Predictors of retention in a randomised trial of smoking cessation in low-socioeconomic status Australian smokers

Background and aimsLittle is known about the factors associated with retention in smoking cessation trials, especially for low-socioeconomic status (low-SES) smokers. This study examined the factors associated with retention of low-SES smokers in the Australian Financial Interventions for Smoking Cessation Among Low-Income Smokers (FISCALS) trial.DesignA two-group parallel block randomised open-label trial with allocation concealment.SettingAustralia. The study was conducted primarily by telephone-based interviews with nicotine replacement therapy delivered via mail.Participants1047 low-SES smokers interested in quitting smoking were randomised.MeasurementsParticipants completed computer assisted telephone interviews (CATIs) at baseline, 2-month and 8-month follow-up. Smoking-related, substance use, mental or physical health, general psychological constructs, sociodemographic and recruitment sources association with retention at 8-month follow-up were examined using binary logistic regression.Findings946 participants (90%) completed the 2-month follow-up interview and 880 participants (84%) completed the 8-month follow-up interview. Retention at 8-months was associated with higher motivation to quit (OR: 1.15; 95% CI: 1.04, 1.27 p < 0.01), more recent quit attempts (OR: 1.20; 95% CI: 1.04, 1.40 p < 0.05), increasing age (OR: 1.05; 95% CI: 1.03, 1.07 p < 0.01), and higher level of education (OR: 2.24; 95% CI: 1.45, 3.46 p < 0.01). Lower retention at 8-months occurred for those participants recruited from posters placed in Department of Human Service Centrelink Offices (OR: 0.56; 95% CI: 0.35, 0.89, p < 0.05) compared to participants recruited from Quitline services. No significant differences in retention were found for participants recruited via newspaper advertisements or word of mouth compared to Quitline services. No significant associations were found between health-related or behavioural factors and retention.ConclusionsIn the context of high overall retention rates from disadvantaged smokers in a randomised trial, retention was greater in those smokers with higher motivation to quit, more recent quit attempts, increased age, higher level of education and for those recruited through Quitline or newspaper advertisements.     

An assessment of an HIV prevention intervention among People Who Inject Drugs in the states of Manipur and Nagaland,India

BackgroundThe present study describes an assessment of a large-scale intervention, “Avahan”, using an evaluation framework that assesses the program coverage, changes in injection patterns, condom use, and STI and HIV prevalence among People Who Inject Drugs (PWID) in two states of India – Manipur and Nagaland.MethodsProgram monitoring data and results from two rounds of a cross sectional biological and behavioural surveys in 2006 (Round 1) and 2009 (Round 2) were used. The sample included 839 and 860 PWIDs from Manipur and 821 and 829 PWIDs from Nagaland in Round 1 and Round 2 respectively for current analysis. Bivariate and multivariate analyses were done to measure the changes in behavioural and biological outcomes between the two rounds and to examine the association between programme exposure and behavioural outcomes.ResultsIn Manipur, about 77% of the PWIDs were contacted by the peer educators/outreach workers every month and about 18% of the PWIDs visited the clinic every month by March 2010. In Nagaland, however, the proportion of PWIDs visiting the clinic monthly remained low (11% in March 2010). PWIDs in both states were more likely to report ‘consistent safe injection practice in the last six months’ in Round 2 compared to Round 1 (Manipur: adjusted odds ratio (aOR): 1.88, 95% confidence intervals (CI): 1.46–2.43; Nagaland: aOR: 2.35, 95% CI: 1.86–2.80) PWIDs were also more likely to report consistent condom use with regular partners in Round 2. The prevalence of Hepatitis B virus (HBV) increased in Round 2 in Manipur (11% vs 6%, p < 0.001) and Nagaland (8% vs 6%, p = 0.05). The prevalence of Hepatitis C virus (HCV) was high and did not change, either in Manipur (67.3% vs 69.9%, p = 0.42) and Nagaland (14.7% vs 15.1%, p = 0.82). Similarly, the prevalence of HIV did not change significantly between the two Rounds either in Manipur (27.8% in Round 1 vs 29.2% in Round 2, p = 0.59) or in Nagaland (1.2% in Round 1 and 1.6% in Round 2 of the IBBA, p = 0.82).ConclusionImprovements in safe injection practices and consistent condom use with regular partners suggest effectiveness of prevention efforts. However, increase in HBV prevalence and non-decline in HCV and HIV prevalence in both the states also underscore the need to continue and intensify targeted interventions (such as Hepatitis B vaccination, needle exchange programmes, condom distribution) for long term risk reduction among PWID population.     

