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PubMed1992

Nicotine and the central nervous system: biobehavioral effects of cigarette smoking.

The effects of nicotine, like those of other drugs with potential for abuse and dependence, are centrally mediated. The impact of nicotine on the central nervous system is neuroregulatory in nature, affecting biochemical and physiological functions in a manner that reinforces drug-taking behavior. Dose-dependent neurotransmitter and neuroendocrine effects occur as plasma nicotine levels rise when a cigarette is smoked. Circulating levels of norepinephrine and epinephrine increase, and the bioavailability of dopamine is altered as well. Among the neuroendocrine effects are release of arginine vasopressin, beta-endorphin, adrenocorticotropic hormone, and cortisol. Notably, several of these neurochemicals are psychoactive and/or known to modulate behavior. Thus, affective states or cognitive demands may be favorably modified (at least temporarily) by nicotine intake. When nicotine is inhaled, the neuroregulatory effects just described are immediately available and the reinforcing effects of the drug are maximized. On the other hand, nicotine gum and most other nicotine replacement vehicles in current use have a slower onset of action, resulting in less reinforcement value. Recent data suggest that smoking cessation rates may be optimized by tailoring the dose of nicotine replacement (for example, 2 or 5 mg of nicotine gum) to the individual degree of nicotine dependence. In view of the dynamic interactions between the neuroregulatory effects of nicotine and a host of environmental conditions, nicotine replacement therapy is best carried out in combination with behavior modification techniques.

Behavior↗
PubMed1999

[Arterial puncture or pulse oximetry?].

Arterial puncture is the general accepted standard method for monitoring oxygen therapy in critically ill patients, but this technique is painful for the patient, has the potential of complications, and does not provide immediate continuous data. Pulse oximetry is a non-invasive method used to measure arterial oxygen saturation with a clinically acceptable accuracy of +/- 2%. Despite some limitations, pulse oximetry is considered to be reliable in most cases in detecting hypoxaemia and monitoring oxygen therapy in stationary units. The pulse oximeter can reduce the number of arterial punctures, personnel's time consumption, and limit oxygen abuse. Furthermore the new transportable and hand-held pulse oximeters offer new possibilities for continuous 24 hour monitoring of oxygen saturation also out of hospitals. The pulse oximeter can optimize monitoring patients' oxygen saturation in the stationary units, however, arterial puncture will remain the most reliable method in the assessment of hypoxaemia and hypercapnia, especially in acute situations.

Arteries↗
PubMed1997

Teratogen update: toluene.

Extrapolating from animal data, at the level at which well-controlled occupational exposure to toluene vapor is encountered, in utero exposure does not pose a significant fetal risk. However, following chronic and excessive industrial accidents or intentional abuse, toluene exposure several orders of magnitude greater exists, and at these levels in utero exposures in both animals and humans have been shown to produce significant delays in fetal growth. At these greater exposure levels, both dose and gestational timing relationships can be demonstrated in animal models. Of note, in both animals and humans, postnatal persistence of growth deficiency has been observed. A pattern of teratogenicity similar to that of the fetal alcohol syndrome is prevalent in all human studies of excessive in utero exposure to toluene. In humans, the effects of in utero toluene exposure among intentional abusers is confounded by such variables as general health and exposure to other teratogens. Chronic toluene abuse produces a renal tubular acidosis with maternal hypokalemia and profoundly lowered serum pH. Further evaluation of greater numbers of infants with respect to maternal renal tubular acidosis will be needed to fully assess the contribution of chronic acidosis. The contribution of maternal acidosis to fetal teratogenicity remains speculative. Coabuse of additional agents, in particular alcohol, may increase the teratogenic risks. The overlap of features following in utero toluene abuse with those of fetal alcohol syndrome suggests a possible common pathway of craniofacial teratogenesis. Lastly, genetic variations that result in deficiency of ALDH2, an enzyme involved in toluene metabolism, may increase the risks of toluene teratogenicity in at-risk individuals at lower levels of exposure. Prospective studies of toluene-exposed pregnancies would provide more information on the fetal effects at these levels.

Abnormalities, Drug-Induced↗
PubMed1997

Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services.

