Non-drug Users Research Articles

Distribution of Hepatitis C Virus (HCV) Genotypes Among Intravenous Drug and Non-Drug User Patients

Genotype distribution of hepatitis C virus (HCV) can vary over the years between different patient groups and regions. The prevalence of intravenous drug users (IVDU) is known to increase in our country, yet there are a limited number of studies investigating the distribution of HCV genotypes in this group. These data are essential for monitorization of the changes in HCV epidemiology. The present study aimed to evaluate the five-year results of HCV genotyping among patients infected with HCV related to IVDU and unrelated to drug use. Plasma samples of 720 patients (HCV antibody, HCV RNA positive), which were sent to our laboratory for HCV genotyping between January 2014-March 2019 were analyzed. HCV RNA extraction from plasma samples was performed in the automated-extraction system of EZ1 advanced (Qiagen, Germany) using the EZ1 virus mini kit v2.0 (Qiagen, Germany). Amplicons were obtained by amplifying the 5'NCR and core gene region in the Rotorgene 6000 real-time PCR (Qiagen, Germany) device with the HCV RNA real-time quantitative 2.0 (NLM, Italy) kit. For the genotyping, a commercial line probe assay (LIPA) based on in vitro reverse hybridization GEN-C2.0 kit (NLM, Italy) which can distinguish 1, 2, 3, 4, 6 genotypes and 1a, 1b, 2a/c, 2b, 3a, 3b, 3c, 3k, 4a, 4b, 4c/d, 4e, 4f, 4h, 5a, 6a/b, 6g, 6f/q, 6m, 7a subtypes of HCV, based on variations in the 5'-NCR and core regions was used. HCV genotype distribution of 266 IVDU (93.2%: male; median age: 25 ± 6.82) and 454 non-drug users (51.3%: male; median age: 56.5 ± 16.06) were examined. In order of frequency in the group with IVDU; genotype 1a, 3a, 1b, 4c/d, 2b, 4, 3 were observed and genotype 1, 2a/c and mixed genotype (1+3a) were detected in one patient. In the group without IVDU, in order of frequency; genotype 1b, 1a, 3a, 1, 2a/c, 4 were observed and genotype 2b, 4c/d, 5a, 6a/b, 6 and mixed genotype (3+4) were detected in one patient. Genotypes 1a and 3a were significantly higher in the IVDU group (p< 0.00001, p< 0.00001), while 1b was significantly higher in patients without IVDU (p< 0.00001). Genotypes 1a and 3a were more common in young men (p< 0.00001, p= 0.000163), while 1b was higher in middleaged women (p< 0.00001). The incidence of genotypes 1b (p= 0.021) and 3a (p= 0.012) was higher in foreign nationals than the Turkish patients. When the HCV genotype distribution was examined by years, it was observed that the percentages of genotype 1b and 1a were decreasing, while the percentage of genotype 3a was increasing. As a result, in this study, HCV genotype distribution among IVDU was observed to be different from the general population without IVDU. It was found that genotypes 1a and 3a were more common in the IVDU group. As in the other regions of our country, genotype 1b was found most frequently in the general population. Genotype 3a increases significantly compared to years. In our study, the determination of genotypes existing in different parts of the world may be due to the foreign nationals living in our city and our region is a tourism center. It is also necessary to investigate whether there is an increase in IVDU over the years.

Noradrenergic correlates of chronic cocaine craving: neuromelanin and functional brain imaging

Preclinical studies have implicated noradrenergic (NA) dysfunction in cocaine addiction. In particular, the NA system plays a central role in motivated behavior and may partake in the regulation of craving and drug use. Yet, human studies of the NA system are scarce, likely hampered by the difficulty in precisely localizing the locus coeruleus (LC). Here, we used neuromelanin imaging to localize the LC and quantified LC neuromelanin signal (NMS) intensity in 44 current cocaine users (CU; 37 men) and 59 nondrug users (NU; 44 men). We also employed fMRI to investigate cue-induced regional responses and LC functional connectivities, as quantified by generalized psychophysiological interaction (gPPI), in CU. Imaging data were processed by published routines and the findings were evaluated with a corrected threshold. We examined how these neural measures were associated with chronic cocaine craving, as assessed by the Cocaine Craving Questionnaire (CCQ). Compared to NU, CU demonstrated higher LC NMS for all probabilistic thresholds defined of 50–90% of the peak. In contrast, NMS of the ventral tegmental area/substantia nigra (VTA/SN) did not show significant group differences. Drug as compared to neutral cues elicited higher activations of many cortical and subcortical regions, none of which were significantly correlated with CCQ score. Drug vs. neutral cues also elicited “deactivation” of bilateral parahippocampal gyri (PHG) and PHG gPPI with a wide array of cortical and subcortical regions, including the ventral striatum and, with small volume correction, the LC. Less deactivation of the PHG (r = 0.40, p = 0.008) and higher PHG-LC gPPI (r = 0.44, p = 0.003) were positively correlated with the CCQ score. In contrast, PHG-VTA/SN connectivity did not correlate with the CCQ score. Together, chronic cocaine exposure may induce higher NMS intensity, suggesting neurotoxic effects on the LC. The correlation of cue-elicited PHG LC connectivity with CCQ score suggests a noradrenergic correlate of chronic cocaine craving. Potentially compensating for memory functions as in neurodegenerative conditions, cue-elicited PHG LC circuit connectivity plays an ill-adaptive role in supporting cocaine craving.

