A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California.

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients' social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

[Comparison of the Prediction Model of Adolescents' Suicide Attempt Using Logistic Regression and Decision Tree: Secondary Data Analysis of the 2019 Youth Health Risk Behavior Web-Based Survey].

PURPOSE: The purpose of this study was to develop and compare the prediction model for suicide attempts by Korean adolescents using logistic regression and decision tree analysis. METHODS: This study utilized secondary data drawn from the 2019 Youth Health Risk Behavior web-based survey. A total of 20 items were selected as the explanatory variables (5 of sociodemographic characteristics, 10 of health-related behaviors, and 5 of psychosocial characteristics). For data analysis, descriptive statistics and logistic regression with complex samples and decision tree analysis were performed using IBM SPSS ver. 25.0 and Stata ver. 16.0. RESULTS: A total of 1,731 participants (3.0%) out of 57,303 responded that they had attempted suicide. The most significant predictors of suicide attempts as determined using the logistic regression model were experience of sadness and hopelessness, substance abuse, and violent victimization. Girls who have experience of sadness and hopelessness, and experience of substance abuse have been identified as the most vulnerable group in suicide attempts in the decision tree model. CONCLUSION: Experiences of sadness and hopelessness, experiences of substance abuse, and experiences of violent victimization are the common major predictors of suicide attempts in both logistic regression and decision tree models, and the predict rates of both models were similar. We suggest to provide programs considering combination of high-risk predictors for adolescents to prevent suicide attempt.

Demographic, nutritional, social and environmental predictors of learning skills and depression in 20,000 Indian adolescents: Findings from the UDAYA survey.

OBJECTIVES: Adolescent wellbeing is critical to breaking the intergenerational cycle of poverty and one in five of the world's adolescents live in India. We explored predictors of learning skills and depression in Indian adolescents. METHODS: Data on adolescents aged 10-19y (three groups: 5,840 unmarried males, 8,953 unmarried females, 4,933 married females) were available from the state-representative Understanding the Lives of Adolescents and Young Adults survey in Uttar Pradesh and Bihar. Multivariable logistic regression models adjusted for cluster sampling design and state fixed effects were used to examine factors (demographic, health/nutrition, social, and environmental) associated with three outcomes: reading proficiency, math proficiency, and depressive symptoms. FINDINGS: Learning skills were poor (28-61% lacked basic reading and math skills depending on adolescent group and outcome) and depression was common (8-26%). Better learning skills were predicted by greater household wealth (AOR 1.72-2.55 depending on group) and household head education (AOR 1.03-1.07 per year), being in school (AOR 4.19-18.65), parental support (AOR 1.11-1.39), having gender equal attitudes (AOR 1.56-2.67), number of food groups consumed at least weekly (unmarried females: AOR 1.11), and having an improved latrine (AOR 1.33-1.51). Poorer learning skills were predicted by family substance use (AOR 0.68-0.74), underweight (males: AOR 0.74), witnessing parental violence (AOR 0.66-0.78). Depressive symptoms were predicted by witnessing parental violence (AOR 1.51-1.92) and experiencing sexual abuse (AOR 2.30-6.16). CONCLUSION: Factors across multiple life dimensions are associated with learning skills and depression in Indian adolescents. Adolescent-focused policies and programs should consider health/nutrition, social, and environmental aspects of life in vulnerable individuals.

Trends and inequalities in the burden of mortality in Scotland 2000-2015.

