554(1661-7340), p-value=0.06]. In particular, female dialysis patients had values comparable to males [9132 (4665-17205) p/d vs men: 10438 (3672-16699) p/d] while non-dialysis female patients had higher levels than males [3274 (1681- 7814) p/g vs 1661 (1661-3354) p/g]. No difference was detected about the diameter of the MPs (IQR) [dialysis patients 4.28 (3.72-4.66) µm vs non-dialysis patients [4.67 (4.15-5.08) µm]. Conclusions Future studies must focus on studying the relationship between exposure to MPs and their levels in dialysis patients as well as investigating the differences between men and women and the possible consequences of dialysis as a further source of exposure. Key messages • On dialysis patients, both men and women, had higher MPs exposition compared to not on dialyzed ones. • Not on dialysis women had higher MPs levels than not on dialysis men.

How vulnerable are people to victimisation of County Lines drug dealing?

The current study examined how willing a non-probability sample of adults were to engage in hypothetical activities typical of County Lines, and whether involvement could be predicted by perceived risk factors. Of the 101 participants; 48% were willing to engage in activities that could lead to cuckooing, 63% to a coffee meet up, 50% to transferring money, 32% would accept free drugs, 56% would pay off a friend’s debt, whereas only 1% were willing to engage in the control scenario (a phone scam). Actual occurrences of these scenarios were also documented and occurred in approximately 1% of the sample. Males and people with greater drug use scores were more likely to endorse engagement in a County Lines scenario involving drugs, whilst greater drug use scores were only associated with a lower risk of a County Lines scenario involving lending money to a friend. Our findings suggest that drug use may predict endorsement to engage in some County Lines scenarios. However, given a small non-probability sample was used in the current study, further development of methodologies to capture the likelihood to engage in County Lines activities are needed.

#6373 EFFECT ON BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS IN PEDIATRIC PATIENTS DURING COVID-19 PANDEMIC CONFINEMENT (COBECOR STUDY)

Abstract Background and Aims Patients monitored in the cardiovascular risk (CVR) consultation usually present overweight/obesity, metabolic syndrome, tendency to hypertension (HT), poor eating habits and sedentary lifestyle, with great resistance to change, great influence of the environment and, frequently, psychosocial limitations. We asked whether home confinement for COVID-19 (March-May 2020) could have negative effects in relation to CVR in these patients. The main objective of this work is to assess this hypothesis with respect to HTN and the use of antihypertensive drugs in these patients. As a secondary objective, we assessed changes in other parameters: body mass index (BMI), level of physical activity and diet. Method Retrospective cohort study with review of 738 ambulatory blood pressure monitoring (ABPM) between 2019-2022 obtaining, after applying the exclusion criteria (no overweight/obesity, poor therapeutic compliance, underlying renal pathology or failure to perform two ABPM in the study period), a final cohort of 46 patients divided into two groups (23 each): one group exposed to home confinement (G1) with one ABPM before and after home confinement and another group not exposed to confinement (G2) with two ABPM in different periods between 2021-2022. Blood pressure (BP) percentile values, dipper pattern, variability and blood pressure load, as well as the rest of the CVR parameters were compared in both periods. Results The mean age was 13 years (13.8 G1/13.2 G2) with a mean time between the 1st and 2nd ABPM of 11 months (11.08 G1/10.95 G2) and a greater reduction in BMI in G2 than in G1 (1.05 G1/1.21 G2). Despite this, the results were not statistically significant. Nor were the results significant in terms of differences in AT or worsening of the dipper pattern (30.4% in G1 and 21.7% in G2). We did observe differences (p<0.022) in the use of antihypertensive drugs, although contrary to our initial hypothesis, with greater use of drugs in G2. Conclusion Although the low sample size, the biases inherent in the design and the lack of previous studies make the interpretability and statistical significance of some results difficult, they reinforce that the measures during confinement did not contemplate all spheres of health and the need to implement specific CVR consultations. Obesity and its associated pathologies are an important public health problem that pediatricians have the responsibility to address.