The Seroprevalence of COVID-19 in Intravenous Drug Users in Comparison to Non-drug Users.

BACKGROUNDCOVID-19 infection has led to a worldwide pandemic, and new cases are on the rise. Intravenous drug users (IVDU) are presumably at a higher risk of being infected since they have poor personal hygiene, live in groups, and have risky behaviors. The current study aimed to evaluate the seroprevalence of COVID-19 in IVDU in comparison with non-drug users (N-DU).METHODS This cross-sectional study was conducted on 167 IVDU and 134 N-DU. A questionnaire gathering data on demographics, comorbidities, and use of personal protective equipment was administered to all participants. In addition, 5 cc of blood was taken from each individual to test for SARS-CoV-2 specific antibodies (Pishtaz Teb SARS-Cov-2 ELISA kits).RESULTSThe mean age of N-DU and IVDU were 38.9 ± 12.9 and 40.38 ± 10.24 years, respectively. COVID-19 seroprevalence in IVDU was 9.7%, and 4.8% in N-DU, but this finding was not statistically significant (p = 0.096).CONCLUSION While the seroprevalence of COVID-19 was not significantly different among the two groups, IVDU should still be considered by policymakers as a high-risk group due to their lifestyle and risky behaviors. Providing personal protective equipment and other means of protection and treatment to this population can help mitigate the spread of and mortality from COVID-19.

Increases in erythrocyte DHA are not associated with increases in LDL-cholesterol: Cooper center longitudinal study

BackgroundThe effects of fish oil products containing docosahexaenoic acid (DHA) on LDL-C levels are controversial. ObjectiveTo determine if changes in erythrocyte DHA are associated with changes in LDL-C levels. MethodsIn this prospective observational study, erythrocyte DHA levels and LDL-C levels were measured in 9253 individuals who presented for at least two examinations at a medical clinic. Changes in DHA levels and the reported use of omega-3 dietary supplements were correlated with changes in LDL-C in multi-variable adjusted models including the use of LDL-C-lowering drugs. ResultsMean (standard deviation) age at baseline was 52.6 (10.6) years, and the time between exams averaged 1.9 (1.4) years. As a group, erythrocyte DHA increased from 5.0% (1.3) to 5.3% (1.3) (p < 0.001), and LDL-C was not significantly changed (109 (33) to 108 (33) mg/dL, p = 0.875). However, in multivariable-adjusted models of within-participant changes, a 1% increase in erythrocyte DHA was associated with a 1.9 mg/dL reduction in LDL-C (95% confidence interval (1.6, 2.2), p < 0.001). Similar relationships were seen with changes in erythrocyte EPA and EPA + DHA. In adjusted analyses, an increased use of omega-3 supplements was associated with a significant increase in erythrocyte DHA and a decrease in LDL-C in both users and non-users of lipid-lowering drugs. ConclusionsIn a predominantly male, normolipidemic, middle-aged cohort, increases in erythrocyte DHA were associated with decreases in LDL-C, and initiating fish oil supplement use did not increase LDL-C. These findings may serve to reassure individuals who, in adopting a more heart-healthy lifestyle, want to increase their omega-3 fatty acid intake.

