bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a single course of corticosteroids given more than 7 days before birth: A systematic review
Authors: McLaughlin Kristin J. , Crowther Caroline A. , Walker Natalie , Harding Jane E.
Published: December 2004

Objectives: To determine the risk of fetal, neonatal and maternal mortality and morbidity for women and their infants who remained undelivered more than 7 days following a course of prenatal corticosteroids.

Design: Systematic review.

Population: Women who gave birth more than 7 days after a course of prenatal corticosteroids compared with women not administered corticosteroids.

Methods: Seven randomised controlled trials were identified which reported outcomes for women and their babies who remained undelivered more than 7 days after exposure to a single course of corticosteroids compared with a placebo/no treatment group.

Main outcome measures: Fetal, neonatal and maternal mortality and morbidity.

Results: Seven trials involving 862 infants, 434 born to corticosteroid treated women and 428 to control women were included in this review. For corticosteroid treated infants there was no reduction in the risk of respiratory distress syndrome (relative risk (RR), 0.72; 95% confidence interval (CI), 0.49–1.07), or stillbirth (RR, 1.67; 95% CI, 0.86–3.25). However, there was a tripling in risk of death for liveborn corticosteroid treated infants (RR, 3.24; 95% CI, 1.32–7.96; P = 0.01), and a doubling in risk of perinatal mortality (RR, 2.13; 95% CI, 1.27–3.57; P < 0.01). Corticosteroid treated infants were born on average 5 days earlier than controls (95% CI, −9.15 to −0.85 days, P = 0.02). Their mothers were more likely to have chorioamnionitis (RR, 2.91; 95% CI, 1.25–6.74; P = 0.01).

Conclusions: Infants exposed to corticosteroids more than 7 days before birth had no reduction in risk of respiratory distress syndrome but increased perinatal mortality.
Role of Ca2+ in corticosterone‐induced muscle growth retardation
Authors: DOI Junko , HARA Tomoko , OHTSUKA Akira , HAYASHI Kunioki
Published: December 2004

The increased plasma glucocorticoid concentration in stressful conditions stimulates muscle protein degradation, and results in growth retardation in animals. However, the mechanism is still to be clarified. The present study was undertaken to examine the participation of Ca2+ in the glucocorticoid action, using nifedipine (NIF), a Ca2+ channel antagonist. The effects of NIF on growth, differentiation, and protein degradation were examined in glucocorticoid‐treated primary cultured chick muscle cells. Muscle cell growth and cell differentiation were assessed by protein content and creatine kinase (CK) activity, respectively, and the rate of myofiblillar protein degradation was estimated by the release of Nτ‐methylhistidine (MeHis). Creatine kinase activity was increased by corticosterone (CTC) and this effect was minimized by NIF. Protein content was decreased by CTC and normalized by NIF. Nτ‐methylhistidine release was significantly increased by CTC and tended to be minimized by NIF. The present results indicate that CTC increases skeletal muscle proteolysis followed by muscle growth retardation partially because of enhanced Ca2+ influx through the NIF‐sensitive Ca2+ channel. Enhanced muscle differentiation by CTC is mediated also by the NIF‐sensitive Ca2+ channel.
Chemical compositions, feed intakes and digestibilities of crop residue based rations in non‐lactating Red Sokoto goats in the subhumid zone of Nigeria
Authors: MALAU‐ADULI Bunmi S. , EDUVIE Lawrence , LAKPINI Clarence , MALAU‐ADULI Aduli E. O.
Published: December 2004

The present study was conducted to evaluate the chemical composition, intake and digestibility of crop residue based rations by Red Sokoto goats maintained on natural pastures and Digitaria smutsii hay during the dry season of the year. Twenty‐eight non‐lactating does were blocked for weight and assigned to 7 treatment groups comprising 4 does each in a completely randomized design. Ration A, the conventional concentrate ration, was used as the positive control, Rations B and C were the two crop residue based test rations, while Ration D, the unsupplemented treatment, was used as the negative control. Each of the supplementation rations was fed at 1% and 2% of the doe's body weight. Ration A had the highest crude protein percentage of 17.19% while Rations B and C had 9.54 and 10.38%, respectively. The naturally grazed pastures and Digitaria smutsii hay (Ration D) contained the least protein: 2.76 and 4.75%, respectively. Ration D also had the highest percentages of acid detergent fiber, neutral detergent fiber and lignin (49.14, 74.73 and 9.49% in hay and 50.29, 8.27 and 11.5% in grazed pastures, respectively). Ration A on the other hand, had the lowest percentages of acid detergent fiber (20.00%), neutral detergent fiber (40.01%) and lignin (4.64%). The results indicated that the supplemented group of does had significantly higher (P < 0.05) dry matter and crude protein intakes as well as nutrient digestibilities than the unsupplemented groups. A comparison of the unsupplemented animals with all the other treatment groups revealed that dry matter digestibility improved by a range of 4.1–27.9%, while crude protein digestibility improved by 17.1–42.2%, the highest value being in does on Ration A. It was concluded that goats were able to subsist and make appreciable gains in the long dry season on crop‐based diets that compared favorably with the conventional concentrate rations. Of the two tested crop residue based rations, Ration C is a better supplementation package than Ration B.
Pipecolic acid in rumen fluid and plasma in ruminant animals
Authors: HUSSAIN‐YUSUF Hazizul , SULTANA Halima , TAKAHASHI Toshihiro , MORITA Tetsuo , SATO Hiroyuki , ITABASHI Hisao , ONODERA Ryoji
Published: December 2004

