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PubMed1995

HIV infection and drug use: influence on cognitive function.

OBJECTIVE: To examine the involvement of cognitive function in HIV-seropositive drug users (DU) in a pre-AIDS state. DESIGN: Fifty-six HIV-positive DU were prospectively evaluated. They belonged to groups II, III and IV (subgroups A, C2 and E) of the 1987 Centers for Disease Control and Prevention classification, with anamnesis negative for neurological pathology. HIV-negative DU (n = 19) and non-DU (n = 27) were used as controls. Infection with HIV and use of toxic drugs were considered variables of influence on cognitive function. METHOD: Subjects underwent neuropsychological evaluation by tests designed to explore cortical and subcortical function. RESULTS: HIV-positive DU showed worse performance scores at the psychometric tests than HIV-negative non-DU, but there was no difference when compared with HIV-negative DU. Ex-DU showed better performance than active DU. No difference with regard to degree of disease evolution was observed among HIV-positive individuals (i.e., groups II and III versus group IV). CONCLUSIONS: There was no evidence of cognitive deficits in HIV-positive individuals in non-AIDS phases to indicate early involvement by HIV at the cerebral level. Progression of the disease, prior to the AIDS phase, did not determine a worsening of intellectual performance. Instead, cognitive function was affected by the chronic and current use of toxic substances. In HIV-positive DU, a decline in cognitive function was found to be attributable to the chronic use of toxic substances rather than HIV infection.

Cognition↗

PubMed2003

How should therapeutic information be transferred to users?

Without an efficient solution to the problems that prevent prescribers and consumers having easy access to published and unpublished evidence, Evidence-Based Medicine will never become a reality. Among the problems, dissemination of the summarized evidence is a major one. It involves representing the summarized evidence in a format that corresponds to the users' needs and knowledge, interpreting it within the context of other related evidence, putting it in perspective, and then delivering it physically to the users at the appropriate time. The current formats, vehicles and representation models, e.g. those for guidelines or textbooks, do not seem efficient enough to fill in the gap of knowledge. We suggest that a new approach is possible by reducing the transferred information to its core and integrating it through appropriate representation models into the doctor's decision-making process.

Decision Making↗

PubMed1977

Reentry: a study of the movement of young drug users toward mainstream society.

In the middle 1960s hundreds of thousands of young people dramatically left American mainstream society to join the hippie movement. Almost ten years after the height of the hippie phenomenon, there has been little longitudinal investigation of the predictions by social scientists that these young people would be lost from future mainstream involvement. In the late 1960s, through a study of young drug users in the Haight-Ashbury neighborhood of San Francisco, my colleagues and I began to assess the degree of movement taken by hippie drug users toward mainstream society. This research focused on the differential outcome of three groups of young drug users, approximately two and a half years after they were initially studied.

Adult↗

PubMed1993

Factors associated with heroin users' AIDS risk-taking behaviours.

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self-report data on needle-sharing and sexual practices were collected from 91 heroin users entering a residential, drug-free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin-dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle-sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle-sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner-city suburbs.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Assessing elemental mercury vapor exposure from cultural and religious practices.

Use of elemental mercury in certain cultural and religious practices can cause high exposures to mercury vapor. Uses include sprinkling mercury on the floor of a home or car, burning it in a candle, and mixing it with perfume. Some uses can produce indoor air mercury concentrations one or two orders of magnitude above occupational exposure limits. Exposures resulting from other uses, such as infrequent use of a small bead of mercury, could be well below currently recognized risk levels. Metallic mercury is available at almost all of the 15 botanicas visited in New York, New Jersey, and Pennsylvania, but botanica personnel often deny having mercury for sale when approached by outsiders to these religious and cultural traditions. Actions by public health authorities have driven the mercury trade underground in some locations. Interviews indicate that mercury users are aware that mercury is hazardous, but are not aware of the inhalation exposure risk. We argue against a crackdown by health authorities because it could drive the practices further underground, because high-risk practices may be rare, and because uninformed government intervention could have unfortunate political and civic side effects for some Caribbean and Latin American immigrant groups. We recommend an outreach and education program involving religious and community leaders, botanica personnel, and other mercury users.

