Drug Use Research Articles

The Impact of Ramadan Fasting on Dyspeptic Complaints.

Dyspepsia, a common gastrointestinal issue characterized by upper abdominal discomfort, can be influenced by diet, medication, and lifestyle changes. Ramadan fasting involves refraining from food and drink from dawn to sunset, affecting various physiological processes, including digestion. The fasting period can range from 12 to 18 hours depending on the year, potentially impacting the prevalence of dyspeptic symptoms. This study aimed to assess the effect of fasting on dyspeptic symptoms, taking into account demographic and clinical factors. A cohort study examined 1258 clinic patients, with 150 meeting specific inclusion criteria. Dyspepsia was diagnosed using Rome IV criteria, with fasting hours taken into consideration. The relationship between dyspepsia, fasting, Non-Steroidal Anti-Inflammatory Drug use, and demographics was analyzed. Dyspepsia was more prevalent in females (32%) compared with males (23%), with a higher proportion of non-fasting women among dyspeptic patients. Older patients (>65y) had a higher prevalence of dyspepsia (P = 0.026). Fasting individuals had a 2.1 times greater likelihood of experiencing dyspeptic symptoms. Although Non-Steroidal Anti-Inflammatory Drug use was lower in fasting patients, no significant association with dyspepsia was observed (P = 0.139). Ramadan fasting increases the risk of dyspeptic symptoms, particularly in women and older adults. Factors such as medication timing and dietary changes during fasting may contribute to this risk. Highlighting the importance of the pre-dawn meal (Suhoor) in managing dyspeptic symptoms is essential. Tailored guidance should be provided to individuals at higher risk during Ramadan.

Use of Potentially Nephrotoxic Drugs in Type 2 Diabetes Patients on SGLT2i: A Trajectories Analysis.

To characterize trajectories of nephrotoxic potential (NxP) drug use among older adults with Type 2 Diabetes (T2D) treated with SGLT2is and identify associated patient characteristics. Using 2012-2019 Medicare data, we selected patients with T2D who filled at least one prescription for SGLT2is. Index date was the date of the first SGLT2i prescription filled. We quantified the number of drugs with NxP used every month during the first 12 months following the index date. The monthly counts of drugs with NxP were incorporated into the group-based trajectory model to identify groups with similar drug use patterns. Finally, we performed a multinomial logistic regression model to examine the association between patient characteristics and group membership. The study cohort comprised 8811 Medicare beneficiaries with T2D who initiated SGLT2i during the study period with the mean age 67.5 ± 10.6 years. We identified 3 trajectories NxP drug use: no (n = 2142, 24%), low (n = 4752, 54%) and high (n = 1917, 22%) use of drugs with NxP, with patients falling into these categories based on the number of drugs with NxP they used over the time: no drugs, one drug, or two or more drugs. Age, gender, low-income subsidy eligibility and clinical characteristics were associated with group membership. We successfully identified three trajectory groups, with a substantial proportion of patients showing low use of drugs with NxP. Both social and clinical factors were associated with the use of NxP drugs.

Intersecting Structural and Psychosocial Conditions: Investigating Injection Drug Use and HIV Among Transgender Women.

Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women than among cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women with a general sample of persons who inject drugs. Participants from the National HIV Behavioral Surveillance were recruited through respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics. Among 1561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (adjusted prevalence ratio = 1.5, 95% confidence interval: 1.2 to 1.8) than among those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (adjusted prevalence ratio = 0.8, 95% confidence interval: 0.7 to 1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%). Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to nonjudgmental and culturally competent harm reduction services.

Association between homelessness and PrEP uptake among men who have sex with men: Results from the American Men's Internet Survey, 2017-2021.

Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by housing insecurity across the US. This study examined the association between homelessness and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among GBMSM in the United States and investigated the modifying effect of injection drug use. 47,750 cisgender GBMSM who participated in the American Men's Internet Survey from 2017 to 2021 and who self-reported not living with HIV were included in this secondary, cross-sectional analysis. Homelessness was defined as living on the street, a shelter, a Single Room Occupancy hotel, or a car in the past 12 months. Associations between sociodemographic characteristics and homelessness were tested using chi-squared tests. Weighted univariable and multivariable Poisson regression models with robust variance estimation assessed associations between homelessness and PrEP uptake; weights were constructed based on race/ethnicity and region. 8304(17.4%) participants reported PrEP uptake in the last 12 months. Those experiencing homelessness were more likely to be younger, Black, uninsured, living in the US South, and report lifetime injection drug use. Homelessness was independently negatively associated with PrEP uptake (aPR=0.85; 95%CI: 0.75, 0.95). Homelessness was negatively associated with PrEP uptake in those not reporting injection drug use (aPR=0.77; 95%CI: 0.67, 0.90). However, homelessness was not associated with PrEP uptake in those reporting injection drug use. Homelessness was associated with lower PrEP uptake among GBMSM. Outreach and peer-based interventions tailored specifically to homeless GBMSM are needed given the disproportionate need. Future research on the impact of macro-level systems of inequality and individuals with marginalized identities are needed to unpack intersectional vulnerabilities.

Patterns of socioeconomic marginalization and non-fatal overdose among people who use drugs: A gender-stratified repeated measures latent class analysis.

While marked gender-based differences in drug-related risk and harm between men women who use drugs have been characterized to some extent, the complex relationship between gendered socioeconomic conditions, overdose risk, and drug use patterns and behaviours remains underexplored. We conducted gender-stratified repeated measures latent class analyses (RMLCA) with data from two ongoing cohorts of people who use drugs in Vancouver, Canada to identify discrete subgroups based on socioeconomic exposures. Multivariable generalized estimating equations models weighted by the respective posterior membership probabilities were applied to estimate the associations between socioeconomic class membership and non-fatal overdose. Sub-analyses investigated whether these relationships were explained by drug use-related variables. Between June 2014 and March 2020, 1723 participants provided 12120 observations. At study baseline, 1074 (62.3%) were men and 649 (37.7%) were women. In RMLCA, five distinct profiles of socioeconomic exposures emerged for men, and four emerged for women. Classes were presented in ascending order of socioeconomic disadvantage (i.e., ranging from Class 1 [least disadvantage] to Class 4/Class 5 [most disadvantage]) and were primarily distinguished by variations in income, material and housing in/security, participation in illegal/informal income generation, and criminal justice involvement. In analyses adjusting for demographic characteristics, for both men and women, progressive increases in exposure to multiple dimensions of disadvantage were positively and independently associated with non-fatal overdose when compared to the least socioeconomically disadvantaged subgroup. Subsequent analyses revealed that systematic differences in drug use patterns and behaviours across categories of socioeconomic disadvantage largely accounted for these relationships. Addressing multiple forms of mutually reinforcing health inequities may offer additional opportunity to mitigate non-fatal overdose in men and women who use drugs.

Factors associated with emergency department methicillin-resistant Staphylococcus aureus coverage in patients with skin and soft tissue infections in an urban, tertiary care emergency department.

Skin and soft tissue infections (SSTIs) are common and contribute significantly to morbidity and healthcare costs in emergency departments (EDs). The rise of antimicrobial resistance, particularly due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), complicates treatment decisions. Objective physical examination findings suggesting need for empiric MRSA coverage are sometimes ignored. Improving initial antimicrobial selection in the ED, especially regarding MRSA, could enhance antimicrobial stewardship. We conducted a retrospective review of patient records for those who presented with SSTIs to an urban tertiary care ED between January 1, 2017, to December 31, 2019. Patients admitted during their initial visit were excluded. Data collected included demographics, vital signs, and laboratory results. Logistic regression was used to assess factors associated with the decision to provide MRSA coverage at presentation, reporting odds ratios with 95% confidence intervals. Among 1675 patients, 42.2% received empiric MRSA coverage. Factors associated with MRSA coverage included male gender, white race, intravenous drug use, immunocompromised status, systemic symptoms, tachycardia, presence of abscess, and surgical consultation. After adjusting for confounders, male gender, history of intravenous drug use, immunocompromised status, systemic symptoms, tachycardia, surgical consultation, and recent antibiotic use remained significantly associated. Several factors, not always aligned with clinical guidelines, influenced the decision to initiate MRSA coverage in the ED. Understanding these determinants may improve antimicrobial stewardship and reduce costs. Future research should focus on patient outcomes based on methicillin-sensitive S. aureus (MSSA) versus MRSA coverage decisions and educational initiatives to improve guideline compliance.