BACKGROUND: Cause-specific mortality trends are routinely reported for Scotland. However, ill-defined deaths are not routinely redistributed to more precise and internationally comparable categories nor is the mortality reported in terms of years of life lost to facilitate the calculation of the burden of disease. This study describes trends in Years of Life Lost (YLL) for specific causes of death in Scotland from 2000 to 2015. METHODS: We obtained records of all deaths in Scotland by age, sex, area and underlying cause of death between 2000 and 2015. We redistributed Ill-Defined Deaths (IDDs) to more exact and meaningful causes using internationally accepted methods. Years of Life Lost (YLL) using remaining life expectancy by sex and single year of age from the 2013 Scottish life table were calculated for each death. These data were then used to calculate the crude and age-standardised trends in YLL by age, sex, cause, health board area, and area deprivation decile. RESULTS: Between 2000 and 2015, the annual percentage of deaths that were ill-defined varied between 10% and 12%. The proportion of deaths that were IDDs increased over time and were more common: in women; amongst those aged 1-4 years, 25-34 years and >80 years; in more deprived areas; and in the island health boards. The total YLL fell from around 17,800 years per 100,000 population in 2000 to around 13,500 years by 2015. The largest individual contributors to YLL were Ischaemic Heart Disease (IHD), respiratory cancers, Chronic Obstructive Pulmonary Disease (COPD), cerebrovascular disease and Alzheimer's/dementia. The proportion of total YLL due to IHD and stroke declined over time, but increased for Alzheimer's/dementia and drug use disorders. There were marked absolute inequalities in YLL by area deprivation, with a mean Slope Index of Inequality (SII) for all causes of 15,344 YLL between 2001 and 2015, with IHD and COPD the greatest contributors. The Relative Index of Inequality (RII) for YLL was highest for self-harm and lower respiratory infections. CONCLUSION: The total YLL per 100,000 population in Scotland has declined over time. The YLL in Scotland is predominantly due to a wide range of chronic diseases, substance misuse, self-harm and increasingly Alzheimer's disease and dementia. Inequalities in YLL, in both relative and absolute terms, are stark.

Liver Disease and Fibrosis Assessment in Substance Use-Related Disorders.

Substance users have the highest prevalence of hepatitis C virus (HCV) infection but have rarely been treated, largely because of their mistrust of the health care system, misconceptions about the consequences of the infection, and concerns regarding interferon-related side effects. With the development of highly efficacious, interferon-free therapeutic regimens without significant side effects, the concept of colocating HCV and substance use treatment would appear to be highly feasible. This process has been further facilitated by widespread clinical adaptation of noninvasive assays for fibrosis assessment, which could be performed routinely in substance use treatment facilities. The most commonly used noninvasive fibrosis assessment methods are serum marker indexes and transient elastography, both of which are very accurate in detecting cirrhosis or the absence of fibrosis, but much less successful in identifying intermediate fibrosis stages. The effect of drugs of abuse on the liver is not completely understood or sufficiently studied. There are no indications that heroin and cocaine affect fibrosis progression, but some recreational drugs (eg, alcohol and cannabis) can induce hepatic injury. In addition, knowledge gaps exist on the effect of impaired liver function on metabolism or transport of agents used to treat substance disorders as well as their interactions with HCV antivirals.

Preclinical Abuse Potential Assessment of Flibanserin: Effects on Intracranial Self-Stimulation in Female and Male Rats.

INTRODUCTION: Flibanserin is a serotonin receptor subtype 1A agonist and 2A antagonist that has been approved by the Food and Drug Administration for treating female sexual interest and arousal disorder. Little is known about the abuse potential of flibanserin. AIM: To examine abuse-related effects of flibanserin in rats using an intracranial self-stimulation (ICSS) procedure previously used to evaluate the abuse potential of other drugs. METHODS: Adult female and male Sprague-Dawley rats with electrodes implanted in the medial forebrain bundle were trained to press a lever for electrical brain stimulation under a "frequency-rate" ICSS procedure. In this procedure, increasing frequencies of brain stimulation maintain increasing rates of responding. Drugs of abuse typically increase (or "facilitate") ICSS rates and produce leftward and upward shifts in ICSS frequency-rate curves, whereas drugs that lack abuse potential typically do not alter or only decrease ICSS rates. Initial studies determined the potency and time course of effects on ICSS produced by acute flibanserin administration (1.0, 3.2 and 10.0 mg/kg). Subsequent studies determined the effects of flibanserin (3.2-18 mg/kg) before and after a regimen of repeated flibanserin administration (5.6 mg/kg/d for 5 days). Effects of the abused stimulant amphetamine (1.0 mg/kg) were examined as a positive control. MAIN OUTCOME MEASURES: Flibanserin effects on ICSS frequency-rate curves in female and male rats were examined and compared with the effects of amphetamine. RESULTS: Baseline ICSS frequency-rate curves were similar in female and male rats. Acute and repeated administrations of flibanserin produced only decreases in ICSS rates, and rate-decreasing effects of the highest flibanserin dose (10 mg/kg) were greater in female than in male rats. In contrast to flibanserin, amphetamine produced an abuse-related increase in ICSS rates that did not differ between female and male rats. CONCLUSION: These results suggest that flibanserin has low abuse potential. In addition, this study suggests that female rats might be more sensitive than male rats to the rate-decreasing effects of high flibanserin doses.