Differential effects of stimulant versus opiate drugs on driving performance

Background and AimsPharmacological differences among different drug classes influence human cognition, visual, and motor behavior in different ways. These differences impact driving safety, and therefore individuals who use stimulant and opioid drugs might experience different patterns in driving safety and impairment in driving performance. This study examined the effect of long-term use of stimulant drugs and of opiate drugs on driving performance, hazard perception, visual search skills and psychomotor skills related to driving. MethodsA total of 75 individuals, including 28 predominantly stimulant users, 22 predominantly opiate users and 25 healthy non-drug users, participated. Driving performance and psychomotor skills were assessed via a 15-minute drive in a simulator; hazard perception was assessed via a computerized task; and visual search skill was assessed by eye tracking. ResultsANOVA analyses indicate both stimulant and opiate users drove at higher speeds and experienced more crashes than the healthy non-drug users. Stimulant but not opiate users violated red light regulations more often than the healthy non-drug users. In the hazard perception task, stimulant drug users performed more poorly than both opioid drug users and healthy non-drug users. Specifically, they had lower saccade movement scores and higher average fixation times. ConclusionsResults confirm that both stimulant drug users and opiate drug users show impaired driving performance compared to healthy non-drug users. Stimulant drug users possessed poorer hazard perception skills compared to the opiate users and the control group, perhaps as a result of cognitive deficits created by the drug use.

Clinical and immunological characteristics of bacterial pneumonia associated with HIV infection coupled to drug addiction

Bacterial pneumonia holds the second place after respiratory tuberculosis in patients with HIV infection. In recent years, sexual transmission of HIV was replaced by injection drug route. It seems of high relevance to advance medical aid to patients with HIV infection and bacterial pneumonia depending on psychoactive substance use.Aim of study — assessment of clinical and immunological manifestations of bacterial pneumonia coupled to HIV infection with respect to verified injection drug use.Materials and methods. Clinical and immunological data collected from 224 patients with HIV infection and pneumonia were retrospectively analyzed: group 1 group — 70 patients with HIV infection, IDU, verified bacterial pneumonia; group 2 — 16 injecting drug users (IDU) with HIV infection and pneumonia of unverified etiology; group 3 — 65 patients with HIV and bacterial pneumonia of verified etiology without injection drug use, group 4 — 73 patients with HIV infection and bacterial pneumonia of unverified etiology, without injection drug use. The data obtained were analyzed by using software Statistica 13.3. Methods of descriptive statistics with calculation of nonparametric criterion — the Kruskall—Wallis test (H-criterion) and χ2 test — were used.Results. Immunological manifestations of HIV infection and bacterial pneumonia were characterized by decreased count of CD4+ cells paralleled with increased count of CD3+ and CD8+ cells at higher magnitude without injection drug use being also featured with peak viral load upon developing pneumonia. Bacterial pneumonia coupled to HIV infection showed clinical manifestations similar both in injecting drug users and non-users, proceeding in 10% cases during normothermia. Injection drug user patients often demonstrated clinical picture of pneumonia resembling those found in sepsis such as pain in the body, muscles, bone aches untypical to HIV-sexually infected subjects. In addition, systolic murmur on a heart top was more often auscultated in this patient group.Conclusion. Subjects self-considered healthy being at risk of sexually transmitted infections should examined for HIV. All subjects manifested with symptoms of the lower airway tract infections in admission department should not be rejected to be hospitalized and undergo chest X-ray examination.

Salivary proteome analysis of crack cocaine dependents

ObjectiveSalivary proteomic analysis may help to understand physiopathological changes in crack cocaine dependents. This study aimed to compare the salivary protein profile between crack cocaine dependents and non-drug users. DesignNine heavy smokers and alcohol consumers men admitted to rehab due to crack cocaine abuse and nine non-drug users age-matched men were evaluated. Unstimulated whole saliva was collected. Proteomic analysis was performed by mass spectrometer. Data were processed using ProteinLynx GlobalServer software. Results were obtained by searching the Homo sapiens database from the UniProt catalog. The search tool IBI-IMIM was used to identify proteins candidates for biomarkers. ResultsThe mean age of crack cocaine and control groups was 36.89 ± 7.78 and 35.78 ± 6.68 years, respectively. 458 salivary proteins were identified in both groups; 305 proteins in the crack cocaine group. Among the 68 proteins presented in both groups, 29 were down-regulated (i.e. “Statherin” and “Transforming growth factor-beta-induced protein ig-h3” were down-regulated at least 10-fold) and 27 up-regulated (i.e. “Negative elongation factor” was up-regulated 19-fold) in the crack cocaine group compared to controls. 90 out of the 458 proteins found in the proteomic analysis were identified as candidates for biomarkers of diseases. Among these, 65 (72.22 %) were detected in the crack cocaine group. ConclusionCrack cocaine dependents with chronic alcohol and tobacco use have a higher number of proteins in saliva compared to non-drug users. 22.3 % of salivary proteins present in crack cocaine dependents were present in controls; 3.9 % of them were expressed in similar quantity.