The authors examined HIV risk-related sexual behaviors in an ethnically diverse sample of HIV seropositive gay and bisexual men (N = 86). Measures of sexual behavior, substance use, condom attitudes, behavior change intentions, and engagement in risk-reducing practices were completed. Thirty-nine percent of the men reported engaging in unprotected anal intercourse in the past 3 months. Unprotected anal intercourse was associated with using nitrite inhalants, sex partners who used substances before sex, and low intentions to change risk behavior. These results highlight the difficulties that people living with HIV infection face in maintaining a lifetime of safer sex and the necessity of integrating clinical and prevention interventions for these persons.

Adult↗
PubMed1987

[Collateral effects of 9-alpha-fluor-prednisolone acetate and kanamycin, administered by nasal spray. Clinical experience and experimental data].

Iatrogenic pathology due to treatment with steroid drugs used by systemic route is well known. On the contrary iatrogenic pathology due to topical use of these drugs is rarely reported. Two cases of abuse of 9-alpha- fluor-prednisolone and kanamycin administered by endonasal route are reported. The same treatment has been carried out in patients and rabbits. Clinical and bio-humoral data in patients and anatomo-pathological findings in rabbits are reported. The risks, sometimes underestimated, of an overdose of corticosteroid and antibiotic drugs used by endonasal route are pointed out.

Administration, Inhalation↗
PubMed2005

Comparative study of drug use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and 2001.

OBJECTIVE: To compare the rate of drug use prevalence and to investigate opinions regarding such use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and again in 2001. METHODS: Both studies followed the same procedures of sampling and data collection. A random sample of undergraduate students, divided into the areas Humanities, Exact Sciences and Biologic Sciences, responded to an anonymous and self-report survey regarding the use of licit and illicit drugs within the last 30 days, within the last 12 months and over the lifetime of the subject. The two surveys were compared through the construction of (95%) confidence intervals for the prevalence differences for each substance by area and by total number of students. The Wald test for homogeneity was applied in order to compare the prevalences. RESULTS: High approval of regularly trying and using cocaine, crack, amphetamines and inhalants was observed. The drugs that showed statistic significant increasing were:lifetime use: alcohol, tobacco, marijuana, inhalants, hallucinogens, amphetamines, anti cholines, barbiturics and any illicit drug;last-12-month use: marijuana, inhalants, amphetamines, hallucinogens and any illicit drug;last-30-day use: marijuana, inhalants, amphetamines and any illicit drug. DISCUSSION: The observed difference in the use of some drugs between the two surveys appears to be a consequence of the higher rates of favorable opinions regarding trying and regularly using some psychoactive substances, a finding that mirrors global trends in drug use.

Adult↗
PubMedDate not supplied

Barriers to employment among working-aged patients with major burn injury.

The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant at P < .001). Of the unemployed patients who received toxicologic screening at admission, 49% tested positive for alcohol and 39% positive for other drugs, percentages that were significantly higher than 26 and 31%, respectively, for the employed. With adjustment for age, sex, race, and education, variables that were most predictive of preinjury unemployment status were preexisting physical disability (odds ratio, 51.0; 95% confidence interval, 7.7-336.9) and being alcohol-positive at admission (odds ratio, 2.8; 95% confidence interval, 1.2-6.8). Unemployed and employed patients also differed significantly in injury patterns and clinical outcomes, with inhalation injury and psychiatric distress being more prevalent among the unemployed and both hand burns and hand surgery among the employed. The greater prevalence of preexisting impairments among survivors who were unemployed before the injury helps explain why preburn employment status is such a powerful determinant of postburn work outcomes, and suggests the need to include psychosocial services in a program of comprehensive rehabilitation.

Adolescent↗
PubMed1992

Student perceptions of the danger of drug use: a factor analysis.

Australian secondary school students from three Year levels were asked to rate the danger involved in various uses of alcohol, tobacco, inhalants, marijuana and other illicit drugs. These ratings were then factor analyzed for each Year level. The results showed a more refined discrimination among the older students, with type of drug and frequency of use being important considerations. Familiarity was a major consideration for the younger students. The cognitive factors derived from the data are consistent with expectations based on the gateway theory of drug use.

Adolescent↗
PubMed1997

Long-term impact of Drug Abuse Resistance Education (D.A.R.E.). Results of a 6-year follow-up.

The long-term effectiveness of Drug Abuse Resistance Education (D.A.R.E.) was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 twelfth-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although the authors found no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th grade, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample but not in a validation sample. Findings from the two studies suggest a possible sleeper effect for D.A.R.E. in reference to the use of harder drugs, especially among teenage males.

Adolescent↗
PubMed1998

Personal characteristics associated with injecting drug use among Latinas in the United States of America.

