Sample records for factors including drug

  1. Identification of Drug Characteristics for Implementing Multiregional Clinical Trials Including Japan.

    PubMed

    Rokuda, Mitsuhiro; Matsumaru, Naoki; Tsukamoto, Katsura

    2018-02-01

    Multiregional clinical trials (MRCT) are a standard strategy used to improve global drug approval efficiency and the feasibility of clinical trials. Japan is the world's third largest drug market with a unique health care system, making it a key inclusion as an operational region for MRCT (MRCT-JP) for global drug development. We aimed to identify the factors required for efficient drug development by comprehensively reviewing the clinical trials of drugs approved in Japan to identify the factors associated with whether or not MRCT-JP is implemented. We surveyed the review reports and summaries of application data published by the Pharmaceuticals and Medical Devices Agency. We identified drugs for which the clinical trial data package included MRCT-JP and selected the same number of drugs for which the clinical trial data package did not include MRCT-JP from the most recent survey period for comparison. We also examined other publication information, in addition to the review reports, as necessary. The influence of each explanatory variable was analyzed by logistic regression analysis, with whether or not MRCT-JP was implemented as the explanatory variable. Statistical significance was set at 5%. In the survey period up to September 2017, 165 drugs developed with MRCT-JP were approved for manufacture and sale in Japan. "Respiratory system," "inhalation," "biological drug," and "under review" evaluation status for the United States, European Union, and other areas, "approved" evaluation status for the United States, "new ingredients," "priority review," "non-Japanese firm," and "Top 1-10" and "Top 11-20" drug sales rankings for pharmaceutical companies were identified as potential factors leading to the implementation of MRCT-JP. In contrast, "general anti-infectives for systemic use," "various," "external," "chemical compound," "unsubmitted" evaluation status for both the United States and European Union, and "Top 51+" drug sales rankings were potential factors for

  2. [Data-mining characteristics of adverse drug reactions and pharmacovi-gilance of Chinese patent drugs including Aconitum herbs].

    PubMed

    Zhang, Xiao-Meng; Li, Fan; Zhang, Bing; Chen, Xiao-Fen; Piao, Jing-Zhu

    2018-01-01

    The common Aconitum herbs in clinical application mainly include Aconiti Radix(Chuanwu), Aconiti Kusnezoffii Radix(Caowu) and Aconiti Lateralis Radix Praeparaia(Fuzi), all of which have toxicity. Therefore, the safety of using Chinese patent drugs including Aconitum herbs has become an hot topic in clinical controversy. Based on the data-mining methods, this study explored the characteristics and causes of adverse drug reactions/events (ADR/ADE) of the Chinese patent drugs including Aconitum, in order to provide pharmacovigilance and rational drug use suggestions for clinical application. The detailed ADR/ADE reports about the Chinese patent drugs including Aconitum herbs were retrieved in the domestic literature databases since 1984 to now. The information extraction and data-mining were conducted based on the platforms of Microsoft office Excel 2016, Clementine 12.0 and Cytoscape 3.3.0. Finally, 78 detailed ADR/ADE reports involving a total of 30 varieties were included. 92.31% ADR/ADE were surely or likely led by the Chinese patent drugs including Aconitum, mostly involving multiple system/organ damages with good prognosis, and even 1 case of death. The incidence of included ADRs/ADEs was associated with various factors such as the patient idiosyncratic, drug toxicity, as well as clinical medication. The patient age was most closely related to ADR/ADEs, and those aged from 60 to 69 were more easily suffered from the ADRs/ADEs of Chinese patent drugs including Aconitum. The probability of ADR/ADEs for the drugs including Chuanwu or Caowu was greater than that of Fuzi, and the using beyond the instructions dose was the most important potential safety hazard in the clinical medication process. For the regular and characteristics of ADR/ADEs led by Chinese patent drugs including Aconitum, special attention shall be paid to the elder patients or with the patients with allergies; strictly control the dosage and course of treatment, strengthen the safety medication

  3. Risk Factors for Drug-Resistant Cap in Immunocompetent Patients.

    PubMed

    Arancibia, Francisco; Ruiz, Mauricio

    2017-03-01

    The increase in drug-resistant community-acquired pneumonia (CAP) is an important problem all over the world. This article explores the current state of antimicrobial resistance of different bacteria that cause CAP and also assesses risk factors to identify those pathogens. In the last two decades, it has been documented that there is a significant increase in drug-resistant Streptococcus pneumoniae and other bacteria causing CAP. The most important risk factors are overuse of antibiotics, prior hospitalization, and lung comorbidities. The direct consequences can be severe, including prolonged stays in hospital, increased costs, and morbi-mortality. However, drug-resistant CAP declined after the introduction of the pneumococcal conjugate vaccine. This review found an increase in resistance to the antibiotics used in CAP, and the risk factor can be used for identifying patients with drug-resistant CAP and initiate appropriate treatment. Judicious use of antibiotics and the development of effective new vaccines are needed.

  4. Factors related to Psychosocial Barriers to Drug Treatment among Chinese Drug Users

    PubMed Central

    Kelly, Brian C; Liu, Tieqiao; Zhang, Guanbai; Hao, Wei; Wang, Jichuan

    2014-01-01

    Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment – absence of problem, negative social support, fear of treatment, and privacy concerns – to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users’ lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population. PMID:24813554

  5. Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions.

    PubMed

    Eschmann, Emmanuel; Beeler, Patrick E; Kaplan, Vladimir; Schneemann, Markus; Zünd, Gregor; Blaser, Jürg

    2014-02-01

    Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient- and physician-related risk factors for the development of hyperkalaemia. The risk for adult patients hospitalised in the University Hospital Zurich between 1 December 2009 and 31 December 2011 of developing hyperkalaemia was correlated with patient characteristics, number, type and duration of potassium-increasing DDIs and frequency of serum potassium monitoring. The 76,467 patients included in this study were prescribed 8,413 potentially severe potassium-increasing DDIs. Patient-related characteristics associated with the development of hyperkalaemia were pulmonary allograft [relative risk (RR) 5.1; p < 0.0001), impaired renal function (RR 2.7; p < 0.0001), diabetes mellitus (RR 1.6; p = 0.002) and female gender (RR 1.5; p = 0.007). Risk factors associated with medication were number of concurrently administered potassium-increasing drugs (RR 3.3 per additional drug; p < 0.0001) and longer duration of the DDI (RR 4.9 for duration ≥6 days; p < 0.0001). Physician-related factors associated with the development of hyperkalaemia were undetermined or elevated serum potassium level before treatment initiation (RR 2.2; p < 0.001) and infrequent monitoring of serum potassium during a DDI (interval >48 h: RR 1.6; p < 0.01). Strategies for reducing the risk of hyperkalaemia during potassium-increasing DDIs should consider both patient- and physician-related risk factors.

  6. PROTECTIVE FACTORS ASSOCIATED WITH SHORT-TERM CESSATION OF INJECTION DRUG USE AMONG A CANADIAN COHORT OF PEOPLE WHO INJECT DRUGS

    PubMed Central

    Luchenski, Serena; Ti, Lianping; Hayashi, Kanna; Dong, Huiru; Wood, Evan; Kerr, Thomas

    2016-01-01

    Introduction and Aims Strategies are needed to transition persons who inject drugs out of injecting. We undertook this study to identify protective factors associated with cessation of injection drug use. Design and Methods Data were derived from three prospective cohorts of people who use illicit drugs in Vancouver, Canada, between September 2005 and November 2011. Generalised estimating equations were used to examine protective factors and 6-month cessation of injection drug use. Results Our sample of 1663 people who inject drugs included 563 (33.9%) women, and median age was 40 years. Overall, 904 (54.4%) individuals had at least one 6-month injection cessation event. In multivariable analysis, protective factors associated with cessation of injection drug use included the following: having a regular place to stay [adjusted odds ratio (AOR) = 1.30; 95% confidence interval (CI) 1.13–1.48]; formal employment (AOR = 1.12; 95% CI 1.01–1.23); social support from personal contacts (AOR = 1.22; 95% CI 1.10–1.35); social support from professionals (AOR = 1.26; 95% CI 1.14–1.39); ability to access health and social services (AOR = 1.21; 95% CI 1.09–1.34); and positive self-rated health (AOR = 1.21, 95% CI 1.11–1.32). Discussion and Conclusions Over half of people who inject drugs in this study reported achieving 6-month cessation of injection drug use, with cessation being associated with a range of modifiable protective factors. Policy makers and practitioners should promote increased access to stable housing, employment, social support and other services to promote cessation of injection drug use. PMID:26661408

  7. Epidemiology and risk factors for drug allergy

    PubMed Central

    Thong, Bernard Y-H; Tan, Teck-Choon

    2011-01-01

    The aim of this review was to describe the current evidence-based knowledge of the epidemiology, prevalence, incidence, risk factors and genetic associations of drug allergy. Articles published between 1966 and 2010 were identified in MEDLINE using the key words adult, adverse drug reaction reporting systems, age factors, anaphylactoid, anaphylaxis, anaesthetics, antibiotics, child, drug allergy, drug eruptions, ethnic groups, hypersensitivity, neuromuscular depolarizing agents, neuromuscular nondepolarizing agents, sex factors, Stevens Johnson syndrome and toxic epidermal necrolysis. Additional studies were identified from article reference lists. Relevant, peer-reviewed original research articles, case series and reviews were considered for review. Current epidemiological studies on adverse drug reactions (ADRs) have used different definitions for ADR-related terminology, often do not differentiate immunologically and non-immunologically mediated drug hypersensitivity, study different study populations (different ethnicities, inpatients or outpatients, adults or children), utilize different methodologies (spontaneous vs. non-spontaneous reporting, cohort vs. case-control studies), different methods of assessing drug imputability and different methods of data analyses. Potentially life-threatening severe cutaneous adverse reactions (SCAR) are associated with a high risk of morbidity and mortality. HLA associations for SCAR associated with allopurinol, carbamazepine and abacavir have been reported with the potential for clinical use in screening prior to prescription. Identification of risk factors for drug allergy and appropriate genetic screening of at-risk ethnic groups may improve the outcomes of drug-specific SCAR. Research and collaboration are necessary for the generation of clinically-relevant, translational pharmacoepidemiological and pharmacogenomic knowledge, and success of health outcomes research and policies on drug allergies. PMID:21480948

  8. Administrative claims analysis of the relationship between warfarin use and risk of hemorrhage including drug-drug and drug-disease interactions.

    PubMed

    Zhang, Kui; Young, Christopher; Berger, Jan

    2006-10-01

    patient copay and deductibles. Logistic regression was used to evaluate the relative risk of hemorrhage in users of warfarin monotherapy and of warfarin users with drug-drug and drug-disease interactions. The comparison group in the logistic regression comprised the members who were not diagnosed with either HF or liver disease and who received warfarin therapy but none of the drugs under study known to cause drug interactions. Therefore, the odds ratios [ORs] produced were estimates of the relative risk of hemorrhage when taking warfarin concomitant with selected drugs and diseases. Of the 17,895 patients who used warfarin during the study year, 2,634 (14.7%) were diagnosed with a hemorrhage event within 1 week after filling a prescription for warfarin. The factors associated with an increased risk of hemorrhage included female gender (OR 1.149; 95% confidence interval [CI], 1.053- 1.253), liver disease (OR 1.764; 95% CI, 1.360-2.288), and HF (OR 1.559; 95% CI, 1.373-1.770). Compared with the use of warfarin alone, the use of either cephalosporins (OR 1.157; 95% CI, 1.043-1.285) or metronidazole (OR 1.578; 95% CI, 1.321-1.886) was associated with increased risk of hemorrhage, whereas the risk of hemorrhage was not greater for concomitant use of warfarin with amiodarone, fibric acid derivatives, or nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 (COX-2) inhibitors. There was no relationship between estimated average daily warfarin dose and prevalence of hemorrhage. Other variables associated with an increased risk of hemorrhage were increased patient age, female gender, 120 days or more of warfarin therapy during the year, 2 or more unique prescriber numbers, and the medical specialty of the first prescriber of warfarin. Over the population of 1.7 million members, the cost for all hemorrhage events within 7 days of a pharmacy claim for warfarin was 0.40 dollars PMPM. Only 2 of 5 combinations of warfarin with drugs in this study were found to be

  9. Factors associated with time between using a drug and injection initiation among people who inject drugs in Kermanshah, Iran.

    PubMed

    Noroozi, Mehdi; Farhadi, Mohammad Hassan; Armoon, Bahram; Farhoudian, Ali; Shushtari, Zahra Jorjoran; Sharhani, Asaad; Karimi, Salah Eddin; Sayadnasiri, Mohammad; Rezaei, Omid; Ghiasvand, Hesam

    2018-05-17

    Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.

  10. Factors associated with prescribing restriction on oncology formulary drugs in Malaysia.

    PubMed

    Fatokun, Omotayo; Olawepo, Michael N

    2016-10-01

    Background Drugs listed on formularies are often subjected to a variety of utilization restriction measures. However, the degree of restriction is influenced by multiple factors, including the characteristics and attributes of the listed drugs. Objective To identify the factors that are associated with the levels of prescribing restriction on oncology formulary drugs in Malaysia. Setting Oncology formulary in Malaysia. Method The Malaysia Drug Code assigned to each of the drug products on the Malaysia Ministry of Health (MOH) drug formulary was used to identify oncology drugs belonging to WHO ATC class L (antineoplastic and immunomodulating agents). Main outcome measures Categories of prescribing restrictions, therapeutic class, drug type, administration mode, number of sources and the post-approval use period. Results Oncology drugs having a shorter post-approval use period (p < 0.001), biologic oncology drugs (p = 0.01) and oncology drugs belonging to immunosuppressant therapeutic class (p = 0.03) were all significantly associated with a greater likelihood of being subjected to a higher level of prescribing restriction. Conclusion This study suggests that safety concerns, costs and potentials for inappropriate use were the important considerations influencing a higher level of prescribing restriction placement on oncology drugs in the Malaysia MOH drug formulary.

  11. Epidemiology and risk factors for drug allergy.

    PubMed

    Thong, Bernard Y-H; Tan, Teck-Choon

    2011-05-01

    The aim of this review was to describe the current evidence-based knowledge of the epidemiology, prevalence, incidence, risk factors and genetic associations of drug allergy. Articles published between 1966 and 2010 were identified in MEDLINE using the key words adult, adverse drug reaction reporting systems, age factors, anaphylactoid, anaphylaxis, anaesthetics, antibiotics, child, drug allergy, drug eruptions, ethnic groups, hypersensitivity, neuromuscular depolarizing agents, neuromuscular nondepolarizing agents, sex factors, Stevens Johnson syndrome and toxic epidermal necrolysis. Additional studies were identified from article reference lists. Relevant, peer-reviewed original research articles, case series and reviews were considered for review. Current epidemiological studies on adverse drug reactions (ADRs) have used different definitions for ADR-related terminology, often do not differentiate immunologically and non-immunologically mediated drug hypersensitivity, study different study populations (different ethnicities, inpatients or outpatients, adults or children), utilize different methodologies (spontaneous vs. non-spontaneous reporting, cohort vs. case-control studies), different methods of assessing drug imputability and different methods of data analyses. Potentially life-threatening severe cutaneous adverse reactions (SCAR) are associated with a high risk of morbidity and mortality. HLA associations for SCAR associated with allopurinol, carbamazepine and abacavir have been reported with the potential for clinical use in screening prior to prescription. Identification of risk factors for drug allergy and appropriate genetic screening of at-risk ethnic groups may improve the outcomes of drug-specific SCAR. Research and collaboration are necessary for the generation of clinically-relevant, translational pharmacoepidemiological and pharmacogenomic knowledge, and success of health outcomes research and policies on drug allergies. © 2011 The Authors

  12. Factors influencing consumer purchasing patterns of generic versus brand name over-the-counter drugs.

    PubMed

    Kohli, Erol; Buller, Allison

    2013-02-01

    US consumers spend more than $20 billion/year on over-the-counter (OTC) drugs. Although generic and brand name OTC drugs share the same active ingredients and undergo the same rigorous Food and Drug Administration approval process, brand name formulations continue to lead the OTC drug market with a higher market share. There is a limited amount of publicly available information regarding consumer perceptions and awareness about generic and brand name OTC drugs. The main objective of this research was to understand what factors influence US consumers to purchase generic versus brand name OTC drugs. The researchers used a 20-question, self-administered, multiple-choice survey to collect data on the factors influencing consumers' preferences for generic versus brand name OTC drugs. Results revealed that the single most influential factor for participants when purchasing OTC drugs was lower cost. Although economic factors play an important role in influencing consumers to choose generic formulations, a variety of other factors including advertisements, duration of the OTC effectiveness, severity of sickness, preferable form of OTC medication, safety of the OTC, relief of multiple symptoms, and preferred company will persuade others to pay more for brand name drugs. Ultimately, increased awareness and use of generic OTC drugs may result in substantial cost savings for consumers.

  13. Factors that condition the spontaneous reporting of adverse drug reactions among nurses: an integrative review.

    PubMed

    De Angelis, Alessia; Colaceci, Sofia; Giusti, Angela; Vellone, Ercole; Alvaro, Rosaria

    2016-03-01

    To describe and synthesise previous research on factors conditioning the spontaneous reporting of adverse drug reactions among nurses. Spontaneous reports of adverse drug reactions by health-care providers, are a main instrument for the continuous evaluation of the risk-benefit ratio of every drug. Under-reporting of adverse drug reactions by all health-care providers, in particular by nurses, is a major limitation to this system. An integrated review of the literature was conducted using MEDLINE, CINAHL, Embase, Scopus databases and Google Scholar. After evaluation for appropriateness related to inclusion/exclusion criteria, 16 studies were included in the final analysis and synthesis. Two factors emerged from the study: (1) intrinsic factors related to nurses' knowledge and attitudes; (2) extrinsic factors related to nurses' interaction with health-care organisations and to the relationship between nurses and physicians. Nurses' attitudes that hinder reporting include ignorance, insecurity, fear and lethargy. Nurses are not fully aware of their role in adverse drug reaction reporting. Nurses must acquire greater knowledge to implement specific skills into their daily clinical practice. To improve nurses' reporting of adverse drug reactions, it is necessary to develop management approaches that modify both intrinsic and extrinsic factors. © 2015 John Wiley & Sons Ltd.

  14. Factors associated with drug-related harms related to policing in Tijuana, Mexico

    PubMed Central

    2011-01-01

    Objective To assess factors associated with drug-related harms related to policing among injection drug users (IDUs) in Tijuana, Mexico. Methods IDUs who were over 18 years old and had injected drugs within the last six months were recruited via respondent-driven sampling and underwent questionnaires and testing for HIV (human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Results Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. Conclusions IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs. PMID:21477299

  15. Factors influencing neonatal therapeutic effect of anti-MRSA drugs.

    PubMed

    Hayashi, H; Matsuzaki, T; Saito, A; Shimizu, M; Matsumoto, Y

    2005-07-01

    Factors influencing the neonatal therapeutic effect of anti-MRSA (methicillin-resistant Staphylococcus aureus) drugs are investigated. This study took place over a two-year period from April 1998 to March 2000. We calculated the non-adjusted odds ratio for each influential factor to determine the therapeutic effect of anti-MRSA drugs. Significant factors for therapeutic effect were found to be platelet count, urea nitrogen, creatinine, and CRP, each measured before starting administration of anti-MRSA drugs; whether blood drug concentration was measured; and whether pneumonia or septicemia was present. There was a tendency where a better therapeutic effect was gained when the total protein and albumin values were high. We applied multivariate logistic regression analysis to these factors, and found the following independent significant factors: CRP (odds ratio (OR) = 1.582), albumin (OR = 3.079), Cre (OR -0.213), whether blood drug concentration was measured (OR = 3.767), and presence of pneumonia or septicemia (OR = 0.216). This result suggests that consideration should be given to these five important factors when treating MRSA patients.

  16. A Comprehensive List of Items to be Included on a Pediatric Drug Monograph

    PubMed Central

    Ito, Shinya; Woods, David; Nunn, Anthony J.; Taketomo, Carol; de Hoog, Matthijs; Offringa, Martin

    2017-01-01

    OBJECTIVES Children require special considerations for drug prescribing. Drug information summarized in a formulary containing drug monographs is essential for safe and effective prescribing. Currently, little is known about the information needs of those who prescribe and administer medicines to children. Our primary objective was to identify a list of important and relevant items to be included in a pediatric drug monograph. METHODS Following the establishment of an expert steering committee and an environmental scan of adult and pediatric formulary monograph items, 46 participants from 25 countries were invited to complete a 2-round Delphi survey. Questions regarding source of prescribing information and importance of items were recorded. An international consensus meeting to vote on and finalize the items list with the steering committee followed. RESULTS Pediatric formularies are most commonly the first resource consulted for information on medication used in children by 31 Delphi participants. After the Delphi rounds, 116 items were identified to be included in a comprehensive pediatric drug monograph, including general information, adverse drug reactions, dosages, precautions, drug-drug interactions, formulation, and drug properties. CONCLUSIONS Health care providers identified 116 monograph items as important for prescribing medicines for children by an international consensus-based process. This information will assist in setting standards for the creation of new pediatric drug monographs for international application and for those involved in pediatric formulary development. PMID:28337081

  17. A Comprehensive List of Items to be Included on a Pediatric Drug Monograph.

    PubMed

    Kelly, Lauren E; Ito, Shinya; Woods, David; Nunn, Anthony J; Taketomo, Carol; de Hoog, Matthijs; Offringa, Martin

    2017-01-01

    Children require special considerations for drug prescribing. Drug information summarized in a formulary containing drug monographs is essential for safe and effective prescribing. Currently, little is known about the information needs of those who prescribe and administer medicines to children. Our primary objective was to identify a list of important and relevant items to be included in a pediatric drug monograph. Following the establishment of an expert steering committee and an environmental scan of adult and pediatric formulary monograph items, 46 participants from 25 countries were invited to complete a 2-round Delphi survey. Questions regarding source of prescribing information and importance of items were recorded. An international consensus meeting to vote on and finalize the items list with the steering committee followed. Pediatric formularies are most commonly the first resource consulted for information on medication used in children by 31 Delphi participants. After the Delphi rounds, 116 items were identified to be included in a comprehensive pediatric drug monograph, including general information, adverse drug reactions, dosages, precautions, drug-drug interactions, formulation, and drug properties. Health care providers identified 116 monograph items as important for prescribing medicines for children by an international consensus-based process. This information will assist in setting standards for the creation of new pediatric drug monographs for international application and for those involved in pediatric formulary development.

  18. 21 CFR 1405.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1405.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  19. Photon buildup factors of some chemotherapy drugs.

    PubMed

    Kavaz, Esra; Ahmadishadbad, Nader; Özdemir, Yüksel

    2015-02-01

    Everyday more and more people are diagnosed with some form of cancer. Some are treatable with chemotherapy alone, while others need radiotherapy and occasionally surgery. Recently, concurrent administration of chemotherapy and radiotherapy has been increasingly used in cancer treatment, leading to improvements in survival as well as quality of life. Accordingly, interaction of chemotherapy drugs with radiation will be meaningful to examine. In the present study, gamma ray energy absorption and exposure of buildup factors were computed using the five-parameter geometric progression (G-P) fitting formula for some chemotherapy drugs in the energy range 0.015-15 MeV, and for penetration depths up to 40 mean free path (mfp). The generated energy absorption (EABF) and exposure buildup factors (EBF) of chemotherapy drugs have been studied as a function of penetration depth and incident photon energy. The significant variations in EABF and EBF for chemotherapy drugs have been observed at the moderate energy region. It has been concluded that the buildup of photons is less in azathioprine and is more in vinblastine compared with other drugs. Buildup factors investigated in the present work could be useful in radiation dosimetry and therapy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  20. Risk Factors Associated with Mortality and Increased Drug Costs in Nonvariceal Upper Gastrointestinal Bleeding.

    PubMed

    Lu, Mingliang; Sun, Gang; Zhang, Xiu-li; Zhang, Xiao-mei; Liu, Qing-sen; Huang, Qi-yang; Lau, James W Y; Yang, Yun-sheng

    2015-06-01

    To determine risk factors associated with mortality and increased drug costs in patients with nonvariceal upper gastrointestinal bleeding. We retrospectively analyzed data from patients hospitalized with nonvariceal upper gastrointestinal bleeding between January 2001-December 2011. Demographic and clinical characteristics and drug costs were documented. Univariate analysis determined possible risk factors for mortality. Statistically significant variables were analyzed using a logistic regression model. Multiple linear regression analyzed factors influencing drug costs. p < 0.05 was considered statistically significant. The study included data from 627 patients. Risk factors associated with increased mortality were age > 60, systolic blood pressure<100 mmHg, lack of endoscopic examination, comorbidities, blood transfusion, and rebleeding. Drug costs were higher in patients with rebleeding, blood transfusion, and prolonged hospital stay. In this patient cohort, re-bleeding rate is 11.20% and mortality is 5.74%. The mortality risk in patients with comorbidities was higher than in patients without comorbidities, and was higher in patients requiring blood transfusion than in patients not requiring transfusion. Rebleeding was associ-ated with mortality. Rebleeding, blood transfusion, and prolonged hospital stay were associated with increased drug costs, whereas bleeding from lesions in the esophagus and duodenum was associated with lower drug costs.

  1. Risk and protective factors for recreational and hard drug use among Malaysian adolescents and young adults.

    PubMed

    Razali, Muzafar Mohd; Kliewer, Wendy

    2015-11-01

    This study investigated risk and protective factors for recreational and hard drug use in Malaysian adolescents and young adults. Participants (n = 859; M age = 17.24 years, SD = 2.75 years, range = 13-25 years; 59% male) were recruited from secondary schools, technical colleges, a juvenile detention center and a national training center in Malaysia. A version of the Communities That Care survey validated for use in Malaysia (Razali & Kliewer, 2015) was used to assess study constructs. One in 6 adolescents and 1 in 3 young adults reported lifetime recreational and hard drug use, with greater use reported by males across all drug categories. Structural equation modeling was used to determine the strongest risk and protective factors for recreational and hard drug use. The overall pattern of findings was similar for recreational and hard drug use. Shared risk factors for lifetime recreational and hard drug use included early initiation of antisocial behavior, peer antisocial behavior, and peer reinforcement for engaging in antisocial behavior; shared protective factors included religious practices and opportunities for prosocial school involvement. Multiple group analyses comparing adolescents and young adults indicated that patterns of risk and protective factors predicting drug use differed across these age groups. There were fewer significant predictors of either recreational or hard drug use for young adults relative to adolescents. Results suggest that interventions should target multiple microsystems (e.g., peer groups, family systems, school environments) and be tailored to the developmental stage of the individual. Copyright © 2015. Published by Elsevier Ltd.

  2. Factors affecting drug-induced liver injury: antithyroid drugs as instances

    PubMed Central

    Niknahad, Hossein; Jamshidzadeh, Akram; Abdoli, Narges

    2014-01-01

    Methimazole and propylthiouracil have been used in the management of hyperthyroidism for more than half a century. However, hepatotoxicity is one of the most deleterious side effects associated with these medications. The mechanism(s) of hepatic injury induced by antithyroid agents is not fully recognized yet. Furthermore, there are no specific tools for predicting the occurrence of hepatotoxicity induced by these drugs. The purpose of this article is to give an overview on possible susceptibility factors in liver injury induced by antithyroid agents. Age, gender, metabolism characteristics, alcohol consumption, underlying diseases, immunologic mechanisms, and drug interactions are involved in enhancing antithyroid drugs-induced hepatic damage. An outline on the clinically used treatments for antithyroid drugs-induced hepatotoxicity and the potential therapeutic strategies found to be effective against this complication are also discussed. PMID:25320726

  3. Pediatric off-label drug use in China: risk factors and management strategies.

    PubMed

    Zhang, Lingli; Li, Youping; Liu, Yi; Zeng, Linan; Hu, Die; Huang, Liang; Chen, Min; Lv, Juan; Yang, Chunsong

    2013-02-01

    To analyze the risk factors of pediatric off-label drug use, and propose management strategies for policy making of the pediatric off-label drug use in China. (i) We applied stratified random sampling to select recipes of children aged 0 to 18 years in pediatric clinics and wards of the West China Second University Hospital in 2010. (ii) All included prescriptions were categorized as off-label use or on-label use, according to the latest package insert licensed by the State Food and Drug Administration. (iii) Risk factors and the weights were calculated using logistic regression. (iv) The correlation between risk factors and the different kinds of off-label prescriptions was presented using adjusted odds ratio, and the impact of the risk factors was measured using standardized partial regression coefficient. (v) SPSS 16.0 was used for statistic analysis. (vi) From the perspective of the medical institutions, pharmaceutical enterprises, professional institutions, and the public, we combined the results of the Evidence-based research on the policy of the off-label drug use in 15 countries and the results of risk factor analysis, in order to propose management strategies for the policy making of pediatric off-label drug use in China. (i) Using the method of sampling, we received 2640 recipes from outpatients and 14,374 prescriptions from 749 inpatients. (ii) The neonates (0 to 27 days) had higher risk in off-label drug use than the other three children age groups. (iii) The dermatological medicines (D), nervous system medicines (N), traditional Chinese medicines, and respiratory drugs (R) were high-risk off-label medicines whose labels should be updated more frequently. (iv) The great factors of off-label drug use are those influence health status and relate to health services (ICD-10:Z00-Z99) (mainly in the clinic of child care and growth development, and in the ward of chemotherapy). (v) Off-label drug use in the ward was 4.4 times than that in clinic service (P < 0

  4. Including adverse drug events in economic evaluations of anti-tumour necrosis factor-α drugs for adult rheumatoid arthritis: a systematic review of economic decision analytic models.

    PubMed

    Heather, Eleanor M; Payne, Katherine; Harrison, Mark; Symmons, Deborah P M

    2014-02-01

    Anti-tumour necrosis factor-α drugs (anti-TNFs) have revolutionised the treatment of rheumatoid arthritis (RA). More effective than standard non-biological disease-modifying anti-rheumatic drugs (nbDMARDs), anti-TNFs are also substantially more expensive. Consequently, a number of model-based economic evaluations have been conducted to establish the relative cost-effectiveness of anti-TNFs. However, anti-TNFs are associated with an increased risk of adverse drug events (ADEs) such as serious infections relative to nbDMARDs. Such ADEs will likely impact on both the costs and consequences of anti-TNFs, for example, through hospitalisations and forced withdrawal from treatment. The aim of this review was to identify and critically appraise if, and how, ADEs have been incorporated into model-based cost-effectiveness analyses of anti-TNFs for adult patients with RA. A systematic literature review was performed. Electronic databases (Ovid MEDLINE; Ovid EMBASE; Web of Science; NHS Economic Evaluations Database) were searched for literature published between January 1990 and October 2013 using electronic search strategies. The reference lists of retrieved studies were also hand searched. In addition, the National Institute for Health and Care Excellence technology appraisals were searched to identify economic models used to inform UK healthcare decision making. Only full economic evaluations that had used an economic model to evaluate biological DMARDs (bDMARDs) (including anti-TNFs) for adult patients with RA and had incorporated the direct costs and/or consequences of ADEs were critically appraised. To be included, studies also had to be available as a full text in English. Data extracted included general study characteristics and information concerning the methods used to incorporate ADEs and any associated assumptions made. The extracted data were synthesised using a tabular and narrative format. A total of 43 model-based economic evaluations of bDMARDs for adult RA

  5. 45 CFR 630.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false What must I include in my drug-free workplace...) NATIONAL SCIENCE FOUNDATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 630.205 What must I include in my drug-free workplace...

  6. 45 CFR 630.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 3 2011-10-01 2011-10-01 false What must I include in my drug-free workplace...) NATIONAL SCIENCE FOUNDATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 630.205 What must I include in my drug-free workplace...

  7. 45 CFR 630.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false What must I include in my drug-free workplace...) NATIONAL SCIENCE FOUNDATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 630.205 What must I include in my drug-free workplace...

  8. 45 CFR 630.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false What must I include in my drug-free workplace...) NATIONAL SCIENCE FOUNDATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 630.205 What must I include in my drug-free workplace...

  9. 45 CFR 630.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 3 2012-10-01 2012-10-01 false What must I include in my drug-free workplace...) NATIONAL SCIENCE FOUNDATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 630.205 What must I include in my drug-free workplace...

  10. 29 CFR 1472.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false What must I include in my drug-free workplace statement... CONCILIATION SERVICE GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1472.205 What must I include in my drug-free workplace...

  11. Structural Factors Influencing Patterns of Drug Selling and Use and HIV Risk in the San Salvador Metropolitan Area

    PubMed Central

    Dickson-Gomez, Julia

    2013-01-01

    This article explores differences in the social context in which crack sales and use and HIV risk take place in seven low-income communities in San Salvador, and structural factors that may influence these differences. The organization of drug selling varied among the communities on a number of dimensions including: whether drug sales were open or closed systems; the type of drug-selling site; and the participation of drug users in drug-distribution roles. Drug-use sites also varied according to whether crack was used in private, semiprivate, or public spaces, and whether individuals used drugs alone or with other drug users. Three patterns of drug use and selling were identified based on the dimensions outlined above. Structural factors that influenced these patterns included the geographic location of the communities, their physical layout, gang involvement in drug sales, and police surveillance. Implications for HIV risk and prevention are explored for each pattern. PMID:20550091

  12. [Protective factors for preventing the use of drugs in the families of a Colombia locality].

    PubMed

    Arias, Núbia Medina; Ferriani, Maria das Graças Carvalho

    2010-01-01

    The aim of this study was to analyze the protective factors that prevent drug use in the families of children who attend Community Homes of Family Well-being in a small Colombian locality. This was a quantitative, descriptive, transversal study, with 256 families constituting the sample. Data were collected through a self-applied questionnaire throughout March and April 2007. Protective factors found included demonstrations of affection toward the children, playing with them and talking to them about things they like, open communication, decision making as a couple, flexibility of the nursing process, and establishment of rules. However, some risk factors were also found, such as consumption of legal drugs such as cigarettes and alcohol, and in a low percentage, consumption of illicit drugs. A high percentage of families consider that drug use must be prevented in the first years of life, by the parents. The protective factors found require reinforcement as they are not very strong, and the risk factors must be controlled to turn them into protective factors.

  13. Prescription Factors Associated with Medication Non-adherence in Japan Assessed from Leftover Drugs in the SETSUYAKU-BAG Campaign: Focus on Oral Antidiabetic Drugs.

    PubMed

    Koyanagi, Kaori; Kubota, Toshio; Kobayashi, Daisuke; Kihara, Taro; Yoshida, Takeo; Miisho, Takamasa; Miura, Tomoko; Sakamoto, Yoshiko; Takaki, Junichi; Seo, Takashi; Shimazoe, Takao

    2016-01-01

    Medication adherence has an important influence on health outcomes in patients with chronic diseases. However, few studies have been performed in Japan to determine factors related to medication non-adherence. The aim of this study was to identify prescription factors related to medication non-adherence by investigating patient characteristics, all prescriptions, and prescriptions for oral antidiabetic drugs (OADs). A retrospective cross-sectional survey of prescription data about implementation of dosing regimen was performed at community pharmacies engaged in appropriate use of leftover drugs. We evaluated the amount of drugs originally prescribed and the reduced amount after use of leftover drugs, and then calculated prescription reduction ratio (PRR). We analyzed prescription factors contributing to non-adherence based on the PRR. Prescription information for 1207 patients was reviewed, revealing that patients were non-adherent to 58% of prescriptions. Lack of a drug copayment, fewer concurrent drugs, and drugs not in single-dose packaging were associated with non-adherence. Among the 1207 patients, 234 prescriptions for diabetes and 452 OAD formulations were included. Forty-seven percent of prescriptions and 29% of the formulations were non-adherent. A higher dosing frequency and preprandial administration were associated with non-adherence. Among the OADs, adherence was lower for α-glucosidase inhibitors and biguanides than for sulfonylureas. Several factors related to patient characteristics, general drug prescriptions, and OAD prescriptions were associated with non-adherence. Further consideration will be needed to improve adherence to medication in Japan. Health care providers should perform more careful monitoring of adherence in patients with the factors identified by this study.

  14. 22 CFR 1008.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What must I include in my drug-free workplace... FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1008.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  15. 22 CFR 210.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 210.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  16. 45 CFR 1173.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1173.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  17. 49 CFR 32.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 32.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  18. 20 CFR 439.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 439.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  19. 45 CFR 1155.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1155.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  20. 22 CFR 1509.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1509.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  1. 22 CFR 133.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false What must I include in my drug-free workplace... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 133.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  2. Risk factors associated with drug use before imprisonment in Peru.

    PubMed

    Hernández-Vásquez, A; Núñez, S; Santero, M; Grendas, L; Huarez, B; Vilcarromero, S; Casas-Bendezú, M; Braun, S; Cortés, S; Rosselli, D

    2018-01-01

    To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused

  3. Self-report prevalence and associated factors to drug hypersensitivity in Mexican young adults.

    PubMed

    Bedolla-Barajas, Martín; Puente-Fernández, Cecilia; Flores-Merino, Miriam V; Morales-Romero, Jaime; Domínguez-García, Ma Victoria

    2017-07-01

    Drug hypersensitivity is defined as any unfavorable reaction that occurs after the administration of any drug. It may or may not be mediated by the involvement of the immune system. Epidemiological data related to drug hypersensitivity reactions in our country are scarce. To determine the prevalence of drug hypersensitivity in a group of young adults, as well as to identify associated factors. A structured questionnaire was applied to young people aged 18 to 25 years. The instrument was oriented to identify reactions of drug hypersensitivity, as well as the most prevalent drugs involved. In addition, a personal and family history of atopic diseases was included. Analysis for associations between variables was been done through logistic regression. The prevalence of drug hypersensitivity reactions was 12% (144 of 1,200). The antibiotics were the agents most related to hypersensitivity reactions (9.8%) followed by nonsteroidal anti-inflammatory drugs (1.6%). Factors associated with drug hypersensitivity were a personal history of asthma, odds ratio (OR) 3.15 (95% confidence interval [CI], 1.44-6.91), maternal and paternal history of drug hypersensitivity, OR 2.33 (95% CI, 1.21-4.48) and OR 3.11 (95% CI, 1.22-7.92), respectively. The results of this research show that drug hypersensitivity in young adults is a highly prevalent event and it is associated with personal history of asthma and history of drug hypersensitivity in parents.

  4. Drug use and its associated factors among money boys in Hunan Province, China.

    PubMed

    Yang, G L; Zhang, A D; Yu, Y; Liu, H; Long, F Y; Yan, J

    2016-11-01

    To describe drug use, types of drugs and related factors among money boys in Hunan Province, China. A cross-sectional study was conducted between July 2012 and January 2013. Based on respondent-driven sampling, researchers located seven 'seeds' via a gay-dating website: http://www.ixxqy.org. After three waves of recruitment, 234 money boys were enrolled. They were asked to complete a 23-item questionnaire regarding demographic characteristics, drug use, a history of human immunodeficiency virus infection and family environment. Descriptive statistics and logistic regression analysis were conducted using Statistical Package for the Social Sciences Version 20.0. In total, 205 valid questionnaires were collected. Based on the data collected, 80 (39.0%) money boys had used drugs within the last 3 months. Rush popper (36.6%) and methamphetamine (12.7%) were used most commonly, and other drugs used were ecstasy (7.8%), ketamine (5.9%), marijuana (2.4%), morphine (1.5%), heroin (1.0%) and cocaine (0.5%). Factors included in the logistic regression were length of service (odds ratio [OR] 0.395, 95% confidence interval [CI] 0.175-0.896), being an only child (OR 2.272, 95% CI 1.108-4.659), relationship between parents (OR 0.428, 95% CI 0.213-0.858) and social network (OR 2.387, 95% CI 1.144-4.970). A shorter length of service and a good relationship between parents were protective factors against drug use, while being an only child and having a wide social network were risk factors. Drug use is common among money boys. This study found that length of service, being an only child, relationship between parents and social network are associated with drug use. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  5. Mesoporous bioactive glasses: structure characteristics, drug/growth factor delivery and bone regeneration application

    PubMed Central

    Wu, Chengtie; Chang, Jiang

    2012-01-01

    The impact of bone diseases and trauma in the whole world has increased significantly in the past decades. Bioactive glasses are regarded as an important bone regeneration material owing to their generally excellent osteoconductivity and osteostimulativity. A new class of bioactive glass, referred to as mesoporous bioglass (MBG), was developed 7 years ago, which possess a highly ordered mesoporous channel structure and a highly specific surface area. The study of MBG for drug/growth factor delivery and bone tissue engineering has grown significantly in the past several years. In this article, we review the recent advances of MBG materials, including the preparation of different forms of MBG, composition–structure relationship, efficient drug/growth factor delivery and bone tissue engineering application. By summarizing our recent research, the interaction of MBG scaffolds with bone-forming cells, the effect of drug/growth factor delivery on proliferation and differentiation of tissue cells and the in vivo osteogenesis of MBG scaffolds are highlighted. The advantages and limitations of MBG for drug delivery and bone tissue engineering have been compared with microsize bioactive glasses and nanosize bioactive glasses. The future perspective of MBG is discussed for bone regeneration application by combining drug delivery with bone tissue engineering and investigating the in vivo osteogenesis mechanism in large animal models. PMID:23741607

  6. Factors related to drug approvals: predictors of outcome?

    PubMed

    Liberti, Lawrence; Breckenridge, Alasdair; Hoekman, Jarno; McAuslane, Neil; Stolk, Pieter; Leufkens, Hubert

    2017-06-01

    There is growing interest in characterising factors associated with positive regulatory outcomes for drug marketing authorisations. We assessed empirical studies published over the past 15 years seeking to identify predictive factors. Factors were classified to one of four 'factor clusters': evidentiary support; product or indication characteristics; company experience or strategy; social and regulatory factors. We observed a heterogeneous mix of technical factors (e.g., study designs, clinical evidence of efficacy) and less studied social factors (e.g., company-regulator interactions). We confirmed factors known to be of relevance to drug approval decisions (imperative) and a cohort of less understood (compensatory) social factors. Having robust supportive clinical evidence, addressing rare or serious illness, following scientific advice and prior company experience were associated with positive outcomes, which illustrated the multifactorial nature of regulatory decision making and factors need to be considered holistically while having varying, context-dependent importance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. 13 CFR 147.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false What must I include in my drug... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (NONPROCUREMENT) Requirements for Recipients...

  8. 13 CFR 147.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false What must I include in my drug... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (NONPROCUREMENT) Requirements for Recipients...

  9. 13 CFR 147.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false What must I include in my drug... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (NONPROCUREMENT) Requirements for Recipients...

  10. 13 CFR 147.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What must I include in my drug... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (NONPROCUREMENT) Requirements for Recipients...

  11. 14 CFR 1267.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false What must I include in my drug-free... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  12. 2 CFR 182.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false What must I include in my drug-free...

  13. 13 CFR 147.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false What must I include in my drug... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (NONPROCUREMENT) Requirements for Recipients...

  14. 14 CFR 1267.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false What must I include in my drug-free... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  15. 2 CFR 182.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false What must I include in my drug-free...

  16. 14 CFR 1267.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false What must I include in my drug-free... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  17. 14 CFR 1267.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true What must I include in my drug-free... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  18. 45 CFR 630.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 45 Public Welfare 3 2012-10-01 2012-10-01 false What must I include in my drug-free awareness...

  19. 24 CFR 21.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false What must I include in my drug-free...

  20. 45 CFR 630.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 45 Public Welfare 3 2011-10-01 2011-10-01 false What must I include in my drug-free awareness...

  1. 29 CFR 1472.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 29 Labor 4 2014-07-01 2014-07-01 false What must I include in my drug-free awareness program? 1472...

  2. 45 CFR 630.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 45 Public Welfare 3 2014-10-01 2014-10-01 false What must I include in my drug-free awareness...

  3. 2 CFR 1401.315 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false What must I include in my drug-free...

  4. 45 CFR 630.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 45 Public Welfare 3 2013-10-01 2013-10-01 false What must I include in my drug-free awareness...

  5. 29 CFR 1472.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 29 Labor 4 2010-07-01 2010-07-01 false What must I include in my drug-free awareness program? 1472...

  6. 29 CFR 1472.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 29 Labor 4 2011-07-01 2011-07-01 false What must I include in my drug-free awareness program? 1472...

  7. 29 CFR 1472.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 29 Labor 4 2012-07-01 2012-07-01 false What must I include in my drug-free awareness program? 1472...

  8. 40 CFR 36.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false What must I include in my drug-free...

  9. 24 CFR 21.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false What must I include in my drug-free...

  10. 29 CFR 1472.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 29 Labor 4 2013-07-01 2013-07-01 false What must I include in my drug-free awareness program? 1472...

  11. 2 CFR 1401.315 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false What must I include in my drug-free...

  12. 45 CFR 630.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 45 Public Welfare 3 2010-10-01 2010-10-01 false What must I include in my drug-free awareness...

  13. 2 CFR 1401.315 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c) Any... may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false What must I include in my drug-free...

  14. Predicting and understanding comprehensive drug-drug interactions via semi-nonnegative matrix factorization.

    PubMed

    Yu, Hui; Mao, Kui-Tao; Shi, Jian-Yu; Huang, Hua; Chen, Zhi; Dong, Kai; Yiu, Siu-Ming

    2018-04-11

    Drug-drug interactions (DDIs) always cause unexpected and even adverse drug reactions. It is important to identify DDIs before drugs are used in the market. However, preclinical identification of DDIs requires much money and time. Computational approaches have exhibited their abilities to predict potential DDIs on a large scale by utilizing pre-market drug properties (e.g. chemical structure). Nevertheless, none of them can predict two comprehensive types of DDIs, including enhancive and degressive DDIs, which increases and decreases the behaviors of the interacting drugs respectively. There is a lack of systematic analysis on the structural relationship among known DDIs. Revealing such a relationship is very important, because it is able to help understand how DDIs occur. Both the prediction of comprehensive DDIs and the discovery of structural relationship among them play an important guidance when making a co-prescription. In this work, treating a set of comprehensive DDIs as a signed network, we design a novel model (DDINMF) for the prediction of enhancive and degressive DDIs based on semi-nonnegative matrix factorization. Inspiringly, DDINMF achieves the conventional DDI prediction (AUROC = 0.872 and AUPR = 0.605) and the comprehensive DDI prediction (AUROC = 0.796 and AUPR = 0.579). Compared with two state-of-the-art approaches, DDINMF shows it superiority. Finally, representing DDIs as a binary network and a signed network respectively, an analysis based on NMF reveals crucial knowledge hidden among DDIs. Our approach is able to predict not only conventional binary DDIs but also comprehensive DDIs. More importantly, it reveals several key points about the DDI network: (1) both binary and signed networks show fairly clear clusters, in which both drug degree and the difference between positive degree and negative degree show significant distribution; (2) the drugs having large degrees tend to have a larger difference between positive degree

  15. 2 CFR 1401.315 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false What must I include in my drug-free...

  16. 2 CFR 182.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false What must I include in my drug-free...

  17. 32 CFR 26.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 32 National Defense 1 2011-07-01 2011-07-01 false What must I include in my drug-free awareness...

  18. 32 CFR 26.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 32 National Defense 1 2014-07-01 2014-07-01 false What must I include in my drug-free awareness...

  19. 32 CFR 26.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 32 National Defense 1 2013-07-01 2013-07-01 false What must I include in my drug-free awareness...

  20. 32 CFR 26.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 32 National Defense 1 2010-07-01 2010-07-01 false What must I include in my drug-free awareness...

  1. 32 CFR 26.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 32 National Defense 1 2012-07-01 2012-07-01 false What must I include in my drug-free awareness...

  2. 2 CFR 182.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false What must I include in my drug-free...

  3. Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors.

    PubMed

    Binswanger, Ingrid A; Nowels, Carolyn; Corsi, Karen F; Glanz, Jason; Long, Jeremy; Booth, Robert E; Steiner, John F

    2012-01-01

    Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners. This qualitative study included former prison inmates (N=29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis. The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family. Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs.

  4. 2 CFR 182.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false What must I include in my drug-free...

  5. 21 CFR 1405.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 21 Food and Drugs 9 2013-04-01 2013-04-01 false What must I include in my drug-free awareness...

  6. 21 CFR 1405.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 21 Food and Drugs 9 2014-04-01 2014-04-01 false What must I include in my drug-free awareness...

  7. 21 CFR 1405.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 21 Food and Drugs 9 2011-04-01 2011-04-01 false What must I include in my drug-free awareness...

  8. 21 CFR 1405.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 21 Food and Drugs 9 2010-04-01 2010-04-01 false What must I include in my drug-free awareness...

  9. 21 CFR 1405.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 21 Food and Drugs 9 2012-04-01 2012-04-01 false What must I include in my drug-free awareness...

  10. Demographics, socio-behavioral factors, and drug use patterns: what matters in spontaneous HCV clearance?

    PubMed

    Shah, Dimpy P; Grimes, Carolyn Z; Brown, Eric; Hwang, Lu-Yu

    2012-02-01

    Hepatitis C virus (HCV), an emerging bloodborne pathogen, causes chronic liver disease frequently except in about 10-20% of infections which undergo spontaneous resolution. Investigating factors that influence viral clearance is essential to understand the natural history of this infection and establishing novel strategies for prevention and treatment. HCV clearance was estimated in a unique cohort of 1,260 HIV and HBV negative current drug users enrolled for a hepatitis B vaccination study. It was defined as the inability to detect viral RNA using a PCR method in presence of serum anti-HCV antibody EIA. Associated demographic and socio-behavioral factors including drug use patterns were identified from the enrolled subjects using multivariate regression analysis. 33.3% (420/1260) of drug users were found positive for anti-HCV antibodies and 14.8% (62/420) of these individuals achieved viral clearance (negative PCR test). Race or ethnicity of the participants was the only significant factor associated with HCV clearance. Hispanics (OR = 3.4, 95% CI: 1.3-8.5, P = 0.01) and Caucasians (OR = 3.1, 95% CI: 1.5-6.6, P = 0.003) had significantly higher odds of clearing the virus compared to African Americans when adjusted for age and gender. None of the socio-behavioral factors including alcohol intake and drug use patterns were significant determinants of HCV clearance. Racial or ethnic differences in HCV clearance were observed in this study suggesting an important role of host genetic susceptibility factors in determining the clinical course of this disease. Further research is needed to examine these genetic associations of host-virus relationships. Copyright © 2011 Wiley Periodicals, Inc.

  11. Evaluation of Factors Affecting Powdered Drug Reconstitution in Microgravity

    NASA Technical Reports Server (NTRS)

    Schaffner, Grant; Johnston, Smith; Marshburn, Tom

    1999-01-01

    standard pharmacological supplies. The experiment included a parametric assessment of possible factors affecting the reconstitution process. The specific questions that we wished to answer were: (1) Is it possible to reconstitute powdered drugs in weightlessness using standard pharmacological equipment? (2) What are the differences between drug reconstitution in a 1-G and a 0-G environment? (3) What techniques of mixing the drug powder and diluent are more successful? (4) What physical and chemical factors play a role in determining the success of mixing and dissolution? (5) Is it necessary to employ crewmember and equipment restraints during the reconstitution process?

  12. 7 CFR 3021.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false What must I include in my drug-free workplace...-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 3021.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a) Tells...

  13. 22 CFR 133.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false What must I include in my drug-free workplace statement? 133.205 Section 133.205 Foreign Relations DEPARTMENT OF STATE MISCELLANEOUS GOVERNMENTWIDE... § 133.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a...

  14. 29 CFR 94.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true What must I include in my drug-free workplace statement? 94... WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 94.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a) Tells your employees...

  15. 22 CFR 312.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What must I include in my drug-free workplace... WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 312.205 What must I include in my drug-free workplace statement? You must publish a statement that— (a) Tells your employees...

  16. Individual and Network Factors Associated With Prevalent Hepatitis C Infection Among Rural Appalachian Injection Drug Users

    PubMed Central

    Lofwall, Michelle R.; Frost, Simon D. W.; Oser, Carrie B.; Leukefeld, Carl G.; Crosby, Richard A.

    2013-01-01

    Objectives. We determined the factors associated with hepatitis C (HCV) infection among rural Appalachian drug users. Methods. This study included 394 injection drug users (IDUs) participating in a study of social networks and infectious disease risk in Appalachian Kentucky. Trained staff conducted HCV, HIV, and herpes simplex-2 virus (HSV-2) testing, and an interviewer-administered questionnaire measured self-reported risk behaviors and sociometric network characteristics. Results. The prevalence of HCV infection was 54.6% among rural IDUs. Lifetime factors independently associated with HCV infection included HSV-2, injecting for 5 or more years, posttraumatic stress disorder, injection of cocaine, and injection of prescription opioids. Recent (past-6-month) correlates of HCV infection included sharing of syringes (adjusted odds ratio = 2.24; 95% confidence interval = 1.32, 3.82) and greater levels of eigenvector centrality in the drug network. Conclusions. One factor emerged that was potentially unique to rural IDUs: the association between injection of prescription opioids and HCV infection. Therefore, preventing transition to injection, especially among prescription opioid users, may curb transmission, as will increased access to opioid maintenance treatment, novel treatments for cocaine dependence, and syringe exchange. PMID:23153148

  17. Incidence, risk factors and treatment outcomes of drug extravasation in pediatric patients in China.

    PubMed

    Yan, Ya-Min; Gong, Mei; Chen, Jia-Ling; Li, Dan; Xu, Ting-Ting; Zou, Huan; Li, Ai-Qiu; Fan, Qiao-Ling; Lu, Qun-Feng

    2017-01-01

    Yan YM, Gong M, Chen JL, Li D, Xu TT, Zou H, Li AQ, Fan QL, Lu QF. Incidence, risk factors and treatment outcomes of drug extravasation in pediatric patients in China. Turk J Pediatr 2017; 59: 162-168. Extravasation injury is a common phenomenon in hospitals. Failure to detect and treat extravasation injury can lead to irreversible local injuries, tissue necrosis and malfunction of the affected tissue. Until now, it is largely unknown about incidence, risk factors and treatment outcomes of extravasation in Chinese pediatric patients. The aim of this study is to explore the incidence, risk factors and summarize the characteristics and treatment outcomes of extravasation injuries resulting in drug extravasation among Chinese children in our hospital. The children undergoing infusion therapy (0-18 years) were enrolled in this study between December 2014 and June 2015 in Shanghai Children`s Hospital. The patients` information including age, gender, injection site, estimated volume of solution extravasated, patient symptoms, severity of extravasation injury, treatment methods, and outcomes was collected. Multivariate logistic regression was used to identify the independent risk factors for the development of extravasation. The incidence of extravasations in pediatric patients was 1.79% (18/1,004). The severity of extravasation was labeled with grade range from Grade 1 through Grade 4: 4 cases with Grade 1, 8 cases with Grade 2, 5 cases with Grade 3, and 1 case with Grade 4. The risk factors of extravasation include infused high volume/day (≥1000 ml), received operation, infused agents with high osmolarity and poor vein condition. The severity of extravasation was related to the large volumes of drug or special drugs (high-osmolarity, high-risk, low pH, etc). All extravasations were treated with physical, pharmacological and surgical intervention according to our standard operation protocols. Systematic implementation of intervention can alleviate the extravasation

  18. 28 CFR 83.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 28 Judicial Administration 2 2012-07-01 2012-07-01 false What must I include in my drug-free...