No Increase in HIV Drug Resistance Mutations among Injecting Drug Users on Methadone Maintenance Therapy: A Prospective Cohort Study.

Whether HIV-positive injecting drug users (IDUs) are at higher risk of developing drug resistance mutations (DRMs) after methadone maintenance therapy (MMT) than any other HIV-positive population is unclear. To compare the incidence of new DRMs in two population groups: antiretroviraltreatment (ART) HIV-positive IDUs and non-drug users. A prospective cohort of ART HIV-positive patients including IDUs who received MMT (MMT group) and non-drug users (N-MMT group) was established from April 2016 to December 2017 in Guangxi, China. Of the 80 participants, 43 were in the MMT group and 37 were in the N-MMT group. Compared with the N-MMT group, the HRs of PIs, NRTIs and NNRTIs for new DRMs in the MMT group was 1.55 (95%CI: 0.28-8.64; P = 0.616), 1.51 (95%CI: 0.44-5.20; P = 0.512) and 0.45 (95%CI: 0.15-1.35; P = 0.155), respectively. There was no dose-response relationship between MMT and new DRMs for PIs, NRTIs and NNRTIs (P > 0.05). The new DRM incidence for NRTIs (138.23 per 104 person-months) was higher than for PIs (94.16 per 104 person-months) and NNRTIs (95.41per 104 person-months) in the MMT group, while the new DRM incidence for NNRTIs (208.24 per 104 person-months) was higher than for PIs (44.13 per 104 person-months) and NRTIs (91.78 per 104 person-months) in the N-MMT group. Among ART HIV-positive patients, there is no significant difference in the incidence of new DRMs between IDUs receiving MMT and non-drug users. MMT has little impact on the development of DRMs among IDUs.

Illegal drugs, education, and labor market outcomes

In this paper we investigate the causal effects of consuming illegal drugs on educational attainment, employment, and wages. To identify these effects we develop and estimate a dynamic structural model to jointly consider decisions of whether to consume drugs, attend school, participate in the labor force, and save.Using data from the National Longitudinal Survey of Youth 1997 (NLSY97), we focus our analysis on males; the period of analysis begins at age 13, when they are young enough to have had no experience with drugs. Contrary to findings in the literature, non-drug users have higher wages than marijuana and/or hard drug users. This effect is small for individuals who consume marijuana in low doses but increases with the frequency of drug use. Results from a counterfactual experiment suggest that a 30 percent increase in the price of marijuana each period would reduce the number of marijuana consumers among the 13- to 30-year-olds by 16 percent. Individuals who are dissuaded from consuming marijuana due to the higher price would increase their level of education, their annual income, and work more.

Sarcopenia and COVID-19: A Manifold Insight on Hypertension and the Renin Angiotensin System.

Sarcopenia and COVID-19: A Manifold Insight on Hypertension and the Renin Angiotensin System.

The Effect of Systemic Corticosteroid Use on the pH and Viscosity of Saliva

Background: Systemic corticosteroid use is undeniable for many patients, and many require long-term use of such drugs. Corticosteroids have adverse and irreversible effects on all organs of the body. One of these complications that have not been studied fully is the drug effect on salivary gland function and the quantity and quality of saliva. Some of the many properties of saliva affected by these drugs are saliva pH and viscosity changes and, therefore, its effect on oral health. Methods: This study was performed on 90 cumulative saliva samples containing three groups of corticosteroid users, including more than 15 mg/day, corticosteroid users less than 15 mg/day, and healthy and non-drug users. Each group contained 30 samples. The unstimulated cumulative saliva of volunteers was collected by spitting method for 5 minutes, and the pH of the samples were measured by digital pH meter, and the viscosity of the samples was calculated based on the comparison of the amount of movement of saliva in the capillary tube in millimeter per second with the control fluids. Statistical analysis was performed by Statistical Package for Social Sciences (SPSS V. 18) software and the analysis of variances (ANOVA), Tukey’s multiple comparisons, or their nonparametric equivalents tests were used. Results: The viscosity of saliva in patients with corticosteroid &gt; 15 mg/day was higher than the healthy subjects (P = 0.028). Also, salivary pH in patients taking corticosteroid &lt; 15mg/day was lower than healthy ones (P = 0.017). There was no significant relationship between gender with pH and salivary viscosity (P = 0.933). Conclusions: Long-term consumption of corticosteroids reduces the pH of saliva and increases its viscosity. Therefore Corticosteroids can cause quantitative and qualitative changes in saliva. It also can affect oral and dental health. Hence, the oral health of people taking corticosteroids should be more noticed.