A survey was conducted to investigate the physiological levels of pipecolic acid (Pip) in rumen fluid and plasma of ruminants such as goats and cattle in the presence or absence of rumen protozoa. The concentration of Pip was determined using HPLC. Basal Pip levels in the rumen fluid and plasma of normal faunated animals were 21 ± 8 and 2.3 ± 1.3 µM, respectively, and levels increased 1–2 h after feeding. The Pip levels in the rumen fluid and plasma of faunated goats and cattle were significantly higher than those of defaunated goats and unfaunated cattle. A small amount of Pip was also found in the rumen fluids of the defaunated and unfaunated animals; this appeared to be derived from feeds such as hay cube and corn silage. The results obtained in the present study suggest that a significant amount of rumen‐produced Pip is likely to be absorbed into the plasma of the host animals and that rumen protozoa significantly enhance the concentration of Pip in the rumen fluid and plasma of ruminant animals.
Prevalence and correlates of intravenous methadone syrup administration in Adelaide, Australia
Authors: Humeniuk Rachel , Ali Robert , McGregor Catherine , Darke Shane
Published: December 2004

Aims  The aims of this study were to determine the prevalence of methadone syrup injecting in Adelaide, South Australia and to characterize methadone injectors, including their heroin use and risk behaviours associated with heroin overdose.

Design  Cross‐sectional design.

Setting  Community setting, principally metropolitan Adelaide.

Participants  Current heroin users (used heroin in the last 6 months), recruited through snowballing.

Measurements  Structured questionnaire.

Findings  Of 365 participants, 18.4% reported having ever injected methadone syrup and 11.0% had injected methadone in the last 6 months. Those that had injected methadone were more likely to be male, and were more likely to be receiving methadone maintenance. They were also maintained on higher doses of methadone than subjects not injecting methadone. A history of methadone injection was associated with more heroin overdose experiences and greater dependence on heroin. Methadone injectors were also more likely to engage in risky behaviours associated with heroin overdose, including using heroin when no other people were present, not trial‐tasting new batches of heroin and polydrug use.

Conclusions  Methadone syrup injectors appear to be at greater risk of a series of harms than subjects not injecting methadone. The prevalence of methadone syrup injecting in Adelaide, South Australia was 11%, which was lower than prevalence in Sydney, New South Wales, but higher than in Melbourne, Victoria. Jurisdictional differences concerning the prevalence of methadone syrup injecting may reflect differing policies by each state to methadone dispensing.
Trends in drug overdose deaths in England and Wales 1993–98: methadone does not kill more people than heroin
Authors: Hickman Matthew , Madden Peter , Henry John , Baker Allan , Wallace Chris , Wakefield Jon , Stimson Gerry , Elliott Paul
Published: December 2004

Aims  To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends.

Design and setting  Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug‐related poisoning mortality database from 1993 to 1998 in England and Wales.

Measurements  Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone‐related overdose compared to dying from heroin/morphine overdose.

Findings  From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22–28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6–13%) for methadone only. This difference was significant (P < 0.001 by test of interaction) after adjustment for sex, age group, polydrug use, area of residence and underlying cause of death. The largest number of deaths occurred on Saturday (673). The OR of death from methadone overdose on Saturday and Sunday was 1.48 (95% CI 1.29–1.71) for methadone‐only deaths compared to dying from heroin/morphine at the weekend after adjustment for other covariates, but the OR was not significant (1.09, 95% CI 0.95–1.25) if the weekend was defined as Friday and Saturday.

Conclusions  There was no evidence that the threefold increase in deaths over time was due to methadone. There was equivocal support only for the hypothesis that there was an excess of deaths from methadone at weekends. Increased interventions to prevent overdose among injectors in England and Wales are long overdue.
Estimating prevalence of problem drug use at national level in countries of the European Union and Norway
Authors: Kraus Ludwig , Augustin Rita , Frischer Martin , Kümmler Petra , Uhl Alfred , Wiessing Lucas
Published: December 2004

Objectives  This paper will present the most recent estimates for problematic drug use in European Member States and explore the problems of comparability.

Methods  Estimates of problematic drug use, derived according to agreed guidelines, were collected from all EU countries and Norway. Methods included multipliers based on treatment, police, mortality or AIDS/HIV data, the capture–recapture method and the multivariate indicator method. Prevalence estimates were transformed into rates per 1000 population aged 15–64 years.