Adult↗

PubMed1977

Depressive mood and adolescent illicit drug use: a longitudinal analysis.

Through the technique of Goodman's log linear method, longitudinal data are analyzed to clarify the relationship between depressive mood and illicit drug use among youths. A representative sample of adolescents (N = 8206) from New York State secondary schools was followed over one academic year. At one point in time, users of illicit drugs other than marihuana (multiple drug users) were significantly more depressed than either nonusers or users of marihuana only. Differing interactive relationships were found over time depending upon the drugs involved. Depressive mood was related to the onset of marihuana use among nonusers and to the termination of marihuana use among users. Depressive mood also predicted the use of other illicit drugs by marihuana users. While the beginning use of illicit drugs other than marihuana was positively associated with increased depressive mood, continued multiple drug use was related to reduced depressive mood.

Adolescent↗

PubMed1992

[Extracurricular activities and drug abuse prevention: a controversial issue].

Data obtained from 16,117 high school students in fifteen Brazilian cities, relating to participation in a number of extracurricular activities and consumption of drugs and alcohol, are described. In the great majority of cases, no association was found between participation in artistic, community or sports-related activities and the use of these substances. On the other hand, a weak but constant negative correlation was found between alcohol/drug consumption and involvement in religious activities. The authors discuss these findings in the light of some of the current preconceptions prevailing in Brazilian society: namely, that such activities constitute effective strategies for drug use prevention; and that "idle" young persons tend to be potential drug users. They also discuss the implications of the fact among students involved in religious activities drug and alcohol consumption has been shown to be slightly lower.

Adolescent↗

PubMed1994

Social support and sexual risk taking among women on methadone.

This study examines the social support network of 109 female methadone patients and explores the relationship between social support and background variables, attitudes toward safer sex and sexual risk behavior. Subjects reported small supportive networks consisting primarily of drug users. Women who felt more loved by, respected by, and involved with a network of communication and mutual obligation, were more likely to feel comfortable talking about safer sex with their sexual partners and asking their sexual partners about their HIV status. They were also less likely to believe that their sexual partners would be upset if they suggested using a condom. No association was found between social support and frequency of condom use or frequency of sex with IV drug users during the last six months. Findings suggest the plausibility of multifaceted social support network interventions designed for methadone maintained women at high risk for HIV infection.

Adult↗

PubMed2004

Estimating the number of drug users in Bangkok 2001: a capture-recapture approach using repeated entries in one list.

BACKGROUND: Conventionally, capture-recapture techniques involving different lists such as police or hospitals are used for quantifying populations which are difficult to count, such as illicit drug user populations. Here, a novel approach is suggested based upon repeated entries in one list, which is less dependent on matching entries from different sources as in the conventional approach. METHODS: For this purpose, a population-based study was conducted that utilizes all data on treatment episodes of drug users from all 61 health treatment centers in the Bangkok metropolitan region to estimate the size of drug use in the Bangkok metropolitan region. The data stem from the drug treatment surveillance system of the Office of the Narcotics Control Board (ONCB) and cover the period from October 1 to December 31, 2001. Based upon the frequency of treatment episodes of each patient, a count distribution arose which could be modelled well by means of a Poisson mixture model. Using this count model, an estimate for the number of unobserved drug users could be constructed. RESULTS: From 11,222 drug users found during the period, 7063 (62.9%) were heroin users, 3346 (29.8%) metamphetamine users, and the remaining 813 (7.3%) distributed under 15 drug categories, none above 1%. The study concentrated on heroin and metamphetamine users who were predominantly male (96.2% for heroin and 91.8% for metamphetamine). Metamphetamine users were younger than heroin users (22.3 years 95% CI: 22.1-22.5 vs. 30.8 years 95% CI: 30.6-31.0). By using the truncated Poisson mixture model, an estimate of the unobserved frequency of drug users with zero treatment episodes could be constructed leading to an estimate of 11,296 (95% CI: 8,964-13,628) heroin users (completeness of identification: 38.42, 95% CI: 34.03-44.04%) and 32,105 (95% CI: 24,647-39,563) metamphetamine users (completeness of identification: 9.44, 95% CI: 7.79-11.97%) for the Bangkok metropolitan region. CONCLUSIONS: The proposed model showed excellent goodness-of-fit, unspecified for drug type and also if specified for the major drug types which allowed the prediction of the unobserved number of drug users in a realistic way, avoiding artefacts due to severe matching problems when using several, different sources. The technique is also easy to implement and can be used routinely to monitor drug user populations in space and time.