137-OR: Trends in Lipid Levels Relative to Lipid-Lowering Drug Use among Danish Type 2 Diabetes Subjects

Background: Lipid-lowering treatment is crucial in preventing cardiovascular disease in type 2 diabetes subjects. It is unknown how well treatment guidelines translate into clinical practice. We examined measured lipid levels in relation to use of lipid-lowering drugs among type 2 diabetes subjects in Denmark from 2010 to 2017. Methods: The study population consisted of 404,389 subjects with type 2 diabetes living in Denmark between 1996 and 2017 identified using the Danish Diabetes Register. Redemptions of prescribed lipid-lowering drugs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels was sourced from the National Laboratory Database containing detailed information on laboratory measurements at major clinical laboratories since 2010. A drug-exposure function was developed and applied to examine follow-up of lipid-lowering drug coverage at any given time based on the redeemed amount and dose of lipid-lowering drugs. Annual mean lipid levels were obtained by calculating the mean lipid measurement value per subject, per calendar year, and per lipid type. Proportions of subjects within LDL thresholds were calculated according to thresholds defined by 2019 European Society of Cardiology dyslipidemia guidelines. Results: In total, 64% of subjects redeemed at least two prescriptions of lipid-lowering drugs during the study period. A decline in levels of total-cholesterol and LDL was observed in the years from 2010 to 2017 in users and non-users of lipid-lowering drugs. Annual mean LDL levels were lower among lipid-lowering drug users compared with non-users (in 2017: 1.84 and 2.57 mmol/L, respectively). A greater fraction of lipid-lowering drug users achieved the LDL goal of &amp;lt;1.8 mmol/L compared with non-lipid-lowering drug users (in 2017: 51.7% and 19%, respectively). Conclusions: Lipid-lowering drug use and LDL levels are far from optimal in the Danish type 2 diabetes population and constitute a large potential for improvement. Disclosure H. Amadid: None. M. Bekker-Nielsen Dunbar: None. P.F. Rønn: Research Support; Self; Amgen, Danish Diabetes Academy. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. J.S. Knudsen: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk A/S. F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; Amgen, AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp &amp; Dohme Corp., Mundipharma International, Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S. Funding Amgen Inc.

Non-medical prescription opioid use among US youth: 2015-2018

ABSTRACT Background Non-medical opioid use (NMOU) is a national public health concern with no signs of abating. While much research has focused on opioid use among adults, significant gaps exist on NMOU among youth. Objective The present study sought to identify the prevalence and correlates to NMOU use among a national sample of US youth ages 12–17 years old over multiple years of data. Methods The National Survey on Drug Use and Health, a repeated, cross-sectional, nationally representative survey of youth and adults in the US, was analyzed. Aggregated NSDUH data (2015–2018) was used to analyze NMOU among 54,866 youth (28,032 males, 26,834 females). Weighted analyses were conducted to determine significant associations to past-year non-medical opioid use. Results Weighted analyses revealed that 3.36% of youth used opioids non-medically in the past year. Compared to 2015, there was a significant decrease in the odds of past-year use in 2017 and 2018. NMOU users tended to be African American, Hispanic, reported major depression in the past year, and engaged in fighting with other youth. Compared to non-users of illegal drugs, youth who used marijuana, alcohol, and cigarettes were more likely to use opioids in the past year. Conclusion The present study found that opioid use is declining among youth. Findings may aid harm reduction efforts, theory-based clinical interventions, and health prevention messaging on opioid use.

Parâmetros maternos e perinatais após intervenções não farmacológicas: um ensaio clínico randomizado controlado