Genomic structural equation modeling of reward-related traits: exploring the genetic factor structure and its relationship with psychopathology.

Reward sensitivity has a partial genetic background, and extreme levels may increase vulnerability to psychopathology. This study explores the genetic factor structure underlying reward-related traits and examines how genetic variance links to psychopathology. We modeled GWAS data from ten reward-related traits: risk tolerance (N = 975,353), extraversion (N = 122,886), sensation seeking (N = 132,395), (lack of) premeditation (N = 132,667), (lack of) perseverance (N = 133,517), positive urgency (N = 132,132), negative urgency (N = 132,559), attentional impulsivity (N = 124,739), motor impulsivity (N = 124,104), and nonplanning impulsivity (N = 123,509) to derive their genetic factor structure. A GWAS on this structure was performed, and polygenic scores (PGS) were generated to test associations with problems related to attention, hyperactivity, autism, aggression, mood, anxiety, alcohol use, smoking, and drug use problems in up to 78,000 individuals from the Dutch Lifelines Study. A two-factor model fit best - "reward interest" (openness to rewards) and "impulsivity" (pursuit of rewards with little consideration of consequences). The reward interest PGS was positively associated with hyperactivity, alcohol, smoking, and drug use, and negatively with autism spectrum problems. The impulsivity PGS was positively associated with all studied psychopathology. These findings demonstrate the feasibility of using related traits to investigate the dimensionality of reward sensitivity and how distinct aspects may be linked to different psychopathology domains.

Region-specific neuroadaptations of CRF1 and CRF2 expression following heroin exposure in female rats

While stress increases vulnerability to development of addiction, the recruitment of corticotropin releasing factor (CRF) with excessive drug use heightens the risk of stress-induced relapse. CRF signaling is transmitted via CRF1 and CRF2 receptors, but the roles of these receptors in heroin self-administration and related neuroadaptations of the CRF system within mesolimbic brain loci are not well understood. In this study, we first investigated the causal role of CRF1 and CRF2 receptors in heroin self-administration. Intracerebroventricular (ICV) microinjections of antalarmin (a CRF1 antagonist) or astressin-2B (a CRF2 antagonist) caused brief, dose-dependent reductions in heroin self-administration in female rats, suggesting that these receptors play a critical role in heroin-motivated behaviors. We then used western blotting to examine neuroadaptive changes to CRF1 and CRF2 receptor expression in key forebrain and midbrain regions associated with opioid addiction. Female Long Evans rats treated with escalating doses of heroin for 16 days demonstrated significantly higher naloxone-precipitated withdrawal symptoms than saline-treated rats. Heroin-treated rats showed a significant decrease in CRF1 receptor protein expression in the ventral tegmental area (VTA) and an increase in the nucleus accumbens (NAc) but no changes in the prefrontal cortex (PFC), insula, dorsal striatum (dSTR), dorsal hippocampus (dHippo), anterior hypothalamus (HYPTH), amygdala, or substantia nigra (SN) as compared to saline-treated rats. After chronic heroin exposure, CRF2 receptor expression was significantly downregulated in the dHippo, VTA and HYPTH but not in the other brain regions we investigated. The results of this study suggest that: (1) CRF1 and CRF2 receptors play an important role in self-administration and (2) heroin exposure may lead to region-specific neuroadaptation of CRF1 and CRF2 receptors. Such neuroadaptations might in part contribute to the continuation of drug use and stress-induced relapse.

Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with the use of antiseizure medications-An overview of clinical data.

The United States Food and Drug Administration (US FDA) released a warning regarding Drug Reactions with Eosinophilia and Systemic Symptoms (DRESS) linked to the use of antiseizure drugs, including levetiracetam and clobazam, on November 28, 2023. Hence, our review focuses on DRESS associated with the use of antiseizure drugs, including Levetiracetam, Clobazam, Carbamazepine, Phenytoin, Phenobarbital, Valproate, Oxcarbazepine, and Lamotrigine. The online databases, such as Medline/Pubmed/PMC, Scopus, Web of Science, Google Scholar, Science Direct, Ebsco, Embase, and reference lists, were searched for relevant publications. Several case reports and reviews of pharmacovigilance data by different regulatory bodies were published regarding DRESS associated with antiseizure drugs. Management strategies for DRESS may include immediate discontinuation of offending medication, administration of systemic corticosteroids, and administration of cyclosporine and intravenous immunoglobulin in cases that are not responding to systemic corticosteroids. Early detection and treatment of DRESS by healthcare professionals is necessary to lower mortality and improve outcomes. The US FDA advises healthcare professionals to be aware of the connection between DRESS and specific antiseizure medications. Patients should be informed by medical professionals about the symptoms and signs of DRESS as well as the risks associated with it. In conclusion, DRESS syndrome, though rare, is a serious hypersensitivity reaction linked to antiseizure drugs like levetiracetam and clobazam. Early detection and discontinuation of the offending drug, coupled with systemic corticosteroids, are essential for effective management. Healthcare professionals must be vigilant in identifying DRESS to reduce mortality and improve patient outcomes.

A Personalized Periodontitis Risk Based on Nonimage Electronic Dental Records by Machine Learning

Objective: This study aimed to develop a machine-learning model to predict the risk for Periodontal Disease (PD) based on nonimage electronic dental records (EDRs).Methods: By using EDRs collected in the BigMouth repository, dental patients from the US were included. Patients were labeled as cases or controls, based on PD diagnosis, treatment and pocketing. By learning from their data, a model was trained. The ability of the developed model to predict PD was evaluated by the accuracy, sensitivity, specificity and area under the curve (AUROC) and the most important features were determined. The best-performing model was applied to the validation set.Results: The final study population included 43,331 participants. Based on the development set, the Random Forest model performed with high sensitivity (81%) and had an excellent AUROC (94%), compared to four other ML and deep learning techniques. The most important predictors were bleeding proportion, age, the number of visits, prior preventive treatment, smoking and drugs usage. When the model was applied to the validation set, the model could detect almost all cases (91%), but overestimated controls (specificity=0.54). When EDRs were retrieved 3 years before the PD diagnosis, the predictions for PD were still sensitive (89%).Conclusion: Based on consistent and complete EDR, ML has an excellent ability to assist with the early detection and prevention of PD cases. Further research is required to follow-up high-risk controls and improve the model's internal and external validation. Improved EDR documentation is an important first step.Clinical significance: If such ML models become clinically applied, clinicians can be assisted with personalized risk predictions based on the individual. If the key riskcontributing factors for the individual are revealed/provided, ML can suggest targeted prevention interventions. These advancements can contribute to a reduced workload, sustainable EDRs, data-based dental care, and, ultimately, improved patient outcomes.

Prevalence of mental health conditions, substance use disorders, suicidal ideation and attempts, and experiences of homelessness among Veterans with criminal-legal involvement: A meta-analysis.

