APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

Amide proton transfer‐weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT‐based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo.

Level of Evidence: 3

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

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Diagnostic performance of diffusion‐weighted (DWI) and dynamic contrast‐enhanced (DCE) MRI for the differentiation of benign from malignant soft‐tissue tumors

Background

A wide range of specificity values for the differentiation of benign and malignant soft‐tissue tumors show the limitations of conventional MRI features. The data obtained by quantitative analysis of diffusion‐weighted image (DWI) and dynamic contrast‐enhanced (DCE) MRIs would provide more objective results, especially in terms of cellularity and perfusion.

Purpose

To evaluate the diagnostic efficacies of DWI and DCE MRI for the differentiation of malignant and benign soft‐tissue tumors.

Study Type

Retrospective.

Subjects

In all, 136 patients (68 females, 68 males; age range 18–86 years, mean age 57.2 years) with soft‐tissue tumors.

Field Strength/Sequence

3 T, DWI, DCE.

Assessment

Tumor sizes, margins, locations, the presence of involvement in bone or neurovascular bundle, peritumoral edema, heterogeneity, and tumor necrosis were investigated on conventional MR images. On DWIs, visual signal drops were assessed and ADC (apparent diffusion coefficient) values were measured. K^trans, K_ep, V_e, and iAUC values, and time–concentration curve (TCC) types were determined using DCE images.

Statistical Tests

The data were statistically analyzed to determine the abilities to differentiate benign and malignant tumors using the chi‐square test, two‐sample t‐test, and receiver operating characteristic (ROC) analysis.

Results

Seventy‐three cases were malignant and 63 benign. Age (mean ages of benign/malignant tumors, 51.75/61.86 years; P = 0.0002) and gender (F:M = 40:23 [benign], F:M = 28:45 [malignant], P = 0.003) influenced the distinction between benign and malignant. Sizes, margins, neurovascular bundle involvement, peritumoral edema, and heterogeneity of the tumors on conventional MR images and DCE parameters (K^trans, K_ep, V_e, and iAUC, and TCC plots) obtained from focal region of interest within a narrow volume of interest significantly differentiated benign and malignant lesions (all P < 0.0001, except V_e [P = 0.0004]). For DWI with ADC mapping, all ADC values and visually signal drops were also significant (P < 0.0001).

Data Conclusion

DWI and DCE‐MRI and derived variables were significantly helpful in discriminating benign and malignant soft‐tissue tumors complementary to conventional MRI.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Background

Although radiation therapy (RT) contributes to survival benefit in many brain tumor patients, it has also been associated with long‐term brain injury. Cerebral microbleeds (CMBs) represent an important manifestation of radiation‐related injury.

Purpose

To characterize the change in size and number of CMBs over time and to evaluate their relationship to white matter structural integrity as measured using diffusion MRI indices.

Study Type

Longitudinal, retrospective, human cohort.

Population

In all, 113 brain tumor patients including patients treated with focal RT (n = 91, 80.5%) and a subset of nonirradiated controls (n = 22, 19.5%).

Field Strength/Sequence

Single and multiecho susceptibility‐weighted imaging (SWI) and multiband, shell, and direction diffusion tensor imaging (DTI) at 7 T.

Assessment

Patients were scanned either once or serially. CMBs were detected and quantified on SWI images using a semiautomated approach. Local and global fractional anisotropy (FA) were measured from DTI data for a subset of 35 patients.

Statistical Tests

Potential risk factors for CMB development were determined by multivariate linear regression and using linear mixed‐effect models. Longitudinal FA was quantitatively and qualitatively evaluated for trends.

Results

All patients scanned at 1 or more years post‐RT had CMBs. A history of multiple surgical resections was a risk factor for development of CMBs. The total number and volume of CMBs increased by 18% and 11% per year, respectively, although individual CMBs decreased in volume over time. Simultaneous to these microvascular changes, FA decreased by a median of 6.5% per year. While the majority of nonirradiated controls had no CMBs, four control patients presented with fewer than five CMBs.

Data Conclusion

Identifying patients who are at the greatest risk for CMB development, with its likely associated long‐term cognitive impairment, is an important step towards developing and piloting preventative and/or rehabilitative measures for patients undergoing RT.

Level of Evidence: 3

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2018;47:1133–1138.

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APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

Amide proton transfer‐weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT‐based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo.

Level of Evidence: 3

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U8E4Dv

Diagnostic performance of diffusion‐weighted (DWI) and dynamic contrast‐enhanced (DCE) MRI for the differentiation of benign from malignant soft‐tissue tumors

Background

A wide range of specificity values for the differentiation of benign and malignant soft‐tissue tumors show the limitations of conventional MRI features. The data obtained by quantitative analysis of diffusion‐weighted image (DWI) and dynamic contrast‐enhanced (DCE) MRIs would provide more objective results, especially in terms of cellularity and perfusion.

Purpose

To evaluate the diagnostic efficacies of DWI and DCE MRI for the differentiation of malignant and benign soft‐tissue tumors.

Study Type

Retrospective.

Subjects

In all, 136 patients (68 females, 68 males; age range 18–86 years, mean age 57.2 years) with soft‐tissue tumors.

Field Strength/Sequence

3 T, DWI, DCE.

Assessment

Tumor sizes, margins, locations, the presence of involvement in bone or neurovascular bundle, peritumoral edema, heterogeneity, and tumor necrosis were investigated on conventional MR images. On DWIs, visual signal drops were assessed and ADC (apparent diffusion coefficient) values were measured. K^trans, K_ep, V_e, and iAUC values, and time–concentration curve (TCC) types were determined using DCE images.

Statistical Tests

The data were statistically analyzed to determine the abilities to differentiate benign and malignant tumors using the chi‐square test, two‐sample t‐test, and receiver operating characteristic (ROC) analysis.

Results

Seventy‐three cases were malignant and 63 benign. Age (mean ages of benign/malignant tumors, 51.75/61.86 years; P = 0.0002) and gender (F:M = 40:23 [benign], F:M = 28:45 [malignant], P = 0.003) influenced the distinction between benign and malignant. Sizes, margins, neurovascular bundle involvement, peritumoral edema, and heterogeneity of the tumors on conventional MR images and DCE parameters (K^trans, K_ep, V_e, and iAUC, and TCC plots) obtained from focal region of interest within a narrow volume of interest significantly differentiated benign and malignant lesions (all P < 0.0001, except V_e [P = 0.0004]). For DWI with ADC mapping, all ADC values and visually signal drops were also significant (P < 0.0001).

Data Conclusion

DWI and DCE‐MRI and derived variables were significantly helpful in discriminating benign and malignant soft‐tissue tumors complementary to conventional MRI.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Background

Although radiation therapy (RT) contributes to survival benefit in many brain tumor patients, it has also been associated with long‐term brain injury. Cerebral microbleeds (CMBs) represent an important manifestation of radiation‐related injury.

Purpose

To characterize the change in size and number of CMBs over time and to evaluate their relationship to white matter structural integrity as measured using diffusion MRI indices.

Study Type

Longitudinal, retrospective, human cohort.

Population

In all, 113 brain tumor patients including patients treated with focal RT (n = 91, 80.5%) and a subset of nonirradiated controls (n = 22, 19.5%).

Field Strength/Sequence

Single and multiecho susceptibility‐weighted imaging (SWI) and multiband, shell, and direction diffusion tensor imaging (DTI) at 7 T.

Assessment

Patients were scanned either once or serially. CMBs were detected and quantified on SWI images using a semiautomated approach. Local and global fractional anisotropy (FA) were measured from DTI data for a subset of 35 patients.

Statistical Tests

Potential risk factors for CMB development were determined by multivariate linear regression and using linear mixed‐effect models. Longitudinal FA was quantitatively and qualitatively evaluated for trends.

Results

All patients scanned at 1 or more years post‐RT had CMBs. A history of multiple surgical resections was a risk factor for development of CMBs. The total number and volume of CMBs increased by 18% and 11% per year, respectively, although individual CMBs decreased in volume over time. Simultaneous to these microvascular changes, FA decreased by a median of 6.5% per year. While the majority of nonirradiated controls had no CMBs, four control patients presented with fewer than five CMBs.

Data Conclusion

Identifying patients who are at the greatest risk for CMB development, with its likely associated long‐term cognitive impairment, is an important step towards developing and piloting preventative and/or rehabilitative measures for patients undergoing RT.

Level of Evidence: 3

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2018;47:1133–1138.

