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1.
Subst Use Misuse ; 59(3): 450-458, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37964569

RESUMO

Background: During the ongoing opioid epidemic, Cuyahoga County (second largest in Ohio) reported overdose mortality rates (54/per 100,000) higher than the national average. Prior research demonstrates that people who use drugs often use alone but there is minimal research on people who died of overdose while using alone. The objective of this study is to examine sociodemographic, toxicologic, and injury characteristics, and emergency medical response to overdose decedents who died using drugs alone. Method: Data from the Cuyahoga County Medical Examiner's Office (2016-2020, N = 2944) on unintentional overdose deaths in adults was tabulated including socio-demographic, toxicologic, and injury-related information. Decedents using drugs alone were identified and compared to those not using alone via Chi-square and Fisher's exact tests. We further fit a multivariate logistic regression model to evaluate socio-demographic, toxicologic, and injury-related factors associated with increased odds of using alone. All results are reported with 95% confidence intervals. Result: Among decedents, 75% (n = 2205) were using drugs alone. Decedents using alone were more likely to be using drugs at home (p = 0.001) or be found dead at the scene (p < 0.001) and less likely to receive naloxone (p < 0.001) have other person/bystander, not using, present (p = 0.002). Using drugs at home (aOR = 1.61[1.19-2.20]) was associated with higher odds of using alone; and being married (aOR = 0.57[0.38-0.86]), having history of illicit drug use (aOR = 0.25[0.08-0.81]) and other person present, who was not using (aOR = 0.58[0.42-0.79]) were associated with lower odds of using alone. Conclusion: New harm reduction approaches targeting people using drugs alone are needed to reduce overdose deaths.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Fentanila , Redução do Dano , Overdose de Drogas/epidemiologia , Naloxona/uso terapêutico , Analgésicos Opioides
2.
Nurs Res ; 69(1): 69-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31804433

RESUMO

BACKGROUND: Although there is a great deal of literature regarding effective recruitment and challenges of recruiting specific patient populations, there is less known about best practices for recruitment of nurses as study subjects. OBJECTIVES: The purpose of this article is to report our experience with recruitment and retention for a randomized trial of an online educational program to prepare oncology nurses to discuss oncology clinical trials with patients. METHODS: The study population included currently employed oncology nurses with direct patient interaction. There were three phases of this study: (1) qualitative interviews, (2) a pilot test, and (3) the randomized trial. Phase 3 was rolled out in five waves of recruitment. The distinct phases of the study-and the gradual roll out of recruitment during Phase 3-allowed us to test and refine our recruitment and retention methods for the randomized trial. Upon analysis of our response rate and attrition after the first wave of recruitment in Phase 3, we made several changes to improve recruitment and retention, including adding incentives, shortening the survey, and increasing the number of reminders to complete the program. RESULTS: The response rate was higher when we used both e-mail and U.S. postal mail solicitations. After the first wave of recruitment in the final phase, changes in our strategies did not increase our overall response rate significantly; however, the rate of attrition following baseline declined. DISCUSSION: Recruitment planning is an important component of successful clinical research. The use of the Internet for both recruitment of subjects and testing of interventions remains a cost-effective and potentially high yield methodology. Our research demonstrated several successful approaches to yield increased participation and retention of subjects, including seeking formal relationships with professional organizations as sponsors or supporters, providing meaningful incentives to participants, keeping surveys or questionnaires as short as possible, and planning multiple follow-up contacts from the outset.