This study examines nonmedical injecting drug use (IDU) among Latinas aged 12 years and older in a nationally representative sample of U.S. households. Data from the 1990-1995 National Household Surveys on Drug Abuse disclosed 154 Latinas with self-reported histories of IDU out of 18,335 Latinas who responded. Hypotheses about correlates of IDU were tested by using the conditional form of multiple logistic regression to compare the characteristics of these IDUs with those of 602 noninjecting Latinas matched on neighborhood of residence. In the USA, an estimated 1% of Latinas age 12 years and older have injected drugs for nonmedical purposes on at least one occasion. IDU was 4.6 to 6.5 times greater for adult Latinas (18-44 years old) when compared to Latinas aged either 12 through 17 years (P < 0.05) or older than 44 years. IDU was an estimated 7.1 times greater for Latinas who reported marijuana use and 5.4 times greater for Latinas who reported inhalant use when compared to Latinas not using these drugs (P < 0.01). In light of recent studies indicating that IDU is a serious public health problem for Latinas in the United States, the observed associations represent first steps in an effort to understand the Latina subgroups most affected by IDU and the underlying risk factors or causes of this behavior.

Adolescent↗
PubMed2004

Increased ethanol drinking after repeated chronic ethanol exposure and withdrawal experience in C57BL/6 mice.

BACKGROUND: The development of dependence may have significant motivational consequences regarding continued use and abuse of ethanol. We have developed a mouse model of ethanol dependence and repeated withdrawals that demonstrates sensitization of seizures and other symptoms of withdrawal. It is unclear whether such experience influences ethanol drinking behavior. The present series of experiments were designed to examine whether repeated cycles of chronic ethanol exposure and withdrawal has an impact on subsequent motivation to voluntarily self-administer ethanol. METHODS: With the use of a modified sucrose-fading procedure, adult male C57BL/6J mice were trained to drink 15% (v/v) ethanol in a limited access procedure (2 hr/day). The animals were not food or water deprived at any time during the experiments. Once stable baseline intake was established, mice were exposed to four cycles of 16 hr of ethanol vapor (or air) in inhalation chambers separated by 8-hr periods of withdrawal. At 32 hr after the last cycle of ethanol exposure, all mice were tested for ethanol intake under limited access conditions for 5 consecutive days. The animals then received a second series of chronic ethanol exposure and withdrawal followed by another 5-day test period for ethanol drinking. RESULTS: Stable daily baseline intake was established in mice that drank 15% ethanol combined with 5% sucrose (experiment 1), 15% ethanol alone (experiment 2), 5% sucrose alone (experiment 3), or 15% ethanol when presented as a choice with water (experiment 4). After repeated cycles of chronic ethanol exposure and withdrawal experience, consumption of ethanol solutions increased over baseline levels and in comparison with control (air-exposed) groups. However, sucrose consumption did not change in mice that were trained to drink 5% sucrose. The increase in ethanol consumption after chronic ethanol exposure and withdrawal experience resulted in a significant increase in resultant blood ethanol levels. CONCLUSIONS: Once the positive reinforcing properties of ethanol were established, chronic ethanol exposure and withdrawal experience resulted in a significant increase in voluntary ethanol drinking that yielded a >2-fold increase in resultant blood ethanol levels. This increase in ethanol intake occurred whether ethanol was presented in combination with sucrose, alone (unadulterated), or as a choice with tap water. Furthermore, this effect seems to be selective for ethanol in that animals that were trained to drink a sucrose solution did not exhibit a change in their intake after similar chronic ethanol exposure. As such, this model may be useful in studying the mechanisms and conditions in which chronic ethanol treatment influences motivation to resume drinking after a period of abstinence (relapse).

Alcohol Drinking↗
PubMed2003

The use and abuse of steroids in perinatal medicine.

