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Digital cognitive-behavioral therapy for substance use: systematic review and meta-analysis of randomized controlled trials. 针对药物使用的数字认知行为疗法:随机对照试验的系统回顾和荟萃分析。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-22 DOI: 10.1080/00952990.2024.2400934
Virgil Lee Gregory, David A Wilkerson, Samantha N Wolfe-Taylor, Breena L Miller, Alexander D Lipsey

Background: Prior meta-analyses have evaluated digital interventions for alcohol exclusively and alcohol/tobacco combined. These meta-analyses showed positive outcomes pertaining to alcohol and alcohol/tobacco combined. Yet questions remain pertaining to the effect of digital cognitive-behavioral therapy (CBT) on reducing alcohol and drug use.Objectives: The purpose of the meta-analysis was to determine the mean effect size, relative to control groups, of digital CBT, for posttest reductions in drug and/or alcohol use.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria was used to guide this review and meta-analysis. Electronic databases (APA PsycArticles, Academic Search Complete, APA PsycInfo, CINAHL Complete, ERIC, MEDLINE, Psychology and Behavioral Sciences Collection, Social Sciences Full Text, Social Work Abstracts, SocINDEX), clinicaltrials.gov, reference lists were searched. The protocol was registered in PROSPERO (ID#: CRD42023471492). The CBT interventions included cognitive restructuring.Results: All but one of the effect sizes favored digital CBT (from -0.02 to -1.45). After the removal an outlier, a small, significant, random effects model Hedges' g summary effect of -0.23 (95% confidence interval: -0.32, -0.14, p < .0001) showed a reduction in substance use at the posttest, favoring digital CBT relative to the control group. A variety of control conditions were used; however, the effects sizes had minimal heterogeneity (k = 17, I2 = 5.34, Q = 16.9, p = .39). The funnel plot and Egger regression test intercept (0.01, p = .99) lacked publication bias.Conclusion: The meta-analytic findings suggest digital CBT is an efficacious treatment for reducing alcohol and drug use overall.

背景先前的荟萃分析评估了针对酗酒和酗酒/烟草结合的数字干预措施。这些荟萃分析表明,酗酒和酗酒/嗜烟综合干预取得了积极的效果。然而,数字认知行为疗法(CBT)对减少酒精和毒品使用的效果仍存在疑问:荟萃分析的目的是确定数字认知行为疗法相对于对照组在测试后减少吸毒和/或酗酒的平均效应大小:方法:采用《系统综述和荟萃分析首选报告项目》标准来指导本次综述和荟萃分析。检索了电子数据库(APA PsycArticles、Academic Search Complete、APA PsycInfo、CINAHL Complete、ERIC、MEDLINE、Psychology and Behavioral Sciences Collection、Social Sciences Full Text、Social Work Abstracts、SocINDEX)、clinicaltrials.gov、参考文献列表。研究方案已在 PROSPERO 注册(ID#: CRD42023471492)。CBT 干预包括认知重组:除一项研究外,其他研究的效应大小均偏向于数字化 CBT(从-0.02 到-1.45)。剔除一个离群值后,随机效应模型的Hedges'g汇总效应为-0.23(95%置信区间:-0.32, -0.14,p k = 17,I2 = 5.34,Q = 16.9,p = .39)。漏斗图和 Egger 回归检验截距(0.01,P = .99)缺乏发表偏倚:荟萃分析结果表明,数字化 CBT 是减少酗酒和吸毒的有效治疗方法。
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引用次数: 0
Substance use and help seeking as coping behaviors among parents and unpaid caregivers of adults in the United States during the COVID-19 pandemic. 在 COVID-19 大流行期间,美国成年人的父母和无偿照顾者使用药物和寻求帮助的应对行为。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-22 DOI: 10.1080/00952990.2024.2394970
Prerna Varma, Lara DePadilla, Mark É Czeisler, Elizabeth A Rohan, Matthew D Weaver, Stuart F Quan, Rebecca Robbins, Chirag G Patel, Stephanie Melillo, Alexandra Drane, Sarah Stephens Winnay, Rashon I Lane, Charles A Czeisler, Mark E Howard, Shantha M W Rajaratnam, Jennifer L Matjasko

