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PubMed2004

Detection of hepatitis C virus in the nasal secretions of an intranasal drug-user.

BACKGROUND: One controversial source of infection for hepatitis C virus (HCV) involves the sharing of contaminated implements, such as straws or spoons, used to nasally inhale cocaine and other powdered drugs. An essential precondition for this mode of transmission is the presence of HCV in the nasal secretions of intranasal drug users. METHODS: Blood and nasal secretion samples were collected from five plasma-positive chronic intranasal drug users and tested for HCV RNA using RT-PCR. RESULTS: HCV was detected in all five blood samples and in the nasal secretions of the subject with the highest serum viral load. CONCLUSIONS: This study is the first to demonstrate the presence of HCV in nasal secretions. This finding has implications for potential transmission of HCV through contact with contaminated nasal secretions.

Journal Article↗

PubMed2006

Cross-modal reorganization and speech perception in cochlear implant users.

Recent work suggests that once the auditory cortex of deaf persons has been reorganized by cross-modal plasticity, it can no longer respond to signals from a cochlear implant (CI) installed subsequently. To further examine this issue, we compared the evoked potentials involved in the processing of visual stimuli between CI users and hearing controls. The stimuli were concentric circles replaced by a different overlapping shape, inducing a shape transformation, known to activate the ventral visual pathway in human adults. All CI users had their device implanted for >1 year, but obtained different levels of auditory performance following training to establish language comprehension. Seven of the 13 patients showed good capacities for speech recognition with the CI (good performers) while the six others demonstrated poor speech recognition abilities (poor performers). The evoked potentials of all patients showed larger amplitudes, with different distributions of scalp activations between the two groups. The poor performers exhibited broader, anteriorly distributed, high P2 amplitudes over the cortex whereas the good performers showed significantly higher P2 amplitudes over visual occipital areas. These results suggest the existence of a profound cross-modal reorganization in the poor performers and an intramodal reorganization in the good performers. We interpret these data on the basis of enhanced audiovisual coupling as the key to a long-term functional improvement in speech discrimination in CI users.

Adolescent↗

PubMed1997

A selected bibliography on the drug use(r) "career".

This paper provides a brief discussion of the issues in examining "heavy" drug use in terms of a "career." This is an old paradigm in drug user research, and one that has produced some of the richest descriptions in the literature. It draws on the analytic approach developed to study other criminal activity in terms of "criminal careers" as well as the literature describing the variety of career "patterns" for substance users. Research into drug user careers is focused on the most serious, chronic substance users and examines the predictors of transition from lower level involvement to higher levels of involvement. Their use differs from that of experimental or social-recreational use in terms of its frequency and its significance in the user's life. The bibliography is divided into two general headings: research which described drug use careers and methodological issues in studying drug use careers. It ranges from classic narratives of the lives of drug users to discussions of the problems of trying to characterize accurately or to follow complex lives over time.

Anthropology, Cultural↗

PubMed2001

The relationship between cannabis use, depression and anxiety among Australian adults: findings from the National Survey of Mental Health and Well-Being.

BACKGROUND: This study aimed to examine the patterns of association between cannabis use, and anxiety and affective disorders, in the general population. METHOD: Data from the Australian National Survey of Mental Health and Well-Being, a representative survey of Australians aged 18 years and over, were analysed to address the following questions: (1) is there an association between cannabis use, DSM-IV abuse and dependence, and DSM-IV affective and anxiety disorders; (2) if so, is it explained by: demographic characteristics, levels of neuroticism, or other drug use; and (3) does the presence of a comorbid affective or anxiety disorder affect the likelihood of treatment seeking among cannabis users? RESULTS: There was a moderate univariate association between involvement with cannabis use in the past 12 months and the prevalence of affective and anxiety disorders. Among those with DSM-IV cannabis dependence, 14% met criteria for an affective disorder, compared to 6% of non-users; while 17% met criteria for an anxiety disorder, compared to 5% of non-users. These associations did not remain significant after including demographics, neuroticism and other drug use in multiple regressions. CONCLUSIONS: Cannabis use did not appear to be directly related to depression or anxiety when account was taken of other drug use. However, the association between heavier involvement with cannabis use and affective and anxiety disorders has implications for the treatment of persons with problematic cannabis use.

