Quality of life in a community sample of young cocaine and/or heroin users: the role of mental disorders.

PURPOSE: Drug addiction and psychiatric disorders are frequently concomitant; however, few studies have investigated the impact of psychiatric disorders other than substance use disorder (SUD) on health-related quality of life (HRQoL) in drug users not in treatment. We studied the association of psychiatric disorders other than SUD with HRQoL in a street-recruited sample of cocaine and/or heroin users. METHODS: It is a cross-sectional study involving 287 young users of cocaine and/or heroin in Barcelona, Spain. HRQoL was assessed with the Nottingham health profile (NHP). Patterns of drug use and mental disorders were assessed using the Spanish version of the psychiatric research interview for substance and mental disorders IV, and degree of dependence through the severity of dependence scale (SDS). The association of mental disorders with HRQoL was assessed through a Tobit regression analysis. RESULTS: The overall NHP score was 23.9 (SD = 20.5, range 0-91.7). Sixty-one percent of the sample had two or more SUDs; 22 % had at least one non-SUD Axis I disorder (anxiety, mood, psychotic, or eating disorder); and 27.2 % had a borderline personality disorder (BPD) and/or antisocial personality disorder. Variables negatively associated with the global NHP score were psychosis [transformed beta coefficient: 15.23; 95 % confidence interval [CI] 4.48-25.97], BPD (9.55; 95 % CI 2.95-16.15), severity of dependence (8.12; 95 % CI 3.37-12.87), having two or more SUDs (for two or three SUDs: 6.83; 95 % CI 2.08-11.59) (>3 SUDs: 7.70; 95 % CI 1.72-13.68) and the intravenous use of some substance (10.20; 95 % CI 6.00-14.40). CONCLUSION: HRQoL among street-recruited illegal substance users was impaired, particularly among those with psychiatric comorbidity, psychosis, and BPD being especially relevant.

Assessment of an outreach street-based HIV rapid testing programme as a strategy to promote early diagnosis: a comparison with two surveillance systems in Spain, 2008-2011.

We assess the added value of a multisite, street-based HIV rapid testing programme by comparing its results to pre-existing services and assessing its potential to reduce ongoing transmission. Between 2008 and 2011, 8,923 individuals underwent testing. We compare outcomes with those of a network of 20 sexually transmitted infections (STI)/HIV clinics (EPI-VIH) and the Spanish National HIV Surveillance System (SNHSS); evaluate whether good visibility prompts testing and assess whether it reaches under-tested populations. 89.2% of the new infections were in men who have sex with men (MSM) vs 78.0% in EPI-VIH and 56.0% in SNHSS. 83.6% of the MSM were linked to care and 20.9% had <350 CD4 HIV prevalence was substantially lower than in EPI-VIH. 56.5% of the HIV-positive MSM tested because they happened to see the programme, 18.4% were previously untested and 26.3% had their last test ≥2 years ago. The programme provided linkage to care and early diagnosis mainly to MSM but attendees presented a lower HIV prevalence than EPI-VIH. From a cost perspective it would benefit from being implemented in locations highly frequented by MSM. Conversely, its good visibility led to reduced periods of undiagnosed infection in a high proportion of MSM who were not testing with the recommended frequency.

Allergy to low dose sugammadex.

We describe the case of a fit 17-year-old man who developed a severe allergic reaction to a low clinical dose of sugammadex (3.2 mg kg(-1) , 200 mg intravenously), 1 min after its administration. This was manifest by an intense erythema over the anterior part of the thorax, severe lip and palpebral oedema and bilateral wheeze. On later investigation, the patient had a positive skin prick test to sugammadex (5-mm diameter response, with a negative saline control and positive histamine control of 5 mm) and no response to any other drug tested. Other diagnostic tests supported a diagnosis of allergic reaction to sugammadex.

Donor-specific antibody detection: comparison of single antigen assay and Luminex crossmatches.

Luminex bead-based assays are routinely used in the study of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSA). Single antigen (SA) assays use beads coated with recombinant antigens whereas Luminex crossmatch (Xm-DSA) tests consist of beads coated with isolated donor-specific HLA molecules. The aim of this study was to compare these techniques used to detect DSA. A total of 24 sera recognizing different HLA class I (seven anti-HLA-A and seven anti-HLA-B) as well as class II (seven anti-HLA-DR and three anti-HLA DQ) specificities by complement dependent cytotoxicity were included in the study. These sera were used undiluted and in serial dilutions to perform both class I and II SA and Xm-DSA assays. In the case of Xm-DSA the same serum was checked with different lysates. A total of 42 lysates were used to perform a total of 61 crossmatches: 42 to detect anti-class I and 19 to detect anti-class II antibodies. The maximum positive dilution was higher for SA in 76% of the class I and in 90% of the class II crossmatches. Those cases with a higher sensitivity of the Xm-DSA could not be explained by a larger number of antigen targets.

