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PloS One 2024Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW).
INTRODUCTION
Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW).
OBJECTIVE
To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil.
METHODS
A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant.
RESULTS
A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use.
CONCLUSION
Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.
Topics: Humans; Female; Brazil; Adult; Transgender Persons; Cross-Sectional Studies; Crack Cocaine; Young Adult; Cocaine-Related Disorders; Prevalence; Male; Marijuana Abuse; Cannabis
PubMed: 38843195
DOI: 10.1371/journal.pone.0304219 -
Frontiers in Public Health 2024As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research...
BACKGROUND
As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood.
METHODS
A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use).
RESULTS
Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive ((358) = 0.16, = 0.003) and anxiety symptom load ((358) = 0.11, = 0.034). Cannabis quantity correlated with depressive ((358) = 0.15, = 0.005), ADHD ((358) = 0.14, = 0.008), and psychosis symptom load ((358) = 0.16, = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency ( = 0.006 and = 0.034, respectively) and quantity ( = 0.037 and = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment.
CONCLUSION
ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.
Topics: Humans; Male; Female; Adult; Cross-Sectional Studies; Switzerland; Depression; Marijuana Abuse; Anxiety; Marijuana Use; Attention Deficit Disorder with Hyperactivity; Self Report; Surveys and Questionnaires; Young Adult; Cannabis; Middle Aged
PubMed: 38841675
DOI: 10.3389/fpubh.2024.1356988 -
Frontiers in Public Health 2024This study explored the impact of a family intervention on the relapse rate of Chinese patients with alcohol dependence.
OBJECTIVE
This study explored the impact of a family intervention on the relapse rate of Chinese patients with alcohol dependence.
METHODS
A total of 151 male patients with alcohol dependence who were discharged from the Substance Dependence Department of the Wenzhou Seventh People's Hospital from January to December 2020 were selected. They were divided into the control ( = 73) and experimental ( = 78) groups. Patients in both groups received routine alcohol cessation treatment. Moreover, patients in the experimental group were followed up by a professional psychiatrist to carry out individual family intervention. The Family Function Rating Scale (FAD), a Self-made general information questionnaire, and the Chinese version of the Family Intimacy and Adaptability Scale (FACESI-CV) were performed. Re-drinking rate and readmission rate were assessed.
RESULTS
Family intervention could reduce relapse rate (31, 39.74%) and rehospitalization (27, 34.62%) compared with the control group. After family training, FAD factor scores were improved in the experiment group in comparison with the control group. Family training improved communication (18.2 ± 3.7), role (20.8 ± 2.5), emotional response (10.8 ± 1.8), emotional involvement (13.7 ± 1.2), behavioral control (19.8 ± 1.2), and overall functionality (23.5 ± 2.1) in the experiment group in comparison with the control group. After family training, intimacy (70.5 ± 8.7) and adaptability (64.1 ± 6.9) in the experiment group was higher than in the control group. After family intervention, Michigan Alcohol Dependence Scale (MAST) (9.21 ± 0.68) and Short-Form 36 (SF-36) (80.32 ± 4.47) in the experiment group were higher than the control group.
CONCLUSION
Family intervention for families of patients with alcohol dependence can improve their family function, increase their family intimacy and adaptability, and reduce the rate of relapse.
Topics: Humans; Male; Alcoholism; Adult; China; Middle Aged; Recurrence; Surveys and Questionnaires; Family Therapy; Family
PubMed: 38841657
DOI: 10.3389/fpubh.2024.1327844 -
Mayo Clinic Proceedings. Innovations,... Jun 2024To evaluate whether access to buprenorphine to treat opioid use disorder (OUD) was associated with the coronavirus disease pandemic, the relaxation of training...
OBJECTIVE
To evaluate whether access to buprenorphine to treat opioid use disorder (OUD) was associated with the coronavirus disease pandemic, the relaxation of training requirements to obtain an X-Waiver to prescribe buprenorphine (April 2021), and the removal of the X-Waiver (December 2022).
PATIENTS AND METHODS
The OptumLabs Data Warehouse, which includes claims from Commercial and Medicare Advantage enrollees, was used to evaluate trends in prescription fills from January 1, 2019, to June 30, 2023. We compared fill patterns of buprenorphine for OUD with acamprosate to treat alcohol use disorder and naltrexone to treat alcohol use disorder or OUD. We evaluated trends in the rate ratio (RR) of overall fills; RR by days supply; distribution of fills by daily dose; and distribution of fills by prescriber type.
RESULTS
Coronavirus disease (RR, 1.06; 95% CI, 1.01-1.11) was associated with a slightly increased rate of fills for Commercial enrollees but not overall or for Medicare Advantage enrollees. There were also no significant increases (>0.05) associated with the change in training requirements or removal of the X-Waiver. Over the study period, there was an increasing share of fills for 16+ mg for Commercial enrollees, and buprenorphine prescribers were more likely to be advanced practice nurses or physician assistants.