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Exploring the Use of ECochG Testing During Electrode Insertion in Cochlear Implant Surgery

Conditions:   Cochlear Implants;   Hearing Preservation Intervention:   Procedure: Electrocochlography Sponsors:   Cambridge University Hospitals NHS Foundation Trust;   University of Cambridge Recruiting (Source: ClinicalTrials.gov)

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Clinical Study of Minimally Invasive Ponto Surgical Technique (MIPS) - Design Iteration

Conditions:   Bone Conduction Deafness;   Unilateral Deafness;   Middle Ear Deafness;   Mixed Hearing Loss Intervention:   Device: Minimally Invasive Ponto Surgery Sponsor:   Oticon Medical Recruiting (Source: ClinicalTrials.gov)

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Exploring the Use of ECochG Testing During Electrode Insertion in Cochlear Implant Surgery

Conditions:   Cochlear Implants;   Hearing Preservation Intervention:   Procedure: Electrocochlography Sponsors:   Cambridge University Hospitals NHS Foundation Trust;   University of Cambridge Recruiting (Source: ClinicalTrials.gov)

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Clinical Study of Minimally Invasive Ponto Surgical Technique (MIPS) - Design Iteration

Conditions:   Bone Conduction Deafness;   Unilateral Deafness;   Middle Ear Deafness;   Mixed Hearing Loss Intervention:   Device: Minimally Invasive Ponto Surgery Sponsor:   Oticon Medical Recruiting (Source: ClinicalTrials.gov)

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A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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MP‐AzeFlu provides rapid and effective allergic rhinitis control: results of a non‐interventional study in Denmark

Background

Allergic rhinitis (AR) control is a priority in the European Union (EU), and Allergic Rhinitis and its Impact on Asthma (ARIA) has endorsed a visual analogue scale (VAS) as the new language of AR control. This study evaluated the effectiveness of MP‐AzeFlu (Dymista®, antihistamine [azelastine], and intranasal corticosteroid [fluticasone propionate]) using a VAS in real‐life clinical practice in Denmark.

Methods

The multicenter, prospective, non‐interventional study included 170 patients (≥12 years) with ARIA‐defined moderate‐to‐severe AR prescribed MP‐AzeFlu. Patients assessed symptom severity using a VAS (0 to 100 mm) on days 0, 1, 3, and 7 and after ∼14 days of MP‐AzeFlu use. On day 3, patients assessed their disease as well controlled, partly controlled, or uncontrolled. Proportions of patients achieving VAS score cutoffs (well‐controlled, partly controlled) were also calculated.

Results

MP‐AzeFlu reduced mean ± standard deviation VAS score from 67.1 ± 19.3 mm at baseline to 28.4 ± 23.7 mm on the last day, a reduction of 38.8 ± 27.3 mm. At day 3, 85.6% of patients considered their symptoms to be partly or well controlled. Effectiveness was consistent across disease severity, phenotype (seasonal, perennial, or combined AR), and patient age. Respectively, 28.2%, 44.2%, 61.6%, and 71.4% of patients achieved ≤38 mm well‐controlled VAS score cutoff on days 1, 3, and 7, and the last day.

Conclusion

MP‐AzeFlu provided effective, rapid, and sustained symptom control in a real‐life setting among patients from Denmark. These results align with EU and ARIA objectives and support the effectiveness of MP‐AzeFlu for the treatment of AR in real life.

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MP‐AzeFlu provides rapid and effective allergic rhinitis control: results of a non‐interventional study in Denmark

Background

Allergic rhinitis (AR) control is a priority in the European Union (EU), and Allergic Rhinitis and its Impact on Asthma (ARIA) has endorsed a visual analogue scale (VAS) as the new language of AR control. This study evaluated the effectiveness of MP‐AzeFlu (Dymista®, antihistamine [azelastine], and intranasal corticosteroid [fluticasone propionate]) using a VAS in real‐life clinical practice in Denmark.

Methods

The multicenter, prospective, non‐interventional study included 170 patients (≥12 years) with ARIA‐defined moderate‐to‐severe AR prescribed MP‐AzeFlu. Patients assessed symptom severity using a VAS (0 to 100 mm) on days 0, 1, 3, and 7 and after ∼14 days of MP‐AzeFlu use. On day 3, patients assessed their disease as well controlled, partly controlled, or uncontrolled. Proportions of patients achieving VAS score cutoffs (well‐controlled, partly controlled) were also calculated.

Results

MP‐AzeFlu reduced mean ± standard deviation VAS score from 67.1 ± 19.3 mm at baseline to 28.4 ± 23.7 mm on the last day, a reduction of 38.8 ± 27.3 mm. At day 3, 85.6% of patients considered their symptoms to be partly or well controlled. Effectiveness was consistent across disease severity, phenotype (seasonal, perennial, or combined AR), and patient age. Respectively, 28.2%, 44.2%, 61.6%, and 71.4% of patients achieved ≤38 mm well‐controlled VAS score cutoff on days 1, 3, and 7, and the last day.

Conclusion

MP‐AzeFlu provided effective, rapid, and sustained symptom control in a real‐life setting among patients from Denmark. These results align with EU and ARIA objectives and support the effectiveness of MP‐AzeFlu for the treatment of AR in real life.

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MRI Radiomic Analysis of IMRT-Induced Bladder Wall Changes in Prostate Cancer Patients: A Relationship with Radiation Dose and Toxicity

Publication date: Available online 18 January 2019

Source: Journal of Medical Imaging and Radiation Sciences

Author(s): Hamid Abdollahi, Kiarash Tanha, Bahram Mofid, Abolfazl Razzaghdoust, Afshin Saadipoor, Leila Khalafi, Mohsen Bakhshandeh, Seied Rabi Mahdavi

Abstract

Background

The main purpose of this study was to assess the structural changes in the bladder wall of prostate cancer patients treated with intensity-modulated radiation therapy using magnetic resonance imaging texture features analysis and to correlate image texture changes with radiation dose and urinary toxicity.

Methods

Ethical clearance was granted to enroll 33 patients into this study who were treated with intensity-modulated radiation therapy for prostate cancer. All patients underwent two magnetic resonance imagings before and after radiation therapy (RT). A total of 274 radiomic features were extracted from MR-T2W–weighted images. Wilcoxon singed rank-test was performed to assess significance of the change in mean radiomic features post-RT relative to pre-RT values. The relationship between radiation dose and feature changes was assessed and depicted. Cystitis was recorded as urinary toxicity. Area under receiver operating characteristic curve of a logistic regression–based classifier was used to find correlation between radiomic features with significant changes and radiation toxicity.

Results

Thirty-three bladder walls were analyzed, with 11 patients developing grade ≥2 urinary toxicity. We showed that radiomic features may predict radiation toxicity and features including S5.0SumVarnc, S2.2SumVarnc, S1.0AngScMom, S0.4SumAverg, and S5. _5InvDfMom with area under receiver operating characteristic curve 0.75, 0.69, 0.65, 0.63, and 0.62 had highest correlation with toxicity, respectively. The results showed that most of the radiomic features were changed with radiation dose.

Conclusion

Feature changes have a good correlation with radiation dose and radiation-induced urinary toxicity. These radiomic features can be identified as being potentially important imaging biomarkers and also assessing mechanisms of radiation-induced bladder injuries.

Résumé

Contexte

Le but premier de cette étude était d'évaluer les changements structurels dans la paroi de la vessie chez les patients atteints d'un cancer de la prostate (PCa) traités par radiothérapie avec modulation d'intensité (IMRT) en utilisant l'analyse des caractéristiques de texture par imagerie par résonance magnétique (IRM) et d'établir une corrélation entre les changements de texture dans les images, la dose de rayonnement et la toxicité urinaire.

Méthodologie

Le comité d'éthique de la recherche a donné son accord pour inscrire à cette étude 33 patients traités pour PCa par IMRT. Tous les patients ont eu deux IRM, avant et après la radiothérapie. Au total, 274 caractéristiques radiomiques ont été extraites des images pondérées MR-T2W. Un test Wilcoxon Signed Rank a été fait pour évaluer la signification du changement dans les caractéristiques radiomiques moyennes après la RT par rapport aux valeurs avant la RT. La relation entre la dose de rayonnement et les changements dans les caractéristiques a été évaluée et illustrée. La cystite a été utilisée comme toxicité urinaire. L'aire sous la courbe de fonction d'efficacité du récepteur d'un classificateur (AUC) basé sur une régression logistique a été utilisée pour déterminer la corrélation entre les caractéristiques radiomiques présentant des changements significatifs et la toxicité du rayonnement.