[Exposure to environmental tobacco smoke at home increases the need for medical attention for respiratory diseases in childhood]. / La exposición al humo de tabaco en el hogar aumenta la frecuentación por patología respiratoria en la infancia.

OBJECTIVES: Children are highly vulnerable to damage from passive smoking as they are unable to avoid environmental tobacco, if present. Some reports have suggested that domestic exposure to environmental tobacco smoke can increase respiratory diseases in children. The aim of this study was to assess whether domestic passive smoking is associated with new respiratory events. METHODS: A descriptive, retrospective study was performed of 410 children aged less than 14 years old. The variables studied were: a) smokers in the household, b) the number of cigarettes smoked per day, c) school attendance, d) the number of siblings, e) previous respiratory diseases among parents and siblings, f) maternal smoking in pregnancy, and g) the number of respiratory events recorded in the previous year. Univariate, bivariate and multivariate analyses were performed. RESULTS: A total of 50.2 % of the children cohabited with smokers at home. The mean number of upper respiratory tract events per child living in environments free of tobacco smoke was 2.53 versus 3.52 when one of the household members smoked. For respiratory disease as a whole, an inverse association with age was found [OR = 0.83; (95 % CI: 0.76-0.90)] and a direct association was found with maternal smoking [OR = 4.56 (95 % CI; 1.84-11.34)]. With upper respiratory tract disease, the OR was 1.4 if the mother smoked 11-20 cigarettes/day, and was 1.9 if the number of cigarettes was > 20. With lower respiratory diseases, the odds ratio was 3.48 (95 % CI; 2.07-6.06) if the mother smoked. CONCLUSIONS: Fifty percent of the children studied were exposed to environmental tobacco smoke in the home. Younger children were at higher risk. The major risk factor for respiratory disease was maternal smoking and the risk increased with the number of cigarettes smoked. Health education is essential to protect children from tobacco smoke exposure.

Tolerogenic response: allorecognition pathways.

The induction of immune tolerance in transplant recipients has been sought for many years but only a fundamental understanding of the immunological mechanisms underlying graft rejection will allow manipulation of the anti-graft immune response. In general, acute rejection is better understood and treated than chronic rejection, as they occur through partially different mechanisms. It is now generally accepted that recognition of same-species, non-self antigens (allorecognition) occurs through at least two different mechanisms, the direct and indirect pathways. In the direct pathway, donor MHC molecules on the surface of donor antigen-presenting cells (APCs) are recognised directly by the recipient's T cells. This mechanism is so immediate that it seems to be primarily involved in acute graft rejection. Since APCs of donor origin are depleted with time a second mechanism, the indirect pathway, takes over to cause chronic rejection, in which foreign MHC molecules are internalised, partially digested and presented as peptides to recipient T cells. Nonetheless, a number of studies are only fully understood when a third proposed allorecognition mechanism is taken into account. This is the semi-indirect pathway, as discussed in this short report.

Lessons from the history of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic among Spanish drug injectors.

In Spain, approximately 10 years passed between the time when human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) harm-reduction programs should have been developed with sufficient coverage to have an optimum impact on public health (before the HIV/AIDS epidemic's explosion in 1984) and the date of their actual implementation. This delay yielded an enormous cost for the country. The introduction of the virus in drug injector networks during a period of widespread diffusion of heroin injection and the lack of political awareness of the growing problem were 2 important factors that contributed to the important diffusion of the HIV infection among Spanish injection drug users. Lessons can be learned that may be of great interest in countries or territories facing similar challenges now and in the future.

Intravenous administration among heroin users having treatment in Spain.

BACKGROUND: Of critical importance to AIDS control in Spain is the analysis of geographical variation and trend over time in the prevalence of intravenous administration in heroin users, as well as the factors associated with the use of this route. METHODS: We carried out a cross-sectional study of 27,655 people admitted to outpatient treatment for heroin dependence in 15 of the 17 Autonomous Communities of Spain during 1991, using data provided by the State Information System on Drug Abuse (SEIT). To assess the association of some factors with use of the intravenous route crude and logistic analysis was performed. RESULTS: The prevalence of intravenous administration in this population was 64.4% with regional differences ranging between 33% and 90%. Crude and logistic analysis demonstrated a strong association with two factors in addition to geography: the year of first use and the age at first use (the earlier the first use, the greater the strength of the association). CONCLUSIONS: These findings are of paramount importance for the control of the HIV epidemic in Spain and further study in this area could help to guide policy development.

