Mcgrawroberson1238
Previous studies conducted on hepatitis C virus (HCV) transmission have focused primarily on its transmission among people who inject drugs. However, there is evidence that transmission may also occur through the sharing of contaminated non-injection implements used to consume drugs nasally, orally, or by inhalation. Studies to date have not conclusively established a relationship between these routes of cocaine use and HCV. We quantified the association between cocaine use and HCV, specifically among individuals who have never injected an illicit substance.
Data from the 2011-2018 National Health and Nutrition Examination Survey were analyzed. Multivariable logistic regression was used to test for an association between cocaine use and HCV among 10,106 individuals (5,201 females). Covariates included age, race, sex, education, income, and immigrant status.
In the unadjusted model, individuals who reported cocaine use had 4.79 (95% CI [2.70, 8.47]) times the odds of ever having HCV compared with those who did not use cocaine. In the adjusted model, individuals who reported cocaine use had 4.48 (95% CI [2.36, 8.50]) times the odds of ever having HCV compared with those who did not use cocaine.
This study highlights that individuals who report non-injection cocaine use have an inflated risk of HCV compared with individuals who report no cocaine use. Harm reduction interventions to reduce the transmission of HCV should therefore be targeted to all people who use drugs, including those who use cocaine orally, intra-nasally, and by inhalation.
This study highlights that individuals who report non-injection cocaine use have an inflated risk of HCV compared with individuals who report no cocaine use. Harm reduction interventions to reduce the transmission of HCV should therefore be targeted to all people who use drugs, including those who use cocaine orally, intra-nasally, and by inhalation.
Adverse childhood experiences (ACEs) and lifetime traumatic events are closely linked to development of comorbid psychiatric symptoms and substance use. Although research shows the risk for psychiatric and substance use comorbidity conferred by early adversity, most studies have not modeled multivariate symptom patterns that include posttraumatic stress disorder (PTSD) symptom criteria (i.e., re-experiencing, effortful avoidance, numbing, and hyperarousal). The aim of the present study was to model multivariate patterns of substance use and psychiatric symptoms, including PTSD criteria, and examine associations between these patterns and early adversity.
Latent profile analysis (LPA) was used in a large, nonclinical sample of community adults (
= 1,431). Relations between profile membership, cumulative ACEs, and demographic covariates were then evaluated.
Results indicated four distinct profiles of psychiatric symptom comorbidity (PSC) (a) PTSD dominant with elevated illicit drug and cannabis use; (b) anxiety and depression dominant with elevated use across substances; (c) avoidance dominant with low severity of all other psychiatric symptoms and substance use; and (d) psychiatrically healthy. Analyses identified significant associations between profile membership and cumulative ACEs and other traumatic events. Cumulative ACEs and traumatic events were highest among the PTSD dominant profile.
A greater understanding of heterogeneous patterns of PSC may allow for future development of treatment care paths that correspond to standard criteria of symptom presentation and severity.
A greater understanding of heterogeneous patterns of PSC may allow for future development of treatment care paths that correspond to standard criteria of symptom presentation and severity.
Although researchers and policy makers have often considered the U.S.-Mexico border region to be at high risk for substance use problems, epidemiological studies of this region have been hard to interpret because of their modest geographic coverage, reliance on self-report, and mixed results. The current study addresses limitations of existing studies and extends the knowledge base by comparing alcohol- and drug-related mortality in counties on versus off the border across all four U.S. border states.
Data were from the 2008-2017 Centers for Disease Control and Prevention WONDER Multiple Causes of Death data set, American Community Survey, and Rural Urban Continuum Codes, including all four border states. Spatial lag models tested differences across on- and off-border counties in total alcohol- and drug-related mortality ("total mortality"), alcohol-related mortality, and drug-related mortality.
In multivariate models, mortality rates were significantly higher in off- versus on-border counties for all three outcomes (
s < .05). Rates for total mortality, alcohol-related mortality, and drug-related mortality were 28%, 82%, and 30% higher, respectively, off versus on the border. Border effects were similar, excluding California; robust over time; and stronger for Latinx versus White decedents.
Results suggest a revised understanding of the border, revealing that residents of interior counties of border states are at highest risk of severe substance use consequences. Results are consistent with other research finding that border counties were protected against drug overdose deaths, particularly for Latinx residents.
Results suggest a revised understanding of the border, revealing that residents of interior counties of border states are at highest risk of severe substance use consequences. Results are consistent with other research finding that border counties were protected against drug overdose deaths, particularly for Latinx residents.