  19. 28 CFR 83.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 28 Judicial Administration 2 2011-07-01 2011-07-01 false What must I include in my drug-free...

  20. 28 CFR 83.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 28 Judicial Administration 2 2014-07-01 2014-07-01 false What must I include in my drug-free...

  1. 28 CFR 83.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 28 Judicial Administration 2 2013-07-01 2013-07-01 false What must I include in my drug-free...

  2. 28 CFR 83.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 28 Judicial Administration 2 2010-07-01 2010-07-01 false What must I include in my drug-free...

  3. 14 CFR § 1267.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... establish an ongoing drug-free awareness program to inform employees about— (a) The dangers of drug abuse in... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false What must I include in my drug-free... ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  4. 22 CFR 1509.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2012-04-01 2009-04-01 true What must I include in my drug-free awareness...

  5. 22 CFR 133.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2010-04-01 2010-04-01 false What must I include in my drug-free awareness...

  6. 22 CFR 1509.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What must I include in my drug-free awareness...

  7. 49 CFR 32.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 49 Transportation 1 2010-10-01 2010-10-01 false What must I include in my drug-free awareness...

  8. 43 CFR 43.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What must I include in my drug-free...

  9. 45 CFR 1155.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 45 Public Welfare 3 2010-10-01 2010-10-01 false What must I include in my drug-free awareness...

  10. 15 CFR 29.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 15 Commerce and Foreign Trade 1 2013-01-01 2013-01-01 false What must I include in my drug-free...

  11. 15 CFR 29.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false What must I include in my drug-free...

  12. 22 CFR 1509.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2014-04-01 2014-04-01 false What must I include in my drug-free awareness...

  13. 22 CFR 210.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2011-04-01 2011-04-01 false What must I include in my drug-free awareness...

  14. 22 CFR 1008.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2012-04-01 2009-04-01 true What must I include in my drug-free awareness...

  15. 34 CFR 84.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 34 Education 1 2011-07-01 2011-07-01 false What must I include in my drug-free awareness program...

  16. 45 CFR 1155.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 45 Public Welfare 3 2011-10-01 2011-10-01 false What must I include in my drug-free awareness...

  17. 34 CFR 84.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 34 Education 1 2010-07-01 2010-07-01 false What must I include in my drug-free awareness program...

  18. 49 CFR 32.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 49 Transportation 1 2013-10-01 2013-10-01 false What must I include in my drug-free awareness...

  19. 49 CFR 32.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 49 Transportation 1 2014-10-01 2014-10-01 false What must I include in my drug-free awareness...

  20. 22 CFR 210.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2010-04-01 2010-04-01 false What must I include in my drug-free awareness...

  1. 34 CFR 84.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 34 Education 1 2014-07-01 2014-07-01 false What must I include in my drug-free awareness program...

  2. 22 CFR 133.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2011-04-01 2011-04-01 false What must I include in my drug-free awareness...

  3. 45 CFR 1155.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 45 Public Welfare 3 2014-10-01 2014-10-01 false What must I include in my drug-free awareness...

  4. 22 CFR 133.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2013-04-01 2013-04-01 false What must I include in my drug-free awareness...

  5. 22 CFR 1509.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2013-04-01 2009-04-01 true What must I include in my drug-free awareness...

  6. 22 CFR 133.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2014-04-01 2014-04-01 false What must I include in my drug-free awareness...

  7. 49 CFR 32.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 49 Transportation 1 2011-10-01 2011-10-01 false What must I include in my drug-free awareness...

  8. 22 CFR 1008.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2013-04-01 2009-04-01 true What must I include in my drug-free awareness...

  9. 22 CFR 1008.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2014-04-01 2014-04-01 false What must I include in my drug-free awareness...

  10. 22 CFR 1008.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What must I include in my drug-free awareness...

  11. 45 CFR 1155.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 45 Public Welfare 3 2013-10-01 2013-10-01 false What must I include in my drug-free awareness...

  12. 45 CFR 1173.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 45 Public Welfare 3 2010-10-01 2010-10-01 false What must I include in my drug-free awareness...

  13. 34 CFR 84.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 34 Education 1 2013-07-01 2013-07-01 false What must I include in my drug-free awareness program...

  14. 15 CFR 29.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false What must I include in my drug-free...

  15. 22 CFR 1509.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2011-04-01 2009-04-01 true What must I include in my drug-free awareness...

  16. 45 CFR 1155.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 45 Public Welfare 3 2012-10-01 2012-10-01 false What must I include in my drug-free awareness...

  17. 22 CFR 133.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 1 2012-04-01 2012-04-01 false What must I include in my drug-free awareness...

  18. 20 CFR 439.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What must I include in my drug-free awareness...

  19. 34 CFR 84.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 34 Education 1 2012-07-01 2012-07-01 false What must I include in my drug-free awareness program...

  20. 22 CFR 1008.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 22 Foreign Relations 2 2011-04-01 2009-04-01 true What must I include in my drug-free awareness...

  1. 15 CFR 29.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 15 Commerce and Foreign Trade 1 2012-01-01 2012-01-01 false What must I include in my drug-free...

  2. 49 CFR 32.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 49 Transportation 1 2012-10-01 2012-10-01 false What must I include in my drug-free awareness...

  3. 15 CFR 29.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-free awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b..., and employee assistance programs; and (d) The penalties that you may impose upon them for drug abuse... 15 Commerce and Foreign Trade 1 2014-01-01 2014-01-01 false What must I include in my drug-free...

  4. 22 CFR 312.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 22 Foreign Relations 2 2010-04-01 2010-04-01 true What must I include in my drug-free awareness...

  5. 7 CFR 3021.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 7 Agriculture 15 2011-01-01 2011-01-01 false What must I include in my drug-free awareness program...

  6. 22 CFR 312.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 22 Foreign Relations 2 2013-04-01 2009-04-01 true What must I include in my drug-free awareness...

  7. 10 CFR 607.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... awareness program to inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy... assistance programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring... 10 Energy 4 2010-01-01 2010-01-01 false What must I include in my drug-free awareness program? 607...

  8. 29 CFR 94.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 29 Labor 1 2014-07-01 2013-07-01 true What must I include in my drug-free awareness program? 94...

  9. 7 CFR 3021.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 7 Agriculture 15 2012-01-01 2012-01-01 false What must I include in my drug-free awareness program...

  10. 22 CFR 312.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 22 Foreign Relations 2 2014-04-01 2014-04-01 false What must I include in my drug-free awareness...

  11. 29 CFR 94.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 29 Labor 1 2012-07-01 2012-07-01 false What must I include in my drug-free awareness program? 94...

  12. 22 CFR 312.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 22 Foreign Relations 2 2011-04-01 2009-04-01 true What must I include in my drug-free awareness...

  13. 7 CFR 3021.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 7 Agriculture 15 2010-01-01 2010-01-01 false What must I include in my drug-free awareness program...

  14. 22 CFR 312.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 22 Foreign Relations 2 2012-04-01 2009-04-01 true What must I include in my drug-free awareness...

  15. 29 CFR 94.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 29 Labor 1 2013-07-01 2013-07-01 false What must I include in my drug-free awareness program? 94...

  16. 29 CFR 94.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 29 Labor 1 2011-07-01 2011-07-01 false What must I include in my drug-free awareness program? 94...

  17. 29 CFR 94.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... inform employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a... programs; and (d) The penalties that you may impose upon them for drug abuse violations occurring in the... 29 Labor 1 2010-07-01 2010-07-01 true What must I include in my drug-free awareness program? 94...

  18. Neuronal plasticity and neurotrophic factors in drug responses

    PubMed Central

    Castrén, Eero; Antila, Hanna

    2017-01-01

    Neurotrophic factors, particularly brain-derived neurotrophic factor (BDNF) and other members of the neurotrophin family, are central mediators of the activity-dependent plasticity through which environmental experiences, such as sensory information are translated into the structure and function of neuronal networks. Synthesis, release and action of BDNF is regulated by neuronal activity and BDNF in turn leads to trophic effects such as formation, stabilization and potentiation of synapses through its high-affinity TrkB receptors. Several clinically available drugs directly activate neurotrophins and neuronal plasticity. In particular, antidepressant drugs rapidly activate TrkB signaling and gradually increase BDNF expression, and the behavioral effects of antidepressants are mediated by and dependent on BDNF signaling through TrkB at least in rodents. These findings indicate that antidepressants, widely used drugs, effectively act as TrkB activators. They further imply that neuronal plasticity is a central mechanism in the action of antidepressant drugs. Indeed, it was recently discovered that antidepressants reactivate a state of plasticity in the adult cerebral cortex that closely resembles the enhanced plasticity normally observed during postnatal critical periods. This state of induced plasticity, known as iPlasticity, allows environmental stimuli to beneficially reorganize networks abnormally wired during early life. iPlasticity has been observed in cortical as well as subcortical networks and is induced by several pharmacological and non-pharmacological treatments. iPlasticity is a new pharmacological principle where drug treatment and rehabilitation cooperate: the drug acts permissively to enhance plasticity and rehabilitation provides activity to guide the appropriate wiring of the plastic network. Optimization of iPlastic drug treatment with novel means of rehabilitation may help improve the efficacy of available drug treatments and expand the use of

  19. 36 CFR § 1212.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true What must I include in my drug...

  20. An Annotated Bibliography of Literature Analyzing Factors of Adolescent Drug Use/Abuse and the Effectiveness of Various Drug Abuse Prevention Programs.

    ERIC Educational Resources Information Center

    Pearish, Pamela L.

    This document reviews literature which analyzes factors of adolescent drug use/abuse and the effectiveness of various drug abuse prevention programs. After a brief introduction to the topic of drug abuse, 16 terms such as "adolescence" and "drug abuse" are defined. Ten papers and articles on the topic of motivations and factors for drug use are…

  1. Risk factors for anti-MRSA drug resistance.

    PubMed

    Abe, Yasuhisa; Shigemura, Katsumi; Yoshida, Hiroyuki; Fujisawa, Masato; Arakawa, Soichi

    2012-11-01

    Meticillin-resistant Staphylococcus aureus (MRSA)-related infections have recently been spreading and are difficult to control, partly because affected patients are frequently in a poor condition. This study retrospectively investigated recent MRSA-related infections focusing on the relationship between clinical risk factors and anti-MRSA drug resistance. The patients with MRSA-related infections in Kobe University Hospital (Kobe, Japan) in 2009 were enrolled in the study. The relationships between various clinical risk factors as well as MRSA bacterial DNA concentration with minimum inhibitory concentrations (MICs) of anti-MRSA drugs were examined. In total, 44 patients were enrolled in the study and MRSA was isolated from blood (23 patients), urine (12 patients) and nasal secretions (9 patients). There was only one resistant strain to linezolid (LZD) among the anti-MRSA drugs tested, and this strain was considered staphylococcal cassette chromosome mec (SCCmec) type IIa from phage open-reading frame typing analyses. Statistical analyses showed that MRSA bacterial DNA concentration, cancer and use of a respirator, respectively, had a significant relationship with the MICs of LZD (P=0.0058) and arbekacin (ABK) (P=0.0003), of quinupristin/dalfopristin (Q/D) (P=0.0500) and ABK (P=0.0133), and of Q/D (P=0.0198) and vancomycin (P=0.0036). In conclusion, bacterial DNA concentration, cancer and use of a respirator were found to be significant risk factors for lower susceptibilities to anti-MRSA drugs; one strain was resistant to LZD. We suggest that further investigation and surveillance for MRSA-related infection are necessary for preventing the spread of MRSA-related infections. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  2. Factors Influencing Transition to Shisheh (Methamphetamine) among Young People Who Use Drugs in Tehran: A Qualitative Study.

    PubMed

    Noroozi, Alireza; Malekinejad, Mohsen; Rahimi-Movaghar, Afarin

    2018-01-29

    Iran has experienced an emerging epidemic of methamphetamine use during recent years which has added to existing non-injecting and injecting opioid use in the country. This study explored factors influencing the initiation into or transition to methamphetamine use among young people who use drugs (PWUD). We conducted 42 semi-structured, in-depth interviews with young PWUD (n = 35) and health care workers (HCWs) (n = 7) between July and October 2011 in Tehran, Iran. The PWUD were purposefully recruited from different tiers of drug services and lived in geographically diverse areas of Tehran. The HCWs were substance use experts and/or service providers of treatment and harm reduction facilities. All interviews were recorded, transcribed, and coded using OpenCode 3.6 software. The predominant factors for initiation into or transition to methamphetamine use were individual domain factors. The peer domain factors were the second most frequently stated perceived factor category for transition to methamphetamine use. Other perceived factors affecting transition to stimulant use included both family and community domains. Drug prevention programs should consider targeting certain settings, including workplaces and sports clubs, for preventative interventions. Existing opioid treatment and harm reduction services should be adjusted in response to the methamphetamine use epidemic.

  3. The Importance of Patient-Specific Factors for Hepatic Drug Response and Toxicity

    PubMed Central

    Lauschke, Volker M.; Ingelman-Sundberg, Magnus

    2016-01-01

    Responses to drugs and pharmacological treatments differ considerably between individuals. Importantly, only 50%–75% of patients have been shown to react adequately to pharmacological interventions, whereas the others experience either a lack of efficacy or suffer from adverse events. The liver is of central importance in the metabolism of most drugs. Because of this exposed status, hepatotoxicity is amongst the most common adverse drug reactions and hepatic liabilities are the most prevalent reason for the termination of development programs of novel drug candidates. In recent years, more and more factors were unveiled that shape hepatic drug responses and thus underlie the observed inter-individual variability. In this review, we provide a comprehensive overview of different principle mechanisms of drug hepatotoxicity and illustrate how patient-specific factors, such as genetic, physiological and environmental factors, can shape drug responses. Furthermore, we highlight other parameters, such as concomitantly prescribed medications or liver diseases and how they modulate drug toxicity, pharmacokinetics and dynamics. Finally, we discuss recent progress in the field of in vitro toxicity models and evaluate their utility in reflecting patient-specific factors to study inter-individual differences in drug response and toxicity, as this understanding is necessary to pave the way for a patient-adjusted medicine. PMID:27754327

  4. Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

    PubMed Central

    Crooks, Denise; Tsui, Judith; Anderson, Bradley; Dossabhoy, Shernaz; Herman, Debra; Liebschutz, Jane M.; Stein, Michael D.

    2016-01-01

    Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets. PMID:25063229

  5. Role of nonalcoholic fatty liver disease as risk factor for drug-induced hepatotoxicity

    PubMed Central

    Massart, Julie; Begriche, Karima; Moreau, Caroline; Fromenty, Bernard

    2017-01-01

    Background Obesity is often associated with nonalcoholic fatty liver disease (NAFLD), which refers to a large spectrum of hepatic lesions including fatty liver, nonalcoholic steatohepatitis (NASH) and cirrhosis. Different investigations showed or suggested that obesity and NAFLD are able to increase the risk of hepatotoxicity of different drugs. Some of these drugs could induce more frequently an acute hepatitis in obese individuals whereas others could worsen pre-existing NAFLD. Aim The main objective of the present review was to collect the available information regarding the role of NAFLD as risk factor for drug-induced hepatotoxicity. For this purpose, we performed a data-mining analysis using different queries including drug-induced liver injury (or DILI), drug-induced hepatotoxicity, fatty liver, nonalcoholic fatty liver disease (or NAFLD), steatosis and obesity. The main data from the collected articles are reported in this review and when available, some pathophysiological hypotheses are put forward. Relevance for patients Drugs that could pose a potential risk in obese patients include compounds belonging to different pharmacological classes such as acetaminophen, halothane, methotrexate, rosiglitazone, stavudine and tamoxifen. For some of these drugs, experimental investigations in obese rodents confirmed the clinical observations and unveiled different pathophysiological mechanisms which could explain why these pharmaceuticals are particularly hepatotoxic in obesity and NAFLD. Other drugs such as pentoxifylline, phenobarbital and omeprazole might also pose a risk but more investigations are required to determine whether this risk is significant or not. Because obese people often take several drugs for the treatment of different obesity-related diseases such as type 2 diabetes, hyperlipidemia and coronary heart disease, it is urgent to identify the main pharmaceuticals that can cause acute hepatitis on a fatty liver background or induce NAFLD worsening

  6. Drug-disease association and drug-repositioning predictions in complex diseases using causal inference-probabilistic matrix factorization.

    PubMed

    Yang, Jihong; Li, Zheng; Fan, Xiaohui; Cheng, Yiyu

    2014-09-22

    The high incidence of complex diseases has become a worldwide threat to human health. Multiple targets and pathways are perturbed during the pathological process of complex diseases. Systematic investigation of complex relationship between drugs and diseases is necessary for new association discovery and drug repurposing. For this purpose, three causal networks were constructed herein for cardiovascular diseases, diabetes mellitus, and neoplasms, respectively. A causal inference-probabilistic matrix factorization (CI-PMF) approach was proposed to predict and classify drug-disease associations, and further used for drug-repositioning predictions. First, multilevel systematic relations between drugs and diseases were integrated from heterogeneous databases to construct causal networks connecting drug-target-pathway-gene-disease. Then, the association scores between drugs and diseases were assessed by evaluating a drug's effects on multiple targets and pathways. Furthermore, PMF models were learned based on known interactions, and associations were then classified into three types by trained models. Finally, therapeutic associations were predicted based upon the ranking of association scores and predicted association types. In terms of drug-disease association prediction, modified causal inference included in CI-PMF outperformed existing causal inference with a higher AUC (area under receiver operating characteristic curve) score and greater precision. Moreover, CI-PMF performed better than single modified causal inference in predicting therapeutic drug-disease associations. In the top 30% of predicted associations, 58.6% (136/232), 50.8% (31/61), and 39.8% (140/352) hit known therapeutic associations, while precisions obtained by the latter were only 10.2% (231/2264), 8.8% (36/411), and 9.7% (189/1948). Clinical verifications were further conducted for the top 100 newly predicted therapeutic associations. As a result, 21, 12, and 32 associations have been studied and

  7. Modifying pro-drug risk factors in adolescents: results from project ALERT.

    PubMed

    Ghosh-Dastidar, Bonnie; Longshore, Douglas L; Ellickson, Phyllis L; McCaffrey, Daniel F

    2004-06-01

    The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4276 eighth graders were assessed 18 months after baseline. Results indicate that Project ALERT had statistically significant effects on all the targeted risk factors associated with cigarette and marijuana use and more modest gains with the pro-alcohol risk factors. The program helped adolescents at low, moderate, and high risk for future use, with the effect sizes typically stronger for the low- and moderate-risk groups. Thus, school-based drug prevention programs can lower risk factors that correlate with drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

  8. 14 CFR 1267.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... workplace statement? 1267.205 Section 1267.205 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 1267.205 What must I include in my drug-free workplace statement? You...

  9. 13 CFR 147.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...-free workplace statement? 147.205 Section 147.205 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (NONPROCUREMENT) Requirements for Recipients Other Than Individuals § 147.205 What must I include in my drug-free workplace statement? You must...

  10. Exploring the Etiologic Factors and Dynamics of Prescription Drug Abuse in Southwest Virginia

    PubMed Central

    Redican, Kerry J; Marek, Lydia I; Brock, Donna JP; McCance-Katz, Elinore F

    2012-01-01

    Background: Prescription drug abuse in Southwest Virginia is a serious problem affecting indi-viduals, families, and communities. The aim of this study was to characterize and understand the extent of the prescription drug abuse problem in Southwest, Virginia as well as the dynamics that surround that abuse. More specifically, the study focused on learning the extent of the problem along with which prescription drugs are typically used prior to entering treatment, reasons for prescription drug and methadone abuse, and the sources for prescription drug use, misuse and abuse. Methods: Mixed methodology was employed which included surveying methadone clinic con-sumers at two treatment clinics in Southwest, Virginia and seven focus field interviews of key community stakeholders. Results: The extent of prescription drug abuse is high and that the demographics of prescription drug users are getting younger and now involve more males than females. Oxycodone, hydroco¬done, methadone, and morphine were the most commonly used drugs prior to enrollment in the clinics with over one-half of methadone-maintained consumers reporting that they had abused benzodiazepines along with opioids. Focus groups and clinic consumer data highlighted the key etiological factors in prescription drug abuse: use (due to workforce related injuries) turning to abuse, wanting to get high, overprescribing and physician issues, lack of information, and cultural acceptance of drug taking as problem solving behavior. The two most common sources for the abused prescription drugs were physicians and street dealers. Conclusions: A constellation of conditions have led to the epidemic of prescription drug abuse in Southwest Virginia, including poverty, unemployment and work-related injuries, besides, public health education programs on the dangers of prescription opiate misuse and abuse are urgently needed. PMID:24688929

  11. Factors associated with inability to access addiction treatment among people who inject drugs in Vancouver, Canada.

    PubMed

    Prangnell, Amy; Daly-Grafstein, Ben; Dong, Huiru; Nolan, Seonaid; Milloy, M-J; Wood, Evan; Kerr, Thomas; Hayashi, Kanna

    2016-02-25

    Addiction treatment is an effective strategy used to reduce drug-related harm. In the wake of recent developments in novel addiction treatment modalities, we conducted a longitudinal data analysis to examine factors associated with inability to access addiction treatment among a prospective cohort of persons who inject drugs (PWID). Data were derived from two prospective cohorts of PWID in Vancouver, Canada, between December 2005 and November 2013. Using multivariate generalized estimating equations, we examined factors associated with reporting an inability to access addiction treatment. In total, 1142 PWID who had not accessed any addiction treatment during the six months prior to interview were eligible for this study, including 364 women (31.9 %). Overall, 188 (16.5 %) reported having sought but were ultimately unsuccessful in accessing addiction treatment at least once during the study period. In multivariate analysis, factors independently and positively associated with reporting inability to access addiction treatment included: binge drug use (Adjusted Odds Ratio [AOR] = 1.65), being a victim of violence (AOR = 1.77), homelessness (AOR = 1.99), and having ever accessed addiction treatment (AOR = 2.33); while length of time injecting was negatively and independently associated (AOR = 0.98) (all p < 0.05). These findings suggest that sub-populations of PWID were more likely to report experiencing difficulty accessing addiction treatment, including those who may be entrenched in severe drug addiction and vulnerable to violence. It is imperative that additional resources go into ensuring treatment options are readily available when requested for these target populations.

  12. 28 CFR 83.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... workplace statement? 83.205 Section 83.205 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) GOVERNMENT-WIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (GRANTS) Requirements for Recipients Other Than Individuals § 83.205 What must I include in my drug-free workplace statement? You must publish a statement...

  13. 40 CFR 36.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... workplace statement? 36.205 Section 36.205 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 36.205 What must I include in my drug-free workplace...

  14. Pattern and risk factors for intentional drug overdose in Saudi Arabia.

    PubMed

    Al-Jahdali, Hamdan; Al-Johani, Abdulaziz; Al-Hakawi, Ahmad; Arabi, Yassen; Ahmed, Qanta A; Altowirky, Jamal; Al Moamary, Mohamed; Binsalih, Salih

    2004-05-01

    Attempted suicide by intentional drug overdose is an understudied subject in Saudi Arabia. Saudi Arabia is an Islamic country where suicide or attempted suicide is strictly prohibited. Despite the strong religious and constitutional sanctions against suicide, cases of intentional drug overdose occasionally occur. Our study represents the first attempt to better understand and characterize this sensitive topic. Using a retrospective chart review of patients aged 12 years and over with a diagnosis of intentional drug overdose between 1997 and 1999, we studied the demographic characteristics, the risk factors, the most commonly used drugs, and the resulting morbidities and mortalities of study subjects. Most of the patients were young (mean age 22 years, SD 4.6, range 15 to 40 years), and most were Saudi nationals (n = 76; 96%). Eighty percent of the patients were women. The occurrence of intentional drug overdose peaked during the month of September (that is, 20% of total cases). Previous suicide attempts, family conflicts, and psychiatric disorders represented significant risk factors. Single-agent overdose occurred in 30% of the patients, and most of the drugs used were prescribed medications (53%). Acetaminophen represented the most common drug (30%). While some patients required prolonged hospital stay or admission to the intensive care unit, no mortalities occurred. Intentional drug overdose is a relatively uncommon reason for hospital admission in Saudi Arabia. This study identifies certain risk factors relevant to the Saudi community and raises awareness about intentional drug overdose.

  15. Drug-induced corneal damage.

    PubMed

    2014-04-01

    Corneal damage can have a variety of causes, including infections, chemical splashes, environmental factors (radiation, trauma, contact lenses, etc.), and systemic diseases (genetic, autoimmune, inflammatory, metabolic, etc.). A wide range of drugs can also damage the cornea. The severity of drug-induced corneal changes can range from simple asymptomatic deposits to irreversible, sight-threatening damage. Several factors can influence the onset of corneal lesions. Some factors, such as the dose, are treatment-related, while others such as contact lenses, are patient-related. A variety of mechanisms may be involved, including corneal dryness, changes in the corneal epithelium, impaired wound healing and deposits. Many drugs can damage the cornea through direct contact, after intraocular injection or instillation, including VEGF inhibitors, anti-inflammatory drugs, local anaesthetics, glaucoma drugs, fluoroquinolones, and preservatives. Some systemically administered drugs can also damage the cornea, notably cancer drugs, amiodarone and isotretinoin. Vulnerable patients should be informed of this risk if they are prescribed a drug with the potential to damage the cornea so that they can identify problems in a timely manner. It may be necessary to discontinue the suspect drug when signs and symptoms of corneal damage occur.

  16. 10 CFR 607.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false What must I include in my drug-free workplace statement? 607.205 Section 607.205 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals...

  17. 34 CFR 84.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false What must I include in my drug-free workplace statement? 84.205 Section 84.205 Education Office of the Secretary, Department of Education GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals...

  18. 24 CFR 21.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... workplace statement? 21.205 Section 21.205 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (GRANTS) Requirements for Recipients Other Than Individuals § 21.205 What must I include in my drug-free workplace...

  19. Risk factors for early adolescent drug use in four ethnic and racial groups.

    PubMed

    Vega, W A; Zimmerman, R S; Warheit, G J; Apospori, E; Gil, A G

    1993-02-01

    It is widely believed that risk factors identified in previous epidemiologic studies accurately predict adolescent drug use. Comparative studies are needed to determine how risk factors vary in prevalence, distribution, sensitivity, and pattern across the major US ethnic/racial groups. Baseline questionnaire data from a 3-year epidemiologic study of early adolescent development and drug use were used to conduct bivariate and multivariate risk factor analyses. Respondents (n = 6760) were sixth- and seventh-grade Cuban, other Hispanic, Black, and White non-Hispanic boys in the 48 middle schools of the greater Miami (Dade County) area. Findings indicate 5% lifetime illicit drug use, 4% lifetime inhalant use, 37% lifetime alcohol use, and 21% lifetime tobacco use, with important intergroup differences. Monotonic relationships were found between 10 risk factors and alcohol and illicit drug use. Individual risk factors were distributed disproportionately, and sensitivity and patterning of risk factors varied widely by ethnic/racial subsample. While the cumulative prevalence of risk factors bears a monotonic relationship to drug use, ethnic/racial differences in risk factor profiles, especially for Blacks, suggest differential predictive value based on cultural differences.

  20. 31 CFR 20.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false What must I include in my drug-free workplace statement? 20.205 Section 20.205 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  1. 31 CFR 20.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false What must I include in my drug-free workplace statement? 20.205 Section 20.205 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  2. 31 CFR 20.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false What must I include in my drug-free workplace statement? 20.205 Section 20.205 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  3. 31 CFR 20.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false What must I include in my drug-free workplace statement? 20.205 Section 20.205 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  4. 31 CFR 20.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false What must I include in my drug-free workplace statement? 20.205 Section 20.205 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for...

  5. 43 CFR 43.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... workplace statement? 43.205 Section 43.205 Public Lands: Interior Office of the Secretary of the Interior GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 43.205 What must I include in my drug-free workplace statement? You must publish a statement...

  6. 15 CFR 29.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... workplace statement? 29.205 Section 29.205 Commerce and Foreign Trade Office of the Secretary of Commerce GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than Individuals § 29.205 What must I include in my drug-free workplace statement? You must publish a statement...

  7. 32 CFR 26.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false What must I include in my drug-free workplace... DoD GRANT AND AGREEMENT REGULATIONS GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL... workplace statement? You must publish a statement that— (a) Tells your employees that the unlawful...

  8. Social and Environmental Factors Influencing In-Prison Drug Use

    ERIC Educational Resources Information Center

    Woodall, James

    2012-01-01

    Purpose: There is a strong political imperative to regard the prison as a key social setting for health promotion, but evidence indicates that drug misuse continues to be a significant issue for many prisoners. This paper aims to examine the social and environmental factors within the setting that influence individuals' drug taking.…

  9. Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis.

    PubMed

    Andrès, E; Kurtz, J E; Perrin, A E; Dufour, P; Schlienger, J L; Maloisel, F

    2001-08-01

    Drug-induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony-stimulating factor (G-CSF) therapy in antithyroid-DIA. Data for 20 patients (10 treated with G-CSF) with antithyroid-DIA (neutrophil count <0.5x10(9)/l) were extracted from a cohort study of DIA patients (n=110). G-CSF (300 microg/day subcutaneously) was used where the neutrophil count was <0.1x10(9)/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34-87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20-60) and 100 mg/day (range 50-150), respectively, for a mean of 37 days (range 31-90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07+/-0.1x10(9)/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G-CSF: 6.8+/-4 days vs. 11.6+/-5; 7.5+/-3.8 days vs. 12+/-4.5; and 7.3+/-4.8 days vs. 13+/-6.1, respectively (all p<0.05). G-CSF induced flu-like symptoms in 30% of patients, but reduced overall costs.

  10. Considering the context: social factors in responses to drugs in humans.

    PubMed

    de Wit, Harriet; Sayette, Michael

    2018-04-01

    Drugs are typically used in social settings. Here, we consider two factors that may contribute to this observation: (i) the presence of other people may enhance the positive mood effects of a drug, and conversely, (ii) drugs may enhance the value of social stimuli. We review evidence from controlled laboratory studies with human volunteers, which investigated either of these interactions between social factors and responses to drugs. We examine the bidirectional effects of social stimuli and single doses of alcohol, stimulants, opioids, and cannabis. All four classes of drugs interact with social contexts, but the nature of these interactions varies across drugs, and depends on whether the context is positive or negative. Alcohol and stimulant drugs enhance the attractiveness of social stimuli and the desire to socialize, and social contexts, in turn, enhance these drugs' effects. In contrast, opioids and cannabis have subtler effects on social interactions and their effects are less influenced by the presence of others. Overall, there is stronger evidence that drugs enhance positive social contexts than that they dampen the negativity of unpleasant social settings. Controlled research is needed to understand the interactions between drugs of abuse and social contexts, to model and understand the determinants of drug use outside the laboratory.

  11. Factors associated with psychoactive drug initiation in a sample of workers in France: results of the VISAT cohort study.

    PubMed

    Boeuf-Cazou, O; Niezborala, M; Marquie, J C; Lapeyre-Mestre, M

    2010-03-01

    To identify which psychosocial factors at work are associated with the initiation of psychoactive drug use in a cohort of healthy French workers. This study used data collected from the VISAT ('Vieillissement, Santé, Travail') cohort which included workers aged 32, 42, 52 and 62 years in 1996 with follow-ups conducted over the following 5 years. Data were collected through interviews and five standardized questionnaires in annual occupational medical examinations in 1996, 1999 and 2001. We defined new consumers of psychoactive drugs according to their answers during the follow-ups and compared their psychosocial and working characteristics to non-consumers. A multivariate logistic regression analysis was performed to investigate factors related to a psychoactive drug initiation. Among 1533 subjects, 5.4% began consuming psychoactive drugs during the follow-up with a twofold rate for women than for men. Factors related to psychoactive drug initiation were different according to gender. In men, initiation was mainly found in participants who were separated, showed high emotional reaction scores and were members of the white-collar working class. We did not find any other occupational factors associated to psychoactive drug initiation in men. By contrast, among women, drug initiation was more frequent in participants who were 52 years old and over, and whose job control-reward level was lower. Psychoactive drug initiation concerned 5.4% of workers within the 5-year interval in this study. The pressure of psychosocial environment was more important in men, whereas age and work-related psychosocial factors were the main factors associated with new consumption among women.

  12. Drug-device combination products in the twenty-first century: epinephrine auto-injector development using human factors engineering.

    PubMed

    Edwards, Eric S; Edwards, Evan T; Simons, F Estelle R; North, Robert

    2015-05-01

    The systematic application of human factors engineering (HFE) principles to the development of drug-device combination products, including epinephrine auto-injectors (EAIs), has the potential to improve the effectiveness and safety of drug administration. A PubMed search was performed to assess the role of HFE in the development of drug-device combination products. The following keywords were used in different combinations: 'human factors engineering,' 'human factors,' 'medical products,' 'epinephrine/adrenaline auto-injector,' 'healthcare' and 'patient safety.' This review provides a summary of HFE principles and their application to the development of drug-device combination products as advised by the US FDA. It also describes the HFE process that was applied to the development of Auvi-Q, a novel EAI, highlighting specific steps that occurred during the product-development program. For drug-device combination products, device labeling and usability are critical and have the potential to impact clinical outcomes. Application of HFE principles to the development of drug-delivery devices has the potential to improve product quality and reliability, reduce risk and improve patient safety when applied early in the development process. Additional clinical and real-world studies will confirm whether the application of HFE has helped to develop an EAI that better meets the needs of patients at risk of anaphylaxis.

  13. 31 CFR 20.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false What must I include in my drug-free awareness program? 20.215 Section 20.215 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than...

  14. 31 CFR 20.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false What must I include in my drug-free awareness program? 20.215 Section 20.215 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than...

  15. 31 CFR 20.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false What must I include in my drug-free awareness program? 20.215 Section 20.215 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than...

  16. 31 CFR 20.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false What must I include in my drug-free awareness program? 20.215 Section 20.215 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than...

  17. 31 CFR 20.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false What must I include in my drug-free awareness program? 20.215 Section 20.215 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Other Than...

  18. Medical and drug risk factors associated with neuroblastoma: a case-control study.

    PubMed

    Kramer, S; Ward, E; Meadows, A T; Malone, K E

    1987-05-01

    A matched case-control study of prenatal risk factors for neuroblastoma was conducted, including 104 cases diagnosed over the period 1970-79 in the Greater Delaware Valley. Significantly elevated odds ratios (ORs) were associated with maternal use of a neurally active drug during pregnancy (OR = 2.83), sex hormone exposure 3 months prior to or during pregnancy (OR = 2.25), frequent alcohol consumption during pregnancy (OR = 9.0), and maternal use of diuretic drugs during pregnancy (OR = 5.75). Significantly more case mothers than control mothers reported use of hair coloring products during pregnancy (OR = 3.0). No association was found between cigarette smoking, coffee consumption, or medical irradiation and case-control status.

  19. Factors Associated with Drug Use among Youth Living in Homeless Shelters.

    ERIC Educational Resources Information Center

    Diaz, Tracy; Dusenbury, Linda; Botvin, Gilbert J.; Farmer-Huselid, Rebecca

    1997-01-01

    Examined predictors of tobacco, alcohol, and marijuana use with homeless adolescents and preadolescents (N=234). Results reveal that social influences (friends and family drug use) are strong predictors of experimental drug use and intentions to use drugs, as are several psychological factors (psychological well-being, assertiveness, and social…

  20. 'They don't look at what affects us': the role of ecodevelopmental factors on alcohol and drug use among Latinos with physical disabilities.

    PubMed

    Cordova, David; Parra-Cardona, Jose Ruben; Blow, Adrian; Johnson, Deborah J; Prado, Guillermo; Fitzgerald, Hiram E

    2015-01-01

    Objectives. Latinos with disabilities disproportionately report substance use, including binge drinking and drug use. Ecodevelopmental factors, including socioeconomic patterning of poverty, social exclusion, and post-colonial racism, have been shown to impact alcohol and drug use. However, this line of research remains underdeveloped among Latinos with disabilities. The purpose of this study was to obtain rich descriptions of the role of ecodevelopmental factors, including family and community, on alcohol and drug use among Latinos with physical disabilities. Methods. We utilized a community-based participatory research design, in conjunction with an innovative methodology referred to as photovoice. Three rounds of photography and focus group interviews were conducted with a total of 17 focus groups. Reflections in each focus group interview were aloud and digitally audiotaped. A total of 28 participants 19-35 years of age (mean age = 27.65, SD = 5.48) participated in each round of photography and focus group interviews. Data analyses followed the tenets of descriptive phenomenology. Results. Findings highlight ecodevelopmental family and community risk and protective factors. At the family level, participants reflected on the ways in which family functioning, including family support, communication, and cohesion, can serve as risk and promotive factors for alcohol and drug use. Additionally, participants described in detail how experiences of poverty, stigma and discrimination, violence, accessibility to alcohol and drugs, accessibility for persons with disabilities, transportation, community support and cohesion, and access to health and mental health services constitute risk and promotive factors at the community level. Conclusion. Findings are suggestive of how ecodevelopmental family and community factors might increase the risk of alcohol and drug use among Latinos with physical disabilities. From this qualitative research, we derive a series of testable

  1. Drugs Used in the Treatment of Rheumatoid Arthritis: Relationship between Current Use and Cardiovascular Risk Factors

    PubMed Central

    Rho, Young Hee; Oeser, Annette; Chung, Cecilia P; Milne, Ginger L; Stein, C Michael

    2009-01-01

    Objectives Drugs used for the treatment of rheumatoid arthritis (RA) have the potential to affect cardiovascular risk factors. There is concern that corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors could affect cardiovascular risk adversely, while drugs such as the antimalarial, hydroxychloroquine, may have beneficial effects. However, there is limited information about cardiovascular risk factors in patients with RA receiving different drugs. Methods We measured cardiovascular risk factors including systolic and diastolic blood pressure, serum HDL and LDL cholesterol, glucose and homocysteine concentrations and urinary F2-isoprostane excretion in 169 patients with RA. Risk factors were compared according to current use of corticosteroids, methotrexate, antimalarials, NSAIDs, COX-2 inhibitors, leflunomide and TNF-α blockers. Comparisons were adjusted for age, sex, race, disease activity (DAS28 score), current hypertension, diabetes, smoking status and statin use. Results No cardiovascular risk factor differed significantly among current users and non-users of NSAIDs, COX-2 inhibitors, methotrexate and TNF-α blockers. Serum HDL cholesterol concentrations were significantly higher in patients currently receiving corticosteroids (42.2 ± 10.5 vs. 50.2 ± 15.3 mg/dL, adjusted P < 0.001). Diastolic blood pressure (75.9 ± 11.2 vs. 72.0 ± 9.1 mm Hg, adjusted P = 0.02), serum LDL cholesterol (115.6 ± 34.7 vs. 103.7 ± 27.8 mg/dL, adjusted P = 0.03) and triglyceride concentrations (157.7 ± 202.6 vs. 105.5 ± 50.5 mg/dL, adjusted P = 0.03) were significantly lower in patients taking antimalarial drugs. Plasma glucose was significantly lower in current lefunomide users (93.0 ± 19.2 vs. 83.6 ± 13.4 mg/dL, adjusted P = 0.006). Conclusions In a cross-sectional setting drugs used to treat RA did not have major adverse effects on cardiovascular risk factors and use of antimalarials was associated with beneficial lipid profiles. PMID

  2. Factors associated with history of drug use among female sex workers (FSW) in a high HIV prevalence state of India.

    PubMed

    Medhi, Gajendra Kumar; Mahanta, Jagadish; Kermode, Michelle; Paranjape, Ramesh S; Adhikary, Rajatashuvra; Phukan, Sanjib Kumar; Ngully, P

    2012-04-05

    The intersection between illicit drug use and female commercial sex work has been identified as an important factor responsible for rising HIV prevalence among female sex workers (FSW) in several northeastern states of India. But, little is know about the factors associated with the use of drugs among FSWs in this region. The objective of the paper was to describe the factors associated with history of drug use among FSWs in Dimapur, an important commercial hub of Nagaland, which is a high HIV prevalence state of India. FSWs were recruited using respondent driven sampling (RDS), and were interviewed to collect data on socio-demographic characteristics and HIV risk behaviours. Biological samples were tested for HIV, syphilis gonorrhea and Chlamydia. Logistic regression analysis was performed to identify factors associated with drug use. Among the 426 FSWs in the study, about 25% (n = 107) reported having ever used illicit drugs. Among 107 illicit drug users, 83 (77.6%) were non-injecting and 24 (22.4%) were injecting drug users. Drug-using FSWs were significantly more likely to test positive for one or more STIs (59% vs. 33.5%), active syphilis (27.1% vs. 11.4%) and Chlamydia infection (30% vs. 19.9%) compared to their non-drug using peers. Drug-using FSWs were also significantly more likely to be currently married, widowed or separated compared with non-drug-using FSWs. In multiple logistic regression analysis, being an alcohol user, being married, having a larger volume of clients, and having sexual partners who have ever used or shared injecting drugs were found to be independently associated with illicit drug use. Drug-using FSWs were more vulnerable to STIs including HIV compared to their non-drug using peers. Several important factors associated with being an FSW who uses drugs were identified in this study and this knowledge can be used to plan more effectively targeted harm reduction strategies and programs.

  3. Factors influencing consumers' attitudinal and behavioral responses to direct-to-consumer and over-the-counter drug advertising.

    PubMed

    Lee, Mina; Whitehill King, Karen; Reid, Leonard N

    2015-04-01

    Using a model developed from the research literature, the authors compared consumers' attitudinal and behavioral responses to direct-to-consumer prescription drug advertising (DCTA) and over-the-counter nonprescription drug advertising (OTCA) of drugs. Adults 18 years of age and older who had taken any prescription drugs in the past 6 months completed online survey questionnaires. Variables measured included demographics (age, gender, race, education, and income), health-related characteristics (health status, prescription and over-the-counter drug use, health consciousness, and involvement with prescription or over-the-counter drugs), perceived amount of attention and exposure to DTCA and OTCA, attitudinal outcomes (skepticism toward DTCA/OTCA and attitude toward DTCA/OTCA), and behavioral outcomes triggered by DTCA and OTCA. The findings indicate that exposure to drug advertising is one of the most significant predictors of attitudinal and behavioral outcomes. Some audience factors such as health status, involvement with drugs, health consciousness, drug use, income, and age also were differentially associated with consumer responses to drug advertising.

  4. “They Don’t Look at What Affects Us”: The Role of Ecodevelopmental Factors on Alcohol and Drug Use among Latinos with Physical Disabilities

    PubMed Central

    Cordova, David; Parra-Cardona, J. Ruben; Blow, Adrian; Johnson, Deborah J.; Prado, Guillermo; Fitzgerald, Hiram E.

    2014-01-01

    Objectives Latinos with disabilities disproportionately report substance use, including binge drinking and drug use. Ecodevelopmental factors, including socioeconomic patterning of poverty, social exclusion and post-colonial racism, have been shown to impact alcohol and drug use. However, this line of research remains under-developed among Latinos with disabilities. The purpose of this study was to obtain rich descriptions of the role of ecodevelopmental factors, including family and community, on alcohol and drug use among Latinos with physical disabilities. Methods We utilized a community-based participatory research design, in conjunction with an innovative methodology referred to as photovoice. Three rounds of photography and focus group interviews were conducted with a total of 17 focus groups. Reflections in each focus group interview were aloud and digitally audiotaped. A total of 28 participants 19–35 years of age (mean age= 27.65, SD= 5.48) participated in each round of photography and focus group interviews. Data analyses followed the tenets of descriptive phenomenology. Results Findings highlight ecodevelopmental family and community risk and protective factors. At the family level, participants reflected on the ways in which family functioning, including family support, communication and cohesion, can serve as risk and promotive factors for alcohol and drug use. Additionally, participants described in detail how experiences of poverty, stigma and discrimination, violence, accessibility to alcohol and drugs, accessibility for persons with disabilities, transportation, community support and cohesion, and access to health and mental health services constitute risk and promotive factors at the community level. Conclusion Findings are suggestive of how ecodevelopmental family and community factors might increase the risk for alcohol and drug use among Latinos with physical disabilities. From this qualitative research, we derive a series of testable

  5. Drug use prevention: factors associated with program implementation in Brazilian urban schools.

    PubMed

    Pereira, Ana Paula Dias; Sanchez, Zila M

    2018-03-07

    A school is a learning environment that contributes to the construction of personal values, beliefs, habits and lifestyles, provide convenient settings for the implementation of drug use prevention programs targeting adolescents, who are the population group at highest risk of initiating drug use. The objective of the present study was to investigate the prevalence of factors associated with implementing drug use prevention programs in Brazilian public and private middle and high urban schools. The present population-based cross-sectional survey was conducted with a probability sample of 1151 school administrators stratified by the 5 Brazilian administrative divisions, in 2014. A close-ended, self-reported online questionnaire was used. Logistic regression analysis was used to identify factors associated with implementing drug use prevention programs in schools. A total of 51.1% of the schools had adopted drug use prevention programs. The factors associated with program implementation were as follows: belonging to the public school network; having a library; development of activities targeting sexuality; development of "Health at School Program" activities; offering extracurricular activities; and having an administrator that participated in training courses on drugs. The adoption of drug use prevention practices in Brazilian schools may be expanded with greater orchestration of schools through specialized training of administrators and teachers, expansion of the School Health Program and concomitant development of the schools' structural and curricular attributes.

  6. Association of Immune Factors with Drug-Resistant Tuberculosis: A Case-Control Study

    PubMed Central

    Sun, En-Tao; Xia, Dan; Li, Ben-He; Ma, Jun; Dong, Yuan-Yuan; Ding, Shu-Shu; Chen, Bai-Feng; Wen, Yu-Feng

    2017-01-01

    Background Presently, studies of factors associated with drug-resistant tuberculosis (TB) focus on patients’ socio-demographic characteristics and living habits, to the exclusion of biochemical indicators, especially immune factors. This study was carried out to determine whether immune factors are associated with drug-resistant TB. Material/Methods A total of 227 drug-resistant pulmonary TB patients and 225 drug-susceptible pulmonary TB patients were enrolled in this study. Information on socio-demographic characteristics and biochemical indicators were obtained through their clinical records. Non-conditional logistic regression was used to analyze the association of these indicators with drug-resistant TB. Results There were significant differences in re-treatment, marital status, alanine aminotransferase (ALT), blood uric acid (BUA), carcino-embryonic antigen (CEA), T-spot, and CD3 and CD4 counts between the 2 groups. In multivariable analysis, re-treatment [Odds Ratio (OR)=5.290, 95% Confidence Interval [CI]=2.652–10.551); CD3 (OR=1.034, 95% CI=1.001–1.068); CD4 (OR=1.035, 95% CI =1.001–1.070) and IgM (OR=1.845, 95% CI=1.153–2.952) were associated with drug-resistant TB. Conclusions These results suggest the need for greater attention to re-treatment cases and immune function when treating drug-resistant TB. PMID:29118314

  7. Antiretroviral Use Among Active Injection-Drug Users: The Role of Patient–Provider Engagement and Structural Factors

    PubMed Central

    Arnsten, Julia H.; Eldred, Lois J.; Wilkinson, James D.; Shade, Starley B.; Bohnert, Amy S.; Yang, Cui; Wissow, Lawrence S.; Purcell, David W.

    2010-01-01

    Abstract HIV-seropositive, active injection-drug users (IDUs), compared with other HIV populations, continue to have low rates of highly active antiretroviral therapy (HAART) use, contributing to disparities in their HIV health outcomes. We sought to identify individual-level, interpersonal, and structural factors associated with HAART use among active IDUs to inform comprehensive, contextually tailored intervention to improve the HAART use of IDUs. Prospective data from three semiannual assessments were combined, and logistic general estimating equations were used to identify variables associated with taking HAART 6 months later. Participants were a community sample of HIV-seropositive, active IDUs enrolled in the INSPIRE study, a U.S. multisite (Baltimore, Miami, New York, San Francisco) prevention intervention. The analytic sample included 1,225 observations, and comprised 62% males, 75% active drug users, 75% non-Hispanic blacks, and 55% with a CD4 count <350; 48% reported HAART use. Adjusted analyses indicated that the later HAART use of IDUs was independently predicted by patient–provider engagement, stable housing, medical coverage, and more HIV primary care visits. Significant individual factors included not currently using drugs and a positive attitude about HAART benefits even if using illicit drugs. Those who reported patient-centered interactions with their HIV primary care provider had a 45% greater odds of later HAART use, and those with stable housing had twofold greater odds. These findings suggest that interventions to improve the HIV treatment of IDUs and to reduce their HIV health disparities should be comprehensive, promoting better patient–provider engagement, stable housing, HAART education with regard to illicit drug use, and integration of drug-abuse treatment with HIV primary care. PMID:20578910

  8. Drug Abuse Education Program. Drug Abuse Education, Grades 5,7,9. Bibliography Included.

    ERIC Educational Resources Information Center

    Baltimore City Public Schools, MD.

    A drug abuse education program was implemented in grades five, seven, and nine in the Baltimore City Public Schools. Unit plans outline the curriculum content and learning activities for each of the three grades. The major objective in grade five is to familiarize pupils with various medically used drugs and to develop an understanding that they…

  9. Multifunctional mesoporous bioactive glasses for effective delivery of therapeutic ions and drug/growth factors.

    PubMed

    Wu, Chengtie; Chang, Jiang

    2014-11-10

    Regeneration of large-size bone defects represents a significant challenge clinically, which requires the use of scaffolds with multifunction, such as anti-bacterial activity, and stimulation of osteogenesis and angiogenesis. It is known that functional ions or drug/growth factors play an important role to stimulate tissue regeneration. Mesoporous bioactive glasses (MBG) possess excellent bioactivity and drug-delivery ability as well as effective ionic release in the body fluids microenvironment due to its specific mesoporous structure and large surface area. For these reasons, functional ions (e.g. lithium (Li), strontium (Sr), Copper (Cu) and Boron (B)) and drug/growth factors (e.g. dexamethasone, vascular endothelial growth factor (VEGF) and bone morphogenetic protein (BMP)) have been incorporated into MBG, which shows high loading efficiency and effective release. The release of therapeutic ions and drug/growth factors from MBG offers it multifunctional properties, such as improved osteogenesis, angiogenesis, anti-bacterial/cancer activity. However, there is no a systematic review about delivery of therapeutic ions and drugs/growth factors from MBG for the functional effect on the tissue regeneration despite that significant progress has been achieved in the past five years. Therefore, in this review, we mainly focused on the new advances for the functional effect of delivering therapeutic ions and drugs/growth factors on the ostegeogenesis, angiogenesis and antibacterial activity. It is expected that the review will offer new concept to develop multifunctional biomaterials for bone regeneration by the synergistic effect of therapeutic ions and drug/growth factors. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Factors Associated With American Indian and White Adolescent Drug Selling in Rural Communities

    PubMed Central

    Eitle, David; Eitle, Tamela McNulty

    2014-01-01

    Relatively few studies have examined the correlates of adolescent drug selling in America, with most of these studies focusing on urban settings. The present study examines the risk and protective factors associated with drug selling among American Indian and white adolescents residing in a rural Northwestern state in the United States. Using survey data collected in 2010-2012, we conduct logistic regression analyses exploring the correlates of drug selling (n=568). Generally, we found support for prior explanations of drug selling, but identified some important race-specific differences. Specifically, we found that stress exposure was a risk factor for American Indians, but not whites. Conversely, academic achievement served as a protective factor for white adolescents but not American Indians. Our findings suggest that the race gap in rural drug selling can be explained by considering differences in social bonds, stress exposure, and exposure to substance using family and friends. PMID:26120365

  11. Factors influencing the preference for purchasing generic drugs in a Southern Brazilian city

    PubMed Central

    Guttier, Marília Cruz; Silveira, Marysabel Pinto Telis; Luiza, Vera Lucia; Bertoldi, Andréa Dâmaso

    2017-01-01

    ABSTRACT OBJECTIVE The objective of this study is to identify factors associated with the preference for purchasing generic drugs in a medium-sized municipality in Southern Brazil. METHODS We have analyzed data from a population-based cross-sectional study conducted in 2012 with a sample of 2,856 adults (≥ 20 years old). The preference for purchasing generic drugs was the main outcome. The explanatory variables were the demographic and socioeconomic variables. Statistical analyses included Poisson regressions. RESULTS The preference for purchasing generic drugs was 63.2% (95%CI 61.4–64.9). The variables correlated with this preference in the fully adjusted models were: male (prevalence ratio [PR] = 1.08; 95%CI 1.03–1.14), age of 20–39 years (PR = 1.10; 95%CI 1.02–1.20), low socioeconomic status (PR = 1.15; 95%CI 1.03–1.28), and good knowledge about generic drugs (PR= 4.66; 95%CI 2.89–7.52). Among those who preferred to purchase generic drugs, 55.1% have reported accepting to replace the prescribed drug (if not a generic) with the equivalent generic drug. Another correlate of the preference for purchasing generic drugs was because individuals consider their quality equivalent to reference medicines (PR = 2.15; 95%CI 1.93–2.41). CONCLUSIONS Knowledge about generic drugs was the main correlate of the preference for purchasing generic drugs. The greater the knowledge or positive perception about generic drugs, the greater is the preference to purchase them. Therefore, educational campaigns for healthcare professionals and consumers appear to be the best strategy for expanding the use of generic drugs in Brazil. PMID:28678909

  12. Factors influencing the preference for purchasing generic drugs in a Southern Brazilian city.

    PubMed

    Guttier, Marília Cruz; Silveira, Marysabel Pinto Telis; Luiza, Vera Lucia; Bertoldi, Andréa Dâmaso

    2017-06-26

    The objective of this study is to identify factors associated with the preference for purchasing generic drugs in a medium-sized municipality in Southern Brazil. We have analyzed data from a population-based cross-sectional study conducted in 2012 with a sample of 2,856 adults (≥ 20 years old). The preference for purchasing generic drugs was the main outcome. The explanatory variables were the demographic and socioeconomic variables. Statistical analyses included Poisson regressions. The preference for purchasing generic drugs was 63.2% (95%CI 61.4-64.9). The variables correlated with this preference in the fully adjusted models were: male (prevalence ratio [PR] = 1.08; 95%CI 1.03-1.14), age of 20-39 years (PR = 1.10; 95%CI 1.02-1.20), low socioeconomic status (PR = 1.15; 95%CI 1.03-1.28), and good knowledge about generic drugs (PR= 4.66; 95%CI 2.89-7.52). Among those who preferred to purchase generic drugs, 55.1% have reported accepting to replace the prescribed drug (if not a generic) with the equivalent generic drug. Another correlate of the preference for purchasing generic drugs was because individuals consider their quality equivalent to reference medicines (PR = 2.15; 95%CI 1.93-2.41). Knowledge about generic drugs was the main correlate of the preference for purchasing generic drugs. The greater the knowledge or positive perception about generic drugs, the greater is the preference to purchase them. Therefore, educational campaigns for healthcare professionals and consumers appear to be the best strategy for expanding the use of generic drugs in Brazil.