Geographical variations in the prevalence of HIV infection among drug users receiving ambulatory treatment in Spain.

To identify the factors responsible for the regional differences in HIV-positive serostatus among drug users in Spain receiving outpatient treatment, the 17 autonomous regions into which Spain is divided were classified as high (mean 52%) or low prevalence groups (mean 34%) depending on the prevalence of seropositivity. In regions where the prevalence of positive serostatus was high, unemployment was more markedly associated with HIV infection than in low prevalence regions, while other potential risk factors yielded the same strength of association. Even so, adjustment for all the factors only accounted for 13% of the total difference in HIV+ prevalence between regions. The current distribution of risk factors among the two groups of autonomous regions does not explain these differences.

PIP: The objective was to identify the factors responsible for the regional differences in HIV-positive serostatus among outpatient drug users (OPDU) in the 17 autonomous regions (AR) of Spain who were receiving ambulatory treatment for opiate or cocaine abuse between April and September 1989. In 83 participating outpatient treatment centers, 1233 patients were recruited. HIV serostatus was obtained for 809 OPDU (65.6%), 18 (2.2%) declined to know their results. A questionnaire collected basic demographic information, data on drug consumption practices, sexual habits, knowledge of HIV and its transmission, desired treatment, and changes in risk behaviors after treatment for drug dependency or after learning of their HIV-positive serostatus. Significant differences were found for sharing injecting equipment, use of condoms, and years of prior drug use. The low-prevalence group (LPG), where mean prevalence was 0.34 (or a mean of 34% among the OPDU), comprised Andalusia, Aragon, Asturias, Balearic Islands, Canary Islands, Cantabria, Valencia, Castilla-La Mancha, Castilla Leon, Extremadura, Murcia, and Navarre. The HIV high prevalence of 0.52 (or a mean of 52% among the OPDU) comprised the regions of Catalonia, Madrid, Basque Country, Galicia, and La Rioja. In the LPG, duration in years of prior drug use, use of non-sterile syringe, and frequency of condom use were significantly associated with the prevalence of HIV infections, while low educational level almost achieved a significant adjusted prevalence odds ratio. In the HPG, only employment status (unemployment) and 3 years of prior drug use were significantly related to seropositivity. In the LPG, the predominant age group was 20-24 years, while in the HPG, it was 25-29 years. The crude association of HPG with seropositivity gave a crude prevalence odds ratio of 2.08. Adjustment for all the factors accounted for only 13% of the total difference in HIV prevalence between regions.

The transition from injecting to smoking heroin in three Spanish cities. The Spanish Group for the Study of the Route of Heroin Administration.

AIMS: To measure the current prevalence of different routes of heroin administration among users and to describe the most frequent patterns in the evolution of the main route from the time of first use to the present and their implications for the control of the HIV epidemic. DESIGN: Cross-sectional study. Face-to-face interviews using a structured questionnaire. SETTING AND PARTICIPANTS: Nine hundred and nine regular heroin users from Madrid, Barcelona and Seville (about 300 per city), half of them recruited in treatment centres and the other half out of treatment. MEASUREMENTS: Socio-demographic characteristics, current and historical behaviours related to route of administration. FINDINGS: Before 1980 injection was the first main route of heroin administration for most users in Barcelona and Madrid; in Seville smoking already predominated, although 40% of users began by injecting. Sniffing subsequently became predominant in Barcelona, while smoking became the predominant first route in Madrid and Seville (smoking has been the only first route in Seville since 1991). The prevalence of injection as the main route of administration during the last 30 days was 77.3% in Barcelona, 24.3% in Madrid and 23.9% in Seville; smoking predominated in the latter two cities. The factors most strongly associated with injection as the preferred route were city of recruitment and having a partner who injected. Some 73% of those who stopped injecting in their last change of route stated that the results of their HIV test or fear of becoming infected had been important in making this decision. CONCLUSIONS: The change from injecting to smoking will greatly facilitate the control of HIV infection in Spain. However, the main causal factor does not appear to be the perception of HIV risk, but rather other, ecological factors (cultural or market-related). The absence of these factors in some areas may impede the spread of smoking.

IV drug users: changes in risk behaviour according to HIV status in a national survey in Spain.