The measures put in place to contain the coronavirus epidemic in France have led to fears of a massive increase in the consumption of alcohol, tobacco, and other drugs.
Taking advantage of an ongoing weekly Internet survey monitoring living conditions of the French population during the containment, we introduced questions on alcohol and tobacco use 1 month after the start of the first containment. Analyses were conducted with multivariate Poisson regressions.
Tobacco consumption remained almost unchanged. By contrast, more than a third of French people did change their weekly alcohol intake 13% increased it, whereas 21% decreased it, indicating that the containment measures were often taken as an opportunity to reduce alcohol consumption, especially among those who drank less than 4 days per week before. Men were more likely to decrease their alcohol intake and less likely to increase it than women, probably because of a differential impact of the reduction of social activities on gendered social roles. The people most affected were smokers and those living in a dwelling in which someone had been infected, including themselves.
The crisis tended to polarize alcohol consumption toward extremes. If the new drinking habits were to continue, the consequences could be beneficial for occasional drinkers but harmful for heavier drinkers.
The crisis tended to polarize alcohol consumption toward extremes. If the new drinking habits were to continue, the consequences could be beneficial for occasional drinkers but harmful for heavier drinkers.
This series reviews three cases of back pain where a highly morbid diagnosis was missed by an emergency physician and subsequently successfully litigated.
We review the clinical entities of spinal epidural abscess and cauda equina syndrome, challenging diagnoses that can be easily missed and lead to patient harm if not treated promptly. Here we offer suggestions for recognizing these conditions quickly, performing an adequate history and exam, and using documentation to support decision-making.
When confronted with an unfortunate medical outcome, maintaining honesty is of paramount importance in medical-legal environments.
When confronted with an unfortunate medical outcome, maintaining honesty is of paramount importance in medical-legal environments.
A 57-year-old, right-hand dominant female presented to the emergency department striking herself with her left hand.
The astute medical staff looked beyond a behavioral health etiology. A detailed history, physical examination, and workup reveals the fascinating final diagnosis.
This case takes the reader through the differential diagnosis and systematic workup of uncontrolled limb movements with discussion of the studies which ultimately led to this patient's diagnosis.
This case takes the reader through the differential diagnosis and systematic workup of uncontrolled limb movements with discussion of the studies which ultimately led to this patient's diagnosis.The roseobacter group of marine bacteria is characterized by a mosaic distribution of ecologically important phenotypes. These are often encoded on mobile extrachromosomal replicons. So far, conjugation had only been experimentally proven between the two model organisms Phaeobacter inhibens and Dinoroseobacter shibae. Here, we show that two large natural RepABC-type plasmids from D. shibae can be transferred into representatives of all known major Rhodobacterales lineages. Complete genome sequencing of the newly established Phaeobacter inhibens transconjugants confirmed their genomic integrity. The conjugated plasmids were stably maintained as single copy number replicons in the genuine as well as the new host. Co-cultivation of Phaeobacter inhibens and the transconjugants with the dinoflagellate Prorocentrum minimum demonstrated that Phaeobacter inhibens is a probiotic strain that improves the yield and stability of the dinoflagellate culture. The transconjugant carrying the 191 kb plasmid, but not the 126 kb sister plasmid, killed the dinoflagellate in co-culture.Streptococcus pneumoniae is a leading cause of ocular infections including serious and sight-threatening conditions. The use of pneumococcal conjugate vaccines (PCV) has substantially reduced the incidence of pneumonia and invasive pneumococcal diseases, but has had limited impact on ocular infections. Additionally, widespread vaccine use has resulted in ongoing selective pressure and serotype replacement in carriage and disease. BIRB 796 clinical trial To gain insight into the population structure of pneumococcal isolates causing ocular infections in a post-PCV-13 time period, we investigated the genomic epidemiology of ocular S. pneumoniae isolates (n=45) collected at Massachusetts Eye and Ear between 2014 and 2017. By performing a series of molecular typing methods from draft genomes, we found that the population structure of ocular S. pneumoniae is highly diverse with 27 sequence types (grouped into 18 clonal complexes) and 17 serotypes being identified. Distribution of these lineages diverged according to the site of isolation,ently, macrolide-resistant isolates carried an ermB gene (n=4), which was co-located with the tetM gene in a Tn-916-like transposon. Our study demonstrates that the population structure of ocular S. pneumoniae is highly diverse, mainly composed by isolates that escape the PCV-13 vaccine, with patterns of tissue/niche segregation, adaptation and specialization. These findings suggest that the population structure of ocular pneumococcus may be shaped by multiple factors including PCV-13 selective pressure, microbial-related and niche-specific host-associated features.