Prevalence and predictors of HCV among a cohort of opioid treatment patients in Dar es Salaam,Tanzania

BackgroundThe government of Tanzania launched an opioid treatment program (OTP), using methadone, in Dar es Salaam in February of 2011. Hepatitis C virus (HCV) is a leading cause of morbidity and mortality globally, especially among people who inject drugs (PWID). We conducted a cross-sectional study among PWID engaged in OTP in Dar es Salaam to describe the prevalence and predictors of HCV antibody serostatus.MethodsRoutine programmatic data on patients enrolled in Muhimbili National Hospital’s OTP clinic from February 2011 to January 2013 were utilized. Multivariable Poisson regression was used to examine factors associated with HCV antibody serostatus.ResultsA total of 630 PWID enrolled into the OTP clinic during the study period, seven percent of which were women. The overall seroprevalence of HCV antibody was 57% (95% Confidence interval: 53–61%). In adjusted analysis, methadone patients who used heroin for 5–10 years (adjusted prevalence ratio; aPR = 1.41; 95% CI: 1.10–1.81) and >10 years (aPR = 1.48; 95% CI: 1.17–1.88) were more likely to be HCV antibody positive, compared to patients who used heroin for <5 years. Patients who reported sharing needles or other equipment at their last injection (aPR = 1.20; 95% CI: 1.01–1.41; p = 0.022), being arrested (aPR = 1.20; 95% CI: 1.04–1.40; p = 0.012) and who were HIV-positive (aPR = 1.84; 95% CI: 1.56–2.16; p < 0.001) were also more likely to be HCV antibody positive than their counterparts.ConclusionOur observed HCV antibody prevalence among PWID engaged in OTP is higher than previously reported estimates in Dar es Salaam. Predictors of HCV antibody serostatus in this sample were similar to those found among PWID in many other settings. Integrating HCV care and treatment into OTP clinics should be considered, leveraging lessons learned from the integration of HIV services into OTP. Global efforts to develop HCV care and treatment programs in low and middle-income countries are critical, especially among PWID who have a high burden of HCV.     

Perceived unmet need for alcohol and drug use treatments and future use of services: Results from a longitudinal study

BackgroundThis study assessed the association of perceived need for and perceived barriers to treatments for substance use disorder (SUD) with subsequent use of these treatments in community settings.MethodsDrawing on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we examined the association of perceived need and barriers to SUD treatments in waves 1 of NESARC (2001–2002; n = 43,093) with the subsequent use of these treatments in the follow-up wave 2 (2004–2005; n = 34,625).ResultsOnly 8.5% (n = 195) of the 2333 NESARC participants with an untreated 12-month SUD in wave 1 perceived a need for SUD treatment. Participants who reported a perceived need were more likely to use these services in follow-up than those who did not report such a need (14.8% vs. 4.9%, adjusted odds ratio [aOR] = 3.16, 95% confidence intervals [CI] = 1.70–5.90, P < 0.001). Among participants who perceived a need, those who reported pessimistic attitudes towards treatments as a barrier were less likely than others to use services in follow-up (aOR = 0.08, 95% CI = 0.01–0.73, P = 0.027). Other barriers, including financial barriers and stigma were not significantly associated with treatment seeking.ConclusionsThe findings suggest the need for a two-pronged approach to improving treatment seeking for SUD in community settings: one focusing on enhancing recognition of these disorders, the other focusing on educating potential consumers regarding the benefits of SUD treatments.     

Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

BackgroundWhilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI).MethodsCross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI).ResultsPrevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61–5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69–3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93–5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27–2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17–1.73, p<0.001).ConclusionsThese findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.     