Adult↗

PubMed2005

Gender differences in the distribution of cocaine and heroin in Central Harlem.

OBJECTIVE: This article investigates the extent to which users of crack, powder cocaine and heroin in Central Harlem participate in various roles involved in distributing these drugs, examining gender differences among distribution roles. METHODS: Several strategies were combined to acquire a sample of 655 hard drug users and sellers who self-reported demographics, drug use and other factors in a face-to-face interview. Chi-square analyses were used to examine factors associated with having drug distribution roles. RESULTS: More than two-fifths (N = 269) of all respondents self-reported participation in at least one current distribution role. The most common roles were acting as a middleman, steering buyers, holding drugs or money, and transporting drugs. Distributors were more likely to have HIV, previous drug treatments, and less education, employment or housing, but had higher incomes than users. A higher proportion of women reported drug distribution roles, but among distributors, men were twice as likely women to be direct sellers and transporters of drugs, and to perform more distribution roles. CONCLUSIONS: Gender contrasts support previous research indicating male dominance of drug distribution roles. Previous studies may underestimate women's participation in distribution roles. Drug treatment programs are encouraged to augment existing relapse prevention activities with distribution prevention efforts.

Adult↗

PubMed2005

Efficient use of synchrotron radiation for macromolecular diffraction data collection.

In recent years, number of X-ray synchrotron beam lines dedicated to collecting diffraction data from macromolecular crystals has exceeded 50. Indeed, today most protein and nucleic acid crystal structures are solved and refined based on the synchrotron data. Collecting diffraction data on a synchrotron beam line involves many technical points, but it is not a mere technicality. Even though the available hardware and software have become more advanced and user-friendly, it is always beneficial if the experimenter is aware of the problems involved in the data collection process and can make informed decisions leading to the highest possible quality of the acquired diffraction data. Various factors, important for the success of data collection experiments and their relevance for different kinds of applications, are discussed.

Computer Simulation↗

PubMed2005

Social disadvantage, mental illness and predictors of legal involvement.

The following study evaluates the complex association between legal involvement and mental illness. It describes a population of consumers of community mental health programs, comparing those with legal involvement to those without legal involvement, on a number of demographic, clinical and social indicators. It is a secondary analysis of data collected in studies making up the Community Mental Health Evaluation Initiative (CMHEI) in the province of Ontario, Canada. Legal involvement was a significant issue among community mental health program consumers; about one in five consumers had at least some contact with the legal system in the preceding nine months. Legally involved consumers were more likely to be in receipt of social assistance and be unstably housed than those legally uninvolved. However, there were no significant differences between legally involved and uninvolved consumers with respect to severity of symptomatology, current medication use or number of hospitalization days in the past 9 months. A predictive model compared the differential impact of clinical and social determinants upon legal involvement. Analyses failed to uncover a significant relationship between severity of psychiatric symptomatology and legal involvement. Significant predictors of legal involvement included gender, race, drug use as well as housing instability, and receipt of social assistance. Legal involvement was attributable to factors other than the severity of mental illness; these results challenge assumptions that the most symptomatically severe consumers are most at risk of legal involvement. Accordingly, the rate of legal involvement in a sample of community mental health program users must be considered in a broad context, with particular emphasis on social disadvantage.