Adolescent↗

PubMed1987

Quantitative microscopy: I. A computer-assisted approach to the study of polymorphonuclear leukocyte (PMN) chemotaxis.

A computer-assisted approach has been designed to analyze and quantitate polymorphonuclear leukocyte (PMN) chemotaxis. This approach involves a rapid, objective, and semiautomated (user-directed) image-analysis system that is video- and microscope-based. The entire system consists of a microvideo set-up that is put on line with a Digital DEC-LSI-11/73 microcomputer, interfaced with a Datacube analog-digital/digital-analog converter. Video signals of PMN movement are digitized by the system at a resolution of 240 pixels vertically by 320 pixels horizontally (at 256 gray levels) and stored in a 76,800-byte frame buffer. The digitized data are stored for later use or utilized immediately for image segmentation, image display, movement, and morphometric computations for each PMN in a maximum phase field (at 645 X high dry) of 50 PMNs at 10-second intervals. The digitized data are used for computation of cell perimeter, surface area, optical density, contour-ratio, position, speed, and direction of locomotion with the utilization of micro-image-analysis programs written in FORTRAN and MACRO assembly language, with the computer operating under RT-11/TSX+. The reliability, objectivity, and reproducibility of measurements made with this quantitative approach have been tested by comparing with manual-tracing measurements of PMN movement. A correlation factor of 0.99 has been obtained. However, the quantitative-microscopic approach is much faster, more objective, less tedious, and much easier to operate than the conventional manual-tracing method.

Chemotaxis, Leukocyte↗

PubMed1996

A simulation model of the dynamics of HIV transmission in intravenous drug users.

The complex dynamics of HIV transmission and subsequent progression to AIDS make the use of traditional mathematical modeling techniques problematic. In a previous paper for this journal, Leslie and Brunham established the utility of a nonmathematical simulation language in modeling HIV transfer under conditions similar to those found among homosexual males. This study considers the application of such an approach in modeling HIV spread among intravenous drug users (IDUs) injecting within a "shooting gallery," a location providing a common needle supply to a large number of users. Modeling HIV transmission in this population involves not only consideration of heterogeneity in partnership selection, but also of the fact that spread of the virus is not directly from person to person, but via injection equipment. The General Purpose Simulation System was used to create a hypothetical cohort of IDUs, drawing from a common needle supply. Following introduction of an index case, the HIV infection rate in this cohort was followed over 5 simulated years. The model was then used to consider the effects of systematic variation in the frequency of injection and needle-cleaning behavior.

Acquired Immunodeficiency Syndrome↗

PubMed2005

A computer-aided design system for revision of segmentation errors.

Automatic image segmentation methods often involve errors, requiring the assistance of the user to correct them. In this paper, a computer-aided design system is introduced for correcting such errors. The proposed system approximates each 3-D region by a parametric surface. Region voxels are first parametrized spherically using a coarse-to-fine subdivision method. By using the voxel positions and their parameter coordinates, control points of a rational Gaussian surface are determined through a least-squares method to approximate the region. Finally, this surface is overlaid with the volumetric image and by locally pulling or pushing it with the mouse while viewing image information, the surface is revised as needed. Typically, a few minutes are sufficient to correct errors in a region.

Algorithms↗

PubMed1993

Evaluation of the effect of contraceptive prices on demand in eight Western European countries.