The impact of unregulated single room occupancy hotels on the health status of illicit drug users in Vancouver

IntroductionSingle room occupancy (SRO) hotel units represent the most basic shelter provided for low-income individuals living in Vancouver's Downtown Eastside (DTES). While homelessness and marginalized housing in general, have been identified as environments that facilitate HIV risk behaviours, less attention has been paid to the specific context of living in SRO hotels. This analysis was therefore undertaken to describe the characteristics of individuals living in SRO hotels and to explore the association between living in SRO hotels and health status.MethodsFrom January 2003 to November 2004, we enrolled participants into a large community-based cohort study (CHASE Project) involving a baseline questionnaire and data linkages to existing health service registries. Recruitment followed census track data in order to select a representative sample of the community residents. Logistic regression was used to identify socio-demographic, drug use, and health status characteristics independently associated with living in SRO hotels.ResultsOf the 2574 participants included in this analysis, 1813 (70%) reported living in SROs and 761 (30%) reported living in stable housing. The median age was 42 years (IQ range: 36–49 years). Among residents of SROs, 1108 (61%) had lived in the current SRO for less than 1 year, with the median number of moves in the past year being 5. Variables found to be independently associated with SROs included HIV infection (Adjusted Odds Ratio [aOR], 1.6 = 95% CI: 1.2–2.0), emergency room use (aOR = 1.7, 95% CI; 1.3–2.2), cocaine injection (aOR = 1.9, 95% CI; 1.5–2.5), heroin injection (aOR = 2.0, 95% CI: 1.6–2.3), recent incarceration (aOR = 2.1, 95% CI: 1.7–2.4), having been physically assaulted (aOR = 2.3, 95% CI: 1.7–2.8), crack cocaine smoking (aOR = 2.3, 95% CI: 1.7–2.7), and crystal methamphetamine injection (aOR = 2.9, 95% CI: 1.7–5.8).ConclusionsLiving in SRO hotels was associated with intensive illicit drug use, and poor health status, including HIV infection. These findings highlight the urgent need to address housing conditions in the DTES that threaten to undermine the harm reduction strategies and drug policy reforms in the City of Vancouver.     

Co-occurrence of tobacco product use,substance use,and mental health problems among youth: Findings from wave 1 (2013–2014) of the population assessment of tobacco and health (PATH) study

IntroductionCigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use.MethodsThe current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12–17 years from Wave 1 (2013–2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems.ResultsIn multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR = 18.9, 95% CI: 15.3–23.4). Cigarette (AOR = 14.7, 95% CI: 11.8–18.2) and cigarillo (AOR = 8.1, 95% CI: 6.3–10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR = 1.6, 95% CI: 1.4–1.8) and externalizing (AOR = 1.4, 95% CI: 1.3–1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR = 3.4, 95% CI: 2.7–4.3) and have mental health (AOR = 1.2, 95% CI: 1.0–1.5) and substance use (AOR = 4.7, 95% CI: 3.4–6.6) problems.ConclusionsRegardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings.     

Waterpipe smoking patterns and symptoms of nicotine dependence: The Waterpipe Dependence in Lebanese Youth Study

IntroductionWaterpipe typically is smoked intermittently over long smoking sessions. Waterpipe is addictive and its users show symptoms of nicotine dependence (ND). This study examined the risk of developing ND symptoms across waterpipe use patterns among Lebanese youth.MethodsWaterpipe use patterns (length of smoking session, smoking a whole waterpipe without sharing, past-30 day use frequency, number of waterpipes smoked) were assessed. Symptoms of ND were assessed using the 10-item Hooked on Nicotine Checklist (HONC; endorsement of ≥ 1 symptom) and the 6 criteria of the International Classification of Diseases-10th revision (ICD-10 ND; presence of ≥ 3 criteria during 12 months).ResultsBoth the proportion of participants endorsing ND symptoms and the average number of endorsed ND symptoms increased with increasing waterpipe use frequency, number of waterpipes smoked, and length of smoking session. The risk of endorsing ≥ 1 HONC symptom increased with increasing number of waterpipes smoked in the past 30-days (≥ 10 vs. < 4 waterpipes; Hazard ratio (HR) = 2.05, 95% CI: 1.52–2.58, p = 0.007), and session length (> 60 min vs. < 30 min; HR = 2.87, 95% CI: 2.83–2.91, p = 0.001). The risk of attaining ICD-10 ND increased with increasing number of waterpipes used in the past 30-days (≥ 10 vs. < 4 waterpipes; HR = 2.56, 95% CI: 1.89–3.22, p = 0.006), and smoking every day/almost every day vs. less than once weekly (HR = 2.86, 95% CI: 2.12–3.60, p = 0.007).ConclusionsIncreasing use frequency, number of waterpipes smoked, and longer smoking sessions were associated with higher risk of ND. The length of smoking session emerged as a novel indicator of ND among waterpipe smokers.     

Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers

BackgroundFollowing tobacco and alcohol, cannabis is the most commonly used substance during pregnancy. Given the high prevalence of concurrent cannabis and tobacco use as well as the health consequences associated with prenatal substance use, we sought to document the relative contributions of psychosocial and psychiatric factors commonly associated with cannabis use in predicting a lifetime cannabis use disorder (CUD) among women who had quit smoking tobacco as a result of pregnancy.MethodsPregnant former tobacco smokers (n = 273) enrolled in a larger randomized controlled trial for postpartum tobacco relapse prevention completed semi-structured psychiatric interviews and self-reported demographic, pregnancy, health, psychosocial, and tobacco use factors during their third trimester of pregnancy.ResultsIn total, 14% (n = 38) of women met criteria for a lifetime CUD. The strongest predictors of a lifetime CUD were a history of having multiple psychiatric disorders (OR = 36.44; 95% CI = 5.03–264.27; p < 0.001) followed by a lifetime alcohol use disorder (OR = 3.54; 95% CI = 1.27–9.87; p < 0.05). In addition, more frequent attempts to quit smoking tobacco (OR = 1.12; 95% CI = 1.01–1.25; p < 0.05) and lower self-efficacy about weight management after quitting smoking tobacco (OR = 0.78; 95% CI = 0.62–0.97; p < 0.05) also were significantly associated with a lifetime CUD.ConclusionsWomen with a history of both cannabis and tobacco dependence may represent a subset of women who need more specialized treatment during the perinatal period to improve substance use outcomes.     

Darunavir/ritonavir and raltegravir coadministered in routine clinical practice: Potential role for an unexpected drug interaction

The present study aimed to investigate potential drug interactions between darunavir and raltegravir in patients treated for HIV infection. We enrolled HIV-infected subjects on darunavir-containing regimens that underwent measurement of plasma darunavir trough concentration (12 ± 3 h after dosing). Two groups of patients were compared: those taking darunavir plus a nucleoside/nucleotide backbone (group 1) or a backbone + raltegravir (group 2). Interindividual pharmacokinetic variability was evaluated through the coefficient of variation (CV_inter).We obtained 156 plasma samples from 63 patients, of which 44 in group 1 and 19 in group 2. Overall, darunavir geometric mean concentration was 2.90 mg/L (95% CI 2.34–3.60) while ritonavir geometric mean concentration was 0.21 mg/L (95% CI 0.17–0.27). We observed a high inter-individual variability in darunavir (CV_inter 59%) and ritonavir (CV_inter 103%) plasma levels. Darunavir concentration correlated with concomitant ritonavir levels (r = 0.476, p < 0.001). Patients in group 1 had a higher darunavir geometric mean concentration than those in group 2 [3.44 mg/L (95% CI 2.79–4.23) versus 1.95 mg/L (95% CI 1.19–3.20), p = 0.017]. However, the proportion of subjects with concomitant HIV-RNA <50 copies/mL was higher in group 2 (78.9% versus 47.7%, p = 0.028). In a multivariable model, raltegravir co-administration was independently related to a lower darunavir concentration (mean difference ?0.25 log₁₀ mg/L, 95% CI ?0.46/?0.04, p = 0.020) after adjusting for time from last drug intake and concomitant drugs used.In conclusion, a potential drug interaction between darunavir and raltegravir was observed, although this did not seem virologically significant. For the distinct metabolic pathways of these drugs, its mechanism remains to be determined.     