Corticosteroids are one of the most powerful drugs increasingly used in the perinatal and neonatal period. This review discusses the merits and demerits of antenatal as well as postnatal use of steroids. A single course of antenatal corticosteroids in women at risk of premature delivery is highly effective in reducing respiratory distress syndrome (RDS), intraventricular haemorrhage and neonatal mortality and also neurodevelopmental sequelae including cerebral palsy. However, there is less evidence to support the practice of multiple courses of corticosteroids, with some animal and retrospective human studies suggesting an association with neurological impairment and reduction in birth weight as well as lung weight. Postnatal systemic corticosteroids have shown benefits in reducing chronic lung disease and improving survival for infants. However, besides short-term adverse effects, the follow-up studies have raised concern that they may increase the risk of neurodevelopmental disability, particularly cerebral palsy in survivors. Systemic corticosteroids may have a role in infants who had repeated and prolonged intubations and those with pressor-resistant hypotension. Alternative strategies for prevention of chronic lung disease, such as inhaled steroids, methylprednisolone and hydrocortisone, may need further studies with larger sample sizes. Data from animal research have revealed that fetal glucocorticoid exposure may have a role in programming the individual to adult degenerative diseases. Based on the current evidence, it is recommended that women at risk of preterm delivery receive a single course of glucocorticoids. Randomised controlled trials are needed to establish the true effects of multiple courses of antenatal corticosteroids. More research is also needed to study the long-term neurodevelopmental outcome of both multiple courses of antenatal corticosteroids, as well as postnatal corticosteroid therapy.

Animals↗
PubMed1988

Repeated intranasal cocaine administration: lack of tolerance to pressor effects.

Three healthy adult male volunteers were allowed to self-administer 96 mg or 4 mg (a dose without measurable effects) of inhaled cocaine approximately once every 35 min during experimental sessions lasting up to 6 h. Heart rate (HR), blood pressure and self-report of drug effects were measured. After inhaling, on average, four doses of 4 mg, subjects voluntarily ended the session. Five out of the six sessions of 96 mg cocaine availability, however, were terminated due to consistent elevated diastolic blood pressure (DP), rather than by subject request. During 96 mg sessions, HR and self-report data either rapidly reached an asymptote or showed a slow rate of increase. Blood pressure, on the other hand, increased throughout the session, generally to the point where the session had to be terminated. These findings suggest the possibility that the rate of development of tolerance to the effects of cocaine may vary as a function of the dependent variable. In addition, the consistent increase in pressor effects may well be a mechanism for the increased cardiovascular toxicity reported for cocaine abusers.

Administration, Intranasal↗
PubMed2003

[Drugs use among adolescents: results from the National Survey on Addictions, 1998].

OBJECTIVE: The aim of this paper is to describe drug and associated factors use among adolescents (12 to 17 years of age). MATERIAL AND METHODS: Data come from the recent Encuesta Nacional de Adicciones, 1998 (National Survey on Addictions) undertaken in urban areas of Mexico. A probabilistic, multi-stage, stratified cluster sampling design was used to select the study population. The sampling unit was the individual in each household. Statistical analysis consisted of the estimation of prevalences of drug use, with 95% confidence intervals. Associations were analyzed using logistic regressions models. RESULTS: Excluding tobacco and alcohol, 3.57% of males and 0.6% of females have used one or more drugs; 2.14% and 0.45% used them in the 12 months previous to the survey, and 1.4% and 0.3% in the previous 30 days, respectively. Marihuana was the drug more often used by males (2.4%) and females (0.45%), followed by inhaled solvents (1.08% and 0.20%), and cocaine (0.99% and 0.22%), respectively. The risk of using illicit drugs was associated to being male, having dropped out from school, perceiving availability, drug use by family and friends, social tolerance among friends, and symptoms of depression. CONCLUSIONS: Adolescents between 12 to 17 years of age are exposed to increasing drug use. The rates of drug use have risen, especially in the northern region of Mexico and in the big urban areas (Tijuana, Mexico City and Guadalajara). These findings emphasize the need to develop campaigns to detect emotional problems. Preventive measures should provide appropriate care to prevent drug use as a mechanism to cope with such emotional conflicts. Also, more intense preventive interventions should be targeted to adolescents with a high probability of developing drug abuse.

Adolescent↗
PubMed1986

Acute cardiac events temporally related to cocaine abuse.

The increasingly widespread use of cocaine in the United States has been accompanied and perhaps exacerbated by the misconception that the drug is not associated with serious medical complications. In particular, the potential for cocaine to precipitate life-threatening cardiac events needs to be reemphasized. We report the clinical and pathological findings in seven people in whom nonintravenous "recreational" use of cocaine was temporally related to acute myocardial infarction, ventricular tachycardia and fibrillation, myocarditis, sudden death, or a combination of these events. We also review data on 19 previously reported cases of cocaine-related cardiovascular disorders. Analysis of all 26 patients indicated the following findings: the cardiac consequences of cocaine abuse are not unique to parenteral use of the drug, since nearly all the patients took the drug intranasally; underlying heart disease is not a prerequisite for cocaine-related cardiac disorders; seizure activity, a well-documented noncardiac complication of cocaine abuse, is neither a prerequisite for, nor an accompanying feature of, cardiac toxicity of cocaine; and the cardiac consequences of cocaine are not limited to massive doses of the drug. Although the pathogenesis of cardiac toxicity of cocaine remains incompletely defined, available circumstantial evidence suggests that cocaine has medical consequences that are equal in importance to its well-documented psychosocial consequences.