Resumo Objetivo Analisar os efeitos do banho quente, de exercicios perineais com bola suica ou de ambos durante o trabalho de parto em parâmetros maternos e perinatais. Metodos Ensaio clinico randomizado controlado incluindo 101 gestantes de baixo risco admitidas em dois centros obstetricos entre junho de 2013 e fevereiro de 2014 com idade minima de 18 anos, gestacao a termo, feto unico em apresentacao cefalica, dilatacao cervical entre 3 e 8 cm, escala de dor ≥5, sem patologias clinicas ou obstetricas ou doenca mental, nao usuarias de drogas psicoativas ou de corticosteroides naturais ou sinteticos, e que nao fizeram uso de produtos de tabaco, cafeina e analgesicos duas, quatro e seis horas antes de serem incluidas no estudo. Os arâmetros maternos e perinatais foram avaliados antes e 30 minutos apos as intervencoes, incluindo: pressao arterial materna, frequencia cardiaca e respiratoria, contratilidade uterina, dilatacao cervical, frequencia cardiaca fetal, linha de base, variabilidade, aceleracoes e desaceleracoes usando cardiotocografia e escala de Apgar (no 1o e 5o minutos apos o nascimento). Os participantes foram alocados aleatoriamente em tres grupos: A) banho quente (33); B) bola suica (35); e C) intervencoes combinadas (33). Resultados Em relacao aos parâmetros maternos, a pressao arterial sistolica foi mantida abaixo de 100 mmHg, com um pequeno aumento no grupo B. A pressao arterial diastolica diminuiu em todos os grupos, mantendo-se, contudo, acima de 70 mmHg. A frequencia cardiaca apresentou diminuicao nos grupos B e C e esteva acima de 80 bpm. A frequencia respiratoria ficou acima de 20 rpm em todos os grupos apos as intervencoes, enquanto a dilatacao cervical foi de 5,0 cm em media antes das intervencoes com aumento de 1,3 cm apos as intervencoes em todos os grupos. Em relacao aos parâmetros fetais, 90% dos fetos em todos os grupos apresentaram frequencia cardiaca normal nos dois periodos avaliados, aceleracoes transitorias estiveram presentes em mais de 80% dos fetos em todos os grupos em ambos os periodos analisados. Nao foi constatada desaceleracao antes da intervencao em aproximadamente 58,4% dos casos. Observou-se desaceleracoes em 52,5% dos casos, principalmente nos grupos A e B. A variabilidade foi normal em mais de 80% dos casos, e um valor <7 na escala de Apgar no primeiro minuto apos o nascimento so foi observado em 14 casos. Nao foram encontradas diferencas significativas na pressao arterial e frequencia cardiaca materna e fetal, incluindo a ocorrencia de aceleracoes transitorias, variabilidade ou desaceleracoes e valores na escala de Apgar tanto na analise inter e intragrupo quanto nos periodos avaliados. Ao comparar os parâmetros maternos antes e 30 minutos apos as intervencoes, observou-se aumento na frequencia respiratoria (p=0,037) e na dilatacao cervical (p<0,001) em todos os grupos de intervencao. Na analise intergrupo, a progressao do trabalho de parto estimulada dos grupos A (p=0,041) e C (p=0,021) em relacao as contracoes uterinas aumentou em comparacao com o grupo B. Conclusao As intervencoes isoladas ou combinadas sao uma forma segura de assistencia ao parto uma vez que elas nao afetam negativamente os parâmetros maternos e perinatais.

Use of cannabis and opioids for chronic pain by older adults: Distinguishing clinical and contextual influences

Chronic pain is one of the most common health-related conditions experienced by Americans over the age of 65. In this study, we examine the intersection between pain, opioids and cannabis use among older adults in Colorado and Illinois and examine how medical needs and other variables associated with a persons' background and attitudes influence choices concerning the use of opioids and cannabis to treat pain. Data were collected via a survey about cannabis and opioids use, and questions related to individual need factors (e.g. pain, quality of life) and contextual factors (e.g. sex, finances, personal attitudes, interaction with physicians) were included in this study. We built a logistic regression model to evaluate factors associated with drug use and a multinomial regression model to understand factors that influence drug choices between cannabis and opioids. A total of 436 individuals completed the survey; 62 used opioids only, 71 cannabis only and 72 used both. When comparing drug users to non-drug users, pain was significantly associated with using cannabis and/or opioids when controlling for other covariates. However, when we compared cannabis users to opioid users, pain was no longer a determining factor. Instead, other contextual factors such as sex, personal beliefs and physician attitudes influenced an individual's choice between cannabis or opioids. This study showed that contextual factors appear to have more influence on an individual's decision to use cannabis as an alternative to opioids than individual need or characteristics.