Community Health Services↗

PubMed2001

ChromWin--a computer program for the determination of enantiomerization barriers in dynamic chromatography.

The software program ChromWin simulates interconversion profiles in dynamic chromatography (rearrangements, isomerizations, epimerizations, diastereomerizations and, notably, enanatiomerizations) on a personal computer in a user-friendly environment. ChromWin is especially suited for systems involving large plate numbers, e.g. gas chromatography (GC) and capillary electrophoresis (CE, CEC, MEKC), and first or pseudo-first order reactions. ChromWin (1) simulates the elution profiles of interconverting enantiomers by different models and yields the rate constant, (2) allows automation of the 'find enantiomerization barrier' function, (3) helps to optimise separation parameters by visualization of the separation process and (4) provides other useful tools for chromatography. In addition to the theoretical plate and the stochastic model a modified and improved stochastic model has been developed and implemented in the program.

Journal Article↗

PubMed2000

A comparison between two neural network rule extraction techniques for the diagnosis of hepatobiliary disorders.

Neural networks have been widely used as tools for prediction in medicine. We expect to see even more applications of neural networks for medical diagnosis as recently developed neural network rule extraction algorithms make it possible for the decision process of a trained network to be expressed as classification rules. These rules are more comprehensible to a human user than the classification process of the networks which involves complex nonlinear mapping of the input data. This paper reports the results from two neural network rule extraction techniques, NeuroLinear and NeuroRule applied to the diagnosis of hepatobiliary disorders. The dataset consists of nine measurements collected from patients in a Japanese hospital and these measurements have continuous values. NeuroLinear generates piece-wise linear discriminant functions for this dataset. The continuous measurements have previously been discretized by domain experts. NeuroRule is applied to the discretized dataset to generate symbolic classification rules. We compare the rules generated by the two techniques and find that the rules generated by NeuroLinear from the original continuously valued dataset to be slightly more accurate and more concise than the rules generated by NeuroRule from the discretized dataset.

Algorithms↗

PubMed2003

Centralized oversight for clinical performance improvement: a pilot initiative at the Lexington VAMC.

BACKGROUND: In July 2000 the Lexington Veterans Affairs Medical Center (Lexington, Ky) centralized oversight of clinical performance improvement (CPI) activities by creating an office of clinical operations (OCO) to improve patient care and operational efficiency. The OCO was designed to eliminate redundancy of effort, correct resource underuse and overuse, and improve the communication of change initiatives and successes. Before 2000 no formal process existed for creating interdisciplinary CPI teams. Lack of organizational oversight for CPI activities had also led to duplication of effort, mixed accountability, and difficulty in remaining focused on organizational goals. CREATING THE OCO: OCO staff have led and facilitated numerous projects, all of which involved interdisciplinary teams consisting of physician and nurse leaders, users, and support staff. The OCO has also developed a utilization management plan for the entire medical center. The OCO formally interfaces with three major arenas of medical center operation: clinical processes, patient safety, and cost-efficiency. CHALLENGES AND LESSONS LEARNED: A major effort of OCO staff has been to learn about data availability and access and to determine how data can be used in a meaningful way to benefit CPI project teams. The creation of the OCO precipitated the typical cultural integration problems that are often encountered with the introduction of new organizational entities that lack existing turf.

Centralized Hospital Services↗

PubMed1998

Marijuana use and treatment outcome among opioid-dependent patients.