Results  Target populations varied according to data selection. Estimates for six partially overlapping types of drug use could be identified: ‘problem opiate use’, ‘problem opiate or cocaine use’, ‘problem amphetamine or opiate use’, ‘problem drug use’, ‘(current) injecting’ and ‘life‐time injecting’. Rates of injectors ranged from 2.6 in Germany to 4.8 in Luxembourg; rates in Austria, Denmark, Finland, Portugal and the United Kingdom fell within this range. For problem opiate use, a group of high prevalence countries were found with average rates exceeding six cases (Italy, Luxembourg, Spain and the United Kingdom) and a group with lower prevalence with average rates close to three cases (Austria, Germany, Ireland, the Netherlands). Rates obtained for France (problem opiate or cocaine use), Finland and Sweden (problem amphetamine or opiate use) are not directly comparable and fall between these rates.

Conclusions  Cross‐national comparisons should be made with care and estimated target populations may vary greatly between countries. For estimating various forms of problem drug use at national level, a multi‐method approach is recommended.
Linking alcohol‐ and drug‐dependent adults to primary medical care: a randomized controlled trial of a multi‐disciplinary health intervention in a detoxification unit
Authors: Samet Jeffrey H. , Larson Mary Jo , Horton Nicholas J. , Doyle Kathleen , Winter Michael , Saitz Richard
Published: December 2004

Aim  Pragmatic approaches to integration of medical care and substance abuse treatment are desired. We assessed the effectiveness of a novel multi‐disciplinary clinic for linking patients in a residential detoxification program to primary medical care.

Participants  We enrolled patients undergoing in‐patient detoxification from alcohol, heroin or cocaine who had no primary care physician into a randomized controlled trial. The intervention consisted of a clinical evaluation at the detoxification unit in the health evaluation and linkage to primary care (HELP) clinic by a nurse, social worker and physician and facilitated referral to an off‐site primary care clinic. The primary outcome of interest was attendance at a primary care appointment within 12 months. Secondary outcomes assessed over 24 months were addiction severity, health‐related quality of life, utilization of medical and addiction services and HIV risk behaviors.

Findings  Of the 470 subjects enrolled, 235 were randomized to the HELP clinic intervention. Linkage to primary medical care occurred in 69% of the intervention group compared to 53% in the control group (P = 0.0003). The clinic was similarly effective for subjects with alcohol and illicit drug problems. Randomization to the HELP clinic resulted in no significant differences in secondary outcomes.

Conclusions  The HELP clinic, a multi‐disciplinary clinic located in a detoxification unit, effectively linked alcohol‐ and drug‐dependent individuals to primary medical care. This intervention utilized a ‘reachable moment’, the period of addiction care, as a window of opportunity for linking substance abusers to medical care.
Use of morphine and 6‐monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin users
Authors: Fugelstad Anna , Ahlner Johan , Brandt Lena , Ceder Gunnel , Eksborg Staffan , Rajs Jovan , Beck Olof
Published: December 2004

Aims To detect risk factors for sudden death from heroin injection.

Design Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6‐monoacetylmorphine (6‐MAM) in blood were included in order to select heroin intoxication cases.

Setting Stockholm, Sweden.

Measurements Autopsy investigation and toxicological analysis of blood and urine; and police reports.

Findings In two‐thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6‐MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one‐quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6‐MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6‐MAM blood concentrations.

Conclusions We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
Short‐term outcomes after brief ambulatory opioid detoxification with buprenorphine in young heroin users
Authors: Gandhi Devang H. , Jaffe Jerome H. , McNary Scot , Kavanagh Greg J. , Hayes Michael , Currens Marian
Published: December 2004

Aims  This study examines the outcomes at 1, 3 and 6 months after a very brief outpatient detoxification with buprenorphine in 18–25‐year‐old heroin users.

Design  Prospective follow‐up study.

Setting  Outpatient drug treatment clinic, providing brief detoxification in downtown Baltimore, Maryland, USA.

Participants  One hundred and twenty‐three subjects between 18 and 25 years old; 56% male; 95% Caucasian; seeking detoxification; living in Baltimore City and five surrounding counties.

Intervention  Detoxification with buprenorphine over 3 days. Follow‐up at 1, 3 and 6 months.

Measurements  Drug use history, the Addiction Severity Index at baseline and follow‐up, urine drug screens, evaluation of the detoxification experience.

Findings  By self‐report, 37% of the total sample were not currently using heroin at 1 month, 32% at 3 months and 29% at 6 months, and 6.7%, 10.1% and 11.8% had an opioid negative urine test at 1, 3 and 6 months, respectively. There was a significant reduction from the baseline in mean Addiction Severity Index drug use composite score, as well as the mean number of days of heroin and cocaine use during past 30 days, that was sustained over the three follow‐up points. Engagement in aftercare was generally poor.

