Factors associated with HIV risk perception among people who inject drugs: Findings from a cross-sectional behavioral survey in Kermanshah,Iran

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors associated with the perception of HIV risk among PWID in Iran.

Methods: We surveyed 433 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Two classes of HIV risk perception (high vs. low) were identified. We used logistic regression to identify factors associated with high HIV risk perception.

Result: Of 433 PWID who participated in this study, 36% (95% confidence interval; CI95%: 25.3%, 42.2%) of participants reported high HIV risk perception. Methamphetamine use (adjusted odds ration; AOR = 3.7, p < 0.05), or use of multiple drugs at the same time (AOR = 1.7, p < 0.05) was associated with higher HIV risk perception. Moreover, PWID who were NSP users had 2.8 times the odds of high risk perception compared with non-Needle and Syringe Program (NSP) users (AOR = 2.8) .

Conclusion: This study implies that initiating drug use at a younger age, using methamphetamine, polydrug use, and needle- and syringe-exchange program utilization were predictors of higher HIV risk perception among PWID in Iran.     

Predictors of HIV-related high-risk sexual behaviors among female substance users

This study aimed to explore predictors of human immunodeficiency virus (HIV)-related risky sexual behaviors among women with substance use. A total of 150 women were selected from harm reduction centers in Tehran, Iran, and completed the risk behavior assessment, the Beck depression inventory, the revised self-efficacy scale, and the peer group beliefs regarding HIV-related risk behaviors scale. The results showed that age (β = ?.07, P ? .01) and exchange of sex for drugs or money (β = 3.34, P ? .001) were significant predictors of whether women had multiple sex partners. Moreover, depression (β = .06, P ? .05), exchange of sex for drugs or money (β = 1.42, P ? .01), and self-efficacy (β = ?.19, P ? .001) significantly predicted unprotected sex among women with substance use. Accordingly, providing female substance users with harm reduction services and developing HIV prevention programs are likely to decrease high-risk sexual behaviors and consequent HIV infection within this vulnerable group.     

Mini mental state examination (MMSE) in substance users and non substance users: A comparison study

ABSTRACT

Background: Due to its progressive nature, substance use impacts the entire aspects of life, and can result in adverse repercussions on mental status. Accordingly, the current article seeks to compare the mental status of substance abusers with that of normal individuals.Methods: The study is a cross-sectional research. The study population is comprised of 50 methamphetamine users, 52 opium users, and 100 normal individuals referred to Farabi Psychiatric Hospital in Kermanshah, 2018, in Iran. The subjects were selected by convenience sampling method and matched in terms of demographic characteristics. Data collection was performed using Mental State Examination (MMSE) and demographic questionnaire.Results: The results showed that mean scores of orientation, attention, and mental status were significantly different between the normal and substance abusers (P < .05). However, the above-mentioned difference was not significant between methamphetamine abusers and opioid abusers (P > .05). In addition, the mean score of the language tests was statistically significant only among the normal and methamphetamine abusers (P < .05).

Conclusions: Based on the obtained results, it can be concluded that the opium and methamphetamine users showed poorer performance in MMSE than the normal group.     

Prevalence and psycho-social determinants of Kratom (Mitragyna speciosa) juice cocktail consumption among youth in Surat Thani Province,Thailand

The objective of this study was to explore the prevalence of Kratom juice cocktail (KJC) consumption among youth and psychosocial determinants using a cross-sectional community-based study design. A total of 468 adolescents in Surat Thani Province were selected using simple random sampling. Self-administered questionnaires were used, and multiple logistic regression was used to identify factors related to the KJC consumption. The findings suggest that the prevalence of KJC use was high (31.4%), while self-efficacy (AOR = 12.95, 95% CI = 1.64–102.35), attitude toward KJC (AOR = 30.14, 95% CI = 6.91–131.53), self-regulation (AOR = 23.80, 95% CI = 3.11–182.28), and existence of peers drinking KJC (AOR = 32.46, 95% CI = 4.86–216.58) were strongly associated with KJC drinking behavior of youth. Youth who drink alcohol (AOR = 5.23, 95% CI = 1.07–25.63), who are employed and have an income (AOR = 4.02, 95% CI = 1.07–15.13) were more likely to drink KJC. Increasing self-efficacy and developing better self-regulation skills to resist the urge to drink KJC in high-risk situations, formulating correct attitudes against drug use, and increasing surveillance of illegal drug use may drive down harmful drug use among youth. In addition, as friends influence KJC consumption, peer education can be used as a KJC consumption prevention strategy.     