Striatal and white matter volumes in chronic ketamine users with or without recent regular stimulant use

BackgroundPrevious studies found enlarged striatum and white matter in those with stimulants use disorders. Whether primarily ketamine users (Primarily-K) and ketamine users who co-used stimulants and other substances (K+PolyS) have abnormal brain volumes is unknown. This study aims to evaluate possible brain structural abnormalities, cognitive function and depressive symptoms, between Primarily-K and K+PolyS users. MethodsStriatal and white matter volumes were automatically segmented in 39 Primarily-K users, 41 K+PolyS users and 46 non-drug users (ND). Cognitive performance in 7 neurocognitive domains and depressive symptoms were also evaluated. ResultsKetamine users had larger caudates than ND-controls (Right: 1-way-ANCOVA-p=0.035; K+PolyS vs. ND, p=0.030; Linear trend for K+PolyS>Primarily-K>ND, p=0.011; Left: 1-way-ANCOVA-p=0.047, Primarily-K vs. ND p=0.051) and larger total white matter (1-way ANCOVA-p=0.009, Poly+K vs. Primarily-K, p=0.05; Poly+K vs. ND p=0.011; Linear trend for K+PolyS>Primarily-K >ND, p=0.004). Across all ketamine users, they performed poorer on Arithmetic, learning and memory tasks, and were more depressed than Non-users (p<0.001 to p=0.001). Greater lifetime ketamine usage correlated with more depressive symptoms (r=0.27, p=0.008). Larger white matter correlated with better learning across all participants (r=0.21, p=0.019), while larger right caudate correlated with lower depression scores in ketamine users (r=-0.28, p=0.013). ConclusionKetamine users had larger caudates and total white matter than ND-controls. The even larger white matter in K+PolyS users suggests additive effects from co-use of ketamine and stimulants. However, across the ketamine users, since greater volumes were associated with better learning and less depressive symptom, the enlarged caudates and white matter might represent a compensatory response.

Drug Use and High-risk Sexual Behavior among School-Going Adolescents in Nigeria

BACKGROUND: Sexual risk behavior and drug abuse among adolescents and youths remained perpetual topical issues of focus in most developmental programs related to developing countries, especially in Nigeria, where the school-going adolescents constitute more than half of the youths. The high level of teenage pregnancy and sexual violence such as abuses and other harmful trajectories including STIs and HIV is increasingly reported than the pre-2000s.&#x0D; AIM: This study focuses on underscoring the variation in risky sexual behavior among school-going users and non-users of drugs. It also analyzed the predisposing factors of drug use among school-going adolescents in Nigeria.&#x0D; METHODS: In combination with problem behavior theory, the research draws data (n = 11,799) from the 2012 National HIV and AIDS and Reproductive Health Survey (NARHS Plus II) collated by the Federal Ministry of Health in Nigeria with support from the Department for International Development and United States Agency for International Development, to underscore the self-reported sexual risk behavior among students who are users and non-users of drugs.&#x0D; RESULTS: The result revealed that 32.5% (male) and 33.4% (female) use drugs. More than half of the respondents reported that they have engaged in sexual intercourse, 27.3% (male) and 31.8% (female) have had ≥2 lifetime sexual partners. There is higher odds ratio (OR) of risky sexual behavior among students that have ever used drugs or taken alcohol (OR = 2.2, 95% CI [1.8–2.8]) for male and (OR = 2.1, 95% CI [0.83–2.03]) for female.&#x0D; CONCLUSION: The study concludes that continued exposure of school-going youths to drugs or alcohol may pose serious challenge of risky sexual behavior and also severe threat to initiatives on zero new HIV infections or zero new AIDS death in Nigeria. The authors recommend that campaign to discourage drug or alcohol use should be intensified and introduced to all schools.

Infectious Endocarditis in the Elderly – Comparative Study of Clinical Features, Course and Outcomes

In the context of the increased incidence of infectious endocarditis (IE) in the elderly, an assessment of clinical features of IE in elderly patients is still controversial.Aim. To study the clinical features and outcomes of IE in patients aged ≥65 years.Material and methods. А comparative assessment of risk factors, etiology, clinical manifestations, outcomes was performed in 75 IE patients ≥65 years old and in 356 IE patients &lt;65 years old.Results. In patients ≥65 years old IE was more often associated with previous medical care (odds ratio [OR]=14.9; 95% confidence interval [95%CI] 8.6;25.9), infections and tumors of the genitourinary system or tumors of the gastrointestinal tract (OR=12.6; 95%CI 6.4;24.6); there were more concomitant oncological diseases (OR=66.2; 95%CI 19.3;226.8), diabetes mellitus (OR=9.9; 95%CI 4.5;22.1), chronic kidney disease (OR=27.0; 95%CI 13.6;53.3). In patients ≥65 years old compared with non-drug users IE patients &lt;65 years old (n=266), the incidence of enterococcal IE was higher (OR=3.3; 95%CI 1.4;7.9); the timing of IE diagnosis was longer – 60 (37;152) vs 30 (20;110) days (p&lt;0.05); cardiac surgery was performed less often (8% vs 24.8%; p&lt;0.05); in-hospital mortality was almost two-fold higher. However, with the exclusion from the mortality rate assessment of postmortem diagnosed IE cases in-hospital mortality in patients ≥65 years old and patients &lt;65 years old did not differ significantly (14.8% vs 12.2% in non-drug users &lt;65 years old and 14.9% in drug-users IE).Conclusion. Late diagnosis of IE and comorbidity, which limits the possibility of cardiac surgery, are the most important prognostic unfavorable features of IE in the elderly.