Conclusions  The findings show a reduced frequency and intensity of drug use, suggesting a possible role for brief outpatient detoxification in reducing the severity of dependence for some younger heroin users who may not yet be ready to engage in long‐term abstinence‐oriented or opioid substitution treatments.
Buprenorphine versus methadone maintenance therapy: a randomized double‐blind trial with 405 opioid‐dependent patients
Authors: Mattick Richard P. , Ali Robert , White Jason M. , O'Brien Susannah , Wolk Seija , Danz Cath
Published: December 2004

Aims  To assess the efficacy of buprenorphine compared with methadone maintenance therapy for opioid dependence in a large sample using a flexible dosing regime and the marketed buprenorphine tablet.

Design  Patients were randomized to receive buprenorphine or methadone over a 13‐week treatment period in a double‐blind, double‐dummy trial.

Setting  Three methadone clinics in Australia.

Participants  Four hundred and five opioid‐dependent patients seeking treatment.

Intervention  Patients received buprenorphine or methadone as indicated clinically using a flexible dosage regime. During weeks 1–6, patients were dosed daily. From weeks 7–13, buprenorphine patients received double their week 6 dose on alternate days.

Measurements  Retention in treatment, and illicit opioid use as determined by urinalysis. Self‐reported drug use, psychological functioning, HIV‐risk behaviour, general health and subjective ratings were secondary outcomes.

Findings  Intention‐to‐treat analyses revealed no significant difference in completion rates at 13 weeks. Methadone was superior to buprenorphine in time to termination over the 13‐week period (Wald χ2 = 4.371, df = 1, P = 0.037), but not separately for the single‐day or alternate‐day dosing phases. There were no significant between‐group differences in morphine‐positive urines, or in self‐reported heroin or other illicit drug use. The majority (85%) of the buprenorphine patients transferred to alternate‐day dosing were maintained in alternate‐day dosing.

Conclusions  Buprenorphine did not differ from methadone in its ability to suppress heroin use, but retained approximately 10% fewer patients. This poorer retention was due possibly to too‐slow induction onto buprenorphine. For the majority of patients, buprenorphine can be administered on alternate days.
Defining ‘current drinkers’ in national surveys: results of the 2000 National Alcohol Survey
Authors: Midanik Lorraine T. , Greenfield Thomas K.
Published: December 2004

Aims  The purpose of this study is to determine which respondents of national surveys who report low ‘usual’ past year drinking frequency, are unsure of their drinking frequency or refuse to answer, are misclassified either as ‘current drinkers’ or as ‘ex‐drinkers.’

Design and setting  The data are from the 2000 National Alcohol Survey, a national household telephone probability sample of adults in all 50 US States and Washington, DC (n = 7612).

Participants  A subsample of 1734 respondents who reported drinking ‘less than once a month but at least once a year’, ‘less than once a year’, ‘refused’ and ‘don’t knows’ were also asked if they had consumed a whole drink of any alcoholic beverage in the 12 months using dates to anchor the question.

Measurements  Five alcohol measures were used to compare groups who changed or did not change their drinking status based on the followup question: volume, mean number of days 5 +, social consequences, dependence symptoms and DSM‐IV.

Findings  The results indicate that only 4.6% of respondents (n = 349) changed their drinking status, and the percentages were equal in both directions. Women were more likely to change their drinking status and specifically become ex‐drinkers based on the follow‐up question. Respondents who became current drinkers drank significantly at a lower average volume than those who remained current drinkers. The prevalence rates based on the five alcohol measures were not affected by how ‘current drinker’ is defined.

Conclusions  Adding the follow‐up question is recommended for new alcohol surveys so that fewer respondents are misclassified.
Delphi survey of experts’ opinions on strategies used by community pharmacists to reduce over‐the‐counter drug misuse
Authors: McBride Andrew J. , Pates Richard , Ramadan Reem , McGowan Christopher
Published: December 2004

Aim  To explore the views of experts within the fields of pharmacy and addiction on the value of current strategies and possible alternatives and to reach an agreement on best practice in the sale of over‐the‐counter (OTC) medicines which are liable to misuse.

Design  Using a modified Delphi approach, an anonymous, international, three‐stage, postal questionnaire was conducted that generated both qualitative and quantitative data.

Participants  Of those contacted by telephone (164) from the United Kingdom, Australia, Canada, New Zealand and United States, 109 experts (66%) agreed to take part. Forty‐three per cent (47/109) completed all three stages of the study.

Measurements  A Delphi technique was employed to gather data. The second and final questionnaires were constructed from the responses to the preceding questionnaires. Content analysis of the qualitative data was carried out at each stage. Statistical analyses of the influence of demographic factors, degree of shift in overall opinion between the first and second stages and degree of agreement between respondents at each stage were also conducted.

Findings  A consensus was reached on the strategies considered the most important and effective. Key areas include improving access to current information, improved staff training, addressing the issues of non‐pharmacy outlets and Internet pharmacy sites. Concerns were expressed regarding the possible conflict between commercial and customer interests.