Assuntos
Pesquisa Biomédica/métodos , Ensaios Clínicos como Assunto/estatística & dados numéricos , Internet , Recursos Humanos de Enfermagem/estatística & dados numéricos , Enfermagem Oncológica/educação , Seleção de Pacientes , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Inquéritos e Questionários , Estados Unidos
3.
Hum Psychopharmacol ; 30(4): 290-4, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26216565

RESUMO

OBJECTIVE: This paper aims to review findings from a longitudinal study of prenatal methylenedioxymethamphetamine (MDMA, "ecstasy") on infant development. METHODS: In a prospective, longitudinal cohort design, we followed 28 MDMA-exposed and 68 non-MDMA-exposed infants from birth to 2 years of age. Women recruited voluntarily into a study of recreational drug use during pregnancy were interviewed to obtain type, frequency, and amount of recreational drug use. Their children were followed for a 2-year period after birth. A large number of drug and environmental covariates were controlled. Infants were seen at 1, 4, 12, 18, and 24 months using standardized normative tests of mental and motor development. RESULTS: There were no differences between MDMA-exposed and non-MDMA-exposed infants at birth except that MDMA-exposed infants were more likely to be male. Motor delays were evident in MDMA infants at each age and amount of MDMA exposure predicted motor deficits at 12 months in a dose-dependent fashion. CONCLUSIONS: Prenatal MDMA exposure is related to fine and gross motor delays in the first 2 years of life. Follow-up studies are needed to determine long-term effects.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Deficiências do Desenvolvimento/etiologia , Alucinógenos/efeitos adversos , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Adulto , Fatores Etários , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Reino Unido
4.
Drug Alcohol Depend Rep ; 8: 100187, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37711883

RESUMO

Introduction: Fentanyl and fentanyl analogs have increased the overdose mortality rates in the United States, significantly impacting states like Ohio. We examined carfentanil overdose deaths, other contributing Cause of Death (COD) drugs, and drug seizure trends from 2016 to 2020 in Northeast Ohio. Materials and methods: We studied death investigation data from the Cuyahoga County, Ohio Medical Examiner's Office (CCMEO) of all fatal accidental opioid overdoses as well as drug seizure data from Cuyahoga County Regional Forensic Science Laboratory (CCRFSL). We also compared decedents' race, gender, age, residential locality, drugs contributing to the COD in opioid cases, and for carfentanil, fentanyl, and cocaine seizures in Cuyahoga County from 2016 to 2020 (N = 2948). Results: Decedents' had an average of three different drugs contributing to their COD. A bimodal carfentanil spike was observed in fatal accidental overdoses in Cuyahoga County for the years 2017 and 2019. Decedents in urban residency, who were Non-Hispanic, White and younger, significantly predicted the presence of carfentanil contributing to the COD. In 2020, decedents who were Black and older were significantly associated with cocaine contributing to the COD. Carfentanil and carfentanil-related overdoses were significantly correlated. Discussion: The pervasiveness of illicitly manufactured fentanyl and fentanyl analog (e.g., carfentanil) mixtures with other drugs are changing the demographics of persons who fatally overdose in Cuyahoga County, OH. Significant trending shifts can also be observed for the presence of carfentanil in decedent and seizure county data. Conclusions: Local data of drug-related overdose deaths and drug seizures from a medical examiner's office and affiliated forensic laboratory lab can be used for timely public health surveillance, and informing prevention, and intervention at the county level.

5.
BMJ Open ; 12(9): e061212, 2022 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115676

RESUMO

OBJECTIVES: To investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation. DESIGN: A mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events. SETTING: A 30-bed mixed medical ward in a public hospital that services Brisbane's southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards. PARTICIPANTS: Nursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited. INTERVENTIONS: The mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards. RESULTS: Four themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported. CONCLUSIONS: As interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.


Assuntos
Medicina , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estudos de Viabilidade , Humanos , Pacientes Internados , Reabilitação do Acidente Vascular Cerebral/métodos
6.
Contemp Clin Trials Commun ; 22: 100789, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34169174

