Carfentanil exposure could cause severe ventilatory depression associated with muscle stiffness, hypoxemia/hypercapnia (due to hypoventilation) and hypothermia; however, its effect on inspiratory motor drive alone (without these associated effects) has not been investigated. This, along with the inhibitory impact of opioids on hypoxic and hypercapnic ventilation, allows us to determine the impacts of carfentanil on the phrenic nerve (PN) activities before and during hypoxia and hypercapnia in this study. Two groups of anesthetized and spontaneously breathing rats were initially exposed to aerosolized vehicle (Ctrl) and carfentanil (1.7 mg/m3) for 10 min. After vagotomy, paralysis and artificial ventilation, the peak and frequency of integrative PN activity (∫PN and fR), minute PN (MPN = ∫PN × fR), arterial blood pressure (ABP) and heart rate (HR) were recorded before and during hypoxia (10% O2 for 1 min) and hypercapnia (10% CO2 for 3 min). Our results showed that: 1) carfentanil significantly reduced MPN and ∫PN by ~50% and led to hypertension without change in fR and HR; 2) hypoxia enhanced MPN, ∫PN and fR and decreased ABP and hypercapnia brought about similar PN responses with HR decreased in the Ctrl rats; and 3) carfentanil strikingly attenuated the MPN, fR and ∫PN during both chemical challenges and exacerbated the hypotension during hypoxia and the bradycardia during hypercapnia. Our results suggest that carfentanil greatly suppresses the inspiratory motor drive, at least partially, via attenuating the chemoreflexes to substantially contribute to carfentanil-induced ventilatory depression and failure.
The intersection of epidemiology and medical science forms the basis of a public health approach to challenging health issues. Although initial conceptions of epidemiology predominantly focused on infectious diseases, the epidemiological approach has been applied successfully to non-infectious or non-communicable diseases including those health issues related to substance use. However, unlike an infectious disease or even a chronic condition such as cancer, substance use is more dynamic with changing forms of the external agent—psychoactive substances-- and the variety of sources for these ‘agents’ that may vary geographically (within and across communities), as well as sociologically (involving a variety of social groups across time and space). As such, the dynamic nature of substance use warrants an epidemiologically-informed system for its prevention and treatment, that includes on-going monitoring and dynamic and timely surveillance systems designed to identify emerging patterns of use that have implications for prevention and treatment, such as new ways to administer substances (e.g., injecting crack cocaine), new ‘mixtures’ of substances (e.g., changing the composition of substances such as mixing fentanyl with heroin or Adderall), new types of substances, and new user groups. This paper demonstrates how this type of epidemiologic information can inform the structure and function of a national comprehensive substance use service delivery system to address the issue on a population level.
Human papillomavirus (HPV) is a common sexually transmitted infection that can lead to a range of serious health issues, including cervical cancer
Oxytocin is a neuropeptide that has potential for the development as an anti-alcoholism treatment. Clinical studies have recently found that intranasal oxytocin treatment reduces alcohol withdrawal symptoms or craving in alcohol-dependent patients with high anxiety. In rodents, activation of oxytocin receptor by systemic or central administration of oxytocin decreases alcohol reward, consumption and cue-induced alcohol seeking behaviors. The neurobiological interaction between oxytocin and mu opioid receptors (MOR) has been well established: MOR agonists or endogenous beta-endorphin inhibit oxytocin release and neuronal activity. Here we explored whether oxytocin under MOR antagonism by naltrexone can enhance the reduction of alcohol intake by oxytocin alone after 3-week excessive alcohol drinking in an intermittent access alcohol (IAA) mouse model or after 1-week abstinence in mouse alcohol deprivation effect (ADE) model. For a genetic control for naltrexone effect, neuronal proopiomelanocortin enhancer (nPE) knockout mice with brain-specific beta-endorphin deficiency were further studied with oxytocin. We found that administration of oxytocin at 0.1 mg/kg [but not 0.01 or 0.03 mg/kg] decreased alcohol intake and preference. When oxytocin co- administered with naltrexone, oxytocin at 0.01-0.03 mg/kg with low doses of naltrexone (0.5 or 1 mg/kg) reduced alcohol drinking more profoundly than the sub-effective doses of oxytocin alone. Alcohol “relapse” in the ADE was prevented by either oxytocin alone or co-administration of oxytocin with naltrexone. The oxytocin effect was confirmed in nPE-/- mice, suggesting independent mechanisms by which oxytocin and naltrexone reduced alcohol drinking. Our study suggests that oxytocin in combination with low-dose naltrexone offers a novel strategy in alcoholism treatment.