Conclusions  The consensus view presented offers practical and realistic guidance for policy‐makers and community pharmacists on the sale of OTC products. It reflects the best evidence to date of expert views in this area and accords with current UK guidelines. The effective implementation of these strategies can only be achieved with improved communication and coordination at local and national level.
Efficacy of exercise counselling as an aid for smoking cessation: a randomized controlled trial
Authors: Ussher Michael , West Robert , McEwen Andy , Taylor Adrian , Steptoe Andrew
Published: December 2004

Aim  To examine whether exercise counselling increases smoking abstinence and reduces tobacco withdrawal and gains in weight and body fat.

Design  A randomized controlled trial.

Setting  A community‐based stop smoking clinic.

Participants  Two hundred and ninety‐nine male and female smokers.

Intervention  Participants were assigned randomly to a 7‐week smoking cessation programme, including nicotine replacement therapy plus either (i) exercise counselling, or (ii) health education advice with equal contact time as for the exercise counselling condition.

Measurements  Six weeks of smoking abstinence was confirmed by expired carbon monoxide.

Findings  There was no significant difference in smoking abstinence between the exercise group (n = 154) and the controls (n = 145) at 6 weeks (39.6% versus 38.6%), nor was there any difference in gains in weight or body fat, although those in the exercise group increased their exercise levels. Exercise participants reported less tension, anxiety and stress than the controls during the first week of smoking abstinence (P = 0.03, 0.01 and 0.04, respectively), less irritability throughout 2 weeks of abstinence (P = 0.03), and less restlessness throughout 3 weeks of abstinence (P = 0.04).

Conclusions  Adding brief exercise counselling to a smoking cessation programme did not increase smoking abstinence or reduce gains in weight or body fat significantly, although exercise levels were raised and there were some beneficial effects on psychological symptoms.
Longer‐term primary prevention for alcohol misuse in young people: a systematic review
Authors: Foxcroft D. R. , Ireland D. , Lister‐Sharp D. J. , Lowe G. , Breen R.
Published: December 2004

Objective  To identify and summarize rigorous evaluations of psychosocial and educational interventions aimed at the primary prevention of alcohol misuse by young people aged up to 25 years, especially over the longer term (>3 years).

Methods  Cochrane Collaboration Systematic Review.

Data sources  A comprehensive search of 22 databases and recursive checking of bibliographies for randomized and non‐randomized controlled trials and interrupted time‐series studies.

Main outcome measures  Objective or self‐report measures of alcohol use and misuse.

Results  Fifty‐six studies were selected for inclusion in the systematic review. Twenty of the 56 studies showed evidence of ineffectiveness. No firm conclusions about the effectiveness of prevention interventions in the short‐ and medium term were possible. Over the longer term (>3 years), the Strengthening Families Programme (SFP) showed promise as an effective prevention intervention. The Number Needed to Treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkenness) was 9 (for all three behaviours). One study also highlighted the potential value of culturally focused skills training over the longer‐term (NNT = 17 over 3.5 years for 4+ drinks in the last week)

Conclusions  (1) Research into important outcome variables needs to be undertaken; (2) the methodology of evaluations needs to be improved; (3) the SFP needs to be evaluated on a larger scale and in different settings; (4) culturally focused interventions require further development and rigorous evaluation; and (5) an international register of alcohol and drug misuse prevention interventions should be established and criteria agreed for rating prevention interventions in terms of safety, efficacy and effectiveness.
Evaluation of the effects of lofexidine and clonidine on naloxone‐precipitated withdrawal in opioid‐dependent humans
Authors: Walsh Sharon L. , Strain Eric C. , Bigelow George E.
Published: December 2004

Aims  To examine the efficacy of lofexidine, an α2 adrenergic agonist, to suppress opioid withdrawal symptoms in opioid‐dependent humans under in‐patient laboratory conditions by using a naloxone challenge procedure.

Design  Randomized, within‐subject, cross‐over design with drug administration taking place under double‐blind and triple‐dummy conditions.

Setting  A 14‐bed in‐patient hospital research unit dedicated to the conduct of behavioral pharmacology studies.

Participants  Eight healthy adult volunteers (two female/six male) with histories of polysubstance abuse and current physical dependence on opioids.

Intervention  Participants were stabilized onto methadone and maintained on 30 mg/day, p.o. throughout the study. Oral placebo, lofexidine (0.4, 0.8 and 1.6 mg, p.o.) and clonidine (0.1 and 0.2 mg, p.o.) were each tested as pre‐treatments once in combination with each of three intramuscular naloxone doses (0, 0.1 and 0.3 mg, i.m.) during 18 separate experimental sessions.

Measurements  An array of physiological indices (e.g. heart rate, blood pressure, pupil diameter) as well as a number of subjective and observer‐rating scales sensitive to opioid withdrawal effects.