  13. Projecting future drug expenditures--2006.

    PubMed

    Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Schumock, Glen T; Grim, Penny; Hunkler, Robert J; Hontz, Karrie M

    2006-01-15

    Drug expenditure trends in 2004 and 2005, projected drug expenditures for 2006, and factors likely to influence drug costs are discussed. Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2004 there was a continued moderation of the increase in drug expenditures. Drug expenditures increased by 8.7% from 2003 to 2004. Through the first nine months of 2005, expenditures increased by only 8.1% compared with 2004. This moderation can be attributed to several factors, including the continued trend toward higher prescription drug cost sharing for insured consumers, growing availability of generic drugs, and lack of "blockbuster" new drugs in recent years. Drug expenditures in 2006 will likely be influenced by similar factors, with few costly new products reaching the market, increased concern over product safety slowing the diffusion of those new agents that do reach the market, and several important patent expirations, leading to slower growth in expenditures. Forecasting and managing rising drug expenditures remains a challenge. Pharmacy managers must remain vigilant in monitoring drug costs in their health system and take a proactive role in pursuing efficient drug utilization. The dynamic health policy environment further complicates drug budgeting and must be considered, especially in integrated health systems responsible for managing inpatient, outpatient, and clinic drug costs. The comparison of health-system-specific data and trends with the national information presented in this article may provide a useful context when presenting institutional drug costs to senior management.

  14. Identifying Risk Factors for Drug Use in an Iranian Treatment Sample: A Prediction Approach Using Decision Trees.

    PubMed

    Amirabadizadeh, Alireza; Nezami, Hossein; Vaughn, Michael G; Nakhaee, Samaneh; Mehrpour, Omid

    2018-05-12

    Substance abuse exacts considerable social and health care burdens throughout the world. The aim of this study was to create a prediction model to better identify risk factors for drug use. A prospective cross-sectional study was conducted in South Khorasan Province, Iran. Of the total of 678 eligible subjects, 70% (n: 474) were randomly selected to provide a training set for constructing decision tree and multiple logistic regression (MLR) models. The remaining 30% (n: 204) were employed in a holdout sample to test the performance of the decision tree and MLR models. Predictive performance of different models was analyzed by the receiver operating characteristic (ROC) curve using the testing set. Independent variables were selected from demographic characteristics and history of drug use. For the decision tree model, the sensitivity and specificity for identifying people at risk for drug abuse were 66% and 75%, respectively, while the MLR model was somewhat less effective at 60% and 73%. Key independent variables in the analyses included first substance experience, age at first drug use, age, place of residence, history of cigarette use, and occupational and marital status. While study findings are exploratory and lack generalizability they do suggest that the decision tree model holds promise as an effective classification approach for identifying risk factors for drug use. Convergent with prior research in Western contexts is that age of drug use initiation was a critical factor predicting a substance use disorder.

  15. The Drug Problem.

    ERIC Educational Resources Information Center

    Gose, Ben

    1995-01-01

    Drug law violations have risen sharply on college campuses, but officials disagree on the reason. Some students feel administrators are invading their privacy. The trend is attributed to several factors, including changes in how violations are counted, reduced tolerance of increased drug use by non-drug-using students, and more vigorous…

  16. Risk factors for adverse drug reactions in pediatric inpatients: A cohort study.

    PubMed

    Andrade, Paulo Henrique Santos; Lobo, Iza Maria Fraga; da Silva, Wellington Barros

    2017-01-01

    The present study aims to identify the risk factors for adverse drug reactions (ADR) in pediatric inpatients. A prospective cohort study in one general pediatric ward in a hospital in Northeast Brazil was conducted in two stages: the first stage was conducted between August 17th and November 6th, 2015, and the second one between March 1st and August 25th, 2016. We included children aged 0-14 years 11 months hospitalized with a minimum stay of 48 hours. Observed outcomes were the ADR occurrence and the time until the first ADR observed. In the univariate analysis, the time to the first ADR was compared among groups using a log-rank test. For the multivariate analysis, the Cox regression model was used. A total of 173 children (208 admissions) and 66 ADR classified as "definite" and "probable" were identified. The incidence rate was 3/100 patient days. The gastro-intestinal system disorders were the main ADR observed (28.8%). In addition, 22.7% of the ADR were related to antibacterials for systemic use and 15.2% to general anesthesia. Prior history of ADR of the child [hazard ratio (HR) 2.44; 95% confidence interval (CI) 1.19-5.00], the use of meglumine antimonate (HR 4.98; 95% CI 1.21-20.54), antibacterial for systemic use (HR 2.75; 95% CI 1.08-6.98) and antiepileptic drugs (HR 3.84; 95% CI 1.40-10.56) were identified risk factors for ADR. We identified as risk factors the prior history of ADR of the child and the use of meglumine antimonate, antibacterial for systemic use and antiepileptic drugs.

  17. Factors influencing family physicians' drug prescribing behaviour in asthma management in primary care.

    PubMed

    Tan, N C; Tay, I H; Ngoh, A; Tan, M

    2009-03-01

    Little is known about the decision pathway that family physicians (FP) take in considering drug therapy for their asthma patients. This study aimed to explore the factors that influence FPs' decisions in prescribing medications for their asthma patients. A qualitative method using focus group discussions (FGD) was used to gather qualitative data based on a semi-structured topic guide from FPs of different training backgrounds and practices. 29 Singapore FPs working as private general practitioners (GP), polyclinic doctors and locums were recruited into five FGDs. The FPs' asthma drug prescription decisions were related to the FPs' medical training and acquisition of asthma-related information and updates. Uncertainty of disease diagnosis, patients' beliefs and their perceptions of the disease and treatment, as well as the FPs' concerns about drug side effects, were significant considerations for the participants. Costs related to differential subsidies in the consultation fees and drugs between public polyclinics and GP clinics in the local primary healthcare system, was a key factor in influencing the FPs' asthma drug treatment decisions. FPs' asthma drug prescribing behaviour is influenced by their medical training, disease definition, patient factors and drug costs in the context of the local primary healthcare system and policy.

  18. Advising depression patients to reduce alcohol and drug use: factors associated with provider intervention in outpatient psychiatry.

    PubMed

    Satre, Derek D; Leibowitz, Amy S; Mertens, Jennifer R; Weisner, Constance

    2014-01-01

    Mental health clinicians have an important opportunity to help depression patients reduce co-occurring alcohol and drug use. This study examined demographic and clinical patient characteristics and service factors associated with receiving a recommendation to reduce alcohol and drug use from providers in a university-based outpatient psychiatry clinic. The sample consisted of 97 participants ages 18 and older who reported hazardous drinking (≥3 drinks/occasion), illegal drug use (primarily cannabis) or misuse of prescription drugs, and who scored ≥15 on the Beck Depression Inventory-II (BDI-II). Participants were interviewed at intake and 6 months. At 6-month telephone interview, 30% of participants reported that a clinic provider had recommended that they reduce alcohol or drug use. In logistic regression, factors associated with receiving advice to reduce use included greater number of drinks consumed in the 30 days prior to intake (p = .035); and greater depression severity on the BDI-II (p = .096) and hazardous drinking at 6 months (p = .05). While participants with greater alcohol intake and depression symptom severity were more likely to receive advice to reduce use, the low overall rate of recommendation to reduce use highlights the need to improve alcohol and drug use intervention among depression patients, and potentially to address alcohol and drug training and treatment implementation issues among mental health providers. © American Academy of Addiction Psychiatry.

  19. Determinants of drug costs in hopitalised patients with haemophilia: impact of recombinant activated factor VII.

    PubMed

    Galanaud, Jean Philippe; Pelletier-Fleury, Nathalie; Logerot-Lebrun, Hélène; Lambert, Thierry

    2003-01-01

    To analyse the determinants of anti-haemophilic drug costs in hospitalised patients with haemophilia and to estimate the impact of recombinant activated factor VII (rFVIIa) therapy on this expenditure. The perspective of the study was from the viewpoint of the hospital. A prospective study was carried out. All patients with haemophilia who were hospitalised in 1999 in Bicêtre public hospital, Paris, France were included in the cohort. For each of the 96 patients (154 hospital stays), we estimated the costs of anti-haemophilic drugs (coagulation concentrates) used. Costs were then stratified by different variables (severity of the disease, presence of a circulating inhibitor to coagulation factors, etc.) and a multivariate model was developed to determine the relationship between these variables and total anti-haemophilic drug costs, while controlling for potential confounders. Our study revealed: (i) the independent role of the five following variables in contributing to high anti-haemophilic drug expenditure: presence of a circulating inhibitor to coagulation factors, odds ratio (OR) = 16.9 (95% CI: 4.3-66); severity of the disease (factor VIII or factor IX < or =0.01 IU/mL), OR = 3.7 (95% CI: 1.6-8.6); length of hospital stay >4 days, OR = 8 (95% CI: 2.2-29.4); age >18 years old, OR = 6.2 (95% CI: 1.6-24.5); and surgical reasons for hospitalisation (whether surgery was haemophilia related [OR = 35.7 (95% CI: 7.3-175)] or not [OR = 5.4 (95% CI: 1.3-22.5)]); (ii) the large share that rFVIIa represented in this expenditure on medicines: rFVIIa was used in 20.1% of hospital stays and accounted for 56.2% of the total anti-haemophilic drug costs, which were estimated at 4,384,732 Euros (2000 values). Our data underline the heavy cost of the treatment of haemophilic patients with an inhibitor to coagulation factors. But, to the question of whether the high expenditure linked to rFVIIa utilisation will be balanced out by later benefits, it is not yet possible to reply

  20. Which factors predict the time spent answering queries to a drug information centre?

    PubMed Central

    Reppe, Linda A.; Spigset, Olav

    2010-01-01

    Objective To develop a model based upon factors able to predict the time spent answering drug-related queries to Norwegian drug information centres (DICs). Setting and method Drug-related queries received at 5 DICs in Norway from March to May 2007 were randomly assigned to 20 employees until each of them had answered a minimum of five queries. The employees reported the number of drugs involved, the type of literature search performed, and whether the queries were considered judgmental or not, using a specifically developed scoring system. Main outcome measures The scores of these three factors were added together to define a workload score for each query. Workload and its individual factors were subsequently related to the measured time spent answering the queries by simple or multiple linear regression analyses. Results Ninety-six query/answer pairs were analyzed. Workload significantly predicted the time spent answering the queries (adjusted R2 = 0.22, P < 0.001). Literature search was the individual factor best predicting the time spent answering the queries (adjusted R2 = 0.17, P < 0.001), and this variable also contributed the most in the multiple regression analyses. Conclusion The most important workload factor predicting the time spent handling the queries in this study was the type of literature search that had to be performed. The categorisation of queries as judgmental or not, also affected the time spent answering the queries. The number of drugs involved did not significantly influence the time spent answering drug information queries. PMID:20922480

  1. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

    PubMed

    Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

    2017-05-22

    Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to

  2. Factors associated with relapse into drug use among male and female attendees of a three-month drug detoxification–rehabilitation programme in Dhaka, Bangladesh: a prospective cohort study

    PubMed Central

    2013-01-01

    Background To determine relapse rates and associated factors among people who use drugs (PWUDs) attending abstinence-oriented drug treatment clinics in Dhaka, Bangladesh. Methods A cohort of male and female PWUDs admitted to the 3-month drug detoxification-rehabilitation treatment programmes of three non-governmental organisation-run drug treatment clinics in Dhaka, Bangladesh were interviewed on admission and over the following 5 months, which included the first 2 months after discharge. The study subjects comprised 150 male and 110 female PWUDs who had been taking opiates/opioids, cannabis or other drugs (including sedatives) before admission, had provided informed consent and were aged ≥16 years. Interviews were conducted using semi-structured questionnaires at four time points; on admission, at discharge and at 1 and 2 months after discharge. Relapse rates were assessed by the Kaplan–Meier method. Factors associated with relapse on enrolment and after discharge were determined using the Cox proportional hazards regression model. Results A greater proportion of female than male subjects relapsed over the study period (71.9% versus 54.5%, p < 0.01). For men, baseline factors associated with relapse were living with other PWUDs (relative hazard ratio [RHR] = 2.27), living alone (RHR = 2.35) and not having sex with non-commercial partners (RHR = 2.27); whereas for women these were previous history of drug treatment (RHR = 1.94), unstable housing (RHR = 2.44), higher earnings (RHR = 1.89), preferring to smoke heroin (RHR = 3.62) and injecting buprenorphine/pethidine (RHR = 3.00). After discharge, relapse for men was associated with unstable housing (RHR = 2.78), living alone (RHR = 3.69), higher earnings (RHR = 2.48) and buying sex from sex workers (RHR = 2.29). Women’ relapses were associated with not having children to support (RHR = 3.24) and selling sex (RHR = 2.56). Conclusions The relapse rate was higher for female PWUDs. For both male and female

  3. Drug-Target Kinetics in Drug Discovery.

    PubMed

    Tonge, Peter J

    2018-01-17

    The development of therapies for the treatment of neurological cancer faces a number of major challenges including the synthesis of small molecule agents that can penetrate the blood-brain barrier (BBB). Given the likelihood that in many cases drug exposure will be lower in the CNS than in systemic circulation, it follows that strategies should be employed that can sustain target engagement at low drug concentration. Time dependent target occupancy is a function of both the drug and target concentration as well as the thermodynamic and kinetic parameters that describe the binding reaction coordinate, and sustained target occupancy can be achieved through structural modifications that increase target (re)binding and/or that decrease the rate of drug dissociation. The discovery and deployment of compounds with optimized kinetic effects requires information on the structure-kinetic relationships that modulate the kinetics of binding, and the molecular factors that control the translation of drug-target kinetics to time-dependent drug activity in the disease state. This Review first introduces the potential benefits of drug-target kinetics, such as the ability to delineate both thermodynamic and kinetic selectivity, and then describes factors, such as target vulnerability, that impact the utility of kinetic selectivity. The Review concludes with a description of a mechanistic PK/PD model that integrates drug-target kinetics into predictions of drug activity.

  4. Update on medical and regulatory issues pertaining to compounded and FDA-approved drugs, including hormone therapy

    PubMed Central

    Pinkerton, JoAnn V.; Pickar, James H.

    2016-01-01

    Abstract Objective: We review the historical regulation of drug compounding, concerns about widespread use of non-Food and Drug Admiistration (FDA)-approved compounded bioidentical hormone therapies (CBHTs), which do not have proper labeling and warnings, and anticipated impact of the 2013 Drug Quality and Security Act (DQSA) on compounding. Methods: US government websites were searched for documents concerning drug compounding regulation and oversight from 1938 (passage of Federal Food, Drug, and Cosmetic Act [FDCA]) through 2014, including chronologies, Congressional testimony, FDA guidelines and enforcements, and reports. The FDCA and DQSA were reviewed. PubMed and Google were searched for articles on compounded drugs, including CBHT. Results: Congress explicitly granted the FDA limited oversight of compounded drugs in a 1997 amendment to the FDCA, but the FDA has encountered obstacles in exercising that authority. After 64 patient deaths and 750 adversely affected patients from the 2012 meningitis outbreak due to contaminated compounded steroid injections, Congress passed the DQSA, authorizing the FDA to create a voluntary registration for facilities that manufacture and distribute sterile compounded drugs in bulk and reinforcing FDCA regulations for traditional compounding. Given history and current environment, concerns remain about CBHT product regulation and their lack of safety and efficacy data. Conclusions: The DQSA and its reinforcement of §503A of the FDCA solidifies FDA authority to enforce FDCA provisions against compounders of CBHT. The new law may improve compliance and accreditation by the compounding industry; support state and FDA oversight; and prevent the distribution of misbranded, adulterated, or inconsistently compounded medications, and false and misleading claims, thus reducing public health risk. PMID:26418479

  5. The processivity factor complex of feline herpes virus-1 is a new drug target.

    PubMed

    Zhukovskaya, Natalia L; Guan, Hancheng; Saw, Yih Ling; Nuth, Manunya; Ricciardi, Robert P

    2015-03-01

    Feline herpes virus-1 (FHV-1) is ubiquitous in the cat population and is a major cause of blindness for which antiviral drugs, including acyclovir, are not completely effective. Recurrent infections, due to reactivation of latent FHV-1 residing in the trigeminal ganglia, can lead to epithelial keratitis and stromal keratitis and eventually loss of sight. This has prompted the medical need for an antiviral drug that will specifically inhibit FHV-1 infection. A new antiviral target is the DNA polymerase and its associated processivity factor, which forms a complex that is essential for extended DNA strand synthesis. In this study we have cloned and expressed the FHV-1 DNA polymerase (f-UL30) and processivity factor (f-UL42) and demonstrated that both proteins are required to completely synthesize the 7249 nucleotide full-length DNA from the M13 primed-DNA template in vitro. Significantly, a known inhibitor of human herpes simplex virus-1 (HSV-1) processivity complex was shown to inhibit FHV-1 processive DNA synthesis in vitro and block infection of cells. This validates using f-UL42/f-UL30 as a new antiviral drug target to treat feline ocular herpes infection. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Anti-inflammatory drugs for Duchenne muscular dystrophy: focus on skeletal muscle-releasing factors.

    PubMed

    Miyatake, Shouta; Shimizu-Motohashi, Yuko; Takeda, Shin'ichi; Aoki, Yoshitsugu

    2016-01-01

    Duchenne muscular dystrophy (DMD), an incurable and a progressive muscle wasting disease, is caused by the absence of dystrophin protein, leading to recurrent muscle fiber damage during contraction. The inflammatory response to fiber damage is a compelling candidate mechanism for disease exacerbation. The only established pharmacological treatment for DMD is corticosteroids to suppress muscle inflammation, however this treatment is limited by its insufficient therapeutic efficacy and considerable side effects. Recent reports show the therapeutic potential of inhibiting or enhancing pro- or anti-inflammatory factors released from DMD skeletal muscles, resulting in significant recovery from muscle atrophy and dysfunction. We discuss and review the recent findings of DMD inflammation and opportunities for drug development targeting specific releasing factors from skeletal muscles. It has been speculated that nonsteroidal anti-inflammatory drugs targeting specific inflammatory factors are more effective and have less side effects for DMD compared with steroidal drugs. For example, calcium channels, reactive oxygen species, and nuclear factor-κB signaling factors are the most promising targets as master regulators of inflammatory response in DMD skeletal muscles. If they are combined with an oligonucleotide-based exon skipping therapy to restore dystrophin expression, the anti-inflammatory drug therapies may address the present therapeutic limitation of low efficiency for DMD.

  7. Anti-inflammatory drugs for Duchenne muscular dystrophy: focus on skeletal muscle-releasing factors

    PubMed Central

    Miyatake, Shouta; Shimizu-Motohashi, Yuko; Takeda, Shin’ichi; Aoki, Yoshitsugu

    2016-01-01

    Duchenne muscular dystrophy (DMD), an incurable and a progressive muscle wasting disease, is caused by the absence of dystrophin protein, leading to recurrent muscle fiber damage during contraction. The inflammatory response to fiber damage is a compelling candidate mechanism for disease exacerbation. The only established pharmacological treatment for DMD is corticosteroids to suppress muscle inflammation, however this treatment is limited by its insufficient therapeutic efficacy and considerable side effects. Recent reports show the therapeutic potential of inhibiting or enhancing pro- or anti-inflammatory factors released from DMD skeletal muscles, resulting in significant recovery from muscle atrophy and dysfunction. We discuss and review the recent findings of DMD inflammation and opportunities for drug development targeting specific releasing factors from skeletal muscles. It has been speculated that nonsteroidal anti-inflammatory drugs targeting specific inflammatory factors are more effective and have less side effects for DMD compared with steroidal drugs. For example, calcium channels, reactive oxygen species, and nuclear factor-κB signaling factors are the most promising targets as master regulators of inflammatory response in DMD skeletal muscles. If they are combined with an oligonucleotide-based exon skipping therapy to restore dystrophin expression, the anti-inflammatory drug therapies may address the present therapeutic limitation of low efficiency for DMD. PMID:27621596

  8. Factor Analysis of the Alcohol and Drug Confrontation Scale (ADCS)

    PubMed Central

    Polcin, Douglas L.; Galloway, Gantt P.; Bostrom, Alan; Greenfield, Thomas K.

    2007-01-01

    The Alcohol and Drug Confrontation Scale (ADCS) is a 72-item instrument that defines confrontation as an individual being told “bad things” might happen if they do not make changes to address alcohol or drug problems or maintain sobriety. Preliminary assessment of the ADCS using substance abusers entering SLH's revealed: 1) Scale items were frequently endorsed; 2) Confrontation was often experienced as accurate and helpful; and 3) Confronters' statements were viewed supportive and accurate. This study reports the results of a factor analysis on a larger sample 179 participants using baseline and 6 month follow-up data. Results yielded a clear two factor solution: 1) Internal Support (alpha = 0.80) and 2) External Intensity (alpha = 0.63). The two factors accounted for 58% of the variance. The ADCS offers a fresh and broader view of confrontation that can be reliably measured. PMID:17270360

  9. Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA

    PubMed Central

    Poowanawittayakom, Nongnooch; Dutta, Anamika; Stock, Shannon; Touray, Sunkaru; Ellison, Richard T.

    2018-01-01

    The epidemic of illicit intravenous drug use (IVDU) in the United States has been accompanied by a surge in drug overdose deaths and infectious sequelae. Candida albicans infections were associated with injection of contaminated impure brown heroin in the 1970s–1990s; however, candidiasis accompanying IVDU became considerably rarer as the purity of the heroin supply increased. We reviewed cases of candidemia occurring over a recent 7-year period in persons >14 years of age at a tertiary care hospital in central Massachusetts. Of the 198 patients with candidemia, 24 cases occurred in patients with a history of IVDU. Compared with non-IVDU patients, those with a history of IVDU were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement, including endocarditis and osteomyelitis. Thus, IVDU appears to be reemerging as a risk factor for invasive candidiasis. PMID:29553923

  10. Projecting future drug expenditures--2010.

    PubMed

    Hoffman, James M; Doloresco, Fred; Vermeulen, Lee C; Shah, Nilay D; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

    2010-06-01

    Drug expenditure trends in 2008 and 2009, projected drug expenditures for 2010, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2010, including drugs in development, the diffusion of new drugs, generic drugs, health care reform, drug safety concerns, and comparative effectiveness research. The increasing availability of important generic drugs continues to moderate growth in drug expenditures. Health care reform initiatives, including the potential for biosimilars legislation, will influence drug expenditures in all settings. From 2007 to 2008, total U.S. drug expenditures increased by 1.8%, with total spending rising from $279.6 billion to $284.7 billion. Growth in drug expenditures in clinics declined to the lowest level in a decade, a 1.0% increase from 2007 to 2008. Hospital drug expenditures increased at a moderate rate of only 2.1% from 2007 to 2008; through the first nine months of 2009, hospital drug expenditures increased by 3.0% compared with the same period in 2008. In 2010, we project a 3-5% increase in drug expenditures in outpatient settings, a 6-8% increase in expenditures for clinic-administered drugs, and a 2-4% increase in hospital drug expenditures.

  11. Drug-Drug Interactions and Diagnostics for Drug Users With HIV and HIV/HCV Coinfections: Introduction.

    PubMed

    Khalsa, Jag H; Talal, Andrew H; Morse, Gene

    2017-03-01

    Substance use and pharmacologic treatment of co-occurring infections such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are associated with many adverse consequences including pharmacokinetic and pharmacodynamic drug-drug interactions (DDIs). The National Institute on Drug Abuse sponsored a 2-day conference on DDIs at which clinicians/scientists from government, academia, and the pharmaceutical industry presented the most current research findings to formulate a comprehensive overview of DDIs. Specific topics discussed included drug metabolism; drug interactions between medications used in the treatment of HIV, HCV, and substance use disorders; intrahepatic concentrations and methods of assessment of drugs in liver disease of varying etiologies and degrees of impairment; and minimally invasive sampling techniques for the assessment of intrahepatic drug concentrations, viral replication, and changes in gene expression in response to treatment. Finally, the speakers identified research targets and priorities on DDIs. Areas of emphasis included development of diagnostic assays for drug concentration assessment in different organs, an enhanced understanding of factors responsible for alterations in drug metabolism and excretion, and establishment of clinical trials and work groups to study DDIs. Our long-term objective is to broaden investigation in the field of DDIs in substance users. © 2017, The American College of Clinical Pharmacology.

  12. Drug-induced Brugada syndrome: Clinical characteristics and risk factors.

    PubMed

    Konigstein, Maayan; Rosso, Raphael; Topaz, Guy; Postema, Pieter G; Friedensohn, Limor; Heller, Karin; Zeltser, David; Belhassen, Bernard; Adler, Arnon; Viskin, Sami

    2016-05-01

    Cardiac arrest may result from seemingly innocuous medications that do not necessarily have cardiac indications. The best-known example is the drug-induced long QT syndrome. A less known but not necessarily less important form of drug-induced proarrhythmia is the drug-induced Brugada syndrome. The purpose of this study was to identify clinical and ECG risk markers for drug-induced Brugada syndrome. Reports of drug-induced Brugada syndrome recounted by an international database (http://www.brugadadrugs.org) were reviewed to define characteristics that identify patients prone to developing this complication. For each patient with drug-induced Brugada syndrome who had an ECG recorded in the absence of drugs, we included 5 healthy controls matched by gender and age. All ECGs were evaluated for Brugada-like abnormalities. Seventy-four cases of drug-induced Brugada syndrome from noncardiac medications were identified: 77% were male, and drug toxicity was involved in 46%. Drug-induced Brugada syndrome from oral medications generally occurred weeks after the initiation of therapy. Mortality was 13%. By definition, all cases had a type I Brugada pattern during drug therapy. Nevertheless, their ECG in the absence of drugs was more frequently abnormal than the ECG of controls (56% vs 33%, P = .04). Drug-induced Brugada syndrome from noncardiac drugs occurs predominantly in adult males, is frequently due to drug toxicity, and occurs late after the onset of therapy. Minor changes are frequently noticeable on baseline ECG, but screening is impractical because of a prohibitive false-positive rate. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  13. Modifying Pro-Drug Risk Factors in Adolescents: Results from Project ALERT

    ERIC Educational Resources Information Center

    Ghosh-Dastidar, Bonnie; Longshore, Douglas L.; Ellickson, Phyllis L.; McCaffrey, Daniel F.

    2004-01-01

    The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11…

  14. Drug Use Among Youth on Probation: Differences in Characteristics and Explanatory Factors.

    ERIC Educational Resources Information Center

    Lopez, John R.

    1997-01-01

    Examines relationships among adolescent drug use and family relationships, aspirations, school involvement, and delinquent behaviors. Analysis of 475 juvenile probationers yielded profiles of marijuana and alcohol use that were influenced by friends' alcohol or marijuana use, selling drugs, and other factors. Recommendations for intervention,…

  15. An overview of drug delivery vehicles for cancer treatment: Nanocarriers and nanoparticles including photovoltaic nanoparticles.

    PubMed

    Chowdhury, Silvia; Yusof, Faridah; Salim, Wan Wardatul Amani Wan; Sulaiman, Nadzril; Faruck, Mohammad Omer

    2016-11-01

    Cancer is a complicated disease for which finding a cure presents challenges. In recent decades, new ways to treat cancer are being sought; one being nanomedicine, which manipulates nanoparticles to target a cancer and release drugs directly to the cancer cells. A number of cancer treatments based on nanomedicine are under way and mostly are in preclinical trials owing to challenges in administration, safety, and effectiveness. One alternative method for drug delivery is the use of photovoltaic nanoparticles, which has the potential to deliver drugs via light activation. The concepts are based on standard photovoltaic cell that holds opposite charges on its surfaces and releases drugs when charge intensity or polarity changes upon photo-stimulation such as from a laser source or sunlight. This review will cover some recent progress in cancer treatment using nanoparticles, including photovoltaic nanoparticles. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Viral hepatitis among drug users in methadone maintenance: associated factors, vaccination outcomes, and interventions.

    PubMed

    Perlman, David C; Jordan, Ashly E; McKnight, Courtney; Young, Christopher; Delucchi, Kevin L; Sorensen, James L; Des Jarlais, Don C; Masson, Carmen L

    2014-01-01

    Drug users are at high risk of viral Hepatitis A, B, and C. The prevalence of Hepatitis A, Hepatitis B, and Hepatitis C, associated factors, and vaccine seroconversion among drug treatment program participants in a randomized controlled trial of hepatitis care coordination were examined. Of 489 participants, 44 and 47% required Hepatitis A/Hepatitis B vaccinations, respectively; 59% were Hepatitis C positive requiring linkage to care. Factors associated with serologic statuses, and vaccine seroconversion are reported; implications for strategies in drug treatment settings are discussed. Results suggest generalizable strategies for drug treatment programs to expand viral hepatitis screening, prevention, vaccination, and linkage to care.

  17. Some current factors influencing the prescribing and use of psychiatric drugs.

    PubMed Central

    Poulsen, R L

    1992-01-01

    A reprise of selected known factors about the influences affecting the prescribing and use of drugs, and some new developments in the drug marketplace, are the basis for this summary and observations about future expectations regarding psychotherapeutic agents. This information can be used to assist in formulating or updating, or both, conceptualizations and hypotheses for future policy and research planning in this area. PMID:1738808

  18. Drug Transporters and Na+/H+ Exchange Regulatory Factor PSD-95/Drosophila Discs Large/ZO-1 Proteins

    PubMed Central

    Walsh, Dustin R.; Nolin, Thomas D.

    2015-01-01

    Drug transporters govern the absorption, distribution, and elimination of pharmacologically active compounds. Members of the solute carrier and ATP binding-cassette drug transporter family mediate cellular drug uptake and efflux processes, thereby coordinating the vectorial movement of drugs across epithelial barriers. To exert their physiologic and pharmacological function in polarized epithelia, drug transporters must be targeted and stabilized to appropriate regions of the cell membrane (i.e., apical versus basolateral). Despite the critical importance of drug transporter membrane targeting, the mechanisms that underlie these processes are largely unknown. Several clinically significant drug transporters possess a recognition sequence that binds to PSD-95/Drosophila discs large/ZO-1 (PDZ) proteins. PDZ proteins, such as the Na+/H+ exchanger regulatory factor (NHERF) family, act to stabilize and organize membrane targeting of multiple transmembrane proteins, including many clinically relevant drug transporters. These PDZ proteins are normally abundant at apical membranes, where they tether membrane-delimited transporters. NHERF expression is particularly high at the apical membrane in polarized tissue such as intestinal, hepatic, and renal epithelia, tissues important to drug disposition. Several recent studies have highlighted NHERF proteins as determinants of drug transporter function secondary to their role in controlling membrane abundance and localization. Mounting evidence strongly suggests that NHERF proteins may have clinically significant roles in pharmacokinetics and pharmacodynamics of several pharmacologically active compounds and may affect drug action in cancer and chronic kidney disease. For these reasons, NHERF proteins represent a novel class of post-translational mediators of drug transport and novel targets for new drug development. PMID:26092975

  19. [Determining factors for the use of anxiolytic and hypnotic drugs in the elderly].

    PubMed

    Téllez-Lapeira, Juan M; López-Torres Hidalgo, Jesús; Gálvez-Alcaraz, Luis; Párraga-Martínez, Ignacio; Boix-Gras, Clotilde; García-Ruiz, Antonio

    To estimate the prevalence of self-reported anxiety/hypnotics use in adults 65 years and older and identify potential factors that determine the use of these drugs. Cross-sectional study conducted on a study population of 1,161 non-institutionalised adults 65 years old and older with enough ability to conduct a personal interview. Participants were randomly selected from health care registers. The main outcomes of interest included consumption of anxiolytics, hypnotics and other drugs (filed by ATC classification system), mood (based on the Yesavage geriatric depression scale), cognitive status (Pfeiffer questionnaire), physical-functional assessment of basic activities of daily living (Katz index), health problems (ICPC-2 classification WONCA), and sociodemographic variables. The prevalence of self-reported anxiety/hypnotics consumption was 16.6% (95% CI: 14.5 - 18.7), of which 90.5% were benzodiazepines (BZD), mainly lorazepam (39.4% of BZD). Long half-life BZD accounted for 24.7% of BZD. Hypnotics accounted for 27.5% of anxiolytics/hypnotics. The use of sedatives/hypnotics was independently associated with other drugs (non-psychotropics) consumption (OR 6.8, 95% CI: 2.1-22.0), presence of established depression (OR: 2.5; 95% CI: 1.0 -5.9), presence of 4 or more comorbidities (OR: 2.0; 95% CI: 1.4-2.9), being female (OR 2.1, 95% CI: 1.5-3.1) and being dependent for basic activities of daily living (OR: 1.8, 95% CI: 1.1-2.9). The prevalence of sedatives/hypnotics use in the elderly from Albacete is high. Several factors were identified as potential determinants of sedatives/hypnotics use in our study population. It will be important to evaluate the misuse of these drugs in order to develop effective, efficient and safe prescription strategies. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Female Ex-Offender Perspectives on Drug Initiation, Relapse, and Desire to Remain Drug Free

    PubMed Central

    Nyamathi, Adeline M.; Srivastava, Neha; Salem, Benissa E.; Wall, Sarah; Kwon, Jordan; Ekstrand, Maria; Hall, Elizabeth; Turner, Susan F.; Faucette, Mark

    2016-01-01

    Recently-released homeless women residing in temporary residential drug treatment programs are at a critical juncture in the process of recovery, transition and reentry. The purpose of this study was to explore factors influencing initial use of drugs and relapse triggers among a sample of incarcerated women exiting jails and prisons, and who are residing in a residential drug treatment (RDT) program and preparing for reentry into their communities. Among this population, relapse to drug use and recidivism are common. A qualitative study was conducted utilizing focus groups to understand the perspectives of formerly incarcerated, currently homeless women residing in a RDT program. Content analysis generated the development of three broad categories: a) factors associated with first drug use; b) factors involved in relapse; c) factors influencing desire to remain drug free. A discussion follows highlighting the importance of targeted interventions at RDT sites that integrate physical, psychological and social needs to optimize reentry into communities. This would include a focus on building self-esteem, life skills, and providing access to resources such as housing, employment, and healthcare. PMID:27195929

  1. Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces: a pilot study.

    PubMed

    Hon, Chun-Yip; Chua, Prescillia Ps; Danyluk, Quinn; Astrakianakis, George

    2014-06-01

    Occupational exposure to antineoplastic drugs has been documented to result in various adverse health effects. Despite the implementation of control measures to minimize exposure, detectable levels of drug residual are still found on hospital work surfaces. Cleaning these surfaces is considered as one means to minimize the exposure potential. However, there are no consistent guiding principles related to cleaning of contaminated surfaces resulting in hospitals to adopt varying practices. As such, this pilot study sought to evaluate current cleaning protocols and identify those factors that were most effective in reducing contamination on drug preparation surfaces. Three cleaning variables were examined: (1) type of cleaning agent (CaviCide®, Phenokil II™, bleach and chlorhexidine), (2) application method of cleaning agent (directly onto surface or indirectly onto a wipe) and (3) use of isopropyl alcohol after cleaning agent application. Known concentrations of antineoplastic drugs (either methotrexate or cyclophosphamide) were placed on a stainless steel swatch and then, systematically, each of the three cleaning variables was tested. Surface wipes were collected and quantified using high-performance liquid chromatography-tandem mass spectrometry to determine the percent residual of drug remaining (with 100% being complete elimination of the drug). No one single cleaning agent proved to be effective in completely eliminating all drug contamination. The method of application had minimal effect on the amount of drug residual. In general, application of isopropyl alcohol after the use of cleaning agent further reduced the level of drug contamination although measureable levels of drug were still found in some cases.

  2. International comparison of the factors influencing reimbursement of targeted anti-cancer drugs.

    PubMed

    Lim, Carol Sunghye; Lee, Yun-Gyoo; Koh, Youngil; Heo, Dae Seog

    2014-11-29

    Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences. We investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online. Japan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = -0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation. Although reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.

  3. Resolution V fractional factorial design for screening of factors affecting weakly basic drugs liposomal systems.

    PubMed

    Nageeb El-Helaly, Sara; Habib, Basant A; Abd El-Rahman, Mohamed K

    2018-07-01

    This study aims to investigate factors affecting weakly basic drugs liposomal systems. Resolution V fractional factorial design (2 V 5-1 ) is used as an example of screening designs that would better be used as a wise step before proceeding with detailed factors effects or optimization studies. Five factors probable to affect liposomal systems of weakly basic drugs were investigated using Amisulpride as a model drug. Factors studied were; A: Preparation technique B: Phosphatidyl choline (PhC) amount (mg) C: Cholesterol: PhC molar ratio, D: Hydration volume (ml) and E: Sonication type. Levels investigated were; Ammonium sulphate-pH gradient technique or Transmembrane zinc chelation-pH gradient technique, 200 or 400 mg, 0 or 0.5, 10 or 20 ml and bath or probe sonication for A, B, C, D and E respectively. Responses measured were Particle size (PS) (nm), Zeta potential (ZP) (mV) and Entrapment efficiency percent (EE%). Ion selective electrode was used as a novel method for measuring unentrapped drug concentration and calculating entrapment efficiency without the need for liposomal separation. Factors mainly affecting the studied responses were Cholesterol: PhC ratio and hydration volume for PS, preparation technique for ZP and preparation technique and hydration volume for EE%. The applied 2 V 5-1 design enabled the use of only 16 trial combinations for screening the influence of five factors on weakly basic drugs liposomal systems. This clarifies the value of the use of screening experiments before extensive investigation of certain factors in detailed optimization studies. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Biomedical HIV prevention including pre-exposure prophylaxis and opiate agonist therapy for women who inject drugs: State of research and future directions

    PubMed Central

    Page, Kimberly; Tsui, Judith; Maher, Lisa; Choopanya, Kachit; Vanichseni, Suphak; Mock, Philip A.; Celum, Connie; Martin, Michael

    2015-01-01

    Women who inject drugs are at higher risk of HIV compared to their male counterparts as a result of multiple factors including biological, behavioral and socio-structural, yet comparatively little effort has been invested in testing and delivering prevention methods that directly target this group. In this paper, we discuss the need for expanded prevention interventions for women who inject drugs, focusing on two safe, effective, and approved, yet underutilized biomedical prevention methods: opiate agonist therapy (OAT) and oral pre-exposure prophylaxis (PrEP). While both interventions are well researched they have not been well examined in the context of gender. We discuss the drivers of women injectors’ higher HIV risk, review the effectiveness of OAT and PrEP interventions among women, and explain why these new HIV prevention tools should be prioritized for women who inject drugs. There is substantial potential for impact of OAT and PrEP programs for women who inject drugs in the context of broader gender-responsive HIV prevention initiatives. While awaiting efficacy data on other biomedical approaches in the HIV prevention research ‘pipeline’, we propose that the scale up and implementation of these proven, safe, and effective interventions are needed now. PMID:25978484

  5. Antiangiogenic drugs synergize with a membrane macrophage colony-stimulating factor-based tumor vaccine to therapeutically treat rats with an established malignant intracranial glioma.

    PubMed

    Jeffes, Edward W B; Zhang, Jian Gang; Hoa, Neil; Petkar, Animesh; Delgado, Christina; Chong, Samuel; Obenaus, Andre; Sanchez, Ramon; Khalaghizadeh, Sakineh; Khomenko, Tetyana; Knight, Brandon A; Alipanah, Reza; Nguyen, Tuong-Vi; Shah, Chirag; Vohra, Seema; Zhuang, Jing-Li; Liu, Jessie; Wepsic, H Terry; Jadus, Martin R

    2005-03-01

    Combining a T9/9L glioma vaccine, expressing the membrane form of M-CSF, with a systemic antiangiogenic drug-based therapy theoretically targeted toward growth factor receptors within the tumor's vasculature successfully treated >90% of the rats bearing 7-day-old intracranial T9/9L gliomas. The antiangiogenic drugs included (Z)-3-[4-(dimethylamino)benzylidenyl]indolin-2-one (a platelet-derived growth factor receptor beta and a fibroblast growth factor receptor 1 kinase inhibitor) and oxindole (a vascular endothelial growth factor receptor 2 kinase inhibitor). A total of 20-40% of the animals treated with the antiangiogenic drugs alone survived, while all nontreated controls and tumor vaccine-treated rats died within 40 days. In vitro, these drugs inhibited endothelial cells from proliferating in response to the angiogenic factors produced by T9/9L glioma cells and prevented endothelial cell tubulogenesis. FITC-labeled tomato lectin staining demonstrated fewer and constricted blood vessels within the intracranial tumor after drug therapy. Magnetic resonance imaging demonstrated that the intracranial T9 glioma grew much slower in the presence of these antiangiogenic drugs. These drugs did not affect in vitro glioma cell growth nor T cell mitogenesis. Histological analysis revealed that the tumor destruction occurred at the margins of the tumor, where there was a heavy lymphocytic infiltrate. Real-time PCR showed more IL-2-specific mRNA was present within the gliomas in the vaccinated rats treated with the drugs. Animals that rejected the established T9/9L glioma by the combination therapy proved immune against an intracranial rechallenge by T9/9L glioma, but showed no resistance to an unrelated MADB106 breast cancer.

  6. [Psychosocial risk factors for illicit drug use in a sample of Mexican high school students].

    PubMed

    Negrete, Bruno Díaz; García-Aurrecoechea, Raúl

    2008-10-01

    To identify psychosocial risk factors for substance abuse among Mexican students and to offer elements for the design of prevention programs. A cross-sectional, nonexperimental study of a sample of 516 high school students in six of Mexico's most important cities. From April-June 2005, a customized version of the Drug Use Screening Inventory (revised) (DUSI-R) was administered. The analysis comprised eight factors: alcohol and drug abuse, affective disorders, poor self-control, poor school adjustment, low social competence, dysfunctional family relationships, social isolation, and being part of a detrimental social network (whose members take drugs and have antisocial attitudes). Factors predictive for illicit drug use were found by logistical regression, and a structural equation model was designed to determine the relationships among the factors. The factors that predicted substance abuse were poor self-control with a tendency to act impulsively and aggressively; associating with troublemakers; and being frequently exposed to family conflicts, violence, and drug and/or alcohol use in the home. The structural equation model indicated that substance abuse is one of a group of disorders directly determined by associating with detrimental peers, and a higher rate of socioaffective disorders, and indirectly, by dysfunctional family relationships. Some of the suggestions made by theoretical models to explain substance abuse were confirmed. These empirically-supported elements can contribute to the design of prevention programs, especially those that are selective and recommended.

  7. Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures.

    PubMed

    Bada, Henrietta S; Bann, Carla M; Whitaker, Toni M; Bauer, Charles R; Shankaran, Seetha; Lagasse, Linda; Lester, Barry M; Hammond, Jane; Higgins, Rosemary

    2012-12-01

    We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure. The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent). A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores. High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.

  8. Confirmatory Factor Analysis and Test-Retest Reliability of the Alcohol and Drug Confrontation Scale (ADCS)

    PubMed Central

    Polcin, Douglas L.; Galloway, Gantt P.; Bond, Jason; Korcha, Rachael; Greenfield, Thomas K.

    2008-01-01

    The addiction field lacks an accepted definition and reliable measure of confrontation. The Alcohol and Drug Confrontation Scale (ADCS) defines confrontation as warnings about the potential consequences of substance use. To assess psychometric properties, 323 individual entering recovery houses in U.S. urban and suburban areas were interviewed between 2003 and 2005 (20% women, 68% white). Analyses included test-retest reliability, confirmatory factor analysis, and measures of internal consistency. Findings support the ADCS as a reliable way of assessing two factors: Internal Support and External intensity. Confrontation was experienced as supportive, accurate and helpful. Additional studies should assess confrontation in different contexts. PMID:20686635

  9. Family Risk Factors for Adolescent Drug Misuse in Spain

    ERIC Educational Resources Information Center

    Secades-Villa, Roberto; Fernandez-Hermida, Jose Ramon; Vallejo-Seco, Guillermo

    2005-01-01

    The main objective of this research was to analyze the influence and the differential weight of certain family factors in Spanish adolescent substance abuse. A representative sample of 1,680 students of both sexes from all over Spain took part in the study. The results show that the variables associated with drug consumption are: male,…

  10. Prevalence of hepatitis C virus infection and associated factors among male illicit drug users in Cuiabá, Mato Grosso, Brazil.

    PubMed

    Novais, Antônia Carlos Magalhães; Lopes, Carmen Luci Rodrigues; Reis, Nádia Rúbia da Silva; Silva, Agabo Macêdo Costa E; Martins, Regina Maria Bringel; Souto, Francisco José Dutra

    2009-09-01

    Intravenous drug injection has been reported as the main risk factor for hepatitis C virus (HCV) infection. The aim of the present study was to describe the prevalence and the epidemiological profile of HCV infection among abusers of illegal injected and non-injected drugs in Cuiabá, state of Mato Grosso, Central Brazil. A cross-sectional study including 314 male drug users from eight detoxification centres was performed. Out of 314 subjects studied, 48 (15.2%) were intravenous drug users. Participants were interviewed and had blood samples taken and tested for the presence of anti-HCV antibodies. Positive samples were tested for the presence of HCV RNA. Genotyping was performed on HCV RNA-positive samples. The overall prevalence of anti-HCV antibodies was 6.4% (n = 20). Out of 20 anti-HCV antibody-positive subjects, 16 (80%) were also HCV RNA-positive. Genotype 1 predominated (75%), followed by 3a (25%). Subtype 1a was more common than 1b. HCV infection was more prevalent among intravenous drug users (33%) than non-injecting users (1.5%). Logistic regression analyses showed independent associations between HCV infection and intravenous drug use, imprisonment and increasing age. In the present study, injecting drug use was the factor most strongly associated to HCV infection and inhaling or sniffing did not represent an increased susceptibility to infection.

  11. Insulin-Like Growth Factor 2 Silencing Restores Taxol Sensitivity in Drug Resistant Ovarian Cancer

    PubMed Central

    Brouwer-Visser, Jurriaan; Lee, Jiyeon; McCullagh, KellyAnne; Cossio, Maria J.; Wang, Yanhua; Huang, Gloria S.

    2014-01-01

    Drug resistance is an obstacle to the effective treatment of ovarian cancer. We and others have shown that the insulin-like growth factor (IGF) signaling pathway is a novel potential target to overcome drug resistance. The purpose of this study was to validate IGF2 as a potential therapeutic target in drug resistant ovarian cancer and to determine the efficacy of targeting IGF2 in vivo. An analysis of The Cancer Genome Atlas (TCGA) data in the serous ovarian cancer cohort showed that high IGF2 mRNA expression is significantly associated with shortened interval to disease progression and death, clinical indicators of drug resistance. In a genetically diverse panel of ovarian cancer cell lines, the IGF2 mRNA levels measured in cell lines resistant to various microtubule-stabilizing agents including Taxol were found to be significantly elevated compared to the drug sensitive cell lines. The effect of IGF2 knockdown on Taxol resistance was investigated in vitro and in vivo. Transient IGF2 knockdown significantly sensitized drug resistant cells to Taxol treatment. A Taxol-resistant ovarian cancer xenograft model, developed from HEY-T30 cells, exhibited extreme drug resistance, wherein the maximal tolerated dose of Taxol did not delay tumor growth in mice. Blocking the IGF1R (a transmembrane receptor that transmits signals from IGF1 and IGF2) using a monoclonal antibody did not alter the response to Taxol. However, stable IGF2 knockdown using short-hairpin RNA in HEY-T30 effectively restored Taxol sensitivity. These findings validate IGF2 as a potential therapeutic target in drug resistant ovarian cancer and show that directly targeting IGF2 may be a preferable strategy compared with targeting IGF1R alone. PMID:24932685

  12. Drugs to Treat Systemic Lupus Erythematosus: Relationship between Current Use and Cardiovascular Risk Factors

    PubMed Central

    Rho, Young Hee; Oeser, Annette; Chung, Cecilia P; Morrow, Jason D; Stein, C Michael

    2008-01-01

    Objectives Cardiovascular risk is increased in patients with systemic lupus erythematosus (SLE). Drugs used to treat SLE can modify traditional cardiovascular risk factors. We examined the effect of selected drugs used in the treatment of SLE on cardiovascular risk factors. Methods We compared systolic and diastolic blood pressure, serum lipid concentrations, glucose, homocysteine, and urinary F2-isoprostane concentrations in 99 patients with lupus who were either current users or non-users of systemic corticosteroids, antimalarials, non-steroidal anti-inflammatory drugs (NSAIDs), COX-2 selective NSAIDs, azathioprine, and methotrexate. Multivariable adjustment was done with linear regression modeling using sex, age and disease activity (SLEDAI) as controlling variables. Results Serum triglyceride concentrations were higher (135.1 ± 61.4 vs. 95.3 ± 47.5 mg/dL, adjusted P = 0.003) in patients receiving corticosteroids. Homocysteine concentrations were marginally higher in patients receiving methotrexate (adjusted P = 0.08). Current use of either NSAIDs or COX-2 inhibitors was not associated with increased cardiovascular risk factors. Current hydroxychloroquine use was not associated with significant alterations in lipid profiles. Conclusions In a non-random sample of patients with SLE, current corticosteroid use was associated with increased triglyceride concentrations, but other drugs had little effect on traditional cardiovascular risk factors. PMID:20157365

  13. The importance of social networks in their association to drug equipment sharing among injection drug users: a review.

    PubMed

    De, Prithwish; Cox, Joseph; Boivin, Jean-François; Platt, Robert W; Jolly, Ann M

    2007-11-01

    To examine the scientific evidence regarding the association between characteristics of social networks of injection drug users (IDUs) and the sharing of drug injection equipment. A search was performed on MEDLINE, EMBASE, BIOSIS, Current Contents, PsycINFO databases and other sources to identify published studies on social networks of IDUs. Papers were selected based on their examination of social network factors in relation to the sharing of syringes and drug preparation equipment (e.g. containers, filters, water). Additional relevant papers were found from the reference list of identified articles. Network correlates of drug equipment sharing are multi-factorial and include structural factors (network size, density, position, turnover), compositional factors (network member characteristics, role and quality of relationships with members) and behavioural factors (injecting norms, patterns of drug use, severity of drug addiction). Factors appear to be related differentially to equipment sharing. Social network characteristics are associated with drug injection risk behaviours and should be considered alongside personal risk behaviours in prevention programmes. Recommendations for future research into the social networks of IDUs are proposed.

  14. Drug Resistance Profiles of Mycobacterium tuberculosis Complex and Factors Associated with Drug Resistance in the Northwest and Southwest Regions of Cameroon

    PubMed Central

    Meriki, Henry D.; Tufon, Kukwah A.; Atanga, Pascal N.; Ane-Anyangwe, Irene N.; Anong, Damian N.; Cho-Ngwa, Fidelis; Nkuo-Akenji, Theresa

    2013-01-01

    Background Anti-tuberculosis drug resistance continues to be a major obstacle to tuberculosis (TB) control programmes with HIV being a major risk factor in developing TB. We investigated anti-TB drug resistance profiles and the impact of socioeconomic as well as behavioural factors on the prevalence of TB and drug resistance in two regions of Cameroon with such data paucity. Methods This was a hospital-based study in which 1706 participants, comprising 1133 females and 573 males consecutively enrolled from selected TB and HIV treatment centres of the Northwest and Southwest regions. Demographic, clinical and self-reported risk behaviours and socioeconomic data were obtained with the consent of participants using questionnaires. Culture and drug resistance testing were performed according to standard procedures. Results The prevalence of resistance to at least one anti-TB drug was 27.7% and multi-drug resistance was 5.9%. Smoking, concurrent alcohol consumption and smoking, being on antiretroviral therapy for ≤ 12 months and previous household contact with TB patient were independently associated with tuberculosis prevalence, while only previous tuberculosis infection was associated with drug resistance in a univariate analysis. Conclusion The study showed a high prevalence of drug resistance TB in the study population with only previous TB infection associated with drug resistance in a univariate analysis. It also provides evidence in our context, of the role of alcohol and smoking in increasing the risk of developing TB, which is more likely in people living with HIV/AIDS. Therefore, it is important for public health authorities to integrate and intensify alcohol/smoking abstention interventions in TB and HIV control programs in Cameroon. PMID:24146991

  15. Withdrawal of antiepileptic drugs.

    PubMed

    Shinnar, S; Berg, A T

    1995-04-01

    Recent literature on withdrawing antiepileptic drug therapy in patients who are seizure free on antiepileptic drugs is reviewed. The average recurrence risk across studies is 29% at 2 years. Factors such as age of onset, etiology of seizures, the electroencephalogram and the epileptic syndrome influence outcome. Factors that need to be considered by the clinician include not just the statistical risk of recurrence but also the consequences of a recurrence, which will be a function of age and sex.

  16. Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People.