RESUMO

BACKGROUND: Clinical trials are a critical source of evidence for oncology care, yet very few patients participate. Among healthcare providers, nurses spend the most time with cancer patients and are the most highly trusted professionals. We developed and evaluated an educational program for oncology nurses targeting knowledge, attitudes, self-efficacy and perceived norms to facilitate discussion about clinical trials and support patient decision making. METHODS: A nationwide sample of oncology nurses were randomly assigned to receive general clinical trials education delivered as text (attention control) vs. tailored video vignettes (intervention) in a web-based continuing education program. Participants completed a baseline assessment and follow up assessments immediately after the educational program and three months later. The primary outcome was intention to discuss clinical trials with patients. Secondary outcomes were knowledge and attitudes about clinical trials, self-efficacy, and perceived norms. RESULTS: 1393 nurses enrolled and completed the educational program and post-intervention assessment (720 control, 673 video). Both text education and tailored video education increased intention to discuss clinical trials with patients, with a greater effect in the video group (p < .0001). Likewise, knowledge, attitudes, perceived behavioral control, and perceived norms were all improved with education in both groups, and the magnitude of benefit was greater (p < .001) for the video group in all outcomes except knowledge. CONCLUSION: A one-time online educational program for oncology nurses improves knowledge, attitudes, self-efficacy and intention to engage patients in discussions about clinical trials. A tailored video format was associated with a greater effect than standard text only material.

7.
West J Nurs Res ; 41(12): 1747-1760, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30782111

RESUMO

In the United States less than 10% of cancer patients engage in clinical trials. Although most oncology nurses have multiple opportunities to discuss clinical trials with patients, barriers including attitudes and social norms may impede these discussions. Guided by the Theory of Planned Behavior, we developed and evaluated measures for attitudes, subjective norms, and perceived behavioral control of nurses for discussing clinical trials with cancer patients. Of the 18,000 Oncology Nurse Society members invited, 1,964 completed the survey. Structural equation modeling and internal consistency reliability were used to evaluate items and constructs. We found that overall model fit and reliability was good: Confirmatory Fit Index (CFI) = 0.91, Root Mean Square Error of Approximation (RMSEA) = 0.05; attitudes, 21 items, alpha = 0.84; perceived behavioral control, 10 items, alpha = 0.85; and subjective norms, 9 items, alpha = 0.89. These measures of attitudes, subjective norms, and perceived behavioral control show good reliability and initial evidence of validity.


Assuntos
Neoplasias/terapia , Enfermeiras e Enfermeiros/psicologia , Enfermagem Oncológica/métodos , Seleção de Pacientes , Adulto , Ensaios Clínicos como Assunto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermagem Oncológica/organização & administração , Enfermagem Oncológica/estatística & dados numéricos , Pacientes , Estados Unidos
8.
J Pediatr ; 151(5): 463-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17961686

RESUMO

OBJECTIVE: To compare severity and determinants of stress and coping in mothers of 8-year-old very low birth weight (VLBW) and term children varying in medical and developmental risk. STUDY DESIGN: Three groups of mothers/infants were prospectively compared in a longitudinal study from birth to 8 years (110 high-risk VLBW, 80 low-risk VLBW, and 112 term). Maternal psychological distress, coping, parenting/marital stress, child health, and family impact were measured in the children at age 8 years. RESULTS: Mothers of VLBW children differed from term mothers, reporting less consensus with partners, more concern for their children's health, less parent-child conflict, and fewer years of education attained. Mothers of high-risk VLBW children experienced the greatest family and personal strains and used less denial and disengagement coping. The groups exhibited no differences in the sense of parenting competence, divorce rate, parenting/marital satisfaction, family cohesion, and psychological distress symptoms. Multiple birth, low socioeconomic status, and lower child IQ added to maternal stress. CONCLUSIONS: VLBW birth has long-term negative and positive impacts on maternal/family outcomes related to the infant's medical risk.


