Characteristics and Outcome of Minority Group Patients in Methadone Maintenance Treatment

Minority status is associated with mental and physical morbidity, substance dependence, and poor outcomes. To compare characteristics and treatment outcomes between patients from two minority groups in Israel (Christians and Muslims) and patients from the majority population (Jews) in methadone maintenance treatment (MMT), we prospectively studied all patients admitted to our clinic between 1993 and 2012 and followed up until 2013; 655 Jews, 67 Christians, and 37 Muslims. Christian patients differed from Jews and Muslims by younger age at admission to MMT, greater prevalence of drug injectors, and a higher proportion of Hepatitis-C and HIV sera positive. Muslims had comparatively less education and a lower proportion of females. The three groups had similar rates of one-year retention (75.9%) and opiate abstinence (68.1%). They also did not differ in long-term retention (up to 20 years): Muslims 5.5 years (95%CI 3.6-7.4), Christians 7.5 years (95%CI 6-9.1), and Jews 7.6 years (95%CI 7-8.2, p = .3). The Hepatitis-C incidence, however, was higher among the 21 admitted Hepatitis-C seronegative minorities (5.0/100 person years) than the 207 Hepatitis-C seronegative non-minority patients (1.7/100 person years, p=0.03). All groups had good treatment outcomes, except for Hepatitis-C seroconversion, which necessitates a specific preventive intervention among the minority groups.     

The Relationship Between Vulnerable Attachment Style,Psychopathology, Drug Abuse,and Retention in Treatment Among Methadone Maintenance Treatment Patients

The relationship between vulnerable attachment style, psychopathology, drug abuse, and retention in treatment among patients in methadone maintenance treatment (MMT) was examined by the Vulnerable Attachment Style Questionnaire (VASQ), the Symptom Checklist-90 (SCL-90), and drug abuse urine tests. After six years, retention in treatment and repeated urine test results were studied. Patients with vulnerable attachment style (a high VASQ score) had higher rates of drug abuse and higher psychopathology levels compared to patients with secure attachment style, especially on the interpersonal sensitivity, anxiety, hostility, phobic anxiety, and paranoid ideation scales. Drug abstinence at baseline was related to retention in treatment and to higher rates of drug abstinence after six years in MMT, whereas a vulnerable attachment style could not predict drug abstinence and retention in treatment. Clinical Implications concerning treatment of drug abusing populations and methodological issues concerning the VASQ’s subscales are also discussed.     

Antidepressants reverse short-photoperiod-induced, forced swim test depression-like behavior in the diurnal fat sand rat: further support for the utilization of diurnal rodents for modeling affective disorders

Recent findings demonstrate strong links between abnormalities in circadian rhythms and sleep and the etiology, pathophysiology and treatment of major affective disorders. Further exploration of these interactions requires the development, identification and utilization of good and predictive animal models. The biology and behavior related to circadian rhythms are significantly different in diurnal and nocturnal rodents. Accordingly, it is possible that exploring the interactions between these mechanisms and affective change in diurnal animals may be advantageous. Recent studies demonstrate that diurnal fat sand rats and Nile grass rats show depression-like behavior when maintained under short-photoperiod (SP) conditions compared with animals maintained under neutral photoperiod (NP) conditions. Moreover, these behaviors were ameliorated after treatment with bright light. The present study further explores the possible utility of sand rats as animal models by testing the effects of antidepressants on the SP-induced depression-like behaviors of sand rats. Sand rats maintained in SP or NP conditions for 3 weeks were treated subchronically (5 injections) with the clinically effective antidepressant bupropion, and their behavior was tested in a number of depression-related tests. Results show that antidepressant treatment reverses the effects of SP conditions in the forced swim test, but that neither SP conditions nor antidepressants influenced sweet solution preference. These results partly support the validity of the sand rat model, but suggest that not all tests that were validated in nocturnal laboratory rodents can be applied to other rodent species and that additional tests should be applied to further explore the validity of the model.     

Precueing attention to the target location diminishes crowding and reduces the critical distance

The identification of a peripheral target surrounded by flankers is often harder than the identification of an identical isolated target. This study examined whether this crowding phenomenon, and particularly its spatial extent, is affected by the allocation of spatial attention to the target location. We measured orientation identification of a rotated T with and without flankers. The distance between the target and the flankers and their eccentricity varied systematically. We manipulated attention via peripheral precues: in the cued condition, a dot indicated the target location prior to its onset. On the neutral condition, a central disk conveyed no information regarding the target location (Experiments 1-2), and on the invalid condition (Experiment 3), an invalid cue attracted attention to a nontarget location. We found, across all experiments, at all eccentricities, a significant attentional enhancement of identification accuracy. Most importantly, we found a significant attentional reduction of the critical distance (i.e., the target-flankers distance at which the flankers no longer interfere with target identification). These attentional effects were found regardless of the presence or absence of a backward mask and whether the attentional cue was informative or not. These findings suggest that attention reduces the spatial extent of crowding.     

Disparities in diabetes care: role of the patient's socio-demographic characteristics

Background  

The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan).     

Thyroid stimulating hormone levels rise after assisted reproductive technology

Purpose

The goal of this study was to determine whether high E2 levels after controlled ovarian hyperstimulation affect TSH.

Methods

Patients completing ART cycles between April-October 2010 were eligible for this cohort study. 180 patients were recruited however those with known thyroid disease were excluded. The final analysis included 154 subjects. Blood was collected at each visit during the ART cycle as well as at the pregnancy test. Samples were frozen at ?20 °C and analyzed together for E2 and TSH using the same assay kit once all patients had completed their cycles. All participants were treated at the McGill University Health Center. A paired t-test was used to study the difference in TSH levels recorded at maximal and minimal Estradiol levels during ovarian stimulation. Multiple regression analysis was then used to determine if factors such as anti-thyroid antibodies and ovarian reserve measures affect this change in TSH. We used multiple imputation methods to account for missing data.

Results

As E2 levels rose from low to supra-physiologic levels during treatment, TSH levels also rose significantly. This increase was clinically significant by the time of pregnancy test. The factors that potentially affected the change in TSH were: male factor/tubal factor infertility, type of protocol used as well as the presence of thyroid antibodies.

Conclusions

Although TSH increases during ART, this change only becomes clinically significant on the day of pregnancy test. Future studies should examine TSH changes specifically in certain “at-risk” sub-groups such as those with antibodies and known thyroid disease.