Prevalence of Mental Disorders in the South-East of Spain, One of the European Regions Most Affected by the Economic Crisis: The Cross-Sectional PEGASUS-Murcia Project.

BACKGROUND: To describe the lifetime and 12-month prevalence, severity and age of onset distribution of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) disorders and to explore the association between socio-demographic variables and economic stressors with mental disorders during the economic crisis in the general population of Murcia (Spain). METHODS AND FINDINGS: The PEGASUS-Murcia Project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia administered between June 2010 and May 2012. DSM-IV disorders were assessed by the Composite International Diagnostic Interview (CIDI 3.0). Main outcome measures were lifetime and 12-month prevalence of Anxiety, Mood, Impulse and Substance Disorders, Severity and Age of Onset. Sociodemographic variables and stressful economic life events during the preceding 12 months were entered as independent variables in a logistic regression analysis. A total of 2,621 participants (67.4% response rate) were interviewed, 54.5% female, mean age 48.6 years. Twelve-month prevalence (95%CI) of disorders: anxiety 9.7% (7.6-12.2), mood 6.6% (5.5-8.1), impulse 0.3% (0.1-1.2) and substance use 1.0% (0.4-2.4) disorders. Lifetime prevalence: anxiety 15.0% (12.3-18.1), mood 15.6% (13.5-18.1), impulse 2.4% (1.4-4.0) and substance use 8.3% (6.2-11.0) disorders. Severity among 12-month cases: serious 29.2% (20.8-39.4), moderate 35.6% (24.0-49.1) and mild severity 35.2% (29.5-41.5). Women were 3.7 and 2.5 times more likely than men to suffer 12-month anxiety and mood disorders, respectively. Substance use was more frequent among men. Younger age and lower income were associated with higher prevalence. Respondents exposed to multiple and recent economic stressors had the highest risk of anxiety disorders. CONCLUSIONS: Mental disorders in the adult population of Murcia during the economic crisis were more prevalent and serious than those in previous estimates for Spain. Prevalence was strongly associated with exposure to stressors related to the economic crisis.

Crushed and injected buprenorphine tablets: characteristics of princeps and generic solutions.

Self-injection of high-dose buprenorphine is responsible for well-described complications. In 2011, we have been alerted by unusual but serious cutaneous complication among injection buprenorphine users. A prospective data collection identified 30 cases of necrotic cutaneous lesions after injection of filtered buprenorphine solution, among which 25 cases occurred following injection of buprenorphine generics. The main goal of our study was to put forward particularities that could explain the cutaneous complications, by qualitatively and quantitatively confronting particles present in Subutex and generics solutions. We used the same protocol that injected-buprenorphine users: generic or subutex tablets were crushed in sterile water and filtered through 2 filters commonly used (cotton-pad and sterifilt). Solutions were analyzed by laser granulometry, flow cytometry and scanning electron microscopy. We have highlighted the wide variation of the quantity and the size of the particles present in solution between the two drugs after cotton-pad filtration. The proportion of particles <10 µm is systematically higher in the generic solutions than with Subutex. All of the insoluble particles found in generic solutions contain silica, whereas non- organic element was to be identified in the insoluble particles of Subutex. One skin biopsy obtained from one patient who developed a necrotic lesion after intravenous injection of filtrated solution of buprenorphine generic, shows non-organic elements. Identification of particles in situ enables us to confirm the presence of silica in the biopsy. Actually the monitoring of patient receiving generic of buprenorphine must be strengthened.

Substance use disorder and its effects on outcomes in men with advanced-stage prostate cancer.