Assuntos
Adaptação Psicológica , Recém-Nascido de muito Baixo Peso , Poder Familiar/psicologia , Estresse Psicológico/epidemiologia , Criança , Pré-Escolar , Escolaridade , Relações Familiares , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Inteligência , Estudos Longitudinais , Masculino , Relações Materno-Fetais , Meio-Oeste dos Estados Unidos , Apego ao Objeto , Estudos Prospectivos , Classe Social , Isolamento Social , Apoio Social , Inquéritos e Questionários
9.
Oncol Nurs Forum ; 44(5): 547-552, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28820515

RESUMO

PURPOSE/OBJECTIVES: To describe oncology nurses' experiences discussing clinical trials with their patients, and to assess barriers to these discussions.
. RESEARCH APPROACH: A qualitative study designed to elicit narratives from oncology nurses. 
. SETTING: Community- and academic-based oncology clinics throughout the United States.
. PARTICIPANTS: 33 oncology nurses involved in direct patient care in community-based and large hospital-based settings. The sample was drawn from members of the Oncology Nursing Society. 
. METHODOLOGIC APPROACH: In-depth interviews were conducted and analyzed using a immersion/crystallization approach to identify themes and patterns. The analyses highlight specific issues, examples, and contexts that present challenges to clinical trial discussions with patients.
. FINDINGS: Oncology nurses view their roles as patient educators and advocates to be inclusive of discussion of clinical trials. Barriers to such discussions include lack of knowledge and strategies for addressing patients' common misconceptions and uncertainty about the timing of discussions.
. INTERPRETATION: These data indicate that enabling nurses to actively engage patients in discussions of clinical trials requires educational interventions to build self-efficacy and close knowledge gaps. 
. IMPLICATIONS FOR NURSING: Oncology nurses can play a critical role in advancing cancer care by supporting patients in decision making about clinical trial participation. This will require training and education to build their knowledge, reduce barriers, and increase their self-efficacy to fulfill this responsibility in various clinical settings.


Assuntos
Atitude do Pessoal de Saúde , Ensaios Clínicos como Assunto/psicologia , Neoplasias/enfermagem , Papel do Profissional de Enfermagem/psicologia , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem Hospitalar/psicologia , Enfermagem Oncológica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos
10.
Psychol Assess ; 18(3): 278-88, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16953731

RESUMO

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factor structure of coping in mothers with high levels of life stress. In Study 1, EFA of the Coping Orientation to Problems Experienced (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989) in a sample of mothers of full-term or very low birth weight 2-year-old children yielded 7 reliable coping factors. Each factor accounted for significant variance in at least 1 of 6 outcomes measuring maternal-child well-being. In Study 2, CFA was used to cross-validate the EFA model on the basis of the responses of mothers of 2-year-old children with prenatal polysubstance exposure. CFA results revealed a moderately good fit, confirming the factor structure in a 2nd, independent sample of mothers with high levels of life stress.


Assuntos
Adaptação Psicológica/fisiologia , Análise Fatorial , Mães/psicologia , Mães/estatística & dados numéricos , Estresse Psicológico/psicologia , Feminino , Humanos , Estudos Longitudinais , Reprodutibilidade dos Testes , Inquéritos e Questionários
11.
Neurotoxicol Teratol ; 54: 22-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26806601

RESUMO

BACKGROUND: Recreational use of 3,4 methylenedioxymethamphetamine (ecstasy, MDMA) is increasing worldwide. Its use by pregnant women causes concern due to potentially harmful effects on the developing fetus. MDMA, an indirect monoaminergic agonist and reuptake inhibitor, affects the serotonin and dopamine systems. Preclinical studies of fetal exposure demonstrate effects on learning, motor behavior, and memory. In the first human studies, we found prenatal MDMA exposure related to poorer motor development in the first year of life. In the present study we assessed the effects of prenatal exposure to MDMA on the trajectory of child development through 2 years of age. We hypothesized that exposure would be associated with poorer mental and motor outcomes. MATERIALS AND METHODS: The DAISY (Drugs and Infancy Study, 2003-2008) employed a prospective longitudinal cohort design to assess recreational drug use during pregnancy and child outcomes in the United Kingdom. Examiners masked to drug exposures followed infants from birth to 4, 12, 18, and 24 months of age. MDMA, cocaine, alcohol, tobacco, cannabis, and other drugs were quantified through a standardized clinical interview. The Bayley Scales (III) of Mental (MDI) and Motor (PDI) Development and the Behavior Rating Scales (BRS) were primary outcome measures. Statistical analyses included a repeated measures mixed model approach controlling for multiple confounders. RESULTS: Participants were pregnant women volunteers, primarily white, of middle class socioeconomic status, average IQ, with some college education, in stable partner relationships. Of 96 women enrolled, children of 93 had at least one follow-up assessment and 81 (87%) had ≥ two assessments. Heavier MDMA exposure (M=1.3±1.4 tablets per week) predicted lower PDI (p<.002), and poorer BRS motor quality from 4 to 24 months of age, but did not affect MDI, orientation, or emotional regulation. Children with heavier exposure were twice as likely to demonstrate poorer motor quality as lighter and non-exposed children (O.R.=2.2, 95%, CI=1.02-4.70, p<.05). DISCUSSION: Infants whose mothers reported heavier MDMA use during pregnancy had motor delays from 4 months to two years of age that were not attributable to other drug or lifestyle factors. Women of child bearing age should be cautioned about the use of MDMA and MDMA-exposed infants should be screened for motor delays and possible intervention.