The effect of safranal,a constituent of Crocus sativus (saffron), on tracheal responsiveness,serum levels of cytokines,total NO and nitrite in sensitized guinea pigs

BackgroundThe effect of safranal (one of the constituents of Crocus sativus) on ovalbumin (OVA) sensitized guinea pigs was examined.MethodsOne group of sensitized guinea pigs were given drinking water alone (group S), three groups drinking water containing three concentrations of safranal and one group contain dexamethasone (S + D). Tracheal responses (TR) of the animals to methacholine as effective concentration causing 50% of maximum response (EC₅₀ M), TR to 0.1% OVA, relative to contraction induced by 100 μM methacholine, IL-4, IFN-γ, total NO and nitrite levels in serum were measured.ResultsThe TR to both methacholine and OVA, the level of total NO, nitrite and IL-4 significantly increased but IFN-γ and IFN-γ/IL-4 ratio was decreased in group S compared controls (p < 0.05 to p < 0.001). The TR to both methacholine and OVA in treated animals with dexamethasone and all concentrations of safranal were significantly decreased compared to S group (p < 0.01 to p < 0.001). The level of serum IL-4 in treated guinea pigs was significantly decreased but IFN-γ and IFN-γ/IL-4 ratio was increased compared to S group (p < 0.01 to p < 0.001). The levels of total NO and nitrite were significantly decreased in treated groups compared to sensitized group (p < 0.05 to p < 0.001).ConclusionThese results showed a preventive effect for safranal on tracheal responses and serum cytokine, total NO and nitrite levels as well as increased Th1/Th2 balance in sensitized guinea pigs.     

Intersecting epidemics of HIV,HCV, and syphilis among soon-to-be released prisoners in Kyrgyzstan: Implications for prevention and treatment

BackgroundCentral Asia is afflicted with increasing HIV incidence, low antiretroviral therapy (ART) coverage and increasing AIDS mortality, driven primarily by people who inject drugs (PWID). Reliable data about HIV, other infectious diseases, and substance use disorders in prisoners in this region is lacking and could provide important insights into how to improve HIV prevention and treatment efforts in the region.MethodsA randomly sampled, nationwide biobehavioural health survey was conducted in 8 prisons in Kyrgyzstan among all soon-to-be-released prisoners; women were oversampled. Consented participants underwent computer-assisted, standardized behavioural health assessment surveys and testing for HIV, HCV, HBV, and syphilis. Prevalence and means were computed, and generalized linear modelling was conducted, with all analyses using weights to account for disproportionate sampling by strata.ResultsAmong 381 prisoners who underwent consent procedures, 368 (96.6%) were enrolled in the study. Women were significantly older than men (40.6 vs. 36.5; p = 0.004). Weighted prevalence (%), with confidence interval (CI), for each infection was high: HCV (49.7%; CI: 44.8–54.6%), syphilis (19.2%; CI: 15.1–23.5%), HIV (10.3%; CI: 6.9–13.8%), and HBV (6.2%; CI: 3.6–8.9%). Among the 31 people with HIV, 46.5% were aware of being HIV-infected. Men, compared to women, were significantly more likely to have injected drugs (38.3% vs.16.0%; p = 0.001). Pre-incarceration and within-prison drug injection, primarily of opioids, was 35.4% and 30.8%, respectively. Independent correlates of HIV infection included lifetime drug injection (adjusted odds ratio [AOR] = 38.75; p = 0.001), mean number of years injecting (AOR = 0.93; p = 0.018), mean number of days experiencing drug problems (AOR = 1.09; p = 0.025), increasing duration of imprisonment (AOR = 1.08; p = 0.02 for each year) and having syphilis (AOR = 3.51; p = 0.003), while being female (AOR = 3.06; p = 0.004) and being a recidivist offender (AOR = 2.67; p = 0.008) were independently correlated with syphilis infection.ConclusionDrug injection, syphilis co-infection, and exposure to increased risk during incarceration are likely to be important contributors to HIV transmission among prisoners in Kyrgyzstan. Compared to the community, HIV is concentrated 34-fold higher in prisoners. A high proportion of undiagnosed syphilis and HIV infections presents a significant gap in the HIV care continuum. Findings highlight the critical importance of evidence-based responses within prison, including enhanced testing for HIV and sexually transmitted infections, to stem the evolving HIV epidemic in the region.     

Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study

BackgroundIn Spain, two smoke-free laws have been passed after the approval of the WHO-FCTC. This study assesses the impact of these Spanish smoking legislations on the active and passive smoking through a population cohort in Barcelona (Spain).MethodsThis is a longitudinal study before and after the implementation of two national smoking bans in Spain in a representative sample (n = 1245) of adults (≥ 16 years old) from Barcelona (Spain) surveyed in 2004–2005 and followed-up in 2013–2014. The final sample analyzed was 736 individuals. Both questionnaires (before and after the two laws) included the same variables about active and passive smoking. We calculated the prevalence and the prevalence ratio (PR, with their 95% confidence intervals, 95% CI) of smoking cigarettes and hand-rolled tobacco and also the prevalence of exposure to secondhand smoke (SHS) at home, work, public transport, leisure time and at any setting after vs. before Spanish legislations.ResultsAfter the implementation of the two Spanish smoke-free bans, a significant decrease was observed in the smoking prevalence (from 34.5% to 26.1%, PR = 0.76, p < 0.001), in the average cigarettes per day (median from 15.2 to 10.0, p < 0.001), and in the percentage of conventional tobacco consumption (from 92.6% to 74.4%, PR = 0.80, p < 0.001). Furthermore, a significant increase in the use of hand-rolled tobacco (from 6.1% to 30.9%, PR = 5.07, p < 0.001) and other tobacco products (from 17.1% to 32.8%, PR = 1.92, p < 0.001) was observed. In addition, a significant decrease in the self-reported SHS exposure was observed in all the assessed settings (home, work, transport, and leisure time).ConclusionsThe implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SHS exposure. However, the smoking of other tobacco products, particularly hand-rolled tobacco, has increased among young population.     

Randomized response estimates for doping and illicit drug use in elite athletes

BackgroundTo date, there are estimates for the percentage of unknown cases of doping and illicit drug use in fitness sports, but not for elite sports. This can be attributed to the problem of implementing questionnaires and surveys to get reliable epidemiological estimates of deviant or illicit behaviour.MethodsAll athletes questioned were subject to doping controls as members or junior members of the national teams. In order to estimate the prevalence of doping and illicit drug abuse, the athletes were either issued an anonymous standardized questionnaire (SQ; n = 1394) or were interviewed using randomized response technique (RRT; n = 480). We used a two-sided z-test to compare the SQ and RRT results with the respective official German NADA data on the prevalence of doping.ResultsOfficial doping tests only reveal 0.81% (n = 25,437; 95% CI: 0.70–0.92%) of positive test results, while according to RRT 6.8% (n = 480; 95% CI: 2.7–10.9%) of our athletes confessed to having practiced doping (z = 2.91, p = 0.004). SQ and RRT both revealed a prevalence of about 7% for illicit drug use, but SQ failed to indicate a realistic prevalence of doping (0.20%; 95% CI: 0.02–0.74%).ConclusionsWe demonstrate for the first time that data from official doping tests underestimate the true prevalence of doping in elite sports by more than a factor of eight. Our results indicate that implementing RRT before and after anti-doping measures could be a promising method for evaluating the effectiveness of anti-doping programs.     

Perfil de uso de los diferentes tipos de nutrición artificial en un hospital de agudos y de crónicos