Résultats

Trente-trois parois de vessies ont été analysées, et 11 patients ont développé une toxicité urinaire de grade ≥2. Nous avons démontré que les caractéristiques radiomiques pouvaient permettre de prédire la toxicité et les caractéristiques du rayonnement, incluant S5.0SumVarnc, S2.2SumVarnc, S1.0AngScMom, S0.4SumAverg et S5. _5InvDfMom avec AUC 0,75, 0,69, 0,65, 0,63 et 0,62 présentaient respectivement la plus forte corrélation avec la toxicité. Les résultats démontrent que la plupart des caractéristiques radiomiques ont été modifiées avec la dose de rayonnement.

Conclusion

Les changements dans les caractéristiques présentent une bonne corrélation avec la dose de rayonnement et la toxicité urinaire induite par le rayonnement. Ces caractéristiques radiomiques peuvent être identifiées comme biomarqueurs d'imagerie potentiellement importants et comme mécanismes d'évaluation des blessures à la vessie induites par le rayonnement.

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MRI Radiomic Analysis of IMRT-Induced Bladder Wall Changes in Prostate Cancer Patients: A Relationship with Radiation Dose and Toxicity

Publication date: Available online 18 January 2019

Source: Journal of Medical Imaging and Radiation Sciences

Author(s): Hamid Abdollahi, Kiarash Tanha, Bahram Mofid, Abolfazl Razzaghdoust, Afshin Saadipoor, Leila Khalafi, Mohsen Bakhshandeh, Seied Rabi Mahdavi

Abstract

Background

The main purpose of this study was to assess the structural changes in the bladder wall of prostate cancer patients treated with intensity-modulated radiation therapy using magnetic resonance imaging texture features analysis and to correlate image texture changes with radiation dose and urinary toxicity.

Methods

Ethical clearance was granted to enroll 33 patients into this study who were treated with intensity-modulated radiation therapy for prostate cancer. All patients underwent two magnetic resonance imagings before and after radiation therapy (RT). A total of 274 radiomic features were extracted from MR-T2W–weighted images. Wilcoxon singed rank-test was performed to assess significance of the change in mean radiomic features post-RT relative to pre-RT values. The relationship between radiation dose and feature changes was assessed and depicted. Cystitis was recorded as urinary toxicity. Area under receiver operating characteristic curve of a logistic regression–based classifier was used to find correlation between radiomic features with significant changes and radiation toxicity.

Results

Thirty-three bladder walls were analyzed, with 11 patients developing grade ≥2 urinary toxicity. We showed that radiomic features may predict radiation toxicity and features including S5.0SumVarnc, S2.2SumVarnc, S1.0AngScMom, S0.4SumAverg, and S5. _5InvDfMom with area under receiver operating characteristic curve 0.75, 0.69, 0.65, 0.63, and 0.62 had highest correlation with toxicity, respectively. The results showed that most of the radiomic features were changed with radiation dose.

Conclusion

Feature changes have a good correlation with radiation dose and radiation-induced urinary toxicity. These radiomic features can be identified as being potentially important imaging biomarkers and also assessing mechanisms of radiation-induced bladder injuries.

Résumé

Contexte

Le but premier de cette étude était d'évaluer les changements structurels dans la paroi de la vessie chez les patients atteints d'un cancer de la prostate (PCa) traités par radiothérapie avec modulation d'intensité (IMRT) en utilisant l'analyse des caractéristiques de texture par imagerie par résonance magnétique (IRM) et d'établir une corrélation entre les changements de texture dans les images, la dose de rayonnement et la toxicité urinaire.

Méthodologie

Le comité d'éthique de la recherche a donné son accord pour inscrire à cette étude 33 patients traités pour PCa par IMRT. Tous les patients ont eu deux IRM, avant et après la radiothérapie. Au total, 274 caractéristiques radiomiques ont été extraites des images pondérées MR-T2W. Un test Wilcoxon Signed Rank a été fait pour évaluer la signification du changement dans les caractéristiques radiomiques moyennes après la RT par rapport aux valeurs avant la RT. La relation entre la dose de rayonnement et les changements dans les caractéristiques a été évaluée et illustrée. La cystite a été utilisée comme toxicité urinaire. L'aire sous la courbe de fonction d'efficacité du récepteur d'un classificateur (AUC) basé sur une régression logistique a été utilisée pour déterminer la corrélation entre les caractéristiques radiomiques présentant des changements significatifs et la toxicité du rayonnement.

Résultats

Trente-trois parois de vessies ont été analysées, et 11 patients ont développé une toxicité urinaire de grade ≥2. Nous avons démontré que les caractéristiques radiomiques pouvaient permettre de prédire la toxicité et les caractéristiques du rayonnement, incluant S5.0SumVarnc, S2.2SumVarnc, S1.0AngScMom, S0.4SumAverg et S5. _5InvDfMom avec AUC 0,75, 0,69, 0,65, 0,63 et 0,62 présentaient respectivement la plus forte corrélation avec la toxicité. Les résultats démontrent que la plupart des caractéristiques radiomiques ont été modifiées avec la dose de rayonnement.

Conclusion

Les changements dans les caractéristiques présentent une bonne corrélation avec la dose de rayonnement et la toxicité urinaire induite par le rayonnement. Ces caractéristiques radiomiques peuvent être identifiées comme biomarqueurs d'imagerie potentiellement importants et comme mécanismes d'évaluation des blessures à la vessie induites par le rayonnement.

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Oxytocin facilitates the proliferation, migration and osteogenic differentiation of human periodontal stem cells in vitro

Publication date: Available online 19 January 2019

Source: Archives of Oral Biology

Author(s): Bin Ge, Hongrui Liu, Qianyu Liang, Lingling Shang, Ting Wang, Shaohua Ge

Abstract

Objective

To explore the effect of oxytocin (OT) on the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells (PDLSCs) in vitro.

Design

PDLSCs were obtained by limiting dilution method. Immunofluorescence (IF), cell-counting kit-8 (CCK8), cell migration assay, Alizarin Red S staining, cetylpyridinium chloride (CPC) colorimetry, quantitative real-time polymerase chain reaction (qRT-PCR), and western blot analysis were used to examine the effect of OT on oxytocin receptor (OTR) expression, cell proliferation, migration and osteogenic differentiation of PDLSCs.

Results

Our study showed that PDLSCs expressed OTR. One hundred nanomolar OT exhibited the maximal effect on migration, while only 50 nM OT significantly promoted proliferation of PDLSCs, as well as mineralized nodule formation and calcium deposition (p < 0.05). Furthermore, 50 nM OT significantly up-regulated expression of osteogenesis-related genes—alkaline phosphatase (ALP), Collagen I (Col I), runt related transcription factor 2 (Runx 2), osteopontin (OPN) and osteocalcin (OCN)—at specific time points compared with osteogenic inductive medium (p < 0.05). In addition, western blot analysis demonstrated that 50 nM OT enhanced protein levels of ALP, Col I, and Runx 2 at day 7 and day 14 (p < 0.01), as well as activating the phosphorylation of extracellular-signal-regulated kinase (ERK) and protein kinase B (AKT) pathway; notably, 50 nM OT inhibited phosphorylation of the phosphatidylinositol 3-kinase (PI3K) pathway (p < 0.05).

Conclusions

OT promoted proliferation, migration, and osteogenic differentiation of PDLSCsin vitro. Furthermore, the effect of OT on osteogenic differentiation was mediated through ERK and AKT pathway. Thus, OT may have potential for use in periodontal regeneration.

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Jagged1 promotes mineralization in human bone-derived cells

Publication date: Available online 18 January 2019

Source: Archives of Oral Biology

Author(s): Thanaphum Osathanon, Jeeranan Manokawinchoke, Noppadol Sa-Ard-Iam, Rangsini Mahanonda, Prasit Pavasant, Jaijam Suwanwela

Abstract

Objectives

The present study aimed to investigate the expression of Notch signaling components during osteogenic differentiation in vitro and bone healing in vivo. In addition, the influence of Notch signaling on osteogenic differentiation of human bone-derived cells was examined.

Methods

Gene expression profiling of osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells in vitro (GSE80614) and bone healing period of murine tibial fracture in vivo (GSE99388) was downloaded from Gene Expression Omnibus database. The expression of Notch signaling components was obtained from bioinformatic tools. Human bone-derived cells were isolated from alveolar and iliac bone. Cells were seeded on Jagged1 immobilized surface. Osteogenic marker gene expression and mineralization were examined using real-time polymerase chain reaction and alizarin red s staining, respectively.