STUDY OBJECTIVE: To determine whether HIV positive intravenous drug users (IVDUs) who were receiving outpatient treatment for opiate and cocaine abuse or dependence used practices aimed at reducing the spread of HIV. DESIGN: Cross sectional study of behaviour and HIV serostatus in IVDUs. SETTING: A nationwide sample, from 83 health centres for outpatient treatment, stratified by autonomous regions. PARTICIPANTS: Altogether 1074 IVDUs were recruited. HIV serostatus could be verified in 738 (68.7%) of these. MEASUREMENTS AND MAIN RESULTS: Crude and adjusted odds ratios and their 95% confidence intervals were estimated to assess the association between HIV serostatus and behavioural changes. In their daily interactions with other members of the same household, seropositive subjects more frequently used preventive methods aimed at avoiding transmission than seronegative patients. Treatment for abuse or dependency before the current regimen had a greater impact in HIV positive than HIV negative subjects in terms of abstaining from risk behaviours. There was a significant trend toward lower drug consumption in HIV positive subjects, and the number of seropositive and seronegative IVDUs who stopped injecting their drugs was significantly higher among the former. Seropositive subjects were also more likely to stop sharing drug injecting equipment and to change their sexual habits; they reported an increased consistent use of condoms. CONCLUSIONS: HIV positive IVDUs were more likely to change their risk behaviours than their HIV negative counterparts.

HIV-transmission knowledge in drug users from outpatient facilities in Spain. A national survey.

Knowledge of AIDS and its transmission was studied in patients undergoing drug-dependence treatment for opiates and/or cocaine. The study area included all of Spain and was carried out via a questionnaire assessing information about risk practices, HIV serostatus, etc, and 13 true or false questions concerning HIV-transmission knowledge. The main purpose of the present study was to analyse the relationship between the level of information found in patients and factors potentially related to it, including the practice of high-risk activities for HIV transmission, the sources of information and behaviour modification. Findings indicate that poor information was associated with the use of non-sterile needles, anal-penis sexual relations, non-use of condoms, lack of preventive measures in daily cohabitation, and lack of previous drug-dependence treatment. Determining factors of being well-informed were a high level of education, a longer duration of intravenous drug use, and contact with the Health Service as a source of information. These findings partially support the need to implement programs aimed at improving knowledge about HIV in the population of drug users.

Methadone treatment in Spain, 1994.

The objective of this study was to describe the methadone treatment (MT) network in Spain, and to evaluate compliance with criteria known to influence the spread of human immunodeficiency virus (HIV). During the last 3 months of 1994, a mailed questionnaire was sent to the coordinators of all methadone treatment centers in Spain. A total of 224 centers completed the questionnaire (90% response rate). The total number of patients receiving MT in the studied centers was 13,402. Their mean age was 29 years, 79% were male, and approximately 60% were HIV positive. The rate of patients in MT varied by Region (mean: 6.7 patients in MT per 10,000 inhabitants). Although the global mean of reported daily dose of methadone was 60 mg, in 44% of the centers it was lower than that. Despite the high number of centers involved with MT in Spain, the coverage by regions is unequal. Studied centers revealed only a moderate adherence to procedures considered to be effective in HIV prevention. Given the magnitude of HIV infection in Spain, there is a clear need for improvement.

Differences in severity of heroin dependence by route of administration: the importance of length of heroin use.

To explore differences in the severity of heroin dependence by route of administration, we interviewed 909 heroin users in three Spanish cities. Dependence was measured with the severity dependence scale (SDS). No major differences in the severity of heroin dependence were detected among users with 5 or more years of heroin use (long-term users), but differences were found among newer users (SDS mean scores, 7.3 in heroin injectors; 7.9 in smokers and 4.6 in sniffers; P = 0.006), especially those with fewer than 3 years of use. Similar differences by route of administration were found when frequency of heroin use (days/month) was considered rather than severity of dependence. However, in the latter case major differences were also found among long-term users. These findings suggest that the route of administration probably influences the rate of progression to dependence but has little influence on the long-run level of dependence. They also help explain some aspects of the transition between routes of heroin administration, which is occurring in different areas.

A global process in motion segregation.