Background: During the COVID-19 pandemic, caregiving responsibilities may have been associated with increased substance use.Objectives: To characterize substance use to cope with stress and willingness to seek help among (i) parents, (ii) unpaid caregivers of adults, and (iii) parent-caregivers.Methods: Data were analyzed for 10,444 non-probabilistic internet-based survey respondents of the COVID-19 Outbreak Public Evaluation (COPE) initiative (5227 females, 5217 males). Questions included new or increased substance use, substance use in the past 30 days to cope, insomnia, mental health, and willingness to seek help.Results: Nearly 20% of parents and unpaid caregivers of adults each reported new or increased use of substances to cope with stress or emotions; 65.4% of parent-caregivers endorsed this response. Compared to non-caregivers, all caregiver groups had higher odds of new or increased use of substances, with parent-caregivers showing the largest effect size (aOR: 7.19 (5.87-8.83), p < .001). Parent-caregivers had four times the adjusted odds of using drugs other than cannabis (aOR: 4.01 (3.15-5.09), p < .001) compared to non-caregivers.Conclusions: Caregivers may initiate or increase substance use as a coping strategy when under stress. The higher odds of substance use underscores the importance of efforts to screen for sleep disturbances and adverse mental health symptoms, particularly among parent-caregivers. Clinicians may consider asking patients about family situations more broadly to help identify people who may be experiencing stress related to caregiving and, if indicated, offer treatment to potentially alleviate some of the risks.

背景:在 COVID-19 大流行期间,护理责任可能与药物使用增加有关:在 COVID-19 大流行期间,护理责任可能与药物使用增加有关:目的:描述(i)父母、(ii)成人的无偿照顾者和(iii)父母照顾者使用药物应对压力和寻求帮助的意愿:对 COVID-19 疫情公共评估(COPE)项目的 10444 名非概率互联网调查对象(女性 5227 人,男性 5217 人)的数据进行了分析。问题包括新使用或增加使用药物、过去 30 天内使用药物应对、失眠、心理健康和寻求帮助的意愿:近 20% 的成年人父母和无偿照顾者都报告说,他们新近使用或增加使用药物来应对压力或情绪;65.4% 的父母照顾者赞同这一回答。与非照顾者相比,所有照顾者群体新使用或增加使用药物的几率都较高,其中父母照顾者的影响最大(aOR:7.19 (5.87-8.83),p p 结论:照顾者在面临压力时可能会开始或增加使用药物,以此作为一种应对策略。使用药物的几率较高,这强调了筛查睡眠障碍和不良心理健康症状的重要性,尤其是在父母照顾者中。临床医生可以考虑更广泛地询问患者的家庭情况,以帮助识别那些可能正在经历与护理相关的压力的人,并在有必要的情况下提供治疗,以潜在地减轻一些风险。
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引用次数: 0
Risk factors of overdose in maternal patients with opioid use disorder: a scoping review. 患有阿片类药物使用障碍的产妇用药过量的风险因素:范围界定综述。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-22 DOI: 10.1080/00952990.2024.2407006
Kelly A Campbell, Anna L Wilson, Marilyn Torres, Neha Dantuluri, Kimberly Fryer

Background: Opioid-related overdoses significantly contribute to mortality in pregnancy and the postpartum period. Few studies report risk factors predisposing pregnant and postpartum patients with opioid use disorder (OUD) to overdose.Objective: This scoping review aims to describe the risk factors predisposing pregnant and postpartum patients with OUD to overdose.Method: Included studies identified pregnant and/or postpartum patients with OUD and differentiated between those who experienced overdose and those who did not. Of the 1060 articles, 8 met the criteria, examining 90,860 pregnant and postpartum patients with OUD.Results: Consistent use of medications for OUD (MOUD) during pregnancy and the postpartum period was the most frequently identified factor reducing overdose risk. Critical times of heightened overdose risk include the first trimester and the 7-12-month postpartum period. Pregnancy complications, such as stillbirth, severe maternal morbidity, preterm birth, and cesarean delivery, also increase risk. Opioid overdose is associated with being houseless, incarcerated, young, unmarried, publicly insured, not graduating high school, co-occurring substance use disorders, and inadequate prenatal care. Legislative changes, such as not classifying OUD in pregnancy as "child abuse" and increasing Medicaid reimbursement for Screening, Brief Intervention, and Referral to Treatment programs, are crucial to reducing risk. The impact of race and the influence of co-occurring psychiatric disorders was inconsistently reported.Conclusion: This scoping review identifies significant risk factors for opioid overdose in pregnant and postpartum patients. Improving access through enhanced Medicaid reimbursement, non-punitive reporting policies, and non-stigmatized care are keys to reducing overdose.