Wide differences exist among European countries as regards national reimbursement schemes and the resulting individual expenditure on contraception. In this current research project annual expenditure and costs in the first year of use were calculated, taking into account existing reimbursement levels, for oral contraceptives, intrauterine devices, condoms, and sterilization in eight Western European countries: Italy, France, United Kingdom, Spain, West Germany, Austria, Sweden and Denmark. The costs were expressed in Swiss francs. For users of oral contraceptives it emerged that the annual expenditure on contraception ranged from nil in the United Kingdom to 172.32 Swiss francs in Austria. In the case of condoms, the cost to users was lowest in the United Kingdom (57.44 Swiss francs) and highest in Spain (105.95 Swiss francs). Expenditure on the use of an intrauterine device in the first year ranged from nil in the United Kingdom and Sweden to 449.87 Swiss francs in Austria, while sterilization was carried out free of charge in France, West Germany and Denmark, as compared with a cost of 677.57 Swiss francs in Italy. The variation in expenditure was largely explained by the extent to which contraception costs are reimbursed in the respective countries. Correlation of the calculated expenditure on a method and its use did not show any statistically significant trend. This suggests that the wide differences in the choice of contraceptive methods between countries are not related to differences in national reimbursement schemes and resulting costs to users, and that other factors must be involved.

Adolescent↗

PubMed2002

Feasibility of placebo-controlled clinical trials of antipsychotic compounds in Europe.

RATIONALE: Placebo-controlled trials (PCTs) are still regulatory requirements for the licensing of new drugs. Most recent phase II and phase III PCTs of antipsychotics in schizophrenia have been conducted outside Europe. This development needs to be better understood. OBJECTIVES: To ascertain the attitude of experienced European schizophrenia researchers to PCTs in acute and maintenance trials and identify national variations. METHODS: A postal questionnaire to recognised schizophrenia researchers across Europe. RESULTS: In all, 115 (77%) questionnaires were returned from 11 countries. There was considerable variation between countries in willingness to conduct PCTs in both acute and maintenance trials. Only 30% (acute trials), respectively 39% (maintenance trials) of the respondents said that they would participate in a PCT. Over one-third of investigators with previous experience of PCTs would not contemplate them now. Many cited the attitude of local ethics committees as the reason for their reluctance. CONCLUSIONS: PCTs are difficult to conduct in Europe. There are potential problems with importing results from one health care context into a significantly different one. The ethical and practical issues need to be addressed by a broad stakeholder group involving the industry, universities, ethics committees and users groups.

Antipsychotic Agents↗

PubMed1998

Polypharmacy: correlations with sex, age and drug regimen. A prescription database study.

OBJECTIVE: To analyse the occurrence of multiple drug use (polypharmacy, PP) in the population and to identify individuals particularly prone to PP. METHODS: Data were derived from the Odense Pharmacoepidemiological Database (OPED) and covered all subsidised prescriptions during 1994 presented by inhabitants in the county of Funen (n = 466567). The number of individuals concurrently using two to four drugs (minor PP) and five or more drugs (major PP) was calculated on a random day in 1994. Drugs were classified according to the Anatomical Therapeutical Chemical (ATC) classification index. The main therapeutic class (second level of the ATC code) was used as an indicator for the type of health problem. A stepwise backwards logistic regression was used to identify predictors of major PP. Odds ratios were calculated for different drug classes, and the age and sex of all drug users. RESULTS: On a random day, 8.3% of the population were exposed to minor PP and 1.2% to major PP. The prevalence of PP increased with age, and from the age of 70 years, two thirds of all drug users were PP users. Drug use was 50% more prevalent among women than men, but over the age of 70, the sexes did not differ in the prevalence of major PP. Many different drug combinations were found, and among major PP users (n = 5443), two thirds had their own unique drug regimen, different from all other drug users. Cardiovascular drugs and analgesics were often involved in PP among the elderly, while asthma drugs, psychotropic drugs and anti-ulcer drugs were predominant among young individuals exposed to PP. The odds ratio (OR) for major PP was substantially increased for individuals treated for cardiovascular diseases (OR, 4.5), anaemia (OR, 4.1) and respiratory diseases (OR, 3.6). CONCLUSIONS: PP is widespread in the population. Clinicians and organisers who are responsible for quality assurance programmes should intensify their surveillance of the groups most prone to PP (the elderly and those using analgesics or drugs for cardiovascular disease, anaemia, asthma and diabetes).

Adolescent↗

PubMed1975

Interactive simulator for pharmacokinetics of repetitive drug dosing.

