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991.
The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report
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Uvaraj Uddayasankar Colin Lee Curtis Oleschuk Gregg Eschun Robert E. Ariano 《Pharmacotherapy》2018,38(6):e41-e45
Carfentanil and related fentanyl analogs have been linked to a number of overdose deaths from drug users in several cities across North America. Diagnosis of carfentanil exposure requires a very high index of clinical suspicion, especially because available laboratory narcotic screens do not detect this agent. We describe a 34‐year‐old man admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil. Urine and whole blood samples were obtained for conventional preliminary drug screen immunoassays for unknown exposures, in addition to utilizing a high‐pressure liquid chromatography–tandem mass spectrometry assay for quantification of carfentanil and its metabolite. The patient was intubated and required mechanically assisted ventilation for 31 hours until he was able to breathe safely on his own. Pharmacokinetic modeling of three timed blood samples identified the elimination half‐life as 5.7 hours for carfentanil and 11.8 hours for the norcarfentanil metabolite. Awakening and breathing spontaneously corresponded to an interpolated blood carfentanil concentration of 0.52 ng/ml. This is the first pharmacokinetic and pharmacodynamic case report on the recreational use of carfentanil. Critical care clinicians should anticipate long periods of ventilatory support in the care of patients exposed to carfentanil. 相似文献
992.
Mary Tresa Zanda 《Drug metabolism reviews》2018,50(1):54-64
AbstractSynthetic cannabinoids have long been studied for their therapeutic potentials. However, during the last decade, new generations of synthetic cannabinoid agonists appeared on the drug market. These new psychoactive substances are currently sold as ‘marijuana-like’ products as they claim to mimic the effects of the psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC). Yet, their effects are more intense and potent than THC, typically last longer and are often associated to serious psychiatric consequences. Animal models of drug addiction are frequently used in preclinical research to assess the abuse potential of new compounds, evaluate drug positive reinforcing effects and analyze drug-induced behaviors. Some of these protocols have been used recently to study the newly synthesized cannabinoid agonists and have started elucidating their pharmacology and actions in the brain. The aim of this review is to summarize the major findings reported by animal studies that tested synthetic cannabinoids of first, second, and third generation by using self-administration and reinstatement models, drug discrimination and conditioned place preference procedures. Altogether, behavioral studies clearly indicate that synthetic cannabinoids possess abuse liability, are likely to activate the brain reward circuit and induce positive subjective and reinforcing effects. 相似文献
993.
Brian Mattera Ethan C. Levine Omar Martinez Miguel Muñoz-Laboy Carolina Hausmann-Stabile José Bauermeister 《Culture, health & sexuality》2018,20(6):607-624
While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice. 相似文献
994.
Katherine Marie Halloran Kathleen Gorman Megan Fallon Alison Tovar 《Journal of nutrition education and behavior》2018,50(4):340-348.e1
Objective
To examine the association between nutrition knowledge, attitudes, and fruit/vegetable intake among Head Start teachers and their classroom mealtime behaviors (self-reported and observed).Design
Cross-sectional design using observation and survey.Setting
Sixteen Head Start centers across Rhode Island between September, 2014 and May, 2015.Participants
Teachers were e-mailed about the study by directors and were recruited during on-site visits. A total of 85 participants enrolled through phone/e-mail (19%) or in person (81%).Main Outcome Measures
Independent variables were nutrition knowledge, attitudes, and fruit/vegetable intake. The dependent variable was classroom mealtime behaviors (self-reported and observed).Analysis
Regression analyses conducted on teacher mealtime behavior were examined separately for observation and self-report, with knowledge, attitudes, and fruit and vegetable intake as independent variables entered into the models, controlling for covariates.Results
Nutrition attitudes were positively associated with teacher self-reported classroom mealtime behavior total score. Neither teacher nutrition knowledge nor fruit/vegetable intake was associated with observed or self-reported classroom mealtime behavior total scores.Conclusion and Implications
There was limited support for associations among teacher knowledge, attitudes, and fruit/vegetable intake, and teacher classroom mealtime behavior. Findings showed that teacher mealtime behavior was significantly associated with teacher experience. 相似文献995.