    PubMed

    Franchi, C; Ardoino, I; Rossio, R; Nobili, A; Biganzoli, E M; Marengoni, A; Marcucci, M; Pasina, L; Tettamanti, M; Corrao, S; Mannucci, P M

    2016-01-01

    The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older). Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (n = 1332), 2010 (n = 1380), and 2012 (n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed. Among 3906 patients prescribed at least one drug at admission, 2156 (55.2%) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95% CI 1.01-1.03), multimorbidity (OR 2.69, 95% CI 2.33-3.10), hypokalemia (OR 2.79, 95% CI 1.32-5.89), atrial fibrillation (OR 1.66, 95% CI 1.40-1.98), and heart failure (OR 3.17, 95% CI 2.49-4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8% were prescribed them at discharge. Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.

  17. Genetics or environment in drug transport: the case of organic anion transporting polypeptides and adverse drug reactions.

    PubMed

    Clarke, John D; Cherrington, Nathan J

    2012-03-01

    Organic anion transporting polypeptide (OATP) uptake transporters are important for the disposition of many drugs and perturbed OATP activity can contribute to adverse drug reactions (ADRs). It is well documented that both genetic and environmental factors can alter OATP expression and activity. Genetic factors include single nucleotide polymorphisms (SNPs) that change OATP activity and epigenetic regulation that modify OATP expression levels. SNPs in OATPs contribute to ADRs. Environmental factors include the pharmacological context of drug-drug interactions and the physiological context of liver diseases. Liver diseases such as non-alcoholic fatty liver disease, cholestasis and hepatocellular carcinoma change the expression of multiple OATP isoforms. The role of liver diseases in the occurrence of ADRs is unknown. This article covers the roles OATPs play in ADRs when considered in the context of genetic or environmental factors. The reader will gain a greater appreciation for the current evidence regarding the salience and importance of each factor in OATP-mediated ADRs. A SNP in a single OATP transporter can cause changes in drug pharmacokinetics and contribute to ADRs but, because of overlap in substrate specificities, there is potential for compensatory transport by other OATP isoforms. By contrast, the expression of multiple OATP isoforms is decreased in liver diseases, reducing compensatory transport and thereby increasing the probability of ADRs. To date, most research has focused on the genetic factors in OATP-mediated ADRs while the impact of environmental factors has largely been ignored.

  18. Individual and couple-level risk factors for hepatitis C infection among heterosexual drug users: a multilevel dyadic analysis.

    PubMed

    McMahon, James M; Pouget, Enrique R; Tortu, Stephanie

    2007-06-01

    Hepatitis C virus (HCV) is the most common bloodborne pathogen in the United States and is a leading cause of liver-related morbidity and mortality. Although it is known that HCV is most commonly transmitted among injection drug users, the role of sexual transmission in the spread of HCV remains controversial because of inconsistent findings across studies involving heterosexual couples. A novel multilevel modeling technique designed to overcome the limitations of previous research was performed to assess multiple risk factors for HCV while partitioning the source of risk at the individual and couple level. The analysis was performed on risk exposure and HCV screening data obtained from 265 drug-using couples in East Harlem, New York City. In multivariable analysis, significant individual risk factors for HCV included a history of injection drug use, tattooing, and older age. At the couple level, HCV infection tended to cluster within couples, and this interdependence was accounted for by couples' drug-injection behavior. Individual and couple-level sexual behavior was not associated with HCV infection. Our results are consistent with prior research indicating that sexual contact plays little role in HCV transmission. Rather, couples' injection behavior appears to account for the clustering of HCV within heterosexual dyads.

  19. [Social support as a protective factor of recurrence after drug addiction treatment].

    PubMed

    Garmendia, María Luisa; Alvarado, María Elena; Montenegro, Mariano; Pino, Paulina

    2008-02-01

    Lack of social support can be one of the factors that influences recurrences of drug consumption after treatment of addictions. To assess the role of social support in maintaining drug abstinence after treatment. We studied 306 subjects that were treated in drug addiction centers, financed by the National Council for Drug Control (CONACE). At discharge, social and demographic data were recorded and the Medical Outcomes Study (MOS) questionnaire was given to evaluate social support. Subjects that achieved abstinence at the moment of discharge were contacted six months later and interrogated about eventual drug consumption thereafter. One hundred fifty three (76% male, aged 32+/-10 years) of 197 abstinent subjects at discharge, were located six months later. Of these, 108 (71%) were not consuming drugs. On univariate analysis, social support had a protective effect against recurrence of drug consumption (OR-0.98; CI 95%=0.96-0.99). This effect remained significant after adjusting for age, sex, occupational situation, mental health self-assessment, family history of alcohol and drug consumption, type of drug treatment and type of discharge as confounding variables (OR=0.97; CI 95%=0.94-0.99). These data provide evidence that social support protects against recurrence into drug consumption at least up to six months. Long-term effects should be evaluated.

  20. 41 CFR 105-74.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What must I include in my drug-free workplace statement? 105-74.205 Section 105-74.205 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION...

  1. The regional drug information service: a factor in health care?

    PubMed Central

    Leach, F N

    1978-01-01

    Most regional health authorities throughout the United Kingdom have established drug information units to provide health service staff with a wide range of information about drugs and drug use. The units, which are staffed by drug information pharmacists, provide their service mainly by answering inquiries, although some disseminate information more positively through lectures and bulletins. An analysis of inquiries received by regional information units during 1976 showed that most were submitted by hospital doctors or pharmacists; comparatively few were received from general practitioners. Topics of inquiry included adverse effects of drugs, source of supply and identification, current treatment, dosage, route, precautions, and pharmaceutical problems such as stability or formulation of drug preparations. A more detailed analysis of the inquiries received by the North-western Regional Drug Information Service at Manchester over three years showed that the number of inquiries gradually increased and that more were received from general practitioners after a programme of lectures had been introduced to tell them about the service. The North-western service also received more requests from hospital pharmacists than other units, though many originated from clinicians. The regional drug information units consulted widely with clinical and other specialists in answering questions, but about a quarter of all inquiries were pharmaceutical, relating to stability and incompatibility. A multidisciplinary approach therefore seems necessary to provide a comprehensive and advisory drug information service. PMID:630339

  2. Occupational and demographic factors associated with drug use among female sex workers at the China-Myanmar border.

    PubMed

    Hail-Jares, Katie; Choi, Sugy; Duo, Lin; Luo, Zhi; Huang, Z Jennifer

    2016-04-01

    Within the last decade, the use of amphetamine type stimulants (ATS) has swelled in Myanmar. Regionally, female sex workers have reported turning to ATS for occupational reasons. In doing so, drug-using female sex workers (FSW) face compounded risks for HIV and other sexually transmitted infections (STI). Here, we examine the factors that impact FSW drug use in Muse, a town along the China-Myanmar border. In 2012, 101 FSW were recruited from entertainment venues and brothels along the Myanmar-Chinese border. Participants participated in a self-administered behavioral survey covering demographics, drug use, sex work, and risk behaviors. Bivariate and regression analyses were conducted in SPSS. Thirty four percent of respondents indicated current drug use. ATS derivatives were the most commonly used drugs (87.5%) with injection drug use being nearly non-existent in the sample. Drug using FSWs were older, had engaged in sex work longer, had more Chinese clients, and were more likely to have a previous boyfriend who had used drugs. They were also 3.5 times more likely to report a STI. Client condom use, HIV testing rates, and familiarity with public health resources did not statistically differ by drug use status. More research is needed to examine how romantic and professional sexual relationships push-and-pull FSW into using drugs. Our results suggest that diverse safer sex strategies, beyond client condom use, should be promoted with drug using FSWs, including strategies that acknowledge the impact of ATS use. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Incidence, characteristics and risk factors of adverse drug reactions in hospitalized children – a prospective observational cohort study of 6,601 admissions

    PubMed Central

    2013-01-01

    Background Adverse drug reactions (ADRs) are an important cause of harm in children. Current data are incomplete due to methodological differences between studies: only half of all studies provide drug data, incidence rates vary (0.6% to 16.8%) and very few studies provide data on causality, severity and risk factors of pediatric ADRs. We aimed to determine the incidence of ADRs in hospitalized children, to characterize these ADRs in terms of type, drug etiology, causality and severity and to identify risk factors. Methods We undertook a year-long, prospective observational cohort study of admissions to a single UK pediatric medical and surgical secondary and tertiary referral center (Alder Hey, Liverpool, UK). Children between 0 and 16 years 11 months old and admitted for more than 48 hours were included. Observed outcomes were occurrence of ADR and time to first ADR for the risk factor analysis. Results A total of 5,118 children (6,601 admissions) were included, 17.7% of whom experienced at least one ADR. Opiate analgesics and drugs used in general anesthesia (GA) accounted for more than 50% of all drugs implicated in ADRs. Of these ADRs, 0.9% caused permanent harm or required admission to a higher level of care. Children who underwent GA were at more than six times the risk of developing an ADR than children without a GA (hazard ratio (HR) 6.40; 95% confidence interval (CI) 5.30 to 7.70). Other factors increasing the risk of an ADR were increasing age (HR 1.06 for each year; 95% CI 1.04 to 1.07), increasing number of drugs (HR 1.25 for each additional drug; 95% CI 1.22 to 1.28) and oncological treatment (HR 1.90; 95% CI 1.40 to 2.60). Conclusions ADRs are common in hospitalized children and children who had undergone a GA had more than six times the risk of developing an ADR. GA agents and opiate analgesics are a significant cause of ADRs and have been underrepresented in previous studies. This is a concern in view of the increasing number of pediatric short

  4. [Customizing dosage drugs what contribution in therapeutic drug monitoring?].

    PubMed

    Abdessadek, Mohammed; Magoul, Rabia; Amarti, Afaf; El Ouezzani, Seloua; Khabbal, Youssef

    2014-01-01

    Drug response is often variable from an individual to another: the same dose of drug administered to different patients could cause variable pharmacological effects in nature and intensity. Those effects are often the result of variability in drugs pharmacokinetics (absorption, distribution, metabolism and elimination) which alter their bioavailability. In fact, two factors should be taken into account: the disease(s) from which the patient suffers, and the associated drugs, because many drug interactions may alter their pharmacokinetics causing consequently quite enough of different therapeutic effects. The choice of the assay of the drug subject in monitoring is crucial, it allows quantifying the in vivo dose of the drug and the quality of compliance thereof, the pharmacokinetic characteristics allows the clinician to adjust the dosage by different approaches so that plasma concentrations are included in the therapeutic range. Therapeutic monitoring aims to increase clinical efficacy and to minimize toxicity.

  5. 34 CFR 86.100 - What must the IHE's drug prevention program include?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., or distribution of illicit drugs and alcohol by students and employees on its property or as part of... Federal law for the unlawful possession or distribution of illicit drugs and alcohol; (3) A description of the health risks associated with the use of illicit drugs and the abuse of alcohol; (4) A description...

  6. Environmental Factors Associated with Psychotropic Drug Use in Brazilian Nightclubs.

    PubMed

    Carlini, Claudia; Andreoni, Solange; Sanchez, Zila M

    2017-08-01

    The purpose of this study was to identify environmental factors associated with patterns of psychotropic drug use in nightclubs. Mixed methods were used to investigate psychotropic drugs consumption among patrons of 31 nightclubs in São Paulo, Brazil. A total of 1822 patrons at the entrance and exit of the venues and 30 staff members of the nightclubs were interviewed. The observational data were collected through 307 h of observational research using a structured guide to register environmental measures. Psychotropic drug use in nightclubs was classified into three categories (1: no drugs; 2: legal drugs [e.g., alcohol and tobacco]; or 3: illicit drugs regardless of alcohol and tobacco use). Illicit drugs used were self-reported by patrons, and alcohol use was measured using a breathalyzer. The data were analyzed in clusters using correlated multinomial logistic regression models. The following environmental variables were associated with illicit drug use in nightclubs: all-you-can-drink service (adjusted odds ratio (aOR) = 11.84, 95%CI [4.06;34.57]) and light effects, such as laser and "disco lights" (aOR = 24.49, 95%CI [8.48;70.77]). The number of bouncers per capita × 100 and the presence of two or more dance floors were inversely associated with the use of illicit drugs (aOR = 0.26, 95%CI [0.11;0.65], and aOR = 0.13, 95%CI [0.06;0.29], respectively). Legal drug use was associated with all-you-can-drink service (aOR = 2.17, 95%CI [1.43;5.04]), the presence of two or more dance floors (aOR = 2.06, 95%CI [1.40;3.05]), and the number of bouncers per capita × 100 (aOR = 1.39, 95%CI [1.22;1.59]). These findings suggest that this is a multivariate phenomenon that would require an integrated approach involving the venue owners, staff members, patrons, local governments, and law enforcement agencies.

  7. Factors influencing oncology nurses' use of hazardous drug safe-handling precautions.

    PubMed

    Polovich, Martha; Clark, Patricia C

    2012-05-01

    To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use, and determine managers' perspectives on the use of HD safe-handling precautions. Cross-sectional, mixed methods; mailed survey to nurses who handle chemotherapy and telephone interviews with managers. Mailed invitation to oncology centers across the United States. 165 nurses who reported handling chemotherapy and 20 managers of nurses handling chemotherapy. Instruments measured the use of HD precautions and individual and organizational factors believed to influence precaution use. Data analysis included descriptive statistics and hierarchical regression. Manager interview data were analyzed using content analysis. Chemotherapy exposure knowledge, self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate. Nurses were well educated, experienced, and certified in oncology nursing. The majority worked in outpatient settings and administered chemotherapy to an average of 6.8 patients per day. Exposure knowledge, self-efficacy for using personal protective equipment, and perceived risk of harm from HD exposure were high; total precaution use was low. Nurse characteristics did not predict HD precaution use. Fewer barriers, better workplace safety climate, and fewer patients per day were independent predictors of higher HD precaution use. HD handling policies were present, but many did not reflect current recommendations. Few managers formally monitored nurses' HD precaution use. Circumstances in the workplace interfere with nurses' use of HD precautions. Interventions should include fostering a positive workplace safety climate, reducing barriers, and providing appropriate nurse-patient ratios.

  8. Protective mental health factors in children of parents with alcohol and drug use disorders: A systematic review

    PubMed Central

    Schwarze, Mirjam; Rumpf, Hans-Jürgen; Metzner, Franka; Pawils, Silke

    2017-01-01

    Children of parents with drug and alcohol use disorders often grow up under severe stress and are at greater risk of developing psychological and social problems. However, a substantial proportion of affected children adapt to their distressing life conditions and show positive development in terms of their mental health. These children are described as resilient. One difference between resilient and maladapted children is the presence of protective factors. The aim of this systematic review is to provide an overview of the current state of the research concerning protective mental health factors in children of parents with alcohol or drug use disorders (COPAD). For that purpose, the PsychInfo, PubMed, CINAHL and ISI Web of Science databases were searched through January 2017. All the identified publications were screened using previously developed inclusion criteria. The search yielded 3,402 articles. Eleven of these publications (2003–2013) met the criteria for inclusion in the present review. Information on the studies was extracted using an extraction form. A narrative analysis was performed, and the methodological quality was examined using a checklist based on the Mixed Methods Appraisal Tool. The research identified familial, parental, child-related and biological factors that influenced mental health outcomes in affected children (N = 1,376, age range = 1–20 years). Overall, protective mental health factors are understudied in this target group. Most of the included studies were conducted in the United States and employed a cross-sectional design. A comparison of the included cross-sectional and longitudinal studies indicated consistent results related to a secure parent-child attachment. Based on the current state of the research, no causal conclusions with regard to the effectiveness of protective factors can be drawn. To develop effective prevention programs, further longitudinal studies and studies assessing the interactions between risk and

  9. Factors associated with drug use among male motorbike taxi drivers in urban Vietnam.

    PubMed

    Nguyen, Huy Van; Vu, Thinh Toan; Pham, Ha Nguyen

    2014-08-01

    A cross-sectional study was conducted on a sample of 291 male motorbike taxi drivers (MMTDs) recruited through social mapping technique in Hanoi, Vietnam, for face-to-face interviews to examine factors associated with drug use among MMTDs using Information-Motivation-Behavioral skills (IMB) model. Among 291 MMTDs, 17.18% reported drug use sometime in their lives, 96% of whom were drug injectors. Being depressed, being originally borne in urban cities, currently residing in rural areas, having a longer time living apart from their wives/lovers, using alcohol, following Buddhism, and reporting lower motivation of HIV prevention predict significantly higher odds of uptaking drugs.

  10. Risk factors associated with default from multi- and extensively drug-resistant tuberculosis treatment, Uzbekistan: a retrospective cohort analysis.

    PubMed

    Lalor, Maeve K; Greig, Jane; Allamuratova, Sholpan; Althomsons, Sandy; Tigay, Zinaida; Khaemraev, Atadjan; Braker, Kai; Telnov, Oleksander; du Cros, Philipp

    2013-01-01

    The Médecins Sans Frontières project of Uzbekistan has provided multidrug-resistant tuberculosis treatment in the Karakalpakstan region since 2003. Rates of default from treatment have been high, despite psychosocial support, increasing particularly since programme scale-up in 2007. We aimed to determine factors associated with default in multi- and extensively drug-resistant tuberculosis patients who started treatment between 2003 and 2008 and thus had finished approximately 2 years of treatment by the end of 2010. A retrospective cohort analysis of multi- and extensively drug-resistant tuberculosis patients enrolled in treatment between 2003 and 2008 compared baseline demographic characteristics and possible risk factors for default. Default was defined as missing ≥60 consecutive days of treatment (all drugs). Data were routinely collected during treatment and entered in a database. Potential risk factors for default were assessed in univariate analysis using chi-square test and in multivariate analysis with logistic regression. 20% (142/710) of patients defaulted after a median of 6 months treatment (IQR 2.6-9.9). Factors associated with default included severity of resistance patterns (pre-extensively drug-resistant/extensively drug-resistant tuberculosis adjusted odds ratio 0.52, 95%CI: 0.31-0.86), previous default (2.38, 1.09-5.24) and age >45 years (1.77, 1.10-2.87). The default rate was 14% (42/294) for patients enrolled 2003-2006 and 24% (100/416) for 2007-2008 enrolments (p = 0.001). Default from treatment was high and increased with programme scale-up. It is essential to ensure scale-up of treatment is accompanied with scale-up of staff and patient support. A successful first course of tuberculosis treatment is important; patients who had previously defaulted were at increased risk of default and death. The protective effect of severe resistance profiles suggests that understanding disease severity or fear may motivate against default. Targeted

  11. Absorption sites of orally administered drugs in the small intestine.

    PubMed

    Murakami, Teruo

    2017-12-01

    In pharmacotherapy, drugs are mostly taken orally to be absorbed systemically from the small intestine, and some drugs are known to have preferential absorption sites in the small intestine. It would therefore be valuable to know the absorption sites of orally administered drugs and the influencing factors. Areas covered:In this review, the author summarizes the reported absorption sites of orally administered drugs, as well as, influencing factors and experimental techniques. Information on the main absorption sites and influencing factors can help to develop ideal drug delivery systems and more effective pharmacotherapies. Expert opinion: Various factors including: the solubility, lipophilicity, luminal concentration, pKa value, transporter substrate specificity, transporter expression, luminal fluid pH, gastrointestinal transit time, and intestinal metabolism determine the site-dependent intestinal absorption. However, most of the dissolved fraction of orally administered drugs including substrates for ABC and SLC transporters, except for some weakly basic drugs with higher pKa values, are considered to be absorbed sequentially from the proximal small intestine. Securing the solubility and stability of drugs prior to reaching to the main absorption sites and appropriate delivery rates of drugs at absorption sites are important goals for achieving effective pharmacotherapy.

  12. 20 CFR 404.1535 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1535... will determine whether your drug addiction or alcoholism is a contributing factor material to the... drug addiction or alcoholism, we must determine whether your drug addiction or alcoholism is a...

  13. 20 CFR 404.1535 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1535... will determine whether your drug addiction or alcoholism is a contributing factor material to the... drug addiction or alcoholism, we must determine whether your drug addiction or alcoholism is a...

  14. 20 CFR 404.1535 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1535... will determine whether your drug addiction or alcoholism is a contributing factor material to the... drug addiction or alcoholism, we must determine whether your drug addiction or alcoholism is a...

  15. 20 CFR 404.1535 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1535... will determine whether your drug addiction or alcoholism is a contributing factor material to the... drug addiction or alcoholism, we must determine whether your drug addiction or alcoholism is a...

  16. Spray-congealed microparticles for drug delivery - an overview of factors influencing their production and characteristics.

    PubMed

    Oh, Ching Mien; Guo, Qiyun; Wan Sia Heng, Paul; Chan, Lai Wah

    2014-07-01

    In any manufacturing process, the success of producing an end product with the desired properties and yield depends on a range of factors that include the equipment, process and formulation variables. It is the interest of manufacturers and researchers to understand each manufacturing process better and ascertain the effects of various manufacturing-associated factors on the properties of the end product. Unless the manufacturing process is well understood, it would be difficult to set realistic limits for the process variables and raw material specifications to ensure consistently high-quality and reproducible end products. Over the years, spray congealing has been used to produce particulates by the food and pharmaceutical industries. The latter have used this technology to develop specialized drug delivery systems. In this review, basic principles as well as advantages and disadvantages of the spray congealing process will be covered. Recent developments in spray congealing equipment, process variables and formulation variables such as the matrix material, encapsulated material and additives will also be discussed. Innovative equipment designs and formulations for spray congealing have emerged. Judicious choice of atomizers, polymers and additives is the key to achieve the desired properties of the microparticles for drug delivery.

  17. Indolealkylamines: biotransformations and potential drug-drug interactions.

    PubMed

    Yu, Ai-Ming

    2008-06-01

    Indolealkylamine (IAA) drugs are 5-hydroxytryptamine (5-HT or serotonin) analogs that mainly act on the serotonin system. Some IAAs are clinically utilized for antimigraine therapy, whereas other substances are notable as drugs of abuse. In the clinical evaluation of antimigraine triptan drugs, studies on their biotransformations and pharmacokinetics would facilitate the understanding and prevention of unwanted drug-drug interactions (DDIs). A stable, principal metabolite of an IAA drug of abuse could serve as a useful biomarker in assessing intoxication of the IAA substance. Studies on the metabolism of IAA drugs of abuse including lysergic acid amides, tryptamine derivatives and beta-carbolines are therefore emerging. An important role for polymorphic cytochrome P450 2D6 (CYP2D6) in the metabolism of IAA drugs of abuse has been revealed by recent studies, suggesting that variations in IAA metabolism, pharmaco- or toxicokinetics and dynamics can arise from distinct CYP2D6 status, and CYP2D6 polymorphism may represent an additional risk factor in the use of these IAA drugs. Furthermore, DDIs with IAA agents could occur additively at the pharmaco/toxicokinetic and dynamic levels, leading to severe or even fatal serotonin toxicity. In this review, the metabolism and potential DDIs of these therapeutic and abused IAA drugs are described.

  18. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.936... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to...

  19. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.936... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to...

  20. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.936... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to...

  1. 20 CFR 416.936 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.936... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to...

  2. Factors influencing the difference between forecasted and actual drug sales volumes under the price-volume agreement in South Korea.

    PubMed

    Park, Sun-Young; Han, Euna; Kim, Jini; Lee, Eui-Kyung

    2016-08-01

    This study analyzed factors contributing to increases in the actual sales volumes relative to forecasted volumes of drugs under price-volume agreement (PVA) policy in South Korea. Sales volumes of newly listed drugs on the national formulary are monitored under PVA policy. When actual sales volume exceeds the pre-agreed forecasted volume by 30% or more, the drug is subject to price-reduction. Logistic regression assessed the factors related to whether drugs were the PVA price-reduction drugs. A generalized linear model with gamma distribution and log-link assessed the factors influencing the increase in actual volumes compared to forecasted volume in the PVA price-reduction drugs. Of 186 PVA monitored drugs, 34.9% were price-reduction drugs. Drugs marketed by pharmaceutical companies with previous-occupation in the therapeutic markets were more likely to be PVA price-reduction drugs than drugs marketed by firms with no previous-occupation. Drugs of multinational pharmaceutical companies were more likely to be PVA price-reduction drugs than those of domestic companies. Having more alternative existing drugs was significantly associated with higher odds of being PVA price-reduction drugs. Among the PVA price-reduction drugs, the increasing rate of actual volume compared to forecasted volume was significantly higher in drugs with clinical usefulness. By focusing the negotiation efforts on those target drugs, PVA policy can be administered more efficiently with the improved predictability of the drug sales volumes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Projecting future drug expenditures--2009.

    PubMed

    Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Doloresco, Fred; Martin, Patrick K; Blake, Sharon; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

    2009-02-01

    Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.

  4. Clinical Risk Factors for In-Hospital Adverse Cardiovascular Events After Acute Drug Overdose

    PubMed Central

    Manini, Alex F.; Hoffman, Robert S.; Stimmel, Barry; Vlahov, David

    2015-01-01

    Objectives It was recently demonstrated that adverse cardiovascular events (ACVE) complicate a high proportion of hospitalizations for patients with acute drug overdoses. The aim of this study was to derive independent clinical risk factors for ACVE in patients with acute drug overdoses. Methods This prospective cohort study was conducted over 3 years at two urban university hospitals. Patients were adults with acute drug overdoses enrolled from the ED. In-hospital ACVE was defined as any of myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest. Results There were 1,562 patients meeting inclusion/exclusion criteria (mean age, 41.8 years; female, 46%; suicidal, 38%). ACVE occurred in 82 (5.7%) patients (myocardial injury, 61; shock, 37; dysrhythmia, 23; cardiac arrests, 22) and there were 18 (1.2%) deaths. On univariate analysis, ACVE risk increased with age, lower serum bicarbonate, prolonged QTc interval, prior cardiac disease, and altered mental status. In a multivariable model adjusting for these factors as well as patient sex and hospital site, independent predictors were: QTc > 500 msec (3.8% prevalence, odds ratio [OR] 27.6), bicarbonate < 20 mEql/L (5.4% prevalence, OR 4.4), and prior cardiac disease (7.1% prevalence, OR 9.5). The derived prediction rule had 51.6% sensitivity, 93.7% specificity, and 97.1% negative predictive value; while presence of two or more risk factors had 90.9% positive predictive value. Conclusions The authors derived independent clinical risk factors for ACVE in patients with acute drug overdose, which should be validated in future studies as a prediction rule in distinct patient populations and clinical settings. PMID:25903997

  5. Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults.

    PubMed

    Hanlon, J T; Perera, S; Newman, A B; Thorpe, J M; Donohue, J M; Simonsick, E M; Shorr, R I; Bauer, D C; Marcum, Z A

    2017-04-01

    There are few studies examining both drug-drug and drug-disease interactions in older adults. Therefore, the objective of this study was to describe the prevalence of potential drug-drug and drug-disease interactions and associated factors in community-dwelling older adults. This cross-sectional study included 3055 adults aged 70-79 without mobility limitations at their baseline visit in the Health Aging and Body Composition Study conducted in the communities of Pittsburgh PA and Memphis TN, USA. The outcome factors were potential drug-drug and drug-disease interactions as per the application of explicit criteria drawn from a number of sources to self-reported prescription and non-prescription medication use. Over one-third of participants had at least one type of interaction. Approximately one quarter (25·1%) had evidence of had one or more drug-drug interactions. Nearly 10·7% of the participants had a drug-drug interaction that involved a non-prescription medication. % The most common drug-drug interaction was non-steroidal anti-inflammatory drugs (NSAIDs) affecting antihypertensives. Additionally, 16·0% had a potential drug-disease interaction with 3·7% participants having one involving non-prescription medications. The most common drug-disease interaction was aspirin/NSAID use in those with history of peptic ulcer disease without gastroprotection. Over one-third (34·0%) had at least one type of drug interaction. Each prescription medication increased the odds of having at least one type of drug interaction by 35-40% [drug-drug interaction adjusted odds ratio (AOR) = 1·35, 95% confidence interval (CI) = 1·27-1·42; drug-disease interaction AOR = 1·30; CI = 1·21-1·40; and both AOR = 1·45; CI = 1·34-1·57]. A prior hospitalization increased the odds of having at least one type of drug interaction by 49-84% compared with those not hospitalized (drug-drug interaction AOR = 1·49, 95% CI = 1·11-2·01; drug-disease interaction AOR = 1·69, CI = 1·15-2

  6. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1536... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...

  7. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1536... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...

  8. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1536... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...

  9. 20 CFR 404.1536 - Treatment required for individuals whose drug addiction or alcoholism is a contributing factor...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 404.1536... Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) If we determine that you are disabled and drug addiction or...

  10. Recent trends for drug lag in clinical development of oncology drugs in Japan: does the oncology drug lag still exist in Japan?

    PubMed

    Maeda, Hideki; Kurokawa, Tatsuo

    2015-12-01

    This study exhaustively and historically investigated the status of drug lag for oncology drugs approved in Japan. We comprehensively investigated oncology drugs approved in Japan between April 2001 and July 2014, using publicly available information. We also examined changes in the status of drug lag between Japan and the United States, as well as factors influencing drug lag. This study included 120 applications for approval of oncology drugs in Japan. The median difference over a 13-year period in the approval date between the United States and Japan was 875 days (29.2 months). This figure peaked in 2002, and showed a tendency to decline gradually each year thereafter. In 2014, the median approval lag was 281 days (9.4 months). Multiple regression analysis identified the following potential factors that reduce drug lag: "Japan's participation in global clinical trials"; "bridging strategies"; "designation of priority review in Japan"; and "molecularly targeted drugs". From 2001 to 2014, molecularly targeted drugs emerged as the predominant oncology drug, and the method of development has changed from full development in Japan or bridging strategy to global simultaneous development by Japan's taking part in global clinical trials. In line with these changes, the drug lag between the United States and Japan has significantly reduced to less than 1 year.

  11. Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper.

    PubMed

    Brockow, K; Aberer, W; Atanaskovic-Markovic, M; Bavbek, S; Bircher, A; Bilo, B; Blanca, M; Bonadonna, P; Burbach, G; Calogiuri, G; Caruso, C; Celik, G; Cernadas, J; Chiriac, A; Demoly, P; Oude Elberink, J N G; Fernandez, J; Gomes, E; Garvey, L H; Gooi, J; Gotua, M; Grosber, M; Kauppi, P; Kvedariene, V; Laguna, J J; Makowska, J S; Mosbech, H; Nakonechna, A; Papadopolous, N G; Ring, J; Romano, A; Rockmann, H; Sargur, R; Sedlackova, L; Sigurdardottir, S; Schnyder, B; Storaas, T; Torres, M; Zidarn, M; Terreehorst, I

    2016-11-01

    The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. In vitro oral drug permeation models: the importance of taking physiological and physico-chemical factors into consideration.

    PubMed

    Joubert, Ruan; Steyn, Johan Dewald; Heystek, Hendrik Jacobus; Steenekamp, Jan Harm; Du Preez, Jan Lourens; Hamman, Josias Hendrik

    2017-02-01

    The assessment of intestinal membrane permeability properties of new chemical entities is a crucial step in the drug discovery and development process and a variety of in vitro models, methods and techniques are available to estimate the extent of oral drug absorption in humans. However, variations in certain physiological and physico-chemical factors are often not reflected in the results and the complex dynamic interplay between these factors is sometimes oversimplified with in vitro models. Areas covered: In vitro models to evaluate drug pharmacokinetics are briefly outlined, while both physiological and physico-chemical factors that may have an influence on these techniques are critically reviewed. The shortcomings identified for some of the in vitro techniques are discussed in conjunction with novel ways to improve and thereby overcome some challenges. Expert opinion: Although conventional in vitro methods and theories are used as basic guidelines to predict drug absorption, critical evaluations have identified some shortcomings. Advancements in technology have made it possible to investigate and understand the role of physiological and physico-chemical factors in drug delivery more clearly, which can be used to improve and refine the techniques to more closely mimic the in vivo environment.

  13. A Bayesian approach for incorporating economic factors in sample size design for clinical trials of individual drugs and portfolios of drugs.

    PubMed

    Patel, Nitin R; Ankolekar, Suresh

    2007-11-30

    Classical approaches to clinical trial design ignore economic factors that determine economic viability of a new drug. We address the choice of sample size in Phase III trials as a decision theory problem using a hybrid approach that takes a Bayesian view from the perspective of a drug company and a classical Neyman-Pearson view from the perspective of regulatory authorities. We incorporate relevant economic factors in the analysis to determine the optimal sample size to maximize the expected profit for the company. We extend the analysis to account for risk by using a 'satisficing' objective function that maximizes the chance of meeting a management-specified target level of profit. We extend the models for single drugs to a portfolio of clinical trials and optimize the sample sizes to maximize the expected profit subject to budget constraints. Further, we address the portfolio risk and optimize the sample sizes to maximize the probability of achieving a given target of expected profit.

  14. Therapeutic drug monitoring of antimetabolic cytotoxic drugs

    PubMed Central

    Lennard, L

    1999-01-01

    Therapeutic drug monitoring is not routinely used for cytotoxic agents. There are several reasons, but one major drawback is the lack of established therapeutic concentration ranges. Combination chemotherapy makes the establishment of therapeutic ranges for individual drugs difficult, the concentration-effect relationship for a single drug may not be the same as that when the drug is used in a drug combination. Pharmacokinetic optimization protocols for many classes of cytotoxic compounds exist in specialized centres, and some of these protocols are now part of large multicentre trials. Nonetheless, methotrexate is the only agent which is routinely monitored in most treatment centres. An additional factor, especially in antimetabolite therapy, is the existence of pharmacogenetic enzymes which play a major role in drug metabolism. Monitoring of therapy could include assay of phenotypic enzyme activities or genotype in addition to, or instead of, the more traditional measurement of parent drug or drug metabolites. The cytotoxic activities of mercaptopurine and fluorouracil are regulated by thiopurine methyltransferase (TPMT) and dihydropyrimidine dehydrogenase (DPD), respectively. Lack of TPMT functional activity produces life-threatening mercaptopurine myelotoxicity. Very low DPD activity reduces fluorouracil breakdown producing severe cytotoxicity. These pharmacogenetic enzymes can influence the bioavailability, pharmacokinetics, toxicity and efficacy of their substrate drugs. PMID:10190647

  15. Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with men (YMSM).

    PubMed

    Kecojevic, Aleksandar; Wong, Carolyn F; Corliss, Heather L; Lankenau, Stephen E

    2015-05-01

    Limited research has focused on prescription drug misuse among young men who have sex with men (YMSM), or investigated risk factors contributing to misuse. This study aims to investigate the relationship between multiple psychosocial risk factors (i.e., childhood abuse, discrimination, mental health distress) and prescription drug misuse among YMSM who are current substance users. YMSM (N=191) who reported prescription drug misuse in the past 6 months were recruited in Philadelphia between 2012 and 2013 to complete an anonymous survey assessing demographic information, substance use, and psychosocial factors. High levels of childhood physical abuse and perceived stress were associated with higher opioid misuse, while high levels of depression were associated with lower misuse of opioids. Those with higher levels of perceived stress were more likely to report higher tranquilizer misuse, while those with more experiences of social homophobia/racism and higher levels of depression and somatization reported higher stimulant misuse. Regarding demographic correlates, older participants were more likely than younger participants to report higher opioid misuse, while racial minorities were less likely than White participants to report higher misuse of tranquilizers, stimulants, and illicit drug use. Bisexual/heterosexual/other identified participants were more likely than gay identified participants to report higher misuse of all three classes of prescription drugs. Associations of risk factors with substance use among YMSM are complex and offer opportunities for additional research. Our findings show that prevention efforts must address substance use among YMSM in sync with psychosocial stressors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Serum vitamin E, C and A status of the drug addicts undergoing detoxification: influence of drug habit, sexual practice and lifestyle factors.

    PubMed

    Nazrul Islam, S K; Jahangir Hossain, K; Ahsan, M

    2001-11-01

    The study was carried out on the hypothesis that drug addicts would have reduced vitamin E, C and A status which could be influenced by drug habit, sexual practice and lifestyle factors. Serum concentrations of Vitamin E, C and A of male drug addicts and cohort controls were analysed, and influence of drug habit, sexual practice and lifestyle factors of the addicts on the vitamin status was assessed. The study was conducted among 253 drug addicts who sought detoxification voluntarily during the period of June 1997 to July 1998 at the Central Drug Addiction Treatment Hospital, Dhaka, and 100 cohort control men. Research instruments were questionnaire and blood specimens. HPLC and spectrophotometric methods were used to determine the vitamin levels in sera of drug addicts. alpha-Tocopherol (12.60+/-3.73 compared with 16.3+/-3.37 micromol/l; t=8.6, P=0.05), ascorbic acid (21.59+/-10.5 compared with 38.3+/-13.62 micromol/l; t=10.93, P=0.003) and retinol (1.15+/-0.39 compared with 1.33+/-0.30 micromol/l; t=5.28, P=0.048) in the drug addicts were significantly low as compared to those in the cohort controls. Use of multiple illicit drugs for a longer period of time did result in reduced levels of these vitamins. A significant reduction in retinol concentration was noted among the multiple drug users (F(2,250)=3.23, P=0.041). Duration of addiction had a significant linear correlation with the level of reduction in retinol (F(2,250)=3.23, P=0.041) and alpha-tocopherol (F(2,250)=3.06, P=0.049). Apart from having a significant negative correlation between number of sexual partners and retinol level (F(3,247)=2.65, P=0.049), sexual practice did not have any influence on the vitamin status of the addicts. Occupation did have a significant effect on the ascorbic acid level (F(4,248)=2.46, P=0.046), but other socioeconomic factors like income, age etc did not influence the vitamin E, C and A levels. Body mass index had a positive linear correlation with the vitamins, but it was

  17. 20 CFR 416.214 - You are disabled and drug addiction or alcoholism is a contributing factor material to the...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false You are disabled and drug addiction or....214 You are disabled and drug addiction or alcoholism is a contributing factor material to the... because you are disabled and drug addiction or alcoholism is a contributing factor material to the...

  18. 20 CFR 416.214 - You are disabled and drug addiction or alcoholism is a contributing factor material to the...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false You are disabled and drug addiction or....214 You are disabled and drug addiction or alcoholism is a contributing factor material to the... because you are disabled and drug addiction or alcoholism is a contributing factor material to the...

  19. 20 CFR 416.214 - You are disabled and drug addiction or alcoholism is a contributing factor material to the...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false You are disabled and drug addiction or....214 You are disabled and drug addiction or alcoholism is a contributing factor material to the... because you are disabled and drug addiction or alcoholism is a contributing factor material to the...

  20. 20 CFR 416.214 - You are disabled and drug addiction or alcoholism is a contributing factor material to the...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false You are disabled and drug addiction or....214 You are disabled and drug addiction or alcoholism is a contributing factor material to the... because you are disabled and drug addiction or alcoholism is a contributing factor material to the...

  1. Sildenafil (Viagra) and club drug use in gay and bisexual men: the role of drug combinations and context.

    PubMed

    Halkitis, Perry N; Green, Kelly A

    2007-06-01

    Data ascertained in a study of club drug use among 450 gay and bisexual men indicate that at least one class of PDE-5 (phosphodiesterase type 5 inhibitor, sildenafil [Viagra]) is used frequently in combination with club drugs such as methamphetamine, MDMA (3,4 methylenedioxymethamphetamine [ecstasy]), ketamine, cocaine, and GHB (gamma hydroxy butyrate). Patterns of sildenafil use in combination with each of the club drugs differ among key demographics including race and age. Multivariate models, controlling for demographic factors, suggest that contextual factors are key to understanding why men mix sildenafil with club drugs, although age may still be an important issue to consider. Of particular importance is the fact that use of club drugs in combination with sildenafil is strongly associated with circuit and sex parties, where a centerpiece of these environments focuses on sexual exchange. These models imply interplay between person-level and contextual factors in explaining drug use patterns and further indicate that interventions aimed at addressing illicit substance use must carefully consider the role of environmental factors in explaining behavior.

  2. Deliberate drug poisonings admitted to an emergency department in Paris area - a descriptive study and assessment of risk factors for intensive care admission.

    PubMed

    Beaune, S; Juvin, P; Beauchet, A; Casalino, E; Megarbane, B

    2016-01-01

    Each year, approximately 165,000 poisonings are managed in the emergency departments (ED) in France. We performed a descriptive analysis of self-poisoned patients admitted to a university hospital ED in the Paris metropolitan area (France) aimed at investigating their outcome and the risk factors for transfer to the intensive care unit (ICU). We retrospectively reviewed patients' records and performed multivariate logistic regression analysis to identify risk factors for ICU admission. During 4 years, 882 self-poisoned patients (median age, 38 years [IQR, 26-47]; sex-ratio, 1M/3F) were admitted to the ED, representing 0.7% of all referred patients. Poisonings mainly resulted from multidrug exposures (53%), including benzodiazepines (78%), serotonin reuptake inhibitors (17%), acetaminophen (13%), antipsychotics (9.5%), imidazopyridines (9.5%), antihypertensive drugs (3%), and polycyclic antidepressants (1.3%). Ethanol was involved in 20% of the exposures. Patients were briefly (<24h) monitored in the ED (55%), transferred to the psychiatric department (30%), medical ward (2%) or ICU (6%), and took an irregular discharge (7%). Among the patients transferred to the ICU, 25% were mechanically ventilated and only one died. Risk factors for ICU admission included antihypertensive (Odds ratio (OR), 40.6; 95%-confidence interval (CI), 7.5-221.9) or antipsychotic drug ingestion (OR, 5.3; CI, 2.0-14.4), male gender (OR, 3.3; CI, 1.30-8.8), and consciousness impairment (OR, 2.1; CI, 1.8-2.5 per point lost in Glasgow coma score). Deliberate drug exposure represents a frequent cause of ED admission. Psychotropic drugs are most commonly involved. Transfer to the ICU is rare and predicted by male gender, drug class, and coma depth.

  3. Cognitive Factors Related to Drug Abuse Among a Sample of Iranian Male Medical College Students

    PubMed Central

    Jalilian, Farzad; Ataee, Mari; Matin, Behzad Karami; Ahmadpanah, Mohammad; Jouybari, Touraj Ahmadi; Eslami, Ahmad Ali; Mahboubi, Mohammad; Alavijeh, Mehdi Mirzaei

    2015-01-01

    Backgrounds: Drug abuse is one of the most serious social problems in many countries. College students, particularly at their first year of education, are considered as one of the at risk groups for drug abuse. The present study aimed to determine cognitive factors related to drug abuse among a sample of Iranian male medical college students based on the social cognitive theory (SCT). Method: This cross-sectional study was carried out on 425 Iranian male medical college students who were randomly selected to participate voluntarily in the study. The participants filled out a self-administered questionnaire. Data were analyzed by the SPSS software (ver. 21.0) using bivariate correlations, logistic and linear regression at 95% significant level. Results: Attitude, outcome expectation, outcome expectancies, subjective norms, and self-control were cognitive factors that accounted for 49% of the variation in the outcome measure of the intention to abuse drugs. Logistic regression showed that attitude (OR=1.062), outcome expectancies (OR=1.115), and subjective norms (OR=1.269) were the most influential predictors for drug abuse. Conclusions: The findings suggest that designing and implementation of educational programs may be useful to increase negative attitude, outcome expectancies, and subjective norms towards drug abuse for college students in order to prevent drug abuse. PMID:26156919

  4. Calcium phosphate ceramic systems in growth factor and drug delivery for bone tissue engineering: A review

    PubMed Central

    Bose, Susmita; Tarafder, Solaiman

    2012-01-01

    Calcium phosphates (CaPs) are the most widely used bone substitutes in bone tissue engineering due to their compositional similarities to bone mineral and excellent biocompatibility. In recent years, CaPs, especially hydroxyapatite and tricalcium phosphate, have attracted significant interest in simultaneous use as bone substitute and drug delivery vehicle, adding a new dimension to their application. CaPs are more biocompatible than many other ceramic and inorganic nanoparticles. Their biocompatibility and variable stoichiometry, thus surface charge density, functionality, and dissolution properties, make them suitable for both drug and growth factor delivery. CaP matrices and scaffolds have been reported to act as delivery vehicles for growth factors and drugs in bone tissue engineering. Local drug delivery in musculoskeletal disorder treatments can address some of the critical issues more effectively and efficiently than the systemic delivery. CaPs are used as coatings on metallic implants, CaP cements, and custom designed scaffolds to treat musculoskeletal disorders. This review highlights some of the current drug and growth factor delivery approaches and critical issues using CaP particles, coatings, cements, and scaffolds towards orthopedic and dental applications. PMID:22127225

  5. Optimization of Primary Drying in Lyophilization during Early Phase Drug Development using a Definitive Screening Design with Formulation and Process Factors.

    PubMed

    Goldman, Johnathan M; More, Haresh T; Yee, Olga; Borgeson, Elizabeth; Remy, Brenda; Rowe, Jasmine; Sadineni, Vikram

    2018-06-08

    Development of optimal drug product lyophilization cycles is typically accomplished via multiple engineering runs to determine appropriate process parameters. These runs require significant time and product investments, which are especially costly during early phase development when the drug product formulation and lyophilization process are often defined simultaneously. Even small changes in the formulation may require a new set of engineering runs to define lyophilization process parameters. In order to overcome these development difficulties, an eight factor definitive screening design (DSD), including both formulation and process parameters, was executed on a fully human monoclonal antibody (mAb) drug product. The DSD enables evaluation of several interdependent factors to define critical parameters that affect primary drying time and product temperature. From these parameters, a lyophilization development model is defined where near optimal process parameters can be derived for many different drug product formulations. This concept is demonstrated on a mAb drug product where statistically predicted cycle responses agree well with those measured experimentally. This design of experiments (DoE) approach for early phase lyophilization cycle development offers a workflow that significantly decreases the development time of clinically and potentially commercially viable lyophilization cycles for a platform formulation that still has variable range of compositions. Copyright © 2018. Published by Elsevier Inc.

  6. Organizational adoption of preemployment drug testing.

    PubMed

    Spell, C S; Blum, T C

    2001-04-01

    This study explored the adoption of preemployment drug testing by 360 organizations. Survival models were developed that included internal organizational and labor market factors hypothesized to affect the likelihood of adoption of drug testing. Also considered was another set of variables that included social and political variables based on institutional theory. An event history analysis using Cox regressions indicated that both internal organizational and environmental variables predicted adoption of drug testing. Results indicate that the higher the proportion of drug testers in the worksite's industry, the more likely it would be to adopt drug testing. Also, the extent to which an organization uses an internal labor market, voluntary turnover rate, and the extent to which management perceives drugs to be a problem were related to likelihood of adoption of drug testing.

  7. Chemotherapy of Rodent Malaria. Evaluation of Drug Action against Normal and Resistant Strains including Exo-Erythrocytic Stages.

    DTIC Science & Technology

    1979-10-01

    AD-RI35 058 CHEMOTHERAPY’OF RODENT MALARIA EVALUATION OF DRUG I/i ACTION AGAINST NORMAL R-.(U) LIVERPOQL SCHOOL OF TROPICAL MEDICINE ENGLAND) DEPT OF...PARS N PETERSUNCLASSIFIED OCT 79 DANDi?79 6 -G94 57 F/ 6 6 /15117EhEEohEohhhiE *flfl 4L 2 Q~ -8 hi 36 11125 LA 11.6 MICROCOPY RESOLUTION TEST CHART...NATIONAL BUREAU OF STANDARDS- 1963-A I" CHEMOTHERAPY RODENT MALARIA EVALUATION OF DRUG AC ON AGAINST NORMAL AND RESISTANT STRAINS INCLUDING EXO

  8. Risk Factors for Breast Cancer, Including Occupational Exposures

    PubMed Central

    Meo, Margrethe; Vainio, Harri

    2011-01-01

    The knowledge on the etiology of breast cancer has advanced substantially in recent years, and several etiological factors are now firmly established. However, very few new discoveries have been made in relation to occupational risk factors. The International Agency for Research on Cancer has evaluated over 900 different exposures or agents to-date to determine whether they are carcinogenic to humans. These evaluations are published as a series of Monographs (www.iarc.fr). For breast cancer the following substances have been classified as "carcinogenic to humans" (Group 1): alcoholic beverages, exposure to diethylstilbestrol, estrogen-progestogen contraceptives, estrogen-progestogen hormone replacement therapy and exposure to X-radiation and gamma-radiation (in special populations such as atomic bomb survivors, medical patients, and in-utero exposure). Ethylene oxide is also classified as a Group 1 carcinogen, although the evidence for carcinogenicity in epidemiologic studies, and specifically for the human breast, is limited. The classification "probably carcinogenic to humans" (Group 2A) includes estrogen hormone replacement therapy, tobacco smoking, and shift work involving circadian disruption, including work as a flight attendant. If the association between shift work and breast cancer, the most common female cancer, is confirmed, shift work could become the leading cause of occupational cancer in women. PMID:22953181

  9. Advancements in ocular drug delivery.

    PubMed

    Weiner, Alan L; Gilger, Brian C

    2010-11-01

    This review covers both noninvasive and invasive ophthalmic drug delivery systems that can have application to therapy of veterinary ophthalmic diseases. Noninvasive approaches include gel technologies, permeation enhancement via pro-drug development, solubilization agents and nanoparticle technologies, iontophoresis, microneedles, drug-eluting contact lenses and eye misters, and microdroplets. More invasive systems include both eroding implants and noneroding technologies that encompass diffusion based systems, active pumps, intraocular lenses, suprachoroidal drug delivery, and episcleral reservoirs. In addition to addressing the physiologic challenges of achieving the necessary duration of delivery, tissue targeting and patient compliance, the commercial development factors of biocompatibility, sterilization, manufacturability and long-term stability will be discussed. © 2010 American College of Veterinary Ophthalmologists.

  10. HIV Testing in Non-Injection Drug Users: Prevalence and Associated Factors.

    PubMed

    Alves Guimarães, Rafael; Lucchese, Roselma; Lara Fernandes, Inaina; Vera, Ivânia; Goulart Rodovalho, Aurélio; Alves Guimarães, Vanessa; Cristina Silva, Graciele; Lopes de Felipe, Rodrigo; Alexandre de Castro, Paulo; Martins Ferreira, Priscilla

    2017-05-24

    The objective of this study was to estimate the prevalence of and identify factors associated with lifetime testing for the human immunodeficiency virus (HIV) in non-injection drug users (NIDU). A cross-sectional study was conducted with 323 individuals in clinics for chemical dependency in the state of Goiás in the Central-West region of Brazil. Logistic regression analysis was used to identify factors associated with lifetime HIV testing. Testing for HIV was associated with age, female gender, crack use, history of sexually transmitted infections, acquaintance with people living with HIV/AIDS and/or who had died from AIDS, and history of having received some instruction on HIV/AIDS prevention methods. It was found that only 26.6% reported having access to the HIV rapid test. We concluded determinants for HIV testing must be taken into account when planning prevention and programming strategies. These include the widening of testing coverage among NIDU, educational health actions, establishment of links between sexually transmitted infection prevention services and addiction treatment services, and the use of rapid tests to help people who are in contact with the virus learn about their HIV status, enter treatment, and improve their quality of life.

  11. Temperament and character modify risk of drug addiction and influence choice of drugs.

    PubMed

    Milivojevic, Dragan; Milovanovic, Srdjan D; Jovanovic, Minja; Svrakic, Dragan M; Svrakic, Nenad M; Svrakic, Slobodan M; Cloninger, C Robert

    2012-01-01

    Drug addiction and alcoholism involve a complex etiopathogenesis with a variable degree of risk contributions from the host (person), environment, and addictive substances. In this work, temperament and character features of individuals addicted to opiates or alcohol are compared with normal controls to study personality factors in the overall risk for drug addiction. The study was done in a permissive environment, with easy access to alcohol and heroin, which facilitated analyses of personality factors in drug choice. Participants included 412 consecutive patients (312 opiate addicts, 100 alcohol addicts) treated at the Specialized Hospital for Chemical Dependency in Belgrade, Serbia, and a community sample of 346 controls. Opiate addicts manifested antisocial temperament configuration (high Novelty Seeking, low Reward Dependence) coupled with high Self-transcendence (ie, susceptibility to fantasy and imagination). Alcohol addicts manifested sensitive temperament configuration (high Novelty Seeking coexisting with high Harm Avoidance). Immature personality was observed far more frequently in opiate addicts than in alcoholics or normals. Novelty Seeking appears to be a general risk factor for drug addiction. High Harm Avoidance appears to channel individuals with high Novelty Seeking towards alcoholism. Immature character traits and probable Personality Disorder increase the risk of illegal drugs. Based on equivalent research in nonpermissive environments, at least a portion of our opiate addicts could have developed alcoholism instead in environments with more limited access to opiates. Personality factors provide useful guidelines for preventive work with young individuals with personality risk factors for drug addiction. Copyright © American Academy of Addiction Psychiatry.

  12. Engineered reversal of drug resistance in cancer cells--metastases suppressor factors as change agents.

    PubMed

    Yadav, Vinod Kumar; Kumar, Akinchan; Mann, Anita; Aggarwal, Suruchi; Kumar, Maneesh; Roy, Sumitabho Deb; Pore, Subrata Kumar; Banerjee, Rajkumar; Mahesh Kumar, Jerald; Thakur, Ram Krishna; Chowdhury, Shantanu

    2014-01-01

    Building molecular correlates of drug resistance in cancer and exploiting them for therapeutic intervention remains a pressing clinical need. To identify factors that impact drug resistance herein we built a model that couples inherent cell-based response toward drugs with transcriptomes of resistant/sensitive cells. To test this model, we focused on a group of genes called metastasis suppressor genes (MSGs) that influence aggressiveness and metastatic potential of cancers. Interestingly, modeling of 84 000 drug response transcriptome combinations predicted multiple MSGs to be associated with resistance of different cell types and drugs. As a case study, on inducing MSG levels in a drug resistant breast cancer line resistance to anticancer drugs caerulomycin, camptothecin and topotecan decreased by more than 50-60%, in both culture conditions and also in tumors generated in mice, in contrast to control un-induced cells. To our knowledge, this is the first demonstration of engineered reversal of drug resistance in cancer cells based on a model that exploits inherent cellular response profiles.

  13. Characterizing the Intersection of Co-Occurring Risk Factors for Illicit Drug Abuse and Dependence in a U.S. Nationally Representative Sample

    PubMed Central

    Kurti, Allison N.; Keith, Diana R.; Noble, Alyssa; Priest, Jeff S.; Sprague, Brian; Higgins, Stephen T.

