Gender influences on initiation of injecting drug use

Background and objectives: Gender differences in illicit drug use patterns and related harms (e.g. HIV infection) are becoming increasingly recognized. However, little research has examined gender differences in risk factors for initiation into injecting drug use. We undertook this study to examine the relationship between gender and risk of injection initiation among street-involved youth and to determine whether risk factors for initiation differed between genders. Methods: From September 2005 to November 2011, youth were enrolled into the At-Risk Youth Study, a cohort of street-involved youth aged 14–26 in Vancouver, Canada. Cox regression analyses were used to assess variables associated with injection initiation and stratified analyses considered risk factors for injection initiation among male and female participants separately. Results: Among 422 street-involved youth, 133 (32.5%) were female, and 77 individuals initiated injection over study follow-up. Although rates of injection initiation were similar between male and female youth (p?=?0.531), stratified analyses demonstrated that, among male youth, risk factors for injection initiation included sex work (Adjusted Hazard Ratio [AHR]?=?4.74, 95% Confidence Intervals [CI]: 1.45–15.5) and residence within the city’s drug use epicenter (AHR?=?1.95, 95% CI: 1.12–3.41), whereas among female youth, non-injection crystal methamphetamine use (AHR?=?4.63, 95% CI: 1.89–11.35) was positively associated with subsequent injection initiation. Conclusion: Although rates of initiation into injecting drug use were similar for male and female street youth, the risk factors for initiation were distinct. These findings suggest a possible benefit of uniquely tailoring prevention efforts to high-risk males and females.     

Initiation of drug dealing among a prospective cohort of street-involved youth

Background: Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population. Objectives: This longitudinal study examines drug dealing initiation among street-involved youth. Methods: Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14–26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing. Results: Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% confidence interval [CI]: 9.9–17.2). In multivariable Cox regression analysis, male gender (adjusted hazard ratio [AHR] = 1.90, 95% CI: 1.06–3.42), homelessness (AHR = 1.88, 95% CI: 1.05–3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47–4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38–4.00) were positively and independently associated with initiating drug dealing. Conclusion: Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.     

Unsafe sexual behaviour associated with hazardous alcohol use among street-involved youth

While risky sexual behaviours related to illicit drug use among street youth have been explored, the impacts of alcohol use have received less attention. This longitudinal study examined hazardous alcohol use among a population of street-involved youth, with particular attention to sexual and drug-related risk behaviours. Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism. We used generalized estimating equations (GEEs) analyses to identify factors associated with hazardous alcohol use. Between 2005 and 2014, 1149 drug-using youth were recruited and 629 (55%) reported hazardous alcohol use in the previous 6 months during study follow-up. In multivariable GEE analyses, unprotected sex (adjusted odds ratio [AOR]?=?1.28, 95% confidence interval [95% CI]?=?1.12–1.46) and homelessness (AOR?=?1.35, 95% CI?=?1.19–1.54) were independently associated with hazardous alcohol use (all p?p?相似文献   

Electronic cigarette initiation among minority youth in the United States

Background: Electronic cigarettes (e-cigarette) use among youth is a pressing public health issue, with prevalence of use surpassing that of tobacco cigarettes. While research concerning e-cigarettes has proliferated in recent years, there is a dearth of information regarding those whose first exposure to tobacco products was an e-cigarette. Objectives: To examine factors associated with e-cigarette initiation among minority youth in the United States. Methods: Data on minority students in middle and high schools in the United States derived from the 2014 National Youth Tobacco Survey (NYTS) were sampled (weighted N = 27,294,454). We examined e-cigarette initiation among minority youth using logistic regression models to identify related factors. Results: In 2014, 736,158 minority youth were e-cigarette initiators. Odds of e-cigarette initiation was highest among Hispanic youth [adjusted odds ratio (AOR) = 2.70; 95% confidence interval (CI) = 1.60–4.56]. Exposure to e-cigarette advertising (AOR = 1.64; 95% CI = 1.07–2.50), perceptions of little to no harm (AOR = 7.08; 95% CI = 4.03–12.46), and believing e-cigarettes were less addictive than tobacco (AOR = 2.15; 95% CI = 1.52–3.02) were associated with e-cigarette initiation. Conclusions: Odds of initiating e-cigarette use was highest among Hispanic youth. Among minority youth, e-cigarette initiation was associated with perceptions of harm and addiction potential, as well as exposure to e-cigarette advertising. Therefore, prevention efforts targeting minority youth who are at risk of becoming e-cigarette initiators may benefit by incorporating these factors into prevention campaigns.     

Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

Abstract

Background: Multiple types of substance use are associated with HIV risk behaviors, but relatively little research has examined the association between marijuana use and risky sexual activities in treatment-seeking polysubstance abusing patients. Objectives: This study evaluated the relationship between marijuana use and sexual behaviors in 239 patients with cocaine, opioid or alcohol use disorders who were initiating outpatient substance use treatment. Methods: Participants completed the HIV Risk Behavior Scale and were classified into one of three groups based on their marijuana use histories: never (n?=?66), past but not current use (n?=?124) or current use (n?=?49). Results: Compared to never marijuana users, current and former marijuana users had a greater likelihood of having more than 50 lifetime sexual partners (odds ratio [OR] and 95% confidence interval [CI]?=?3.9 [1.0–15.7] and 5.2 [1.6–17.3], respectively). Former marijuana users had increased risk of low frequency condom use with casual partners relative to never users (OR [95% CI]?=?2.9 [1.1–7.6]). Moreover, current marijuana users were more likely than never users to have had more than two recent sexual partners (OR [95% CI]?=?8.1 [1.94–33.44]). Conclusion: Treatment-seeking polysubstance abusers with current or past marijuana use histories may be at greater risk of HIV infection than their counterparts who do not use marijuana. These data underscore the importance of increasing awareness about the potential association between marijuana use and increased high-risk sexual behavior among polysubstance abusing patients.     

The impact of limited English proficiency on asthma action plan use

Objective: The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers. Methods: A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than “very well”. Data were analyzed using Fisher’s exact test and odds ratios (OR). Results: One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p?=?.01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3–6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7–7.0]), age of child >7 years (OR 1.0 [95% CI 0.5–2.4]), caregiver education?≥?associate degree (OR 1.4 [95% CI 0.6–3.0]), private insurance (OR 0.7 [95% CI 0.3–1.8]), White race (OR 0.7 [95% CI 0.2–2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2–1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3–2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child’s asthma as mild/well controlled. Conclusion: Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.     

The importance of proteinuria and prior cardiovascular disease in all major clinical outcomes of atherosclerotic renovascular disease – a single-center observational study

Background

Identification of patients at risk of developing adverse events would enable aggressive medical therapy and possibly targeted revascularization. The aim of this study is to characterize the determinants of long-term outcomes in atherosclerotic renovascular disease (ARVD).

Methods

Patients with a radiological diagnosis of ARVD were recruited into this single-center prospective cohort study between 1986 and 2014. Data collected included baseline co-morbid conditions, annualized prescribed medications and laboratory data (serum creatinine [υmol/L], proteinuria [g/24 h]). Multivariable Cox regression analysis was used to explore association with these end-points: death, end-stage kidney disease (ESKD), cardiovascular event (CVE) and the first of any of these events.

Results

A total of 872 patients were recruited into this study. However, 42 patients were excluded due to missing baseline data and hence case records for 830 patients were reviewed. Over median follow-up of 57.1 months (interquartile range: 21.7–96.9), incidence per 100 patient years of death, ESKD, CVE and any event was 13.5, 4.2, 8.9 and 21.0 respectively. Macrovascular disease (MVD), congestive heart failure (CHF), flash pulmonary oedema (FPE) and greater proteinuria at baseline were individually associated with increased risk for all end-points in multivariable analysis (Death: MVD –HR 1.24 [95% CI 1.02–1.50]; CHF –HR 1.33 [95% CI 1.08–1.64]; FPE – HR 2.10 [95% CI 1.50–2.92]; proteinuria – HR 1.14 [95% CI 1.08–1.20]). Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89–0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70–0.98]; statins: HR 0.79 [95% CI 0.66–.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71–1.00]; statins: HR 0.79 [95% CI 0.66–0.93]). Revascularization was associated with reduced risk of death (HR 0.65 [95% CI 0.51–0.83]) and ESKD (HR 0.59 [95% CI 0.46–0.76]).