BACKGROUND: Substance use disorder in patients with cancer has implications for outcomes. The objective of this study was to analyze the effects of the type and timing of substance use on outcomes in elderly Medicare recipients with advanced prostate cancer. METHODS: This was an observational cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2000 to 2009. Among men who were diagnosed with advanced prostate cancer between 2001 and 2004, we identified those who had a claim for substance use disorder in the year before cancer diagnosis, 1 year after cancer diagnosis, and an additional 4 years after diagnosis. The outcomes investigated were use of health services, costs, and mortality. RESULTS: The prevalence of substance use disorder was 10.6%. The category drug psychoses and related had greater odds of inpatient hospitalizations (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9-2.8), outpatient hospital visits (OR, 2.6; 95% CI, 1.9-3.6), and emergency room visits (OR, 1.7; 95% CI, 1.2-2.4). Substance use disorder in the follow-up phase was associated with greater odds of inpatient hospitalizations (OR, 2.0; 95% CI, 1.8-2.2), outpatient hospital visits (OR, 2.0; 95% CI, 1.7-2.4), and emergency room visits (OR, 1.7; 95% CI, 1.5-2.1). Compared with men who did not have substance use disorder, those in the category drug psychoses and related had 70% higher costs, and those who had substance use disorder during the follow-up phase had 60% higher costs. The hazard of all-cause mortality was highest for patients in the drug psychoses and related category (hazard ratio, 1.3; 95% CI, 1.1-1.7) and the substance use disorder in treatment phase category (hazard ratio, 1.5; 95% CI, 1.3-1.7). CONCLUSIONS: The intersection of advanced prostate cancer and substance use disorder may adversely affect outcomes. Incorporating substance use screening and treatments into prostate cancer care guidelines and coordination of care is desirable.

Assessment of whole brain white matter integrity in youths and young adults with a family history of substance-use disorders.

Individuals with a family history of substance use disorders (FH+) are at a greater risk of developing substance use disorders than their peers with no such family histories (FH-) and this vulnerability is proportional to the number of affected relatives (FH density). The risk for developing substance use disorders peaks during adolescence to early adulthood in the general population, and that is thought to be related to delayed maturation of frontocortical and frontostriatal functional circuits. We hypothesized that FH+ youth and young adults have impaired myelination of frontocortical and frontostriatal white matter tracts. We examined fractional anisotropy (FA) data in 80 FH+ and 34 FH- youths (12.9 ± 1.0 years) and in 25 FH+ and 30 FH- young adults (24.3 ± 3.4 years). FH+ youths had lower FA values in both frontocortical and frontostriatal tracts as well as parietocortical tracts including the anterior, superior and posterior corona radiata and the superior frontal-occipital fasciculus. Moreover, FA values in these tracts were negatively correlated with FH density. FH+ adults had lower FA values in two frontocortical tracts: the genu of the corpus callosum and anterior corona radiata and also significant negative correlations between FA and FH density in these same tracts. In both groups, lower FA values corresponded to higher radial diffusivity suggesting reduced axonal myelination. We interpreted our findings as evidence for impaired myelination of frontal white matter that was proportional to FH density. Our data suggest that deficits may partially resolve with age, paralleling an age-related decline in risk for developing substance use disorders.

Assessment of the abuse potential of MDMA in the conditioned place preference paradigm: role of CB1 receptors.

Numerous reports have highlighted the role of the endocannabinoid system in the addictive potential of MDMA (3,4-methylenedioxy-methamphetamine). A previous report showed that CB1 knockout (KOCB1) mice do not acquire MDMA self-administration, despite developing conditioned place preference (CPP). This contradiction could be due to the particular procedure of place conditioning used. The present work compares MDMA-induced CPP in KOCB1 mice using unbiased and biased procedures of place conditioning. In the unbiased procedure, MDMA induced CPP and reinstatement of the extinguished preference in wild type (WT) mice, but not in KOCB1 mice. In contrast, in a biased protocol of CPP, MDMA produced preference in both types of mice. The anxiolytic response induced by MDMA in the elevated plus maze (EPM) was observed only in KOCB1 mice and may have been responsible, at least partially, for the CPP in the biased procedure. A neurochemical analysis revealed that KOCB1 mice presented higher striatal DA and DOPAC levels in response to MDMA, but no alterations in their levels of monoamine transporters. In line with previous self-administration studies, our data suggest that CB1 receptors play an important role in the reinforcing effects of MDMA, and that the experimental procedure of CPP employed should be taken into account when drawing conclusions.

Family burden with substance dependence: a study from India.

BACKGROUND & OBJECTIVES: A substance dependent person in the family affects almost all aspects of family life. This leads to problems, difficulties or adverse events which impact the lives of family members and causes enormous burden on family caregivers. The present study aimed to assess the pattern of burden borne by the family caregivers of men with alcohol and opioid dependence. METHODS: A cross-sectional study was conducted with ICD-10 diagnosed substance dependence subjects and their family caregivers attending a de-addiction centre at a multispecialty teaching hospital in north India. Family Burden Interview Schedule was used to assess the pattern of burden borne by the family caregivers of 120 men with alcohol and/or opioid dependence. RESULTS: Compared to opioid and alcohol+opioid dependence groups, more often the alcohol dependence group was older, married, currently working, having a higher income and with the wife as a caregiver. Family burden was moderate or severe in 95-100 per cent cases in all three groups and more for 'disruption of family routine', 'financial burden', 'disruption of family interactions' and 'disruption of family leisure'. Family burden was associated with low income and rural location. It was associated neither with age, education or duration of dependence of the patients, nor with family size, type of caregiver or caregiver's education and occupation. INTERPRETATION & CONCLUSIONS: Almost all (95-100%) caregivers reported a moderate or severe burden, which indicates the gravity of the situation and the need for further work in this area.