    2016-01-01

    Few studies have attempted to characterize how co-occurring risk factors for substance use disorders intersect. A recent study examined this question regarding cigarette smoking and demonstrated that co-occurring risk factors generally act independently. The present study examines whether that same pattern of independent intersection of risk factors extends to illicit drug abuse/dependence using a U.S. nationally representative sample (National Survey on Drug Use and Health, 2011–2013). Logistic regression and classification and regression tree (CART) modeling were used to examine risk of past-year drug abuse/dependence associated with a well-established set of risk factors for substance use (age, gender, race/ethnicity, education, poverty, smoking status, alcohol abuse/dependence, mental illness). Each of these risk factors was associated with significant increases in the odds of drug abuse/dependence in univariate logistic regressions. Each remained significant in a multivariate model examining all eight risk factors simultaneously. CART modeling of these 8 risk factors identified subpopulation risk profiles wherein drug abuse/dependence prevalence varied from < 1% to > 80% corresponding to differing combinations of risk factors present. Alcohol abuse/dependence and cigarette smoking had the strongest associations with drug abuse/dependence risk. These results demonstrate that co-occurring risk factors for illicit drug/abuse dependence generally intersect in the same independent manner as risk factors for cigarette smoking, underscoring further fundamental commonalities across these different types of substance use disorders. These results also underscore the fundamental importance of differences in the presence of co-occurring risk factors when considering the often strikingly different prevalence rates of illicit drug abuse/dependence in U.S. population subgroups. PMID:27687534

  14. Relationship between Paronychia and Drug Concentrations of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors.

    PubMed

    Masago, Katsuhiro; Irie, Kei; Fujita, Shiro; Imamichi, Fumiko; Okada, Yutaka; Katakami, Nobuyuki; Fukushima, Shoji; Yatabe, Yasushi

    2018-06-14

    The purpose of the study was to evaluate the site of paronychia in patients with non-small cell lung cancer harboring an epidermal growth factor receptor (EGFR) gene activating mutation who were treated with EGFR tyrosine kinase inhibitors (EGFR TKIs). The study included 55 patients with non-small-cell lung cancer who were treated with an EGFR TKIs. Resulting all toxicities were graded using the Common Terminology Criteria for Adverse Events version 4.0 system. Drug concentrations were determined with use of a quantum triple-quadrupole mass spectrometer and dried blood spots testing. Paronychia most commonly occurred in the thumb and the big toe. There was no correlation between the severity of paronychia and the drug concentration of each EGFR TKI at the site of paronychia. The mean penetration rates of the drug from plasma to the tip of the finger and toe were 74.1% (erlotinib), 82.2% (gefitinib), and 99.9% (afatinib). High concentrations of an EGFR TKI at the affected site did not play a role in the onset mechanism of paronychia. Therefore, educating patients about ways to avoid compression may be a better approach to managing this adverse event than reducing the dose of the EGFR-TKI or stopping treatment. © 2018 S. Karger AG, Basel.

  15. Hallucinogens and Dissociative Drugs, Including LSD, PCP, Ketamine, Dextromethorphan. National Institute on Drug Abuse Research Report Series.

    ERIC Educational Resources Information Center

    National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD.

    Research is developing a clearer picture of the dangers of mind-altering drugs. The goal of this report is to present the latest information to providers to help them strengthen their prevention and treatment efforts. A description is presented of dissociative drugs, and consideration is given as to why people take hallucinogens. The physical…

  16. Prescription drug coverage and effects on drug expenditures among elderly Medicare beneficiaries.

    PubMed

    Huh, Soonim; Rice, Thomas; Ettner, Susan L

    2008-06-01

    To identify determinants of drug coverage among elderly Medicare beneficiaries and to investigate the impact of drug coverage on drug expenditures with and without taking selection bias into account. The primary data were from the 2000 Medicare Current Beneficiary Survey (MCBS) Cost and Use file, linked to other data sources at the county or state-level that provided instrumental variables. Community-dwelling elderly Medicare beneficiaries who completed the survey were included in the study (N=7,525). A probit regression to predict the probability of having drug coverage and the effects of drug coverage on drug expenditures was estimated by a two-part model, assuming no correlation across equations. In addition, the discrete factor model estimated choice of drug coverage and expenditures for prescription drugs simultaneously to control for self-selection into drug coverage, allowing for correlation of error terms across equations. Findings indicated that unobservable characteristics leading elderly Medicare beneficiaries to purchase drug coverage also lead them to have higher drug expenditures on conditional use (i.e., adverse selection), while the same unobservable factors do not influence their decisions whether to use any drugs. After controlling for potential selection bias, the probability of any drug use among persons with drug coverage use was 4.5 percent higher than among those without, and drug coverage led to an increase in drug expenditures of $308 among those who used prescription drugs. Given significant adverse selection into drug coverage before the implementation of the Medicare Prescription Drug Improvement and Modernization Act, it is essential that selection effects be monitored as beneficiaries choose whether or not to enroll in this voluntary program.

  17. Interactions of HIV and drugs of abuse: the importance of glia, neural progenitors, and host genetic factors.

    PubMed

    Hauser, Kurt F; Knapp, Pamela E

    2014-01-01

    Considerable insight has been gained into the comorbid, interactive effects of HIV and drug abuse in the brain using experimental models. This review, which considers opiates, methamphetamine, and cocaine, emphasizes the importance of host genetics and glial plasticity in driving the pathogenic neuron remodeling underlying neuro-acquired immunodeficiency syndrome and drug abuse comorbidity. Clinical findings are less concordant than experimental work, and the response of individuals to HIV and to drug abuse can vary tremendously. Host-genetic variability is important in determining viral tropism, neuropathogenesis, drug responses, and addictive behavior. However, genetic differences alone cannot account for individual variability in the brain "connectome." Environment and experience are critical determinants in the evolution of synaptic circuitry throughout life. Neurons and glia both exercise control over determinants of synaptic plasticity that are disrupted by HIV and drug abuse. Perivascular macrophages, microglia, and to a lesser extent astroglia can harbor the infection. Uninfected bystanders, especially astroglia, propagate and amplify inflammatory signals. Drug abuse by itself derails neuronal and glial function, and the outcome of chronic exposure is maladaptive plasticity. The negative consequences of coexposure to HIV and drug abuse are determined by numerous factors including genetics, sex, age, and multidrug exposure. Glia and some neurons are generated throughout life, and their progenitors appear to be targets of HIV and opiates/psychostimulants. The chronic nature of HIV and drug abuse appears to result in sustained alterations in the maturation and fate of neural progenitors, which may affect the balance of glial populations within multiple brain regions. © 2014 Elsevier Inc. All rights reserved.

  18. Interactions of HIV and drugs of abuse: the importance of glia, neural progenitors, and host genetic factors

    PubMed Central

    Hauser, Kurt F.; Knapp, Pamela E.

    2015-01-01

    Considerable insight has been gained into the comorbid, interactive effects of HIV and drug abuse in the brain using experimental models. This review, which considers opiates, methamphetamine, and cocaine, emphasizes the importance of host genetics and glial plasticity in driving the pathogenic neuron remodeling underlying neuro-acquired immunodeficiency syndrome (neuroAIDS) and drug abuse comorbidity. Clinical findings are less concordant than experimental work, and the response of individuals to HIV and to drug abuse can vary tremendously. Host-genetic variability is important in determining viral tropism, neuropathogenesis, drug responses, and addictive behavior. However, genetic differences alone cannot account for individual variability in the brain “connectome”. Environment and experience are critical determinants in the evolution of synaptic circuitry throughout life. Neurons and glia both exercise control over determinants of synaptic plasticity that are disrupted by HIV and drug abuse. Perivascular macrophages, microglia, and to a lesser extent astroglia can harbor the infection. Uninfected bystanders, especially astroglia, propagate and amplify inflammatory signals. Drug abuse by itself derails neuronal and glial function, and the outcome of chronic exposure is maladaptive plasticity. The negative consequences of coexposure to HIV and drug abuse are determined by numerous factors including genetics, sex, age, and multidrug exposure. Glia and some neurons are generated throughout life and their progenitors appear to be targets of HIV and opiates/psychostimulants. The chronic nature of HIV and drug abuse appears to result in sustained alterations in the maturation and fate of neural progenitors, which may affect the balance of glial populations within multiple brain regions. PMID:25175867

  19. Predicting drug-target interactions by dual-network integrated logistic matrix factorization

    NASA Astrophysics Data System (ADS)

    Hao, Ming; Bryant, Stephen H.; Wang, Yanli

    2017-01-01

    In this work, we propose a dual-network integrated logistic matrix factorization (DNILMF) algorithm to predict potential drug-target interactions (DTI). The prediction procedure consists of four steps: (1) inferring new drug/target profiles and constructing profile kernel matrix; (2) diffusing drug profile kernel matrix with drug structure kernel matrix; (3) diffusing target profile kernel matrix with target sequence kernel matrix; and (4) building DNILMF model and smoothing new drug/target predictions based on their neighbors. We compare our algorithm with the state-of-the-art method based on the benchmark dataset. Results indicate that the DNILMF algorithm outperforms the previously reported approaches in terms of AUPR (area under precision-recall curve) and AUC (area under curve of receiver operating characteristic) based on the 5 trials of 10-fold cross-validation. We conclude that the performance improvement depends on not only the proposed objective function, but also the used nonlinear diffusion technique which is important but under studied in the DTI prediction field. In addition, we also compile a new DTI dataset for increasing the diversity of currently available benchmark datasets. The top prediction results for the new dataset are confirmed by experimental studies or supported by other computational research.

  20. 42 CFR 410.10 - Medical and other health services: Included services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... (p) Hepatitis B vaccine. (q) Blood clotting factors for hemophilia patients competent to use these... furnished without charge or included in the physicians' bills. (c) Services and supplies, including partial... dialysis patients, and, on or after January 1, 1994, for dialysis patients, competent to use the drug; self...

  1. Seroprevalence of Hepatitis B Infection and Associated Risk Factors among Drug Users in Drop-in Centers of Isfahan, Iran.

    PubMed

    Taleban, Roya; Moafi, Mohammad; Ataei, Behrooz; Yaran, Majid; Nokhodian, Zary; Kassaian, Nazila; Adibi, Peyman; Javadi, Abbasali

    2018-01-01

    Scientists perceive drug users (DUs) as a high-risk population for hepatitis B virus (HBV) infection. Effective strategies aiming at the reduction of HBV infection can be depicted when its epidemiological status is clearly defined. The present study provides new insight into associated risk factors of HBV infection and its seroepidemiological status among DUs attending drop-in centers (DICs). This was a cross-sectional study, which was implemented in 7 DICs of Isfahan province. The sample size included 539 participants. Demographic data and risk factors for HBV infection were obtained by a trained social worker using a self-made structured questionnaire. Venous blood sample was obtained and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and total hepatitis B core antibody (HBcAb) using enzyme-linked immunosorbent assay. Mean age of the participants was 31.76 ± 8.4 years. They were generally male, Iranian, urban, with an education level of high school or less. The prevalence of HBV infection (HBsAg and/or HBcAb) was 18% (88.490). Regression analysis showed that age, bloodletting, and drug injection, being the sexual partner of injecting DU (IDU), as well as frequency and duration of imprisonment positively correlated with HBV infection. Drug injection bloodletting, and being the sexual partner of IDU, as well as frequency and duration of imprisonment could be considered as contributing factors in HBV infection.

  2. 76 FR 36543 - Draft Guidance for Industry and Food and Drug Administration Staff: Applying Human Factors and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-22

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0469] Draft Guidance for Industry and Food and Drug Administration Staff: Applying Human Factors and Usability Engineering To Optimize Medical Device Design; Availability AGENCY: Food and Drug Administration, HHS. ACTION...

  3. Neighbourhood Socio-Economic Factors in Relation to Student Drug Use and Programs.

    ERIC Educational Resources Information Center

    Smart, Reginald G.; And Others

    1994-01-01

    Examines relationships between drug use problems and socioeconomic status of neighborhoods where students in grades 11 and 13 reside. Found largest number of alcohol and drug problems in areas with lowest socioeconomic characteristics, characterized by low-cost substandard housing, social and racial problems, and delinquency. Includes 13…

  4. Risk Factors Associated with Default from Multi- and Extensively Drug-Resistant Tuberculosis Treatment, Uzbekistan: A Retrospective Cohort Analysis

    PubMed Central

    Lalor, Maeve K.; Greig, Jane; Allamuratova, Sholpan; Althomsons, Sandy; Tigay, Zinaida; Khaemraev, Atadjan; Braker, Kai; Telnov, Oleksander; du Cros, Philipp

    2013-01-01

    Background The Médecins Sans Frontières project of Uzbekistan has provided multidrug-resistant tuberculosis treatment in the Karakalpakstan region since 2003. Rates of default from treatment have been high, despite psychosocial support, increasing particularly since programme scale-up in 2007. We aimed to determine factors associated with default in multi- and extensively drug-resistant tuberculosis patients who started treatment between 2003 and 2008 and thus had finished approximately 2 years of treatment by the end of 2010. Methods A retrospective cohort analysis of multi- and extensively drug-resistant tuberculosis patients enrolled in treatment between 2003 and 2008 compared baseline demographic characteristics and possible risk factors for default. Default was defined as missing ≥60 consecutive days of treatment (all drugs). Data were routinely collected during treatment and entered in a database. Potential risk factors for default were assessed in univariate analysis using chi-square test and in multivariate analysis with logistic regression. Results 20% (142/710) of patients defaulted after a median of 6 months treatment (IQR 2.6–9.9). Factors associated with default included severity of resistance patterns (pre-extensively drug-resistant/extensively drug-resistant tuberculosis adjusted odds ratio 0.52, 95%CI: 0.31–0.86), previous default (2.38, 1.09–5.24) and age >45 years (1.77, 1.10–2.87). The default rate was 14% (42/294) for patients enrolled 2003–2006 and 24% (100/416) for 2007–2008 enrolments (p = 0.001). Conclusions Default from treatment was high and increased with programme scale-up. It is essential to ensure scale-up of treatment is accompanied with scale-up of staff and patient support. A successful first course of tuberculosis treatment is important; patients who had previously defaulted were at increased risk of default and death. The protective effect of severe resistance profiles suggests that understanding disease

  5. Family Risk and Resiliency Factors, Substance Use, and the Drug Resistance Process in Adolescence.

    ERIC Educational Resources Information Center

    Moon, Dreama G.; Jackson, Kristina M.; Hecht, Michael L.

    2000-01-01

    Study tests two models to compare the effects of risk and resiliency across gender and ethnicity. Results support the model in which risk and resiliency are discrete sets of factors and demonstrate that overall resiliency factors play a larger role than risk factors in substance use and drug resistance processes. Gender proved to be an important…

  6. What Matters Most? Assessing the Influence of Demographic Characteristics, College-Specific Risk Factors, and Poly-Drug Use on Nonmedical Prescription Drug Use

    ERIC Educational Resources Information Center

    Lanier, Christina; Farley, Erin J.

    2011-01-01

    Objective: Although prior recent research has revealed a significant relationship between the nonmedical use of prescription drugs, demographic characteristics, college-specific risk factors, and other substance use among college students, there remains a need to conduct a comparative analysis on the differential impact these factors may have on…

  7. Drugs and Diseases Interacting with Cigarette Smoking in US Prescription Drug Labelling.

    PubMed

    Li, Haibo; Shi, Qiang

    2015-05-01

    The US Food and Drug Administration (FDA) draft guidance for industry on drug interaction studies recommends, but does not mandate, that both cigarette smokers and non-smokers can be used to study drug metabolism in clinical trials, and that important results related to smoking should be included in drug labelling to guide medication usage. This study aimed to provide a comprehensive review of drugs or diseases interacting with smoking, as presented in all US drug labelling. The 62,857 drug labels deposited in the FDA Online Label Repository were searched using the keywords 'smoke', 'smoker(s)', 'smoking', 'tobacco' and 'cigarette(s)' on 19 June 2014. The resultant records were refined to include only human prescription drug labelling, for manual examination. For 188 single-active-ingredient drugs and 36 multiple-active-ingredient drugs, the labelling was found to contain smoking-related information. The pharmacokinetics of 29 and 21 single-active-ingredient drugs were affected and unaffected, respectively, by smoking. For the remaining drugs, the provided information related to smoking affecting efficacy, safety or diseases but not pharmacokinetics. Depending on the nature of specific drugs, the perturbation in pharmacokinetic parameters in smokers ranged from 13 to 500%, in comparison with non-smokers. Dosage modifications in smokers are necessary for four drugs and may be necessary for six drugs, but are unnecessary for seven drugs although the pharmacokinetic parameters of four of them are affected by smoking. Cigarette smoking is a risk factor for 16 types of diseases or adverse drug reactions. For one single-active-ingredient contraceptive drug and 10 multiple-active-ingredient contraceptive drugs, a black box warning (the FDA's strongest safety warning) is included in the labelling for increased risks of heart attacks and strokes in female smokers, and "women are strongly advised not to smoke" when using these drugs. This study presents the first

  8. Overview of Drug Delivery Methods in Exotics, Including Their Anatomic and Physiologic Considerations.

    PubMed

    Coutant, Thomas; Vergneau-Grosset, Claire; Langlois, Isabelle

    2018-05-01

    Drug delivery to exotic animals may be extrapolated from domestic animals, but some physiologic and anatomic differences complicate treatment administration. Knowing these differences enables one to choose optimal routes for drug delivery. This review provides practitioners with a detailed review of the currently reported methods used for drug delivery of various medications in the most common exotic animal species. Exotic animal peculiarities that are relevant for drug administration are discussed in the text and outlined in tables and boxes to help the reader easily find targeted information. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Neural mechanisms of reproduction in females as a predisposing factor for drug addiction.

    PubMed

    Hedges, Valerie L; Staffend, Nancy A; Meisel, Robert L

    2010-04-01

    There is an increasing awareness that adolescent females differ from males in their response to drugs of abuse and consequently in their vulnerability to addiction. One possible component of this vulnerability to drug addiction is the neurobiological impact that reproductive physiology and behaviors have on the mesolimbic dopamine system, a key neural pathway mediating drug addiction. In this review, we examine animal models that address the impact of ovarian cyclicity, sexual affiliation, sexual behavior, and maternal care on the long-term plasticity of the mesolimbic dopamine system. The thesis is that this plasticity in synaptic neurotransmission stemming from an individual's normal life history contributes to the pathological impact of drugs of abuse on the neurobiology of this system. Hormones released during reproductive cycles have only transient effects on these dopamine systems, whereas reproductive behaviors produce a persistent sensitization of dopamine release and post-synaptic neuronal responsiveness. Puberty itself may not represent a neurobiological risk factor for drug abuse, but attendant behavioral experiences may have a negative impact on females engaging in drug use.

  10. Neural Mechanisms of Reproduction in Females as a Predisposing Factor for Drug Addiction

    PubMed Central

    Hedges, Valerie L.; Staffend, Nancy A.; Meisel, Robert L.

    2010-01-01

    There is an increasing awareness that adolescent females differ from males in their response to drugs of abuse and consequently in their vulnerability to addiction. One possible component of this vulnerability to drug addiction is the neurobiological impact that reproductive physiology and behaviors have on the mesolimbic dopamine system, a key neural pathway mediating drug addiction. In this review, we examine animal models that address the impact of ovarian cyclicity, sexual affiliation, sexual behavior, and maternal care on the long-term plasticity of the mesolimbic dopamine system. The thesis is that this plasticity in synaptic neurotransmission stemming from an individual’s normal life history contributes to the pathological impact of drugs of abuse on the neurobiology of this system. Hormones released during reproductive cycles have only transient effects on these dopamine systems, whereas reproductive behaviors produce a persistent sensitization of dopamine release and postsynaptic neuronal responsiveness. Puberty itself may not represent a neurobiological risk factor for drug abuse, but attendant behavioral experiences may have a negative impact on females engaging in drug use. PMID:20176045

  11. [Factors influencing activity of oral anticoagulants. Interactions with drugs and food].

    PubMed

    Sawicka-Powierza, Jolanta; Rogowska-Szadkowska, Dorota; Ołtarzewska, Alicja Małgorzata; Chlabicz, Sławomir

    2008-05-01

    Oral anticoagulants (OAC) are commonly used as a life-long therapy in prevention of systemic embolism in patients with atrial fibrillation, valvular heart disease and prosthetic hart valves and in the primary and secondary prevention of venous thromboembolism. They are also used for the prevention of thromboembolic events in patients with acute myocardial infarction and with angina pectoris, in patients with biological hart valves and after some types of orthopaedics surgery. The International Normalized Ratio (INR) is used to evaluate the efficacy of anti-coagulant therapy. The risk of thromboembolic and haemorrhagic complications increases when the INR is out of the therapeutic range. The aim of this study was to present information about the factors influencing activity of oral anticoagulants and interactions between oral anticoagulants and drugs or food. The effect of oral anticoagulants is influenced by genetic and environmental factors such as: medicines, food, diseases and pre-existing conditions. A common mutation in the gene coding for the cytochrome P450 (CYP2C9), with one or more combinations of its polymorphisms, is responsible for the reduced warfarin requirements or for the resistance to warfarin. A mutation in the factor IX is responsible for the risk of bleeding during OAC therapy without excessive prolongation of the prothrombin time (PT). Drugs, herbs and multivitamin supplements can alter the absorption, pharmacokinetics or pharmakodynamics of OAC. Nonsteroid anti-inflammatory drugs and paracetamol in combination with OAC seem to be the most dangerous because they are available without prescription and are used without medical consultation. Patients on OAC therapy are sensitive to changing dietary intake of vitamin K, which is supplied from phylloquinones in plants or from vitamin K-containing medicines. The effect of OAC can be influenced by other existing factors like: fever, diarrhoea, alcohol abuse or physical hyperactivity. Some malignancies

  12. The Development of a Test to Assess Drug Using Behavior.

    ERIC Educational Resources Information Center

    Althoff, Michael E.

    The objective of the study was to develop a test which could measure both the qualitative and quantitative aspects of drug-using behavior, including such factors as attitudes toward drugs, experience with drugs, and knowledge about drugs. The Drug Use Scale was developed containing 134 items and dealing with five classes of drugs: marijuana,…

  13. Recommendations for Optimizing Tuberculosis Treatment: Therapeutic Drug Monitoring, Pharmacogenetics, and Nutritional Status Considerations

    PubMed Central

    Choi, Rihwa; Jeong, Byeong-Ho

    2017-01-01

    Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host. These factors should be considered for effective tuberculosis control. Therefore, therapeutic drug monitoring (TDM), which is individualized drug dosing guided by serum drug concentrations during treatment, and pharmacogenetics-based personalized dosing guidelines of anti-tuberculosis drugs could reduce the incidence of adverse drug reactions and increase the likelihood of successful treatment outcomes. Moreover, assessment and management of comorbid conditions including nutritional status could improve anti-tuberculosis treatment response. PMID:28028995

  14. Recommendations for Optimizing Tuberculosis Treatment: Therapeutic Drug Monitoring, Pharmacogenetics, and Nutritional Status Considerations.

    PubMed

    Choi, Rihwa; Jeong, Byeong Ho; Koh, Won Jung; Lee, Soo Youn

    2017-03-01

    Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host. These factors should be considered for effective tuberculosis control. Therefore, therapeutic drug monitoring (TDM), which is individualized drug dosing guided by serum drug concentrations during treatment, and pharmacogenetics-based personalized dosing guidelines of anti-tuberculosis drugs could reduce the incidence of adverse drug reactions and increase the likelihood of successful treatment outcomes. Moreover, assessment and management of comorbid conditions including nutritional status could improve anti-tuberculosis treatment response.

  15. Psychosocial aspects of drug dependence: the Nigerian experience.

    PubMed

    Pela, O A

    1984-01-01

    This paper provides an operational definition and lists some psychosocial questions usually asked about drug dependence. It then reviews the literature on drug abuse in Nigeria, extracting some of the psychosocial variables involved. The review indicates that drug abuse is associated with polygamous or large monogamous families, which may be suggestive of "stressful sibling rivalry." Other factors included defiance of or rebellion against parental control, the facilitation of social intercourse, and harmful early childhood experiences. The social factors implicated include urbanization, Westernization, and migration which may weaken the traditional African support system. An important out-growth of the review is that the psychosocial variables implicated are not different from those observed in other cultures. However, an important social dimension is the prescribing and dispensing practices of Nigerian medical doctors and pharmacists which encourage drug abuse.

  16. 38 CFR 48.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 48.215 Section 48.215 Pensions, Bonuses, and Veterans' Relief DEPARTMENT...

  17. 38 CFR 48.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 48.215 Section 48.215 Pensions, Bonuses, and Veterans' Relief DEPARTMENT...

  18. 38 CFR 48.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 48.215 Section 48.215 Pensions, Bonuses, and Veterans' Relief DEPARTMENT...

  19. 38 CFR 48.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 48.215 Section 48.215 Pensions, Bonuses, and Veterans' Relief DEPARTMENT...

  20. 38 CFR 48.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free workplace; (c... that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 48.215 Section 48.215 Pensions, Bonuses, and Veterans' Relief DEPARTMENT...

  1. Blocking Infralimbic Basic Fibroblast Growth Factor (bFGF or FGF2) Facilitates Extinction of Drug Seeking After Cocaine Self-Administration.

    PubMed

    Hafenbreidel, Madalyn; Twining, Robert C; Rafa Todd, Carolynn; Mueller, Devin

    2015-12-01

    Drug exposure results in structural and functional changes in brain regions that regulate reward and these changes may underlie the persistence of compulsive drug seeking and relapse. Neurotrophic factors, such as basic fibroblast growth factor (bFGF or FGF2), are necessary for neuronal survival, growth, and differentiation, and may contribute to these drug-induced changes. Following cocaine exposure, bFGF is increased in addiction-related brain regions, including the infralimbic medial prefrontal cortex (IL-mPFC). The IL-mPFC is necessary for extinction, but whether drug-induced overexpression of bFGF in this region affects extinction of drug seeking is unknown. Thus, we determined whether blocking bFGF in IL-mPFC would facilitate extinction following cocaine self-administration. Rats were trained to lever press for intravenous infusions of cocaine before extinction. Blocking bFGF in IL-mPFC before four extinction sessions resulted in facilitated extinction. In contrast, blocking bFGF alone was not sufficient to facilitate extinction, as blocking bFGF and returning rats to their home cage had no effect on subsequent extinction. Furthermore, bFGF protein expression increased in IL-mPFC following cocaine self-administration, an effect reversed by extinction. These results suggest that cocaine-induced overexpression of bFGF inhibits extinction, as blocking bFGF during extinction permits rapid extinction. Therefore, targeted reductions in bFGF during therapeutic interventions could enhance treatment outcomes for addiction.

  2. 36 CFR 1212.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 1212.215 Section 1212.215 Parks, Forests, and Public Property NATIONAL...

  3. 36 CFR 1212.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 1212.215 Section 1212.215 Parks, Forests, and Public Property NATIONAL...

  4. 36 CFR 1212.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 1212.215 Section 1212.215 Parks, Forests, and Public Property NATIONAL...

  5. 36 CFR 1212.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... drug-free awareness program? 1212.215 Section 1212.215 Parks, Forests, and Public Property NATIONAL...

  6. Mucoadhesive drug delivery systems

    PubMed Central

    Shaikh, Rahamatullah; Raj Singh, Thakur Raghu; Garland, Martin James; Woolfson, A David; Donnelly, Ryan F.

    2011-01-01

    Mucoadhesion is commonly defined as the adhesion between two materials, at least one of which is a mucosal surface. Over the past few decades, mucosal drug delivery has received a great deal of attention. Mucoadhesive dosage forms may be designed to enable prolonged retention at the site of application, providing a controlled rate of drug release for improved therapeutic outcome. Application of dosage forms to mucosal surfaces may be of benefit to drug molecules not amenable to the oral route, such as those that undergo acid degradation or extensive first-pass metabolism. The mucoadhesive ability of a dosage form is dependent upon a variety of factors, including the nature of the mucosal tissue and the physicochemical properties of the polymeric formulation. This review article aims to provide an overview of the various aspects of mucoadhesion, mucoadhesive materials, factors affecting mucoadhesion, evaluating methods, and finally various mucoadhesive drug delivery systems (buccal, nasal, ocular, gastro, vaginal, and rectal). PMID:21430958

  7. DrugBank: a knowledgebase for drugs, drug actions and drug targets

    PubMed Central

    Wishart, David S.; Knox, Craig; Guo, An Chi; Cheng, Dean; Shrivastava, Savita; Tzur, Dan; Gautam, Bijaya; Hassanali, Murtaza

    2008-01-01

    DrugBank is a richly annotated resource that combines detailed drug data with comprehensive drug target and drug action information. Since its first release in 2006, DrugBank has been widely used to facilitate in silico drug target discovery, drug design, drug docking or screening, drug metabolism prediction, drug interaction prediction and general pharmaceutical education. The latest version of DrugBank (release 2.0) has been expanded significantly over the previous release. With ∼4900 drug entries, it now contains 60% more FDA-approved small molecule and biotech drugs including 10% more ‘experimental’ drugs. Significantly, more protein target data has also been added to the database, with the latest version of DrugBank containing three times as many non-redundant protein or drug target sequences as before (1565 versus 524). Each DrugCard entry now contains more than 100 data fields with half of the information being devoted to drug/chemical data and the other half devoted to pharmacological, pharmacogenomic and molecular biological data. A number of new data fields, including food–drug interactions, drug–drug interactions and experimental ADME data have been added in response to numerous user requests. DrugBank has also significantly improved the power and simplicity of its structure query and text query searches. DrugBank is available at http://www.drugbank.ca PMID:18048412

  8. Prenatal drug exposure effects on subsequent vulnerability to drug abuse.

    PubMed

    Glantz, Meyer D; Chambers, Jessica Campbell

    2006-01-01

    Research has shown that both prenatal alcohol and tobacco exposure are associated with increased risk of significant adverse medical, developmental, and behavioral outcomes including substance abuse. Research on the outcomes of prenatal exposure to illicit drugs (PNDE) has also found increased physical and behavioral problems for gestationally drug-exposed children. However, a clear picture has not emerged on whether the consequences of PNDE are independent from those associated with having a substance abusing parent and whether PNDE increases vulnerability to drug abuse. Because of its typical co-occurrence with factors inherent in having a drug-abusing parent, PNDE is at least a marker of significant increased risk for a range of negative outcomes including greater vulnerability to substance abuse. Although a review of the relevant research literatures indicates that the direct consequences of PNDE appear to be generally both subtle and nonglobal, PNDE does appear to have negative developmental and behavioral outcomes, and there is evidence that it is a modest direct contributor to increased substance abuse vulnerability.

  9. Role of innate and drug-induced dysregulation of brain stress and arousal systems in addiction: Focus on corticotropin-releasing factor, nociceptin/orphanin FQ, and orexin/hypocretin

    PubMed Central

    Martin-Fardon, Rémi; Zorrilla, Eric P.; Ciccocioppo, Roberto; Weiss, Friedbert

    2010-01-01

    Stress-like symptoms are an integral part of acute and protracted drug withdrawal, and several lines of evidence have shown that dysregulation of brain stress systems, including the extrahypothalamic corticotropin-releasing factor (CRF) system, following long-term drug use is of major importance in maintaining drug and alcohol addiction. Recently, two other neuropeptide systems have attracted interest, the nociceptin/orphanin FQ (N/OFQ) and orexin/hypocretin (Orx/Hcrt) systems. N/OFQ participates in a wide range of physiological responses, and the hypothalamic Orx/Hcrt system helps regulate several physiological processes, including feeding, energy metabolism, and arousal. Moreover, these two systems have been suggested to participate in psychiatric disorders, including anxiety and drug addiction. Dysregulation of these systems by chronic drug exposure has been hypothesized to play a role in the maintenance of addiction and dependence. Recent evidence demonstrated that interactions between CRF-N/OFQ and CRF-Orx/Hcrt systems may be functionally relevant for the control of stress-related addictive behavior. The present review discusses recent findings that support the hypotheses of the participation and dysregulation of these systems in drug addiction and evaluates the current understanding of interactions among these stress-regulatory peptides. PMID:20026088

  10. Drug-resistance patterns of Mycobacterium tuberculosis strains and associated risk factors among multi drug-resistant tuberculosis suspected patients from Ethiopia.

    PubMed

    Mesfin, Eyob Abera; Beyene, Dereje; Tesfaye, Abreham; Admasu, Addisu; Addise, Desalegn; Amare, Miskir; Dagne, Biniyam; Yaregal, Zelalem; Tesfaye, Ephrem; Tessema, Belay

    2018-01-01

    Multidrug drug-resistant tuberculosis (MDR-TB) is a major health problem and seriously threatens TB control and prevention efforts globally. Ethiopia is among the 30th highest TB burden countries for MDR-TB with 14% prevalence among previously treated cases. The focus of this study was on determining drug resistance patterns of Mycobacterium tuberculosis among MDR-TB suspected cases and associated risk factors. A cross-sectional study was conducted in Addis Ababa from June 2015 to December 2016. Sputum samples and socio-demographic data were collected from 358 MDR-TB suspected cases. Samples were analyzed using Ziehl-Neelsen technique, GeneXpert MTB/RIF assay, and culture using Lowenstein-Jensen and Mycobacterial growth indicator tube. Data were analyzed using SPSS version 23. A total of 226 the study participants were culture positive for Mycobacterium tuberculosis, among them, 133 (58.8%) participants were males. Moreover, 162 (71.7%) had been previously treated for tuberculosis, while 128 (56.6%) were TB/HIV co-infected. A majority [122 (54%)] of the isolates were resistant to any first-line anti-TB drugs. Among the resistant isolates, 110 (48.7%) were determined to be resistant to isoniazid, 94 (41.6%) to streptomycin, 89 (39.4%) to rifampicin, 72 (31.9%) to ethambutol, and 70 (30.9%) to pyrazinamide. The prevalence of MDR-TB was 89 (39.4%), of which 52/89 (58.4%) isolates were resistance to all five first-line drugs. Risk factors such as TB/HIV co-infection (AOR = 5.59, p = 0.00), cigarette smoking (AOR = 3.52, p = 0.045), alcohol drinking (AOR = 5.14, p = 0.001) hospital admission (AOR = 3.49, p = 0.005) and visiting (AOR = 3.34, p = 0.044) were significantly associated with MDR-TB. The prevalence of MDR-TB in the study population was of a significantly high level among previously treated patients and age group of 25-34. TB/HIV coinfection, smoking of cigarette, alcohol drinking, hospital admission and health facility visiting were identified as risk factors

  11. Factors related to successful treatment of drug-resistance tuberculosis in H. Adam Malik hospital, Medan, Indonesia

    NASA Astrophysics Data System (ADS)

    Manurung, M. P. F.; Siagian, P.; Sinaga, B. Y. M.; Mutiara, E.

    2018-03-01

    The number of drug-resistant TB cases keeps increasing for over the years. Drug-resistant TB is adifficult case because of the treatment, many side effects, more expensive, and less satisfactory results. This study is a retrospective cohort design aimed to determine the factors influencing the success of TB drug resistance treatment at H. Adam Malik Hospital during 2012–2015. The number of confirmed patients with drug-resistant TB was 223 people, 153 male, and 70 female. Two factors have been found to affect the treatment outcomes significantly, age and resistance pattern (P<0.05). Patients aged <50 years old have 2.73 times greater chance of recovery than patients aged ≥50 years old. Based on resistance pattern, patients with rifampicin resistant or poly-resistant would be 6.4 times more likely to recover compared with pre-XDR patients. There was no significant difference in the success rate of treatment among MDR patients compared with rifampicin resistant or poly-resistant cases. Age and resistance pattern has been proved to influence the success of drug-resistant TB treatment.

  12. Cardiovascular drugs inducing QT prolongation: facts and evidence.

    PubMed

    Taira, Carlos A; Opezzo, Javier A W; Mayer, Marcos A; Höcht, Christian

    2010-01-01

    Acquired QT syndrome is mainly caused by the administration of drugs that prolong ventricular repolarization. On the other hand, the risk of drug-induced torsades de pointes is increased by numerous predisposing factors, such as genetic predisposition, female sex, hypokalemia and cardiac dysfunction. This adverse reaction is induced by different chemical compounds used for the treatment of a variety of pathologies, including arrhythmias. As it is known, antiarrhythmic agents and other cardiovascular drugs can prolong the QT interval, causing this adverse reaction. Of the 20 most commonly reported drugs, 10 were cardiovascular agents and these appeared in 348 of the reports (46%). Class Ia antiarrhythmic agents have frequently been linked to inducing arrhythmia, including torsades de pointes. Sotalol and amiodarone, class III antiarrhythmics, are known to prolong the QT interval by blocking I(Kr). Due to the severity of events caused by the therapeutic use of these drugs, in this work of revision the cardiovascular drugs that present this property and the factors and evidence will be mentioned.

  13. Exploring the role of socioeconomic factors in the development and spread of anti-malarial drug resistance: a qualitative study.

    PubMed

    Anyanwu, Philip Emeka; Fulton, John; Evans, Etta; Paget, Timothy

    2017-05-18

    Malaria remains a global health issue with the burden unevenly distributed to the disadvantage of the developing countries of the world. Poverty contributes to the malaria burden as it has the ability to affect integral aspects of malaria control. There have been renewed efforts in the global malaria control, resulting in reductions in the global malaria burden over the last decade. However, the development of resistance to artemisinin-based combination therapy threatens the sustainability of the present success in malaria control. Anti-malarial drug use practices/behaviours remain very important drivers of drug resistance. This study adopted a social epidemiological stance in exploring the underlying socioeconomic factors that determine drug use behaviours promoting anti-malarial drug resistance. A qualitative approach, involving the use of interviews, was used in this inquiry to explore the existing anti-malarial drug use practices in the Nigerian population; and the different socioeconomic factors influencing the behaviours. The significant malaria treatment behaviours influenced by socioeconomic factors in this study were the practice of 'mixing' drugs for malaria treatment, presumptive treatment, sharing of malaria treatment course, and the use of anti-malaria monotherapies. All the rural dwellers in this study reported they have mixed drugs for malaria treatment. When symptoms were experienced, socio-economic factors, like type of settlement, income level and occupation, tended to determine the treatment behaviour and, therefore, informed and determined the experience of the illness. Social and economic contexts can influence behaviours as they contribute in shaping norms and in creating opportunities that promote certain behaviours. As shown in this study, income level and type of settlement, as structural factors, affect the decision on where to seek malaria treatment and whether or not a malaria diagnostic test will be used prior to treatment. One of the

  14. 20 CFR 416.935 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.935... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.935 How we will determine whether your drug addiction or alcoholism is a contributing factor material to...

  15. 20 CFR 416.935 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.935... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.935 How we will determine whether your drug addiction or alcoholism is a contributing factor material to...

  16. 20 CFR 416.935 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.935... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.935 How we will determine whether your drug addiction or alcoholism is a contributing factor material to...

  17. 20 CFR 416.935 - How we will determine whether your drug addiction or alcoholism is a contributing factor material...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... addiction or alcoholism is a contributing factor material to the determination of disability. 416.935... AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and Alcoholism § 416.935 How we will determine whether your drug addiction or alcoholism is a contributing factor material to...

  18. Impact of physiological, physicochemical and biopharmaceutical factors in absorption and metabolism mechanisms on the drug oral bioavailability of rats and humans.

    PubMed

    Hurst, Susan; Loi, Cho-Ming; Brodfuehrer, Joanne; El-Kattan, Ayman

    2007-08-01

    The onset, intensity and duration of therapeutic response to a compound depend on the intrinsic pharmacological activity of the drug and pharmacokinetic factors related to its absorption, distribution, metabolism and elimination that are inherent to the biological system. The process of drug transfer from the site of administration to the systemic circulation and the interspecies factors that impact this process are the scope of this review. In general, the factors that influence oral drug bioavailability via absorption and metabolism can be divided into physicochemical/biopharmaceutical and physiological factors. Physicochemical and biopharmaceutical factors that influence permeability and solubility tend to be species independent. Although there are significant differences in the anatomy and physiology of the gastrointestinal tract, these are not associated with significant differences in the rate and extent of drug absorption between rats and humans. However, species differences in drug metabolism in rats and humans did result in significant species differences in bioavailability. Overall, this review provides a better understanding of the interplay between drug physicochemical/biopharmaceutical factors and species differences/similarities in the absorption and metabolism mechanisms that affect oral bioavailability in rats and humans. This will enable a more rational approach to perform projection of oral bioavailability in human using available rat in vivo data.

  19. Projecting future drug expenditures--2012.

    PubMed

    Hoffman, James M; Li, Edward; Doloresco, Fred; Matusiak, Linda; Hunkler, Robert J; Shah, Nilay D; Vermeulen, Lee C; Schumock, Glen T

    2012-03-01

    Factors likely to influence drug expenditures, drug expenditure trends in 2010 and 2011, and projected drug expenditures for 2012 are discussed. Data were analyzed to provide drug expenditure trends for total drug expenditures and the hospital and clinic sectors. Data were obtained from the IMS Health National Sales Perspectives database. From 2009 to 2010, total U.S. drug expenditures increased by 2.7%, with total spending rising from $299.2 billion to $307.5 billion. Drug expenditures in clinics grew by 6.0% from 2009 to 2010. Hospital drug expenditures increased at the moderate rate of 1.5% from 2009 to 2010; through the first nine months of 2011, hospital drug expenditures increased by only 0.3% compared with the same period in 2010. The dominant trend over the past several years is substantial moderation in expenditure growth for widely used drugs, primarily due to the ongoing introduction and wide use of generic versions of high-cost, frequently used medications. At the end of 2010, generic drugs accounted for 78% of all retail prescriptions dispensed. Another pattern is substantial increases in expenditures for specialized medications, particularly in the outpatient setting as growth in prescription drug expenditures for clinic-administered drugs consistently outpaces growth in total expenditures. Various factors are likely to influence drug expenditures in 2012, including drugs in development, the diffusion of new drugs, generic drugs, drug shortages, and biosimilars. For 2012, we project a 3-5% increase in total drug expenditures across all settings, a 5-7% increase in expenditures for clinic-administered drugs, and a 0-2% increase in hospital drug expenditures.

  20. Physiologically-Based Pharmacokinetic Modeling of Macitentan: Prediction of Drug-Drug Interactions.

    PubMed

    de Kanter, Ruben; Sidharta, Patricia N; Delahaye, Stéphane; Gnerre, Carmela; Segrestaa, Jerome; Buchmann, Stephan; Kohl, Christopher; Treiber, Alexander

    2016-03-01

    Macitentan is a novel dual endothelin receptor antagonist for the treatment of pulmonary arterial hypertension (PAH). It is metabolized by cytochrome P450 (CYP) enzymes, mainly CYP3A4, to its active metabolite ACT-132577. A physiological-based pharmacokinetic (PBPK) model was developed by combining observations from clinical studies and physicochemical parameters as well as absorption, distribution, metabolism and excretion parameters determined in vitro. The model predicted the observed pharmacokinetics of macitentan and its active metabolite ACT-132577 after single and multiple dosing. It performed well in recovering the observed effect of the CYP3A4 inhibitors ketoconazole and cyclosporine, and the CYP3A4 inducer rifampicin, as well as in predicting interactions with S-warfarin and sildenafil. The model was robust enough to allow prospective predictions of macitentan-drug combinations not studied, including an alternative dosing regimen of ketoconazole and nine other CYP3A4-interacting drugs. Among these were the HIV drugs ritonavir and saquinavir, which were included because HIV infection is a known risk factor for the development of PAH. This example of the application of PBPK modeling to predict drug-drug interactions was used to support the labeling of macitentan (Opsumit).

  1. The Interactions of P-Glycoprotein with Antimalarial Drugs, Including Substrate Affinity, Inhibition and Regulation

    PubMed Central

    Senarathna, S M D K Ganga; Page-Sharp, Madhu; Crowe, Andrew

    2016-01-01

    The combination of passive drug permeability, affinity for uptake and efflux transporters as well as gastrointestinal metabolism defines net drug absorption. Efflux mechanisms are often overlooked when examining the absorption phase of drug bioavailability. Knowing the affinity of antimalarials for efflux transporters such as P-glycoprotein (P-gp) may assist in the determination of drug absorption and pharmacokinetic drug interactions during oral absorption in drug combination therapies. Concurrent administration of P-gp inhibitors and P-gp substrate drugs may also result in alterations in the bioavailability of some antimalarials. In-vitro Caco-2 cell monolayers were used here as a model for potential drug absorption related problems and P-gp mediated transport of drugs. Artemisone had the highest permeability at around 50 x 10−6 cm/sec, followed by amodiaquine around 20 x 10−6 cm/sec; both mefloquine and artesunate were around 10 x 10−6 cm/sec. Methylene blue was between 2 and 6 x 10−6 cm/sec depending on the direction of transport. This 3 fold difference was able to be halved by use of P-gp inhibition. MRP inhibition also assisted the consolidation of the methylene blue transport. Mefloquine was shown to be a P-gp inhibitor affecting our P-gp substrate, Rhodamine 123, although none of the other drugs impacted upon rhodamine123 transport rates. In conclusion, mefloquine is a P-gp inhibitor and methylene blue is a partial substrate; methylene blue may have increased absorption if co-administered with such P-gp inhibitors. An upregulation of P-gp was observed when artemisone and dihydroartemisinin were co-incubated with mefloquine and amodiaquine. PMID:27045516

  2. Estimating the Marginal Effect of Socioeconomic Factors on the Demand of Specialty Drugs

    PubMed Central

    Jebeli, Seyede Sedighe Hosseini; Barouni, Mohsen; Orojloo, Parvane Heidari; Mehraban, Sattar

    2015-01-01

    Given the growing importance and role of drugs in the treatment of diseases, as well as replacement of them rather than expensive and often unsafe procedures, study of socioeconomicfactors affecting future demand for them seems necessary. we seek to examine the extent of to which socioeconomic factors affect specialty medicine use by the patients.using data from questionnaires completed by 280 patients with multiple sclerosis, hemophilia, thalassemia, and chronic kidney disease, we estimate marginal effect of significant variables in probitmodel. We found that the need for the patient(ME=0.858), deterioration of the patient (ME=-0.001), household size (ME =0.0004), House Ownership (ME=-0.002), gender (ME=-0.04), income (ME=-0.0007), education (ME=-0.0021) and job (ME=-0.0021) are significant variables affecting demand for specialty drugs. We conclude that it can be programmed to promote and protect the welfare of patients by specific factors such as income, and largely affect the demand of medication and medical services. Therefore economic aid to these patients should not be limited only to medical subsidies, especially in patients with MS, income and welfare can reduce drug demand. PMID:25716405

  3. Estimating the marginal effect of socioeconomic factors on the demand of specialty drugs.

    PubMed

    Hosseini Jebeli, Seyede Sedighe; Barouni, Mohsen; Orojloo, Parvane Heidari; Mehraban, Sattar

    2014-09-25

    Given the growing importance and role of drugs in the treatment of diseases, as well as replacement of them rather than expensive and often unsafe procedures, study of socioeconomicfactors affecting future demand for them seems necessary.we seek to examine the extent of to which socioeconomic factors affect specialty medicine use by the patients.using data from questionnaires completed by 280 patients with multiple sclerosis, hemophilia, thalassemia, and chronic kidney disease, we estimate marginal effect of significant variables in probit model.We found that the need for the patient(ME = 0.858), deterioration of the patient (ME = -0.001), household size (ME = 0.0004), House Ownership (ME = -0.002), gender (ME = -0.04), income (ME = -0.0007), education (ME = -0.0021) and job (ME = -0.0021) are significant variables affecting demand for specialty drugs. We conclude that it can be programmed to promote and protect the welfare of patients by specific factors such as income, and largely affect the demand of medication and medical services. Therefore economic aid to these patients should not be limited only to medical subsidies, especially in patients with MS, income and welfare can reduce drug demand.

  4. Drug-Induced QTc Interval Prolongation: A Multicenter Study to Detect Drugs and Clinical Factors Involved in Every Day Practice.

    PubMed

    Keller, Guillermo A; Alvarez, Paulino A; Ponte, Marcelo L; Belloso, Waldo H; Bagnes, Claudia; Sparanochia, Cecilia; Gonzalez, Claudio D; Villa Etchegoyen, M Cecilia; Diez, Roberto A; Di Girolamo, Guillermo

    2016-01-01

    The actual prevalence of drug induced QTc prolongation in clinical practice is unknown. Our objective was to determine the occurrence and characteristics of drug-induced QT prolongation in several common clinical practices. Additionally, a subgroup of patients treated with dextropropoxyphene of particular interest for the regulatory authority was analysed. Medical history and comorbidities predisposing to QT interval prolongation were registered for 1270 patient requiring medical assistance that involved drug administration. Three ionograms and ECGs were performed: baseline, intra- and after treatment; QT interval was corrected with Bazzet formula. Among patients, 9.9% presented QTc >450/470 ms, 3% QTc > 500 ms, 12.7% ΔQTc >30 ms and 5.2% ΔQTc >60 ms. QTc prolongation associated with congestive heart failure, ischemic cardiopathy, diabetes, renal failure, arrhythmias, hypothyroidism, and bradycardia. At univariate analysis, clarithromycin, haloperidol, tramadol, amiodarone, glyceryl trinitrate, amoxicillin + clavulanic acid, amoxicillin + sulbactam, ampicillin + sulbactam, fentanyl, piperacillin + tazobactam, and diazepam prolonged QTc. Prolongation remained significantly associated with furosemide, clarithromycin, glyceryl trinitrate and betalactamase inhibitors after multivariate analysis. QT interval prolongation in everyday practice is frequent, in association to clinical factors and drugs that can be easily identified for monitoring and prevention strategies.

  5. Fibroblast growth factor receptors in breast cancer: expression, downstream effects, and possible drug targets.

    PubMed

    Tenhagen, M; van Diest, P J; Ivanova, I A; van der Wall, E; van der Groep, P

    2012-08-01

    Cancer treatments are increasingly focusing on the molecular mechanisms underlying the oncogenic processes present in tumors of individual patients. Fibroblast growth factor receptors (FGFRs) are among the many molecules that are involved in oncogenesis and are currently under investigation for their potential as drug targets in breast cancer patients. These receptor tyrosine kinases play a role in several processes including proliferation, angiogenesis, and migration. Alterations in these basal processes can contribute to the development and progression of tumors. Among breast cancer patients, several subgroups have been shown to harbor genetic aberrations in FGFRs, including amplifications of FGFR1, FGFR2, and FGFR4 and mutations in FGFR2 and FGFR4. Here, we review in vitro and in vivo models that have partly elucidated the molecular implications of these different genetic aberrations, the resulting tumor characteristics, and the potential of FGFRs as therapeutic targets for breast cancer treatment.

  6. Investigating factors leading to fogging of glass vials in lyophilized drug products.

    PubMed

    Abdul-Fattah, Ahmad M; Oeschger, Richard; Roehl, Holger; Bauer Dauphin, Isabelle; Worgull, Martin; Kallmeyer, Georg; Mahler, Hanns-Christian

    2013-10-01

    Vial "Fogging" is a phenomenon observed after lyophilization due to drug product creeping upwards along the inner vial surface. After the freeze-drying process, a haze of dried powder is visible inside the drug product vial, making it barely acceptable for commercial distribution from a cosmetic point of view. Development studies were performed to identify the root cause for fogging during manufacturing of a lyophilized monoclonal antibody drug product. The results of the studies indicate that drug product creeping occurs during the filling process, leading to vial fogging after lyophilization. Glass quality/inner surface, glass conversion/vial processing (vial "history") and formulation excipients, e.g., surfactants (three different surfactants were tested), all affect glass fogging to a certain degree. Results showed that the main factor to control fogging is primarily the inner vial surface hydrophilicity/hydrophobicity. While Duran vials were not capable of reliably improving the level of fogging, hydrophobic containers provided reliable means to improve the cosmetic appearance due to reduction in fogging. Varying vial depyrogenation treatment conditions did not lead to satisfying results in removal of the fogging effect. Processing conditions of the vial after filling with drug product had a strong impact on reducing but not eliminating fogging. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. CYP gene family variants as potential protective factors in drug addiction in Han Chinese.

    PubMed

    Zhang, Hongxing; Yang, Qi; Zheng, Wenkai; Ouyang, Yongri; Yang, Min; Wang, Fengjiao; Jin, Tianbo; Zhang, Ji; Wang, Zhenyuan

    2016-08-01

    There is growing evidence that genetic factors also contribute to drug addiction. The human cytochrome P450 has shown special interest because of pharmacokinetic variation in different individuals and populations, which is largely determined by the relevant genes. The present study aimed to investigate the polymorphism of the CYP/addicts relationship. We genotyped 13 tag single-nucleotide polymorphisms (tSNPs) from three genes, including 692 cases and 700 controls. Sequenom MassARRAY RS1000 (Sequenom, Inc., San Diego, CA, USA) was used for SNP genotyping. Statistical analysis of the association between tSNPs and drug addiction was performed using the chi-squared test and SNP Stats software (http://bioinfo.iconcologia.net). The T/T genotype of rs2242480 in CYP3A4 was associated with decreased risk in the recessive model (p = 0.0002). Allele frequency at rs3743484 in CYP1A2 showed significant differences between addicts and controls (p = 0.046; odds ratio = 0.80; 95% confidence interval = 0.65-1.00). In genetic model analyses, the minor C allele of rs3743484 in CYP1A2 was associated with a reduced risk of drug addiction based on analysis using codominant and additive models (p = 0.027 dominant model; p =0.038 additive model). Our findings show that at allelic and genotypic level polymorphisms in CYP3A4 and CYP1A2 are significantly associated with a reduced risk of drug addiction in X'ian Han Chinese individuals. However, this result needs to be confirmed in additional studies. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. [Risk/protective factors and prevention programs for drug dependence in Peru].

    PubMed

    Cabanillas-Rojas, William

    2012-03-01

    Risk/ protective factors (RPF) are main elements for the analysis, understanding and formulation of answers for the prevention of drug dependences. The objective of this article is to present a literature review about the RPF and their implications in the design of preventive programs. It will focus on individual (genetic aspects, early experiences and psicosocial skills), family (parental control and monitoring, permissiveness, parenting styles), peer (group pressure and social norms) and communitarian (disorganization) RPF. On the other hand, the need of incorporating a multifactor conceptual framework for the preventive approach to drug dependences, articulating the intervention spaces (school, family and community), assuming and evolving perspective allowing the implementations of sustained actions is evidenced. On top, the implications for future research and public policy formulation are discussed.

