Liposomes; nanotechnology; topotecan; camptothecins; kinetics; membrane binding; permeability
Most young adult women who smoke marijuana also drink alcohol. Marijuana-related problems are associated with marijuana use frequency. We hypothesized that increased alcohol use frequency potentiates the association between frequency of marijuana use and marijuana-related problem severity.
We recruited women age 18–24 who smoked marijuana at least monthly and were not treatment-seeking. Marijuana and alcohol use were measured using the Timeline Followback method. Problems associated with marijuana use were assessed using the Marijuana Problems Scale.
Participants (n=332) averaged 20.5 (± 1.8) years of age, were 66.7% non-Hispanic White, and reported using marijuana on 51.5 (± 30.6) and alcohol on 18.9 (± 16.8) of the 90 previous days. Controlling for education, ethnicity, years of marijuana use, and other drug use, frequency of marijuana use (b = .22, p < .01) and frequency of alcohol use (b = 0.13, p < .05) had statistically significant positive effects on marijuana problem severity. In a separate multivariate model, the linear by linear interaction of marijuana by alcohol use frequency was statistically significant (b = 0.18, p < .01) consistent with the hypothesis.
Concurrent alcohol use impacts the experience of negative consequences from marijuana use in a community sample of young women. Discussions of marijuana use in young adults should consider the possible potentiating effects of alcohol use.
Marijuana; alcohol; young adults; drug consequences; women
Intimate partner violence (IPV) is a highly prevalent and concerning problem among methadone maintenance populations, and previous studies have shown a relationship between a history of IPV and increased substance use and affective disturbances.
The current study examined 1) the association between recent IPV victimization and alcohol and cocaine use and 2) the relationship between recent IPV victimization and depression in a sample of smokers (n=203) in methadone maintenance treatment (MMT). Participants in this study completed a battery of assessments that included standard questionnaires of trauma, alcohol and substance use, and depression. Parallel logistic and linear regression models were used to estimate the adjusted association of IPV victimization and depressive symptoms and evaluate the adjusted association of victimization with recent substance use.
Participants recently victimized by partners were shown to have significantly higher mean CES-D scores (b = 0.54, 95%CI 0.07; 1.02, p < .05) and were found to have a 6 times greater likelihood of cocaine use (OR = 6.65, 95%CI 1.61; 27.46, p < .01) after controlling for age, gender, education, opiate use and ethnicity.
These findings support the notion that IPV victimization can potentially increase depression and other substance use among MMT patients, which can have a deleterious impact on treatment.
Intimate Partner Violence; Methadone Maintenance; Depression
In methadone maintenance treatment programs (MMTPs), 80–90% of participants smoke cigarettes. Patients in MMTPs are at particular risk for life stress, and nicotine, as well as other substances like alcohol, benzodiazepines, cocaine, marijuana, and opiates have been shown to reduce the effects of stress. Use of these addictive substances to cope with stress may precipitate illicit opiate relapse in MMTP patients. In the current study, we examined the relationship between perceived stress and substance abuse.
Participants were 315 cigarette smokers recruited from nine MMTPs for a smoking cessation study. Logistic regression was used to evaluate the adjusted association of perceived stress with dichotomous indicators of hazardous alcohol use and recent substance use at baseline.
After controlling for demographic and smoking-related variables, perceived stress was associated positively and significantly with the likelihood of screening positive for hazardous drinking or alcohol-related problems (OR = 1.13, 95%CI 1.02; 1.25), with the likelihood of recent cocaine use (OR = 1.18, 95%CI 1.02; 1.37), and with the likelihood of recent benzodiazepine use (OR = 1.24, 95%CI 1.07).
Perceived stress may be a marker of patients’ risk for illicit substance use, a known risk factor for illicit opiate relapse. These findings indicate that cigarette use might not be sufficient in managing stress and methadone-maintained persons turn to other substances for relief.