背景:与阿片类药物相关的用药过量是造成孕期和产后死亡的重要原因。很少有研究报告了阿片类药物使用障碍(OUD)孕妇和产后患者易发生用药过量的风险因素:本范围综述旨在描述妊娠期和产后阿片类药物滥用症患者易发生用药过量的风险因素:方法:纳入的研究确定了妊娠期和/或产后 OUD 患者,并对用药过量和未用药过量的患者进行了区分。在 1060 篇文章中,有 8 篇符合标准,对 90,860 名患有 OUD 的孕妇和产后患者进行了研究:结果:在怀孕期间和产后持续使用治疗 OUD 的药物(MOUD)是最常见的降低用药过量风险的因素。用药过量风险增加的关键时期包括妊娠头三个月和产后 7-12 个月。妊娠并发症,如死胎、严重的孕产妇发病率、早产和剖腹产也会增加风险。阿片类药物过量与无房、被监禁、年轻、未婚、有公共保险、高中未毕业、并发药物使用障碍和产前护理不足有关。立法变革对于降低风险至关重要,例如不将孕期 OUD 归为 "虐待儿童",增加医疗补助对筛查、简单干预和转诊治疗计划的报销。关于种族的影响以及并发精神疾病的影响的报告并不一致:此次范围界定审查确定了孕妇和产后患者阿片类药物过量的重要风险因素。通过加强医疗补助报销、非惩罚性报告政策和非污名化护理来改善获取途径是减少用药过量的关键。
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引用次数: 0
Plasma leptin levels are lower in females, but not males, with ketamine use disorder. 患有氯胺酮使用障碍的女性血浆瘦素水平较低,而男性则没有。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-21 DOI: 10.1080/00952990.2024.2394963
Ming-Chyi Huang, Li-Jung Chiang, Wan-Hsi Chien, Tung-Hsia Liu, Chun-Hsin Chen, Yu-Li Liu

Background: Ketamine has emerged as a prominent substance of misuse. Leptin, an adipocyte-derived polypeptide hormone, has been implicated in the development of addiction. Sex-specific changes in leptin levels have been demonstrated following acute ketamine administration; the persistence of long-term ketamine use on leptin levels is uncertain.Objectives: To assess the sex-difference of leptin levels, and their persistence, in individuals with ketamine use disorder (KUD) compared to healthy controls.Methods: Plasma leptin levels were measured in 62 healthy controls (37 males, 25 females) and 68 participants with KUD (50 males, 18 females) on the first day (baseline) and after 1 and 2 weeks of abstinence. As leptin levels are affected by body mass index (BMI), BMI-adjusted leptin (leptin/BMI ratio) was also examined. Mixed model for repeated measures was used to examine changes after ketamine abstinence.Results: Compared to same-sex controls, female, but not male, participants with KUD demonstrated lower leptin levels and leptin/BMI ratio at baseline, week 1, and week 2 (leptin levels: p = .001, 0.006 and 0.032, respectively; leptin/BMI ratio: p = .004, 0.022, and 0.09, respectively). Repeated measures showed that leptin levels and the leptin/BMI ratio increased after 2 weeks of abstinence in male participants with KUD (p = .002 and 0.011, respectively), but females did not show such an increase (p > .05).Conclusions: Sex-specific differences were observed in leptin levels and the leptin/BMI ratio in individuals with KUD compared to controls. Lower leptin levels in females with KUD persisted after 2 weeks of abstinence.