Results

From bioinformatic analysis of gene expression profiling, various Notch signaling components were differentially expressed during osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells in vitro and bone healing period of murine tibial fracture in vivo. The common genes differentially regulated of these two datasets were Hes1, Aph1a, Nsctn, Furin, Adam17, Hey1, Pcsk5, Nedd4, Jag1, Heyl, Notch3, Dlk1, and Hey2. For an in vitro analysis, the mineral deposition markedly increased after seeding human bone-derived cells on Jagged1 immobilized surface, correspondingly with the increase of ALP mRNA expression. Jagged1 treatment downregulated TWIST2 mRNA expression in both human alveolar and iliac bone-derived cells.

Conclusion

Notch signaling is regulated during osteogenic differentiation and bone healing. In addition, the activation of Notch signaling promotes osteogenic differentiation in human alveolar and iliac bone-derived cells. Therefore, Notch signaling manipulation could be a useful approach for enhancing bone regeneration.

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Oxytocin facilitates the proliferation, migration and osteogenic differentiation of human periodontal stem cells in vitro

Publication date: Available online 19 January 2019

Source: Archives of Oral Biology

Author(s): Bin Ge, Hongrui Liu, Qianyu Liang, Lingling Shang, Ting Wang, Shaohua Ge

Abstract

Objective

To explore the effect of oxytocin (OT) on the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells (PDLSCs) in vitro.

Design

PDLSCs were obtained by limiting dilution method. Immunofluorescence (IF), cell-counting kit-8 (CCK8), cell migration assay, Alizarin Red S staining, cetylpyridinium chloride (CPC) colorimetry, quantitative real-time polymerase chain reaction (qRT-PCR), and western blot analysis were used to examine the effect of OT on oxytocin receptor (OTR) expression, cell proliferation, migration and osteogenic differentiation of PDLSCs.

Results

Our study showed that PDLSCs expressed OTR. One hundred nanomolar OT exhibited the maximal effect on migration, while only 50 nM OT significantly promoted proliferation of PDLSCs, as well as mineralized nodule formation and calcium deposition (p < 0.05). Furthermore, 50 nM OT significantly up-regulated expression of osteogenesis-related genes—alkaline phosphatase (ALP), Collagen I (Col I), runt related transcription factor 2 (Runx 2), osteopontin (OPN) and osteocalcin (OCN)—at specific time points compared with osteogenic inductive medium (p < 0.05). In addition, western blot analysis demonstrated that 50 nM OT enhanced protein levels of ALP, Col I, and Runx 2 at day 7 and day 14 (p < 0.01), as well as activating the phosphorylation of extracellular-signal-regulated kinase (ERK) and protein kinase B (AKT) pathway; notably, 50 nM OT inhibited phosphorylation of the phosphatidylinositol 3-kinase (PI3K) pathway (p < 0.05).

Conclusions

OT promoted proliferation, migration, and osteogenic differentiation of PDLSCsin vitro. Furthermore, the effect of OT on osteogenic differentiation was mediated through ERK and AKT pathway. Thus, OT may have potential for use in periodontal regeneration.

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Jagged1 promotes mineralization in human bone-derived cells

Publication date: Available online 18 January 2019

Source: Archives of Oral Biology

Author(s): Thanaphum Osathanon, Jeeranan Manokawinchoke, Noppadol Sa-Ard-Iam, Rangsini Mahanonda, Prasit Pavasant, Jaijam Suwanwela

Abstract

Objectives

The present study aimed to investigate the expression of Notch signaling components during osteogenic differentiation in vitro and bone healing in vivo. In addition, the influence of Notch signaling on osteogenic differentiation of human bone-derived cells was examined.

Methods

Gene expression profiling of osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells in vitro (GSE80614) and bone healing period of murine tibial fracture in vivo (GSE99388) was downloaded from Gene Expression Omnibus database. The expression of Notch signaling components was obtained from bioinformatic tools. Human bone-derived cells were isolated from alveolar and iliac bone. Cells were seeded on Jagged1 immobilized surface. Osteogenic marker gene expression and mineralization were examined using real-time polymerase chain reaction and alizarin red s staining, respectively.

Results

From bioinformatic analysis of gene expression profiling, various Notch signaling components were differentially expressed during osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells in vitro and bone healing period of murine tibial fracture in vivo. The common genes differentially regulated of these two datasets were Hes1, Aph1a, Nsctn, Furin, Adam17, Hey1, Pcsk5, Nedd4, Jag1, Heyl, Notch3, Dlk1, and Hey2. For an in vitro analysis, the mineral deposition markedly increased after seeding human bone-derived cells on Jagged1 immobilized surface, correspondingly with the increase of ALP mRNA expression. Jagged1 treatment downregulated TWIST2 mRNA expression in both human alveolar and iliac bone-derived cells.

Conclusion

Notch signaling is regulated during osteogenic differentiation and bone healing. In addition, the activation of Notch signaling promotes osteogenic differentiation in human alveolar and iliac bone-derived cells. Therefore, Notch signaling manipulation could be a useful approach for enhancing bone regeneration.

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The effects of different packing materials on healing and hearing after trauma to middle ear mucosa, an experimental study in rats

Publication date: Available online 20 January 2019

Source: American Journal of Otolaryngology

Author(s): Baklaci Deniz, Kum Rauf Oguzhan, Ozdemir Erdem, Sahin Hasan, Yilmaz Yavuz Fuat, Ozcan Muge

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The effects of different packing materials on healing and hearing after trauma to middle ear mucosa, an experimental study in rats

Publication date: Available online 20 January 2019

Source: American Journal of Otolaryngology

Author(s): Baklaci Deniz, Kum Rauf Oguzhan, Ozdemir Erdem, Sahin Hasan, Yilmaz Yavuz Fuat, Ozcan Muge

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Frequency characteristics and speech recognition in cartilage conduction

Publication date: Available online 19 January 2019

Source: Auris Nasus Larynx

Author(s): Tadashi Nishimura, Ryosuke Miyamae, Hiroshi Hosoi, Osamu Saito, Ryota Shimokura, Toshiaki Yamanaka, Tadashi Kitahara

Abstract

Objective

Cartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.

Methods

Eight volunteers with normal hearing participated. The performance-intensity function and maximum speech recognition scores for CC with an earplug (i.e., occluded) and air conduction (AC) were measured under high- and low-pass filter (HPF and LPF) conditions, respectively.

Results

An HPF improved the maximum speech recognition scores for CC in occluded ears. The scores for CC (occluded) under the conditions of the first- and second-order HPF did not differ from that for AC under the no-filter condition. Conversely, an LPF reduced the scores for AC. The scores and confusion matrices under the second-order LPF condition were similar to those for CC (occluded).

Conclusion

The conditions under the second-order LPF resembled those of CC in occluded ears. An HPF can compensate excessive low-tone emphasis and improve speech recognition.

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Frequency characteristics and speech recognition in cartilage conduction

Publication date: Available online 19 January 2019

Source: Auris Nasus Larynx

Author(s): Tadashi Nishimura, Ryosuke Miyamae, Hiroshi Hosoi, Osamu Saito, Ryota Shimokura, Toshiaki Yamanaka, Tadashi Kitahara

Abstract

Objective

Cartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.

Methods

Eight volunteers with normal hearing participated. The performance-intensity function and maximum speech recognition scores for CC with an earplug (i.e., occluded) and air conduction (AC) were measured under high- and low-pass filter (HPF and LPF) conditions, respectively.

Results

An HPF improved the maximum speech recognition scores for CC in occluded ears. The scores for CC (occluded) under the conditions of the first- and second-order HPF did not differ from that for AC under the no-filter condition. Conversely, an LPF reduced the scores for AC. The scores and confusion matrices under the second-order LPF condition were similar to those for CC (occluded).

Conclusion

The conditions under the second-order LPF resembled those of CC in occluded ears. An HPF can compensate excessive low-tone emphasis and improve speech recognition.

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Rectal administration of midazolam plus ketamine as conscious sedation for injured paediatric patients requiring Oral surgery

Publication date: Available online 19 January 2019

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Aya Yoshino, Mika Seto, Ryosuke Mano, Ryosuke Kita, Shintaro Ishida, Naoko Aoyagi, Tomoki Shimamura, Seiji Kondo

Abstract

Objective

Rectal sedation has been in use for many years in paediatric dentistry. The purpose of this study was to retrospectively investigate the incidence of rectal sedation with midazolam plus ketamine for oral minor surgery among paediatric patients in our department.