Perceived stress; methadone; nicotine; substance abuse
This study examined associations between substance use behaviors and self-reported health among hospitalized heroin users. Of the 112 participants, 53 (47%) reported good or better health. In multivariable logistic regression models, each day of heroin use in the last month was associated with an 8% lower odds of reporting health as good or better (OR=.92; 95%CI 0.87, 0.97, p < .05). Cocaine, cannabis, cigarettes, alcohol use, unintentional overdose, nor injection drug use were associated with health status.
Heroin addiction; health status; HRQOL; overdose
Urinary catheterization is a common procedure, particularly among patients with neurogenic bladder secondary to spinal cord injury. Urethral catheterization is associated with the well-recognized complications of catheter-associated urinary tract infections and limited genitourinary trauma. Unintentional ureteral cannulation represents a rare complication of urethral catheterization and has been previously described in only eight cases within the literature. We describe two cases of aberrant ureteral cannulation involving two patients with quadriplegia. These cases along with prior reports identify the spastic, insensate bladder and altered pelvic sensorium found in upper motor neuron syndromes as major risk factors for ureteral cannulation with a urinary catheter.
Catheters; Neurogenic urinary bladder; Quadriplegia; Ureter
The current standard for posttraumatic stress disorder (PTSD) diagnosis is a 3-factor model (re-experiencing, avoidance, and hyperarousal). Two 4-factor models of PTSD, the emotional numbing model (re-experiencing, avoidance, emotional numbing, and hyperarousal) and the dysphoria model (re-experiencing, avoidance, dysphoria, and hyperarousal), have considerable empirical support in the extant literature. However, a newer 5-factor model of PTSD has been introduced that is receiving interest. The 5-factor model differs from the four-factor models in its placement of three symptoms (irritability, sleep disturbance, and concentration difficulties) into a separate cluster termed dysphoric arousal. We empirically compared the theoretical factor structures of 3-, 4-, and 5-factor models of PTSD symptoms to find the best fitting model in a sample of opioid dependent hospitalized patients.
Confirmatory factor analyses were conducted on the 17 self-reported PTSD symptoms of the Posttraumatic Checklist- Civilian Version (PCL-C) in a sample of 151 men and women with opioid dependence.
Both four-factor models fit the observed data better than the three-factor model of PTSD; the dysphoria model was preferred to the emotional numbing model in this sample. The recently introduced five-factor model fit the observed data better than either four factor model.
PTSD is a heterogeneous disorder comprised of symptoms of re-experiencing, avoidance, numbing, and dysphoria. Three symptoms, irritability, sleep disturbance, and concentration difficulties, may represent a unique latent construct separate from these four symptom clusters in opioid dependent populations who have experienced traumatic events.
PTSD; opiate dependence; factor analysis
Age-associated skeletal muscle mass loss curtails quality of life and may contribute to defects in metabolic homeostasis in older persons. The onset of sarcopenia occurs in middle age in rhesus macaques although the trigger has yet to be identified. Here we show that a shift in metabolism occurs in advance of the onset of sarcopenia in rhesus vastus lateralis. Multiphoton laser scanning microscopy detects a shift in the kinetics of photon emission from autofluorescent metabolic cofactors NADH and FAD. Lifetime of both fluorophores is shortened at mid-age and this is observed in both free and bound constituent pools. Levels of FAD and free NADH are increased and the NAD/NADH redox ratio is lower. Concomitant with this, expression of fiber type myosin isoforms is altered resulting in a shift in fiber type distribution, activity of cytochrome c oxidase involved in mitochondrial oxidative phosphorylation is significantly lower, and the sub-cellular organization of mitochondria in oxidative fibers is compromised. A regulatory switch involving the transcriptional coactivator PGC-1α directs metabolic fuel utilization and governs the expression of structural proteins. Age did not significantly impact total levels of PGC-1α; however, its sub-cellular localization was disrupted, suggesting that PGC-1α activities may be compromised. Consistent with this, intracellular lipid storage is altered and there is shift to larger lipid droplet size that likely reflect a decline in lipid turnover or a loss in efficiency of lipid metabolism. We suggest that changes in energy metabolism contribute directly to skeletal muscle aging in rhesus monkeys.
Aging; metabolism; NAD; mitochondria; PGC-1α; skeletal muscle; rhesus monkeys
The aim of this study is to describe the change in erectile dysfunction (ED) symptoms in the first 12 weeks of outpatient buprenorphine therapy.