The correlation between alcohol consumption and risky sexual behaviours among people living with HIV/AIDS

The objectives of this study were to determine if significant correlation exists between drinking any alcoholic beverage and risky sex among 326 AIDS patients. Participants completed anonymous surveys. The result of the regression and Pearson correlation analyses revealed a significant positive correlation between drinking alcohol before sex and frequency of condom use (p<0.0001). The number of sex partners respondents reported was also correlated with the frequency of alcohol use (p = 0.003). The result shows that the quantity of alcohol consumption was correlated with two indicators of risky sex: having multiple sexual partners (p<0.0001) and having sexual intercourse without a condom (p<0.001). Interventions are that integrate HIV risk reduction with alcohol risk reduction is very useful to minimize the risk of new HIV infections and/or manage existing infections.     

Risk factors for recurrent cystitis following acute cystitis in female patients

We conducted a retrospective analysis of acute cystitis (AC) patients to evaluate the risk factors of recurrent cystitis (RC) patients following AC. The clinical records of 254 subjects with a confirmed diagnosis of AC and 90 healthy subjects who visited the Health Promotion Center between 2008 and 2012 were reviewed. A patient was diagnosed with RC if she was treated for three or more symptomatic episodes of cystitis over a 12-month period. Results were analyzed according to three groups: normal control (group A, n = 90), AC (group B, n = 121), and RC (group C, n = 133). Women in the cystitis groups (groups B and C) were more likely to have diabetes, be menopausal, have a history of catheterization or sexually transmitted infections (STI), have a low daily water intake, have frequent sexual intercourse, and to use contraception more frequently than the normal control group (P < 0.05). In groups B and C, Escherichia coli was the most common uropathogen, followed by Staphylococcus saprophyticus, Enterococcus species, and Klebsiella species. There were no differences between groups in the detection rates of these uropathogens. Factors that affected progression to RC were diabetes, catheterization history, STI history, sexual intercourse more than four times per month, sexual intercourse in the last month, and the use of contraceptives (P < 0.05). The identification of these factors may help develop preventive, diagnostic, and therapeutic strategies for treating RC that has progressed from AC.     

Partner notification among HCV-positive couples who inject drugs

Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan.

Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N?=?136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services.

Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR?=?2.4, p?<?0.05), having more than one sexual partner (OR?=?2.5, p?<?0.05), and participation in a needle exchange program (OR?=?4.3, p?<?0.01) were positively associated with notifying one's partner.

Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.     

Gender and knowledge about HIV,risky sexual behavior,and safer sex practices

The purpose of this study was to examine gender differences in knowledge about HIV, the reported incidence of risky sexual behavior, and comfort with safer sexual practices among young adults. The conceptual framework was social role theory, which argues for the influence of gender roles on beliefs and social behaviors. Participants were 141 female and 131 male college students who responded to questions regarding their knowledge of HIV, risk-taking behaviors with respect to HIV, and comfort with safer sexual behaviors. Overall, respondents had accurate knowledge about HIV. However, men reported engaging in significantly more risky behaviors than women. More men reported that intercourse without a condom occurred in unplanned, spontaneous situations, while under the influence of alcohol or drugs, or with a person not well known. More women reported that intercourse without a condom occurred in long-term relationships. Women were significantly more comfortable abstaining from sexual intercourse and asking partners about their sexual history while men were significantly more comfortable buying condoms. Both men and women reported comfort using condoms. Gender roles help to explain why men are willing to take more risks, and in what situations risk taking is apt to occur. ©1995 John Wiley & Sons, Inc.     

INTIMACY AND RISKY SEXUAL BEHAVIOR—WHAT DOES IT HAVE TO DO WITH DEATH?