背景:氯胺酮已成为一种常见的滥用药物。瘦素是一种源自脂肪细胞的多肽激素,与成瘾的形成有关。急性吸食氯胺酮后,瘦素水平的性别特异性变化已被证实;长期吸食氯胺酮对瘦素水平的持续影响尚不确定:与健康对照组相比,评估氯胺酮使用障碍(KUD)患者瘦素水平的性别差异及其持续性:方法:测量62名健康对照者(37名男性,25名女性)和68名氯胺酮使用障碍患者(50名男性,18名女性)在戒毒第一天(基线)以及戒毒1周和2周后的血浆瘦素水平。由于瘦素水平受体重指数(BMI)的影响,因此还研究了BMI调整瘦素(瘦素/BMI比值)。采用重复测量混合模型研究氯胺酮戒断后的变化:与同性对照组相比,女性氯胺酮患者在基线、第1周和第2周的瘦素水平和瘦素/体重指数比值较低(瘦素水平:分别为p = .001、0.006和0.032;瘦素/体重指数比值:分别为p = .004、0.022和0.09)。重复测量结果表明,KUD 男性参与者在禁欲 2 周后,瘦素水平和瘦素/体重指数比值均有所上升(p = .002 和 0.011,分别为 0.002 和 0.011),但女性参与者的瘦素水平和瘦素/体重指数比值没有上升(p > .05):结论:与对照组相比,KUD 患者的瘦素水平和瘦素/体重指数比率存在性别差异。KUD女性患者较低的瘦素水平在禁欲2周后仍持续存在。
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引用次数: 0
Geographic trends in overall and long-acting opioid prescriptions under Medicaid and Medicare Part D in the United States, 2013-2021. 2013-2021 年美国医疗补助计划和医疗保险 D 部分的总体阿片类药物处方和长效阿片类药物处方的地域趋势。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-15 DOI: 10.1080/00952990.2024.2400916
Shanshan Wang, Matthew E Rossheim, Scott T Walters, Rajesh R Nandy, Kari Northeim

Background: Amid the national opioid epidemic, it is important to assess trends in opioid prescriptions. Long-acting opioids (LAOs) are of particular interest as they are among the most intensely misused prescription opioids. Moreover, understanding geographic trends in opioid prescriptions may help identify state-level variations, illustrating state-specific disparities.Objectives: The study aims to determine geographic trends in overall and LAO prescriptions under Medicaid and Medicare Part D from 2013 to 2021.Methods: We used data from the Centers for Medicare & Medicaid Services on opioid prescriptions from 2013 to 2021. The opioid prescribing proportion was calculated as the number of opioid claims divided by the total number of overall drug claims. The LAO prescribing proportion was calculated as number of LAO claims divided by total opioid claims.Results: Despite a general decrease nationwide, Medicaid opioid prescribing proportions increased in Iowa, Montana, and Virginia. There was an increasing trend in the national-level Medicaid LAO prescribing proportion from 2017 to 2021, with a 14.1% point increase (p for the annual percent change [APC]<0.05). For Medicare Part D, the overall prescribing proportions fell by 1.7% points from 2013 to 2021, while the LAO prescribing proportion fell by 3% points from 2016 to 2021 (p for APC < .05).Conclusions: The increasing trends in national-level Medicaid LAO prescribing and Medicaid opioid prescribing in Iowa, Montana, and Virginia are concerning, and have implications for clinical opioid prescribing. The decreasing trends in Medicare Part D may reflect ongoing efforts in opioid prescription management.

背景:在全国阿片类药物流行之际,评估阿片类药物处方的趋势非常重要。长效类阿片(LAOs)是滥用最严重的处方类阿片之一,因此特别值得关注。此外,了解阿片类药物处方的地域趋势可能有助于确定州一级的差异,从而说明各州的具体差异:本研究旨在确定 2013 年至 2021 年医疗补助计划和医疗保险 D 部分中阿片类药物总处方量和 LAO 处方量的地域趋势:我们使用了美国医疗保险与医疗补助服务中心提供的 2013 年至 2021 年阿片类药物处方数据。阿片类药物处方比例的计算方法是:阿片类药物报销申请数量除以总体药物报销申请总数。LAO处方比例的计算方法是LAO申请数量除以阿片类药物申请总数:结果:尽管全国范围内阿片类药物处方比例普遍下降,但爱荷华州、蒙大拿州和弗吉尼亚州的医疗补助阿片类药物处方比例却有所上升。从 2017 年到 2021 年,全国范围内的医疗补助 LAO 处方比例呈上升趋势,增加了 14.1 个百分点(P 为年度百分比变化 [APC])结论:全国范围内的医疗补助 LAO 处方比例呈上升趋势,增加了 14.1 个百分点(P 为年度百分比变化 [APC]):爱荷华州、蒙大拿州和弗吉尼亚州的国家级医疗补助 LAO 处方和医疗补助阿片类药物处方的增加趋势令人担忧,并对阿片类药物的临床处方产生影响。医疗保险 D 部分的减少趋势可能反映了阿片类药物处方管理方面的持续努力。
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引用次数: 0
Leveraging extended-release buprenorphine to improve care for opioid use disorder in the criminal-legal system. 利用缓释丁丙诺啡改善对刑事法律系统中阿片类药物使用障碍的护理。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-09 DOI: 10.1080/00952990.2024.2401980
Sean M Murphy
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引用次数: 0
Supporting medication-assisted recovery in recovery residences: staff support, managing built environment threats, and building a supportive network. 在康复住所支持药物辅助康复:员工支持、管理建筑环境威胁和建立支持网络。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-09 DOI: 10.1080/00952990.2024.2401983
Kathryn R Gallardo, I Niles Zoschke, Hannah L N Stewart, J Michael Wilkerson, Elizabeth A Henry, Sheryl A McCurdy