  9. 36 CFR 1212.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... drug-free workplace statement? 1212.205 Section 1212.205 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION GENERAL RULES GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE... my drug-free workplace statement? You must publish a statement that— (a) Tells your employees that...

  10. Hispanic youth involvement in over-the-counter drug use: parent, peer, and school factors.

    PubMed

    Vidourek, Rebecca A; King, Keith A; Fehr, Sara K

    2014-01-01

    Research on substance use among Hispanic youth is lacking. The purpose of this study was to examine over-the-counter drug use among Hispanic youth. Of Hispanic youth, 23.9% used an over-the-counter drug for the purpose of getting high. Involvement in prosocial behaviors was correlated with decreased over-the-counter use for females and high school students. Involvement in risky behaviors increased the risk of use for males, females, junior high school students, and high school students. Significant differences were found based on parent, peer, teacher, and school factors. Prevention and intervention programs should address over-the-counter drug use among Hispanic youth.

  11. Screening of cardiovascular risk factors in patients with schizophrenia and patients treated with antipsychotic drugs: are we equally exhaustive as with the general population?

    PubMed

    Castillo-Sánchez, Miguel; Fàbregas-Escurriola, Mireia; Bergè-Baquero, Daniel; Fernández-SanMartín, MªIsabel; Goday-Arno, Albert

    2017-01-01

    Many studies have previously shown increased cardiovascular risk factors related to schizophrenia independently from the use of antipsychotic drugs. However, a poorer effort in clinical detection and management of cardiovascular risk in patients with severe mental illness could also explain these results. To test this hypothesis, we analyzed the differences in screening and incidence of cardiovascular risk factors between schizophrenia, non-schizophrenic patients on treatment with antipsychotic drugs (NS-TAD) and the general population. Data from adult subjects assessed by high-quality register general practitioners from 2006 to 2011 were extracted from the Catalonian SIDIAP database. The schizophrenia, NS-TAD, and control groups were compared in terms of measurements and incidence of diabetes, dyslipidemia, obesity, hypertension, and smoking. A total of 4911 patients in the schizophrenia group, 4157 in NS-TAD group, and 98644 in the control group were included. Schizophrenia patients were screened for dyslipidemia and diabetes more frequently than the control group, while for obesity or hypertension, they were screened equal to controls. Also, as compared to the control group, the NS-TAD group was more frequently screened for obesity with no differences in dyslipidemia and diabetes and less frequently for hypertension. Smoking was less frequently screened in both study groups. The incidence of all risk factors studied in both study groups was higher than or equal to the control group, except for hypertension, which had lower incidence. The lack of screening of risk factors does not appear decisive in the increased cardiovascular risk of patients diagnosed with schizophrenia seen in primary care. Studies evaluating the possible under diagnosis of the risk factors are required. Schizophrenia (SZ); Treatment with antipsychotic drugs (TAD); Cardiovascular risk factor/s (CVRF); Without schizophrenia but on therapy with antipsychotic drugs (NS-TAD); Defined Daily Dose

  12. Antithyroid drug-induced agranulocytosis.

    PubMed

    Sun, Ming-Tsung; Tsai, Chen-Hao; Shih, Kuang-Chung

    2009-08-01

    Antithyroid drugs are widely used to treat hyperthyroidism, especially Graves' disease, but they tend to cause agranulocytosis, which increases the mortality rate. Granulocyte colony-stimulating factor decreases the duration of recovery from agranulocytosis. We retrospectively studied cases of antithyroid drug-induced agranulocytosis over the past 10 years in a northern Taiwan medical center. A clinical evaluation was conducted, including a review of complete blood cell counts and differential counts. Four cases were included in this analysis. Agranulocytosis persisted in 2 cases despite a change in therapy from propylthiouracil to methimazole. Fever, sore throat, and diarrhea were common symptoms of agranulocytosis. Initial white blood cell counts ranged from 450 to 1,710/microL. Only 1 case had a positive result from a throat swab culture (Staphylococcus aureus). Three of 4 cases received granulocyte colony-stimulating factor therapy, and the recovery time ranged from 3 to 13 days. All of the patients recovered from agranulocytosis. We concluded that: (1) conducting a routine complete blood cell count is beneficial in alerting caregivers to the possibility of agranulocytosis; (2) educating patients about the common symptoms of agranulocytosis may contribute to an early diagnosis; (3) providing granulocyte colony-stimulating factor therapy to patients results in good prognosis; and (4) monitoring for cross-reactions between drugs should be performed to prevent further episodes of agranulocytosis.

  13. Transcription Factor Activities Enhance Markers of Drug Sensitivity in Cancer.

    PubMed

    Garcia-Alonso, Luz; Iorio, Francesco; Matchan, Angela; Fonseca, Nuno; Jaaks, Patricia; Peat, Gareth; Pignatelli, Miguel; Falcone, Fiammetta; Benes, Cyril H; Dunham, Ian; Bignell, Graham; McDade, Simon S; Garnett, Mathew J; Saez-Rodriguez, Julio

    2018-02-01

    Transcriptional dysregulation induced by aberrant transcription factors (TF) is a key feature of cancer, but its global influence on drug sensitivity has not been examined. Here, we infer the transcriptional activity of 127 TFs through analysis of RNA-seq gene expression data newly generated for 448 cancer cell lines, combined with publicly available datasets to survey a total of 1,056 cancer cell lines and 9,250 primary tumors. Predicted TF activities are supported by their agreement with independent shRNA essentiality profiles and homozygous gene deletions, and recapitulate mutant-specific mechanisms of transcriptional dysregulation in cancer. By analyzing cell line responses to 265 compounds, we uncovered numerous TFs whose activity interacts with anticancer drugs. Importantly, combining existing pharmacogenomic markers with TF activities often improves the stratification of cell lines in response to drug treatment. Our results, which can be queried freely at dorothea.opentargets.io, offer a broad foundation for discovering opportunities to refine personalized cancer therapies. Significance: Systematic analysis of transcriptional dysregulation in cancer cell lines and patient tumor specimens offers a publicly searchable foundation to discover new opportunities to refine personalized cancer therapies. Cancer Res; 78(3); 769-80. ©2017 AACR . ©2017 American Association for Cancer Research.

  14. [Are there any sex/gender differences in drug use and drug addiction?].

    PubMed

    Mendrek, Adrianna

    Drug use and drug addiction have been traditionally considered to be a male problem, however the gender gap has been decreasing over the past few decades. Thus, while the prevalence of alcohol, cannabis and nicotine dependence is still overall greater among men than among women, sex/gender differences in the abuse of stimulants and opiates seem to have disappeared. Moreover, women appear to be more prone to develop drug dependence, suffer more severe physical and psychological consequences of drug abuse, and have more difficulties quitting the habit. Numerous psychological, socio-cultural and biological factors have been implicated in these changing statistics. For example, while a large proportion of men initiate drug use to induce feelings of elation, energy or focus, women frequently start taking drugs to alleviate pre-existing mental health problems, including high levels of stress, feelings of alienation, depression, anxiety, or post-traumatic stress disorder. This maladaptive self-medication strategy often results in a faster transition to a habitual drug use and eventually a more severe dependence. In addition, the socio-cultural norms (particularly in the Western society) have changed dramatically over the past few decades. Thus, while there is still a more severe stigma and prejudice against women who use drugs (especially if they are pregnant of have children), overall there is much greater acceptance of women's drug use than it was several decades ago. Moreover, women have much greater access to various drugs of abuse than they used to have. Finally, over the past couple of decades new research started emerging pointing to some neurobiological factors that could also contribute to sex differences in drug addiction. Thus, there is now evidence that dopamine system, which for decades has been strongly implicated in drug reinforcement, is sexually dimorphic. The number of dopaminergic neurons, the density of the dopaminergic terminals, as well as

  15. Discovering drugs for the treatment of Ebola virus

    DTIC Science & Technology

    2017-08-04

    Discovering drugs for the treatment of Ebola virus Sandra L. Bixler, Allen J. Duplantier and Sina Bavari Address United States Army Medical...with the recent West African outbreak resulting in over 11,000 deaths. This review provides a summary of the status of drug discovery and development...disease, including small molecules, immunotherapeutics, host factors, and clinical disease management options. Introduction Drug development for

  16. Drug Use and Sex Work Among At-risk Women: A Qualitative Study of Initial Factors.

    PubMed

    Roshanfekr, Payam; Noori, Roya; Dejman, Masoumeh; Fathi Geshnigani, Zahra; Rafiey, Hassan

    2015-06-01

    In recent years, there has been an increasing interest in performing research on drug use and sex work among at-risk women. Although there is a well-documented literature of the initial reasons associated with drug use and sex work among women, there is, however, a paucity of information in this area in Iran. This study aimed to explore the initial reasons associated with drug use and sex work in a group of female treatment seekers, who presented health-related risk behaviors, in Tehran, Iran. This qualitative study enrolled a total of 65 at-risk women, from five women-specific drug clinics, who participated in the study in 2011. Individual in-depth interviews were conducted. Focus group interviews were conducted with 10 key informants. All interviews were audio-taped and thematically written. The recorded data were analyzed using ATLASti qualitative research software version 10. The median age of the sample was 34 years. In addition, 44.6% of subjects were opiate users, and 55.4% were users of opiates and methamphetamine. Sex work was the main source of income for almost half of the sample. The most frequently reported reasons, associated with initial drug use, were extrinsic motivations, including the drug-using family, friends or social networks. Intrinsic motivations, including curiosity and individual willingness to use drugs, were other initial reasons. The most frequently reported reasons, associated with initial sex work, included the need to purchase drugs and financial problems. The study findings demonstrated a number of reasons associated with initial drug use and sex work. The role of sex work in providing drugs necessitates education and prevention. Special treatment programs should be implemented to prevent sex work among at-risk women in Iran.

  17. Factors associated with willingness to participate in a pharmacologic addiction treatment clinical trial among people who use drugs.

    PubMed

    Uhlmann, Sasha; Milloy, Michael John; Ahamad, Keith; Nguyen, Paul; Kerr, Thomas; Wood, Evan; Richardson, Lindsey

    2015-06-01

    Although new medications are needed to address the harms of drug addiction, rates of willingness to participate in addiction treatment trials among people who use drugs (PWUD), have not been well characterized. One thousand twenty PWUD enrolled in two community-recruited cohorts in Vancouver, Canada, were asked whether they would be willing to participate in a pharmacologic addiction treatment trial. Logistic regression was used to identify factors independently associated with a willingness to participate. Among the 1,020 PWUD surveyed between June 1, 2013 and November 30, 2013, 58.3% indicated a willingness to participate. In multivariate analysis, factors independently associated with a willingness to participate in a pharmacologic addiction treatment trial included: daily heroin injection (Adjusted Odds Ratio [AOR] = 1.75; 95% Confidence Interval [CI]: 1.13 - 2.72); daily crack smoking (AOR = 1.81; 95% CI: 1.23 - 2.66); sex work involvement (AOR = 2.22; 95% CI: 1.21 - 4.06); HIV seropositivity (AOR = 1.49; 95% CI: 1.15 - 1.94); and methadone maintenance therapy participation (AOR = 1.77; 95% CI: 1.37-2.30). High rates of willingness to participate in a pharmacologic addiction treatment trial were observed in this setting. Importantly, high-risk drug and sexual activities were positively associated with a willingness to participate, which may suggest a desire for new treatment interventions among PWUD engaged in high-risk behavior. These results highlight the viability of studies seeking to enroll representative samples of PWUD engaged in high-risk drug use. © American Academy of Addiction Psychiatry.

  18. Herb-drug, food-drug, nutrient-drug, and drug-drug interactions: mechanisms involved and their medical implications.

    PubMed

    Sørensen, Janina Maria

    2002-06-01

    Adverse drug reactions (ADRs) and iatrogenic diseases have been identified as significant factors responsible for patient morbidity and mortality. Significant studies on drug metabolism in humans have been published during the last few years, offering a deeper comprehension of the mechanisms underlying adverse drug reactions and interactions. More understanding of these mechanisms, and of recent advances in laboratory technology, can help to evaluate potential drug interactions when drugs are prescribed concurrently. Increasing knowledge of interindividual variation in drug breakdown capacity and recent findings concerning the influence of environment, diet, nutrients, and herbal products can be used to reduce ADRs and iatrogenic diseases. Reviewed data suggest that drug treatment should be increasingly custom tailored to suit the individual patient and that appropriately co-prescribed diet and herbal remedies, could increase drug efficacy and lessen drug toxicity. This review focuses mainly on recently published research material. The cytochrome p450 enzymes, their role in metabolism, and their mechanisms of action are reviewed, and their role in drug-drug interactions are discussed. Drug-food and drug-herb interactions have garnered attention. Interdisciplinary communication among medical herbalists, medical doctors, and dietetic experts needs to be improved and encouraged. Internet resources for obtaining current information regarding drug-drug, drug-herb, and drug-nutrient interactions are provided.

  19. Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in Northern Mexico

    PubMed Central

    Morris, Meghan D.; Lemus, Hector; Wagner, Karla D.; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A.

    2012-01-01

    Aims To identify factors associated with time to initiation of (1) sex work prior to injecting drugs, (2) injection drug use, and (3) concurrent sex work and injection drug use (i.e., initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Design Parametric survival analysis of baseline data for time to initiation event. Setting Tijuana and Ciudad Juarez situated on the Mexico-U.S. border. Participants 575 FSW-IDUs aged ≥18. Measurements Interview-administered surveys assessing context of sex work and injection drug use initiation. Findings Nearly half (n=256) initiated sex work prior to beginning to inject, a third (n=163) initiated injection first, and a quarter (n=136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Conclusions Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one third initiate injection drug use before beginning sex work, and one quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. PMID:22775475

  20. Applicability of bioanalysis of multiple analytes in drug discovery and development: review of select case studies including assay development considerations.

    PubMed

    Srinivas, Nuggehally R

    2006-05-01

    The development of sound bioanalytical method(s) is of paramount importance during the process of drug discovery and development culminating in a marketing approval. Although the bioanalytical procedure(s) originally developed during the discovery stage may not necessarily be fit to support the drug development scenario, they may be suitably modified and validated, as deemed necessary. Several reviews have appeared over the years describing analytical approaches including various techniques, detection systems, automation tools that are available for an effective separation, enhanced selectivity and sensitivity for quantitation of many analytes. The intention of this review is to cover various key areas where analytical method development becomes necessary during different stages of drug discovery research and development process. The key areas covered in this article with relevant case studies include: (a) simultaneous assay for parent compound and metabolites that are purported to display pharmacological activity; (b) bioanalytical procedures for determination of multiple drugs in combating a disease; (c) analytical measurement of chirality aspects in the pharmacokinetics, metabolism and biotransformation investigations; (d) drug monitoring for therapeutic benefits and/or occupational hazard; (e) analysis of drugs from complex and/or less frequently used matrices; (f) analytical determination during in vitro experiments (metabolism and permeability related) and in situ intestinal perfusion experiments; (g) determination of a major metabolite as a surrogate for the parent molecule; (h) analytical approaches for universal determination of CYP450 probe substrates and metabolites; (i) analytical applicability to prodrug evaluations-simultaneous determination of prodrug, parent and metabolites; (j) quantitative determination of parent compound and/or phase II metabolite(s) via direct or indirect approaches; (k) applicability in analysis of multiple compounds in select

  1. Anthropological Approach of Adherence Factors for Antihypertensive Drugs

    PubMed Central

    Sarradon-Eck, Aline; Egrot, Marc; Blance, Marie Anne; Faure, Muriella

    2010-01-01

    Objective: Uncontrolled high blood pressure leads clinicians to wonder about adherence degree among hypertensive patients. In this context, our study aims to describe and analyze patients' experience of antihypertensive drugs in order to shed light on the multiple social and symbolic logics, forming part of the cultural factors shaping personal medication practices. Methods: The medical inductive and comprehensive anthropological approach implemented is based on an ethnographic survey (observations of consultations and interviews). Semi-structured interviews were conducted with 68 hypertensive patients (39 women and 29 men, between the ages of 40 and 95, of whom 52 were over 60) who had been receiving treatment for over a year. Results: Antihypertensive drugs are reinterpreted when filtered through the cultural model of physiopathology (the body as an engine). This symbolic dimension facilitates acceptance of therapy but leads to a hierarchization of other prescribed drugs and of certain therapeutic classes (diuretics). Prescription compliance does not solely depend on the patient's perception of cardiovascular risk, but also on how the patient fully accepts the treatment and integrates it into his or her daily life; this requires identification with the product, building commitment and self-regulation of the treatment (experience, managing treatment and control of side effects, intake and treatment continuity). Following the prescription requires a relationship based on trust between the doctor and patient, which we have identified in three forms: reasoned trust, emotional trust and conceded trust. Conclusion: Consideration and understanding of these pragmatic and symbolic issues by the treating physician should aid practitioners in carrying out their role as medical educators in the management of hypertension. This paper was originally published in French, in the journal Pratiques et organisation des soins 39(1): 3-12. PMID:21532764

  2. A Review of Factors That Influence Individual Compliance with Mass Drug Administration for Elimination of Lymphatic Filariasis

    PubMed Central

    Krentel, Alison; Fischer, Peter U.; Weil, Gary J.

    2013-01-01

    Background The success of programs to eliminate lymphatic filariasis (LF) depends in large part on their ability to achieve and sustain high levels of compliance with mass drug administration (MDA). This paper reports results from a comprehensive review of factors that affect compliance with MDA. Methodology/Principal Findings Papers published between 2000 and 2012 were considered, and 79 publications were included in the final dataset for analysis after two rounds of selection. While results varied in different settings, some common features were associated with successful programs and with compliance by individuals. Training and motivation of drug distributors is critically important, because these people directly interact with target populations, and their actions can affect MDA compliance decisions by families and individuals. Other important programmatic issues include thorough preparation of personnel, supplies, and logistics for implementation and preparation of the population for MDA. Demographic factors (age, sex, income level, and area of residence) are often associated with compliance by individuals, but compliance decisions are also affected by perceptions of the potential benefits of participation versus the risk of adverse events. Trust and information can sometimes offset fear of the unknown. While no single formula can ensure success MDA in all settings, five key ingredients were identified: engender trust, tailor programs to local conditions, take actions to minimize the impact of adverse events, promote the broader benefits of the MDA program, and directly address the issue of systematic non-compliance, which harms communities by prolonging their exposure to LF. Conclusions/Significance This review has identified factors that promote coverage and compliance with MDA for LF elimination across countries. This information may be helpful for explaining results that do not meet expectations and for developing remedies for ailing MDA programs. Our

  3. Drug-resistant tuberculosis in subjects included in the Second National Survey on Antituberculosis Drug Resistance in Porto Alegre, Brazil*, **

    PubMed Central

    Micheletti, Vania Celina Dezoti; Moreira, José da Silva; Ribeiro, Marta Osório; Kritski, Afranio Lineu; Braga, José Ueleres

    2014-01-01

    OBJECTIVE: To describe the prevalence of multidrug-resistant tuberculosis (MDR-TB) among tuberculosis patients in a major Brazilian city, evaluated via the Second National Survey on Antituberculosis Drug Resistance, as well as the social, demographic, and clinical characteristics of those patients. METHODS: Clinical samples were collected from tuberculosis patients seen between 2006 to 2007 at three hospitals and five primary health care clinics participating in the survey in the city of Porto Alegre, Brazil. The samples were subjected to drug susceptibility testing. The species of mycobacteria was confirmed using biochemical methods. RESULTS: Of the 299 patients included, 221 (73.9%) were men and 77 (27.3%) had a history of tuberculosis. The mean age was 36 years. Of the 252 patients who underwent HIV testing, 66 (26.2%) tested positive. The prevalence of MDR-TB in the sample as a whole was 4.7% (95% CI: 2.3-7.1), whereas it was 2.2% (95% CI: 0.3-4.2) among the new cases of tuberculosis and 12.0% (95% CI: 4.5-19.5) among the patients with a history of tuberculosis treatment. The multivariate analysis showed that a history of tuberculosis and a longer time to diagnosis were both associated with MDR-TB. CONCLUSIONS: If our results are corroborated by other studies conducted in Brazil, a history of tuberculosis treatment and a longer time to diagnosis could be used as predictors of MDR-TB. PMID:24831400

  4. Factors Predisposing Drug Abuse.

    ERIC Educational Resources Information Center

    Cheney, Carl D.; Phelps, Brady J.

    The exact nature of the events which may predispose a person to substance abuse is not known. This paper provides a theoretical discussion and review which emphasizes three contexts which have been shown to predispose on individual to drug abuse: (1) prenatal exposure to a given substance; (2) environmental conditions present upon first exposure…

  5. 41 CFR 105-74.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... my drug-free awareness program? 105-74.215 Section 105-74.215 Public Contracts and Property...

  6. 41 CFR 105-74.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... my drug-free awareness program? 105-74.215 Section 105-74.215 Public Contracts and Property...

  7. 41 CFR 105-74.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... my drug-free awareness program? 105-74.215 Section 105-74.215 Public Contracts and Property...

  8. 41 CFR 105-74.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... my drug-free awareness program? 105-74.215 Section 105-74.215 Public Contracts and Property...

  9. 41 CFR 105-74.215 - What must I include in my drug-free awareness program?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... employees about— (a) The dangers of drug abuse in the workplace; (b) Your policy of maintaining a drug-free... penalties that you may impose upon them for drug abuse violations occurring in the workplace. ... my drug-free awareness program? 105-74.215 Section 105-74.215 Public Contracts and Property...

  10. Prevalence of, and factors associated with, adolescent physical fighting while under the influence of alcohol or drugs.

    PubMed

    Kodjo, Cheryl M; Auinger, Peggy; Ryan, Sheryl A

    2004-10-01

    To determine: (a) the prevalence of physical fighting while under the influence of alcohol or drugs, and (b) the associations among demographic factors, other risk behaviors, and physical fighting while under the influence of substances. Cross-sectional analysis of The National Longitudinal Study of Adolescent Health (Add Health) 1994-1995, a school-based, nationally representative survey of 6504 7th to 12th graders. The dependent outcome variables of interest were: "The most recent time you got into a fight, had you been drinking?" and "Have you ever gotten into a fight when you had been using drugs?" Independent variables included: demographics, adolescent characteristics and risk behaviors, home environment, and peer substance use. Univariate and bivariate analyses, and logistic regressions, using SUDAAN, were performed for the two outcome behaviors for the overall sample (p drug users (n = 1869) reported being under the influence while fighting. These adolescents were significantly more likely to injure or sustain injury than their counterparts. Selling drugs, gang fighting, and peer substance use were significantly associated with both outcomes. A significant proportion of adolescents who use substances also engage in physical fighting while under the influence. Health providers should counsel their patients about the potential for injury and be mindful that concurrent fighting and substance use may be markers for other more high-risk delinquent behaviors.

  11. Brain-derived neurotrophic factor and addiction: Pathological versus therapeutic effects on drug seeking

    PubMed Central

    Barker, Jacqueline M.; Taylor, Jane R.; De Vries, Taco J.; Peters, Jamie

    2015-01-01

    Many abused drugs lead to changes in endogenous brain-derived neurotrophic factor (BDNF) expression in neural circuits responsible for addictive behaviors. BDNF is a known molecular mediator of memory consolidation processes, evident at both behavioral and neurophysiological levels. Specific neural circuits are responsible for storing and executing drug-procuring motor programs, whereas other neural circuits are responsible for the active suppression of these “seeking” systems. These seeking-circuits are established as associations are formed between drug-associated cues and the conditioned responses they elicit. Such conditioned responses (e.g. drug seeking) can be diminished either through a passive weakening of seeking-circuits or an active suppression of those circuits through extinction. Extinction learning occurs when the association between cues and drug are violated, for example, by cue exposure without the drug present. Cue exposure therapy has been proposed as a therapeutic avenue for the treatment of addictions. Here we explore the role of BDNF in extinction circuits, compared to seeking-circuits that “incubate” over prolonged withdrawal periods. We begin by discussing the role of BDNF in extinction memory for fear and cocaine-seeking behaviors, where extinction circuits overlap in infralimbic prefrontal cortex (PFC). We highlight the ability of estrogen to promote BDNF-like effects in hippocampal–prefrontal circuits and consider the role of sex differences in extinction and incubation of drug-seeking behaviors. Finally, we examine how opiates and alcohol “break the mold” in terms of BDNF function in extinction circuits. PMID:25451116

  12. Factors Influencing the Use of a Mobile App for Reporting Adverse Drug Reactions and Receiving Safety Information: A Qualitative Study.

    PubMed

    de Vries, Sieta T; Wong, Lisa; Sutcliffe, Alastair; Houÿez, François; Ruiz, Carmen Lasheras; Mol, Peter G M

    2017-05-01

    A mobile app may increase the reporting of adverse drug reactions (ADRs) and improve the communication of new drug safety information. Factors that influence the use of an app for such two-way risk communication need to be considered at the development stage. Our aim was to reveal the factors that may influence healthcare professionals (HCPs) and patients to use an app for two-way risk communication. Focus group discussions and face-to-face interviews were conducted in the Netherlands, Spain and the UK. Patients with type 2 diabetes mellitus, patients with a rare disease or their caregivers and adolescents with health conditions were eligible to participate. HCPs included pharmacists, paediatricians, general practitioners, internists, practice nurses and professionals caring for patients with a rare disease. Patients and HCPs were recruited through various channels. The recorded discussions and interviews were transcribed verbatim. The dataset was analysed using thematic analysis and arranged according to the Unified Theory of Acceptance and Use of Technology. Seven focus group discussions and 13 interviews were conducted. In total, 21 HCPs and 50 patients participated. Identified factors that may influence the use of the app were the type of feedback given on reported ADRs, how ADR reports are stored and the type of drug news. Also mentioned were other functions of the app, ease of use, type of language, the source of safety information provided through the app, security of the app, layout, the operating systems on which the app can be used and the costs. Further research is needed to assess associations between user characteristics and the direction (positive or negative) of the factors potentially influencing app use.

  13. The association of antidepressant drug usage with cognitive impairment or dementia, including Alzheimer disease: A systematic review and meta‐analysis

    PubMed Central

    Moraros, John; Nwankwo, Chijioke; Patten, Scott B.

    2016-01-01

    1 Objective To determine if antidepressant drug usage is associated with cognitive impairment or dementia, including Alzheimer disease (AD). 2 Method We conducted a systematic search of Medline, PubMed, PsycINFO, Web of Science, Embase, CINAHL, and the Cochrane Library. An initial screen by abstracts and titles was performed, and relevant full articles were then reviewed and assessed for their methodologic quality. Crude effect estimates were extracted from the included articles and a pooled estimate was obtained using a random effects model. 3 Results Five articles were selected from an initial pool of 4,123 articles. Use of antidepressant drugs was associated with a significant twofold increase in the odds of some form of cognitive impairment or dementia (OR = 2.17). Age was identified as a likely modifier of the association between antidepressant use and some form of cognitive impairment or AD/dementia. Studies that included participants with an average age equal to or greater than 65 years showed an increased odds of some form of cognitive impairment with antidepressant drug usage (OR = 1.65), whereas those with participants less than age 65 revealed an even stronger association (OR = 3.25). 4 Conclusions Antidepressant drug usage is associated with AD/dementia and this is particularly evident if usage begins before age 65. This association may arise due to confounding by depression or depression severity. However, biological mechanisms potentially linking antidepressant exposure to dementia have been described, so an etiological effect of antidepressants is possible. With this confirmation that an association exists, clarification of underlying etiologic pathways requires urgent attention. PMID:28029715

  14. Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in northern Mexico.

    PubMed

    Morris, Meghan D; Lemus, Hector; Wagner, Karla D; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A

    2013-01-01

    To identify factors associated with time to initiation of (i) sex work prior to injecting drugs initiation; (ii) injection drug use prior to sex work initiation; and (iii) concurrent sex work and injection drug use (i.e. initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Parametric survival analysis of baseline data for time to initiation event. Tijuana and Ciudad Juarez situated on the Mexico-US border. A total of 557 FSW-IDUs aged ≥18 years. Interview-administered surveys assessing context of sex work and injection drug use initiation. Nearly half (n = 258) initiated sex work prior to beginning to inject, a third (n = 163) initiated injection first and a quarter (n = 136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one-third initiate injection drug use before beginning sex work and one-quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  15. Method for protecting bone marrow against chemotherapeutic drugs and radiation therapy using transforming growth factor beta 1

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Keller, J.R.; Ruscetti, F.W.; Wiltrout, R.

    1989-06-29

    Presented is a method for protecting hematopoietic stem cells from the myelotoxicity of chemotherapeutic drugs or radiation therapy, which comprises administering to a subject a therapeutically effective amount of transforming growth factor beta 1 for protecting bone marrow from the myelotoxicity of chemotherapeutic drugs or radiation therapy.

  16. Prediction and Factor Extraction of Drug Function by Analyzing Medical Records in Developing Countries.

    PubMed

    Hu, Min; Nohara, Yasunobu; Nakamura, Masafumi; Nakashima, Naoki

    2017-01-01

    The World Health Organization has declared Bangladesh one of 58 countries facing acute Human Resources for Health (HRH) crisis. Artificial intelligence in healthcare has been shown to be successful for diagnostics. Using machine learning to predict pharmaceutical prescriptions may solve HRH crises. In this study, we investigate a predictive model by analyzing prescription data of 4,543 subjects in Bangladesh. We predict the function of prescribed drugs, comparing three machine-learning approaches. The approaches compare whether a subject shall be prescribed medicine from the 21 most frequently prescribed drug functions. Receiver Operating Characteristics (ROC) were selected as a way to evaluate and assess prediction models. The results show the drug function with the best prediction performance was oral hypoglycemic drugs, which has an average AUC of 0.962. To understand how the variables affect prediction, we conducted factor analysis based on tree-based algorithms and natural language processing techniques.

  17. Clinical pharmacokinetics of non-opiate abused drugs.

    PubMed

    Busto, U; Bendayan, R; Sellers, E M

    1989-01-01

    The present review discusses the available data on the kinetic properties of non-opiate abused drugs including psychomotor stimulants, hallucinogens and CNS-depressants. Some of the drugs of abuse reviewed here are illicit drugs (e.g. cannabis, cocaine), while others are effective pharmacological agents but have the potential to be abused (e.g. benzodiazepines). Although some of the drugs mentioned in this review have been in use for centuries (e.g. caffeine, nicotine, cocaine, cannabis), knowledge of their kinetics and metabolism is very recent and in some cases still incomplete. This is partially due to the difficulties inherent in studying drugs of abuse in humans, and to the complex metabolism of some of these drugs (e.g. cannabis, caffeine) which has made it difficult to develop sensitive assays to determine biological pathways. Although drugs of abuse may have entirely different intrinsic pharmacological effects, the kinetic properties of such drugs are factors contributing to abuse and dependence. The pharmacokinetic properties that presumably contribute to self-administration and drug abuse include rapid delivery of the drug into the central nervous system and high free drug clearance. Kinetic characteristics also play an important role in the development of physical dependence and on the appearance of a withdrawal syndrome: the longer the half-life, the greater the likelihood of the development of physical dependence; the shorter the half-life, the earlier and more severe the withdrawal. The balance between these 2 factors, which has not yet been carefully studied, will also influence abuse patterns. The clinical significance of kinetic characteristics with respect to abuse is discussed where possible.

  18. Drug-food and drug-nutrient interactions.

    PubMed

    Roe, D A

    1985-07-01

    This article analyzes the modifying effects on absorption rates, disposition, and therapeutic effects when drugs interact with both nutrient and non-nutrient food and beverage components. A classification of drug-nutrient interactions is presented and a profile of risk factors is developed. Drug absorption can be affected by food components through changes in gastric emptying time, filling of the gastrointestinal tract, adsorption of drug onto food components, interaction of drug with a food substance, changes in splanchnic blood flow, and bile release. Drugs may be metabolized faster when patients are on high protein-low carbohydrate diets. Adverse drug reactions can be precipitated by intake with specific foods or alcoholic beverages. In addition, certain drugs can produce nutritional toxicity or deficiencies. For example, the vitamin B6 requirements of oral contraceptive (OC) users are increased over those of nonusers; however, the subclinical deficiencies of folacin, riboflavin, and vitamins B12 and C that were associated with pre-1974 OCs have been lessened by recent reductions in OC's estrogen content. The major risk factor for drug-nutrient and drug-alcohol incompatibilities is lack of awareness on the part of the patient of the circumstances in which such a reaction is likely to occur. Patients with diagnoses of depression, anxiety-depression, phobic anxiety, Hodgkin's disease, tuberculosis, bacterial enteritis, giadiasis, trichomonal vaginitis, dermatophytosis, and alcoholism are at greatest risk. High-risk groups for drug-induced nutritional deficiencies are the elderly, alcoholics, pregnant women, epileptics, and cancer patients.

  19. Prevalence and risk factors for injection site skin infections among people who inject drugs (PWID) in Tehran.

    PubMed

    Noroozi, Mehdi; Armoon, Bahram; Ghisvand, Hesam; Noroozi, Alireza; Karimy, Mahmood; Bazrafshan, Mohammad Rafi; Marshall, Brandon D L; Dieji, Bahman

    2018-05-20

    Injection drug use is one of the major public health problems in Iran. Injection drug use is associated with numerous negative health outcomes, such as blood-borne infections (HIV, HCV) and injection site skin infections (abscesses, cellulitis). The aim of this study was to determine prevalence of injection site skin infections and its associated risk factors among people who inject drugs (PWID) in Tehran, Iran. The cross-sectional study was conducted from March to August 2016 in Tehran province. A total of 500 PWID were recruited by convenience and snowball sampling from Drop-in Centers (DIC) in the South of Tehran. Our primary outcomes were self-report of ever having injection sites skin infections and receiving treatment for them. We first examined associations between individual variables and lifetime history of having injection site infections in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Variables with P-value <.2 were included in a multiple logistic regression model. Overall, 40% (CI95%: 30.3%, 52.2%) of participants reported ever having an injection site infection. In the multivariable model, those with low socioeconomic status (AOR = 2.4, P = .03), self-reported as HIV positive (AOR =1.6, P = .01), reporting more than 3 injections per day (AOR = 4.1, P = .03) and reuse of their own syringes (AOR = 8.5, P = .03) were more likely to have injection sites skin infections. PWID who used needle and syringe program (NSP) services were less likely to report injection site infections (AOR = 0.5, P = .04). We have identified several risk factors for injection sites infections among PWID, including frequency of injection per day, reuse of their own syringes, not using NSP services, HIV status, socioeconomic status with skin infections in PWID. Prevention strategies to reduce skin infections should focus on high-risk injection behaviors and improving access to NSP services. © 2018 Wiley Periodicals, Inc.

  20. Tuberculosis drug issues: prices, fixed-dose combination products and second-line drugs.

    PubMed

    Laing, R O; McGoldrick, K M

    2000-12-01

    Access to tuberculosis drugs depends on multiple factors. Selection of a standard list of TB drugs to procure is the first step. This paper reviews the advantages and disadvantages of procuring and using fixed-dose combination (FDC) products for both the intensive and continuation phases of treatment. The major advantages are to prevent the emergence of resistance, to simplify logistic management and to reduce costs. The major disadvantage is the need for the manufacturers to assure the quality of these FDCs by bioavailability testing. The paper reports on the inclusion of second-line TB drugs in the 1999 WHO Essential Drug List (EDL). The need to ensure that these drugs are used within established DOTS-Plus programs is stressed. The price of TB drugs is determined by many factors, including producer prices, local taxes and duties as well as mark-ups and fees. TB drug prices for both the public and private sectors from industrialized and developing countries are reported. Price trends over time are also reported. The key findings of this study are that TB drug prices have generally declined in developing countries while they have increased in developed countries, both for the public and private sectors. Prices vary between countries, with the US paying as much as 95 times the price paid in a specific developing country. The prices of public sector first-line TB drugs vary little between countries, although differences do exist due to the procurement methods used. The price of tuberculin, a diagnostic agent, has increased dramatically in the US, with substantial inter-country variations in price. The paper suggests that further research is necessary to identify the reasons for the price disparities and changes over time, and suggests methods which can be used by National Tuberculosis Programme managers to ensure availability of quality assured TB drugs at low prices.

  1. [Overdose of heroin and influencing factors in intravenous drug users in parts of Yunnan].

    PubMed

    Zhou, Y; Luo, W; Cao, X B; Zhang, B; Wu, Z Y

    2016-05-01

    To assess the prevalence of overdose of heroin and risk factors in intravenous drug users(IDUs)in Yunnan Province. During July-August of 2015, IDUs were recruited from four methadone maintenance treatment(MMT)clinics and two compulsory drug rehabilitation centers in Honghe and Dehong prefectures, Yunnan province. The information about IDUs ' demographic characteristics and drug use history, overdose of heroin in previous12 months and the latest overdose of heroin were collected through face to face questionnaire survey. The factors associated with overdose of heroin were evaluated with logistic regression models. Of the 340 IDUs surveyed, 85.3%(290/340)were males, the mean age was 37.7±8.7 years, 65.6%(223/340)were Han ethnicity, and 49.4%(167/338)were HIV positive, 22.6%(77/340)reported having used club-related drugs(such as ephedrine, methamphetamine, benzodiazepines and ketamine)in the previous 12 months. Of the 340 IDUs, 41.8%(142/340)had at least one overdose of heroin in their lifetime(median: 3 overdoses)and 15.6%(53/340)had at least one overdose of heroin(median : 1 overdose use)in previous 12 months. The mean age of the 53 IDUs was(36.7 ± 8.4)years, and 83.0%(44/53)of them were males, the average drug use history was(16.5 ± 7.6)years. Dosage increase(26.4%, 14/53)and multidrug use(28.3%, 15/53)were the main causes for overdose of heroin. Multiple logistic regression analysis indicated that methadone maintenance treatment during the past year(OR=0.534, 95%CI: 0.290-0.980)was independently associated with decreased risk of overdose of heroin, needle sharing in the past 6 months(OR=2.735, 95%CI: 1.383-5.407)and being forced to receive drug rehabilitation for less than one year(OR=2.881, 95% CI: 1.226-6.767)were independently associated with increased risk of overdose of heroin. Overdose of heroin is common among IDUs in Yunnan. It is necessary to encourage IDUs to receive MMT and strengthen the health education about the prevention of overdose of heroin

  2. Factors associated with failure of oncology drugs in late-stage clinical development: A systematic review.

    PubMed

    Jardim, Denis L; Groves, Eric S; Breitfeld, Philip P; Kurzrock, Razelle

    2017-01-01

    We aimed to describe the reasons for failure of experimental anticancer drugs in late-stage clinical development. We searched the PharmaProjects database (https://citeline.com/products/pharmaprojects/) for anticancer drugs discontinued between 01/01/2009 and 06/30/2014. Drug programs that reached phase III trials, but never gained Food and Drug Administration (FDA) approval were compared to 37 anti-cancer drugs achieving FDA approval in this time period. Forty-two drugs fit our criteria for development failures. These failed drugs (49% targeted, 23% cytotoxics, and 28% other) were tested in 43 cancer indications (drug programs). Only 16% (7/43) of failed drug programs adopted a biomarker-driven rationale for patient selection versus 57% (21/37) of successful drug programs (P<0.001). Phase II trial information was available in 32 of 43 failed drug programs and in 32 of 37 successful programs. Nine of the 32 trials (28%) of failed drugs versus 28 of 32 trials (87%) of successful drugs (P<0.001) achieved proof of concept (single agent response rate (RR) ⩾20% or combination therapy showing a ⩾20% RR increase above the median historical RR without the experimental agent (with a minimal absolute increase of 5%) or a randomized phase II trial showing significance (P⩽0.05) for its primary outcome). No pattern of study sites, trial design or funding characteristics emerged from the failed drug analysis. For drugs that reached Phase III, lack of a biomarker-driven strategy and failure to attain proof of concept in phase II are potential risk factors for later discontinuation, especially for targeted agents. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Analysis of factors associated with hiccups based on the Japanese Adverse Drug Event Report database.

    PubMed

    Hosoya, Ryuichiro; Uesawa, Yoshihiro; Ishii-Nozawa, Reiko; Kagaya, Hajime

    2017-01-01

    Hiccups are occasionally experienced by most individuals. Although hiccups are not life-threatening, they may lead to a decline in quality of life. Previous studies showed that hiccups may occur as an adverse effect of certain medicines during chemotherapy. Furthermore, a male dominance in hiccups has been reported. However, due to the limited number of studies conducted on this phenomenon, debate still surrounds the few factors influencing hiccups. The present study aimed to investigate the influence of medicines and patient characteristics on hiccups using a large-sized adverse drug event report database and, specifically, the Japanese Adverse Drug Event Report (JADER) database. Cases of adverse effects associated with medications were extracted from JADER, and Fisher's exact test was performed to assess the presence or absence of hiccups for each medication. In a multivariate analysis, we conducted a multiple logistic regression analysis using medication and patient characteristic variables exhibiting significance. We also examined the role of dexamethasone in inducing hiccups during chemotherapy. Medicines associated with hiccups included dexamethasone, levofolinate, fluorouracil, oxaliplatin, carboplatin, and irinotecan. Patient characteristics associated with hiccups included a male gender and greater height. The combination of anti-cancer agent and dexamethasone use was noted in more than 95% of patients in the dexamethasone-use group. Hiccups also occurred in patients in the anti-cancer agent-use group who did not use dexamethasone. Most of the medications that induce hiccups are used in chemotherapy. The results of the present study suggest that it is possible to predict a high risk of hiccups using patient characteristics. We confirmed that dexamethasone was the drug that has the strongest influence on the induction of hiccups. However, the influence of anti-cancer agents on the induction of hiccups cannot be denied. We consider the results of the present

  4. Cross sectional study of factors associated to self-reported blood-borne infections among drug users.

    PubMed

    Reyes-Urueña, Juliana; Brugal, M Teresa; Majo, Xavier; Domingo-Salvany, Antonia; Caylà, Joan A

    2015-11-13

    The study's aim was to estimate the self-reported prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), and to describe their associated risk factors in a population of users of illicit drugs recruited in Catalonia- Spain, during 2012. Cross-sectional study. People with illicit drugs use were selected in three different types of healthcare centres. The questionnaire was a piloted, structured ad hoc instrument. An analysis was made to identify factors associated to self-reported HCV, HIV and co-infection. Correlates of reported infections were determined using univariate and multivariate Poisson regression (with robust variance). Among 512 participants, 39.65% self-reported positive serostatus for HCV and 14.84% for HIV, co-infection was reported by 13.48%. Among the 224 injecting drug users (IDUs), 187 (83.48%), 68 (30.36%) and 66 (29.46%) reported being positive for HCV, HIV and co-infection, respectively. A higher proportion of HIV-infected cases was observed among women, (18.33% vs. 13.78% in men). Prevalence of HCV, HIV and co-infection were higher among participants with early onset of drug consumption, long periods of drug injection or who were unemployed. A positive serostatus was self-reported by 21(7.34%) participants who did not report any injection; among them 16 and eight, reported being positive for HCV and HIV, respectively; three reported co-infection. Only two people declared exchanging sex for money. For those that reported a negative test, the median time since the last HIV test was 11.41 months (inter-quartile range (IQR) 4-12) and for the HCV test was 4.5 months (IQR 2-7). Among drug users in Catalonia, HIV, HCV and co-infection prevalence are still a big issue especially among IDUs. Women and drug users who have never injected drugs are groups with a significant risk of infection; this might be related to their high-risk behaviours and to being unaware of their serological status.

  5. Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review.

    PubMed

    Mekonnen, Alemayehu B; Alhawassi, Tariq M; McLachlan, Andrew J; Brien, Jo-Anne E

    2018-03-01

    Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5-20.1%), while adverse drug events causing admission were reported in 2.8% (0.7-6.4%) of patients but it was reported that a median of 43.5% (20.0-47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0-0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8-72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5-50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge

  6. Factors associated with the consumption of psychotropic drugs in a cohort of men and women aged 50 and over.

    PubMed

    Empereur, F; Baumann, M; Alla, F; Briançon, S

    2003-02-01

    The use of psychotropic drugs has increased continuously over recent years in industrialized countries. In Europe, France has the highest consumption of such drugs. The aim of this study was to identify the sociodemographic and medical factors associated with the use of psychotropic agents. Data, collected as part of the SUVIMAX (SUpplementation en VItamines et sels Mineraux AntioXydants) prevention trial, from a self- administered questionnaire involving 7299 subjects aged 45-60 years, were subjected to logistic regression analysis. A total of 467 subjects used psychotropic drugs (8.4% of the women, 4.6% of the men). Use of psychotropic drugs increased in subjects of both sexes with past history of depression, perception of poor health and use of other drug treatments. Widowhood in men [odds ratio (OR) = 3.4; 95% CI = 1.6-7.3] and divorce in women (OR = 2; 95% CI = 1.2-3.2) were also associated with an increased use of psychotropic drugs. Interaction was demonstrated between educational level and occupational satisfaction in men (OR = 2.9; 95% CI = 1.5-5.8) and between perception of health status and use of other types of medication in women (OR = 6.5; 95% CI = 4.6-9.5). The results of our study are consistent with those of others in demonstrating that specific socio-occupational factors in men and specific medical factors in women influence extent of use of psychotropic drugs.

  7. Role of Dopamine Signaling in Drug Addiction.

    PubMed

    Chen, Wan; Nong, Zhihuan; Li, Yaoxuan; Huang, Jianping; Chen, Chunxia; Huang, Luying

    2017-01-01

    Addiction is a chronic, relapsing disease of the brain that includes drug-induced compulsive seeking behavior and consumption of drugs. Dopamine (DA) is considered to be critical in drug addiction due to reward mechanisms in the midbrain. In this article, we review the major animal models in addictive drug experiments in vivo and in vitro. We discuss the relevance of the structure and pharmacological function of DA receptors. To improve the understanding of the role of DA receptors in reward pathways, specific brain regions, including the Ventral tegmental area, Nucleus accumbens, Prefrontal cortex, and Habenula, are highlighted. These factors contribute to the development of novel therapeutic targets that act at DA receptors. In addiction, the development of neuroimaging method will increase our understanding of the mechanisms underlying drug addiction. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  8. A Factor Analytic Model of Drug-Related Behavior in Adolescence and Its Impact on Arrests at Multiple Stages of the Life Course

    PubMed Central

    2016-01-01

    Objectives Recognizing the inherent variability of drug-related behaviors, this study develops an empirically-driven and holistic model of drug-related behavior during adolescence using factor analysis to simultaneously model multiple drug behaviors. Methods The factor analytic model uncovers latent dimensions of drug-related behaviors, rather than patterns of individuals. These latent dimensions are treated as empirical typologies which are then used to predict an individual’s number of arrests accrued at multiple phases of the life course. The data are robust enough to simultaneously capture drug behavior measures typically considered in isolation in the literature, and to allow for behavior to change and evolve over the period of adolescence. Results Results show that factor analysis is capable of developing highly descriptive patterns of drug offending, and that these patterns have great utility in predicting arrests. Results further demonstrate that while drug behavior patterns are predictive of arrests at the end of adolescence for both males and females, the impacts on arrests are longer lasting for females. Conclusions The various facets of drug behaviors have been a long-time concern of criminological research. However, the ability to model multiple behaviors simultaneously is often constrained by data that do not measure the constructs fully. Factor analysis is shown to be a useful technique for modeling adolescent drug involvement patterns in a way that accounts for the multitude and variability of possible behaviors, and in predicting future negative life outcomes, such as arrests. PMID:28435183

  9. Isolation and identification of flavonoids, including flavone rotamers, from the herbal drug 'Crataegi folium cum flore' (hawthorn).

    PubMed

    Rayyan, S; Fossen, T; Solheim Nateland, H; Andersen, O M

    2005-01-01

    Twelve flavonoids, including seven flavones, four flavonols and one flavanone, were isolated from methanolic extract of the herbal drug 'Crataegi folium cum flore' (hawthorn leaves and flowers) by a combination of CC (over Amberlite XAD-7 and Sephadex LH-20) and preparative HPLC. Their structures, including that of the novel flavonol 8-methoxykaempferol 3-O-(6"-malonyl-beta-glucopyranoside), were elucidated by homo- and heteronuclear NMR and electrospray/MS. The 1H- and 13C-NMR of all compounds, including rotameric pairs of five flavone C-glycosides, were assigned. The presence and relative proportion of each rotamer was shown by various NMR experiments, including two-dimensional nuclear Overhauser and exchange spectroscopy, to depend on solvent, linkage position and structure of the C-glycosyl substituent.

  10. Trypanosome RNA polymerases and transcription factors: sensible trypanocidal drug targets?

    PubMed

    Vanhamme, Luc

    2008-11-01

    Trypanosomes and Leishmaniae are the agents of several important parasitic diseases threatening hundreds of million human beings worldwide. As they diverged early in evolution, they display original molecular characteristics. These peculiarities are each defining putative specific targets for anti-parasitic drugs. Transcription displays its lot of unique characteristics in trypanosomes and will be taken as an example to uncover these targets. Unique features of transcription in trypanosomes include constitutive and poly-cistronic transcription by RNA polymerase II as well as transcription of protein-coding genes by RNA polymerase I. It is becoming clear that these unique mechanisms are performed by dedicated molecular players. The first of them have been recently characterized. They are reviewed and their suitability as drug targets is commented.

  11. Silk Fibroin-Based Nanoparticles for Drug Delivery

    PubMed Central

    Zhao, Zheng; Li, Yi; Xie, Mao-Bin

    2015-01-01

    Silk fibroin (SF) is a protein-based biomacromolecule with excellent biocompatibility, biodegradability and low immunogenicity. The development of SF-based nanoparticles for drug delivery have received considerable attention due to high binding capacity for various drugs, controlled drug release properties and mild preparation conditions. By adjusting the particle size, the chemical structure and properties, the modified or recombinant SF-based nanoparticles can be designed to improve the therapeutic efficiency of drugs encapsulated into these nanoparticles. Therefore, they can be used to deliver small molecule drugs (e.g., anti-cancer drugs), protein and growth factor drugs, gene drugs, etc. This paper reviews recent progress on SF-based nanoparticles, including chemical structure, properties, and preparation methods. In addition, the applications of SF-based nanoparticles as carriers for therapeutic drugs are also reviewed. PMID:25749470

  12. Cost-effectiveness and pricing of antibacterial drugs.

    PubMed

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of 'value', which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. © 2015 The Authors. Chemical Biology & Drug Design Published by John Wiley & Sons Ltd.

  13. Religion as a protective factor against drug use among Brazilian university students: a national survey.

    PubMed

    Gomes, Fernanda Carolina; de Andrade, Arthur Guerra; Izbicki, Rafael; Moreira Almeida, Alexander; Oliveira, Lúcio Garcia de

    2013-03-01

    To investigate the relationship between religiosity and drug use among Brazilian university students. This manuscript is part of the "First Nationwide Survey on the Use of Alcohol, Tobacco and Other Drugs among College Students in the 27 Brazilian State Capitals". In this study, 12,595 university students were divided into two groups according to their attendance at religious services: frequent attenders (FR; 39.1%) and non-frequent attenders (NFR; 60.8%). Subsequently, we analyzed their responses to a structured, anonymous questionnaire on drug use and other behaviors. Individual multivariate logistic regression models tested the association between religiosity and drug use (alcohol, tobacco, marijuana and at least one illicit drug). Drug use over the last 30 days was higher among NFR students even after controlling for demographic variables. NFR students were more likely to use alcohol OR = 2.52; 95% CI: 2.08-3.06, tobacco (2.83; 2.09-3.83), marijuana (2.09; 1.39-3.11) and at least one illicit drug (1.42; 1.12-1.79) compared to FR students. Religiosity was found to be a strongly protective factor against drug use among Brazilian university students. However, more studies are needed to identify the mechanisms by which religiosity exerts this protective influence.

  14. Mechanism-based inactivation of human cytochrome P450 enzymes: strategies for diagnosis and drug-drug interaction risk assessment.

    PubMed

    Venkatakrishnan, K; Obach, R S; Rostami-Hodjegan, A

    2007-01-01

    Among drugs that cause pharmacokinetic drug-drug interactions, mechanism-based inactivators of cytochrome P450 represent several of those agents that cause interactions of the greatest magnitude. In vitro inactivation kinetic data can be used to predict the potential for new drugs to cause drug interactions in the clinic. However, several factors exist, each with its own uncertainty, that must be taken into account in order to predict the magnitude of interactions reliably. These include aspects of in vitro experimental design, an understanding of relevant in vivo concentrations of the inactivator, and the extent to which the inactivated enzyme is involved in the clearance of the affected drug. Additionally, the rate of enzyme degradation in vivo is also an important factor that needs to be considered in the prediction of the drug interaction magnitudes. To address mechanism-based inactivation for new drugs, various in vitro experimental approaches have been employed. The selection of approaches for in vitro kinetic characterization of inactivation as well as in vitro-in vivo extrapolation should be guided by the purpose of the exercise and the stage of drug discovery and development, with an increase in the level of sophistication throughout the research and development process.

  15. [Predictive factors of clinically significant drug-drug interactions among regimens based on protease inhibitors, non-nucleoside reverse transcriptase inhibitors and raltegravir].

    PubMed

    Cervero, Miguel; Torres, Rafael; Jusdado, Juan José; Pastor, Susana; Agud, Jose Luis

    2016-04-15

    To determine the prevalence and types of clinically significant drug-drug interactions (CSDI) in the drug regimens of HIV-infected patients receiving antiretroviral treatment. retrospective review of database. Centre: Hospital Universitario Severo Ochoa, Infectious Unit. one hundred and forty-two participants followed by one of the authors were selected from January 1985 to December 2014. from their outpatient medical records we reviewed information from the last available visit of the participants, in relation to HIV infection, comorbidities, demographics and the drugs that they were receiving; both antiretroviral drugs and drugs not related to HIV infection. We defined CSDI from the information sheet and/or database on antiretroviral drug interactions of the University of Liverpool (http://www.hiv-druginteractions.org) and we developed a diagnostic tool to predict the possibility of CSDI. By multivariate logistic regression analysis and by estimating the diagnostic performance curve obtained, we identified a quick tool to predict the existence of drug interactions. Of 142 patients, 39 (29.11%) had some type of CSDI and in 11.2% 2 or more interactions were detected. In only one patient the combination of drugs was contraindicated (this patient was receiving darunavir/r and quetiapine). In multivariate analyses, predictors of CSDI were regimen type (PI or NNRTI) and the use of 3 or more non-antiretroviral drugs (AUC 0.886, 95% CI 0.828 to 0.944; P=.0001). The risk was 18.55 times in those receiving NNRTI and 27,95 times in those receiving IP compared to those taking raltegravir. Drug interactions, including those defined as clinically significant, are common in HIV-infected patients treated with antiretroviral drugs, and the risk is greater in IP-based regimens. Raltegravir-based prescribing, especially in patients who receive at least 3 non-HIV drugs could avoid interactions. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  16. The association of antidepressant drug usage with cognitive impairment or dementia, including Alzheimer disease: A systematic review and meta-analysis.