Background:Depression in the peripartum period is prevalent in low-income-countries. The identification of women needing referral is often lacking and on the other hand, women in need of support and treatment do not make use of existing support.Objectives:To identify risk factors for fetal and postnatal consequences of depression in pregnancy and to investigate further management once women at risk have been identified.Methods:The Safe Passage Study was a large prospective multicenter international study. Extensive information, including the Edinburgh postnatal depression scale (EPDS), was collected during the study. At risk women were referred to the study's social worker (SW). Women were categorized according to risk on their EPDS results. Risk categories were characterized and investigated for infant outcomes.Results:Data from 5,489 women were available for analysis and revealed a 51% prevalence of prenatal depression. Fourteen percent of at-risk women attended SW appointments, while 36% accepted the SW referral but persistently failed to attend. At risk women were significantly younger, had less formal education, had lower monthly income, and lived in more crowded conditions. They used significantly more alcohol and cigarettes. Their infants had shorter gestational ages, lower birth weights and were more growth restricted. Infants of depressed women who missed appointments weighed less and were more growth restricted.Conclusion:Women with high EPDSs had less favorable socioeconomic conditions, used more alcohol or tobacco during pregnancy, and their infants weighed less with more growth restriction. Women who repeatedly missed their appointments came from the poorest socioeconomic conditions and their infants had worse birth outcomes.
Background A worldwide and ever-growing population of children are using psychoactive substances. To slow this problem, the Child Intervention for Living Drug-Free (CHILD) Curriculum was created to train treatment providers on how to screen, assess, and treat children between the ages of 4-12 years of age exposed to or actively using psychoactive substances. The purpose of the present project was to evaluate the extent to which completion of a six-session training of the six courses of the CHILD Curriculum met the objective of increasing the participants' knowledge of the Curriculum's approach to treating children for substance use problems. Methods 71 participants from Africa, Asia, and South America were invited for training and 100% accepted the invitation. Trainees completed an in-person small-group course, occurring over 32 days and comprising 256 total hours. During the CHILD Curriculum training, they completed six separate, 20-item, multiple choice knowledge assessment measures, one for each of the six courses comprising the Curriculum. Results Significant (ps<.001) improvement in knowledge in each course was associated with a multivariate measure of strength of the relationship that indicated the change was substantial for five courses (R2s>.5) and moderate for a sixth course. Percentage change from baseline varied from a low of 17% to a high of 63%. Conclusion The CHILD Curriculum provides a useful educational framework to ensure knowledge gains by trainees. This curriculum content and evaluation provides a framework for future training of providers to pre-adolescent children who use psychoactive substances or are at risk for such use.