Assuntos
Deficiências do Desenvolvimento/etiologia , Alucinógenos/efeitos adversos , Transtornos Motores/etiologia , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Transtornos Psicomotores/etiologia , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/complicações
12.
J Dev Behav Pediatr ; 24(4): 233-41, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12915795

RESUMO

The associations of infant medical risk, prematurity, and maternal psychological distress with the quality of maternal-infant interactions during the first year of life were evaluated in a prospective, longitudinal follow-up from birth. A total of 103 high-risk very low birth weight (VLBW) infants with bronchopulmonary dysplasia, 68 low-risk VLBW infants without bronchopulmonary dysplasia, and 117 healthy term infants were seen at 1, 8, and 12 months of age. Videotaped feedings at each age were rated using the Nursing Child Assessment Feeding Scale, and mothers completed the Brief Symptom Inventory as a measure of psychological distress. VLBW infant status was related to both maternal and infant behaviors as well as to maternal distress, and these relationships varied with infant age. Overall, VLBW infants displayed fewer responsive, clear interactions, with differences from term infants increasing over time. Maternal distress was related to less cognitive growth fostering for all mothers. Because maternal distress is more prevalent in mothers of VLBW infants postpartum, intervention efforts should focus on assessment of maternal distress and the challenges posed by the interactive behaviors of VLBW infants.


Assuntos
Comportamento do Lactente , Recém-Nascido de muito Baixo Peso/psicologia , Relações Mãe-Filho , Mães/psicologia , Adulto , Displasia Broncopulmonar/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/psicologia , Doenças do Prematuro/psicologia , Estudos Longitudinais , Masculino , Comportamento Materno
13.
J Commun Disord ; 35(5): 393-406, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12194561

RESUMO

UNLABELLED: A prospective follow-up of very low birth weight infants (VLBW) with (n = 89) and without (n = 71) bronchopulmonary dysplasia (BPD) and Term control children (n = 93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups. The BPD and VLBW groups did not differ on expressive language, oral motor skills, or verbal IQ. The groups also differed in enrollment in special classes and speech-language therapy, with almost half (48%) of the BPD group enrolled in speech-language therapy compared to 21% of the VLBW group, and 9% of the Term group. These results suggest that BPD may have adverse effects on speech development as well as on performance IQ, motor skills, and receptive language over and above the effects of VLBW. LEARNING OUTCOMES: (1) As a result of this activity the reader will be able to describe what BPD is and how it impacts speech and language. (2) As a result of this activity the reader will be able to discuss how children with VLBW with BPD differ from children with VLBW without BPD in their developmental outcomes.