Veterans with histories of criminal-legal system involvement are considered high-priority within Veterans Health Administration (VHA) and criminal-legal settings. Over several decades, a large literature has accumulated to study these Veterans' needs. To consolidate findings, this meta-analysis provides aggregated prevalence estimates of common mental health conditions, substance use disorders, suicidal thoughts and behaviors, and experiences of homelessness among Veterans with current or prior involvement with the United States criminal-legal system. A total of 79 samples encompassing over 1.2 million Veterans were analyzed. Results estimate 8 in 10 Veterans with criminal-legal involvement experience a mental health condition, 7 in 10 a substance use disorder, 1 in 10 a history of suicidal ideation, and 4 in 10 a history of homelessness. Veterans with current (versus prior) criminal-legal involvement had higher rates of alcohol use, drug use, and current homelessness. Samples consisting of Veterans with a history of incarceration and samples collected in non-VHA settings tended to have lower rates of psychosocial difficulty relative to samples consisting of Veterans with other forms of criminal-legal involvement or collected in VHA settings, respectively. Remaining gaps in the literature include research on criminal-legal involved Veterans under community supervision, and/or from demographic minority groups.

Research on genetic variant characteristics in ADME genes based on whole-exome sequencing in the Han Chinese population.

Genetic variants in absorption, distribution, metabolism, and excretion (ADME) genes affect drug efficacy and side effects. Whole-exome sequencing (WES) effectively identifies these variants. Findings from Western populations may not apply to the Han Chinese population due to ethnic differences. This study aimed to investigate genetic variants, metabolic phenotypes, and drug impacts related to ADME genes in the Han Chinese population using WES data. ADME genes and drug profiles were sourced from multiple databases. WES data were collected from 357 samples at Third Xiangya Hospital and 5,000 samples from the "HuaBiao Project." After WES, fastp was used for quality control; BWA, samtools, and the Picard software were used for comparison, sequencing, and de-duplication; GATK was used for base quality score recalibration; and variant quality score recalibration was carried out after detecting the variants, and the variants were annotated using ANNOVAR. ADME genes and drug profiles were obtained through PharmGKB and other databases, and then all variants in the exonic regions of ADME genes were extracted. The distributional characteristics of these variants, ethnic differences, and metabolic phenotype distribution of important ADME genes, such as CYP2B6, were analyzed. Prediction of deleterious variants of ADME gene employed the ADME gene variant prediction framework, and western blotting and enzyme assays were used to validate the impact of harmful variants. We integrated 604 ADME genes and 972 drugs. There were 33,925 single nucleotide polymorphisms (SNPs) and 484 insertion-deletions (InDels) in 5,357 Han Chinese WES samples; 88.9 % were rare. Of the SNPs, 60.9 % are new functional mutations in enzyme and transporter genes; InDels also affected these genes. We discovered Chinese-specific variants in key ADME genes and ethnic-specific metabolic phenotypes that could affect drug use. Finally, we screened 3,657 potentially harmful mutations; 45.6 % are novel. Western blotting and enzyme activity assays confirmed several harmful mutations significantly reduced CYP2C19 gene expression and function (P < 0.01).

Sleep deprivation alters hepatic UGT1A9 and propofol metabolism in mice.

Sleep deprivation (SD) causes circadian misalignment, and circadian clock disruption is associated with metabolic diseases such as obesity, insulin resistance, and diabetes. However, the underlying mechanism for SD-induced circadian clock disruption as well as metabolic enzyme changes is still lacking. Here, we developed SD sensitizes mice with disrupted circadian rhythms to demonstrate the regulation role and mechanism of SD in UDP-glucuronosyltransferases (UGTs) expression and the metabolism of corresponding substrates. We found that UGT Family 1 Member A9 (UGT1A9) expression was significantly decreased in the liver of SD mice, which led to an elevation exposure and prolonged anesthesia effect of propofol, which was attributed to the decreased metabolism. Meanwhile, SD down-regulated basic helix-loop-helix ARNT like 1 (BMAL1) and its target clock genes period circadian clock (Per), cryptochrome circadian regulator (Cry), and nuclear receptor subfamily 1 group D member 1 (Rev-erb) expression in mice. Furthermore, the positive regulation of UGTIA9 mRNA and protein levels by Bmal1 was confirmed in hepatocyte-specific Bmal1-knockout mice (Bmal1-hkO) and Bmal1-overexpressed AML-12 cells. At last, through a combination of promoter analysis, luciferase reporter assay, and chromatin immunoprecipitation (ChIP) assay, it was conducted that Bmal1 regulates Ugtla9 expression by directly binding the -864bp E-box in Ugtla9 promotor or indirectly acting on the Rev-erbα- differentiated embryo chondrocyte 2 (Dec2) axis. In conclusion, our findings suggested that SD can lead to altered drug disposition and effects in vivo, and Bmal1 plays a crucial role in the crosstalk between SD-induced circadian clock disruption and drug metabolism. It initiates a new direction for the understanding of drug efficacy and toxicity changes in SD conditions and provides a scientific basis for improving the rationality of drug use.