ObjectiveTo evaluate the use of parenteral, enteral, and mixed nutrition in one acute and one chronic hospital.DesignRetrospective, non-randomised, observational study.Study sitesSouth Seville Health Area: Acute Hospital (H1) and Chronic Hospital (H2) with 447 and 84 beds, respectively.We analysed all episodes of artificial nutrition administered in a 6-month period. Exclusion criteria included: age <18 years, oral supplements, and peripheral nutrition.ResultsArtificial nutrition was used in a total of 568 episodes: 406 were enteral nutrition, 162 were parenteral nutrition, constituting 4.95%, 3.54% and 1,41% of all hospitalisations, respectively. Enteral nutrition was more common at H2 hospital (n = 219, 15.5/100 hospitalisations) and parenteral nutrition was more commonly used at H1 (n = 155, 6.96/100 hospitalisations), with the ICU providing the majority of treatments (43.8%).Mixed nutritional support was used in 68 patients (0.59% of all cases), and was most commonly used in the surgery department (n = 32, P<.001). The most commonly used enteral formula was the special diabetes diet; 41.2% at H1 and 46.6% at H2. Patient mortality with enteral nutrition was 37% at H1, 63% at H2, and was correlated with age (OR = 1.025, 95% CI: 1.006-1.046, P<.05), male sex (OR = 1.612, 95% CI: 1.023-2.540, P<.05), and time in ICU (OR = 49.379, 95% CI: 11.971-203.675, P<.01).ConclusionsEnteral nutrition was more frequently used in both the acute and chronic hospitals. Parenteral nutrition and mixed nutritional support were used almost exclusively at the acute hospital.     

Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack

AimsTo analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting.DesignRetrospective study.SettingA community drug service in London, UK.Participants325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine).MeasurementsLogistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service).FindingsFor the general model participants choosing methadone were more likely to use heroin at follow up (OR = 2.36, 95% CI: 1.40–3.17) as were daily crack users on methadone (OR = 2.62, 95% CI: 0.96–7.16).For the methadone model only daily crack use predicted heroin use at follow up (OR = 2.62, 95% CI: 0.96–7.16).For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR = 0.85, 95% CI: 0.75–0.95; OR = 1.31, 95% CI: 1.06–1.60 and OR = 6.04, 95% CI: 1.26–28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR = 6.68, 95% CI: 0.37–119.59; OR = 106.31, 95% CI: 3.41–3313.30) and daily (OR = 57.49 (95% CI: 2.37–1396.46; OR = 170.99 (95% CI: 4.61–6339.47) users.ConclusionsMost of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.     

Using actor-partner interdependence modeling to understand recent illicit opioid use and injection drug use among men in community supervision and their female partners in New York City

BackgroundThe United States’ opioid crisis disproportionately affects individuals in the criminal justice system. Intimate partners can be a source of social support that helps reduce substance use, or they can serve as a driver of continued or increased substance use. Better understanding of the association between intimate partner characteristics and illicit opioid use and injection drug use among individuals in community supervision could be vital to developing targeted interventions.MethodsUsing actor-partner interdependence models, we examined individual and partner characteristics associated with recent illicit opioid use and injection drug use among males in community supervision settings in New York City (n = 229) and their female partners (n = 229).ResultsHigher levels of depression (aOR 1.98, 95% CI [1.39–2.82], p ≤ 0.01) and anxiety (aOR 1.98, 95% CI [1.42–2.75], p ≤ 0.01) were associated with recent opioid use among males in community supervision. Females with a partner having higher levels of anxiety were more likely to have recently used opioids (aOR 1.52, 95% CI [1.06–2.16], p ≤ 0.05). Males with a female partner with higher levels of anxiety (aOR 2.16, 95% CI [1.31–3.56], p ≤ 0.01) or depression (aOR 1.70, 95% CI [1.01–2.86], p ≤ 0.05) were more likely to recently inject drugs. Women with a male partner who had been in prison were more likely to have recently injected drugs (aOR 3.71, 95% CI [1.14–12.12], p ≤ 0.05), but women who had a male partner who had been arrested in the past three months were less likely to have recently injected (aOR 0.08, 95% CI [0.02–0.46], p ≤ 0.01).ConclusionsResults suggest that recent individual illicit opioid use and injection drug use is associated not only with individual-level factors, but also with partner factors, highlighting the need for couple-based approaches to address the opioid epidemic.     