Assuntos
Displasia Broncopulmonar/epidemiologia , Transtornos da Linguagem/epidemiologia , Distúrbios da Fala/epidemiologia , Criança , Feminino , Seguimentos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Transtornos da Linguagem/diagnóstico , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Distúrbios da Fala/diagnóstico
14.
J Psychopharmacol ; 28(1): 55-61, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24327452

RESUMO

BACKGROUND: The recreational drug MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' is associated with heightened psychiatric distress and feelings of depression. The Drugs and Infancy Study (DAISY) monitored the psychiatric symptom profiles of mothers who used Ecstasy/MDMA while pregnant, and followed them over the first year post-partum. METHODS: We compared 28 young women whom took MDMA during their pregnancy with a polydrug control group of 68 women who took other psychoactive drugs while pregnant. The Brief Symptom Inventory (BSI) was completed for several periods: The first trimester of pregnancy; and 1, 4 and 12 months after childbirth. Recreational drug use was monitored at each time point. RESULTS: During the first trimester of pregnancy, MDMA-using mothers reported higher depression scores than the polydrug controls. At 1 year after childbirth, their BSI depression scores were significantly lower, now closer to the control group values. At the same time point, their self-reported use of MDMA became nearly zero, in contrast to their continued use of Cannabis/marijuana, nicotine and alcohol. We found significant symptom reductions in those with BSI obsessive-compulsive and interpersonal sensitivity, following Ecstasy/MDMA cessation. CONCLUSIONS: The findings from this unique prospective study of young recreational drug-using mothers are consistent with previous reports of improved psychiatric health after quitting MDMA.


Assuntos
Depressão/induzido quimicamente , Depressão/psicologia , Usuários de Drogas/psicologia , Drogas Ilícitas/efeitos adversos , Mães/psicologia , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Adulto , Estudos de Casos e Controles , Depressão/complicações , Feminino , Nível de Saúde , Humanos , Gravidez , Escalas de Graduação Psiquiátrica , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Fatores de Tempo , Adulto Jovem
15.
Neurotoxicol Teratol ; 34(3): 303-10, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22387807

RESUMO

3,4-methylenedioxymethamphetamine (MDMA) or "Ecstasy" is one of the most widely used illicit recreational drugs among young adults. MDMA is an indirect monoaminergic agonist and reuptake inhibitor that primarily affects the serotonin system. Preclinical studies in animals have found prenatal exposure related to neonatal tremors and long-term learning and memory impairments. To date, there are no prospective studies of the sequelae of prenatal exposure to MDMA in humans, despite concerns about its potential for harmful effects to the fetus. The present study is the first to prospectively identify MDMA-using women during pregnancy and to document patterns and correlates of use with neonatal and early infancy outcomes of offspring. All mothers and infants were prospectively recruited through the Case Western Reserve University (CWRU) and University of East London (UEL) Drugs and Infancy Study (DAISY) that focused on recreational drug use in pregnant women. Women were interviewed about substance use prior to and during pregnancy and infants were seen at 1 and 4 months using standardized, normative assessments of neonatal behavior, and cognitive and motor development, including the NICU Network Neurobehavioral Scale (NNNS), the Bayley Mental and Motor Development Scales (MDI, PDI), and the Alberta Infant Motor Scales (AIMS). The sample was primarily middle class with some university education and in stable partner relationships. The majority of women recruited had taken a number of illicit drugs prior to or during pregnancy. Group differences between those polydrug using women who had specifically used MDMA during pregnancy (n=28) and those who had not (n=68) were assessed using chi-square and t-tests. MDMA and other drug effects were assessed through multiple regression analyses controlling for confounding variables. Women who used MDMA during pregnancy had fewer prior births and more negative sequelae associated with their drug use, including more health, work, and social problems. MDMA exposed infants differed in sex ratio (more male births) and had poorer motor quality and lower milestone attainment at 4 months, with a dose-response relationship to amount of MDMA exposure. These findings suggest risk to the developing infant related to MDMA exposure and warrant continued follow-up to determine whether early motor delays persist or resolve.