DRUGSIM is a highly interactive program allowing simulation of the effects of repeated drug administration by a variety of routes on plasma concentrations of drugs over a period of time. Drug parameters are read from a data file; prescriptions are obtained from the user at various points during run time. The results for one or two compartment pharmacokinetics are plotted on a storage display tube, and the user is queried for further prescriptions. Simulation involves a point-slope method with a variable time step. The program is written in Fortran IV and run on a DEC PDP-10 computer using a Computek 611 display terminal.

Administration, Oral↗

PubMedDate not supplied

Some potential contributions of reinforcement and consumer-demand theory to reducing cocaine use.

Cocaine abuse remains a daunting United States public health problem. Recreational cocaine use is decreasing, but regular use indicative of dependence is stable or increasing. Treatment interventions are often characterized by high rates of early attrition and continued drug use and involve only a small proportion of cocaine users. Hence, more effective and expanded strategies for motivating individuals to forgo or reduce cocaine use are needed. This commentary has a two-part purpose: (a) to underscore the fundamental role of reinforcement in the genesis and maintenance of cocaine use and (b) to illustrate how that knowledge in combination with consumer-demand theory might be translated into effective strategies for reducing cocaine use.

Adult↗

PubMed2005

An alternative method for electrophoretic gel image analysis in the GelMaster software.

A novel methodology of electrophoretic gel image analysis has been proposed that is based on two-dimensional image processing methods instead of previously used one-dimensional Gaussian deconvolution. The crucial problem of the analysis of imperfect gels, that consists in band detection, is solved using the algorithms of band boundary detection and intensity homogeneity indication. The template approach represents the core element of the developed algorithms. The GelMaster software system has been developed in which the novel algorithms are implemented. It involves two-stage interaction with the user: detection of the true bands and deleting the false band detections. The main features of the GelMaster system and the most important algorithms are described.

Algorithms↗

PubMed2006

Pattern of use and subjective effects of Salvia divinorum among recreational users.

BACKGROUND: Salvia divinorum is a member of the Lamiaceae family and contains the psychotropic diterpene and kappa-opioid receptor agonist salvinorin-A. Originally a shamanic inebriant used by the Mexican Mazatec Indians, the plant and its preparations are becoming increasingly popular among non-traditional users. METHODS: Demographic data and information on pattern of use and subjective effects were obtained by means of self-report questionnaires from a sample of 32 recreational users of salvia and other psychedelics. RESULTS: Involvement with salvia appeared to be a recent phenomenon. Smoking the extract was the preferred form of administration. Subjective effects were described as intense but short-lived, appearing in less than 1 min and lasting 15 min or less. They included psychedelic-like changes in visual perception, mood and somatic sensations, and importantly, a highly modified perception of external reality and the self, leading to a decreased ability to interact with oneself or with one's surroundings. CONCLUSIONS: Although some aspects of the subjective effects reported were similar to high doses of classical psychedelics with serotonin-2A receptor agonist activity, the intense derealization and impairment reported appear to be a characteristic of salvia. The observed simultaneous high scores on the LSD and PCAG subscales of the Addiction Research Center Inventory (ARCI) have been previously reported for other kappa-opioid agonists, and support kappa receptor activation as the probable pharmacologic mechanism underlying the modified state of awareness induced by salvia.

Adult↗

PubMed2006

Towards the implementation of the "basket of options" approach to helminth parasite control of livestock: emphasis on the tropics/subtropics.

The virtual reliance on anthelmintic drugs alone to control internal parasites of livestock is inappropriate and ultimately unsustainable. In the tropics and subtropics, widespread and high levels of anthelmintic resistance, particularly in nematode parasites of small ruminants, is rife. But more to the point, many farmers in these regions of the world are resource poor and cannot afford, or are reluctant to purchase drugs that may also be of dubious quality. As it is with any intervention, the benefits must outweigh the costs. This is not only in terms of conventional parameters such as reduced mortality and increasing productivity (meat, milk, fibre and traction power) of livestock, but also within the broad framework of helminths of veterinary/human importance, the aim should be a positive impact on reducing the threat of helminth zoonoses. However, understanding the issues involved and education of the end-users (farmers) is of fundamental importance, before any internal parasite control program should be promoted. Within the above context, we provide examples of how the "basket of options" approach could be adopted for the control of three quite disparate helminth problems in the tropics and subtropics, viz.: strongyle nematode infections of donkeys, the Taenia solium cysticercosis/taeniosis problem of pig and man and Haemonchus contortus infections in small ruminants. The "best practice" approaches can be defined as those "basket of options" that are practical, affordable, available and appropriate, whether to the commercial producer, or to the resource-poor farmer. Constraints that may restrict applying such options are accessibility to, and affordability of, suitable remedies and above all, the availability of information needed to make informed decisions in this regard.