Erectile dysfunction is highly prevalent in men who use illicit opioids when compared with the general population. To date, no study has examined ED symptoms over time in men initiating buprenorphine therapy for opioid dependence.
A randomized, double blind, placebo-controlled trial was conducted to determine whether escitalopram treatment of depressive symptoms begun 1 week prior to buprenorphine induction would improve treatment retention. Male patients completed the International Index of Erectile Function scale at baseline prior to induction and monthly thereafter. A score of 25 or less on the erectile function domain (range 1–30) is considered indicative of erectile dysfunction.
A total of 111 male subjects enrolled: mean age 38.5 (± 9.7) years, 80.1% non-Hispanic Caucasian; 67.3% reported heroin as their opioid of choice. Mean IIEF at baseline was 20.4 (± 10.5). At baseline, 44.1% of the entire cohort had erectile dysfunction; among those who identified as sexually active at baseline, 26.1% had ED. Baseline erectile function was inversely and significantly correlated with age (r = −.27, p = .006), but was not associated significantly with race, heroin use, years of opioid use, smoking, or hazardous use of alcohol. Compared to baseline, mean erectile function was significantly improved (p = .001) at 3 months, and sexual desire (p = .002) improved significantly at both 2- and 3-month assessments.
Erectile dysfunction is highly prevalent in depressed males using illicit opioids. Men who remain in buprenorphine treatment for 3 months show improvement in erectile function and sexual desire.
Opioid dependence; Buprenorphine; Erectile dysfunction
Lapse to opiate use after initiation of buprenorphine treatment is common and is a strong predictor of poor treatment retention and increased risk of chronic opiate use. Drug-cues and situations or events associated with distress are known to provoke craving and increase risk for lapse. The current study evaluated the predictive validity of a behavioral index of persistence during a stress-challenge among opiate users identified as affectively vulnerable to lapse risk due to elevated depressive symptoms.
Patients from on ongoing clinical trial (n=48) completed a stress-challenge task prior to receiving their first dose of buprenorphine.
After controlling for levels of craving on their induction day, persistence on the stress-challenge task prior to initiating buprenorphine treatment was associated with successful transition to early abstinence, and lower rates of opiate use during the initial three months of buprenorphine treatment across antidepressant and placebo groups.
Results from this preliminary study suggest the promise of laboratory-based behavioral paradigms in facilitating understanding of important mechanisms of early lapse. Identifying individual behavioral responses to drug- and stress-cues prior to attempts at abstinence may facilitate delivery of adjunctive behavioral treatments to prevent early lapse.
Methadone-maintained persons are at increased risk for many physical and mental health disorders compared to the general population. Increased physical activity could offset these risks. We assessed physical activity level, and perceived benefits and barriers to exercise in a group of 305 methadone-maintained smokers. Mean participant age was 39.9 years of age, 50.2% were male, 79.7% were non-Hispanic White, and mean body mass index was 29.8. Nearly 45% endorsed fair or poor physical health. Although participants perceived many benefits of exercise and few barriers, only 38% of participants met weekly recommendations for physical activity, and nearly 25% reported no physical activity. Those who met recommended guidelines were significantly more likely to endorse relapse prevention as a benefit of exercise. Motivating MMT patients to increase physical activity could have important physical, mental health, and drug treatment benefits.
Methadone; exercise; barriers; benefits; relapse prevention
Sedentary behavior has been linked to many physical and mental health disorders including heightened risk for depression. Methadone-maintained individuals are at increased risk for depression and have been shown to be physically active at lower rates than the general population.
We assessed the relationship between sitting time, physical activity, and depression in a group of 315 methadone-maintained smokers.
Mean participant age was 39.9 years of age, 49.5% were male, and 79.4% were non-Hispanic White. The mean time reported sitting each day was 320.4 minutes and the mean CES-D depression score was 12.0. After controlling for background characteristics, physical function, and physical activity, depression was significantly and positively related to sitting time.