The current series of studies was conducted to explore the interplay between death awareness, fear of intimacy, and unsafe sex. In Study 1 (n = 73), making mortality salient led to higher willingness to engage in risky sexual behaviors, in comparison to a control condition. In addition, only in the mortality salience condition, lower fear of intimacy was associated with higher sexual risk taking. Moreover, higher accessibility of death-related thoughts was found either following induction of thoughts about risky sex in Study 2 (n = 68), or upon the induction of thoughts about fear of intimacy in Study 3 (n = 74), in comparison to the induction of thoughts about a neutral theme. The findings extended Terror Management Theory to the realm of risky sexual behavior and are discussed in view of the terror management function of close relationships.     

Correlates and predictors of impulsivity in adults with methamphetamine use disorder

Impulsivity is known to increase the likelihood of using stimulant drugs which in turn may increase impulsivity, leading to potentially hazardous use. However, little research has been conducted on impulsivity in methamphetamine (MA) users. In this case-control cross-sectional study, 54 adults with MA use disorder (MUD) were compared to 52 matched healthy control (HC) participants using the UPPS-P Impulsive Behavior Scale (UPPS-P). Demographic and clinical correlates and predictors of impulsivity in MUD participants were also investigated. Our findings indicate that the MUD cohort had significantly increased impulsivity (p < 0.01) compared to the HCs. In the MUD cohort, the UPPS-P total score was also positively correlated with the number of comorbid mental disorders (r = 0.29, p = 0.04), and degree of family impairment (r = 0.37, p < 0.01). Multiple linear regression analysis showed that the level of family impairment associated with MUD was significantly associated with impulsivity, explaining 16% of the variance (R² = .16, F(2,51) = 4.88, p = .01). Understanding the clinical correlates and predictors of impulsivity in MUD may inform prevention, early identification, and intervention.     

Drug dealing and drug using behaviors among people who inject drugs in Colombia: A cross-sectional study

Introduction: People who inject drugs (PWID) are highly exposed to drug-dealing networks. In Colombia, a recent dramatic increase in drug consumption has been reported. However, involvement of PWID in drug dealing, their demographics, and drug using behaviors has not been studied. Methods: A cross-sectional study involving 1,099 PWID recruited by Respondent Driven-Sampling in five Colombian cities was conducted in 2014. Correlates of demographic characteristics, drug dealing, and injection behaviors were examined by multivariate analysis, and a binary logistic regression model. Results: Drug-dealing PWID were predominantly male (86%) with a mean age of 26 years. 56% of participants—of whom 64% had low familial socioeconomic status—had been involved in drug dealing in the previous six months. Compared to non-drug-dealing PWID, drug-dealing PWID reported higher daily injection rate (AOR: 1.3), higher odds of injection equipment confiscation by the police (AOR: 1.4), and were less likely to pay for the drugs they injected (AOR: 0.6). Conclusions: Involvement of Colombian PWID in drug dealing was higher than previously reported, and drug-dealing PWID presented sociodemographic vulnerabilities and risky injection practices. Addressing these findings may lead to effective policy design and implementation, decreased drug-dealing involvement, harm reduction, and consumption prevention.     

Assessment of microembolization associated with revascularization in acute myocardial infarction: MDCT cardiac perfusion and function study

To use multi-detector computed tomography (MDCT) for assessing the effects of coronary microemboli on pre-existing acute myocardial infarct (AMI) and to compare this pathology to LAD microembolization and occlusion/reperfusion. An angioplasty balloon catheter was placed in the LAD coronary artery of pigs under X-ray guidance. Four animals served as controls without intervention (group A) and an additional 24 animals (8/group) were subjected to microembolization (group B), occlusion/reperfusion (group C) or combination of the two insults (group D). MDCT was used to assess perfusion, LV function and viability. At postmortem, the LV sections were stained with hematoxylin/eosin and triphenyltetrazolium chloride (TTC). Dynamic perfusion and helical cine MDCT demonstrated decline in regional LV perfusion and function, respectively, after all interventions. MDCT showed significant differences in ejection fraction between groups: A = 57.5 ± 4.7 %, B = 40.3 ± 0.5 % P < 0.05, C = 34.9 ± 1.3 % P < 0.05 and D = 30.7 ± 1.2 % P < 0.05, while viability MDCT demonstrated differences in enhancement patterns and extents of damage between the groups (B = 9.1 ± 0.4 % LV mass, C = 11.9 ± 0.7 % and D = 16.2 ± 1.2 %, P < 0.05) and extent of microvascular obstruction (MVO) (group C = 3.2 ± 1.0 % LV mass versus D = 5.2 ± 0.7 %, P < 0.01). DE-MDCT overestimated all types of myocardial damage compared with TTC, but showed a close correlation (r > 0.7). Microscopic examination confirmed the presence of patchy and contiguous necrosis, MVO, edema and calcium deposits. Dynamic and helical cine MDCT imaging can grade LV dysfunction and perfusion deficit, respectively. DE-MDCT demonstrated a large and persistent MVO zone after microembolization of pre-existing AMI. Furthermore, it has the potential to visualize patchy microinfarct, detect perfusion deficits and dysfunction at the border zone after microembolization of pre-existing AMI.     