Background: While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting.Objectives: The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents' MAR pathway.Methods: We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder.Results: We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants' community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access.Conclusion: Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.

背景:虽然治疗阿片类药物使用障碍(MOUD)的药物能有效减少过量用药,但 MOUD 的广泛采用和实施仍然不足。我们需要创新的方法来促进阿片类药物的使用,并为患者的药物辅助康复(MAR)提供支持。为服用 MOUD 的人提供服务的康复住所数量正在稳步增长,但人们对康复住所环境中如何推广 MOUD 和 MAR 途径却知之甚少:本定性分析旨在描述康复之家如何促进 MOUD 的启动并支持居民的 MAR 途径:方法: 我们对居住在德克萨斯州五个城市的康复之家的 93 名居民(59.1% 为男性;38.7% 为女性)进行了访谈,这些康复之家为阿片类药物使用障碍患者提供服务:我们发现,康复公寓的工作人员通过将可能从 MOUD 中受益的人与适当的医疗服务提供者联系起来,弥补了社区中的医疗服务缺口。康复公寓的工作人员还通过主办或联系居民参加匿名药物辅助康复会议,加强了参与者的MAR支持同伴社区。此外,康复居住地还帮助一些居民克服了阻碍他们获得 MOUD 的常见后勤障碍(如交通问题、住房不稳定、与提供者的距离):结论:为服用 MOUD 的人提供服务的康复住所是一种很好的康复支持服务,可以促进 MOUD 的启动和 MAR 途径。
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引用次数: 0
Social influence on drug use and sexual behaviors among rural LGBTQ+ individuals. 社会对农村 LGBTQ+ 吸毒和性行为的影响。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-07 DOI: 10.1080/00952990.2024.2400919
Heather Tillewein, Georgia Luckey, Meghan Elgee, Wiley Jenkins

Background: Traveling to meet sexual partners and substance use are associated with increased risk of infectious disease. It is important to understand what factors may increase substances use or increased infection transmission risk (IITR) sexual behaviors among rural LGBTQ+ individuals.Objective: This study investigates substance use and sexual behaviors associated with increased infection transmission risk among rural LGBTQ+ individuals, and how these are associated with relationship type (friends or romantic partners) and travel distance.Methods: Participants (18 years+, identify as LGBTQ+, and provided a $25 gift card) were recruited from Illinois (25 counties), in 2021. Data included demographics, sexual and drug use behaviors, and assessed how these behaviors varied by relationship type and distance traveled (e.g. when meeting friends out-of-state).Results: The 398 participants were 79.1% White and 12.3% Black. By orientation, 29% heterosexual, 36% gay/lesbian, and 35% bisexual/other. By identity, 43% cisgender male, 51% cisgender female, and 6% genderqueer/other. Alcohol use while visiting out-of-state friends was more frequent among transgender (vs cisgender men; OR = 9.686, 95% confidence interval = 2.123-44.19), and individuals traveling > 1/month (all p < .050). Infection-related sexual behaviors while visiting out-of-state romantic partners was more frequent among prescription medication misuse (all p < .050) and traveling > 1/week (vs < 1/month; OR = 3.399, 95% CI = 1.037-11.144).Conclusion: This study of rural LGBTQ+ identified that alcohol use was associated with travel to visit out-of-state romantic partners, and prescription medication misuse increased infection-related sexual behavior during out-of-state travel. Health professionals can develop substance use and increased infection transmission risk sexual behavior interventions on gender minority groups in rural areas and target those who are traveling.