Findings  As expected, lofexidine and clonidine both produced dose‐related decreases in blood pressure and heart rate but few subjective effects; naloxone increased opioid withdrawal signs and symptoms in a dose‐ and time‐dependent fashion. Although both lofexidine and clonidine reduced the cardiovascular response to naloxone challenge, close inspection of the data reveal that this occurred only to the extent that baseline physiological parameters were reduced, while neither drug significantly modified the overall magnitude of the response to naloxone. Moreover, neither lofexidine nor clonidine suppressed the subjective discomfort of opioid withdrawal or significantly reduced other autonomic signs of opioid withdrawal, such as lacrimation or rhinorrhea.

Conclusions  These data suggest that lofexidine is well tolerated even at supratherapeutic acute doses. However, its failure to modify most signs and symptoms of opioid withdrawal suggest that its effective use in spontaneous withdrawal will require concomitant medications for improved therapeutic response.
Alcohol: No Ordinary Commodity. A summary of the book
Authors:   Alcohol & Public Policy Group
Published: December 2004

This article summarizes the contents ofAlcohol: No Ordinary Commodity—Research and public policy(Baboret al. 2003). The first part of the book describes why alcohol is no ordinary commodity, and presents epidemiological data on the global burden of alcohol‐related problems. The second part of the book reviews the scientific evidence for strategies and interventions designed to prevent or minimize alcohol‐related harm: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drinking‐driving countermeasures, regulating alcohol promotion, education and persuasion strategies and treatment services. The final section considers the policymaking process on the local, national and international levels, and provides a synthesis of evidence‐based strategies and interventions from a policy perspective.
Major depression in patients with substance use disorders: relationship to 12‐Step self‐help involvement and substance use outcomes
Authors: Kelly John F. , McKellar John D. , Moos Rudolf
Published: December 2004

Aims  Many patients treated for substance use disorders (SUDs) who become involved in 12‐Step self‐help groups have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), among SUD patients in particular, concerns have been raised over whether these benefits extend to dual diagnosis patients. This study examined the influence of comorbid MDD among patients with SUDs on 12‐Step self‐help group involvement and its relation to treatment outcome.

Design  A quasi‐experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years postdischarge.

Participants  A total of 2161 male patients recruited during in‐patient SUD treatment, of whom 110 had a comorbid MDD diagnosis (SUD‐MDD) and 2051 were without psychiatric comorbidity (SUD‐only).

Findings  SUD‐MDD patients were initially less socially involved in and derived progressively less benefit from 12‐Step groups over time compared to the SUD‐only group. However, substance use outcomes did not differ by diagnostic cohort. In contrast, despite using substantially more professional out‐patient services, the SUD‐MDD cohort continued to suffer significant levels of depression.

Conclusions  Treatment providers should allocate more resources to targeting depressive symptoms in SUD‐MDD patients. Furthermore, SUD‐MDD patients may not assimilate as readily into, nor benefit as much from, traditional 12‐Step self‐help groups such as Alcoholics Anonymous, as psychiatrically non‐comorbid patients. Newer, dual‐diagnosis‐specific, self‐help groups may be a better fit for these patients, but await further study.
Contextual factors and youth tobacco use: policy linkages
Authors: Chaloupka Frank J.
Published: December 2004

This paper provides a short commentary on the set of papers contained in this special issue that discuss various contextual factors that affect youth smoking. It highlights the interrelationships between the economic and policy factors, media influences, community factors, peer influences and familial factors that impact on youth smoking. Particular emphasis is given to the direct effects of prices and policies on youth smoking, and to the indirect effects of these factors as they work through the other contextual factors.
The case for studying multiple contexts simultaneously
Authors: Cook Thomas D.
Published: December 2004

Individuals live in multiple social contexts simultaneously, whether they be family, peer, neighborhood, school or work contexts. In individual lives, it is likely that the forces within any one context that promote healthy human development are correlated with whatever causal forces operate to the same end in other contexts. This paper explores why it is important to consider social contexts, not singly as in traditional neighborhood or school or work‐site research, but in combination.
Familial influences on adolescent smoking
Authors: Avenevoli Shelli , Merikangas Kathleen Ries
Published: December 2004

The family unit is the primary source of transmission of basic social, cultural, genetic, and biological factors that may underlie individual differences in smoking. Existing information on the role of familial factors in tobacco use is characterized by two separate, but somewhat overlapping, lines of research: genetic epidemiological studies and risk‐factor research. The present paper summarizes and evaluates studies assessing the association between adolescent smoking and parent and sibling smoking behaviors. A review of 87 studies reveals that methods are limited by a lack of standardized instruments, failure to measure important confounding and mediating factors, reliance on cross‐sectional designs and the use of inconsistent definitions of tobacco‐related behavior and assessment procedures. Moreover, there are no systematic family studies of the acquisition and continuation of smoking that have employed contemporary methodological standards for examining familial aggregation of tobacco behaviors among adolescents. Findings across studies show weak and inconsistent associations between parent and adolescent smoking; inconsistent findings may be attributed to methodological issues or associated factors that may complicate the relation between parent and adolescent smoking. Sibling and peer smoking show greater associations with adolescent smoking. Suggestions for future research include contemporary family studies that delineate meaningful phenotypes of tobacco use and prospective work on the later stages of tobacco use and the timing of the influence and valence of parent and family factors. Integration of the risk factor approach within the family study design may enrich both approaches to elucidate familial influences on smoking.
Theory, measurement, and methods in the study of family influences on adolescent smoking
Authors: Darling Nancy , Cumsille Patricio
Published: December 2004