Background:Substance use during pregnancy and early parenting years is a well-known global public health problem, but the literature comparing treatment programs for this subpopulation across countries is limited. This article both describes three women-centered treatment programs in the United States, Brazil, and Argentina and examines similarities and differences among the programs in terms of patient characteristics. Such an analysis can better inform clinicians in the assessment and treatment of women who use substances and improve the universal understanding about them.Methods:A secondary data analysis of patient characteristics (e.g., pregnant at treatment admission) and patient history (e.g., substance dependence diagnosis, family history of substance use, co-occurring mental health issues) of reproductive age women (N=356) from substance use treatment programs in the United States, Brazil, and Argentina.Results:The Horizons program admitted the highest percentage of pregnant women (60%), Lua Nova (36%), and Casa Santa Clara (17%). Horizons patients (82%) were more likely to have a substance dependence diagnosis than Lua Nova (15%) or Casa Santa Clara patients (13%). Horizons patients (78%) were more likely to have a family history of substance use than Lua Nova (15%) or Casa Santa Clara (57%) patients. Horizons was also more likely than Lua Nova or Casa Santa Clara to have patients who had entered mental health treatment (70% vs. 19% vs. 9%, respectively).Conclusion:Substance use problems that continue during pregnancy and parenting are common within different cultures and societies. These analyses identified similarities and differences in patient characteristics, history, and treatment programs. Cross-cultural comparisons of treatment approaches provide opportunities for clinicians to explore new ways of caring for this population.
INTRODUCTION:Alcohol screening, brief intervention and referral to treatment is mandated within the level 1 pediatric trauma center. However, data on the prevalence of alcohol and drug use among admitted pediatric trauma patients is limited. Our study objective was to describe substance use and related negative consequences in admitted adolescent trauma patients across three pediatric level 1 trauma centers.METHODS:This surveillance study was nested within a study on electronically delivered parenting skills education to parents of admitted adolescents (12-17 years) screening positive for alcohol or drug use. Enrolled adolescents completed baseline assessments to examine demographics, substance use and related negative consequences. Thirty-seven parent-adolescent dyads enrolled in the intervention study.RESULTS:Participants were eligible if they received a positive CRAFFT score or a positive biological screen for alcohol or drug use at time of the hospital admission. Of those enrolled into the study, 9 (24%) reported no substance use in the prior 12 months in our assessment battery. Of the remaining 28 patients, 6 (16%) reported using only alcohol, 10 (27%) only marijuana, 9 (24%) both alcohol and marijuana, and 3 (8%) alcohol and marijuana with other drugs in the past 12 months. Negative consequences reported varied between those who reported alcohol use only and those who reported marijuana use only with physical consequences of use most often being reported by those using alcohol (hangover, vomiting), and psychosocial consequences (getting into trouble with parents, doing something later regret) by those who used only marijuana.CONCLUSION:These findings support the use of laboratory screening and screening questionnaires for all adolescent trauma admissions to capture a complete picture of alcohol and drug use.
In the current research, we examined the association of key risk and protective factors for gambling involvement from the domains of family environment, conduct problems/delinquency, substance use, and depressive psychopathology in a nationally representative sample. The sample was comprised of 13,291 young adults (ages 18-26; Meanage = 22.8) self-identifying as European American (n=9,939) or African American (n=3,335) who participated in Wave III (n = 15,170) of the restricted-use National Longitudinal Study of Adolescent to Adult Health. We used separate logistic regressions to study participation in specific gam bling categories (lottery games, casino-type games, other games). Childhood neglect, physical discipline, and current alcohol use was associated across each of the three gam bling categories. Our results also revealed differences between European American and African American subjects. Current cannabis use was associated with all three categories among African Americans, while current cigarette use was associated among European Americans for lottery games, and depression (female) was associated with other games. We also applied multinomial logistic regression to study gambling involvement based on the number of gam bling categories that the participant engaged in 2 or more (referent), only 1, or none at all. Our results revealed that delinquency/conduct symptoms (AOR=0.83) along with cannabis use (African American; AOR =0.66), cigarette use (European American; AOR =0.83), current alcohol use (AOR=0.66) were associated with gambling in two categories vs. gambling in one category. Childhood physical discipline (AOR=0.75) and childhood neglect (AOR=0.75) were associated with gam bling in two categories vs. no gambling. Further are needed to investigate the developmental pathways leading to increased gam bling involvement among African American and European American adolescents and young adults.