Methods

The incidence of rectal sedation for paediatric outpatients under the age 6 years requiring oral surgery of our department between January 2007 and December 2016 was retrospectively analysed. Rectal sedation was given to 10 paediatric patients (8 boys and 2 girls) and consisted of a 0.1 mg/kg dose of midazolam and a 5 mg/kg dose of ketamine.

Results

Every case was a traumatic injury, the most common region was the tongue, and the most frequent type of wound was a laceration. With respect to sedative effects, approximately 30 min after rectal administration of the two drugs, good anxiolysis and cooperation were obtained, and few adverse effects were seen in all 10 cases although there were some cases that were difficult to treat.

Conclusions

Rectal administration of midazolam plus ketamine provides a safe and reliable method for paediatric outpatients requiring an oral surgery procedure.

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Rectal administration of midazolam plus ketamine as conscious sedation for injured paediatric patients requiring Oral surgery

Publication date: Available online 19 January 2019

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Aya Yoshino, Mika Seto, Ryosuke Mano, Ryosuke Kita, Shintaro Ishida, Naoko Aoyagi, Tomoki Shimamura, Seiji Kondo

Abstract

Objective

Rectal sedation has been in use for many years in paediatric dentistry. The purpose of this study was to retrospectively investigate the incidence of rectal sedation with midazolam plus ketamine for oral minor surgery among paediatric patients in our department.

Methods

The incidence of rectal sedation for paediatric outpatients under the age 6 years requiring oral surgery of our department between January 2007 and December 2016 was retrospectively analysed. Rectal sedation was given to 10 paediatric patients (8 boys and 2 girls) and consisted of a 0.1 mg/kg dose of midazolam and a 5 mg/kg dose of ketamine.

Results

Every case was a traumatic injury, the most common region was the tongue, and the most frequent type of wound was a laceration. With respect to sedative effects, approximately 30 min after rectal administration of the two drugs, good anxiolysis and cooperation were obtained, and few adverse effects were seen in all 10 cases although there were some cases that were difficult to treat.

Conclusions

Rectal administration of midazolam plus ketamine provides a safe and reliable method for paediatric outpatients requiring an oral surgery procedure.

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Role of the Human Papillomavirus in Malignant Transformation of Oral Leukoplakia Distinct from Oropharyngeal Squamous Cell Carcinoma: A Study of 76 Patients with Internal-Control Specimens.

Publication date: Available online 19 January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Wenyan Wu, Zhen Wang, Zengtong Zhou

Abstract

Objective

This study sought to investigate the role of human papillomaviruses (HPV) in oral leukoplakia (OLK) carcinogenesis, with the oral cavity as the site of interest.

Study Design

A total of 76 patients (152 specimens) were enrolled. The patients were divided into two groups: the malignant transformation of OLK (OLK-MT) group and the non-malignant transformation of OLK (OLK-non-MT) group. HPV reverse dot blot analysis, HPV DNA polymerase chain reaction (PCR) and p16INK4A immunohistochemistry (IHC) were used to determine HPV infection status.

Results

Carcinogenesis of OLK was commonly located in the lateral/ventral tongue, buccal mucosa, and gingiva. Based on the initial specimens, only 5.3% (4/76) of patients were HPV-16 positive, and these patients' final specimens were negative. Overexpression of p16INK4A in the initial stage was associated with OLK carcinogenesis (p=0.013, OR=3.544).

Conclusions

OLK carcinogenesis was common in patients who were elderly, female, and non-smokers/non-drinkers; had lesions located in the lateral/ventral tongue; had OLK with dysplasia; and overexpressed p16INK4A during the initial stage. HPV might be an opportunistic infection in the oral cavity and may not be a cause of OLK carcinogenesis. p16INK4A expression that initially increases and then diminishes or disappears might be an early predictor of OLK carcinogenesis.

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Alcohol-related protective behavioral strategies as a mediator of the relationship between drinking motives and risky sexual behaviors

Publication date: June 2019

Source: Addictive Behaviors, Volume 93

Author(s): Alison Looby, Adrian J. Bravo, Tess M. Kilwein, Lauren Zimmerman, Matthew R. Pearson, Protective Strategies Study Team

Abstract

Risky sexual behaviors (RSB) frequently occur in the context of alcohol use and are associated with distinct drinking motives among college students. Use of alcohol protective behavioral strategies (PBS) is associated with reductions in alcohol use and related problems, which may extend to alcohol-related RSB. Moreover, as PBS use mediates the relationship between positive reinforcement drinking motives and alcohol-related problems, the same may be true for alcohol-related RSB, specifically. The current study examined whether PBS mediates the relationship between drinking motives and RSB among college students. Participants (N = 2039, 72.8% female, M_age = 19.79) from ten universities across ten U.S. states completed an online survey assessing past-month drinking motivation, alcohol PBS, alcohol consumption, and RSB. To test study aims, a saturated path model in which drinking motives were modeled as predictors of RSB via PBS use subscales and alcohol consumption was conducted. Several double mediation effects were found, such that stronger endorsement of motives (i.e., social, enhancement, conformity, coping for depression) were associated with lower PBS (particularly manner of drinking and serious harm reduction), which was associated with higher alcohol use, which was associated with higher RSB. Multi-group models found the mediation effects to be gender invariant, although several differences in direct associations were found across genders. For college students high in positive reinforcement motives (i.e., social or enhancement) for drinking, interventions that aim to increase PBS use, specifically related to modifying the manner in which one drinks and avoiding very dangerous consequences, may be effective in reducing alcohol-related RSB.

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Increasing marijuana use for black adolescents in the United States: A test of competing explanations

Publication date: Available online 19 January 2019

Source: Addictive Behaviors

Author(s): Richard Miech, Yvonne M. Terry-McElrath, Patrick M. O'Malley, Lloyd D. Johnston

Abstract

Aims

In the last decade the relatively lower levels of marijuana use for black relative to non-black high school seniors has grown smaller and disappeared, drawing to a close a unique disparity that actually favored a disadvantaged group for at least thirty years. In this study we test trends in cigarette smoking and religiosity as possible explanations for this closing disparity. The study also examines whether increasing marijuana levels for black adolescents is better characterized as a cohort effect or an historical period effect.

Design

Analyses use relative risk regression and focus on data from yearly, cross-sectional surveys from the time period 2008–2017.

Setting and participants

Data comes from the nationally-representative Monitoring the Future survey, which conducts in-school surveys of secondary school students. The analysis uses data from 114,552 high school seniors (in 12th grade), 123,594 in 10th grade, and 136,741 in 8th grade.

Findings

Past 12-month marijuana prevalence significantly increased for black as compared to non-black adolescents from 2008 to 2017 in 12th grade, 10th grade, and 8th grade. The increase attenuated by more than half and was not statistically significant after cigarette smoking. In contrast, the increase was little changed after adjusting adolescent levels of religiosity. The increase is better characterized as a cohort effect than a period effect.

Conclusions

These results support the increase in marijuana use for black relative to non-black adolescents as an unexpected consequence of the great decline in adolescent cigarette smoking, which has occurred slower for black adolescents.

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The relationship between foster care entries and high-dose opioid prescribing in California

Publication date: Available online 18 January 2019

Source: Addictive Behaviors

Author(s): Troy Quast, Melissa A. Bright, Chris Delcher

Abstract

An important effect of the current opioid epidemic is on children whose parents are unable to provide appropriate care. We employ quarterly, county-level data for California for 2009–2016 to study the relationship between foster care entries and opioid misuse by their parents. Our linear regression analysis includes both county and time fixed effects and controls related to child removal risk. We improve on the limited existing research in the area by analyzing higher frequency data, examining a proximal measure of opioid abuse, and allowing for differential associations by urbanicity. We found a positive association between the rate of child removals and the rate of residents who were cumulatively prescribed a high dose of opioids (>90 morphine milligram equivalents (MMEs) per day) during the quarter. A one standard deviation in this rate is associated with a roughly 9% increase in the overall removal rate. We further found that the association between removals and high MMEs is especially pronounced in rural areas and largely not existent in urban areas. Our results provide a more precise estimate of the relationship between the potential for opioid misuse and child welfare.

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Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Christina M. Sellers, Ruth G. McRoy, Kimberly H. McManama O'Brien

Abstract

Background

The purpose of this study was to investigate the longitudinal predictors of alcohol use, marijuana use, and suicidal ideation among maltreated adolescents.