Assuntos
Drogas Ilícitas/toxicidade , Comportamento do Lactente/efeitos dos fármacos , N-Metil-3,4-Metilenodioxianfetamina/toxicidade , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Adulto , Feminino , Idade Gestacional , Humanos , Lactente , Comportamento do Lactente/psicologia , Recém-Nascido , Masculino , Testes Neuropsicológicos , Gravidez , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal/psicologia , Estudos Prospectivos
16.
Pediatrics ; 130(3): 407-13, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22908109

RESUMO

OBJECTIVE: A widely used illicit recreational drug among young adults, 3,4-methylenedioxymethamphetamine (MDMA) or ecstasy, is an indirect monoaminergic agonist/reuptake inhibitor affecting the serotonin system. Preclinical studies found prenatal exposure related to long-term learning and memory impairments. There are no studies of sequelae of prenatal MDMA exposure in humans, despite potential harmful effects to the fetus. METHODS: A total of 96 women in the United Kingdom (28 MDMA users; 68 non-MDMA) were interviewed about recreational drug use during pregnancy. Their infants were seen at 12 months using standardized assessments of cognitive, language, and motor development (Preschool Language Scale, Bayley Mental and Motor Development and Behavior Rating Scales [Mental Development Index, Psychomotor Development Index, Behavioral Rating Scale]). Mothers completed the Child Domain Scale of the Parenting Stress Index, The Home Observation of the Environment Scale (in interview), the Brief Symptom Inventory, and the Drug Abuse Screening Test. Women were primarily middle class with some university education, in stable partner relationships, and polydrug users. MDMA and other drug effects were assessed through multiple regression analyses controlling for confounding variables, and analysis of covariance comparing heavier versus lighter and nonexposed groups. RESULTS: Amount of prenatal MDMA exposure predicted poorer infant mental and motor development at 12 months in a dose-dependent manner. Heavily exposed infants were delayed in motor development. Lighter-exposed infants were comparable to nonexposed infants. There were no effects on language, emotional regulation, or parenting stress. CONCLUSIONS: Findings document persistent neurotoxic effects of heavier prenatal MDMA exposure on motor development through the first year of life.


Assuntos
Deficiências do Desenvolvimento/induzido quimicamente , Alucinógenos/efeitos adversos , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Cognição/efeitos dos fármacos , Deficiências do Desenvolvimento/diagnóstico , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Masculino , Gravidez , Desempenho Psicomotor/efeitos dos fármacos , Fatores Socioeconômicos
17.
Arch Pediatr Adolesc Med ; 164(6): 518-24, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20530301

RESUMO

OBJECTIVE: To determine longitudinal outcomes and contributors to parental stress and coping in mothers of very low-birth-weight (VLBW) children. DESIGN: Prospective cohort follow-up of high-risk VLBW children (n = 113), low-risk VLBW children (n = 80), and term children (n = 122) and their mothers from birth to 14 years. SETTING: Recruitment from level III neonatal intensive care and term nurseries in a large Midwestern region with follow-up at an academic medical center. PARTICIPANTS: A total of 315 mother-infant dyads enrolled from November 8, 1989, to February 22, 1992. MAIN EXPOSURES: High-risk VLBW infants had bronchopulmonary dysplasia. Comparison groups were demographically similar low-risk VLBW children (without bronchopulmonary dysplasia) and term children. MAIN OUTCOME MEASURES: Child IQ and self-report measures of parenting stress, family impact, maternal coping, education, and social support. RESULTS: After VLBW birth, mothers attained fewer additional years of education than term mothers (P = .04). Mothers of high-risk VLBW children felt more personal stress (P = .006) and family stress (P = .009) under conditions of low social support and had greater child-related stress than term mothers; however, they also expressed the highest levels of parenting satisfaction at 14 years. They became less likely to use denial (P = .02) and mental disengagement (P = .03) as coping mechanisms over time. Except for education attainment, mothers of low-risk VLBW infants did not differ from mothers of term children and at 14 years reported the lowest stress. CONCLUSIONS: Parenting a VLBW child had both positive and negative outcomes, dependent on child medical risk, child IQ, social support, and maternal coping mechanisms, suggesting that mothers experience posttraumatic growth and resilience after significant distress post partum.