Excess cardiometabolic risk in children and adolescents initiating antipsychotic treatment compared to young adults: results from a nationwide cohort study.

Antipsychotic treatment is associated with cardiometabolic risks that may be especially detrimental to children and adolescents. In this Danish population-based cohort study, we included individuals with psychiatric diagnoses who initiated antipsychotics in 2000-2021 at age 6-31 years. We assessed the risk of cardiometabolic adverse events up to 10 years following incident exposure to antipsychotics, compared to age- and sex-matched unexposed individuals with psychiatric diagnoses. Cox regression models were used to calculate hazard ratios (HRs) after adjustment using high-dimensional propensity scores, including age, sex, calendar time, hospital diagnoses, and prescription drug use. HRs were compared between incident exposure in youths (6-17 years) and young adults (18-31 years), and between incident exposure in children (6-11 years) and adolescents (12-17 years). The total cohort consisted of 335,093 individuals, including 36,092 subjects exposed to antipsychotics (children and adolescents: 8,547, mean follow-up: 6.8±3.2 years; young adults: 27,545, mean follow-up: 6.5±3.4 years) and 299,001 age-, sex- and calendar-matched unexposed subjects. The incidence rate of cardiometabolic events was higher for young adults initiating antipsychotics than for children and adolescents (23.2 vs. 14.1 events/1,000 person-years). However, the adjusted excess risk of cardiometabolic events was significantly higher in exposed compared to unexposed children and adolescents (HR=1.87, 95% CI: 1.71-2.05) than in exposed compared to unexposed young adults (HR=1.46, 95% CI: 1.40-1.51) (p<0.001). The excess risk of cardiometabolic events was even higher when antipsychotic treatment was initiated before age 12 years (HR=2.44; 95% CI: 1.99-2.98) than at age 12-17 years (HR=1.69, 95% CI: 1.52-1.87) (p=0.012). Concerning specific cardiometabolic outcomes, there was an effect of age at antipsychotic initiation on the risks of metabolic syndrome (p=0.011) and obesity (p<0.001), that were higher among children and adolescents than young adults. Thus, initiation of antipsychotic treatment before age 18 years is associated with an excess risk of cardiometabolic events compared to age- and sex-matched youths with psychiatric disorders but unexposed to antipsychotics. The excess cardiometabolic risk is significantly higher than that of individuals who start antipsychotic treatment in early adulthood, and significantly higher for treatment onset in childhood compared to adolescence. On the basis of these findings, recommendations are provided about the use of antipsychotics in children and adolescents.

Assessment and Evaluation of Consumer Awareness and Self-Medication Use Practices Towards Over the Counter (OTC) Analgesics. A Cross-Sectional Study in Abha-Saudi Arabia.