Interventions to decrease time spent sitting and increase physical activity could have important benefits for the mental health of methadone-maintained individuals. This population is often underserved and suffers disproportionately from limited physical and mental health functioning, making them an ideal population for low-cost interventions to reduce sitting time and/or increase physical activity to improve well-being.
Methadone; exercise; sedentary; depression
This pilot study tested the efficacy of a brief intervention using motivational interviewing (MI) plus mindfulness meditation (MM) to reduce marijuana use among young adult female. Thirty-four female marijuana users between the ages of 18–29 were randomized to either the intervention group (n = 22), consisting of 2 sessions of MI-MM or an assessment-only control group (n = 12). Participants’ marijuana use was assessed at baseline, 1, 2, and 3 months post-treatment. Fixed-effects regression modeling was used to analyze treatment effects. Participants randomized to the intervention group were found to use marijuana on 6.15 (z = −2.42, p=.015), 7.81 (z = −2.78, p=.005), and 6.83 (z = −2.23, p=.026) fewer days at months 1, 2, and 3, respectively, than controls. Findings from this pilot study provide preliminary evidence for the feasibility and effectiveness of a brief MI-MM for young adult female marijuana users.
Marijuana; Females; Mindfulness; Motivational Enhancement; Anxiety
Exchange of prescription medications is a significant public health problem particularly among substance abusing populations. Little is known about the extent of medication sharing and receiving behaviors in methadone maintenance treatment (MMT) populations and the factors associated with such behaviors.
We examined rates, and factors associated with past year medication sharing and receiving practices of 315 MMT smokers who had enrolled in a clinical trial of smoking cessation. Sequential logistic regression models estimated the effect of demographic and substance use variables on the probability of sharing or receiving medications.
Participants averaged 40 years of age, and 49% were male. Among persons prescribed medications, 19.9% reported sharing. Nearly 40% had used medication not prescribed to them. Pain medications, sleep medications, and sedatives, were most commonly shared and received. Younger age was a significant predictor of both sharing medications (OR = 0.92, 95%CI 0.88; 0.96, p < .01) and receiving medications (OR = 0.94; 95%CI 0.92, 0.97, p < .01). Financial hardship (OR = 2.05; 95%CI 1.13; 3.72, p < .05), and recent use of heroin (OR = 5.59, 95%CI 1.89; 16.57, p < .01) or cocaine (OR = 3.70, 95%CI 1.48; 9.28, p < .05), were also independently associated with a significantly higher likelihood of receiving prescription drugs of abuse.
The high prevalence of prescription medication sharing and receiving behaviors among persons in MMT often include substances with abuse potential and suggest the need for comprehensive approaches for minimizing this phenomenon.
Methadone; Prescription medication; diversion
trans-2,6-Difluoro-4′-N,N-dimethylaminostilbene (DFS), a synthetic stilbene, displayed potent preclinical anti-cancer activities exceeding that observed for naturally occurring resveratrol. In this study, a simple and sensitive HPLC method was developed and validated to quantify DFS in rat plasma. The lower limit of quantification (LLOQ) was 5 ng/ml. The intra- and inter-day variation in terms of relative standard deviation (RSD) was all less than 10%. The bias rate ranged from −11.5% to 6.2% while the absolute recovery ranged from 94.1 ± 2.3 to 97.3 ± 4.4%. The pharmacokinetic profiles of DFS were examined in Sprague-Dawley rats after intravenous administration (2 mg/kg). DFS displayed moderate clearance (Cl = 61.5 ± 17.7 ml/min/kg) and a relatively prolonged terminal elimination half-life (t1/2 λz) of 351 ± 180 min. Aqueous solubility played a crucial role in the oral absorption of DFS. When DFS was given as a suspension (6 mg/kg), the absolute oral bioavailability (F) was almost negligible. However, when DFS was given in a solution prepared with hydroxypropyl-β-cyclodextrin (6 mg/kg), the F was 12.4 ± 10.7%. Dose-escalation to 15 mg/kg resulted in much higher systemic exposure (F = 40.2 ± 10.0%). As DFS is orally available after formulation with hydroxypropyl-β-cyclodextrin and pharmacologically active systemic concentrations could be achieved after a single oral dose, the use of DFS as a cancer hemopreventive/chemotherapeutic agent is possible.
trans-2,6-Difluoro-4′-N,N-dimethylaminostilbene; HPLC; Pharmacokinetics; Absolute oral bioavailability; Dose-escalation
When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems.