Assuntos
Adaptação Psicológica , Recém-Nascido de muito Baixo Peso/psicologia , Relações Mãe-Filho , Mães/psicologia , Poder Familiar/psicologia , Estresse Psicológico , Adolescente , Adulto , Displasia Broncopulmonar , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/psicologia , Masculino , Comportamento Materno , Estudos Prospectivos , Nascimento a Termo , Adulto Jovem
18.
J Psychopharmacol ; 24(9): 1403-10, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19939863

RESUMO

While recreational drug use in UK women is prevalent, to date there is little prospective data on patterns of drug use in recreational drug-using women immediately before and during pregnancy. A total of 121 participants from a wide range of backgrounds were recruited to take part in the longitudinal Development and Infancy Study (DAISY) study of prenatal drug use and outcomes. Eighty-six of the women were interviewed prospectively while pregnant and/or soon after their infant was born. Participants reported on use immediately before and during pregnancy and on use over their lifetime. Levels of lifetime drug use of the women recruited were high, with women reporting having used at least four different illegal drugs over their lifetime. Most users of cocaine, 3,4-methylenedioxy-N-methylamphetamine (MDMA) and other stimulants stopped using these by the second trimester and levels of use were low. However, in pregnancy, 64% of the sample continued to use alcohol, 46% tobacco and 48% cannabis. While the level of alcohol use reduced substantially, average tobacco and cannabis levels tended to be sustained at pre-pregnancy levels even into the third trimester (50 cigarettes and/or 11 joints per week). In sum, while the use of 'party drugs' and alcohol seems to reduce, levels of tobacco and cannabis use are likely to be sustained throughout pregnancy. The data provide polydrug profiles that can form the basis for the development of more realistic animal models.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Drogas Ilícitas , Fumar Maconha/epidemiologia , N-Metil-3,4-Metilenodioxianfetamina , Complicações na Gravidez/epidemiologia , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Feminino , Alucinógenos , Humanos , Estudos Longitudinais , Gravidez , Trimestres da Gravidez , Detecção do Abuso de Substâncias , Reino Unido/epidemiologia
19.
Arch Pediatr Adolesc Med ; 161(11): 1082-7, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17984411

RESUMO

OBJECTIVE: To investigate the relationship between the severity-based definition of bronchopulmonary dysplasia (BPD), choice of treatment, and neurocognitive outcomes at age 3 and 8 years. DESIGN: This is a secondary analysis of data collected from a prospective, longitudinal sample of 99 children with a history of BPD. SETTING: Children born with BPD admitted to 3 hospitals from February 1, 1989, to November 31, 1991. PARTICIPANTS: Ninety-nine children with BPD were longitudinally assessed at age 3 and 8 years. Three severity groups (mild, moderate, and severe) were formed based on gestational age and need for supplemental oxygen therapy. MAIN EXPOSURES: Supplemental oxygen therapy for 28 days or longer, birth weight less than 1500 g, and radiographic evidence of lung disease. MAIN OUTCOME MEASURES: Neurologic and medical outcomes; type of medical management; and language, achievement, and cognitive functioning were compared among the 3 severity groups. RESULTS: Severity classification of BPD was associated with poorer outcomes. Compared with children with mild or moderate BPD, children with severe BPD performed more poorly on IQ tests (Mental Development Index, 90 vs 76.4; and Psychomotor Development Index, 92.5 vs 73.9) and language measures (total, 95 vs 82) at age 3 years and performance IQ (86 vs 75) and perceptual organization (86 vs 76) at age 8 years. Severity of BPD was not associated with choice of medical management but was related to educational interventions. Children with severe BPD received more special education services (69% vs 44%) than did children with mild BPD. CONCLUSIONS: The severity-based classification clarifies the relationship between BPD and developmental sequelae. Children with severe BPD required more interventions at age 8 years than did children with mild or moderate BPD.


Assuntos
Displasia Broncopulmonar/classificação , Displasia Broncopulmonar/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Índice de Gravidade de Doença , Criança , Pré-Escolar , Transtornos Cognitivos/epidemiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Masculino
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