Conclusion

All patients with ARVD require intensive vascular protection therapy to help mitigate systemic atherosclerosis, optimize cardiovascular risk and improve clinical outcomes. More effort is required to identify the minority of patients who may benefit from revascularization.

     

An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men

Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β?=??0.36; 95% CI: ?0.69, ?0.02; p?=?0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β?=??0.95; 95% CI: ?1.44, ?0.46; p?<?0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β?=??0.87; 95% CI: ?1.38, ?0.36; p?=?0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β?=?0.25; 95% CI: 0.16, 0.34; p?<?0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.     

Classification of alcohol use disorders among nightclub patrons: associations between high-risk groups,sociodemographic factors and illicit drug use

Background: Nightclubs are favorable environments for alcohol abuse and the use of other drugs among patrons. Objective: To identify patterns of alcohol use in a high-risk population and their relationship with sociodemographic factors and illicit drug use. Methods: A portal survey technique was used to recruit patrons in 31 nightclubs in the city of São Paulo, Brazil. A two stage sampling method allowed the selection of nightclubs and patrons within a nightclub. A total of 1057 patrons answered to a three stages-survey (nightclub entrance and exit face-to-face interviews and a day-after online questionnaire). Entrance survey offered information on sociodemographic data and history of drug use. The day-after survey used the Alcohol Use Disorders Identifications Test (AUDIT) that identified patterns of alcohol abuse disorders. Data were modeled using an ordered logit regression analysis, considering sample weights. Results: Almost half of the nightclub patrons presented any alcohol use disorder (AUDIT score ≥8). Being male (OR?=?1.68; 95% CI?=?1.09–2.60) and single (OR?=?1.71; 95% CI?=?1.05–2.76) increased the chances for more severe alcohol use disorders. Having a graduate degree (OR?=?0.57; 95% CI?=?0.38–0.87) and age ≥35 years (OR?=?0.48; 95% CI?=?0.27–0.85) decreased the chances of patrons’ alcohol use disorders. The prevalence rates of past-year marijuana, cocaine and inhalants use increased with the increased level of alcohol use disorders. Conclusions: Patrons of nightclubs show higher prevalence rates for any alcohol use disorders than the general population. Patrons could benefit from governmental brief intervention or referral to treatment for alcohol used disorders disclosed in nightclubs.     

Insights into reasons for discontinuation according to year of starting first regimen of highly active antiretroviral therapy in a cohort of antiretroviral‐naïve patients

Objectives

The aim of the study was to determine whether the incidence of first‐line treatment discontinuations and their causes changed according to the time of starting highly active antiretroviral therapy (HAART) in an Italian cohort.

Methods

We included in the study patients from the Italian COhort Naïve Antiretrovirals (ICoNA) who initiated HAART when naïve to antiretroviral therapy (ART). The endpoints were discontinuation within the first year of ≥1 drug in the first HAART regimen for any reason, intolerance/toxicity, poor adherence, immunovirological/clinical failure and simplification. We investigated whether the time of starting HAART (stratified as ‘early’, 1997–1999; ‘intermediate’, 2000–2002; ‘recent’, 2003–2007) was associated with the probability of reaching the endpoints by a survival analysis.