To assess and evaluate consumer awareness and common medication use practices towards OTC analgesics, with a focus on the impact of irrational drug use and its implications for public health and safety. This includes identifying gaps in knowledge, evaluating the potential consequences of misuse, and discussing how these findings can inform future educational initiatives and policy development to promote safer medication practices. This was a cross-sectional, semi-quantitative survey of 750 Saudi volunteers both males and females aged between 18 and 65 years. A validated self-administered questionnaire was used among randomly selected volunteers with a history of OTC analgesic use. A total of 750 questionnaires were administered and the response rate was measured to be 75.6%. More than 50% of the study population used OTC analgesics without a prescription and reported using analgesics as soon as they start experiencing any pain. Paracetamol was found to be the most predominantly used analgesic. The most common indication of OTC analgesic use was reported for headache and toothache whereas irrational use of analgesics in terms of dose, frequency and indication was found to be to the extent of 50%. Primary source of information related to OTC analgesic use was obtained from pharmacy personnel (31.7%), and Patient Insert Leaflets (PIL) (28.7%). Majority of the respondents (64.3%) didn't know the safe maximum dose of Paracetamol, whereas 73.3% used to stop medicine only after experiencing some side effects. 52.4% of the respondents were not aware about the most common side effects, and potential interactions of analgesic medications. Our study highlights the menace of self-medication practices and irrational use of OTC analgesic by the study participants. Immediate remedial measure need to be taken to discourage self-medication and improve rational use of OTC drugs which can be achieved by focusing on improving the consumers' awareness of self-medication and the rational use of medications.

Academic Performance, Absenteeism, and Drug Use in Emerging Adulthood

Academic Performance, Absenteeism, and Drug Use in Emerging Adulthood

A family affair? Long-term economic and mental health effects of spousal cancer

Research on the family spillover effects of health shocks, which has focused mainly on labor market outcomes, has yielded inconclusive results, with limited insight into long-term consequences or underlying mechanisms. We analyze the short- and long-term impacts of cancer on the unaffected spouse’s labor supply and mental health as well as marital stability, considering gender and relative income status within the households. Using population-based register data from Finland (1995–2019) and a dynamic difference-in-differences design, we observe two key findings. First, a cancer diagnosis leads to very modest changes in a spouse’s labor supply but significant increases in the likelihood of psychotropic drug use and psychiatric outpatient visits. Second, the main results mask considerable heterogeneity regarding relative income within the household. Secondary earners increase their labor supply in response to fatal cancers but decrease it in non-fatal cases, while breadwinners show small negative responses in both. Bereaved women with lower income share experience more psychiatric symptoms, a trend not observed in men. Our findings reveal the importance of pre-shock breadwinner status in family responses to health shocks, suggesting the need for targeted support for caregiving and bereaved spouses.

Antimicrobial Drug Use and Changing Trends From 2021 to 2023-A Case Study of a General Hospital in Sichuan Province.

Antibiotic resistance (AR) is a growing concern as a result of the widespread and excessive use of antibiotics. Because of this, China's health authorities have implemented a number of antibiotic control measures, including a requirement that the intensity of antibiotic usage stay within 40.00 DDDs. This study, which used a tertiary general hospital in Sichuan Province as an example, examined the hospital's trend in antibiotic use from 2021 to 2023, the relationship between antibiotic use and hospitalization days and CMI, and the viability of 40.000 DDDs in light of the evolving medical landscape. Data were obtained through the hospital information system (HIS) and the hospital DRG system. Boston matrix diagrams were used to find the departments that needed to be focused on control, Cochran-Armitage trend test, and ANOVA to analyze the trends of AUR and antimicrobial use density (AUD) in the hospital over time in the last 3 years and to analyze the factors affecting the changes in antibiotic consumption. Over the previous 3 years, the hospital's antibiotic use rate varied between 40% and 50%, and its intensity of use varied between 40.000 and 50.000 DDDs, both of which were rather steady. January 2023 had a significant rise, with an AUD of 59.38 DDDs and an AUR of 61.80%. The second quadrant has eight departments. Each department's AUD varied dramatically; neurosurgery saw an increase annually (p < 0.05), abdominal wall surgery and gastrointestinal hernia procedures, obstetrics and gynaecologist, and ophthalmology saw a drop annually (p < 0.05). The average number of preoperative hospitalization days (r = 0.1402, p < 0.01) and the CMI (r = 0.4864, p < 0.001) were strongly connected with the AUD of surgical and nonsurgical departments, respectively. Hospitals should concentrate on the issue of surgical departments' lengthy preoperative prophylactic medication times. AUD management should also be dynamically modified based on CMI, particularly in departments in the second quadrant (low CMI and high AUD). Furthermore, it is challenging to maintain the hospital AUD target value of 40.00 DDDs under the new medical model, given the decline in hospitalization days of discharged patients and the high prevalence of infectious diseases. It is also unclear whether this target value is still appropriate given the current state of medicine.