Administration, Inhalation↗
PubMed1978

Use and abuse of oxygen in the newborn.

Hypoxia must be prevented in the newborn. It causes atelectasis, acidosis and pulmonary vasoconstriction, which leads to further hypoxia and, ultimately, brain damage. On the other hand, retrolental fibroplasia and bronchopulmonary dysplasia may result from too-vigorous use of oxygen therapy. Frequent blood gas measurements are required. Administered oxygen must be humidified and heated, and the oxygen concentration must be monitored with each delivery system. It is not enough to know the oxygen flow rate; an oxygen analyzer is essential.

Heating↗
PubMed2001

[An epidemiological study of spongiform leucoencephalopathy among heorin abusers].

OBJECTIVE: To understand the distribution and related risk factors of heroin spongiform leucoencephalopathy among drug users in coastland of Guangdong Province. METHODS: A cross-sectional study was conducted in four thousand four hundred and twenty eight drug users from eighteen detoxification organizations in six cities on coastland of Guangdong, using clustered random sampling methods. The six cities are Chaoyang (714), Heyuan (462), Shantou (572), Huidong (1286), Guangzhou (871) and Zhanjiang (523) and heroin abuse was considered serious in these cities. Questionnaire was used to collect the data on sex (man 3632, 82 percent; woman 795, 18 percent), age (minimum 15y, maximum 54y), duration of using heroin (minimum 1 month, maximum 150 months), daily dosage (minimum 0.02 g, maximum 6.0 g) and manner of using heroin. In addition, the neurological examination was taken in all of them and cerebral MRI was carried out in those with signs of cerebellar ataxia. RESULTS: Results showed that the total incidence of heroin spongiform leucoencephalopathy in six cities is 3.16 per thousand. Poisson regression analysis showed that the incidence was related to residential areas. In comparison with other cities, there are higher incidences in Chaoyang and Heyuan. Our investigation also showed that all the patients with this disease used heroin by inhaling the pyrolysate. The incidence of heroin spongiform leucoencephalopathy was unrelated to the daily inhaling amount of heroin and the duration of inhaling heroin. No differences could be observed between the groups of different age and sex. CONCLUSIONS: Spongiform leucoencephalopathy after inhalation of heroin is a rare complication and has never been reported in mainland of China before. The lesions are symmetrical and spongiform, but not necrotic and the cerebellum is invariably involved--a feature consistent with the clinical presentation that begins with ataxia. Cerebral CT showed symmetrical non-enhancing hypodense areas in both cerebellar hemispheres. Cerebral MRI showed the corresponding areas with decreased signal intensity on T1 weighted images and increased signal intensity on T2 weighted images. There was no contrast enhancement. When it occurs, several cases are affected as a small epidemic. It is suggested that the aetiology is related to the heroin batch and could perhaps be a toxic effect of a substance which came from heroin pyrolysis.

Administration, Inhalation↗
PubMedDate not supplied

Drug use and associated factors among rural adolescents in Costa Rica.

The objectives of this study, carried out in 1995, were to assess both licit and illicit substance use among rural male and female Costa Rican adolescents, and associated health, psychological, and psychosocial problems. A sample of 304 students from rural schools was randomly selected. The mean age for females was 14.7 years (S.D. = 1.71), and for males was 14.4 years (S.D. = 1.62). The data were collected using the Latin-American version of Drug Use Screening Inventory (DUSI). Results showed a high prevalence of past-year alcohol use for both males and females (56.6% and 47.4%, respectively), and a lower prevalence of past-year tobacco use (44.0% and 7.7%). There results also showed a low level of use of solvent inhalants and benzodiazepines. In terms of illicit drugs, males preferred cocaine and marijuana, while females only reported amphetamine use. An analysis of adolescent functioning showed differences among alcohol users and nonusers in behavior patterns and peer relationships. However, no significant differences were found regarding rebellion, depression, and social isolation. The implications of these results are discussed, along with the importance of enhancing prevention, as well as early detection and intervention.

Adolescent↗