Results

Overall, the 1‐year probability of discontinuation of ≥1 drug in the first regimen was 36.1%. The main causes of discontinuation were intolerance/toxicity (696 of 1189 patients; 58.5%) and poor adherence (285 of 1189 patients; 24%). The hazards for all‐reason change were comparable according to calendar period [2000–2002, adjusted relative hazard (ARH) 0.82, 95% confidence interval (CI) 0.69–0.98; 2003–2007, ARH 0.94, 95% CI 0.76–1.16, vs. 1997–1999; global P‐value=0.08]. Patients who started HAART during the ‘recent’ period were less likely to change their initial regimen because of intolerance/toxicity (ARH 0.67, 95% CI 0.51–0.89 vs. ‘early’ period). Patients who started in the ‘intermediate’ and ‘recent’ periods had a higher risk of discontinuation because of simplification (ARH 15.26, 95% CI 3.21–72.45, and ARH 37.97, 95% CI 7.56–190.64, vs. ‘early’ period, respectively).

Conclusions

It seems important to evaluate reason‐specific trends in the incidence of discontinuation in order to better understand the determinants of changes over time. The incidence of discontinuation because of intolerance/toxicity has declined over time while simplification strategies have become more frequent in recent years. Intolerance/toxicity remains the major cause of drug discontinuation.     

Gender disparity in utilization rates of substance abuse services among female ex-offenders: a population-based analysis

Abstract

Background: The use and abuse of substances is common among offender populations. Although the female former offender population has risen substantially in recent decades, relatively little is known about their substance abuse treatment experiences. Objective: This study examines disparities in substance abuse treatment utilization among the US population with special focus upon formerly incarcerated female offenders. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n?=?43,093) collected in 2001–2002 and 2004–2005 the authors compared lifetime rates of substance abuse treatment utilization between female and male ex-offenders with the U.S. general population. The sample population covered inpatient and community based substance use treatment, detoxification and rehabilitation programs. It is a nationally representative sample of noninstitutionalized persons over the age of 18. Multinomial logistic regression was performed and likelihood of using substance use treatment and services was calculated using adjusted odds ratios (AOR). Results: Compared to male ex-offenders, female ex-offenders were 52% less likely to use substance-abuse treatment services (AOR?=?0.48, 95% CI?=?0.26–0.89) and 51% less likely to use rehabilitation programs (AOR?=?0.49, 95% CI?=?0.26–0.93). Compared to females in the general population, female ex-offenders were 10 times more likely to use substance-abuse treatment services (AOR?=?10.14, 95% CI?=?5.71–18.00), 10.5 times more likely to use substance detoxification programs (AOR?=?10. 45, 95% CI?=?5.64–19.39); 8 times more likely to use inpatient wards (AOR?=?8.05, 95% CI?=?4.16–15.59); 9 times more likely to use outpatient wards (AOR?=?9.06, 95% CI?=?4.89–16.81), and 12 times more likely to use substance-abuse rehabilitation programs (AOR?=?12.06, 95% CI?=?6.55–22.22). Conclusions: While female ex-offenders were more likely to have used a range of substance abuse services when compared to the general population, they were less likely to use substance-abuse treatment services and rehabilitation programs than male ex-offenders.     

Sexual risk behavior and uptake of HIV counseling and testing among youth in Metropolitan Kumasi,Ghana

Research on HIV counselling and testing (HCT) has proliferated in Ghana but limited evidence exists about the uptake of HCT among a large population that has been shown to engage in HIV risk-related behavior in Metropolitan Kumasi. With retrospective cross-sectional data from a representative sample of sexually active young people, multivariate logistic regression models examine the variables associated with HCT uptake in Kumasi. Among 906 participants (male 51% and female 49%, with a mean age ±SD, 25?±?6), 22% had utilized HCT in the last six months despite the higher knowledge of HCT (84%) mainly through mass media (65%) and health providers (27%). Besides, less than 20% of the sample intended to undergo HCT services. Multivariate logistic regression analysis showed that female gender (adjusted odds ratio [aOR]?=?1.830; 95% CI: 1.280–47.831; p?p?=?0.040), having sexual intercourse with irregular partner (aOR?=?5.597; 95% CI: 1.776–17.638; p?=?0.018), practiced unprotected sex (aOR?=?2.614; 95% CI: 1.821–6.472; p?=?0.002), having multiple sex partners (aOR?=?2.902; 95% CI: 1.405–7.226; p?p?相似文献   