Advancing our understanding of the intersection between emotion regulation and alcohol and drug use problems: Dyadic analysis in couples with intimate partner violence and alcohol use disorder

BackgroundAn extensive body of literature has linked emotion regulation to alcohol and drug use problems, including among populations characterized by intimate partner violence (IPV). Advancing this research, the goal of the current study was to examine cognitive emotion regulation strategies and alcohol and drug use problems within a dyadic framework. Specifically, we examined actor and partner effects of maladaptive and adaptive cognitive emotion regulation strategies on alcohol and drug use problems. MethodsEighty-four romantic couples (N = 168 total participants) participating in a randomized controlled trial who reported physical IPV and an alcohol use disorder completed self-reported measures of cognitive emotion regulation as well as alcohol and drug use problems. ResultsRegarding actor effects, men’s greater use of maladaptive cognitive emotion regulation strategies was positively related to their alcohol use problems (p < .001), whereas both women’s (p = .02) and men’s (p = .047) greater use of adaptive cognitive emotion regulation strategies was negatively related to their own alcohol use problems. In terms of partner effects, men’s greater use of maladaptive cognitive emotion regulation strategies (p = .001) and less use of adaptive cognitive emotion regulation strategies (p = .017) was related to their partners’ greater drug use problems. ConclusionsFindings replicate and extend existing work in this area, showing that men’s and women’s emotion regulation strategies are related to their own alcohol and drug use problems and that men’s cognitive emotion regulation strategies are also related to their partners’ drug use problems.

Ibrutinib in Advanced Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: Lower Risk of Hepatitis B Virus Reactivation

Introduction: Therapy of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with drugs such as ibrutinib and rituximab is often associated with immune suppression, opportunistic infections, and reactivation of virus infections such as hepatitis B virus (HBV). This risk is especially important in geographical regions like Asia where many potential therapy recipients have HBV infection. Also, whether safety and efficacy of ibrutinib in Asians and Europeans with advanced CLL/SLL are similar is unknown. We determined the safety and efficacy of ibrutinib compared with rituximab in advanced CLL/SLL including persons with HBV infection. We compared outcomes with data published from trials in persons of European descent. Methods: This is a post hoc analysis of a multicenter, phase-3 trial (NCT01973387). Subjects with advanced CLL/SLL were randomized 2:1 to receive ibrutinib, 420 mg/day, or rituximab, 500 mg/mE + 2, for 6 cycles. Subjects with resolved HBV infection were included. Endpoints were progression-free survival (PFS), overall response rate (ORR), survival, and adverse events including resolved HBV reactivation. Results: 131 subjects received ibrutinib (N = 87) or rituximab (N = 44) including 53 with resolved HBV infection. Median follow-up was 31 months (95% confidence interval: 28, 32 months). ORR was 61% (50, 71%) versus 7% (2, 18%; p < 0.001). Median PFS was not reached in the ibrutinib cohort but must be >40 months versus 8 months (7, 9 months; p < 0.0001) in the rituximab cohort. Median survival was not reached but must be >40 months versus 27 months (17 months, NE; p = 0.0006). In multivariable analyses, receiving ibrutinib increased PFS (hazard rate [HR] for failure = 0.12 [0.06, 0.23]; p < 0.001) and decreased risk of death (HR = 0.31 [0.15, 0.63]; p < 0.001). Median duration of exposure to ibrutinib was significantly longer than exposure to rituximab (28 vs. 5 months). The safety profile of ibrutinib was consistent with that observed in previous studies with no new safety signal. No subject receiving ibrutinib had HBV reactivation versus 2 receiving rituximab, despite much greater use of drugs to prevent HBV reactivation in the rituximab cohort. Outcomes were like those reported in persons of European descent, except ORR which, was unreliably correlated with PFS in Asians. Conclusion: Ibrutinib is safe and effective in persons with advanced CLL/SLL and better than rituximab in all therapy outcomes including risk of HBV reactivation. Outcomes with ibrutinib in Chinese were like those reported in persons of predominately European descent.