The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007–2008 were included. Propensity scores were used to help adjust for group differences.
Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002).
Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.
Substance abuse; Cost analysis; Health care utilization; Commercial health insurance; Parity
A new skin and needle hygiene intervention, designed to reduce high-risk injection practices associated with bacterial and viral infections, was tested in a pilot, randomized controlled trial. Participants included 48 active heroin injectors recruited through street outreach and randomized to either the two-session intervention or an assessment-only condition (AO) and followed for six months. The primary outcome was skin and needle cleaning behavioral skills measured by videotaped demonstration. Secondary outcomes were high-risk injection practices, intramuscular injection, and bacterial infections. Intervention participants had greater improvements on the skin (d = 1.00) and needle cleaning demonstrations (d = .52) and larger reductions in high-risk injection practices (d = .32) and intramuscular injection (d = .29), with a lower incidence rate of bacterial infections (HR = .80), at 6-months compared to AO. The new intervention appears feasible and promising as a brief intervention to reduce bacterial and viral risks associated with drug injection.
injection drug use; bacterial infections; intervention; randomized controlled trial; risk reduction; heroin
Light smoking is particularly prevalent among Latino smokers. Nicotine replacement (NRT) and varenicline are effective medications for smoking cessation for moderate-heavy smokers, but have not been tested in light smokers and thus there are no treatment guidelines for use with light smokers. This pilot trial tested the efficacy of NRT and varenicline in increasing smoking abstinence among Latino light smokers. A 3-group (NRT, varenicline, varenicline-placebo) randomized design was used and Latino light smokers (≤10 cpd) received 12 weeks of treatment which included a culturally-informed behavioral health session and ongoing medication management visits. At follow-up, there were no abstinent participants in the placebo and NRT groups. However, 30% of participants in the varenicline group were abstinent at the 3, 4, and 6 month follow-up. This study represents the only investigation that specifically targets Latino light smokers using these treatments and characterizing their treatment adherence.
Latinos; Hispanics; light smokers; varenicline; adherence; NRT
Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.
A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). Using MANCOVAs and adjusting for health-related attitudes, values, and practices, we examined gender differences in relationships between alcohol consumption and health.
More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers.
Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.
Alcohol Drinking; Gender; Health Status; Health Behaviors; Health-related Attitudes
A cocktail of six lytic bacteriophages, SalmoFresh™, significantly (p < 0.05) reduced the number of surface-applied Salmonella Kentucky and Brandenburg from stainless steel and glass surfaces by > 99% (2.1–4.3 log). Both strains were susceptible to SalmoFresh™ in the spot-test assay. Conversely, SalmoFresh™ was unable to reduce surface contamination with a Salmonella Paratyphi B strain that was not susceptible to the phage cocktail in the spot-test assay. However, by replacing two SalmoFresh™ component phages with two new phages capable of lysing the Paratyphi B strain in the spot-test assay, the target range of the cocktail was shifted to include the Salmonella Paratyphi B strain. The modified cocktail, SalmoLyse™, was able to significantly (p < 0.05) reduce surface contamination of the Paratyphi B strain by > 99% (2.1–4.1 log). The data show that both phage cocktails were effective in significantly reducing the levels of Salmonella on hard surfaces, provided the contaminating strains were susceptible in the spot-test (i.e., spot-test susceptibility was indicative of efficacy in subsequent surface decontamination studies). The data also support the concept that phage preparations can be customized to meet the desired antibacterial application.