Methods

Longitudinal data from this study come from three waves of the National Survey of Child and Adolescent Wellbeing II (NSCAW II). Participants included 1050 adolescents (M_age = 14.13) who were subjects of child abuse or neglect investigations. Items from the Health Risk Behavior Questionnaire were used to measure alcohol and marijuana use. Suicidal ideation was measured using an item from the Childhood Depression Inventory. Data on deviant peer affiliation, caregiver health, maltreatment type, age, race, and gender were also collected.

Results

Marijuana use, suicidal ideation, caregiver drug abuse, deviant peer affiliation, age, and race were predictive of alcohol use. Alcohol use, deviant peer affiliation, age, and time were predictive of marijuana use. Alcohol use, deviant peer affiliation, age, and gender predicted suicidal ideation.

Conclusions

Longitudinal evidence indicated that individual, family, and peer factors played an important role in predicting alcohol use, marijuana use, and suicidal ideation among child welfare involved adolescents. In addition, this study provides evidence of a potentially reciprocal relationship between alcohol use and suicidal ideation among this population. Intervention efforts for reducing the public health problems of substance use and suicide among child welfare involved adolescents should focus on the importance of peers in influencing thoughts and behaviors, as well as the functional relationship between alcohol use and suicidal ideation.

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Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): C. Truong, N. Krawczyk, M. Dejman, S. Marshall-Shah, K. Tormohlen, D. Agus, J. Bass

Abstract

Objective

This qualitative study identifies and describes experiences and challenges to retention of individuals with opioid use disorder (OUD) who participated in a low-threshold combined buprenorphine-peer support treatment program in Baltimore.

Methods

In-depth semi-structured interviews with staff and former clients of the Project Connections Buprenorphine Program (PCBP) (9 people) and focus group discussions with current and previous clients of PCBP (7 people) were conducted. Content analysis was used to extract themes regarding barriers to enrolling and remaining in, and transitioning from the program.

Results

Primary challenges identified by the participants included struggles with cravings and symptoms of withdrawal, comorbid mental health issues, criminal justice system involvement, medication stigma, and conflicts over level of flexibility regarding program requirements and the role of employment.

Conclusions

This study identified several obstacles clients face when seeking care through a combined buprenorphine-peer support model. Findings highlight potential programmatic factors that can be improved and additional resources that may support treatment retention rates and better outcomes. Despite challenges, low-threshold and community-based programs can increase access to effective maintenance treatment for OUD, especially among vulnerable populations who may not have access to formal health services.

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Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity?

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): H.B. Clayton, J. Andrzejewski, M. Johns, R. Lowry, C. Ashley

Abstract

Objective

Limited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity.

Methods

Data from the 2015 national Youth Risk Behavior Survey (n = 15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity.

Results

All SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR = 2.39;95% CI:2.15,2.65 vs aPR = 1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12).

Conclusions

The relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health.

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Culturally relevant risk and protective factors for nonmedical use of prescription opioids among incarcerated African American men

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Paris B. Wheeler, Danelle Stevens-Watkins, Myles Moody, Jardin Dogan, Dominiqueca Lewis

Abstract

Background

Recent studies have demonstrated that nonmedical use of prescription opioids (NMUPO) is a national phenomenon affecting a multitude of subpopulations, including incarcerated African American men. However, there has been little investigation of the correlates of NMUPO among this population.

Objective

Grounded in primary socialization theory, the current study aimed to examine the association between family bonds, family history of prescription drug misuse, and mental health symptoms on NMUPO among African American incarcerated men.

Method

A step-wise logistic regression was conducted to determine whether family and mental health factors affected the likelihood of lifetime NMUPO.

Results

Prescription drug misuse among immediate family members (p < 0.001) and lifetime experience of serious anxiety (p = 0.003) were significantly associated with an increased likelihood of NMUPO. Having a close personal relationship with one's father was significantly associated with a decreased likelihood of NMUPO (p = 0.034).

Conclusions/Importance

Risk and protective factors are identified that can be incorporated into interventions aimed at reducing or preventing NMUPO among African American men. Directions for future research on NMUPO among African American incarcerated men are discussed.

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Exposure to ENDS advertising and use of marijuana in ENDS among college students

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Daniel S. Kreitzberg, Josephine T. Hinds, Keryn E. Pasch, Alexandra Loukas, Cheryl L. Perry

Abstract

Background

Factors associated with marijuana use in electronic nicotine delivery systems (ENDS) are largely unknown. ENDS advertising, through subtle normative cues as well as explicit and implicit messages suggesting ENDS products are socially condoned and healthier alternatives, may influence the use of marijuana in ENDS. The aim of our study was to examine the association between exposure to ENDS advertising and subsequent use of ENDS with marijuana among college students.

Methods

Data for this study were from waves 2 and 4 of the Marketing and Promotions across Colleges in Texas (M-PACT) study. Participants included 3720 college students (mean age = 21.4, SD = 2.3; 35.78% white; 35.7% male) across 24 colleges in Texas who completed online tobacco behavior surveys one year apart. Multilevel logistic regression was conducted to examine the association between ENDS advertising exposure at wave 2 (spring 2015) and use of marijuana in ENDS one year later at wave 4 (spring 2016), controlling for age, sex, race/ethnicity, and wave 2 sensation-seeking, impulsivity, current tobacco use, current marijuana use, and ever use of ENDS with marijuana. Use of ENDS to consume marijuana in the past six months was the outcome variable and ENDS advertising exposure was the independent variable.

Results

Nearly half of participants reported ever ENDS use at waves 2 and 4, and 10% used marijuana in ENDS in the past 6-months at wave 4. Multilevel logistic regression analyses indicated that for every unit increase in ENDS advertising exposure, the odds of subsequently using ENDS with marijuana one year later were 1.08 times (95% CI = 1.01–1.14) greater.

Conclusions

ENDS advertising uniquely contributed to the subsequent use of marijuana in an ENDS, over and above the effects of other risk factors.

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Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Gitau Mburu, Mark Limmer, Paula Holland

Abstract

Introduction

Gender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise.

Methods

We performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis.

Results

Boyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation.

Conclusions

Some boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.

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Estimates of the national trend of drugs use during 2000–2030 in China: A population-based mathematical model

Publication date: Available online 16 January 2019

Source: Addictive Behaviors

Author(s): Shu Su, Christopher Kincaid Fairley, Limin Mao, Nicholas A. Medland, Jun Jing, Feng Cheng, Lei Zhang

Abstract

Background

The use of synthetic drugs has exceeded heroin to become a major public health concern in China. We aimed to estimate the trend of heroin-only, synthetic drug-only and poly-drug (heroin and synthetic drug) use during 2000–2030 period in China using existing data.

Methods

We used data from the Annual Report on Drug Control in China and peer-reviewed publications. We constructed a mathematical model to estimate the drug use trend based on Monte Carlo simulations.

Results

The best calibrated model estimated that the number of drug users would increase from 0.86 million to 3,120,059 (95% CI 2,669,214-3,570,904) during 2000–2030 period. The proportion of heroin-only users among the total drug users will decrease from 96.8% (95% CI, 96.6–97.1%) in 2000 to 36.9% (30.1–40.8%) in 2030, while the proportion of synthetic drug-only users will increase from 1.1% (0.9–1.3%) in 2000 to 57.7% (51.7–65.6%) in 2030. In contrast, the proportion of poly-drug users shared an increasing trend during 2000–2016 (from 2.1% (1.5–2.8%) to 15.1 (13.8–17.1%)) but declined to 5.5% (3.4–7.2%) in 2030. Estimated 46,370 (41,634-51,106) heroin-only users and 3767 (3481–4053) synthetic drug only users initiated poly-drug use in 2000. We observed a cross-over in 2012 where more synthetic drug-only users were initiating heroin use than heroin-only users initiating synthetic drug use. There will be estimated 2,094,052 (1,819,830–2,368,274) synthetic drug-only users and poly-drug users 211,407 (177,150–245,664) in 2030.

Conclusions

Synthetic drug use will become dominant in drug users in China, but poly-drug use of both heroin and synthetic drugs will remain substantial.

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Perceived need and availability of psychosocial interventions across buprenorphine prescriber specialties

Publication date: Available online 16 January 2019

Source: Addictive Behaviors

Author(s): Lewei (Allison) Lin, Michelle R. Lofwall, Sharon L. Walsh, Hannah K. Knudsen

Abstract

Introduction

Psychosocial interventions are often recommended as part of buprenorphine treatment for patients with opioid use disorder, but little is known about prescriber perspectives of their use and how this varies across buprenorphine prescriber specialties.