Cocaine cue-induced mesocorticolimbic activation in cocaine users: Effects of personality traits, lifetime drug use, and acute stimulant ingestion.

Stimulant drug-paired cues can acquire the ability to activate mesocorticolimbic pathways and lead to new bouts of drug use. Studies in laboratory animals suggest that these effects are augmented by progressively greater drug use histories, impulsive personality traits, and acute drug ingestion. As a preliminary test of these hypotheses in humans, we exposed cocaine users (n = 14) and healthy volunteers (n = 10) to cocaine-related videos during two functional magnetic resonance imaging (fMRI) sessions, once following acute administration of placebo and once following d-amphetamine (0.3 mg/kg, p.o.). Across sessions, cocaine users showed larger cocaine cue-induced responses than healthy controls in the associative striatum and midbrain. Among the cocaine users, larger drug cue-induced responses during the placebo session were correlated with higher Barratt Impulsiveness Scale (BIS-11) nonplanning scores (associative striatum) and greater lifetime use of stimulant drugs (limbic, associative, and sensorimotor striatum). The administration of d-amphetamine did not augment the cue-induced activations, but, in cocaine users, drug cue-induced striatal activations were more widespread following prolonged cocaine cue exposure. Together, these effects of past and present drug use might aggravate the risk for stimulant drug use problems.

Prevalence, risk and protective factors of alcohol use disorder during the COVID-19 pandemic in U.S. military veterans

BackgroundThere have been reports of increased alcohol consumption during the COVID-19 pandemic in the general population. However, little is known about the impact of the pandemic on the prevalence of alcohol use disorder (AUD), especially in high-risk samples such as U.S. military veterans. MethodsData were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 U.S. veterans. Pre-pandemic and 1-year peri-pandemic risk and protective factors associated with incident and chronic probable AUD were examined. ResultsA total of 6.9 % (n = 183) of veterans were classified as chronic probable AUD, 3.2 % (n = 85) as remitted from AUD, and 2.7 % (n = 71) as incident probable AUD during the pandemic; the prevalence of probable AUD in the full sample remained stable —10.1 % pre-pandemic and 9.6 % peri-pandemic. Younger age, greater pre-pandemic alcohol use severity, and COVID-related stressors were associated with incident AUD during the pandemic, whereas higher pre-pandemic household income was associated with lower risk of this outcome. Younger age, combat experience, lifetime substance use disorder, greater drug use severity, lower dispositional optimism, and more COVID-related worries and social restriction stress were associated with higher risk of chronic AUD. ConclusionsNearly 1-in-10 US veterans screened positive for AUD 1-year into the pandemic; however, the pre- and 1-year peri-pandemic prevalence of probable AUD remained stable. Veterans who are younger, have served in combat roles, endorse more COVID-related stressors, and have fewer socioeconomic resources may be at higher risk for AUD during the pandemic.

Predictors of cannabis use among first-time justice-involved youth: A cohort study

BackgroundJustice-involved youth use cannabis at higher rates than their same-aged peers increasing likelihood of adverse behavioral health consequences and continued legal involvement. This study examined individual level predictors of early onset use cannabis use (<13 years of age) and cannabis use initiation in the 12 months following first court contact. MethodsParticipants were 391 first-time justice-involved youth (56.9 % male; Mage = 14.6 years; 32.1 % White, 11.1 % Black, 14.7 % Other/Multi-racial, 42.2 % Latinx) and an involved caregiver (87.2 % female; Mage = 41.0 years). Baseline assessments captured individual level factors; cannabis use was assessed every four months post-baseline for 12 months. Primary analyses involved multivariable modified Poisson regressions and survival analysis. ResultsIn multivariable models, youth who reported lifetime cannabis use (n = 188, 48.1 %) were older, reported alcohol use and positive cannabis use expectancies. Greater self-control and self-concept were associated with lower likelihood of lifetime cannabis use. Youth who initiated cannabis during the 12-month follow-up (n = 30, 14.8 %) tended to be older, White/non-Latinx, and to report more psychiatric symptoms (posttraumatic stress, externalizing, internalizing, and affect dysregulation), delinquent behavior, lower levels of self-control, poorer self-concept, greater drug use intentions and positive cannabis expectancies. In the multivariable survival analysis, affect dysregulation, internalizing symptoms, and more positive cannabis expectancies remained independently and positively associated with cannabis initiation. ConclusionsThere is a critical and unique window of opportunity to prevent cannabis use initiation among first-time justice-involved youth. Research is needed to determine whether brief interventions that aim to modify expectancies about cannabis use reduce rates of cannabis initiation in this underserved population.