Economic crisis, unemployment and illegal drug consumption in Spain

Purpose The purpose of this paper is to analyse the association between drug consumption and unemployment. This paper also studies the differential association between these variables in both the pre- and current-crisis periods. The results are compared in an attempt to verify that the population of users is more vulnerable in terms of how likely they are to get and hold down a job in the labour market. Design/methodology/approach Matching methods and microdata from the Survey on Alcohol and Drugs in Spain, EDADES are used. The use of these methods on the estimates carried out prove to be particularly effective in reducing treatment-selection bias. The authors’ interest is also to analyse the differential association between the interest variables in both the pre- and current-crisis periods. For this purpose, the authors also use the differences-in-differences (DID) estimation method between the two periods to check if the impact of drug use on unemployment depends on the economic context. The estimations are compared in an attempt to verify that the population of users is less likely to attain and hold down a job in the labour market than non-drug users. Findings The results obtained in the current study are consistent with the hypothesis that drug use decreases an individual’s capacity and availability when he or she is trying to enter the labour market. In both 2007 and 2013, drug users were more likely to be unemployed, regardless of the type of drug. Differences in the probability of being unemployed intensify during an economic crisis. In light of these results, it is possible to conclude that the negative effect of drug consumption on an individual’s employability is increased during periods of economic recession. Research limitations/implications The study presented here has some limitations. Firstly, cross-sectional data were used to examine the causal relationship between consumption and employment. In this sense, the results are susceptible to bias. The unavailability of longitudinal data on the same individual made it impossible for the researchers to consider periods of abstinence, the duration of periods of consumption and how this consumption affected an individual’s productivity and his or her working situation. Another limitation is that certain relevant unemployment variables may have been omitted. Among the variables that affect an individual’s labour participation is the existence of sources of income as an alternative to market salaries. With state subsidies, income from illegal activities and money sent by family or friends, an individual may decide not to work. This problem could be mitigated if omitted variables operate in a similar way throughout both of the periods examined. Social implications Given the results obtained in this paper, the authors believe that public policy conclusions should be mainly concerned with the importance of implementing proactive employment policies, along with family support programmes and a greater role for primary care among the people with the highest risks of exclusion. Health treatment should go jointly with measures that make it easier for individuals to enter the workforce. These steps would only be possible with an improved level of education and more complete professional profiles, to increase motivation when individuals seek employment. Originality/value This study could make various contributions to the existing body of evidence. In the authors’ knowledge, this is the first attempt to document the effect of the economic crisis on the employability of the drug-using population in contrast with the general population. Moreover, a methodology is presented that provides an alternative to those used in earlier studies, in terms of reducing treatment-selection bias. At the same time, the use of a DID estimation method between pre- and current-crisis periods allow us to check if the impact of drugs consumption on unemployment depends on the economic context.

Pattern and associated factors of psychoactive substance use among undergraduate students in a North-eastern Nigerian University

Objective: There is an increased trend in the use of psychoactive substances among youths in Northern Nigeria. Youths use substances to enhance performances. Studies have shown associations between drug use and psychiatric morbidity. This study examined the use of psychoactive substances among undergraduates. It also assessed the presence of psychiatric morbidity among the users and nonusers of psychoactive drugs.&#x0D; Method: The study was a cross-sectional study using WHO Student Drug Use Survey Questionnaire and GHQ-12 for 983 undergraduates of a northern Nigeria university.&#x0D; Results: The prevalence rate of psychoactive substance use was 36.5%. Tobacco, stimulants and alcohol were commonly used drugs. Parental separation and fathers' use of drugs were factors associated with the use of psychoactive substances. Psychiatric morbidity among substance users and non-users were 31.0% and 11.8%&#x0D; Conclusion: The study found high rate for the use of psychoactive substances among the students with correspondingly high rate of psychiatric morbidity among the users of psychoactive substances.&#x0D; Keywords: Psychoactive substance; Psychiatric morbidity; undergraduate students.