Methods

A large US sample of physicians actively prescribing buprenorphine (N = 1174) was surveyed from July 2014 to January 2017. Analyses examined prescriber characteristics and their perceptions and use of psychosocial interventions across three groups of physicians: primary care providers (PCPs), addiction physicians/psychiatrists, and other physicians.

Results

Across all prescribers, 93.3% (n = 1061) report most patients would benefit from formal counseling during buprenorphine treatment while only 36.4% (n = 414) believe there are adequate numbers of counselors in their community. Among addiction physicians/psychiatrists, 75.9% (n = 416) report their treatment setting has the resources to provide psychiatric services to patients with complex psychiatric problems compared to 29.1% (n = 130) of PCPs and 29.6% (n = 39, p < .001) of other physicians. Addiction physicians/psychiatrists report a higher proportion of patients received counseling from clinicians in their practice while PCPs report a higher percentage of patients received counseling from external providers.

Conclusions

The majority of prescribers believe patients receiving buprenorphine would benefit from psychosocial interventions and there is variation in how these services are delivered. However, many prescribers, especially those without addiction or psychiatry backgrounds, report their settings do not have adequate psychosocial treatment resources for patients with complex psychosocial needs. Future work developing novel models of psychosocial interventions may be helpful to support prescribers to effectively treat complex patients with opioid use disorders.

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Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls

Publication date: Available online 16 January 2019

Source: Addictive Behaviors

Author(s): Traci Marie Schwinn, Steven Paul Schinke, Bryan Keller, Jessica Hopkins

Abstract

Introduction

Rates of drug use among early adolescent girls meet or exceed rates of their male counterparts. Girls are also vulnerable to differential risk factors for drug use. Yet, expressly designed prevention programs targeting this population are absent. The present study reports 2- and 3-year findings on a web-based drug abuse prevention program for adolescent girls.

Methods

A sample of adolescent girls (N = 788) were recruited via Facebook. Online, all girls completed pretests; girls were randomly assigned to a 9-session intervention arm or to a measurement-only control arm and all girls completed posttests. All girls also completed 1-, 2-, and 3-year follow-up measurements.

Results

At 2-year follow-up and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette, marijuana, and "other" drug use (club drugs, cocaine, ecstasy, hallucinogens, heroin, inhalants, methamphetamines, steroids, prescription drugs), lower rates of peer drug use, and increased scores on drug refusal skills, coping skills, self-esteem, media literacy, and self-efficacy. At 3-year follow-up, and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette and e-cigarette use, lower rates of peer drug use, lower reported anxiety and stress, and increased scores on drug refusal skills, self-esteem, media literacy, self-efficacy, and body image.

Conclusions

Longitudinal outcome data lend support to the efficacy of a gender-specific, web-based drug abuse prevention program to reduce adolescent girls' drug use rates and associated risk factors.

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Young adults report increased pleasure from using e-cigarettes and smoking tobacco cigarettes when drinking alcohol

Publication date: Available online 16 January 2019

Source: Addictive Behaviors

Author(s): Johannes Thrul, Noah R. Gubner, Chiara L. Tice, Nadra E. Lisha, Pamela M. Ling

Abstract

Background

Cigarettes share a high rate of co-use with alcohol, particularly among young adults. Studies have demonstrated greater perceived pleasure from smoking cigarettes when drinking alcohol. However, little is known about co-use of electronic cigarettes (e-cigs) and alcohol. The current study sought to compare extent of use and perceived pleasure from cigarettes and e-cigs when drinking alcohol.

Methods

Young adult bar patrons in California cities (San Diego, Los Angeles, and San Francisco) were recruited in 2015–16 using randomized time-location sampling. Participants completed cross-sectional surveys in bars, reporting the percent of cigarette smoking/e-cig use that occurred under the influence of alcohol, and reported if pleasure from smoking cigarettes/using e-cigs changed when drinking alcohol. Analyses are limited to participants reporting current (past 30-day) use of cigarettes, e-cigs, and alcohol (N = 269; M age = 24.1; 40.1% female, 36.1% Non-Hispanic White).

Results

Participants reported a greater percentage of cigarette smoking compared to e-cig use under the influence of alcohol (cigarettes M = 63.6%; e-cigs M = 46.7%; p < .001). Participants also reported increased pleasure both from smoking cigarettes (M = 3.9; [compared to midpoint of scale 3 - "no change"] p < .001) and using e-cigs (M = 3.3; p < .001) when drinking alcohol. The increase in pleasure was more pronounced for cigarettes compared to e-cigs (p < .001).

Conclusions

Drinking alcohol is associated with increases in perceived rewarding effects of both cigarettes and e-cigs and thus may increase their abuse liability. This effect may be stronger for cigarettes, which could be an important barrier to switching completely from smoking cigarettes to using e-cigs, or quitting both entirely.

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Role of the Human Papillomavirus in Malignant Transformation of Oral Leukoplakia Distinct from Oropharyngeal Squamous Cell Carcinoma: A Study of 76 Patients with Internal-Control Specimens.

Publication date: Available online 19 January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Wenyan Wu, Zhen Wang, Zengtong Zhou

Abstract

Objective

This study sought to investigate the role of human papillomaviruses (HPV) in oral leukoplakia (OLK) carcinogenesis, with the oral cavity as the site of interest.

Study Design

A total of 76 patients (152 specimens) were enrolled. The patients were divided into two groups: the malignant transformation of OLK (OLK-MT) group and the non-malignant transformation of OLK (OLK-non-MT) group. HPV reverse dot blot analysis, HPV DNA polymerase chain reaction (PCR) and p16INK4A immunohistochemistry (IHC) were used to determine HPV infection status.

Results

Carcinogenesis of OLK was commonly located in the lateral/ventral tongue, buccal mucosa, and gingiva. Based on the initial specimens, only 5.3% (4/76) of patients were HPV-16 positive, and these patients' final specimens were negative. Overexpression of p16INK4A in the initial stage was associated with OLK carcinogenesis (p=0.013, OR=3.544).

Conclusions

OLK carcinogenesis was common in patients who were elderly, female, and non-smokers/non-drinkers; had lesions located in the lateral/ventral tongue; had OLK with dysplasia; and overexpressed p16INK4A during the initial stage. HPV might be an opportunistic infection in the oral cavity and may not be a cause of OLK carcinogenesis. p16INK4A expression that initially increases and then diminishes or disappears might be an early predictor of OLK carcinogenesis.

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Alcohol-related protective behavioral strategies as a mediator of the relationship between drinking motives and risky sexual behaviors

Publication date: June 2019

Source: Addictive Behaviors, Volume 93

Author(s): Alison Looby, Adrian J. Bravo, Tess M. Kilwein, Lauren Zimmerman, Matthew R. Pearson, Protective Strategies Study Team

Abstract

Risky sexual behaviors (RSB) frequently occur in the context of alcohol use and are associated with distinct drinking motives among college students. Use of alcohol protective behavioral strategies (PBS) is associated with reductions in alcohol use and related problems, which may extend to alcohol-related RSB. Moreover, as PBS use mediates the relationship between positive reinforcement drinking motives and alcohol-related problems, the same may be true for alcohol-related RSB, specifically. The current study examined whether PBS mediates the relationship between drinking motives and RSB among college students. Participants (N = 2039, 72.8% female, M_age = 19.79) from ten universities across ten U.S. states completed an online survey assessing past-month drinking motivation, alcohol PBS, alcohol consumption, and RSB. To test study aims, a saturated path model in which drinking motives were modeled as predictors of RSB via PBS use subscales and alcohol consumption was conducted. Several double mediation effects were found, such that stronger endorsement of motives (i.e., social, enhancement, conformity, coping for depression) were associated with lower PBS (particularly manner of drinking and serious harm reduction), which was associated with higher alcohol use, which was associated with higher RSB. Multi-group models found the mediation effects to be gender invariant, although several differences in direct associations were found across genders. For college students high in positive reinforcement motives (i.e., social or enhancement) for drinking, interventions that aim to increase PBS use, specifically related to modifying the manner in which one drinks and avoiding very dangerous consequences, may be effective in reducing alcohol-related RSB.

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Increasing marijuana use for black adolescents in the United States: A test of competing explanations

Publication date: Available online 19 January 2019

Source: Addictive Behaviors

Author(s): Richard Miech, Yvonne M. Terry-McElrath, Patrick M. O'Malley, Lloyd D. Johnston

Abstract

Aims

In the last decade the relatively lower levels of marijuana use for black relative to non-black high school seniors has grown smaller and disappeared, drawing to a close a unique disparity that actually favored a disadvantaged group for at least thirty years. In this study we test trends in cigarette smoking and religiosity as possible explanations for this closing disparity. The study also examines whether increasing marijuana levels for black adolescents is better characterized as a cohort effect or an historical period effect.