Vitamin D Binding Protein rs7041 polymorphism and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor

BackgroundVitamin D deficiency represents a major health problem in general population, especially for its association with cardiovascular disorders and thrombotic risk, even in patients on dual antiplatelet therapy (DAPT). Vitamin D Binding Protein (VDBP) is the main transporter of vitamin D in the bloodstream and genetic polymorphisms of this protein have been shown to account for a significant variability of vitamin D levels and its systemic effects. Contrasting data have linked the rs7041 T → G substitution with cardiovascular disease. However, no study has so far addressed the role of rs7041 polymorphism on platelet reactivity in patients on DAPT, that was the aim of the present study.MethodsPatients treated with DAPT (ASA and clopidogrel or ticagrelor) for an ACS or elective PCI were scheduled for platelet function assessment at 30–90 days post-discharge. Platelet function was assessed by Multiplate® (Roche Diagnostics AG), and VDBP genetic status by polymerase chain reaction and restriction fragment length polymorphism technique. Fasting samples were obtained for main chemistry parameters and vitamin D levels assessment.ResultsWe included 400 patients, 187 (46.8%) receiving clopidogrel and 213 (53.2%) ticagrelor. The genetic polymorphism rs7041 (T → G) was observed in 318 patients, (79.5%), in 38.7% of them in homozygosis. Main clinical and chemistry features did not significantly differ according to genetic status, but for a higher rate of ACE-inhibitors and beta-blockers use among the carriers of the G allele (p = 0.04 and p = 0.01, respectively).VDBP genetic status did not affect the rate of HRPR with ADP-antagonists (25.6% vs 24.6% vs 28.5%, p = 0.59; adjusted OR[95%CI] = 0.94[0.52–1.7], p = 0.83 for T/G patients; adjusted OR[95%CI] = 1.14[0.6–2.2], p = 0.67 for G homozygotes).However, the rate of HRPR with ADP-antagonists was influenced by severe hypovitaminosis D (< 10 ng/ml) only in patients carrying the G allele, especially in homozygosis (T/T: 25.9% vs 26.1%, p = 0.99; G carriers: 22.1% vs 35.3%, p = 0.02, p_interaction = 0.019; adjusted OR[95%CI] = 1.93[1.11–3.34], p = 0.02 for G carriers).ConclusionThe present study shows that rs7041 polymorphism of Vitamin D Binding Protein does not affect platelet reactivity or the rate of HRPR among patients receiving DAPT. However the carriage of the G allele could condition the impact of hypovitaminosis D on the response to antiplatelet agents, increasing the occurrence of HRPR especially in homozygotes, thus suggesting a more significant role of vitamin D deficiency among these patients.     

Dietary fatty acid content influences the expression of genes involved in the lipid turnover and inflammation in mouse colon and spleen

BackgroundDietary interventions can improve gastrointestinal (GI) symptoms. We determined the effects of fatty acids (FAs) supplementation with medium- and long-chain saturated FAs on mouse GI motility and correlated them with the expression of genes for free FA receptors (FFAR)1-4, FA binding protein 4 (FABP4) and inflammation.MethodsForty-eight BalbC were assigned to: standard diet (STD), diet rich in medium-chain saturated FAs (COCO) and long-chain saturated FAs (HF) (7% by weight). Body weight (BW) and food intake (FI) were monitored for 8-weeks. GI motility was determined by fecal pellet output (FPO) and colon bead expulsion tests. FABP4 inhibitor, BMS309403 (1 mg/kg, ip) was injected to half of each group 2 days/week. mRNA expression of FABP4, (FFAR)1-4, and pro-inflammatory cytokines were measured in colonic and splenic tissues using real-time PCR.ResultsCOCO and HF decreased FI. COCO accelerated overall GI transit (p < 0.05). COCO increased the mRNA expression of FFAR2 (p < 0.001) and TNFα (p < 0.01); HF increased the expression of FABP4 and FFAR4 (p < 0.05), and FFAR2 (p < 0.001) in the colon, and decreased FFAR1 and FFAR4 (p < 0.001), TNFα (p < 0.01) and IL-1β (p < 0.05) in splenic tissues. BMS309403 decreased the FI and delayed colonic transit in STD+BMS and COCO+BMS vs. STD (p < 0.05). HF+BMS increased colonic expression of FFAR3 (p < 0.01), TNFα (p < 0.01), IL-6 (p < 0.01), and reduced FFAR4 (p < 0.05); COCO + BMS decreased TNFα (p < 0.01).ConclusionDiversification in the dietary lipid content affected GI motility in mice and the expression of FFARs and pro-inflammatory cytokines in vivo.