背景:旅行会见性伴侣和使用药物与传染病风险增加有关。了解哪些因素可能会增加农村 LGBTQ+ 个人的药物使用或增加感染传播风险(IITR)的性行为非常重要:本研究调查了与农村 LGBTQ+ 感染传播风险增加相关的药物使用和性行为,以及这些行为与关系类型(朋友或恋爱伴侣)和旅行距离之间的关系:2021 年,在伊利诺伊州(25 个县)招募参与者(18 岁以上,认同为 LGBTQ+,并提供 25 美元礼品卡)。数据包括人口统计学特征、性行为和吸毒行为,并评估了这些行为在关系类型和旅行距离(如在州外与朋友会面时)方面的差异:398 名参与者中,79.1% 为白人,12.3% 为黑人。按性取向划分,异性恋占 29%,同性恋/双性恋占 36%,双性恋/其他占 35%。按身份划分,43% 为顺性男性,51% 为顺性女性,6% 为异性/其他。变性人(vs 顺性别男性;OR = 9.686,95% 置信区间 = 2.123-44.19)和旅行次数大于 1 次/月(均为 p p 1 次/周(vs 结论:变性人和顺性别男性更经常在探访州外朋友时饮酒:这项针对农村 LGBTQ+ 的研究发现,饮酒与前往州外探望恋爱伴侣有关,而滥用处方药会增加州外旅行期间与感染有关的性行为。卫生专业人员可以针对农村地区的性别少数群体和旅行者制定药物使用和增加感染传播风险的性行为干预措施。
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引用次数: 0
"I drink less and that's no small matter": a qualitative descriptive study of a managed alcohol program evaluation in Barcelona. "我喝得少了,这可不是件小事":对巴塞罗那酒精管理计划评估的定性描述研究。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-07 DOI: 10.1080/00952990.2024.2404242
David Filomena Velandia, Ester Aranda Rodríguez, Amaia Garrido Albaina, Catrina Clotas, Montse Bartroli Checa, M Isabel Pasarín Rua, Mercè Gotsens

Background: The concurrence of homelessness and alcohol use disorder (AUD) has negative consequences in affected individuals. Managed alcohol programs (MAPs), a harm reduction strategy based on providing regular doses of alcohol to individuals with AUD, have emerged as a potential solution to reduce alcohol-related harms.Objectives: This study examined the impact of a MAP implemented in Barcelona on patterns of alcohol and other psychoactive substance use, health, and quality of life among people who use drugs and were experiencing homelessness. The research also incorporated a gender perspective and focused on individuals who had accessed a residential center.Methods: A descriptive qualitative design was used, employing semi-structured interviews with eight participants who were enrolled in the MAP (three women, five men) and four program professionals. Thematic analysis was used to analyze the resulting data.Results: The domains guiding the study appeared as outcome themes: patterns of use of alcohol and other substances, health, quality of life and impact on female-identified participants. Participants reported improved health due to reduced consumption of alcohol and other substances, better anxiety management, and reconnection to health services. The participants reported enhanced quality of life, including feeling safer, and better use of time, which had been spent on meeting their basic needs. Women reported that a key benefit of the program was living in a sexism-free environment.Conclusion: These results appear to demonstrate that harm reduction strategies prioritizing basic needs and adopting a gender-sensitive perspective can positively impact the health and quality of life of people experiencing homelessness with AUD.