AIMS: Information concerning the association between marijuana use and opioid dependence and its treatment is needed to determine effective clinical guidelines for addressing marijuana use among opioid abusers. SETTING AND PARTICIPANTS: Marijuana use was assessed in 107 people enrolled in treatment for opioid dependence. DESIGN AND MEASUREMENT: Univariate comparisons of marijuana users and non-users and multivariate regression analyses were performed to examine associations between marijuana use and socio-demographic, psychosocial, medical and substance-use variables. The relationship between marijuana use and treatment outcome was also explored in a subset of this sample who received treatment that included buprenorphine detoxification and behavior therapy (N = 79). FINDINGS: Sixty-six per cent of participants were current marijuana users and almost all (94%) continued to use during treatment. Users were less likely to be married than non-users, and more likely to report financial difficulties, be involved in drug dealing and engage in sharing of needles (p < 0.05). A unique effect of marijuana use on drug dealing and sharing needles was retained after statistically controlling for the influence of heroin and alcohol use and other socio-demographic variables. No significant adverse relations were observed between marijuana use and treatment outcome. CONCLUSION: Pending a more comprehensive understanding of the function and consequences of marijuana use on psychosocial functioning, it appears that progress in treatment for opioid dependence can be made without mandating that patients abstain from marijuana use.

Adult↗

PubMed2001

Co-prescribing of SSRIs and TCAs in Australia: how often does it occur and who is doing it?

AIMS: To determine the frequency with which the selective serotonin re-uptake inhibitor (SSRI) antidepressants are used as add-on therapy to the tricyclic antidepressants (TCA) rather than as replacement therapy. METHODS: The data analysed were profiles of prescription records by date of supply to the patient. From within the national administrative dispensing claims database, the subset eligible for social security entitlements was identified as individuals by means of their coded permanent identification numbers (PINs). Following the initial supply of an SSRI in January 1996, the subsequent 6 months dispensing of SSRI and TCA antidepressants to these individuals was examined. The main outcome measure was the proportion of individuals to whom SSRIs and TCAs were dispensed concurrently, as an indirect measure of coprescription. In instances where a patient was receiving prescriptions for SSRIs and TCAs that had been written by the one doctor only, the major specialty of the doctor was investigated. RESULTS: 55 271 PINs were dispensed 63 865 SSRI prescriptions in January 1996 which represented over half (52%) of the total community SSRI prescriptions dispensed in that month. The number of these patients meeting the criteria for coprescription of SSRIs and TCAs over the next 6 months was 2773 (5%). The coprescribing instances were highest in Queensland and the prescribers most frequently involved had psychiatry major specialty codes. CONCLUSIONS: Among SSRI users there is a cohort of patients who, within the same time frame, are receiving supplies of a TCA, the nonselective drug that the SSRIs were designed to replace. This is indirect evidence of probable coprescription. Such combination use is of uncertain clinical and cost effectiveness, and carries additional risks. The SSRIs were included on the subsidy list in Australia on the basis of reasonable cost effectiveness as monotherapy compared with the TCAs. Our data imply that for some patients, antidepressant prescribing is inconsistent with the basis on which government subsidy was approved.

Adult↗

PubMed2002

Application of a computerized nursing care plan system in one hospital: experiences of ICU nurses in Taiwan.

AIM OF THE STUDY: The purpose of this paper is to present ICU nurses' experiences with a computerized nursing care plan system at a medical centre in Taiwan. BACKGROUND: Computerized nursing care plans have been implemented in recent years, but users' perceptions of this technology have not been comprehensively explored. It is believed that by taking into consideration users' experiences with computer use, strategies and programs can be developed to help users adapt to new systems. METHODS: A qualitative study, involving one-to-one interviews, was conducted with 12 Registered Nurses. Data were analysed according to Miles and Huberman's data reduction, data display and conclusion verification process. FINDINGS: Themes related to the clinical impact of system use were: 'saves paper/time', 'time-consuming for print-outs', 'de-individualization of care plan', 'routine/paperwork requirement', 'no consensus for nursing diagnoses', and 'guidelines for the novice'. CONCLUSIONS: Nurses prefer tools that can help them save time with paperwork and focus on targeting patient problems. With careful assessment and evaluation of nurses' experiences in the use of clinical computer systems, the success of computer implementation can be enhanced.

Attitude to Computers↗