This paper discusses three dilemmas faced by researchers interested in family influences in substance use: the transitional nature of adolescent smoking, the complexity and multi‐dimensionality of family forms and influences, and the inter‐relationship of family influences with other key developmental contexts. Methodological and conceptual issues stemming from these dilemmas are discussed with regard to understanding why previous reviews have found the correlations between family predictors and adolescent smoking to be relatively low. In particular, the importance of understanding time, the transitional nature of the phenomenon, and within‐ and between‐ family processes are emphasized. More appropriate conceptual and statistical models for analyzing family influences are suggested, including both mixed models and person‐centered approaches.
Peers and adolescent smoking
Authors: Kobus Kimberly
Published: December 2004

There is a considerable body of empirical research that has identified adolescent peer relationships as a primary factor involved in adolescent cigarette smoking. Despite this large research base, many questions remain unanswered about the mechanisms by which peers affect youths’ smoking behavior. Understanding these processes of influence is key to the development of prevention and intervention programs designed to address adolescent smoking as a significant public health concern. In this paper, theoretical frameworks and empirical findings are reviewed critically which inform the current state of knowledge regarding peer influences on teenage smoking. Specifically, social learning theory, primary socialization theory, social identity theory and social network theory are discussed. Empirical findings regarding peer influence and selection, as well as multiple reference points in adolescent friendships, including best friendships, romantic relationships, peer groups and social crowds, are also reviewed. Review of this work reveals the contribution that peers have in adolescents’ use of tobacco, in some cases promoting use, and in other cases deterring it. This review also suggests that peer influences on smoking are more subtle than commonly thought and need to be examined more carefully, including consideration of larger social contexts, e.g. the family, neighborhood, and media. Recommendations for future investigations are made, as well as suggestions for specific methodological approaches that offer promise for advancing our knowledge of the contribution of peers on adolescent tobacco use.
An ecological approach to understanding youth smoking trajectories: problems and prospects
Authors: Wilcox Pamela
Published: December 2004

Non‐random patterns of aggregate youth smoking rates and trajectories across communities suggest that individual‐level characteristics cannot account fully for the behavior in question. Instead, at least part of the explanation must lie somewhere within the community context. Such community‐level contextual effects can impact directly both group and individual‐level behavior (e.g. main effects), and they can also condition the effects of individual‐level factors on individual behaviors (e.g. moderating effects). This paper reviews previous research examining community‐level contextual effects regarding smoking and substance use more generally and identifies important limitations of this extant work, thus defining an agenda for future empirical studies. Next, the (in)compatibility of previous empirical findings with current theoretical models is discussed. In offering an alternative to these existing models, the paper concludes with presentation and discussion of a multi‐level, integrated model of adolescent smoking trajectories. In this model, community/institutional forces are presumed to impact smoking above and beyond individual‐level main effects. These posited community‐level forces are broad and varied, representing school characteristics, neighborhood demographic characteristics, religious culture, media influence, economic context, health services and so on. In addition to exhibiting contextual main effects, the effects of community in the proposed multilevel model can be mediated by community‐level processes, including the processes of control and socialization discussed herein. Also, community‐level characteristics may interact in producing certain tobacco‐use outcomes and, perhaps most importantly, they may moderate or condition the effects of interindividual differences on smoking.
Role of the media in influencing trajectories of youth smoking
Authors: Wakefield Melanie , Flay Brian , Nichter Mark , Giovino Gary
Published: December 2004

This paper summarizes results of empirical studies on cigarette advertising and promotions, antismoking advertising, product placement in movies, on television and in music media and news coverage about smoking. In addition, we provide an overview of some of the theoretical literature relevant to the study of media uses and effects. Finally, we discuss empirical findings in the context of these theories to draw some conclusions about media influences on smoking and identify issues for further research. We conclude that (a) the media both shape and reflect social values about smoking; (b) the media provide new information about smoking directly to audiences; (c) the media act as a source of observational learning by providing models which teenagers may seek to emulate; (d) exposure to media messages about smoking also provides direct reinforcement for smoking or not smoking; (e) the media promote interpersonal discussion about smoking; (f) the media can influence ‘intervening’ behaviors that may make teenage smoking less likely; and (g) antismoking media messages can also set the agenda for other change at the community, state or national level. We outline priorities for further research which emphasize the need for longitudinal studies, multi‐level studies, an awareness of the probably dynamic relationship between tobacco advertising and antismoking advertising, the importance of determining appraisal of tobacco industry youth smoking prevention efforts and the dearth of research on news coverage about smoking.
Prices, policies and youth smoking, May 2001
Authors: Liang Lan , Chaloupka Frank , Nichter Mark , Clayton Richard
Published: December 2004