    PubMed

    Moraros, John; Nwankwo, Chijioke; Patten, Scott B; Mousseau, Darrell D

    2017-03-01

    To determine if antidepressant drug usage is associated with cognitive impairment or dementia, including Alzheimer disease (AD). We conducted a systematic search of Medline, PubMed, PsycINFO, Web of Science, Embase, CINAHL, and the Cochrane Library. An initial screen by abstracts and titles was performed, and relevant full articles were then reviewed and assessed for their methodologic quality. Crude effect estimates were extracted from the included articles and a pooled estimate was obtained using a random effects model. Five articles were selected from an initial pool of 4,123 articles. Use of antidepressant drugs was associated with a significant twofold increase in the odds of some form of cognitive impairment or dementia (OR = 2.17). Age was identified as a likely modifier of the association between antidepressant use and some form of cognitive impairment or AD/dementia. Studies that included participants with an average age equal to or greater than 65 years showed an increased odds of some form of cognitive impairment with antidepressant drug usage (OR = 1.65), whereas those with participants less than age 65 revealed an even stronger association (OR = 3.25). Antidepressant drug usage is associated with AD/dementia and this is particularly evident if usage begins before age 65. This association may arise due to confounding by depression or depression severity. However, biological mechanisms potentially linking antidepressant exposure to dementia have been described, so an etiological effect of antidepressants is possible. With this confirmation that an association exists, clarification of underlying etiologic pathways requires urgent attention. © 2016 The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.

  17. [Prevalence of illicit drug use and associated factors during pregnancy in the BRISA cohort].

    PubMed

    Rocha, Priscila Coimbra; Britto e Alves, Maria Teresa Seabra Soares de; Chagas, Deysianne Costa das; Silva, Antônio Augusto Moura da; Batista, Rosangela Fernandes Lucena; Silva, Raimundo Antonio da

    2016-01-01

    This study analyzes the prevalence of illicit drug use and associated factors during pregnancy. This was a cross-sectional study of participants in the BRISA prenatal care cohort. Frequencies and hierarchical logistic regression were used. Estimated prevalence rates were 1.45% for illicit drug use, 22.32% for alcohol consumption, and 4.22% for smoking. The study population was mostly young (81% in the 20-34-year bracket), with 9 to 11 years of schooling (75.55%), with more than half of the women outside the workforce (52.18%), and in economic class "C" (67.61%). Pregnant women showed a high level of stress (24.46%), moderate to intense anxiety (40.84%), and severe depressive symptoms (28.8%). Approximately half (49.72%) of the pregnant women reported some type of violence, and they had wide networks (72.77%) and low social support (65.21%). Use of legal drugs, high stress levels, and single parenthood were independently associated with illicit drug use in pregnancy.

  18. A review on therapeutic drug monitoring of immunosuppressant drugs.

    PubMed

    Mohammadpour, Niloufar; Elyasi, Sepideh; Vahdati, Naser; Mohammadpour, Amir Hooshang; Shamsara, Jamal

    2011-11-01

    : Immunosuppressants require therapeutic drug monitoring because of their narrow therapeutic index and significant inter-individual variability in blood concentrations. This variability can be because of factors like drug-nutrient interactions, drug-disease interactions, renal-insufficiency, inflammation and infection, gender, age, polymorphism and liver mass. Drug monitoring is widely practiced especially for cyclosporine, tacrolimus, sirolimus and mycophenolic acid. CYCLOSPORINE: Therapeutic monitoring of immunosuppressive therapy with cyclosporine is a critical requirement because of intra- and inter-patient variability of drug absorption, narrow therapeutic window and drug induced nephrotoxicity. MYCOPHENOLIC ACID MPA: Some reasons for therapeutic drug monitoring of MPA during post-transplant period include: relationship between MPA pharmacokinetic parameters and clinical outcomes, Inter-patient pharmacokinetic variability for MPA despite fixed MMF doses, alternations of MPA pharmacokinetics during the first months after transplantation, drug- drug interaction and influence of kidney function on MPA pharmacokinetic. SIROLIMUS: A recent review of the pharmacokinetics of sirolimus suggested a therapeutic range of 5 to 10 μg l(-1) in whole blood. However, the only consensus guidelines published on the therapeutic monitoring of sirolimus concluded that there was not enough information available about the clinical use of the drug to make recommendations. TACROLIMUS: Sudies have shown, in kidney and liver transplant patients, significant associations of low tacrolimus concentrations with rejection and of high concentrations with nephrotoxicity. Although the feasibility of a limited sampling scheme to predict AUC has been demonstrated, as yet, trough, or pre-dose, whole blood concentration monitoring is still the method of choice.

  19. The affective dimension of pain as a risk factor for drug and alcohol addiction.

    PubMed

    LeBlanc, Dana M; McGinn, M Adrienne; Itoga, Christy A; Edwards, Scott

    2015-12-01

    Addiction, or substance use disorder (SUD), is a devastating psychiatric disease composed of multiple elemental features. As a biobehavioral disorder, escalation of drug and/or alcohol intake is both a cause and consequence of molecular neuroadaptations in central brain reinforcement circuitry. Multiple mesolimbic areas mediate a host of negative affective and motivational symptoms that appear to be central to the addiction process. Brain stress- and reinforcement-related regions such as the central amygdala (CeA), prefrontal cortex (PFC), and nucleus accumbens (NAc) also serve as central processors of ascending nociceptive input. We hypothesize that a sensitization of brain mechanisms underlying the processing of persistent and maladaptive pain contributes to a composite negative affective state to drive the enduring, relapsing nature of addiction, particularly in the case of alcohol and opioid use disorder. At the neurochemical level, pain activates central stress-related neuropeptide signaling, including the dynorphin and corticotropin-releasing factor (CRF) systems, and by this process may facilitate negative affect and escalated drug and alcohol use over time. Importantly, the widespread prevalence of unresolved pain and associated affective dysregulation in clinical populations highlights the need for more effective analgesic medications with reduced potential for tolerance and dependence. The burgeoning epidemic of prescription opioid abuse also demands a closer investigation into the neurobiological mechanisms of how pain treatment could potentially represent a significant risk factor for addiction in vulnerable populations. Finally, the continuing convergence of sensory and affective neuroscience fields is expected to generate insight into the critical balance between pain relief and addiction liability, as well as provide more effective therapeutic strategies for chronic pain and addiction. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Narcotic Drug Use Among Patients with Lower Back Pain in Employer Health Plans: A Retrospective Analysis of Risk Factors and Health Care Services

    PubMed Central

    Rhee, YongJoo; Taitel, Michael S.; Walker, David R.; Lau, Denys T.

    2009-01-01

    Objective: This study examines the risk factors of narcotic drug use, medical and pharmacy claim costs, and health services use among lower back pain (LBP) patients who use narcotic medications. Methods: This retrospective study used administrative claims data between September 2002 and March 2004 from 3 employer health plans that collectively contained records of 165,569 employees 18 to 64 years of age. Multivariate regression analyses were performed to examine risk factors and health care services use consequences of narcotic drug use in patients with LBR Results: The study sample included 13,760 patients with LBP due to mechanical causes. Nearly 60% were female and the average age was 47 years. Almost half of the patients with LBP (45%) used narcotic drugs. Narcotic-using patients with LBP had significantly higher rates of comorbid conditions than patients with LBP not using narcotic drugs; hypertension (23% vs 13%), arthritis (14% vs 4%), depression (10% vs 5%), anxiety (6% vs 3%), and cancer (2% vs 1%) (P < 0.001). Patients with LBP with 2 identified psychological comorbid conditions, depression and anxiety, on average used more narcotic medications. Patients with LBP who had surgery were significantly more likely to use narcotic drugs within 1 week of procedure than those patients without surgery (P < 0.001). In contrast, patients with LBP who had chiropractic services for LBP were less likely to take narcotic drugs within 7 days after services compared to those without chiropractic services (P < 0.001). Furthermore, controlling for health conditions, patients with LBP who took narcotic medications were significantly more likely than patients not taking narcotics to have an emergency room visit within 30 days after the initial narcotic drug prescription dates (P < 0.001). Narcotic-using patients with LBP accounted for 62% of health care costs among all patients with LBP. The average monthly health care cost for a narcotic-using LBP patient was $1222, compared

  1. Early development of infants exposed to drugs prenatally.

    PubMed

    Eyler, F D; Behnke, M

    1999-03-01

    This article includes a summary and critique of methodological limitations of the peer-reviewed studies of developmental outcome during the first 2 years in children prenatally exposed to the most commonly used drugs of abuse: tobacco, alcohol, marijuana, heroin/methadone, and cocaine. Reported effects vary by specific drug or drug combinations and amount and timing of exposure; however, few thresholds have been established. Drug effects also appear to be exacerbated in children with multiple risks, including poverty, and nonoptimal caregiving environments. Although prenatal exposure to any one drug cannot reliably predict the outcome of an individual child, it may be a marker for an array of variables that can impact development. Appropriate intervention strategies require future research that determines which factors place exposed children at risk and which are protective for optimal development.

  2. gene2drug: a computational tool for pathway-based rational drug repositioning.

    PubMed

    Napolitano, Francesco; Carrella, Diego; Mandriani, Barbara; Pisonero-Vaquero, Sandra; Sirci, Francesco; Medina, Diego L; Brunetti-Pierri, Nicola; di Bernardo, Diego

    2018-05-01

    Drug repositioning has been proposed as an effective shortcut to drug discovery. The availability of large collections of transcriptional responses to drugs enables computational approaches to drug repositioning directly based on measured molecular effects. We introduce a novel computational methodology for rational drug repositioning, which exploits the transcriptional responses following treatment with small molecule. Specifically, given a therapeutic target gene, a prioritization of potential effective drugs is obtained by assessing their impact on the transcription of genes in the pathway(s) including the target. We performed in silico validation and comparison with a state-of-art technique based on similar principles. We next performed experimental validation in two different real-case drug repositioning scenarios: (i) upregulation of the glutamate-pyruvate transaminase (GPT), which has been shown to induce reduction of oxalate levels in a mouse model of primary hyperoxaluria, and (ii) activation of the transcription factor TFEB, a master regulator of lysosomal biogenesis and autophagy, whose modulation may be beneficial in neurodegenerative disorders. A web tool for Gene2drug is freely available at http://gene2drug.tigem.it. An R package is under development and can be obtained from https://github.com/franapoli/gep2pep. dibernardo@tigem.it. Supplementary data are available at Bioinformatics online.

  3. Increasing availability of illicit drugs among people who inject drugs in Bangkok, Thailand.

    PubMed

    Hayashi, Kanna; Nosyk, Bohdan; Ti, Lianping; Suwannawong, Paisan; Kaplan, Karyn; Wood, Evan; Kerr, Thomas

    2013-09-01

    In recent years, the Thai government has strengthened drug law enforcement as a strategy to address a continuing epidemic of illicit drug use. We sought to assess temporal trends in street-level availability of illicit drugs among injection drug users (IDUs) in Bangkok, Thailand. Using univariate statistics and multivariate logistic regression, we assessed changes in the availability of five substances (heroin, methamphetamine, crystal methamphetamine, midazolam, and illicit methadone) between 2009 and 2011 and examined social, structural and individual factors influencing availability among community-recruited samples of IDUs in Bangkok. Availability was measured in three levels: immediate (available in ≤10 min); moderate (available in 10-90 min); and delayed (available in >90 min; our reference category). The analyses included 718 IDUs, including 165 (23.0%) women. Controlling for changes in participant characteristics between assessments, and in a period of constant nominal illicit drug prices, moderate availability of all substances increased significantly between 2009 and 2011, with adjusted odds ratios ranging between 2.36 (illicit methadone) and 4.61 (crystal methamphetamine) (all p<0.01). Immediate availability of all substances but heroin also increased (all p<0.01). More immediate availability of methamphetamine was also associated with a history of incarceration (p<0.05). Despite the Thai government's intensified drug suppression efforts, the availability of illicit drugs among IDUs in Bangkok increased significantly between 2009 and 2011. The findings raise concern about the overreliance on drug law enforcement-based approaches and point to the need for greater investment in evidence-based drug policies. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. Biomedical HIV Prevention Including Pre-exposure Prophylaxis and Opiate Agonist Therapy for Women Who Inject Drugs: State of Research and Future Directions.

    PubMed

    Page, Kimberly; Tsui, Judith; Maher, Lisa; Choopanya, Kachit; Vanichseni, Suphak; Mock, Philip A; Celum, Connie; Martin, Michael

    2015-06-01

    Women who inject drugs (WWID) are at higher risk of HIV compared with their male counterparts as a result of multiple factors, including biological, behavioral, and sociostructural factors, yet comparatively little effort has been invested in testing and delivering prevention methods that directly target this group. In this article, we discuss the need for expanded prevention interventions for WWID, focusing on 2 safe, effective, and approved, yet underutilized biomedical prevention methods: opiate agonist therapy (OAT) and oral pre-exposure prophylaxis (PrEP). Although both interventions are well researched, they have not been well examined in the context of gender. We discuss the drivers of women injectors' higher HIV risk, review the effectiveness of OAT and PrEP interventions among women, and explain why these new HIV prevention tools should be prioritized for WWID. There is substantial potential for impact of OAT and PrEP programs for WWID in the context of broader gender-responsive HIV prevention initiatives. Although awaiting efficacy data on other biomedical approaches in the HIV prevention research "pipeline," we propose that the scale-up and implementation of these proven, safe, and effective interventions are needed now.

  5. Association of serum brain derived neurotropic factor with duration of drug-naive period and positive-negative symptom scores in drug naive schizophrenia.

    PubMed

    Bakirhan, Abdurrahim; Yalcin Sahiner, Safak; Sahiner, Ismail Volkan; Safak, Yasir; Goka, Erol

    2017-01-01

    The aim of this study was to compare the serum brain derived neurotropic factor (BNDF) levels of patients with schizophrenia who had never received an antipsychotic treatment with those of a control group. Also, to analyze the relationship between the Positive and Negative Symptom Scale (PANSS) scores and BDNF levels of the patients during the period they were drug-naive. The sample of the study comprised patients who presentedto the Psychiatry Clinic and were admitted after a distinctive schizophrenia diagnosis was made in accordance with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnosis classification and who were not using and never had any antipsychotic medicine. A total of 160 participants were included in the study, 80 of whom had schizophrenia patients and 80 constituted the age- and sex-matched healthy control group. Before the start of the treatment, the serum samples to be checked for the BDNF levels were collected from the patients. The difference between the average BDNF levels of the groups were statistically significant (t = -5.25; p˂.001). An analysis as to whether there was a relation between the BDNF levels and the drug-naïve duration indicated no correlations. An examination of the relationship between PANSS scores and BDNF levels of the patients yielded no correlations. Serum BDNF levels seem to be one of the indicators of schizophrenia and its progress; nevertheless, we still do not have sufficient information about this neurotropic factor. In light of our study, the neurodevelopmental changes that occur at disease onset of the illness prominently affect the progress of the illness, which highlights the importance of the treatment in the early stages.

  6. Are Outness and Community Involvement Risk or Protective Factors for Alcohol and Drug Abuse Among Sexual Minority Women?

    PubMed

    Feinstein, Brian A; Dyar, Christina; London, Bonita

    2017-07-01

    Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW's substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one's sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.

  7. Candida Species From Eye Infections: Drug Susceptibility, Virulence Factors, and Molecular Characterization.

    PubMed

    Ranjith, Konduri; Sontam, Bhavani; Sharma, Savitri; Joseph, Joveeta; Chathoth, Kanchana N; Sama, Kalyana C; Murthy, Somasheila I; Shivaji, Sisinthy

    2017-08-01

    To determine the type of Candida species in ocular infections and to investigate the relationship of antifungal susceptibility profile to virulence factors. Fifty isolates of yeast-like fungi from patients with keratitis, endophthalmitis, and orbital cellulitis were identified by Vitek-2 compact system and DNA sequencing of ITS1-5.8S-ITS2 regions of the rRNA gene, followed by phylogenetic analysis for phenotypic and genotypic identification, respectively. Minimum inhibitory concentration of six antifungal drugs was determined by E test/microbroth dilution methods. Phenotypic and genotypic methods were used to determine the virulence factors. Phylogenetic analysis showed the clustering of all isolates into eight distinct groups with a major cluster formed Candida parapsilosis (n = 21), which was the most common species by both Vitek 2 and DNA sequencing. Using χ2 test no significant difference was noted between the techniques except that Vitek 2 did not identify C. viswanathii, C. orthopsilosis, and two non-Candida genera. Of 43 tested Candida isolates high susceptibility to amphotericin B (39/43, 90.6%) and natamycin (43/43, 100%) was noted. While none of the isolates produced coagulase, all produced esterase and catalase. The potential to form biofilm was detected in 23/43 (53.4%) isolates. Distribution of virulence factors by heat map analysis showed difference in metabolic activity of biofilm producers from nonbiofilm producers. Identified by Vitek 2 and DNA sequencing methods C. parapsilosis was the most common species associated with eye infections. Irrespective of the virulence factors elaborated, the Candida isolates were susceptible to commonly used antifungal drugs such as amphotericin B and natamycin.

  8. Factors affecting the persistence of drug-induced reprogramming of the cancer methylome

    PubMed Central

    Bell, Joshua S. K.; Kagey, Jacob D.; Barwick, Benjamin G.; Dwivedi, Bhakti; McCabe, Michael T.; Kowalski, Jeanne; Vertino, Paula M.

    2016-01-01

    ABSTRACT Aberrant DNA methylation is a critical feature of cancer. Epigenetic therapy seeks to reverse these changes to restore normal gene expression. DNA demethylating agents, including 5-aza-2′-deoxycytidine (DAC), are currently used to treat certain leukemias, and can sensitize solid tumors to chemotherapy and immunotherapy. However, it has been difficult to pin the clinical efficacy of these agents to specific demethylation events, and the factors that contribute to the durability of response remain largely unknown. Here we examined the genome-wide kinetics of DAC-induced DNA demethylation and subsequent remethylation after drug withdrawal in breast cancer cells. We find that CpGs differ in both their susceptibility to demethylation and propensity for remethylation after drug removal. DAC-induced demethylation was most apparent at CpGs with higher initial methylation levels and further from CpG islands. Once demethylated, such sites exhibited varied remethylation potentials. The most rapidly remethylating CpGs regained >75% of their starting methylation within a month of drug withdrawal. These sites had higher pretreatment methylation levels, were enriched in gene bodies, marked by H3K36me3, and tended to be methylated in normal breast cells. In contrast, a more resistant class of CpG sites failed to regain even 20% of their initial methylation after 3 months. These sites had lower pretreatment methylation levels, were within or near CpG islands, marked by H3K79me2 or H3K4me2/3, and were overrepresented in sites that become aberrantly hypermethylated in breast cancers. Thus, whereas DAC-induced demethylation affects both endogenous and aberrantly methylated sites, tumor-specific hypermethylation is more slowly regained, even as normal methylation promptly recovers. Taken together, these data suggest that the durability of DAC response is linked to its selective ability to stably reset at least a portion of the cancer methylome. PMID:27082926

  9. 38 CFR 48.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... drug-free workplace statement? 48.205 Section 48.205 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL... workplace statement? You must publish a statement that— (a) Tells your employees that the unlawful...

  10. Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico

    PubMed Central

    Reyes-López, Alfonso; Garduño-Espinosa, Juan; Muñoz-Hernández, Onofre

    2018-01-01

    Background Drug-drug interactions (DDIs) detected in a patient may not be clinically apparent (potential DDIs), and when they occur, they produce adverse drug reactions (ADRs), toxicity or loss of treatment efficacy. In pediatrics, there are only few publications assessing potential DDIs and their risk factors. There are no studies in children admitted to emergency departments (ED). The present study estimates the prevalence and describes the characteristics of potential DDIs in patients admitted to an ED from a tertiary care hospital in Mexico; in addition, potential DDI-associated risk factors are investigated. Methods A secondary analysis of data from 915 patients admitted to the ED of the Hospital Infantil de México “Federico Gómez” was conducted. The Medscape Drug Interaction Checker software was used to identify potential DDIs. The results are expressed as number of cases (%), means (95% CI) and medians (25-75th percentiles). Count data regressions for number of total and severity-stratified potential DDIs were performed adjusting for patient characteristics, number of administered drugs, days of stay, presence of ADRs and diagnoses. Results The prevalence of potential DDIs was 61%, with a median of 4 (2–8). A proportion of 0.2% of potential DDIs was “Contraindicated”, 7.5% were classified as “Serious”, 62.8% as “Significant” and 29.5% as “Minor”. Female gender, age, days of stay, number of administered drugs and diagnoses of Neoplasms (C00-D48), Congenital malformations (Q00-Q99), Diseases of the Blood, Blood-forming Organs and Immunity (D50-D89) and Diseases of the nervous system (G00-G99) were significantly associated with potential DDIs. Conclusion The prevalence of potential DDIs in the ED is high, and strategies should therefore be established to monitor patients’ safety during their stay, in addition to conducting investigations to estimate the real harm potential DDIs inflict on patients. PMID:29304072

  11. Glucose-6-phosphate dehydrogenase deficiency and antimalarial drug development.

    PubMed

    Beutler, Ernest; Duparc, Stephan

    2007-10-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is relatively common in populations exposed to malaria. This deficiency appears to provide some protection from this infection, but it can also cause hemolysis after administration of some antimalarial drugs, especially primaquine. The risk of drug-induced G6PD deficiency-related hemolysis depends on a number of factors including the G6PD variant, the drug and drug dosage schedule, patient status, and disease factors. Although a great deal is known about the molecular biology of G6PD, determining the potential for drug-induced hemolysis in the clinical setting is still challenging. This report discusses the potential strategies for assessing drug-induced G6PD deficiency-related hemolytic risk preclinically and in early clinical trials. Additionally, the issues important for conducting larger clinical trials in populations in which G6PD deficiency is prevalent are examined, with a particular focus on antimalarial drug development.

  12. The insults of illicit drug use on male fertility.

    PubMed

    Fronczak, Carolyn M; Kim, Edward D; Barqawi, Al B

    2012-01-01

    One-third of infertile couples may have a male factor present. Illicit drug use can be an important cause of male factor infertility and includes use of anabolic-androgenic steroids, marijuana, opioid narcotics, cocaine, and methamphetamines. The use of these illicit drugs is common in the United States, with a yearly prevalence rate for any drug consistently higher in males compared with females. We aim to provide a review of recent literature on the prevalence and effects of illicit drug use on male fertility and to aid health professionals when counseling infertile men whose social history suggests illicit drug use. Anabolic-androgenic steroids, marijuana, cocaine, methamphetamines, and opioid narcotics all negatively impact male fertility, and adverse effects have been reported on the hypothalamic-pituitary-testicular axis, sperm function, and testicular structure. The use of illicit drugs is prevalent in our society and likely adversely impacting the fertility of men who abuse drugs.

  13. Cost-effectiveness and Pricing of Antibacterial Drugs

    PubMed Central

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of ‘value’, which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. PMID:25521641

  14. Experiment on the factors for enhancing the susceptibility of cancer cells to chemotherapeutic drug by ultrasound microbubbles.

    PubMed

    Zhao, Ying-Zheng; Gao, Hui-Sheng; Zhou, Zhi-Cai; Tang, Qin-Qin; Lu, Cui-Tao; Jin, Zhuo; Tian, Ji-Lai; Xu, Yan-Yan; Tian, Xin-Qiao; Wang, Lee; Kong, Fan-Lei; Li, Xiao-Kun; Huang, Pin-Tong; He, Hui-Liao; Wu, Yan

    2010-07-01

    The objective of this study was to investigate the factors for enhancing the susceptibility of cancer cells to chemotherapeutic drug by ultrasound microbubbles. Ultrasound (US) combined with phospholipid-based microbubbles (MB) was used to enhance the susceptibility of colon cancer cell line SWD-620 to anticancer drugs Topotecan hydrochloride (TOP). Experiments were designed to investigate the influence of main factors on cell viability and cell inhibition, such as US intensity, MB concentration, drug combination with MB, asynchronous action between US triggered cavitation and drug entering cell, MB particle size. US exposure for 10 sec with US probe power at 0.6 W/cm(2) had satisfied cell viability. Treated with US combined with 15% MB, cell viability maintained more than 85% and cell inhibition 86.16%. Under optimal US combined with MB, TOP showed much higher cell inhibition than that of only TOP group. Cell inhibition under short delayed time (<2 h) for TOP addition did not show obvious difference. In terms of MB particle size, the order of cell inhibition was: Mixture > Micron bubble part > Nanometer bubble part. US combined with MB can enhance the susceptibility of cancer cells to chemotherapeutic drug, which may provide a potential method for US-mediated tumor chemotherapy.

  15. Importance of Control Groups When Delineating Antibiotic Use as Risk Factors for Carbapenem-Resistance, Extreme-Drug and Pan-Drug Resistance in Acinetobacter baumannii and Pseudomonas aeruginosa: A Systematic Review and Meta-Analysis.

    PubMed

    Lim, Cheryl Li Ling; Chua, Alvin Qijia; Teo, Jocelyn Qi Min; Cai, Yiying; Lee, Winnie; Kwa, Andrea Lay-Hoon

    2018-06-02

    Carbapenem-resistant (CR), extreme-drug-resistant (XDR) & pan-drug-resistant (PDR) AB and PA (AB-PA) pose a huge clinical threat. This study reviews the impact of control groups on association of antecedent antibiotic use & acquisition of CR/XDR/PDR AB-PA. Studies investigating the role of antibiotics as risk factor for CR/XDR/PDR AB-PA acquisition in adult hospitalized patients from 1950 to 2016 were identified with databases. These were divided into 2 groups: antibiotic-resistant versus antibiotic-sensitive pathogens (Group I); versus no infection (Group II). A random effects model was performed. Eighty-five studies (46 AB, 38 PA, 1 both) with 22,396 patients were included. CR, XDR & PDR was investigated in 60, 20 and 2 studies respectively. Prior antibiotic exposure was associated with significant acquisition of CR/XDR/PDR AB-PA in both Groups I and II (p <0.05). Antibiotic classes implicated in both groups include aminoglycosides, carbapenems, glycopeptides and penicillins. Cephalosporin use was not associated with resistance in either group. Fluoroquinolones exposure was only associated with resistance in Group I but not Group II. Control groups play an important role in determining magnitudes of risk estimates for risk factor studies, hence careful selection is necessary. Antibiotic exposure increases acquisition of highly-resistant AB-PA, thus appropriate antibiotic use is imperative. Copyright © 2018. Published by Elsevier Ltd.

  16. The effects of emulsifying agents on disposition of lipid-soluble drugs included in fat emulsion.

    PubMed

    Suzuki, Yasuyuki; Masumitsu, Yasushi; Okudaira, Kazuho; Hayashi, Masahiro

    2004-02-01

    The uses for drug delivery systems of two soybean oil fat emulsions prepared with an emulsifying agent, phosphatidyl choline (PC) or Pluronic F-127 (PLU), were examined comparatively in vivo and in vitro. In the presence of lipoprotein lipase (LPL) in vitro, the mean particle size of the PLU emulsion changed less than that of the PC emulsion. The production of non-esterified fatty acid (NEFA) from the PLU emulsion in the presence of LPL was smaller than that from the PC emulsion. These in vitro results indicate that the PLU emulsion is more stable than the PC emulsion. Plasma NEFA concentration following intravenous administration of the emulsions decreased with time for the PC emulsion, but was kept lower and constant for the PLU emulsion, supporting the in vitro stability data. The order of plasma cyclosporine A (CsA) concentration following intravenous administration in the above two emulsions and the mixed solution of polyethylene glycol 400 (PEG) and dimethylamide (DMA) in rats was PLU emulsion>PC emulsion>PEG/DMA solution. The plasma concentration was maintained higher and tissue distribution lower for the PLU emulsion than for other formulations. The uptake of oil violet (OV) into the rat parenchymal cells from the PLU emulsion was approximately half that from the PC emulsion, but the uptake into the Kupffer cells was almost equal in both emulsions. In conclusion, these emulsifying agents can control plasma elimination and tissue distribution of lipophilic drugs included in the emulsion. The use of the emulsion formulation makes it possible to avoid side effects through the reduction of drug uptake into non-targeted tissues.

  17. Nanobiotechnology-based drug delivery in brain targeting.

    PubMed

    Dinda, Subas C; Pattnaik, Gurudutta

    2013-01-01

    Blood brain barrier (BBB) found to act as rate limiting factor in drug delivery to brain in combating the central nervous system (CNS) disorders. Such limiting physiological factors include the reticuloendothelial system and protein opsonization, which present across BBB, play major role in reducing the passage of drug. Several approaches employed to improve the drug delivery across the BBB. Nanoparticles (NP) are the solid colloidal particle ranges from 1 to 1000 nm in size utilized as career for drug delivery. At present NPs are found to play a significant advantage over the other methods of available drug delivery systems to deliver the drug across the BBB. Nanoparticles may be because of its size and functionalization characteristics able to penetrate and facilitate the drug delivery through the barrier. There are number of mechanisms and strategies found to be involved in this process, which are based on the type of nanomaterials used and its combination with therapeutic agents, such materials include liposomes, polymeric nanoparticles and non-viral vectors of nano-sizes for CNS gene therapy, etc. Nanotechnology is expected to reduce the need for invasive procedures for delivery of therapeutics to the CNS. Some devices such as implanted catheters and reservoirs however will still be needed to overcome the problems in effective drug delivery to the CNS. Nanomaterials are found to improve the safety and efficacy level of drug delivery devices in brain targeting. Nanoegineered devices are found to be delivering the drugs at cellular levels through nono-fluidic channels. Different drug delivery systems such as liposomes, microspheres, nanoparticles, nonogels and nonobiocapsules have been used to improve the bioavailability of the drug in the brain, but microchips and biodegradable polymeric nanoparticulate careers are found to be more effective therapeutically in treating brain tumor. The physiological approaches also utilized to improve the transcytosis capacity

  18. Pharmacogenetics in drug regulation: promise, potential and pitfalls

    PubMed Central

    Shah, Rashmi R

    2005-01-01

    Pharmacogenetic factors operate at pharmacokinetic as well as pharmacodynamic levels—the two components of the dose–response curve of a drug. Polymorphisms in drug metabolizing enzymes, transporters and/or pharmacological targets of drugs may profoundly influence the dose–response relationship between individuals. For some drugs, although retrospective data from case studies suggests that these polymorphisms are frequently associated with adverse drug reactions or failure of efficacy, the clinical utility of such data remains unproven. There is, therefore, an urgent need for prospective data to determine whether pre-treatment genotyping can improve therapy. Various regulatory guidelines already recommend exploration of the role of genetic factors when investigating a drug for its pharmacokinetics, pharmacodynamics, dose–response relationship and drug interaction potential. Arising from the global heterogeneity in the frequency of variant alleles, regulatory guidelines also require the sponsors to provide additional information, usually pharmacogenetic bridging data, to determine whether data from one ethnic population can be extrapolated to another. At present, sponsors explore pharmacogenetic influences in early clinical pharmacokinetic studies but rarely do they carry the findings forward when designing dose–response studies or pivotal studies. When appropriate, regulatory authorities include genotype-specific recommendations in the prescribing information. Sometimes, this may include the need to adjust a dose in some genotypes under specific circumstances. Detailed references to pharmacogenetics in prescribing information and pharmacogenetically based prescribing in routine therapeutics will require robust prospective data from well-designed studies. With greater integration of pharmacogenetics in drug development, regulatory authorities expect to receive more detailed genetic data. This is likely to complicate the drug evaluation process as well as

  19. Systematic review of factors affecting pharmaceutical expenditures.

    PubMed

    Mousnad, Mohamed Awad; Shafie, Asrul Akmal; Ibrahim, Mohamed Izham

    2014-06-01

    To systematically identify the main factors contributing to the increase in pharmaceutical expenditures. A systematic search of published studies was conducted utilising major widely used electronic databases using the search terms 'factors,' 'financing,' 'pharmaceutical,' and 'expenditures.' To be included, the studies needed to: (1) measure at least one of the following outcomes: total growth in pharmaceutical expenditures, price growth or quantity growth; (2) mention a clear method for analysing the impact of factors affecting the increases in drug expenditures; (3) be written in English. Nonprimary articles that were published only as an abstract, a review, a commentary or a letter were excluded. From a total of 2039 studies, only 25 were included in the full review. The main determinant categories that were identified in the review were factors related to price, utilisation, therapeutic choice, demand and health care system. The major cost drivers were found to be changes in drug quantities and therapies as well as new drugs. It is important for policymakers to understand pharmaceutical spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Adverse drug reactions to antiretroviral therapy (ARVs): incidence, type and risk factors in Nigeria

    PubMed Central

    2012-01-01

    Background Data on adverse drug reactions (ADRs) related to antiretroviral (ARV) use in public health practice are few indicating the need for ART safety surveillance in clinical care. Objectives To evaluate the incidence, type and risk factors associated with adverse drug reactions (ADRs) among patients on antiretroviral drugs (ARV). Methods Patients initiated on ARVs between May 2006 and May 2009 were evaluated in a retrospective cohort analysis in three health facilities in Nigeria. Regimens prescribed include nucleoside backbone of zidovudine (AZT)/lamivudine (3TC), stavudine (d4T)/3TC, or tenofovir (TDF)/3TC in combination with either nevirapine (NVP) or efavirenz (EFV). Generalized Estimating Equation (GEE) model was used to identify risk factors associated with occurrence of ADR. Results 2650 patients were followed-up for 2456 person-years and reported 114 ADRs (incidence rate = 4.6/100 person-years).There were more females 1706(64%) and 73(64%) of the ADRs were reported by women. Overall, 61(54%) of ADRs were reported by patients on AZT with 54(47%) of these occurring in patients on AZT/NVP. The commonest ADRs reported were pain 25(30%) and skinrash 10(18%). Most ADRs were grade 1(39%) with only 1% being life threatening (grade 4). Adjusted GEE analysis showed that ADR was less likely to occur in patients on longer duration of ART compared to the first six months on treatment; 6-12 months AOR 0.38(95% CI:0.16-0.91) and 12-24 months AOR 0.34(95% CI:0.16-0.73) respectively. Compared to patients on TDF, ADR was less likely to occur in patients on d4T and AZT AOR 0.18(95% CI 0.05-0.64) and AOR 0.24(95% CI:0.7-0.9) respectively. Age, gender and CD4 count were not significantly associated with ADRs. Conclusion ADRs are more likely to occur within the first six months on treatment. Close monitoring within this period is required to prevent occurrence of severe ADR and improve ART adherence. Further research on the tolerability of tenofovir in this environment is

  1. 2 CFR 182.205 - What must I include in my drug-free workplace statement?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... workplace statement? 182.205 Section 182.205 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE... drug-free workplace statement? You must publish a statement that— (a) Tells your employees that the...

  2. Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions.

    PubMed

    Michel, Laurent; Des Jarlais, Don C; Duong Thi, Huong; Khuat Thi Hai, Oanh; Pham Minh, Khuê; Peries, Marianne; Vallo, Roselyne; Nham Thi Tuyet, Thanh; Hoang Thi, Giang; Le Sao, Mai; Feelemyer, Jonathan; Vu Hai, Vinh; Moles, Jean-Pierre; Laureillard, Didier; Nagot, Nicolas

    2017-10-01

    The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Risk Factors for Acquisition of Drug Resistance during Multidrug-Resistant Tuberculosis Treatment, Arkhangelsk Oblast, Russia, 2005–2010

    PubMed Central

    Ershova, Julia; Vlasova, Natalia; Nikishova, Elena; Tarasova, Irina; Eliseev, Platon; Maryandyshev, Andrey O.; Shemyakin, Igor G.; Kurbatova, Ekaterina; Cegielski, J. Peter

    2015-01-01

    Acquired resistance to antituberculosis drugs decreases effective treatment options and the likelihood of treatment success. We identified risk factors for acquisition of drug resistance during treatment for multidrug-resistant tuberculosis (MDR TB) and evaluated the effect on treatment outcomes. Data were collected prospectively from adults from Arkhangelsk Oblast, Russia, who had pulmonary MDR TB during 2005–2008. Acquisition of resistance to capreomycin and of extensively drug-resistant TB were more likely among patients who received <3 effective drugs than among patients who received >3 effective drugs (9.4% vs. 0% and 8.6% vs. 0.8%, respectively). Poor outcomes were more likely among patients with acquired capreomycin resistance (100% vs. 25.9%), acquired ofloxacin resistance (83.6% vs. 22.7%), or acquired extensive drug resistance (100% vs. 24.4%). To prevent acquired drug resistance and poor outcomes, baseline susceptibility to first- and second-line drugs should be determined quickly, and treatment should be adjusted to contain >3 effective drugs. PMID:25988954

  4. Qualitative models of seat discomfort including static and dynamic factors.

    PubMed

    Ebe, K; Griffin, M J

    2000-06-01

    Judgements of overall seating comfort in dynamic conditions sometimes correlate better with the static characteristics of a seat than with measures of the dynamic environment. This study developed qualitative models of overall seat discomfort to include both static and dynamic seat characteristics. A dynamic factor that reflected how vibration discomfort increased as vibration magnitude increased was combined with a static seat factor which reflected seating comfort without vibration. The ability of the model to predict the relative and overall importance of dynamic and static seat characteristics on comfort was tested in two experiments. A paired comparison experiment, using four polyurethane foam cushions (50, 70, 100, 120 mm thick), provided different static and dynamic comfort when 12 subjects were exposed to one-third octave band random vertical vibration with centre frequencies of 2.5 and 5.5 Hz, at magnitudes of 0.00, 0.25 and 0.50 m x s(-2) rms measured beneath the foam samples. Subject judgements of the relative discomfort of the different conditions depended on both static and dynamic characteristics in a manner consistent with the model. The effect of static and dynamic seat factors on overall seat discomfort was investigated by magnitude estimation using three foam cushions (of different hardness) and a rigid wooden seat at six vibration magnitudes with 20 subjects. Static seat factors (i.e. cushion stiffness) affected the manner in which vibration influenced the overall discomfort: cushions with lower stiffness were more comfortable and more sensitive to changes in vibration magnitude than those with higher stiffness. The experiments confirm that judgements of overall seat discomfort can be affected by both the static and dynamic characteristics of a seat, with the effect depending on vibration magnitude: when vibration magnitude was low, discomfort was dominated by static seat factors; as the vibration magnitude increased, discomfort became dominated

  5. Prevalence and associated factors of illicit drug use among university students in the association of southeast Asian nations (ASEAN).

    PubMed

    Yi, Siyan; Peltzer, Karl; Pengpid, Supa; Susilowati, Indri Hapsari

    2017-04-06

    Illicit drug use among university students has been recognized as a global public health issue in recent years. It may lead to poor academic performance that in turn leads to poor productivity in their later life. This study explores prevalence of and factors associated with illicit drug use among university students in the Association of Southeast Asian Nations (ASEAN). This multi-country cross-sectional study was conducted in 2015 in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. A multi-stage cluster sampling was used to select undergraduate students from one or two universities in each country for self-administered questionnaire survey. Multivariate logistic regression analyses was performed to explore risk factors related to illicit drug use. Participants included 7,923 students with a mean age of 20.6 years (SD = 2.8), ranging from 18-30 years. The overall prevalence of frequent (≥10 times), infrequent (1-9 times) and ever (at least once) illicit drug use in the past 12 months was 2.2, 14.7, and 16.9%, respectively. After adjustment, male students were significantly less likely to be infrequent (1-9 times vs. never), but significantly more likely to be ever users compared to females. Compared to those living with parents/guardians, students living away from parents/guardians were significantly less likely to be frequent (≥10 times vs. never) and infrequent users. Students from lower-middle-income countries were significantly more likely to be frequent and infrequent users, but significantly less likely to be ever users compared to those from upper-middle or high-income countries. Students with poor subjective health status were significantly more likely to be frequent users compared to those who reported good subjective health status. Students who reported binge drinking in the past month were significantly more likely to be infrequent users, but significantly less likely to be ever users. Our

  6. Population-based differences in treatment outcome following anticancer drug therapies.

    PubMed

    Ma, Brigette By; Hui, Edwin P; Mok, Tony Sk

    2010-01-01

    Population-based differences in toxicity and clinical outcome following treatment with anticancer drugs have an important effect on oncology practice and drug development. These differences arise from complex interactions between biological and environmental factors, which include genetic diversity affecting drug metabolism and the expression of drug targets, variations in tumour biology and host physiology, socioeconomic disparities, and regional preferences in treatment standards. Some well-known examples include the high prevalence of activating epidermal growth factor receptor (EGFR) mutations in pulmonary adenocarcinoma among northeast (China, Japan, Korea) and parts of southeast Asia (excluding India) non-smokers, which predict sensitivity to EGFR kinase inhibitors, and the sharp contrast between Japan and the west in the management and survival outcome of gastric cancer. This review is a critical overview of population-based differences in the four most prevalent cancers in the world: lung, breast, colorectal, and stomach cancer. Particular attention is given to the clinical relevance of such knowledge in terms of the individualisation of drug therapy and in the design of clinical trials. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  7. Identifying Some Factors That Might Predispose Drug Abuse among Learners in a South African Township School

    ERIC Educational Resources Information Center

    Grobler, R.; Khatite, M.

    2012-01-01

    This study inquires into some of the factors that might predispose the use and abuse of drugs among secondary school learners in a township school. The objective of this research is to identify these factors and to offer a few suggestions on how the abuse may be prevented. A quantitative research strategy is used and a document analysis technique…

  8. Clinical implications of drug abuse epidemiology.

    PubMed

    Schulden, Jeffrey D; Lopez, Marsha F; Compton, Wilson M

    2012-06-01

    Research on the epidemiology of illicit drug use disorders provides continued critical insights into the distribution and determinants of drug use and drug use disorders in the United States. This research serves as a foundation for understanding the etiology of these disorders, helping to disentangle the complex interrelationship of developmental, genetic, and environmental risk and protective factors. Building on an understanding of this research in substance abuse epidemiology, it is important for clinicians to understand the unique trends in drug use in the overall communities that they serve and the unique risk factors for given individuals. The generally high prevalence of substance use disorders, along with their high comorbidity with other psychiatric disorders and with the HIV epidemic, make prevention, evaluation, and referral for treatment for drug abuse an important part of routine clinical practice in a range of clinical settings, including primary care, psychiatric, and emergency department settings. Ongoing efforts to ensure insurance coverage parity for the treatment of mental health and substance use disorders offer the promise of continued improvements in the integration and availability of such services in the broader US health care system.

  9. Willingness to use drug checking within future supervised injection services among people who inject drugs in a mid-sized Canadian city.

    PubMed

    Kennedy, Mary Clare; Scheim, Ayden; Rachlis, Beth; Mitra, Sanjana; Bardwell, Geoff; Rourke, Sean; Kerr, Thomas

    2018-04-01

    Esclating epidemics of fatal overdose are affecting communities across Canada. In many instances, the unanticipated presence of powerful opioids, such as fentanyl, in street drugs is a contributing factor. Drug checking offered within supervised injection services (SIS) is being considered as a potential measure for reducing overdose and related harms. We therefore sought to characterize the willingness of people who inject drugs (PWID) to use drug checking within SIS. Data were derived from a cross-sectional survey examining the feasibility of SIS in London, Canada, a mid-sized city. Multivariable logistic regression was used to examine factors associated with willingness to frequently (always or usually) use drug checking at SIS. Between March and April 2016, 180 PWID were included in the present study, including 68 (38%) women. In total, 78 (43%) reported that they would frequently check their drugs at SIS if this service were available. In multivariable analyses, female gender (Adjusted Odds Ratio [AOR] = 2.31; 95% confidence interval [CI]: (1.20-4.46), homelessness (AOR = 2.36; 95% CI: 1.14-4.86), and drug dealing (AOR = 2.16; 95% CI: 1.07-4.33) were positively associated with willingness to frequently check drugs at SIS. These findings highlight the potential of drug checking as a complement to other services offered within SIS, particularly given that subpopulations of PWID at heightened risk of overdose were more likely to report willingness to frequently use this service. However, further research is needed to determine the possible health impacts of offering drug checking at SIS. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment.

    PubMed

    Schneider, Katharina Luise; Kastenmüller, Kathrin; Weckbecker, Klaus; Bleckwenn, Markus; Böhme, Miriam; Stingl, Julia Carolin

    2018-06-01

    Drug-drug interactions (DDIs) are an important risk factor for adverse drug reactions. Older, polymedicated patients are particularly affected. Although antithrombotics have been detected as high-risk drugs for DDIs, data on older patients exposed to them are scarce. Baseline data of 365 IDrug study outpatients (≥ 60 years, use of an antithrombotic and one or more additional long-term drug) were analyzed regarding potential drug-drug interactions (pDDIs) with a clinical decision support system. Data included prescription and self-medication drugs. The prevalence of having one or more pDDI was 85.2%. The median number of alerts per patient was three (range 0-17). For 58.4% of the patients, potential severe/contraindicated interactions were detected. Antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) showed the highest number of average pDDI alert involvements per use (2.9 and 2.2, respectively). For NSAIDs, also the highest average number of severe/contraindicated alert involvements per use (1.2) was observed. 91.8% of all pDDI involvements concerned the 25 most frequently used drug classes. 97.5% of the severe/contraindicated pDDIs were attributed to only nine different potential clinical manifestations. The most common management recommendation for severe/contraindicated pDDIs was to intensify monitoring. Number of drugs was the only detected factor significantly associated with increased number of pDDIs (p < 0.001). The findings indicate a high risk for pDDIs in older, polymedicated patients on antithrombotics. As a consequence of patients' frequently similar drug regimens, the variety of potential clinical manifestations was small. Awareness of these pDDI symptoms and the triggering drugs as well as patients' self-medication use may contribute to increased patient safety.

  11. [Parents and teachers perception of the risky factors for legal or illegal drugs consumption among students].

    PubMed

    Sánchez, Fátima Morán; Ferriani, Maria das Graças Carvalho

    2004-01-01

    This work had the opportunity to know and analyze the parents and teachers' perception about the risky factors that influence in scholars for the legal and illegal consumption of drugs. The methodology focused is the qualitative one, of the descriptive explanatory type with the modality of case study. The sample consisted on 8 parents and 8 teachers from the 5th, 6th and 7th basic grades of the Fiscal Primary School, "Carmen Navarro Wither" from Guayaquil, Ecuador. To obtain the data, it was used the "focused group technique" and the observation participation. Also, the thematic containing analysis was done. During the develop of the focused group, it was showed by the parents and teachers a lot of interest and preoccupation about the topic and they perceived it as risky factors the following: The economic situation that commonly force the parents' emigration, the influence of the surroundings and the ignorance of parents and teachers about the drugs topic. Besides, they really would like to know and learn more the drugs' consumption prevention to raise, in this way, the children's rejection about it.

  12. Drug–Target Kinetics in Drug Discovery

    PubMed Central

    2017-01-01

    The development of therapies for the treatment of neurological cancer faces a number of major challenges including the synthesis of small molecule agents that can penetrate the blood-brain barrier (BBB). Given the likelihood that in many cases drug exposure will be lower in the CNS than in systemic circulation, it follows that strategies should be employed that can sustain target engagement at low drug concentration. Time dependent target occupancy is a function of both the drug and target concentration as well as the thermodynamic and kinetic parameters that describe the binding reaction coordinate, and sustained target occupancy can be achieved through structural modifications that increase target (re)binding and/or that decrease the rate of drug dissociation. The discovery and deployment of compounds with optimized kinetic effects requires information on the structure–kinetic relationships that modulate the kinetics of binding, and the molecular factors that control the translation of drug–target kinetics to time-dependent drug activity in the disease state. This Review first introduces the potential benefits of drug-target kinetics, such as the ability to delineate both thermodynamic and kinetic selectivity, and then describes factors, such as target vulnerability, that impact the utility of kinetic selectivity. The Review concludes with a description of a mechanistic PK/PD model that integrates drug–target kinetics into predictions of drug activity. PMID:28640596

  13. Animal husbandry practices in rural Bangladesh: potential risk factors for antimicrobial drug resistance and emerging diseases.

    PubMed

    Roess, Amira A; Winch, Peter J; Ali, Nabeel A; Akhter, Afsana; Afroz, Dilara; El Arifeen, Shams; Darmstadt, Gary L; Baqui, Abdullah H

    2013-11-01

    Antimicrobial drug administration to household livestock may put humans and animals at risk for acquisition of antimicrobial drug-resistant pathogens. To describe animal husbandry practices, including animal healthcare-seeking and antimicrobial drug use in rural Bangladesh, we conducted semi-structured in-depth interviews with key informants, including female household members (n = 79), village doctors (n = 10), and pharmaceutical representatives, veterinarians, and government officials (n = 27), and performed observations at animal health clinics (n = 3). Prevalent animal husbandry practices that may put persons at risk for acquisition of pathogens included shared housing and water for animals and humans, antimicrobial drug use for humans and animals, and crowding. Household members reported seeking human and animal healthcare from unlicensed village doctors rather than formal-sector healthcare providers and cited cost and convenience as reasons. Five times more per household was spent on animal than on human healthcare. Strengthening animal and human disease surveillance systems should be continued. Interventions are recommended to provide vulnerable populations with a means of protecting their livelihood and health.

  14. Prevalence of HCV infection and associated factors among illicit drug users in Breves, State of Pará, northern Brazil.

    PubMed

    Pacheco, Suzy Danielly Barbosa; Silva-Oliveira, Gláucia Caroline; Maradei-Pereira, Luciana Maria Cunha; Crescente, José Ângelo Barletta; Lemos, José Alexandre Rodrigues de; Oliveira-Filho, Aldemir Branco de

    2014-01-01

    Illicit drug users (DUs) are vulnerable to hepatitis C virus (HCV) infection. The shared use of illicit drugs is the main method of HCV transmission. A cross-sectional study was conducted in Breves, in northern Brazil. We surveyed 187 DUs to determine the prevalence of and factors associated with HCV infection. The prevalence of anti-HCV antibodies was 36.9%, and the prevalence of hepatitis C virus-ribonucleic acid (HCV-RNA) was 31%. Hepatitis C virus infection was associated with tattoos, intravenous drug use, shared use of equipment for drug use, drug use for longer than 3 years, and daily drug use. Strategies for preventing and controlling HCV transmission should be implemented among DUs.

  15. Working conditions and psychotropic drug use: cross-sectional and prospective results from the French national SIP study.

    PubMed

    Lassalle, Marion; Chastang, Jean-François; Niedhammer, Isabelle

    2015-04-01

    Prospective studies exploring the associations between a large range of occupational factors and psychotropic drug use among national samples of workers are seldom. This study investigates the cross-sectional and prospective associations between occupational factors, including a large set of psychosocial work factors, and psychotropic drug use in the national French working population. The study sample comprised 7542 workers for the cross-sectional analysis and 4213 workers followed up for a 4-year period for the prospective analysis. Psychotropic drug use was measured within the last 12 months and defined by the use of antidepressants, anxiolytics or hypnotics. Three groups of occupational factors were explored: classical and emergent psychosocial work factors, working time/hours and physical work exposures. Weighted Poisson regression analyses were performed to adjust for covariates. In the cross-sectional analysis, psychological demands, low social support and hiding emotions were associated with psychotropic drug use. Job insecurity for men and night work for women were associated with psychotropic drug use. In the prospective analysis, hiding emotions and physical exposure were predictive of psychotropic drug use. Dose-response associations were observed for the frequency/intensity of exposure and repeated exposure to occupational factors. This study underlines the role of psychosocial work factors, including emergent factors, in psychotropic drug use. Prevention policies oriented toward psychosocial work factors comprehensively may be useful to reduce this use. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Efficacy of gene-therapy based on adenovirus encoding granulocyte-macrophage colony-stimulating factor in drug-sensitive and drug-resistant experimental pulmonary tuberculosis.

    PubMed

    Francisco-Cruz, Alejandro; Mata-Espinosa, Dulce; Ramos-Espinosa, Octavio; Marquina-Castillo, Brenda; Estrada-Parra, Sergio; Xing, Zhou; Hernández-Pando, Rogelio

    2016-09-01

    Tuberculosis (TB), although a curable disease, remains a major cause of morbidity and mortality worldwide. It is necessary to develop a short-term therapy with reduced drug toxicity in order to improve adherence rate and control disease burden. Granulocyte-macrophage colony-stimulating factor (GM-CSF) may be a key cytokine in the treatment of pulmonary TB since it primes the activation and differentiation of myeloid and non-myeloid precursor cells, inducing the release of protective Th1 cytokines. In this work, we administrated by intratracheal route recombinant adenoviruses encoding GM-CSF (AdGM-CSF). This treatment produced significant bacterial elimination when administered in a single dose at 60 days of infection with drug sensitive or drug resistant Mtb strains in a murine model of progressive disease. Moreover, AdGM-CSF combined with primary antibiotics produced more rapid elimination of pulmonary bacterial burdens than conventional chemotherapy suggesting that this form of treatment could shorten the conventional treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Robust Programming Problems Based on the Mean-Variance Model Including Uncertainty Factors

    NASA Astrophysics Data System (ADS)

    Hasuike, Takashi; Ishii, Hiroaki

    2009-01-01

    This paper considers robust programming problems based on the mean-variance model including uncertainty sets and fuzzy factors. Since these problems are not well-defined problems due to fuzzy factors, it is hard to solve them directly. Therefore, introducing chance constraints, fuzzy goals and possibility measures, the proposed models are transformed into the deterministic equivalent problems. Furthermore, in order to solve these equivalent problems efficiently, the solution method is constructed introducing the mean-absolute deviation and doing the equivalent transformations.

  18. Drug use among men with unfulfilled wish to father children: a retrospective analysis and discussion of specific drug classes.