Predictors of Relapse in Women after Substance Use Treatment: A Cross-sectional Study in the West of Iran

Background: Many individuals undergo drug addiction treatment relapse after treatment. Additionally, a few studies have focused on the unique challenges faced by women in addiction recovery. Therefore, we aimed to identify predictors of relapse among women who have undergone drug addiction treatment to develop a more effective intervention program tailored to their needs. Methods: The present cross-sectional study evaluated 320 addicted women from Lorestan province, Iran, in 2020 who had used illegal substances. Convenience sampling was used to select participants from outpatient addiction treatment centers, triangular clinics, and rehabilitation centers. Demographic characteristics, drug use patterns, and risk factors for addiction were recorded. Predictors of relapse were evaluated using a negative binomial regression model. Results: The study included women with a mean age of 34.78±9.31 years who had a history of drug addiction relapse. Around 43.44% of the women were married and 36.88% lived with their husbands. Methamphetamine, opium, and heroin were the commonly used drugs. The study found that women with primary school education had a higher rate of relapse (IRR: 1.71, p = 0.01) and women with husbands being substance users (IRR: 1.34, p = 0.014), history of imprisonment (IRR: 1.51, p = 0.002), smoking (IRR: 1.91, p &lt; 0.001), and alcohol consumption (IRR: 1.49, p = 0.005) were also associated with a higher rate of relapse. Conclusion: In conclusion, this study found that women with primary school education, husbands being substance users, history of imprisonment, smoking, and alcohol consumption behavior had a higher rate of relapse. By addressing the identified predictors of relapse, such programs can improve the success rate of addiction treatment and promote long-term recovery among women. In addition, this study highlights that addiction relapse is not necessarily caused by a single factor, and several different personal and environmental factors can influence this issue.

HBV and HCV testing outcomes among marginalized communities in Italy, 2019–2024: a prospective study

The health of the marginalized populations is crucial for public health and inequalities. The World Health Organization (WHO) Global Hepatitis Report 2024 stated that over 304 million people were living with Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV) infection in 2022. We performed HBV/HCV screenings among marginalized communities to reveal hidden infections and link-to-care positive participants. From January 2019 to May 2024, finger-prick tests were used to conduct on-site screenings at non-profit organizations in Tuscany, Italy. Positive participants were referred to the closest outpatient clinic. Eighty/1812 (4.4%) participants were Hepatitis B surface Antigen (HBsAg)+, mostly men (p<0.001) and non-Italian natives compared to those HBsAg- (p<0.001). Fifty-two/1812 (2.9%) were anti-HCV+ with a higher proportion of Italians (p<0.001) and lower education level (p<0.01) compared to the anti-HCV-. Intravenous drug use was an independent factor for being anti-HCV+ (p<0.0001). Among the HBsAg+individuals, 66.3% (53/80) were linked and 90.4% (48/53) retained in care (treated/monitored). Of the anti-HCV participants requiring clinical evaluation, 37.8% (14/37) were linked to care, and all the 11/14 (88.6%) viremic patients were successfully treated. We found higher HBV/HCV positivity compared to national prevalences. Participation and linkage to care were successful. The young mean age (33.6yrs) of HBsAg+individuals, primarily from regions with low vaccinal adherence, indicated geographical origin as a key risk factor. HCV positivity was associated with extreme marginality. The results stress the need to implement marginalized groups screening to target HBV/HCV hidden infections, reducing disparities in healthcare and advancing towards the WHO 2030 elimination goal. Gilead Sciences; Fondazione Cassa di Risparmio di Pistoia e Pescia; Regione Toscana.