Observers viewed sparse random dot cinematograms in which the moving dots were confined to eight windows. The motions in seven of the windows were consistent with a global flow pattern, while the direction of motion in the eighth window deviated from this pattern. The observer's task was to determine which of the eight windows contained the inconsistent motion. The task was performed on two types of global flow patterns: spirals, which appear rigid, and deformations, which appear highly non-rigid. Although these patterns produce qualitatively different global percepts, they are exactly matched in their local velocities and velocity differences. Observers were better able to locate an inconsistent motion in spiral patterns than in deformation patterns, indicating that they were using more than just local motion information to find the target. This result is taken as indirect support for a segregation process that involves fitting the stimulus with a global motion pattern and segregating motions inconsistent with this pattern.

The effect of 3D structure on motion segmentation.

A smooth surface imaged on the retina produces a smooth flow field. Thus, the visual system may group regions of smoothly varying flow to segment surfaces. We tested this idea by having observers perform a segmentation task on several stimuli that differed in their 3D interpretations but were all matched in the smoothness of their 2D flow fields. Performance varied across conditions with the best performance occurring when the stimulus stimulated a rigid plane. This result suggests that while observers may use deviations from smoothness to segment a broad class of motion stimuli, they use a more precise strategy to segment stimuli with a familiar 3D interpretation.

Evidence for two speed signals: a coarse local signal for segregation and a precise global signal for discrimination.

In calculating the precise speed of an object, the visual system must integrate motion measurements across time and space while keeping motion measurements from different objects separate. We examined whether an initial coarse estimate of local speed may be used to segregate the motions of different objects prior to a precise calculation of object speed. Our stimuli consisted of 256 dots that moved upward at two speeds. In Expt 1, each dot alternated between the two speeds every 133 msec. When the speed alternations were asynchronous across dots, subject saw two transparent surfaces moving at different speeds and their ability to discriminate changes in the slow speed were unaffected by the presence of the fast speed. This experiment suggests that before integration, motion measurements may be segregated according to speed. We sought more conclusive evidence for this claim in Expts 2 and 3. In Expt 2, dots with 33 msec lifetimes were used to generate the two speeds. Although individual dots permitted only crude speed discrimination, subjects perceived this stimulus as two surfaces moving at different speeds and they precisely judged the slower speed. Apparently, the coarse local signals generated by the slow dots were segregated from those of the fast dots and then separately integrated to produce a precise speed signal. In Expt 3, the dots again moved at two speeds, but each speed was generated by a range of spatial and temporal displacements. Once more, subjects saw two surfaces and precisely judged the speed of the slower surface, demonstrating that segregation may be based solely on differences in local speed.(ABSTRACT TRUNCATED AT 250 WORDS)

The contributions of figure and ground textures to segmentation.

Several models of texture segmentation use spatial gradients in the activity of early filters to locate texture boundaries. The models assume that these filters are identical to those involved in the detection and discrimination of near threshold patterns. The models differ in how activity gradients from different types of filters are combined. We examined this question by measuring the respective contributions of a figure and a ground texture to segmentation. Vertical and horizontal line segments were used to construct two perfectly discriminable textures and these textures were used to construct four types of displays. Each display contained an obliquely oriented figure, but the displays differed in the way this figure was defined. Displays consisted of either (1) a horizontally textured figure on a blank background, (2) a blank figure on a vertically textured background, (3) a horizontally textured figure on a vertically textured background or (4) a figure with a mixed texture (50% vertical lines, 50% horizontal lines) on a blank background. In a two-alternative forced-choice experiment, observers were asked to judge the figure's orientation (right or left oblique), and the contrast of the textures was varied across trials. The resulting psychometric functions for segmentation were very similar for the four types of displays, suggesting ways in which a simple model of segmentation should be modified.

Stereo matching precedes dichoptic masking.

Stereo matching can intervene to prevent dichoptic masking. In a dichoptic masking paradigm we measured the contrast threshold for a bar target, presented to one eye, as a function of the contrast of an identical masking bar, presented at retinal correspondence in the other eye. Confirming previous studies of dichoptic masking with sinusoidal gratings, the test bar thresholds rose proportionally with increasing masking contrast. This threshold elevation was almost nullified when an extra bar was presented to the eye seeing the test stimulus. Release from masking occurred when the disparity between the masking bar and extra bar was < 20 min arc over a range of contrast levels (8-45%), and for bars containing either broad spatial frequency spectra or bars with only high spatial frequencies (peak = 12 c/deg). The latter result rules out an explanation for the release from masking based on contrast discrimination in low spatial frequency channels. The extra bar was effective in releasing the test bar from masking as long as the extra bar's contrast was greater than about one-fifth the contrast of the mask, a result that suggests that there is a contrast threshold for stereo matching. We interpret our findings to indicate that a stage of stereo matching occurs prior to the neural site limiting dichoptic contrast discrimination.