Problemas de salud mental entre dermatólogos latinoamericanos durante la pandemia de COVID-19

Introduction. A mental health survey was done in the context of the COVID-19 pandemic among Latin American dermatologists through CILAD (Colegio Ibero-Latinoamericano de Dermatología) with the participation of both specialists and residents from twenty countries. Objective. To evaluate mental health problems among Latin American dermatologists during the COVID-19 pandemic. Material and Methods. This quantitative, cross-sectional comparative study took place between June and July 2020. The evaluation, made online, had two sections: the first one explored the socio-demographic variables, and the second was a filter including self-application instruments for the assessment of Post-Traumatic Stress Disorder (PTSD), general anxiety, health anxiety and somatic symptoms, and risk of depression. Results. The sample included a total of 554 subjects, most of them women and dermatologists. In the mental health assessment, there were differences between those dermatologists who care for COVID-19 and those who do not regarding a greater use of drugs; 21.5% of dermatologists reported being COVID-19 first-line care health personnel. The risk of having PTSD is significantly higher among them than among those who do not work with COVID-19 patients (36.8% vs. 16.6%); they have more insomnia incidence (21.8% vs. 10.8%); more risk of depression (66.6% vs. 47.6%) and greater consumption of substances (15.1% vs. 5.3%). Conclusions. Dermatologists and dermatology residents at the first line of care in the current pandemic show identifiable mental health problems; thus, mitigation measurements have to be taken about it.

Costs of Treatment of Severe COPD Exacerbation in Serbia

Abstract The main objective of this investigation was to determine and summarize the economic burden of severe COPD exacerbations that required hospitalization and the difference in the costs of treatment between patients with frequent (at least two exacerbations in one year) and infrequent exacerbation. Our results suggested that significantly more resources had to be spent to treat patients with at least two hospitalizations during the study related to the use of medications primarily affecting the respiratory system (corticosteroids, p = 0.013, theophylline, p = 0.007) and total hospital stay (31336.68 ± 19140 RSD/517.53 ± 316.1 EUR versus 23650.15 ± 14956.0 RSD/390.59 ± 247 EUR, p=0.002) compared to patients who stayed in a semi-intensive care unit (12875.35 ± 20742.54 RSD versus 4310.62 ± 9779.78 RSD/ 212.64 ± 342.57 EUR versus 71.19 ± 161.51 EUR, p=0.006). Based on the total number of days in the hospital, the costs of the drugs, the materials used and services provided, patients from the frequent exacerbation group had significantly higher costs (80034.1 ± 36823.7 RSD/1321.78 ± 608.15 EUR versus 69425.5 ± 34083.1 RSD/1146.58 ± 562.89 EUR) comparedthan patients in the infrequent exacerbation group (p=0.039). Our results indicate that significantly more funds will be spent treating the deterioration of patients who stay longer in the hospital or in the semi-intensive care unit. Their condition will require a significantly greater use of drugs that are primarily used to treat the respiratory system and, therefore, will utiliseutilize significantly more resources.