Risks Surrounding Drug Trade Involvement Among Street-Involved Youth

Background: Street-involved youth have been shown to be involved in the street-level illicit drug trade in a number of jurisdictions, though little is known about risk factors and sequelae of this behavior. The present study was therefore conducted to investigate factors associated with the street-level drug trade involvement among street-based youth. Methods: We used logistic regression to examine factors associated with drug dealing among participants in the At-Risk Youth Study in Vancouver, Canada. We also examined motivations for drug trade involvement and types of drugs sold by participants. Results: Overall, 529 street-involved youth were followed during the study period, of whom 307 (58.0%) reported having been involved in the drug trade in the last six months. In a logistic regression analysis, crack cocaine use (Adjusted Odds Ratio [AOR] = 1.84, 95% CI: 1.28–2.67), homelessness (AOR = 1.58, 95% CI: 1.04–2.40), and having been assaulted by police (AOR = 1.85, 95% CI: 1.14–3.00) were independently associated with drug dealing among cohort participants. Among participants who reported drug dealing, 263 (85.6%) individuals stated that the main reason that they sold drugs was to pay for their personal drug use. Conclusions: In our setting, street-involved youth implicated in the drug trade are characterized by drug-related and sociodemographic vulnerabilities. These individuals also appear to be motivated by drug dependence and report elevated levels of police violence. Our findings have immediate implications for drug strategies targeting street-level drug dealing.     

Asthma prevalence among Hispanic adults in Puerto Rico and Hispanic adults of Puerto Rican descent in the United States – results from two national surveys

Abstract

Objective: To assess whether asthma prevalence differs between Hispanic adults living in Puerto Rico and Hispanic adults of Puerto Rican descent living in the United States. Methods: We used 2008–2010 Behavioral Risk Factor Surveillance System data, administered in Puerto Rico for Hispanic adults living in Puerto Rico (Hispanics in Puerto Rico), and 2008–2010 National Health Interview Survey data for Hispanic adults of Puerto Rican descent living in the United States (Puerto Rican Americans). We used 95% confidence intervals (CIs) to compare asthma prevalence between corresponding subgroups; non-overlapping CIs indicate statistical significance. Chi-square test and multivariate logistic regression were used to assess the association between current asthma status and socio-demographic factors and health risk behaviors within each Puerto Rican population. Results: Current asthma prevalence among Hispanics in Puerto Rico (7.0% [6.4%–7.7%]) was significantly lower than the prevalence among Puerto Rican Americans (15.6% [13.0%–18.1%]). The prevalence among almost all socio-demographic and health risk subgroups of Hispanics in Puerto Rico was significantly lower than the prevalence among the corresponding subgroups of Puerto Rican Americans. Adjusting for potential confounders did not alter the results. Asthma prevalence was significantly associated with obesity among Puerto Rican Americans (adjusted prevalence ratios [aPR]?=?1.5 [1.1–2.0]), and among Hispanics in Puerto Rico was associated with obesity (aPR?=?1.6 [1.3–1.9]), smoking (aPR?=?1.4 [1.1–1.9]) and being female (aPR?=?1.9 [1.5–2.4]). Conclusion: Asthma was more prevalent among Puerto Rican Americans than Hispanics in Puerto Rico. Although the observed associations did not explain all variations in asthma prevalence between these two populations, they may lay the foundation for future research.     