CONCLUSION
We did not find meaningful improvement in access in response to coronavirus disease or the changes in the X-Waiver. These findings suggest that interventions beyond removing the X-Waiver may be needed to improve buprenorphine access.
PubMed: 38841599
DOI: 10.1016/j.mayocpiqo.2024.04.004 -
JAAD Case Reports Jun 2024
PubMed: 38841517
DOI: 10.1016/j.jdcr.2023.08.006 -
Cureus May 2024Marchiafava-Bignami disease (MBD) is a rare demyelinating disease associated with chronic alcohol use and/or malnutrition leading to vitamin deficiency. Clinical...
Marchiafava-Bignami disease (MBD) is a rare demyelinating disease associated with chronic alcohol use and/or malnutrition leading to vitamin deficiency. Clinical presentation is diverse and can range from mild neurological deficits of dysarthria and confusion to severe symptoms such as coma or even death. Diagnosis is made using imaging modalities including magnetic resonance imaging (MRI) and computed tomography (CT) with the rise in technological advances placing MRI as the most sensitive and specific imaging technology for diagnosis. Classic MBD imaging demonstrates demyelination and necrotic damage of the corpus callosum. While MBD is a well-documented neurologic complication of chronic alcoholism, its occurrence and presentation in the context of concurrent polysubstance abuse remain underexplored. We outline the case of a 27-year-old male with polysubstance use disorder presenting with subacute neurological deterioration and demyelination of the splenium of the corpus callosum.
PubMed: 38841043
DOI: 10.7759/cureus.59730 -
Australian Journal of General Practice Jun 2024Our understanding of community members' expectations and experiences of discussing alcohol use in general practice settings is limited, particularly for people with...
BACKGROUND AND OBJECTIVES
Our understanding of community members' expectations and experiences of discussing alcohol use in general practice settings is limited, particularly for people with heavy alcohol use.
METHOD
Qualitative interviews were conducted with people with heavy alcohol use to explore their experiences of discussing alcohol use with their general practitioner (GP). Interviews were audio-recorded and transcribed, and data were analysed using an inductive thematic approach.
RESULTS
Three themes were identified: (1) patient perceptions of alcohol discussions in primary care; (2) the importance of the doctor-patient relationship; and (3) consequences of unmet health needs and expectations. Patients expect their GPs to initiate conversations about alcohol use. Positive interactions are characterised by GPs' caring, non-judgemental and collaborative approach, whereas negative interactions focus on a perceived lack of knowledge or ability to manage excessive alcohol use.
DISCUSSION
Alcohol harm reduction efforts should include strategies for bolstering the therapeutic relationship between GPs and their patients.
Topics: Humans; Qualitative Research; Male; Female; Physician-Patient Relations; Australia; Middle Aged; Adult; General Practice; Alcohol Drinking; Interviews as Topic; Aged; Alcoholism; Communication
PubMed: 38840381
DOI: 10.31128/AJGP-08-23-6952 -
JAMA Network Open Jun 2024Despite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use, and data on the epidemiology of...
IMPORTANCE
Despite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use, and data on the epidemiology of cannabis use, and especially medical cannabis use among primary care patients, are limited.
OBJECTIVE
To describe the prevalence of, factors associated with, and reasons for past-3 month cannabis use reported by primary care patients.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used electronic health record data from patients aged 18 years and older who had an annual wellness visit between January 2021 and May 2023 from a primary care clinic within a university-based health system in Los Angeles, California.
EXPOSURES
Factors of interest included age, race and ethnicity, sex, employment status, and neighborhood Area Deprivation Index (ADI).
MAIN OUTCOMES AND MEASURES
Cannabis use was assessed using the Alcohol Substance Involvement Screening Test (ASSIST). Patients were also asked about reasons for use, symptoms for which they used cannabis, and mode of use.
RESULTS
Among the 175 734 patients screened, the median (range) age was 47 (18-102) years; 101 657 (58.0%) were female; 25 278 (15.7%) were Asian, 21 971 (13.7%) were Hispanic, and 51 063 (31.7%) were White. Cannabis use was reported by 29 898 (17.0%), with 10 360 (34.7%) having ASSIST scores indicative of moderate to high risk for cannabis use disorder (CUD). Prevalence of cannabis use was higher among male patients than female patients (14 939 [20.0%] vs 14 916 [14.7%]) and younger patients (18-29 years, 7592 [31.0%]; ≥60 years, 4200 [8.5%]), and lower among those who lived in the most disadvantaged neighborhoods (ADI decile 9-10, 189 [13.8%]; ADI decile 1-2, 12 431 [17.4%]). The most common modes of use included edibles (18 201 [61.6%]), smoking (15 256 [51.7%]), and vaporizing (8555 [29.0%]). While 4375 patients who reported using cannabis (15.6%) did so for medical reasons only, 21 986 patients (75.7%) reported using cannabis to manage symptoms including pain (9196 [31.7%]), stress (14 542 [50.2%]), and sleep (16 221 [56.0%]). The median (IQR) number of symptoms managed was 2 (1-4), which was higher among patients who were at moderate to high risk for CUD (4 [2-6] symptoms).