Vietnamese female sex workers in rural cross-border areas of Guangxi, China: migration and HIV/STI risk behaviors

ABSTRACT China’s HIV/AIDS epidemic continues to grow in rural and less developed areas. This consecutive cross-sectional study examines demographic and behavioral factors associated with HIV/STI infection, Hepatitis C (HCV) and other sexually transmitted infections (STIs) among Vietnamese female sex workers (FSW), a vulnerable population who cross into Guangxi, China. This study is a secondary data analysis of 303 Vietnamese and 4,348 Chinese FSWs recruited over seven years from two Chinese counties that border Vietnam. Logistic regression models compared demographics, HIV/STI status, HIV/AIDS-related knowledge, attitudes, and risk behaviors between Vietnamese FSWs and Chinese FSWs. Compared with Chinese FSWs, Vietnamese FSWs were younger, had attained lower education levels, were highly mobile, more likely to report using drugs, and were more vulnerable to HIV/STIs. Younger age, less educational attainment, shorter time in their current working location, no voluntary HIV testing in the last year, greater drug use, and not using condoms for all commercial sex in the last month were associated with higher HIV/STIs. In conclusion, several factors were associated with HIV/STI risk in Vietnamese cross-border FSWs. There is a pressing need to improve support systems for Vietnamese cross-border FSW and health system cooperation across the Chinese/Vietnamese border.

Racial/Ethnic Differences in Drug- and Alcohol-Related Arrest Outcomes in a Southwest County From 2009 to 2018.

Objectives. To estimate the association between race/ethnicity and drug- and alcohol-related arrest outcomes.Methods. We used multinomial logistic regression and general estimating equations to estimate the association between race/ethnicity and arrest outcomes in 36 073 drug- and alcohol-related arrests obtained from administrative records in a Southwest US county from 2009 to 2018. Results were stratified by charge type.Results. Among misdemeanor drug- and alcohol-related arrests, American Indian/Alaska Native (AI/AN; adjusted odds ratio [AOR] = 3.60; 95% confidence interval [CI] = 3.32, 3.90), Latino (AOR = 1.53; 95% CI = 1.35, 1.73), and Black persons (AOR = 1.28; 95% CI = 1.05, 1.55) were more likely than White persons to be booked into jail as opposed to cited and released. AI/AN (AOR = 10.77; 95% CI = 9.40, 12.35), Latino (AOR = 2.63; 95% CI = 2.12, 3.28), and Black persons (AOR = 1.84; 95% CI = 1.19, 2.84) also were more likely than White persons to be convicted and serve time for their misdemeanor charges. Results were similar for felony drug- and alcohol-related arrests aggregated and stratified.Conclusions. Our results suggest that race/ethnicity is associated with outcomes in drug-related arrests and that overrepresentation of racial/ethnic minorities in the criminal justice system cannot be attributed to greater use of drugs and alcohol in general.

Police Contact, Procedural Injustice, and Drug Use

Drawing on general strain theory, this article explores whether young people’s perceptions of procedural injustice in their interactions with police, as well as their economic dissatisfaction, are associated with drug use. We examine whether levels of police contact increase the likelihood of perceptions of procedural injustice, and if the relationships between procedural injustice and drug use as well as economic dissatisfaction and drug use are influenced by associations with drug-using peers, legal cynicism, and levels of social support. Using a sample of 449 individuals aged 16–30 years in three Canadian cities, the findings suggest that police contact has a direct relationship with drug use, but it also has an indirect relationship mediated by procedural injustice. Further, economic dissatisfaction, homelessness, legal cynicism, and drug-using peers are also associated with greater drug use. The relationships between procedural injustice and drug use and economic dissatisfaction and drug use are stronger at lower levels of social support. Findings are discussed and suggestions for future research are offered.