Salmonella; SalmoFresh™; SalmoLyse™; bacteriophage; food safety; phage; surface decontamination
A 55-year-old man was hospitalized for a neurologic and infectious workup after having hallucinations and productive cough for 2 days. During hospitalization, he experienced dark stools with an acute drop in hemoglobin. Upper endoscopy and colonoscopy were negative for an identifiable source of bleed. Capsule endoscopy was later done and subsequently an anteroposterior abdominal radiograph confirmed the presence of a retained capsule near the junction of the descending and distal transverse colon, likely contained within a colonic diverticulum. In the interim, the patient developed acute right-sided lumbar radiculopathy prompting emergent lumbar spine magnetic resonance imaging (MRI). During the scanning process, the retained capsule was seen and the test was immediately terminated without harm to the patient. Device retention is a complication unique to capsule endoscopy, occurring at a rate of 1% to 1.7%; retained devices are considered a danger and contraindication to MRI.
Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers. Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until becoming ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships.
A stratified random sample of health-plan members (7884; 2995 males, 4889 females) completed a mail survey that was linked to 24 months of health-plan records. Data were used to examine relationships between alcohol use, gender, health-related attitudes/practices, health, and prevention-service use.
Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher BMI (negative).
When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.
Alcohol Drinking; Preventive Care; Gender; Health Status; Health Behaviors; Health-related Attitudes
Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care.
A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). We linked survey data to 24 months of health-plan records to examine relationships between alcohol use, gender, health-related attitudes, practices, health, and service use. In-depth interviews with a stratified 150-respondent subsample explored individuals’ reasons for seeking or avoiding care.
Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher BMI, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care.
Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.
Alcohol Drinking; Health Services Utilization; Gender; Health Status; Health Behavior; Health-related Attitudes
Incarcerated women are at high risk for sexually transmitted infections (STI). Left untreated, these infections can have severe adverse health effects. This study presents prevalence rates of Trichomonas, Chlamydia, and Gonorrhea, and factors related to having an STI in a sample of 245 hazardously-drinking incarcerated women who reported heterosexual intercourse in the previous 3 months. Vaginal swabs were collected following the self-report baseline assessment. Participants averaged 34.1 (± 8.9) years of age; 174 (71.3%) were non-Hispanic Caucasian, 47 (19.3%) were African-American, 17 (7.0%) were Hispanic, and 6 (2.5%) were of other racial or ethnic origins. Twenty-three percent of participants tested positive for Chlamydia, Trichomonas, or Gonorrhea. Being African-American, more frequent sex with a casual partner, and reporting more than one male partner were significantly positively related to STI, while more frequent sex with a main partner was inversely related. Due to the high rates of infection in this population, jail admission provides a public health opportunity to access a concentrated group of STI-infected women. STI testing targeted at specific demographic factors, for instance younger age, will miss infected women. Risky sexual partnerships, as well as the benefit of maintaining stable main partnerships may be important topics during STI prevention interventions.
prevalence; sexually transmitted infections; incarceration; women
To test whether trazodone, one of the most commonly prescribed medications for treatment of insomnia, improves subjective and/or objective sleep among methadone-maintained persons with sleep complaints, we performed a randomized, double-blind, placebo-controlled trial with six month follow-up.
From eight methadone maintenance programs in the northeastern United States, we recruited 137 persons receiving methadone for at least one month who reported a Pittsburgh Sleep Quality Index (PSQI) score of six or higher. Two-night home polysomnography (PSG) was completed at baseline and one month later, with morning surveys and urine drug toxicologies. Interviews assessed sleep over the past 30 days at baseline and 1-, 3-, and 6- month follow-ups.
Participants averaged 38 years of age, were 47% male, and had a mean PSQI total score of 12.9 (± 3.1). At baseline, intervention groups did not significantly differ on 10 PSG-derived objective sleep measures and 11 self-reported measures. Over 88% (n = 121) of participants completed the PSG at 1-month. Without adjusting p-values for multiple comparisons, only 1 of 21 sleep measure comparisons was statistically significant (p<.05). The effect of trazodone on mean PSQI scores during the six-month follow-up was not statistically significant (p = .10). Trazodone neither significantly increased nor decreased illicit drug use relative to placebo.
Trazodone did not improve subjective or objective sleep in methadone-maintained persons with sleep disturbance. Other pharmacologic and non-pharmacologic treatments should be investigated for this population with high rates of insomnia.
Trazodone; Methadone; Opiate dependence; Sleep