Given the efficacy of new medications for Hepatitis C virus (HCV), we aimed to determine whether drinking relates to HCV treatment access among the high-risk group of individuals with HIV/HCV co-infection.We sampled 210 patients in a sexual health clinic; of these, 39 reported HIV/HCV co-infection (79.49% male; 56.41% Black). Patients completed a self-report survey on drinking and treatment history.Those drinking despite health problems reported less HCV treatment (p =0.035). Drinking despite health problems did not relate to whether HCV treatment was recommended by providers, and binge drinking did not relate to either HCV outcome. Drinking was unrelated to HIV treatment.HIV/HCV co-infected individuals drinking despite health problems are in urgent need of attention, to reduce drinking and increase engagement in treatment. Drinking despite health problems m ay serve as an effective screening question to identify HIV/HCV co-infected drinkers who are most at risk of being untreated.
BACKGROUND:Over half of young adults with schizophrenia smoke. Quitting before age 30 could prevent some of the disparate morbidity and mortality due to smoking-related diseases. However, little research has addressed smoking in this group nor evaluated strategies to help young adults with schizophrenia quit smoking.METHODS:We compared demographic and smoking-related characteristics of young adults and those over 30 years of age among 184 smokers with schizophrenia. With a series of regression models, we assessed whether age, gender, smoking characteristics, social norms, attitudes, and perceived behavioral control predicted intention to quit smoking and to use cessation treatments.RESULTS:Young adults had smoked for fewer years, had lower nicotine dependence, and had lower breath carbon monoxide levels than those over 30, yet awareness of the harms of smoking and readiness to quit were similar between groups. Attitudes about smoking, attitudes about cessation treatment, social norms for cessation treatment, and perceived behavioral control for cessation treatment significantly predicted intention to use cessation treatment. Age was not a predictor of intention to quit, nor to use cessation treatment.CONCLUSIONS:Young adults with schizophrenia are amenable to smoking cessation intervention. Increasing awareness of the safety, efficacy and access to cessation treatments among smokers with schizophrenia and also among those in their social network may improve use of effective cessation treatment. These strategies may enhance the standard educational approach (increasing awareness of harms). Research is needed to evaluate such intervention strategies in smokers with schizophrenia of all ages.
Cite this article: Donadon MF, Hallak JEC, Osório FL (2016) Impact of Cognitive Deficits in Patients with Cirrhosis and Alcoholic Hepatopathy after Reduction in Alcohol Intake. J Subst Abuse Alcohol 4(2): 1047. *Corresponding author Flávia de Lima Osório, Department of Neuroscience and Behavior, University of São Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, São Paulo, CEP 14048-900, Brazil, Tel: 551636022837; Email:
This study examined the impact of passive versus active parental consent procedures on response rates and nonresponse bias when recruiting 9th grade students for a schoolbased alcohol intervention. Results indicated a significant difference in response rates when using passive parental consent procedures (91.8%) compared to active parental consent procedures (30.4%). Additionally, students recruited with active parental consent procedures reported lower rates of alcohol use and lower levels of alcoholrelated consequences than those recruited with passive parental consent procedures. There were no differences in demographic variables between the two groups. Findings indicate active parental consent procedures may result in an underrepresentation of students reporting alcohol use and alcohol-related consequences, compromising the generalizability of findings in school-based alcohol intervention research. We suggest researchers incorporate strategies shown to increase response rates when using active parental consent procedures to minimize nonresponse bias.