    PubMed

    Pompe, Sina V; Strobach, Dorothea; Stief, Christian G; Becker, Armin J; Trottmann, Matthias

    2016-06-01

    Male infertility is a multifactorial state. Among other risk factors, drugs can adversely affect male fertility and male sexual function. In a retrospective study we aimed to analyse how many involuntarily childless men seeking fertility evaluation consume drugs, which drugs and if these are potentially affecting male reproductive function. We retrospectively identified involuntarily childless men presenting for fertility evaluation at an andrologic outpatient department from 2011 to 2014. Medical records were searched for current drug use, age, diseases affecting male fertility, and number and kind of drugs. Drugs were classified according to their Anatomical Therapeutic Chemical code. Adverse drug reactions on male sexual function and fertility were searched in two independent literature sources. Drug use was documented for 244 of 522 patients (46.7%). The patients' mean age was 37.7 ± 8.7; the total number of drug intakes was 554 (mean 2.3 ± 1.9), corresponding to 201 different drugs. The most often involved Anatomical Therapeutic Chemical groups were nervous system (N), alimentary tract/metabolism (A), cardiovascular (C), and respiratory system (R) (n = 277; 50.0%). Fertility impairment was reported for 15.9%, and adverse drug reactions on male sexual function were found for 51.2% of all identified drugs. Underreporting of consumed drugs was likely, especially for non-prescription drugs. A high percentage of involuntarily childless men is taking drugs that can potentially influence male reproductive function. As drug intake represents a modifiable risk factor, fertility evaluation requires a comprehensive medication review including prescription and non-prescription drugs. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Despite 2007 law requiring FDA hotline to be included in print drug ads, reporting of adverse events by consumers still low.

    PubMed

    Du, Dongyi; Goldsmith, John; Aikin, Kathryn J; Encinosa, William E; Nardinelli, Clark

    2012-05-01

    In 2007 the federal government began requiring drug makers to include in their print direct-to-consumer advertisements information for consumers on how to contact the Food and Drug Administration directly, either by phone or through the agency's website, to report any adverse events that they experienced after taking a prescription drug. Adverse events can range from minor skin problems like itching to serious injuries or illness that result in hospitalization, permanent disability, or even death. Even so, current rates of adverse event reporting are low. We studied adverse event reports about 123 drugs that came from patients before and after the enactment of the print advertising requirement and estimated that requirement's impact with model simulations. We found that if monthly spending on print direct-to-consumer advertising increased from zero to $7.7 million per drug, the presence of the Food and Drug Administration contact information tripled the increase in patient-reported adverse events, compared to what would have happened in the absence of the law. However, the absolute monthly increase was fewer than 0.24 reports per drug, suggesting that the public health impact of the increase was small and that the adverse event reporting rate would still be low. The study results suggest that additional measures, such as more publicity about the Adverse Event Reporting System or more consumer education, should be considered to promote patient reporting of adverse events.

  20. Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis.

    PubMed

    Savitr Sastri, B V; Arivazhagan, A; Sinha, Sanjib; Mahadevan, Anita; Bharath, R D; Saini, J; Jamuna, R; Kumar, J Keshav; Rao, S L; Chandramouli, B A; Shankar, S K; Satishchandra, P

    2014-05-15

    Mesial temporal sclerosis (MTS) is the most common cause of drug resistant epilepsy amenable for surgical treatment and seizure control. This study analyzed the outcome of patients with MTS following anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH) over 10 years and correlated the electrophysiological and radiological factors with the post operative seizure outcome. Eighty seven patients were included in the study. Sixty seven (77.2%) patients had an Engel Class 1 outcome, 9 (11.4%) had Class 2 outcome. Engel's class 1 outcome was achieved in 89.9% at 1 year, while it reduced slightly to 81.9% at 2 years and 76.2% at 5 year follow up. Seventy seven (88.5%) patients had evidence of hippocampal sclerosis on histopathology. Dual pathology was observed in 19 of 77 specimens with hippocampal sclerosis, but did not influence the outcome. Factors associated with an unfavorable outcome included male gender (p=0.04), and a higher frequency of pre-operative seizures (p=0.005), whereas the presence of febrile seizures (p=0.048) and loss of hippocampal neurons in CA4 region on histopathology (p=0.040) were associated with favorable outcome. The effect of CA4 loss on outcome is probably influenced by neuronal loss in other subfields as well since isolated CA4 loss was rare. Abnormal post operative EEG at the end of 1 week was found to be a significant factor predicting unfavorable outcome (p=0.005). On multivariate analysis, the pre-operative seizure frequency was the only significant factor affecting outcome. The present study observed excellent seizure free outcome in a carefully selected cohort of patients with MTS with refractory epilepsy. The presence of dual pathology did not influence the outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. The enemy within: Targeting host-parasite interaction for antileishmanial drug discovery.

    PubMed

    Lamotte, Suzanne; Späth, Gerald F; Rachidi, Najma; Prina, Eric

    2017-06-01

    The state of antileishmanial chemotherapy is strongly compromised by the emergence of drug-resistant Leishmania. The evolution of drug-resistant phenotypes has been linked to the parasites' intrinsic genome instability, with frequent gene and chromosome amplifications causing fitness gains that are directly selected by environmental factors, including the presence of antileishmanial drugs. Thus, even though the unique eukaryotic biology of Leishmania and its dependence on parasite-specific virulence factors provide valid opportunities for chemotherapeutical intervention, all strategies that target the parasite in a direct fashion are likely prone to select for resistance. Here, we review the current state of antileishmanial chemotherapy and discuss the limitations of ongoing drug discovery efforts. We finally propose new strategies that target Leishmania viability indirectly via mechanisms of host-parasite interaction, including parasite-released ectokinases and host epigenetic regulation, which modulate host cell signaling and transcriptional regulation, respectively, to establish permissive conditions for intracellular Leishmania survival.

  2. The effect of victimization, mental health, and protective factors on crime and illicit drug use among homeless young adults.

    PubMed

    Tyler, Kimberly A; Kort-Butler, Lisa A; Swendener, Alexis

    2014-01-01

    Although research has found high rates of child maltreatment, widespread victimization, and other negative outcomes among homeless youth and young adults, resiliency among this population has largely been understudied. Specifically, a gap remains in terms of how protective factors such as self-efficacy, low deviant beliefs, and religiosity operate among homeless youth and young adults. The purpose of this study is to examine the relationship between various forms of victimization, mental health, and protective factors with property and violent crime and illicit drug use among homeless young adults. Results from regression analyses indicate that running away from home more frequently, experiencing more physical victimization on the street, higher levels of self-efficacy, and more deviant beliefs were associated with greater property crime. Significant correlates of violent crime included being male, running away from home more frequently, greater sexual and physical victimization on the street, higher levels of self-efficacy, and more deviant beliefs. Finally, being male, running away more frequently from home, greater child physical abuse and partner victimization, and more deviant beliefs were all associated with greater illicit drug use. Self-efficacy was positively related to both property and violent crime, suggesting that it may not operate for homeless young adults in the same manner as it does for normative populations.

  3. Illicit drug use and adverse birth outcomes: is it drugs or context?

    PubMed

    Schempf, Ashley H; Strobino, Donna M

    2008-11-01

    Prenatal drug use is commonly associated with adverse birth outcomes, yet no studies have controlled for a comprehensive set of associated social, psychosocial, behavioral, and biomedical risk factors. We examined the degree to which adverse birth outcomes associated with drug use are due to the drugs versus surrounding factors. Data are from a clinical sample of low-income women who delivered at Johns Hopkins Hospital between 1995 and 1996 (n = 808). Use of marijuana, cocaine, and opiates was determined by self-report, medical record, and urine toxicology screens at delivery. Information on various social, psychosocial, behavioral, and biomedical risk factors was gathered from a postpartum interview or the medical record. Multivariable regression models of birth outcomes (continuous birth weight and low birth weight ([LBW] < 2,500 g)) were used to assess the effect of drug use independent of associated factors. In unadjusted results, all types of drug use were related to birth weight decrements and increased odds of LBW. However, only the effect of cocaine on continuous birth weight remained significant after adjusting for all associated factors (-142 g, p = 0.05). No drug was significantly related to LBW in fully adjusted models. About 70% of the unadjusted effect of cocaine use on continuous birth weight was explained by surrounding psychosocial and behavioral factors, particularly smoking and stress. Most of the unadjusted effects of opiate use were explained by smoking and lack of early prenatal care. Thus, prevention efforts that aim to improve newborn health must also address the surrounding context in which drug use frequently occurs.

  4. Investigating the Effects of Loading Factors on the In Vitro Pharmaceutical Performance of Mesoporous Materials as Drug Carriers for Ibuprofen

    PubMed Central

    Lai, Junmin; Lin, Wu; Scholes, Peter; Li, Mingzhong

    2017-01-01

    The aim of the study was to investigate the effects of the loading factors, i.e., the initial drug loading concentration and the ratio of the drug to carriers, on the in vitro pharmaceutical performance of drug-loaded mesoporous systems. Ibuprofen (IBU) was used as a model drug, and two non-ordered mesoporous materials of commercial silica Syloid® 244FP (S244FP) and Neusilin® US2 (NS2) were selected in the study. The IBU-loaded mesoporous samples were prepared by a solvent immersion method with a rotary evaporation drying technique and characterized by polarized light microscopy (PLM), Fourier transform infrared (FTIR) spectroscopy, X-ray powder diffraction (XRPD) and differential scanning calorimetry (DSC). Dissolution experiments were performed in simulated gastric media at 37 °C under non-sink conditions. The concentration of IBU in solution was determined by HPLC. The study showed that the dissolution rate of IBU can be improved significantly using the mesoporous S224FP carriers due to the conversion of crystalline IBU into the amorphous form. Both of the loading factors affected the IBU dissolution kinetics. Due to the molecular interaction between the IBU and NS2 carriers, the loading factors had little effects on the drug release kinetics with incomplete drug desorption recovery and insignificant dissolution enhancement. Care and extensive evaluation must therefore be taken when mesoporous materials are chosen as carrier delivery systems. PMID:28772509

  5. A survey on the factors influencing the pattern of medicine's use: Concerns on irrational use of drugs.

    PubMed

    Soleymani, Fatemeh; Ahmadizar, Fariba; Meysamie, Alipasha; Abdollahi, Mohammad

    2013-04-01

    Pharmacists have a remarkable role in rational use of drugs by dissemination of drug information to guide patients, physicians, and policy makers. The present study was undertaken to evaluate the pharmacists' view point about the main factors affecting current drug use pattern regarding rational drug use and the most effective strategies for improving and promoting rational drug use among pharmacists. In a cross-sectional survey, pre-designed questionnaires were filled in convenient sampling by pharmacists who had attended the congress of rational drug use in Tehran, Iran. A total of 144 pharmacists with the average age of 40.78 years old were enrolled to the study. Data indicated that the most priorities in irrational use of drugs from pharmacists' view point were lack of appropriate cooperation and communication between physicians and pharmacists (39%), pharmacists' low tariff and economic issues (34%), lack of public knowledge about drug usage (45%), and lack of supervisory regulations on pharmacy practice (15.8%). In this study, lack of public knowledge and awareness about appropriate use of medicines was the most important element from pharmacists' viewpoint in occurrence of irrational drug use. Dissemination of information and compiling of diverse strategies in education, management, regulation, and finance can be very efficient due to a strong relationship between drug policies and performance of regulations and supervisions as well as drug services.

  6. Mechanical microencapsulation: The best technique in taste masking for the manufacturing scale - Effect of polymer encapsulation on drug targeting.

    PubMed

    Al-Kasmi, Basheer; Alsirawan, Mhd Bashir; Bashimam, Mais; El-Zein, Hind

    2017-08-28

    Drug taste masking is a crucial process for the preparation of pediatric and geriatric formulations as well as fast dissolving tablets. Taste masking techniques aim to prevent drug release in saliva and at the same time to obtain the desired release profile in gastrointestinal tract. Several taste masking methods are reported, however this review has focused on a group of promising methods; complexation, encapsulation, and hot melting. The effects of each method on the physicochemical properties of the drug are described in details. Furthermore, a scoring system was established to evaluate each process using recent published data of selected factors. These include, input, process, and output factors that are related to each taste masking method. Input factors include the attributes of the materials used for taste masking. Process factors include equipment type and process parameters. Finally, output factors, include taste masking quality and yield. As a result, Mechanical microencapsulation obtained the highest score (5/8) along with complexation with cyclodextrin suggesting that these methods are the most preferable for drug taste masking. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Illicit and pharmaceutical drug consumption estimated via wastewater analysis. Part A: chemical analysis and drug use estimates.

    PubMed

    Baker, David R; Barron, Leon; Kasprzyk-Hordern, Barbara

    2014-07-15

    This paper presents, for the first time, community-wide estimation of drug and pharmaceuticals consumption in England using wastewater analysis and a large number of compounds. Among groups of compounds studied were: stimulants, hallucinogens and their metabolites, opioids, morphine derivatives, benzodiazepines, antidepressants and others. Obtained results showed the usefulness of wastewater analysis in order to provide estimates of local community drug consumption. It is noticeable that where target compounds could be compared to NHS prescription statistics, good comparisons were apparent between the two sets of data. These compounds include oxycodone, dihydrocodeine, methadone, tramadol, temazepam and diazepam. Whereas, discrepancies were observed for propoxyphene, codeine, dosulepin and venlafaxine (over-estimations in each case except codeine). Potential reasons for discrepancies include: sales of drugs sold without prescription and not included within NHS data, abuse of a drug with the compound trafficked through illegal sources, different consumption patterns in different areas, direct disposal leading to over estimations when using parent compound as the drug target residue and excretion factors not being representative of the local community. It is noticeable that using a metabolite (and not a parent drug) as a biomarker leads to higher certainty of obtained estimates. With regard to illicit drugs, consistent and logical results were reported. Monitoring of these compounds over a one week period highlighted the expected recreational use of many of these drugs (e.g. cocaine and MDMA) and the more consistent use of others (e.g. methadone). Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Patterns of, and Factors Associated With, Illicit Pharmaceutical Opioid Analgesic Use in a Prospective Cohort of People Who Inject Drugs in Melbourne, Australia.

    PubMed

    Horyniak, Danielle; Agius, Paul A; Degenhardt, Louisa; Reddel, Siobhan; Higgs, Peter; Aitken, Campbell; Stoové, Mark; Dietze, Paul

    2015-01-01

    People who inject drugs (PWID) are a key population engaging in pharmaceutical opioid analgesic (PO) use, yet little is known about patterns of illicit PO use among this group. The aims of this research were to measure the prevalence and frequency of lifetime and past-month illicit PO use and injection in a sample of regular PWID, to examine patterns of past-month illicit PO use within individuals over time, and to identify factors independently associated with past-month illicit PO use. Data were drawn from a prospective cohort study of regular PWID (N = 666) in Melbourne, Australia. Data from five waves of annual data collection (including baseline) were analyzed descriptively and using generalized estimating equations (GEE). At baseline, 59% of participants reported lifetime illicit PO use and 20% reported past-month use, predominantly through injecting. Most illicit PO users at baseline transitioned to nonuse of illicit POs across the study period. In multivariable GEE analysis, factors associated with past-month illicit PO use included past-year arrest [adjusted odds ratio (AOR): 1.39], opioids other than heroin as drug of choice (AOR: 5.14), experiencing poorer physical health (AOR: 0.98) and a range of other drug use variables. We found little evidence of ongoing illicit PO use among those followed up, with illicit PO use linked to polydrug use more broadly. Nonetheless, trends in illicit PO use among PWID should continue to be monitored and harm reduction interventions implemented to reduce the associated public health risks.

  9. The Mediating and Moderating Effects of Parent and Peer Influences upon Drug Use among African American Adolescents

    ERIC Educational Resources Information Center

    Clark, Trenette T.; Belgrave, Faye Z.; Abell, Melissa

    2012-01-01

    This study recruited 567 African American youth (mean age = 15.27 years; 65.1% girls) to examine the role of parent and peer contexts on drug use among African American adolescents. Data were collected on demographics, drug refusal efficacy, drug use, and various psychosocial factors including family and peer factors. When controlling for age and…

  10. A review of drug delivery systems for capsule endoscopy.

    PubMed

    Munoz, Fredy; Alici, Gursel; Li, Weihua

    2014-05-01

    The development of a highly controllable drug delivery system (DDS) for capsule endoscopy has become an important field of research due to its promising applications in therapeutic treatment of diseases in the gastrointestinal (GI) tract and drug absorption studies. Several factors need to be considered to establish the minimum requirements for a functional DDS. Environmental factors of the GI tract and also pharmaceutical factors can help determine the requirements to be met by a DDS in an endoscopic capsule. In order to minimize the influence of such factors on the performance of an effective DDS, at least two mechanisms should be incorporated into a capsule endoscope: an anchoring mechanism to control the capsule position and a drug release mechanism to control variables such as the drug release rate, number of doses and amount of drug released. The implementation of such remotely actuated mechanisms is challenging due to several constraints, including the limited space available in a swallowable capsule endoscope and the delicate and complex environment within the GI tract. This paper presents a comprehensive overview of existing DDS. A comparison of such DDS for capsule endoscopy based on the minimum DDS requirements is presented and future work is also discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Drug Dependence Treatment Awareness among Japanese Female Stimulant Drug Offenders

    PubMed Central

    Yatsugi, Shinzo; Fujita, Koji; Kashima, Saori; Eboshida, Akira

    2016-01-01

    Few stimulant drug users receive adequate treatment. This cross-sectional study describes the characteristics of female drug offenders that use stimulants and clarifies the factors related to the awareness of treatment for drug dependencies. We included 80 females imprisoned due to stimulant control law violations from 2012 to 2015. The characteristics of the female prisoners were stratified according to various treatment awareness levels, and associations between each characteristic and treatment awareness were evaluated using logistic regression models. The average period of stimulant drug use was 17.7 years. Participants imprisoned for the second time were significantly more likely to consider treatment compared to those imprisoned only once: odds ratio (OR) = 3.2 (95% confidence interval (CI): 1.0–10.7). This elevated OR was diluted in repeat offenders. Participants who had experienced multiple aftereffects (≥7) or serious depressive symptoms were also more likely to consider treatment: OR = 6.1 (95% CI: 1.8–20.8) and OR = 2.5 (95% CI: 1.0–6.2), respectively. Second-time stimulant offenders or offenders who had experienced health problems were more likely to consider it important to receive drug dependence treatment. To overcome relapses of stimulant use, it is recommended that stimulant use offenders are encouraged to accept adequate treatment. PMID:27845738

  12. Extending the DIDEO ontology to include entities from the natural product drug interaction domain of discourse.

    PubMed

    Judkins, John; Tay-Sontheimer, Jessica; Boyce, Richard D; Brochhausen, Mathias

    2018-05-09

    Prompted by the frequency of concomitant use of prescription drugs with natural products, and the lack of knowledge regarding the impact of pharmacokinetic-based natural product-drug interactions (PK-NPDIs), the United States National Center for Complementary and Integrative Health has established a center of excellence for PK-NPDI. The Center is creating a public database to help researchers (primarly pharmacologists and medicinal chemists) to share and access data, results, and methods from PK-NPDI studies. In order to represent the semantics of the data and foster interoperability, we are extending the Drug-Drug Interaction and Evidence Ontology (DIDEO) to include definitions for terms used by the data repository. This is feasible due to a number of similarities between pharmacokinetic drug-drug interactions and PK-NPDIs. To achieve this, we set up an iterative domain analysis in the following steps. In Step 1 PK-NPDI domain experts produce a list of terms and definitions based on data from PK-NPDI studies, in Step 2 an ontology expert creates ontologically appropriate classes and definitions from the list along with class axioms, in Step 3 there is an iterative editing process during which the domain experts and the ontology experts review, assess, and amend class labels and definitions and in Step 4 the ontology expert implements the new classes in the DIDEO development branch. This workflow often results in different labels and definitions for the new classes in DIDEO than the domain experts initially provided; the latter are preserved in DIDEO as separate annotations. Step 1 resulted in a list of 344 terms. During Step 2 we found that 9 of these terms already existed in DIDEO, and 6 existed in other OBO Foundry ontologies. These 6 were imported into DIDEO; additional terms from multiple OBO Foundry ontologies were also imported, either to serve as superclasses for new terms in the initial list or to build axioms for these terms. At the time of writing, 7

  13. Increased prescribing of Valium, Librium, and other drugs--an example of the influence of economic and social factors on the practice of medicine.

    PubMed

    Waldron, I

    1977-01-01

    Drug prescriptions per capita in the United States have more than doubled since 1950 without a commensurate improvement in health. Drugs are often prescribed for clinical conditions in which therapeutic benefits do not outweigh the risk of adverse drug reactions. Deaths due to adverse drug reactions are roughly as frequent as deaths due to automobile accidents. Valium and Librium are the first and fourth most commonly prescribed drugs in the U.S., used by one ten adults each year. The rapid rise in use of these drugs has occurred during a period of rising social stress, as indicated by increases in alcohol consumption, suicide, and homicide, Valium and Librium are frequently prescribe for patients who go to doctors with social or other nonmedical problems, often in lieu of attempts to resolve these underlying problems. Overprescribing occurs because the decision to prescribe is influenced not only by consideration of therapeutic benefit, but also by nonmedical factors, for example the widespread expectation by both patient and doctor that the doctor will provide a drug or some other technological treatment. Prescribing decisions are also influenced by the profit-motivated activities of drug companies, including the expenditure of almost one-quarter of every sales dollar on drug promotion. The most widely used source of drug information for doctors is the industry-sponsored Physicians' Desk Reference, which overrates the therapeutic value of Valium and Librium as compared to disinterested medical sources. Drug companies also contribute to overprescribing by introducing numerous minor variants of existing drugs. The therapeutic benefits of such new drugs are often overestimated in the early years of use when adverse side effects are not well known and apparent efficacy is enhanced by placebo effects in uncontrolled observations.

  14. Recreational drug use and related social factors among HIV-positive men in Japan.

    PubMed

    Togari, Taisuke; Inoue, Yoji; Takaku, Yosuke; Abe, Sakurako; Hosokawa, Rikuya; Itagaki, Takashi; Yoshizawa, Shigeyuki; Oki, Sachiko; Katakura, Naoko; Yamauchi, Asae; Wakabayashi, Chihiro; Yajima, Takashi

    2016-07-01

    This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.

  15. Freeze-drying of nanosuspensions, part 3: investigation of factors compromising storage stability of highly concentrated drug nanosuspensions.

    PubMed

    Beirowski, Jakob; Inghelbrecht, Sabine; Arien, Albertina; Gieseler, Henning

    2012-01-01

    On the basis of a previously developed formulation and process guideline for lyophilized, highly concentrated drug nanosuspensions for parenteral use, it was the purpose of this study to demonstrate that the original nanoparticle size distribution can be preserved over a minimum period of 3 months, even if aggressive primary drying conditions are used. Critical factors were evaluated that were originally believed to affect storage stability of freeze-dried drug nanoparticles. It was found that the nature and concentration of the steric stabilizer, such as Poloxamer 338 and Cremophor EL, are the most important factors for long-term stability of such formulations, independent of the used drug compound. The rational choice of an adequate steric stabilizer, namely Poloxamer 338, in combination with various lyoprotectants seems crucial to prevent physical instabilities of the lyophilized drug nanoparticles during short-term stability experiments at ambient and accelerated conditions. A 200 mg/mL concentration of nanoparticles could successfully be stabilized over the investigated time interval. In the course of the present experiments, polyvinylpyrrolidone, type K15 was found superior to trehalose or sucrose in preserving the original particle size distribution, presumably based on its surface-active properties. Lastly, it was demonstrated that lower water contents are generally beneficial to stabilize such systems. Copyright © 2011 Wiley-Liss, Inc.

  16. High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia.

    PubMed

    Moreno-Gutiérrez, Paula Andrea; Gaviria-Mendoza, Andrés; Cañón, Mauricio Montoya; Machado-Alba, Jorge Enrique

    2016-08-01

    Medication is one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and the older adult population is at particularly high risk. The aim of the present study was to describe the prescription patterns of drugs with a risk of TdP in the Colombian older adult population. Patients older than 65 years who received medication with a risk of TdP during three consecutive months were selected. The medication was obtained and classified according to the QT Drug List from Crediblemeds.org. The data were analysed using SPSS-22. A total of 55 932 patients were chronically receiving QT-prolonging drugs; 61.9% (n = 34 ,632) were women and the mean age of the sample was 75.6 years. Drugs with a conditional risk were consumed by 95.2% of patients, 5.3% received drugs with a known risk and 2.9% received drugs with a possible risk. Two or more QT-prolonging drugs were consumed by 10.3% of the patients (n = 5786). Most of the sample (96.8%, n = 54 170) had at least one additional risk factor for LQTS, with a mean of 3.1 ± 0.9 risk factors. Patients receiving QT-prolonging drugs for psychiatric and neurological disease were at a higher risk of major polypharmacy [odds ratio (OR) 3.0; 95% confidence interval (CI) 2.80, 3.22) and of receiving high doses of QT-prolonging drugs (OR 3.8; 95% CI 3.52, 4.05). The widespread use of medication that causes TdP and the high prevalence of additional risks in the older adult population raise the need for accurate prediction of risk and constant patient monitoring. Patients taking psychiatric drugs are at a higher risk of TdP. © 2016 The British Pharmacological Society.

  17. High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia

    PubMed Central

    Moreno‐Gutiérrez, Paula Andrea; Gaviria‐Mendoza, Andrés; Cañón, Mauricio Montoya

    2016-01-01

    Aims Medication is one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and the older adult population is at particularly high risk. The aim of the present study was to describe the prescription patterns of drugs with a risk of TdP in the Colombian older adult population. Methods Patients older than 65 years who received medication with a risk of TdP during three consecutive months were selected. The medication was obtained and classified according to the QT Drug List from Crediblemeds.org. The data were analysed using SPSS‐22. Results A total of 55 932 patients were chronically receiving QT‐prolonging drugs; 61.9% (n = 34 ,632) were women and the mean age of the sample was 75.6 years. Drugs with a conditional risk were consumed by 95.2% of patients, 5.3% received drugs with a known risk and 2.9% received drugs with a possible risk. Two or more QT‐prolonging drugs were consumed by 10.3% of the patients (n = 5786). Most of the sample (96.8%, n = 54 170) had at least one additional risk factor for LQTS, with a mean of 3.1 ± 0.9 risk factors. Patients receiving QT‐prolonging drugs for psychiatric and neurological disease were at a higher risk of major polypharmacy [odds ratio (OR) 3.0; 95% confidence interval (CI) 2.80, 3.22) and of receiving high doses of QT‐prolonging drugs (OR 3.8; 95% CI 3.52, 4.05). Conclusions The widespread use of medication that causes TdP and the high prevalence of additional risks in the older adult population raise the need for accurate prediction of risk and constant patient monitoring. Patients taking psychiatric drugs are at a higher risk of TdP. PMID:27060989

  18. Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors.

    PubMed

    Moody, Raymond L; Starks, Tyrel J; Grov, Christian; Parsons, Jeffrey T

    2018-05-01

    The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.

  19. [Open narcissism, covered narcissism and personality disorders as predictive factors of treatment response in an out-patient Drug Addiction Unit].

    PubMed

    Salazar-Fraile, José; Ripoll-Alandes, Carmen; Bobes, Julio

    2010-01-01

    Although a high prevalence of personality disorders has been reported in substance users, the literature on their value for predicting treatment response is controversial. On the other hand, while the predictive validity of personality traits as predictors of response to drug abuse or dependence has been studied, research on the validity of narcissistic personality traits is scarce. To study the predictive value of personality disorders, narcissistic personality traits and self-esteem for predicting treatment response. We assessed 78 patients attended at an addiction treatment unit using personality disorder diagnoses and measures of self-esteem, narcissism and covert (hypersensitive) narcissism. These variables were used in a Cox survival model as predictive variables of time to relapse into drug use. Hypersensitive (covert) narcissism and borderline and passive-aggressive personality disorders were risk factors for relapse into drug use, while open narcissism was a protective factor. Self-esteem did not show predictive validity. Personality disorders characterized by impulsivity-instability and passivity-resentfulness show higher risk of relapse into drug abuse. Personality traits characterized by high sensitivity to humiliation increase the risk of relapse, whereas pride and self-confidence are protective factors.

  20. The enemy within: Targeting host–parasite interaction for antileishmanial drug discovery

    PubMed Central

    Späth, Gerald F.; Rachidi, Najma; Prina, Eric

    2017-01-01

    The state of antileishmanial chemotherapy is strongly compromised by the emergence of drug-resistant Leishmania. The evolution of drug-resistant phenotypes has been linked to the parasites’ intrinsic genome instability, with frequent gene and chromosome amplifications causing fitness gains that are directly selected by environmental factors, including the presence of antileishmanial drugs. Thus, even though the unique eukaryotic biology of Leishmania and its dependence on parasite-specific virulence factors provide valid opportunities for chemotherapeutical intervention, all strategies that target the parasite in a direct fashion are likely prone to select for resistance. Here, we review the current state of antileishmanial chemotherapy and discuss the limitations of ongoing drug discovery efforts. We finally propose new strategies that target Leishmania viability indirectly via mechanisms of host–parasite interaction, including parasite-released ectokinases and host epigenetic regulation, which modulate host cell signaling and transcriptional regulation, respectively, to establish permissive conditions for intracellular Leishmania survival. PMID:28594938

  1. Predictive Factors of Spontaneous Reporting of Adverse Drug Reactions among Community Pharmacists.

    PubMed

    Yu, Yun Mi; Lee, Euni; Koo, Bon Sun; Jeong, Kyeong Hye; Choi, Kyung Hee; Kang, Lee Kyung; Lee, Mo Se; Choi, Kwang Hoon; Oh, Jung Mi; Shin, Wan Gyoon

    2016-01-01

    To evaluate the association between spontaneous reporting (SR) and the knowledge, attitude, and needs of community pharmacists (CPs), using a questionnaire following a conceptual model known as the mixed model of knowledge-attitude-practices and the satisfaction of needs. Self-administered questionnaires were used with a nationwide convenience sample of CPs between September 1, 2014 and November 25, 2014 in Korea. The association between SR and the predictive factors was evaluated using multivariate logistic regression analysis. In total, 1,001 questionnaires were analyzed. The mean age of the respondents and the number of years spent in community pharmacy practice were 45.6 years and 15.3 years, respectively. CPs with experience of SR was 29.4%. Being older than 60 (ORadj, 0.16; 95% CI, 0.06-0.42), having prior experience with adverse drug reactions (ADR) (ORadj, 6.46; 95% CI, 2.46-16.98), having higher specific knowledge of SR (ORadj, 3.58; 95% CI, 1.96-6.56), and having less concern about the obstacles to SR (ORadj, 0.36; 95% CI, 0.23-0.57) were significant contributing factors to SR. The main obstacles to SR included perception of ADRs as 'not serious ADR' (77.9%), 'already well known ADR' (81.5%), and 'uncertain about causality' (73.3%). CPs without reporting experience had greater concerns related to the reporting method and the liability of the pharmacy than those with reporting experience (p<0.05). Findings from our study showed around one in three CPs had ADR reporting experience in Korea, while 87.1% had prior experience with ADR cases. The knowledge of SR, prior experience of ADR, and less concern about the obstacles to SR were contributing factors for reporting levels.

  2. Predictive Factors of Spontaneous Reporting of Adverse Drug Reactions among Community Pharmacists

    PubMed Central

    Yu, Yun Mi; Lee, Euni; Koo, Bon Sun; Jeong, Kyeong Hye; Choi, Kyung Hee; Kang, Lee Kyung; Lee, Mo Se; Choi, Kwang Hoon; Oh, Jung Mi; Shin, Wan Gyoon

    2016-01-01

    Purpose To evaluate the association between spontaneous reporting (SR) and the knowledge, attitude, and needs of community pharmacists (CPs), using a questionnaire following a conceptual model known as the mixed model of knowledge-attitude-practices and the satisfaction of needs. Methods Self-administered questionnaires were used with a nationwide convenience sample of CPs between September 1, 2014 and November 25, 2014 in Korea. The association between SR and the predictive factors was evaluated using multivariate logistic regression analysis. Results In total, 1,001 questionnaires were analyzed. The mean age of the respondents and the number of years spent in community pharmacy practice were 45.6 years and 15.3 years, respectively. CPs with experience of SR was 29.4%. Being older than 60 (ORadj, 0.16; 95% CI, 0.06–0.42), having prior experience with adverse drug reactions (ADR) (ORadj, 6.46; 95% CI, 2.46–16.98), having higher specific knowledge of SR (ORadj, 3.58; 95% CI, 1.96–6.56), and having less concern about the obstacles to SR (ORadj, 0.36; 95% CI, 0.23–0.57) were significant contributing factors to SR. The main obstacles to SR included perception of ADRs as ‘not serious ADR’ (77.9%), ‘already well known ADR’ (81.5%), and ‘uncertain about causality’ (73.3%). CPs without reporting experience had greater concerns related to the reporting method and the liability of the pharmacy than those with reporting experience (p<0.05). Conclusions Findings from our study showed around one in three CPs had ADR reporting experience in Korea, while 87.1% had prior experience with ADR cases. The knowledge of SR, prior experience of ADR, and less concern about the obstacles to SR were contributing factors for reporting levels. PMID:27192159

  3. Development of Nano-Liposomal Formulations of Epidermal Growth Factor Receptor Inhibitors and their Pharmacological Interactions on Drug-Sensitive and Drug-Resistant Cancer Cell Lines

    NASA Astrophysics Data System (ADS)

    Trummer, Brian J.

    A rapidly expanding understanding of molecular derangements in cancer cell function has led to the development of selective, targeted chemotherapeutic agents. Growth factor signal transduction networks are frequently activated in an aberrant fashion, particularly through the activity of receptor tyrosine kinases (RTK). This has spurred an intensive effort to develop receptor tyrosine kinase inhibitors (RTKI) that are targeted to specific receptors, or receptor subfamilies. Chapter 1 reviews the pharmacology, preclinical, and clinical aspects of RTKIs that target the epidermal growth factor receptor (EGFR). EGFR inhibitors demonstrate significant success at inhibiting phosphorylation-based signaling pathways that promote cancer cell proliferation. Additionally RTKIs have physicochemical and structural characteristics that enable them to function as inhibitors of multi-drug resistance transport proteins. Thus EGFR inhibitors and other RTKIs have both on-target and off-target activities that could be beneficial in cancer therapy. However, these agents exert a number of side effects, some of which arise from their hydrophobic nature and large in vivo volume of distribution. Side effects of the EGFR inhibitor gefitinib include skin rash, severe myelotoxicity when combined with certain chemotherapeutic agents, and impairment of the blood brain barrier to xenobiotics. Weighing the preclinical and clinical observations with the EGFR inhibitors, we developed the primary overall hypothesis of this research: that drug-carrier formulations of RTKIs such as the EGFR inhibitors could be developed based on nanoparticulate liposomal carriers. Theoretically, this carrier strategy would ameliorate toxicity and improve the biodistribution and tumor selectivity of these agents. We hypothesized specifically that liposomal formulations could shift the biodistribution of EGFR inhibitors such as gefitinib away from skin, bone marrow, and the blood brain barrier, and toward solid tumors

  4. Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver.

    PubMed

    Werb, Daniel; Wood, Evan; Small, Will; Strathdee, Steffanie; Li, Kathy; Montaner, Julio; Kerr, Thomas

    2008-08-01

    Drug market policing has been associated with various harms among injection drug users (IDU). However, little is known about instances in which drugs and injecting equipment are confiscated from IDU in the absence of a formal arrest. We examined factors associated with being stopped, searched, or detained by police among participants in the Vancouver Injection Drug Users Study (VIDUS) using logistic regression. We also examined actions taken by study participants immediately following instances in which drugs or syringes were confiscated by police. Among 465 active IDU, 130 (28.0%) reported being detained by police in the last 6 months without being arrested. In multivariate logistic regression analysis, factors associated with being stopped, searched or detained by police included homelessness (Adjusted Odds Ratio [AOR]=3.96, 95% CI: 1.86-8.45), recent incarceration (AOR=3.52, 95% CI: 1.75-7.10), frequent crack use (AOR=2.24, 95% CI: 1.34-3.74), requiring help injecting (AOR=5.20, 95% CI: 1.21-22.39), and lending syringes (AOR=3.18, 95% CI: 1.09-9.30). Of those who reported being detained, 34% participants reported having had drugs confiscated, and 70% of these reported that they immediately acquired more drugs. Fifty-one percent of participants who reported being detained also reported having had syringes confiscated, and of this group, 6% reported immediately borrowing used syringes. Our study demonstrates that the IDU most affected by street-level policing tend to possess various characteristics, such as homelessness, that place them at heightened risk for various adverse health outcomes. Our findings also suggest that the confiscation of drugs and/or needles and syringes through discretionary policing practices have the potential to exacerbate drug market activity or prompt increased syringe borrowing. These findings indicate the need for ongoing evaluation of the public health impacts of discretionary policing approaches.

  5. Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.

    PubMed

    McCusker, J; Willis, G; McDonald, M; Lewis, B F; Sereti, S M; Feldman, Z T

    1994-01-01

    The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.

  6. PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol

    PubMed Central

    2013-01-01

    Background Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use. Methods A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored

  7. Drug-eluting stent in malignant biliary obstruction

    NASA Astrophysics Data System (ADS)

    Lee, Dong-Ki; Jang, Sung Ill

    2012-10-01

    Endoscopic stent insertion is the treatment of choice for patients with malignant biliary obstruction. However, conventional stents enable only mechanical palliation of the obstruction, without any anti-tumor effects. Drugeluting stent (DES), which was first introduced in coronary artery disease, are currently under investigation for sustaining stent patency and prolonging patient survival by inhibiting tumor ingrowth in malignant biliary obstruction. Many factors affecting efficient drug delivery have been studied to determine how drugs with antitumor effects suppress tumor ingrowth, including the specific drugs incorporated, means of incorporating the drugs, mode of drug release, and stent structure. Advances have resulted in the construction of more effective non-vascular DES and ongoing clinical research. Non-vascular DES is expected to play a vital role in prolonging the survival of patients with malignant biliary obstruction.

  8. Potential drugs which activate nuclear factor E2-related factor 2 signaling to prevent diabetic cardiovascular complications: A focus on fumaric acid esters.

    PubMed

    Zhou, Shanshan; Jin, Jingpeng; Bai, Tao; Sachleben, Leroy R; Cai, Lu; Zheng, Yang

    2015-08-01

    Diabetes and its cardiovascular complications have been a major public health issue. These complications are mainly attributable to a severe imbalance between free radical and reactive oxygen species production and the antioxidant defense systems. Nuclear factor E2-related factor 2 (Nrf2) is a transcription factor that controls the basal and inducible expression of a battery of antioxidant enzyme genes and other cyto-protective phase II detoxifying enzymes. As a result, Nrf2 has gained great attention as a promising drug target for preventing diabetic cardiovascular complications. And while animal studies have shown that several Nrf2 activators manifest a potential to efficiently prevent the diabetic complications, their use in humans has not been approved due to the lack of substantial evidence regarding safety and efficacy of the Nrf2 activation. We provide here a brief review of a few clinically-used drugs that can up-regulate Nrf2 with the potential of extending their usage to diabetic patients for the prevention of cardiovascular complications and conclude with a closer inspection of dimethyl fumarate and its mimic members. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Personal and Situational Factors in Drug Use as Perceived by Kibbutz Youth.

    ERIC Educational Resources Information Center

    Wolf, Yuval; And Others

    1995-01-01

    Sixteen 17-year-old kibbutz members, including 7 hashish smokers and 9 nonsmokers, assessed the probability that a young person of similar background would use drugs. It was found that hashish smokers assigned meaningful importance to a combined influence of personal predisposition and group pressure, while the nonsmokers considered only group…

  10. Variation in response to drugs: Part II. Environmental and nutritional variables.

    PubMed

    Fraser, H S; Tibbits, R C

    1983-06-01

    The importance of environmental factors for drug metabolism has recently been established. This paper reviews the major environmental and nutritional sources of variation in drug response. Environmental variables examined include drug interactions, alcohol, cigarette smoking, marijuana, other socially used drugs, steroid oral contraceptives (OCs), and agricultural industrial contaminants. Drug-drug interactions act chiefly by induction or inhibition of the microsomal metabolizing enzyme system. The effect of alcohol on the metabolism of other drugs depends on the drug, the dose of alcohol, the duration of exposure, and possibly diet and the presence of disease. Cigarette smoke affects the biotransformation of several drugs, and smokers often require higher doses of oxidized drugs. An additive effect of cigarette smoke and marijuana has been observed, resulting in the halving of the half-life of some drugs. Caffeine may serve as a competitive inhibitor of microsomal enzymes. Chemical pollutants such as chlorinated and polycyclic hydrocarbons can alter the hepatic drug metabolizing enzyme activity. The nutritional variables examined include malnutrition, anemia, vegetarian diets, dietary contaminants, and specific microconstituents of diet. Total dietary protein has a more critical effect on drug metabolism than fat or carbohydrate. These findings indicate that many factors in each patient are capable of altering drug response. Assessment of these variables permits more rational prescribing practices. For example, most patients over age 70 or vegetarian OC users require half the usual dosage of most drugs, whereas smokers and industrial workers require higher than recommended doses. Plasma measurements are of value in such assessments. Developing countries are advised to encourage rational use of a restricted number of drugs through an understanding of the sources of variation in drug response. This requires communication between clinical pharmacologists, other

  11. Prevalence and risk factors for carriage of multi-drug resistant Staphylococci in healthy cats and dogs

    PubMed Central

    Regula, Gertraud; Petrini, Orlando; Zinsstag, Jakob; Schelling, Esther

    2013-01-01

    We investigated the distribution of commensal staphylococcal species and determined the prevalence of multi-drug resistance in healthy cats and dogs. Risk factors associated with the carriage of multi-drug resistant strains were explored. Isolates from 256 dogs and 277 cats were identified at the species level using matrix-assisted laser desorption ionisation-time of flight mass spectrometry. The diversity of coagulase-negative Staphylococci (CNS) was high, with 22 species in dogs and 24 in cats. Multi-drug resistance was frequent (17%) and not always associated with the presence of the mecA gene. A stay in a veterinary clinic in the last year was associated with an increased risk of colonisation by multi-drug resistant Staphylococci (OR = 2.4, 95% CI: 1.1~5.2, p value LRT = 0.04). When identifying efficient control strategies against antibiotic resistance, the presence of mechanisms other than methicillin resistance and the possible role of CNS in the spread of resistance determinants should be considered. PMID:23820161

  12. The Alternative Sigma Factors SigE and SigB Are Involved in Tolerance and Persistence to Antitubercular Drugs

    PubMed Central

    Pisu, Davide; Provvedi, Roberta; Espinosa, Dulce Mata; Payan, Jorge Barrios; Boldrin, Francesca; Palù, Giorgio; Hernandez-Pando, Rogelio

    2017-01-01

    ABSTRACT The emergence and spread of drug-resistant Mycobacterium tuberculosis strains possibly threaten our ability to treat this disease in the future. Even though two new antitubercular drugs have recently been introduced, there is still the need to design new molecules whose mechanisms of action could reduce the length of treatment. We show that two alternative sigma factors of M. tuberculosis (SigE and SigB) have a major role in determining the level of basal resistance to several drugs and the amount of persisters surviving long-duration drug treatment. We also demonstrate that ethambutol, a bacteriostatic drug, is highly bactericidal for M. tuberculosis mutants missing either SigE or SigB. We suggest that molecules able to interfere with the activity of SigE or SigB not only could reduce M. tuberculosis virulence in vivo but also could boost the effect of other drugs by increasing the sensitivity of the organism and reducing the number of persisters able to escape killing. PMID:28993339

  13. A general assessment of the physiochemical factors that influence leachables accumulation in pharmaceutical drug products and related solutions.

    PubMed

    Jenke, Dennis

    2011-01-01

    The accumulation of organic compounds associated with plastic materials into pharmaceutical products and their associated solutions has important suitability for use consequences for those pharmaceutical solutions, most notably in terms of safety and efficacy. The interaction between the pharmaceutical solution and the plastic material is driven and controlled by the same thermodynamic and kinetic factors that regulate the interaction between the constituents of any comparable two-phased system. These physiochemical factors are delineated in this article, and their application to pharmaceutical products is demonstrated. When drug products are packaged in plastic container systems, substances may leach from the container and accumulate in the product. The magnitude of this leaching, and thus the effect that leachables have on the drug product, is controlled by certain thermodynamic and kinetic processes. These factors are described and detailed in this article.

  14. Spray-dried nanofibrillar cellulose microparticles for sustained drug release.

    PubMed

    Kolakovic, Ruzica; Laaksonen, Timo; Peltonen, Leena; Laukkanen, Antti; Hirvonen, Jouni

    2012-07-01

    Nanofibrillar cellulose (also referred to as cellulose nanofibers, nanocellulose, microfibrillated or nanofibrillated cellulose) has gained a lot of attention in recent years in different research areas including biomedical applications. In this study we have evaluated the applicability of nanofibrillar cellulose (NFC) as a material for the formation of matrix systems for sustained drug delivery. For that purpose, drug loaded NFC microparticles were produced by a spray drying method. The microparticles were characterized in terms of size and morphology, total drug loading, and physical state of the encapsulated drug. Drug release from the microparticles was assessed by dissolution tests, and suitable mathematical models were used to explain the drug releasing kinetics. The particles had spherical shapes with diameters of around 5 μm; the encapsulated drug was mainly in amorphous form. The controlled drug release was achieved. The drug releasing curves were fitted to a mathematical model describing the drug releasing kinetics from a spherical matrix. Different drugs had different release kinetics, which was a consequence of several factors, including different solubilities of the drugs in the chosen medium and different affinities of the drugs to the NFC. It can be concluded that NFC microparticles can sustain drug release by forming a tight fiber network and thus limit drug diffusion from the system. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Discontinued drugs in 2012: cardiovascular drugs.

    PubMed

    Zhao, Hong-Ping; Jiang, Hong-Min; Xiang, Bing-Ren

    2013-11-01

    The continued high rate of cardiovascular morbidity and mortality has attracted wide concern and great attention of pharmaceutical industry. In order to reduce the attrition of cardiovascular drug R&D, it might be helpful recapitulating previous failures and identifying the potential factors to success. This perspective mainly analyses the 30 cardiovascular drugs dropped from clinical development in 2012. Reasons causing the termination of the cardiovascular drugs in the past 5 years are also tabulated and analysed. The analysis shows that the attrition is highest in Phase II trials and financial and strategic factors and lack of clinical efficacy are the principal reasons for these disappointments. To solve the four problems (The 'better than the Beatles' problem, the 'cautious regulator' problem, the 'throw money at it' tendency and the 'basic researchbrute force' bias) is recommended as the main measure to increase the number and quality of approvable products.

  16. First national survey of anti-tuberculosis drug resistance in Azerbaijan and risk factors analysis

    PubMed Central

    Akhundova, I.; Seyfaddinova, M.; Mammadbayov, E.; Mirtskulava, V.; Rüsch-Gerdes, S.; Bayramov, R.; Suleymanova, J.; Kremer, K.; Dadu, A.; Acosta, C. D.; Harries, A. D.; Dara, M.

    2014-01-01

    Setting: Civilian population of the Republic of Azerbaijan. Objectives: To determine patterns of anti-tuberculosis drug resistance among new and previously treated pulmonary tuberculosis (TB) cases, and explore their association with socio-demographic and clinical characteristics. Design: National cross-sectional survey conducted in 2012–2013. Results: Of 789 patients (549 new and 240 previously treated) who met the enrolment criteria, 231 (42%) new and 146 (61%) previously treated patients were resistant to any anti-tuberculosis drug; 72 (13%) new and 66 (28%) previously treated patients had multidrug-resistant TB (MDR-TB). Among MDR-TB cases, 38% of new and 46% of previously treated cases had pre-extensively drug-resistant TB (pre-XDR-TB) or XDR-TB. In previously treated cases, 51% of those who had failed treatment had MDR-TB, which was 15 times higher than in relapse cases (OR 15.2, 95%CI 6–39). The only characteristic significantly associated with MDR-TB was a history of previous treatment (OR 3.1, 95%CI 2.1–4.7); for this group, history of incarceration was an additional risk factor for MDR-TB (OR 2.8, 95%CI 1.1–7.4). Conclusion: Azerbaijan remains a high MDR-TB burden country. There is a need to implement countrywide control and innovative measures to accelerate early diagnosis of drug resistance in individual patients, improve treatment adherence and strengthen routine surveillance of drug resistance. PMID:26393092

  17. Multifunctional High Drug Loading Nanocarriers for Cancer Drug Delivery

    NASA Astrophysics Data System (ADS)

    Jin, Erlei

    2011-12-01

    Most anticancer drugs have poor water-solubility, rapid blood clearance, low tumor-selectivity and severe systemic toxicity to healthy tissues. Thus, polymeric nanocarriers have been widely explored for anticancer drugs to solve these problems. However, polymer nanocarriers developed to date still suffer drawbacks including low drug loading contents, premature drug release, slow cellular internalization, slow intracellular drug release and thereby low therapeutic efficiency in cancer thermotherapy. Accordingly, in this dissertation, functional nanocapsules and nanoparticles including high drug loading liposome-like nanocapsules, high drug loading phospholipid-mimic nanocapsules with fast intracellular drug release, high drug loading charge-reversal nanocapsules, TAT based long blood circulation nanoparticles and charge-reversal nuclear targeted nanoparticles are designed and synthesized. These functional carriers have advantages such as high drug loading contents without premature drug release, fast cellular internalization and intracellular drug release, nuclear targeted delivery and long blood circulation. As a result, all these drug carriers show much higher in vitro and in vivo anti-cancer activities.

  18. Self-assembly behaviours of peptide-drug conjugates: influence of multiple factors on aggregate morphology and potential self-assembly mechanism

    NASA Astrophysics Data System (ADS)

    Fan, Qin; Ji, Yujie; Wang, Jingjing; Wu, Li; Li, Weidong; Chen, Rui; Chen, Zhipeng

    2018-04-01

    Peptide-drug conjugates (PDCs) as self-assembly prodrugs have the unique and specific features to build one-component nanomedicines. Supramolecular structure based on PDCs could form various morphologies ranging from nanotube, nanofibre, nanobelt to hydrogel. However, the assembly process of PDCs is too complex to predict or control. Herein, we investigated the effects of extrinsic factors on assembly morphology and the possible formation of nanostructures based on PDCs. To this end, we designed a PDC consisting of hydrophobic drug (S)-ketoprofen (Ket) and valine-glutamic acid dimeric repeats peptide (L-VEVE) to study their assembly behaviour. Our results showed that the critical assembly concentration of Ket-L-VEVE was 0.32 mM in water to form various nanostructures which experienced from micelle, nanorod, nanofibre to nanoribbon. The morphology was influenced by multiple factors including molecular design, assembly time, pH and hydrogen bond inhibitor. On the basis of experimental results, we speculated the possible assembly mechanism of Ket-L-VEVE. The π-π stacking interaction between Ket molecules could serve as an anchor, and hydrogen bonded-induced β-sheets and hydrophilic/hydrophobic balance between L-VEVE peptide play structure-directing role in forming filament-like or nanoribbon morphology. This work provides a new sight to rationally design and precisely control the nanostructure of PDCs based on aromatic fragment.

  19. Self-assembly behaviours of peptide-drug conjugates: influence of multiple factors on aggregate morphology and potential self-assembly mechanism.

    PubMed

    Fan, Qin; Ji, Yujie; Wang, Jingjing; Wu, Li; Li, Weidong; Chen, Rui; Chen, Zhipeng

    2018-04-01

    Peptide-drug conjugates (PDCs) as self-assembly prodrugs have the unique and specific features to build one-component nanomedicines. Supramolecular structure based on PDCs could form various morphologies ranging from nanotube, nanofibre, nanobelt to hydrogel. However, the assembly process of PDCs is too complex to predict or control. Herein, we investigated the effects of extrinsic factors on assembly morphology and the possible formation of nanostructures based on PDCs. To this end, we designed a PDC consisting of hydrophobic drug ( S )-ketoprofen (Ket) and valine-glutamic acid dimeric repeats peptide (L-VEVE) to study their assembly behaviour. Our results showed that the critical assembly concentration of Ket-L-VEVE was 0.32 mM in water to form various nanostructures which experienced from micelle, nanorod, nanofibre to nanoribbon. The morphology was influenced by multiple factors including molecular design, assembly time, pH and hydrogen bond inhibitor. On the basis of experimental results, we speculated the possible assembly mechanism of Ket-L-VEVE. The π-π stacking interaction between Ket molecules could serve as an anchor, and hydrogen bonded-induced β-sheets and hydrophilic/hydrophobic balance between L-VEVE peptide play structure-directing role in forming filament-like or nanoribbon morphology. This work provides a new sight to rationally design and precisely control the nanostructure of PDCs based on aromatic fragment.

  20. Sociodemographic factors influence use of proton pump inhibitors among users of nonsteroidal anti-inflammatory drugs.

    PubMed

    van Boxel, Ofke S; Hagenaars, Matthijs P; Smout, André J P M; Siersema, Peter D

    2009-08-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs. Although adequate gastroprotection is indicated in individuals at high risk for upper gastrointestinal complications, underutilization of preventive strategies has been demonstrated. We investigated the utilization of proton pump inhibitors (PPIs) in high risk, short term users of NSAIDs and assessed the association between sociodemographic factors and the rates at which PPIs are prescribed. A retrospective study was conducted using data from 2.8 million individuals. Short term use was defined as an isolated period of NSAID use between 7 to 30 days. Logistic regression was performed to determine sociodemographic factors associated with PPI inhibitor use. A total of 155,825 short term users of NSAID were identified. Of these, 52,842 subjects (33.9%) had 1 or more risk factors; 56.1% of these subjects did not receive PPIs. Utilization was associated with sociodemographic factors of patients (such as older age [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.64-1.99], female gender [OR, 1.14; 95% CI, 1.10-1.18], risk factors for upper gastrointestinal complications [OR, 3.72; 95% CI, 3.45-4.00]) and physicians (such as female gender [OR, 1.09; 95% CI, 1.03-1.14], practice in a deprived area [OR, 0.57; 95% CI, 0.53-0.61], or an urban area [OR, 0.86; 95% CI, 0.82-0.90]). Adequate gastroprotection is not provided to more than 50% of short term users of NSAIDs who are at an increased risk for upper gastrointestinal complications. Utilization is associated with sociodemographic factors of patients and physicians.

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