A structural equation model for predicting depressive symptomatology in Black, Asian and Minority Ethnic gay, lesbian and bisexual people in the UK

ABSTRACT This study identifies the predictors of depressive symptomatology in Black, Asian and Minority Ethnic (BAME) lesbian, gay and bisexual (LGB) people in the UK. 289 White and BAME LGB individuals participated in a cross-sectional survey. BAME participants exhibited significantly more discrimination, rejection from significant others, ethnic victimisation, internalised homophobia and concealment motivation than White participants. They manifested greater internalised homophobia, less outness and greater drug use than White participants. Outness was associated with less depressive symptomatology, and internalised homophobia and victimisation with more depressive symptomatology. The structural equation model showed a significant effect of ethnicity on depressive symptomatology. This relationship was mediated by the situational stressors, the psychological schemata and coping variables. Consistent with the cognitive-behavioural model, the results indicate that exposure to situational stressors can increase the risk of developing a self-hatred and depressive psychological self-schema, maladaptive coping strategies and depressive symptomatology in BAME LGB people in the UK.

Sexual abuse, family violence/conflict, substance use, religion and spirituality among Icelandic adolescents

Experiencing sexual abuse and family violence/conflict is related to greater risk of adolescent substance use (drugs, alcohol and cigarettes), with significant health implications. Religion and spirituality are connected with less substance use, which may be even more true for adolescents with a history of abuse, violence and conflict. Currently Nordic research on this topic is lacking, but the Nordic religious context is unique, with populous State churches but low public attendance at religious events. This study examined the relationships of sexual abuse and family violence/conflict with substance use, as well as the buffering effects of religion (religious participation and parent and peer religion, PPR) and spirituality (one’s own relationship with a higher power). Population survey data from Icelandic adolescents (N = 7365) were analyzed using hierarchical linear regression. Sexual abuse and family violence/conflict related to greater substance use. Spirituality and PPR were connected to less substance use, but religious participation related to greater use of drugs and cigarettes. Both spirituality and PPR buffered the relationships between sexual abuse and family violence/conflict and cigarette use. In addition, spirituality was a buffer between sexual abuse and family violence/conflict and drug use. Certain aspects of religion and spirituality may therefore have positive effects on adolescents, which are particularly pronounced for victims of sexual abuse and family violence/conflict. More research is needed to fully understand these relationships and how they relate to the lives of Nordic youth.

N-Acetylcysteine treatment during acute stress prevents stress-induced augmentation of addictive drug use and relapse.

Converging epidemiological studies show that a life-threatening event increases the incidence of posttraumatic stress disorder (PTSD), which carries 30% to 50% comorbidity with substance use disorders (SUDs). Such comorbidity results in greater drug use and poorer treatment outcomes. There is overlap between the enduring synaptic neuroadaptations produced in nucleus accumbens core (NAcore) by acute restraint stress and cocaine self-administration. Because of these coincident neuroadaptations, we hypothesized that an odor paired with acute restraint stress would reinstate drug seeking and chose two mechanistically distinct drugs of abuse to test this hypothesis: alcohol and cocaine. Rats were trained to self-administer either drug beginning 3 weeks after odor pairing with acute stress or sham, and acute restraint stress increased alcohol consumption. Following context extinction training, the stress-paired odor reinstated both alcohol and cocaine seeking, while an unpaired odor had no effect. N-Acetylcysteine (NAC) restores drug and stress-induced reductions in glial glutamate transporter-1 and has proven effective at reducing cue-induced reinstatement of drug seeking. We administered NAC for 5 days prior to reinstatement testing and abolished the capacity of the stress-paired odor to increase alcohol and cocaine seeking. Importantly, daily NAC given during or just following experiencing acute restraint stress also prevented the capacity of stress-paired odors to reinstate alcohol and cocaine seeking and prevented stress-induced deficits in behavioral flexibility. These data support using daily NAC treatment during or immediately after experiencing a strong acute stress to prevent subsequent conditioned stress responding, in particular relapse and cognitive deficits induced by stress-conditioned stimuli.