Emerging drugs of abuse, such as xylazine (XYL), are receiving great interest due to increasing use and the potential health toxicity effects, in the addict population. XYL is an alpha two agonist without medical applications in humans. Our previous studies indicated XYL and its combination with cocaine (COC) and/or 6-monoacetylmorphine (6-MAM) induced apoptotic cell death and DNA fragmentation in endothelial cells. In addition XYL and 6-MAM trigger reactive oxygen species (ROS) production in these cells. This study aim is identify apoptosis path way in cell death and determine cell cycle effects of xylazine and its combination with COC and 6-MAM in Human umbilical vein endothelial cells (HUVEC, EA.hy926). HUVEC were treated with XYL (60 μM), COC (160 μM), 6-MAM (160 μM), camptothecin (Positive control, 50 μM), XYL/COC (50 μM), XYL/6-MAM (50 μM) and XYL/COC/6-MAM (40 μM) for a period of 24 hours. Activation of caspases 8 and 9, and cell cycle assessment were analyzed using differential microscopy assays. RESULTS reveal that all drugs tested in this study and their combinations activate caspases 8 and 9, involved in extrinsic and intrinsic pathways respectively. Also, these drugs in combination have presented cell cycle arrest in G2/M phase. While cells treated with COC and 6-MAM, show cell cycle arrest in G0/ G1 phase. The ndings suggest that these drugs trigger apoptotic process in human endothelial cells involving both extrinsic and intrinsic pathways, and furthermore induce cell cycle arrest in two of the major checkpoints. Language: en
Repetitive transcranial magnetic stimulation (rTMS) is a new frontier in the examination of addictive behaviors and perhaps the development of new interventions. This study examined differences in recruitment, eligibility, and retention among smokers and nonsmokers in an rTMS study. We modeled participant eligibility and study completion among eligible participants accounting for demographic differences between smokers and nonsmokers. Nonsmokers were more likely than smokers to remain eligible for the study after the in-person screen (84.2% versus 57.4%; OR 4.0 CI: 1.0, 15.4, p=0.05) and to complete the study (87.5% versus 59.3%; OR=43.9 CI: 2.8, 687.2, p=0.007). The preliminary findings suggest that careful screening for drugs of abuse and brain abnormalities among smokers prior to administering rTMS is warranted. More research is needed concerning the prevalence of brain abnormalities in smokers. Smokers might need to be informed about a higher risk of incidental MRI findings.
The present quasi-experiment examined the direct and indirect effects of recovery support telephone calls following adolescent substance use disorder treatment. Six-month outcome data from 202 adolescents who had received recovery support calls from primarily pre-professional (i.e., college-level social service students) volunteers was compared to 6-month outcome data from a matched comparison sample of adolescents (n = 404). Results suggested adolescents in the recovery support sample had significantly greater reductions in their recovery environment risk relative to the comparison sample (β = -.17). Path analysis also suggested that the reduction in recovery environment risk produced by recovery support calls had indirect impacts (via recovery environment risk) on reductions in social risk (β = .22), substance use (β = .23), and substance-related problems (β = .16). Finally, moderation analyses suggested the effects of recovery support calls did not differ by gender, but were significantly greater for adolescents with lower levels of treatment readiness. In addition to providing rare empirical support for the effectiveness of recovery support services, an important contribution of this study is that it provides evidence that recovery support services do not necessarily have to be "peer-based," at least in terms of the recovery support service provider having the experiential credentials of being "in recovery." If replicated, this latter finding may have particularly important implications for helping increase the recovery support workforce.
Early onset of smoking is associated with heavier tobacco consumption and longer smoking careers. Consequently, obtaining accurate estimates of early smoking is a priority. The purpose of this study was to examine the utility of proxy reports of the age of smoking initiation, and specifically to explore whether there are differences in the consistency of proxy-reported and self-reported smoking behaviors. Data came from the 2002-2003 Tobacco Use Supplement to the Current Population Survey, where the current smoking behaviors and smoking history of participants were reported by self-and proxy-respondents on two occasions, one year apart. Sequential multiple-testing methods were used to assess significance of the differences in reported prevalence of consistent reports among specific sub-populations defined by age, gender and survey administration mode. Results indicated that self-reports are more reliable (more consistent over time) than proxy reports or mixed reports that include self-report at one time point and proxy reports at another. The rate of perfect agreement was also highest for self-reports. The impact of respondent type on the consistency of reports also depended on the target subjects' age and the survey administration mode (phone or in-person).