背景:无家可归和酒精使用障碍(AUD)同时存在,会对受影响的个人造成负面影响。酒精管理计划(MAPs)是一种减少伤害的策略,其基础是向酒精使用障碍患者定期提供一定剂量的酒精,它已成为减少酒精相关伤害的一种潜在解决方案:本研究探讨了在巴塞罗那实施的酒精管理计划对无家可归的吸毒者使用酒精和其他精神活性物质的模式、健康和生活质量的影响。研究还纳入了性别视角,并重点关注进入寄宿中心的个人:研究采用了描述性定性设计,对参加 MAP 的 8 名参与者(3 名女性,5 名男性)和 4 名项目专业人员进行了半结构化访谈。采用主题分析法对所得数据进行分析:结果:指导研究的领域是结果主题:酒精和其他物质的使用模式、健康、生活质量以及对女性参与者的影响。参与者报告说,由于减少了酒精和其他物质的消费,健康状况得到了改善,焦虑得到了更好的控制,并重新获得了医疗服务。参与者报告说,生活质量得到了提高,包括感觉更安全,以及更好地利用了用于满足其基本需求的时间。妇女们表示,该计划的一个主要好处是生活在一个没有性别歧视的环境中:这些结果似乎表明,优先考虑基本需求并采用性别敏感视角的减低伤害策略可以对患有 AUD 的无家可归者的健康和生活质量产生积极影响。
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引用次数: 0
A study of long-term supraphysiologic-dose anabolic-androgenic steroid use on cognitive function in middle-aged men. 一项关于中年男性长期服用超生理剂量合成代谢雄性类固醇对认知功能影响的研究。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-07 DOI: 10.1080/00952990.2024.2403582
Marc J Kaufman, James I Hudson, Gen Kanayama, Samantha Muse, Jiana Schnabel, Rosalind Sokoll, Harrison G Pope

Background: Long-term use of supraphysiologic doses of anabolic-androgenic steroids (AAS) has been associated with impaired visuospatial memory in young men but little is known about its cognitive effects in middle-aged men.Objectives: We compared cognition in middle-aged men with histories of long-term AAS use and age-matched non-users.Methods: We administered cognitive tests from the CANTAB battery to 76 weightlifters aged 37-60 years (mean [SD] 48.5 [6.5] years), of whom 51 reported at least 2 years of cumulative AAS use and 25 reported no AAS exposure.Results: We found no significant AAS user versus non-user group differences on visuospatial, verbal memory, emotional recognition, or executive function tasks (corrected p's ≥ .00089; effect sizes ≤ .5).Conclusions: Our null visuospatial task findings contrast with our prior younger cohort study (mean age 37.1 [7.1] years), in which we found impaired visuospatial task performance in people who use AAS, and with other reports of cognitive impairments in younger men use AAS. Men who use AAS may develop early visuospatial memory deficits that stabilize by middle age while middle-aged non-users' performance may "catch up" due to normal age-related visuospatial declines. Similar effects could contribute to our null findings on other tasks. Between-study cohort substance use differences or environmental factor differences that modify cognition, such as study geographical location and time of year, also could contribute to our discordant findings. Since young adult male AAS users experience increased mortality from unnatural causes, improving our understanding of AAS cognitive effects in this age group is important.

背景:长期使用超生理剂量的合成代谢雄性类固醇(AAS)与年轻男性视觉空间记忆受损有关,但对其对中年男性认知的影响却知之甚少:目的:我们比较了有长期服用 AAS 史的中年男性与年龄匹配的非服用者的认知能力:我们对年龄在 37-60 岁(平均 [SD] 48.5 [6.5] 岁)的 76 名举重运动员进行了 CANTAB 测试中的认知测试,其中 51 人报告至少有 2 年的 AAS 累积使用史,25 人报告未接触过 AAS:结果:我们发现,在视觉空间、言语记忆、情绪识别或执行功能任务上,AAS使用者与非使用者组之间没有明显差异(校正P≥0.00089;效应大小≤0.5):我们的视觉空间任务无效研究结果与我们之前的年轻队列研究(平均年龄为 37.1 [7.1] 岁)形成了鲜明对比,在该研究中,我们发现使用雌激素的人的视觉空间任务表现受损,这也与其他关于使用雌激素的年轻男性认知障碍的报告形成了鲜明对比。使用安非他明类兴奋剂的男性可能在早期就出现了视觉空间记忆缺陷,到中年时这种缺陷趋于稳定,而未使用安非他明类兴奋剂的中年男性的表现则可能因与年龄相关的正常视觉空间能力下降而 "迎头赶上"。类似的影响也可能导致我们在其他任务上的结论为空。研究队列之间的药物使用差异或改变认知的环境因素差异,如研究的地理位置和时间,也可能导致我们的研究结果不一致。由于AAS的年轻男性使用者因非正常原因导致的死亡率增加,因此提高我们对AAS对这一年龄组的认知影响的认识非常重要。
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American Journal of Drug and Alcohol Abuse
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