Youth smoking continues to be an important public health problem. Many policy tools designed to reduce youth smoking are based on economic principles. This paper describes the economic and policy context of tobacco use aiming at reducing youth smoking and explains the economic rationale for tobacco control tools such as excise tax and price, clean indoor air laws, youth access laws and the broad provision of health information to the public. An overview of economic models of addiction provides the framework for empirical analysis of the impact of these policies. This is followed by a summary of the empirical evidence of the effectiveness of various tobacco control tools that are primarily economic in nature. The most consistent finding in this literature is that higher cigarette prices discourage youth smoking. Compared to the effects of cigarette taxation and price on youth smoking, the evidence on the effectiveness of the youth access laws and clean indoor air laws are still mixed and inconclusive. More research is needed to address issues such as: (1) the effects of gender, age, race and socio‐economic status on the relationship between tobacco control policies and youth smoking; (2) better measurement of the outcome variables to account for the multi‐dimensional nature of dependence; and (3) the effects of excise taxes and other tobacco control policies with regard to a host of dimensions of smoking such as initiation, cessation, and more generally the trajectories of tobacco use that would include patterns of progression, maintenance, regression, cessation, and relapse. More frequently collected longitudinal data than those currently available are needed to address the above issues. Understanding smoking behavior cannot be achieved without incorporating familial and other social contexts.
Political economy of youth smoking regulation
Authors: Pollack Harold A. , Jacobson Peter D.
Published: December 2004

This paper considers the political economy of tobacco regulation—that is, the interplay between politics and markets in tobacco regulation. In surveying the interest‐group politics of tobacco control, it describes political advantages held by a profitable and concentrated industry engaged in tobacco production. It also considers reasons for the surprising political success of tobacco control advocates over the past decade. The paper considers challenges faced by tobacco control advocates, who face their own obstacles to collective action in promoting effective tobacco regulation. Both public officials and tobacco control advocates face stronger incentives to advocate new legislation than they do to ensure effective implementation of existing regulatory measures. The essay concludes by considering the Master Settlement Agreement, whose detailed implementation remains uncertain after the election of the Bush administration.
Smoking: what does culture have to do with it?
Authors: Nichter Mark
Published: December 2004

In this commentary issues are raised relating to the role of ethnicity and ‘culture’ as a context influencing adolescent smoking. A processual rendering of culture is encouraged, as is an appreciation of intraethnic diversity. The question posed is ‘what is cultural about particular patterns, transitions and trajectories of smoking?’ Productive ways of investigating patterns of smoking which attend to class, ethnicity, gender norms, modernity and popular culture are focused upon as an ongoing project subject to both the identity needs of youth and the agenda of the tobacco industry. Promising areas of research are identified, as are the potential contributions of ethnographies of tobacco use.
Habitat occurrence and feeding ecology of Crocidura montis and Lophuromys flavopunctatus on Mt. Elgon, Uganda
Authors: Clausnitzer V. , Churchfield S. , Hutterer R.
Published: December 2004

The distribution, habitat occurrence and feeding ecology of Crocidura montis and Lophuromys flavopunctatus coexisting in the afro‐alpine zone on Mt. Elgon, Uganda, are described. Crocidura montis was the only shrew species occupying the afro‐alpine zone, but was not found in forested habitats below 3200 m. While there was considerable overlap in habitat occurrence between the two species, C. montis was most abundant in the montane grassland and in drier sites while L. flavopunctatus occupied a wider range of habitats and wetter sites. C. montis ate a diversity of invertebrates, the most important being Coleoptera, Araneae and Lumbricidae. Invertebrates, mostly Diptera larvae, Lumbricidae and Coleoptera, formed a major component of the L. flavopunctatus diets, plus plant material (particularly Hepaticae and monocots). The arthropod components of the diets reflected their abundance in pitfall samples.
Forest succession in Kibale National Park, Uganda: implications for forest restoration and management
Authors: Lwanga Jeremiah S.
Published: December 2004

Forest succession was studied in four plots in former grasslands at the Ngogo study area in Kibale National Park, Uganda. The plots were located in areas that had been protected from fire for 0.58, 25, 9 and ≈30 years for plots 1, 2, 3 and 4, respectively. Species richness reflected the length of time that the plot had been protected from fire; it was highest in plot 4 and lowest in plot 1. Species density, stem density and basal area were all highest in plot 4 and lowest in plot 1. The species densities of plots 2 and 3 were not different. Similarly, plots 2 and 4 did not differ with regard to stem density or basal area. Animal seed dispersers played a vital role in the colonization of grasslands by forest tree species.