Do good psychosocial working conditions prolong working lives? Findings from a prospective study in Sweden

Due to an ageing population, governments in European countries are striving to keep older workers longer in the workforce. Remarkably few studies have paid attention to the influence of psychosocial working conditions on timing of retirement for older workers in and beyond normative retirement age. The aim of the present study was to examine whether good psychosocial working conditions contribute to prolonged working lives among older workers (59 years and above). A particular question was whether such conditions increase in importance with age. Seven waves (2006–2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (N?=?6000, observations?=?10,632). Discrete-time event history analyses showed that higher levels of job resources (decision authority [OR 1.13, 95% CI 1.06–1.22], skill use [OR 1.17, 95% CI 1.07–1.29], learning opportunities [OR 1.22, 95% CI 1.13–1.31], social support [OR 1.29 (95% CI 1.16–1.42], work-time control [OR 1.07, 95% CI 1.01–1.13], and reward [OR 1.40, 95% CI 1.24–1.57])—but not lower levels of job demands (quantitative and emotional demands or effort)—were associated with working longer (continued work two years later). Also, low effort-reward imbalance (OR 0.84 [95% CI 0.73–0.96]) was associated with working longer. In addition, skill use, work-time control, reward, and low effort-reward imbalance increased in importance with age for continued work. These results suggest that providing older workers with control over their work tasks, giving opportunities for learning and using their skills, as well as rewarding and acknowledging their achievements, may keep them in the workforce longer. Especially, job resources may grow in importance with age.

     

Study of functional variants of the BANK1 gene in rheumatoid arthritis

Objective

To investigate 1 functional (rs17266594) and 2 potentially functional (rs10516487 and rs3733197) BANK1 variants, which were previously identified as systemic lupus erythematosus (SLE) susceptibility markers, to test whether they are associated with rheumatoid arthritis (RA).

Methods

Four different cohorts were included in the study: 1,080 RA patients and 1,368 healthy controls from Spain, 278 RA patients and 568 healthy controls from Sweden, 288 RA patients and 287 healthy controls from Argentina, and 288 RA patients and 288 healthy controls from Mexico. Samples were genotyped for BANK1 single‐nucleotide polymorphisms (SNPs) using a TaqMan 5′‐allele discrimination assay. Statistical analysis comparing allele and genotype distributions was performed with the chi‐square test.

Results

We did not find a significant association between RA and the rs10516487 and rs17266594 BANK1 polymorphisms. However, there was an increase in the major alleles among RA patients. Similarly, for rs3733197, there was an increase in the major allele among patients in every cohort. Nevertheless, this skewing reached statistical significance in the Spanish (P = 0.01, odds ratio [OR] 1.17 [95% confidence interval (95% CI) 1.03–1.32]) and Argentinean (P = 0.04, OR 1.31 [95% CI 1.00–1.72]) populations. We found a significant association of rs10516487 (P = 0.005, OR 1.15 [95% CI 1.04–1.28]) and rs3733197 (P = 0.0009, OR 1.17 [95% CI 1.07–1.29]) with RA in the pooled analysis. In a 3‐SNP haplotype analysis, we found that the major TGG haplotype was significantly associated with RA (P = 0.005, OR 1.14 [95% CI 1.04–1.25]). In addition, we found a common CAA haplotype that was protective against RA (P = 0.0004, OR 0.82 [95% CI 0.74–0.92]).

Conclusion

These results suggest that BANK1 SNPs and haplotypes may contribute to RA susceptibility with a low risk.

     

Clinical effectiveness of golimumab in Crohn’s disease: an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)

Abstract

Objective: The effectiveness of golimumab in Crohn’s disease (CD) is largely unknown as it is not approved for the treatment of the disease. We aimed to identify the population of CD patients treated with golimumab in Sweden, to assess the effectiveness of golimumab (defined as the drug retention rate), and to identify predictors of drug discontinuation.

Methods: Patients with CD who received at least one injection of golimumab were identified through the Swedish National Quality Registry for Inflammatory Bowel Disease, which includes prospectively collected clinical information. Cox regression models were used to identify predictors of golimumab discontinuation.