Drogas: quem é saudável vive longe do álcool e das drogas: 3ª fase: válido até junho de 2012 / Vila Saúde

Vila Saúde é um conjunto de filmes educativos em formato de episódios temáticos de curta duração. Os episódios se passam num bairro imaginário – Vila Saúde – onde personagens nascidos da realidade viverão situações temáticas. O projeto trabalhará em uma linha de moderno entendimento do tema onde saúde não é apenas ausência de doença, mas também bem-estar biológico, psicológico e social. Neste episódio o tema das drogas é abordado

Economic constraint and modes of consumption of addictive goods.

BACKGROUND: To see how economic recession, or, more generally, how increased economic constraint amongst drug users may impact their behaviour regarding the mode of drug consumption. METHODS: The theoretical framework is the theory of rational addiction - drug users are considered to be rational and well-informed about the way they use drugs and the consequences of using them. Surveys in the specialist literature dealing with the potential changes in the economic context of drugs users, and with the mechanisms of the bioavailability of psychoactive substances are examined in order to highlight one of the strategies drug users can implement to circumvent economic problems - namely a change in the mode of administration. An examination of ethnographic studies and French data are also used to test our assumptions. RESULTS: Changes in the mode of drug consumption can be the result of a maximization behaviour. Injection is the most effective way to reach a maximum bioavailability of substances. There is evidence in favour of the hypothesis that in times of economic recession, when the economic resources of drug users can decrease, they may prefer injection to other modes of administration in order to maximize the effect of what they have purchased. CONCLUSION: In times of economic recession, harm reduction policy has to be reinforced as injection behaviour can increase. As a result, economic and social policies should be an integral consideration for health policy issues.

The behavioral economics of drug dependence: towards the consilience of economics and behavioral neuroscience.

In this chapter, we review the research in this growing field by first discussing the concepts related to price and consumption (demand), its applications to the study of drug consumption and drug seeking, and the impact of other commodities on drug consumption. We then review the discounting of future commodities and events among the addicted, review the most recent research examining the neural correlates of discounting, and describe and review the new theory of addiction that results from that research. We conclude by addressing the next research steps that these advances engender.

Targeted lipidomics and drug abuse research.

Contemporaneously with genomics and proteomics technologies, lipidomics may be recognized as the next important emerging technology. The emergence of this important area of "omics" could very well mark the beginning of "the decade of the lipids." A workshop on lipidomics was held in Washington, DC, by the National Institute on Drug Abuse (NIDA) in April 2004. The goal of the workshop was to bring together scientists working at the frontier of lipid research, to discuss their findings in this area and to promote "lipidomics," in general, but also with a special focus on its application to drug abuse research and development of therapies to treat addiction.

Assessment of neurotoxicity from potential medications for drug abuse: ibogaine testing and brain imaging.

New technologies utilized for monitoring brain function can be more sensitive in the assessment of desired or undesired pharmacological effects than can clinical examination. Nonetheless, careful case-by-case analysis is required to determine to what extent a change detected with a sensitive imaging modality will have clinical significance. Whereas in some instances the technology may suggest a subclinical condition years before clinical signs develop, in other instances changes seen may be compensated for through system reserves, redundancy, or plasticity. Furthermore, simultaneous application of several assay instruments, including behavioral, electrophysiological, and nuclear medicine approaches, may be appropriate and useful for establishing correlations between changes in specific aspects of brain function and amelioration of a disease (drug abuse disorder) or its sequelae. In the example of ibogaine, a testing strategy was developed to assess human subjects for possible changes in cerebellar function (that were suggested by preclinical findings indicating subtle damage). Thus, subjects may be tested for subclinical alterations during and immediately following a clinical trial. This "harbinger of toxicity" approach would provide clinicians the critical data necessary for appropriate follow-up of subjects as well as the propriety of continuance of the clinical trials within the ibogaine project.