Computed tomography calcium score scan for attenuation correction of N-13 ammonia cardiac positron emission tomography: effect of respiratory phase and registration method

The use of coronary calcium scoring (CaScCT) for attenuation correction (AC) of ¹³N-ammonia PET/CT studies (NH₃) is still being debated. We compare standard ACCT to CaScCT using various respiratory phases and co-registration methods for AC. Forty-one patients underwent a stress/rest NH₃. Standard ACCT scans and CaScCT acquired during inspiration (CaScCTinsp, 26 patients) or expiration (CaScCTexp, 15 patients) were used to correct PET data for photon attenuation. Resulting images were compared using Pearson’s correlation and Bland–Altman (BA) limits of agreement (LA) on segmental relative and absolute coronary blood flow (CBF) using both manual and automatic co-registration methods (rigid-body and deformable). For relative perfusion, CaScCTexp correlates better than CaScCTinsp with ACCT when using manual co-registration (r = 0.870; P < 0.001 and r = 0.732; P < 0.001, respectively). Automatic co-registration provides the best correlation between CaScCTexp and ACCT for relative perfusion (r = 0.956; P < 0.001). Both CaScCTinsp and CaScCTexp yielded excellent correlations with ACCT for CBF when using manual co-registration (r = 0.918; P < 0.001; BA mean bias 0.05 ml/min/g; LA: ?0.42 to +0.3 ml/min/g and r = 0.97; P < 0.001; BA mean bias 0.1 ml/min/g; LA: ?0.65 to +0.5 ml/min/g, respectively). The use of CaScCTexp and deformable co-registration is best suited for AC to quantify relative perfusion and CBF enabling substantial radiation dose reduction.     

Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease

Background

Limited information exists on the prognostic impact of bleeding after percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD). We investigated the impact of bleeding after PCI on the outcome of these patients.

Methods

The study included 2,934 patients with estimated creatinine clearance <60 ml/min. Bleeding events within 30 days after PCI were assessed using the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 1-year mortality.

Results

Bleeding events occurred in 485 patients (16.5 %). BARC classes were: class 1 (n = 155), class 2 (n = 73), class 3a (n = 182), class 3b (n = 68), class 3c (n = 6) and class 4 (n = 1). There were 212 deaths over the first year after PCI: 60 deaths in patients who bled and 152 deaths in patients who did not bleed (Kaplan–Meier [KM] estimates, 12.5 and 6.3 %; odds ratio [OR] = 2.11, 95 % confidence interval [CI] 1.57–2.83, P < 0.001). Nonfatal myocardial infarction occurred in 71 patients who bled and in 141 patients who did not bleed (KM estimates, 14.8 and 5.8 %; OR = 2.70 [2.05–3.55], P < 0.001). After adjustment, bleeding was independently associated with increased risk of 1-year mortality (adjusted hazard ratio [HR] = 1.90 [1.33–2.72], P < 0.001) and myocardial infarction (adjusted HR = 2.74 [1.99–3.78], P < 0.001). Bleeding improved the discriminatory power of the multivariable model for prediction of mortality (absolute and relative integrated discrimination improvement [IDI], 0.011 and 15.4 %; P = 0.004) or myocardial infarction (absolute and relative IDI, 0.017 and 70.8 %; P < 0.001).

Conclusions

Peri-PCI bleeding in patients with CKD is independently associated with the increased risk of 1-year mortality and nonfatal myocardial infarction.