Animal Husbandry↗

PubMed1998

Human factors for pleasure in product use.

Traditionally, human factors have tended to concentrate on making products 'usable'--focusing on utilitarian, functional product benefits. This paper reports an interview-based study looking at the issue of 'pleasure' in product use. The study was a 'first pass' at addressing the hedonic and experiential benefits and penalties associated with product use, and at identifying the properties of a product that influence how pleasurable or displeasurable it is to use. Feelings associated with using pleasurable products included security, confidence, pride, excitement and satisfaction. Displeasurable products, meanwhile, were associated with feelings that included annoyance, anxiety, contempt and frustration. The properties of products that were salient in terms of influencing the level of pleasure/displeasure with a product included features, usability, aesthetics, performance and reliability. Responses to questions investigating behavioural correlates to pleasure in product use suggested that pleasurable products were used more regularly and that future purchase choices would be affected by the level of pleasure in product use. It is concluded that the issue of pleasure in product use involves more than usability alone. As the user's representative in the product creation process, the human factors specialist should consider many other factors in order to ensure that the user's experience of product use is maximised.

Consumer Behavior↗

PubMed2006

[Directly observed therapy (DOT): from tuberculosis to HIV].

BACKGROUND: Combination antiretroviral therapy, which is the standard of care since 1996, has been demonstrated to be very effective in suppressing plasma viral load in patients infected with HIV. Optimal benefit from antiretroviral drugs, however, is obtained when the patient adheres strictly to the rigorous treatment regimen. For some patients it is difficult to obtain good adherence to antiretroviral regimens. In response to these concerns, different strategies, such as directly observed therapy, have been proposed to attempt to improve adherence to antiretroviral treatment. Directly observed therapy is a strategy that has its roots in the treatment of tuberculosis and it consists essentially of taking the medication in the presence of a health care provider or another designated person. This strategy has been recently tried in the treatment of HIV but its efficacy remains unknown. METHOD: A Medline and Medscape search was performed to review all pertinent publications on the use of directly observed therapy in HIV infection. RESULTS: Twenty-five papers published between 1996 and 2004 were selected. Almost all the studies were performed in industrialized countries in North America and Europe. The majority of the studies are retrospective, six of them comparing at least two strategies (directly observed therapy vs standard of care). Only one randomized trial has been found. The patients involved in the studies are intravenous drug users or particularly non-adherent patients. Almost all studies show a better rate of adherence or a better control of the viremia in patients on directly observed therapy. CONCLUSIONS: The directly observed therapy seems to be a valuable and feasible way to raise the adherence rate in HIV patients with a problem of non-adherence to antiretroviral treatments. Clinical trials are needed to evaluate the efficacy of this strategy to raise the adherence rate among patients who need additional support to take their antiretrovirals.

Antiretroviral Therapy, Highly Active↗

PubMed2004

Supporting the psychosocial needs of patients in general practice: the role of a voluntary referral service.

This qualitative study describes and analyses the key features of a practice based voluntary referral service called the Patient Support Service (PSS). This involved collecting interview data from 11 service users and 8 service providers, which was analysed using 'Framework,' a qualitative method of applied policy research. The study findings describe the PSS, its perceived effectiveness and barriers to service provision. Following this, a series of strategic recommendations for service development are presented. It is concluded that voluntary patient referral services, such as the PSS, broaden the referral options available for managing patients with psychosocial problems in primary care.

Attitude of Health Personnel↗