Results: The study cohort involved 94 patients of whom the majority (96.8%) had previously discontinued at least one anti-tumour necrosis factor (anti-TNF) agent. The drug retention rate at 12 weeks was 85.1%. Predictors of golimumab discontinuation at 12 weeks were previous surgery (adjusted HR?=?7.52, 95% CI: 1.12–50.36), concomitant corticosteroid use at baseline (adjusted HR?=?5.70, 95% CI: 1.13–28.68) and female sex (adjusted HR?=?6.59; 95% CI: 1.04–41.62). The median duration of follow-up was 89 (IQR: 32–158) weeks. The drug retention at the most recent follow-up was 35.1%. Predictors of golimumab discontinuation at the most recent follow-up were corticosteroid use at baseline (adjusted HR?=?2.60, 95% CI: 1.17–5.79) and female sex (adjusted HR?=?2.24; 95% CI: 1.19–4.23).

Conclusion: Patients with CD treated with golimumab were a treatment-refractory group. Despite this, more than one-third of the patients appeared to have had clinical benefit after a median follow-up of more than 1.5 years.     

Antibiotic use in infancy and the risk of asthma in Mexican American children

Objective: This study examined the associations of antibiotic use in infancy with lifetime doctor-diagnosed asthma and current wheeze among Mexican American children. Methods: In a population-based, cross-sectional investigation, parents of 2023 children 4–18 years of age completed a questionnaire/interview addressing respiratory conditions, antibiotic use, and covariates. Results: In adjusted analyses, among children without history of ear infections in infancy, children who used antibiotics ≥3 times and 1–2 times were more likely to report doctor-diagnosed asthma compared with their peers who did not use antibiotics in infancy [adjusted odds ratio (aOR)?=?5.14, 95% confidence interval (CI): 2.88–9.17, and aOR?=?2.15, 95% CI: 1.26–3.69, respectively, p trend < 0.0001]. The respective aORs for current wheeze were 3.67 (95% CI: 1.95–6.89) and 1.63 (95% CI: 0.91–2.95). Antibiotic use in infancy was not associated with asthma or current wheeze in children who had ear infections in infancy. In additional analyses, antibiotic use in infancy was associated with asthma in children without parental history of asthma or allergies (aOR?=?2.73, 95% CI: 1.70–4.39) but not in those with parental history of asthma or allergies. Among Mexico-born participants born in rural areas, antibiotic use in infancy was associated with a seven-fold increase in risk of asthma (aOR?=?7.21, 95% CI: 1.46–35.65), while the association was non-significant in Mexico-born children born in urban areas in Mexico. Conclusions: Antibiotic use in infancy may increase the risk of asthma and wheezing, but these associations were limited to subgroups of children.     

Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users

Aims Despite proven benefits of antiretroviral therapy (ART), many human immunodeficiency virus (HIV)‐infected injection drug users (IDU) do not access treatment even in settings with free health care. We examined whether methadone maintenance therapy (MMT) increased initiation and adherence to ART among an IDU population with free health care. Design We examined prospectively a cohort of opioid‐using antiretroviral‐naive HIV‐infected IDU and investigated factors associated with initiation of antiretroviral therapy as well as subsequent adherence. Factors associated independently with time to first initiation of antiretroviral therapy were modelled using Cox proportional hazards regression. Findings Between May 1996 and April 2008, 231 antiretroviral‐naive HIV‐infected opioid‐using IDU were enrolled, among whom 152 (65.8%) initiated ART, for an incidence density of 30.5 [95% confidence interval (CI): 25.9–35.6] per 100 person‐years. After adjustment for time‐updated clinical characteristics and other potential confounders, use of MMT was associated independently with more rapid uptake of antiretroviral therapy [relative hazard = 1.62 (95% CI: 1.15–2.28); P = 0.006]. Those prescribed methadone also had higher rates of ART adherence after first antiretroviral initiation [odds ratio = 1.49 (95% CI: 1.07–2.08); P = 0.019]. Conclusion These results demonstrate that MMT contributes to more rapid initiation and subsequent adherence to ART among opioid‐using HIV‐infected IDU. Addressing international barriers to the use and availability of methadone may increase dramatically uptake of HIV treatment among this population.