CONCLUSIONS AND RELEVANCE
In this study, cannabis use and risk of CUD were common, and more than three-quarters of patients who reported any cannabis use reported doing so to manage a health-related symptom. These findings suggest that integration of information regarding cannabis use for symptom management could help provide a crucial point-of-care opportunity for clinicians to understand their patients' risk for CUD.
Topics: Humans; Male; Female; Middle Aged; Adult; Cross-Sectional Studies; Primary Health Care; Aged; Adolescent; Young Adult; Los Angeles; Aged, 80 and over; Prevalence; Marijuana Use
PubMed: 38837159
DOI: 10.1001/jamanetworkopen.2024.14809 -
Critical Care Explorations Jun 2024Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors.
IMPORTANCE
Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors.
OBJECTIVES
To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment.
DESIGN, SETTING, AND PARTICIPANTS
This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data.
MAIN OUTCOMES AND MEASURES
Our primary outcome of physical functional impairment was defined by handgrip strength and the short physical performance battery. We explored associations between functional impairment and sociodemographic factors that included race/ethnicity, sex, primary language, education status, and medical comorbidities.
RESULTS
More than 75% of ICU survivors were affected by physical functional impairment at discharge and longitudinally at 3- to 6-month follow-up. We did not see a significant difference in the proportion of patients with physical functional impairment by race/ethnicity, primary language, or education status. Impairment was relatively higher in the follow-up period among women, compared with men, and those with comorbidities. Among 18 patients with scores at both time points, White patients demonstrated greater change in handgrip strength than non-White patients. Four non-White patients demonstrated diminished handgrip strength between discharge and follow-up.
CONCLUSIONS AND RELEVANCE
In this exploratory analysis, we saw that the prevalence of objective physical functional impairment among ICU survivors was high and persisted after hospital discharge. Our findings suggest a possible relationship between race/ethnicity and physical functional impairment. These exploratory findings may inform future investigations to evaluate the impact of sociodemographic factors on functional recovery.
Topics: Humans; Male; Female; Middle Aged; Intensive Care Units; Survivors; Aged; Sociodemographic Factors; Hand Strength; Longitudinal Studies; Physical Functional Performance; Colorado; Adult; Patient Discharge; Louisiana; Critical Illness
PubMed: 38836576
DOI: 10.1097/CCE.0000000000001100 -
Frontiers in Endocrinology 2024Type 1 diabetes (T1D) is a metabolic disease characterized by insulin deficiency and subsequent hyperglycemia. Cardiovascular diseases are the prime cause of mortality...
INTRODUCTION
Type 1 diabetes (T1D) is a metabolic disease characterized by insulin deficiency and subsequent hyperglycemia. Cardiovascular diseases are the prime cause of mortality and morbidity among patients with T1D. Accumulating metabolic disturbances and accelerated cardiac fibrosis fuel the development of heart dysfunction. As insulin resistance (IR) is a risk factor for the development and worsened course of heart failure, this study aimed to assess its impact on heart function in patients with T1D.
METHODS
Adult participants were recruited prospectively. The inclusion criteria included a diagnosis of T1D. The exclusion criteria were other types of diabetes, symptoms/treatment of heart failure, AST and/or ALT exceeding the upper reference limit by ≥2x, hepatitis, alcoholism, metformin treatment, and pregnancy. The participants underwent a medical interview, physical examination, biochemical test, and echocardiography.
RESULTS
The mean age in the study group was 38 ± 9.6 years, and the mean diabetes duration was 21.8 ± 11.3 years. The median BMI in the study cohort was 23.39 kg/m. Patients with IR had significantly lower mitral E/A ratio and left ventricular and left atrial volume ratio (LVLAVR), higher LV mass index, and presented with altered mitral annular velocities.
CONCLUSIONS
IR seems to accelerate the pattern of typical changes in heart function among patients with T1D, especially in the overweight subgroup.
Topics: Humans; Female; Male; Insulin Resistance; Diabetes Mellitus, Type 1; Adult; Overweight; Middle Aged; Prospective Studies; Echocardiography
PubMed: 38836221
DOI: 10.3389/fendo.2024.1384514