Design

Analyses use relative risk regression and focus on data from yearly, cross-sectional surveys from the time period 2008–2017.

Setting and participants

Data comes from the nationally-representative Monitoring the Future survey, which conducts in-school surveys of secondary school students. The analysis uses data from 114,552 high school seniors (in 12th grade), 123,594 in 10th grade, and 136,741 in 8th grade.

Findings

Past 12-month marijuana prevalence significantly increased for black as compared to non-black adolescents from 2008 to 2017 in 12th grade, 10th grade, and 8th grade. The increase attenuated by more than half and was not statistically significant after cigarette smoking. In contrast, the increase was little changed after adjusting adolescent levels of religiosity. The increase is better characterized as a cohort effect than a period effect.

Conclusions

These results support the increase in marijuana use for black relative to non-black adolescents as an unexpected consequence of the great decline in adolescent cigarette smoking, which has occurred slower for black adolescents.

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The relationship between foster care entries and high-dose opioid prescribing in California

Publication date: Available online 18 January 2019

Source: Addictive Behaviors

Author(s): Troy Quast, Melissa A. Bright, Chris Delcher

Abstract

An important effect of the current opioid epidemic is on children whose parents are unable to provide appropriate care. We employ quarterly, county-level data for California for 2009–2016 to study the relationship between foster care entries and opioid misuse by their parents. Our linear regression analysis includes both county and time fixed effects and controls related to child removal risk. We improve on the limited existing research in the area by analyzing higher frequency data, examining a proximal measure of opioid abuse, and allowing for differential associations by urbanicity. We found a positive association between the rate of child removals and the rate of residents who were cumulatively prescribed a high dose of opioids (>90 morphine milligram equivalents (MMEs) per day) during the quarter. A one standard deviation in this rate is associated with a roughly 9% increase in the overall removal rate. We further found that the association between removals and high MMEs is especially pronounced in rural areas and largely not existent in urban areas. Our results provide a more precise estimate of the relationship between the potential for opioid misuse and child welfare.

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Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Christina M. Sellers, Ruth G. McRoy, Kimberly H. McManama O'Brien

Abstract

Background

The purpose of this study was to investigate the longitudinal predictors of alcohol use, marijuana use, and suicidal ideation among maltreated adolescents.

Methods

Longitudinal data from this study come from three waves of the National Survey of Child and Adolescent Wellbeing II (NSCAW II). Participants included 1050 adolescents (M_age = 14.13) who were subjects of child abuse or neglect investigations. Items from the Health Risk Behavior Questionnaire were used to measure alcohol and marijuana use. Suicidal ideation was measured using an item from the Childhood Depression Inventory. Data on deviant peer affiliation, caregiver health, maltreatment type, age, race, and gender were also collected.

Results

Marijuana use, suicidal ideation, caregiver drug abuse, deviant peer affiliation, age, and race were predictive of alcohol use. Alcohol use, deviant peer affiliation, age, and time were predictive of marijuana use. Alcohol use, deviant peer affiliation, age, and gender predicted suicidal ideation.

Conclusions

Longitudinal evidence indicated that individual, family, and peer factors played an important role in predicting alcohol use, marijuana use, and suicidal ideation among child welfare involved adolescents. In addition, this study provides evidence of a potentially reciprocal relationship between alcohol use and suicidal ideation among this population. Intervention efforts for reducing the public health problems of substance use and suicide among child welfare involved adolescents should focus on the importance of peers in influencing thoughts and behaviors, as well as the functional relationship between alcohol use and suicidal ideation.

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Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): C. Truong, N. Krawczyk, M. Dejman, S. Marshall-Shah, K. Tormohlen, D. Agus, J. Bass

Abstract

Objective

This qualitative study identifies and describes experiences and challenges to retention of individuals with opioid use disorder (OUD) who participated in a low-threshold combined buprenorphine-peer support treatment program in Baltimore.

Methods

In-depth semi-structured interviews with staff and former clients of the Project Connections Buprenorphine Program (PCBP) (9 people) and focus group discussions with current and previous clients of PCBP (7 people) were conducted. Content analysis was used to extract themes regarding barriers to enrolling and remaining in, and transitioning from the program.

Results

Primary challenges identified by the participants included struggles with cravings and symptoms of withdrawal, comorbid mental health issues, criminal justice system involvement, medication stigma, and conflicts over level of flexibility regarding program requirements and the role of employment.

Conclusions

This study identified several obstacles clients face when seeking care through a combined buprenorphine-peer support model. Findings highlight potential programmatic factors that can be improved and additional resources that may support treatment retention rates and better outcomes. Despite challenges, low-threshold and community-based programs can increase access to effective maintenance treatment for OUD, especially among vulnerable populations who may not have access to formal health services.

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Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity?

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): H.B. Clayton, J. Andrzejewski, M. Johns, R. Lowry, C. Ashley

Abstract

Objective

Limited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity.

Methods

Data from the 2015 national Youth Risk Behavior Survey (n = 15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity.

Results

All SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR = 2.39;95% CI:2.15,2.65 vs aPR = 1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12).

Conclusions

The relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health.

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Culturally relevant risk and protective factors for nonmedical use of prescription opioids among incarcerated African American men

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Paris B. Wheeler, Danelle Stevens-Watkins, Myles Moody, Jardin Dogan, Dominiqueca Lewis

Abstract

Background

Recent studies have demonstrated that nonmedical use of prescription opioids (NMUPO) is a national phenomenon affecting a multitude of subpopulations, including incarcerated African American men. However, there has been little investigation of the correlates of NMUPO among this population.

Objective

Grounded in primary socialization theory, the current study aimed to examine the association between family bonds, family history of prescription drug misuse, and mental health symptoms on NMUPO among African American incarcerated men.

Method

A step-wise logistic regression was conducted to determine whether family and mental health factors affected the likelihood of lifetime NMUPO.

Results

Prescription drug misuse among immediate family members (p < 0.001) and lifetime experience of serious anxiety (p = 0.003) were significantly associated with an increased likelihood of NMUPO. Having a close personal relationship with one's father was significantly associated with a decreased likelihood of NMUPO (p = 0.034).

Conclusions/Importance

Risk and protective factors are identified that can be incorporated into interventions aimed at reducing or preventing NMUPO among African American men. Directions for future research on NMUPO among African American incarcerated men are discussed.

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Exposure to ENDS advertising and use of marijuana in ENDS among college students

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Daniel S. Kreitzberg, Josephine T. Hinds, Keryn E. Pasch, Alexandra Loukas, Cheryl L. Perry

Abstract

Background

Factors associated with marijuana use in electronic nicotine delivery systems (ENDS) are largely unknown. ENDS advertising, through subtle normative cues as well as explicit and implicit messages suggesting ENDS products are socially condoned and healthier alternatives, may influence the use of marijuana in ENDS. The aim of our study was to examine the association between exposure to ENDS advertising and subsequent use of ENDS with marijuana among college students.

Methods

Data for this study were from waves 2 and 4 of the Marketing and Promotions across Colleges in Texas (M-PACT) study. Participants included 3720 college students (mean age = 21.4, SD = 2.3; 35.78% white; 35.7% male) across 24 colleges in Texas who completed online tobacco behavior surveys one year apart. Multilevel logistic regression was conducted to examine the association between ENDS advertising exposure at wave 2 (spring 2015) and use of marijuana in ENDS one year later at wave 4 (spring 2016), controlling for age, sex, race/ethnicity, and wave 2 sensation-seeking, impulsivity, current tobacco use, current marijuana use, and ever use of ENDS with marijuana. Use of ENDS to consume marijuana in the past six months was the outcome variable and ENDS advertising exposure was the independent variable.

Results

Nearly half of participants reported ever ENDS use at waves 2 and 4, and 10% used marijuana in ENDS in the past 6-months at wave 4. Multilevel logistic regression analyses indicated that for every unit increase in ENDS advertising exposure, the odds of subsequently using ENDS with marijuana one year later were 1.08 times (95% CI = 1.01–1.14) greater.

Conclusions

ENDS advertising uniquely contributed to the subsequent use of marijuana in an ENDS, over and above the effects of other risk factors.

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Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

Publication date: Available online 17 January 2019

Source: Addictive Behaviors

Author(s): Gitau Mburu, Mark Limmer, Paula Holland

Abstract

Introduction

Gender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise.

Methods

We performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis.

Results

Boyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation.

Conclusions

Some boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.

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