Maternal role strain and depressive symptoms among female sex workers in Mexico: the moderating role of sex work venue

ABSTRACTStressors that arise in parenting are likely to have an adverse impact on the psychological well-being of female sex workers (FSWs), particularly in low- to middle-income countries (LMIC). This study examined the association between maternal role strain and depressive symptoms among 426 FSW mothers with dependent-age children (aged < 18 years) in Tijuana and Cd. Juarez, Mexico (2016–2017). Four dimensions of maternal role strain (e.g., child emotional and behavioral problems) were examined in relation to maternal depressive symptoms. We also investigated whether the relationship between maternal role strain and depressive symptoms was modified by venue of sex work. Compared to indoor/establishment-based FSWs, street-based FSWs reported significantly more child-related financial strain. In multiple regression analysis, having more depressive symptoms was associated with identifying as a street-based FSW, greater use of drugs, lower emotional support, more child-related financial strain and more emotional and behavioral problems in children. A significant interaction was identified such that the association between maternal role strain and depressive symptoms was stronger for indoor/establishment-based compared to street-based FSWs. These findings suggest the need to address parenting strain and type of sex work venue in the development of counseling programs to improve the mental health of FSWs in LMIC.

Peripheral Manifestations in Spondyloarthritis and their Effect: An Ancillary Analysis of the ASAS-COMOSPA Study.

To determine the factors associated with the presence of peripheral manifestations in patients with spondyloarthritis (SpA) from the Assessment in SpondyloArthritis international Society (ASAS)-COMOSPA study, and to evaluate the effect of these symptoms on treatment and patient-reported outcomes (PRO). All patients from the ASAS-COMOSPA study were included. All patients had an SpA diagnosis according to the rheumatologist. Patients and disease characteristics associated with the presence of these peripheral manifestations (peripheral arthritis, peripheral enthesitis, or dactylitis) were analyzed by univariate and multivariate logistic regression. Patients who reported peripheral manifestations were divided into 3 categories: current, history, and no history. The effect of peripheral involvement on PRO was evaluated through the use of 1-factor ANOVA. Out of the 3984 patients included in ASAS-COMOSPA, 2562 (64.3%) reported at least 1 peripheral manifestation, with a prevalence of 51.5%, 37.8%, and 15.6% for peripheral arthritis, peripheral enthesitis, and dactylitis, respectively. Being from South America, having a history of uveitis, having a current case or history of psoriasis, and the absence of HLA-B27 were associated with higher prevalence of peripheral manifestations. Patients with peripheral involvement showed greater use of drugs, and those with "current" peripheral manifestations showed higher levels in all PRO, in contrast to those with past or no history. Peripheral manifestations appear in 64% of patients with SpA. Psoriasis and the absence of HLA-B27 are associated with the development of peripheral symptoms. The presence of any peripheral symptom at the time of the visit was associated with higher scores in all PRO.

Understanding Intersectionality and Resiliency among Transgender Adolescents: Exploring Pathways among Peer Victimization, School Belonging, and Drug Use.

Transgender youth experience elevated levels of victimization and may therefore report greater drug use than their cisgender peers, yet little is known about protective factors like school belonging that may mediate this relationship. Further, scant research has explored the experiences of youth at the intersection of transgender identity and youth of color status or low socioeconomic status, especially with respect to these multiple minority statuses’ associations with peer victimization, drug use, and school belonging. Using data from the California Healthy Kids Survey, the current study employs structural equation modeling to explore the relationships among school belonging, peer victimization, and drug use for transgender youth. Findings indicate that school belonging does mediate the pathway between peer victimization and drug use for transgender youth and that although youth of color experience greater victimization, they do not engage in greater drug use than their white transgender peers. Based on these results, those concerned with the healthy futures of transgender youth should advocate for more open and affirming school climates that engender a sense of belonging and treat transgender youth with dignity and fairness.

Lack of efficacy in a randomised trial of a brief intervention to reduce drug use and increase drug treatment services utilisation among adult emergency department patients over a 12-month period

ObjectivesAssess the 12-month efficacy of a brief intervention (BI) on reducing drug use and increasing drug treatment services utilisation among adult emergency department (ED) patients.MethodsThis randomised, controlled trial enrolled 18–64-year-old...