Aileen S. Garcia Dipti A. Dev Virginia C. Stage 《Journal of nutrition education and behavior》2018,50(9):905-912
Objective
Determine the predictors of child care providers’ parent engagement regarding child nutrition in child care centers (CCCs) and family child care homes (FCCHs).Design
Cross-sectional.Setting
Child care centers and FCCHs.Participants
Child care center directors (n?=?337) and FCCH providers (n?=?1,153) completed a self-administered survey.Main Outcome Measures
Fifteen variables were examined as predictors for parent engagement: providers’ perceived barriers to communication, participation in Go Nutrition and Physical Self- Assessment in Child Care, National Association for the Education of Young Children accreditation, participation in Quality Ratings and Improvement Systems, feeding practices, and professional development.Analysis
Structural equation modeling examined the relation between variables for CCCs and for FCCHs.Results
For CCCs, NAEYC accreditation, providers’ perceived barriers regarding parents’ cultural beliefs about food, parents not liking the taste of healthy foods, and parents prioritizing other food-related topics over healthy eating significantly predicted parent engagement. For FCCHs, participation in Go Nutrition and Physical Self- Assessment in Child Care, perceiving parents to be busy, not wanting to offend parents, and practicing family-style dining were significantly related to parent engagement. For both CCCs and FCCHs, professional development regarding child nutrition was related to parent engagement.Conclusions and Implications
Focusing professional development on child care contexts and addressing providers’ perceived barriers may improve parent engagement. 相似文献996.
997.
Sara C. Folta Susan Koch-Weser Lindsay A. Tanskey Christina D. Economos Aviva Must Claire Whitney Catherine M. Wright Jeanne P. Goldberg 《Journal of nutrition education and behavior》2018,50(2):180-189.e1
Objective
To develop a branding strategy for a campaign to improve the quality of foods children bring from home to school, using a combined healthy eating and eco-friendly approach and for a control campaign focusing solely on nutrition.Methods
Formative research was conducted with third- and fourth-grade students in lower- and middle-income schools in Greater Boston and their parents. Phase I included concept development focus groups. Phase II included concept testing focus groups. A thematic analysis approach was used to identify key themes.Results
In phase I, the combined nutrition and eco-friendly messages resonated; child preference emerged as a key factor affecting food from home. In phase II, key themes included fun with food and an element of mystery. Themes were translated into a concept featuring food face characters.Conclusions and Implications
Iterative formative research provided information necessary to create a brand that appealed to a specified target audience. 相似文献998.
Lisa M. Najavits Karen Krinsley Molly E. Waring Matthew W. Gallagher Christopher Skidmore 《Substance use & misuse》2018,53(11):1788-1800
Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. Objective: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present. Methods: Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions. Results: Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe—predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action. 相似文献
999.
Background: Studies on sexual functioning of populations with substance use disorders (SUDs) are mostly conducted with male substance users. We have very limited information about the sexuality and related factors in women with opioid use disorder (OUD). Objectives: We aimed to evaluate the relationship between childhood traumatic experiences (CTEs) and sexual dysfunctions (SDs) of women with OUD and to compare it with a sample of women who do not have SUD. Methods: Participants included 51 outpatient women with OUD who were on opioid maintenance treatment (OMT) with Buprenorphine/Naloxone and 48 women without SUD. Participants were evaluated by a semi-structured sociodemographic form, the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Results: In women with OUD; CTQ-28, BDI, STAI, and GRISS scores were significantly higher. In the partial correlation analysis, sexual abuse was found to be significantly correlated with nonsensuality, avoidance and total GRISS score. In stepwise regression model, sexual abuse was found to predict SDs together with depression. Conclusions: CTE, SD, depression, and anxiety rates were higher in the women with OUD. Especially childhood sexual abuse was associated with SDs in this group. Sexual abuse was predicting SDs together with depression. Further investigation of different characteristics of women with SUD may give an opportunity to clinicians to have a better understanding for adaptable treatment strategies. 相似文献
1000.
Ann M. Cheney Christine N. Newkirk Vhuhwavho M. Nekhavhambe Matthew Baron Rotondi Alison Hamilton 《Journal of ethnicity in substance abuse》2018,17(1):32-49
ABSTRACTIn this article, we examine methamphetamine (meth) use initiation as influenced by Latinas’ social positions within institutions (e.g., family and economy). We conducted ethnographic fieldwork in five women’s residential substance use treatment facilities in Los Angeles County with women who considered meth to be their primary drug of choice. Using an urban ethnographic framing, we demonstrate the effects of low-income young Latinas’ spatial- and social-context rendered vulnerability to abuse and neglect, and the resulting emotional distress, on meth use initiation. When considering pathways to substance use intervention for vulnerable Latina girls and women, clinicians, researchers, and policy makers need to understand substance use pathways as dynamic processes to cope with psychosocial stress while living in communities with easy access to illicit substances such as methamphetamine. 相似文献