bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptomatic pulmonary cryptococcosis in solid organ transplantation: report of four cases and review of the literature
Authors: Mueller N.J. , Fishman J.A.
Published: October 2003

Abstract: Cryptococcus neoformans is the third most common cause of invasive fungal infections in solid organ transplantation. The infection generally presents as disseminated disease, involving multiple sites including the central nervous system, lungs, and skin. An increase in the incidence of primary pulmonary cryptococcal infections has been reported recently in solid organ recipients; these infections were generally symptomatic with an accelerated clinical course. We report four cases of asymptomatic pulmonary cryptococcosis in solid organ recipients (kidney, n=2, heart, n=2). In each case, an incidental finding on a routine chest radiograph led to the microbiological or histopathological diagnosis of invasive pulmonary C. neoformans infection. In these patients, cryptococcosis occurred a median of 25 months (range 7–36 months) after organ transplantation. All patients had a calcineurin inhibitor, prednisone, and azathioprine or mycophenolate mofetil as part of their immunosuppressive therapy at the time of diagnosis. Serum cryptococcal antigen was available and positive in the three patients studied; assessment of cerebrospinal fluid (CSF) of all four patients revealed no organisms by smear or culture. Therapy consisted of oral fluconazole in all cases, with flucytosine in one case, combined with resection of lung tissue in two individuals. All patients have remained free of cryptococcal disease (follow‐up median 42 months, from 18 to 88 months). Cryptococcal disease in solid organ recipients may present as asymptomatic, localized pulmonary disease. The natural history of such infections is unknown. New pulmonary radiographic findings should prompt an aggressive diagnostic evaluation including serum and CSF cryptococcal antigen assays, and a biopsy of pulmonary lesions. Prolonged therapy may be used to reduce the risk of progression and dissemination during periods of intensified immune suppression.
Infectious complications following nonmyeloablative allogeneic hematopoietic stem cell transplantation
Authors: Busca A. , Locatelli F. , Barbui A. , Ghisetti V. , Cirillo D. , Serra R. , Audisio E. , Falda M.
Published: October 2003

Abstract:  Nonmyeloablative hematopoietic stem cell transplantation (NST) has been explored in hematological malignancies and solid tumors in an attempt to minimize treatment‐related toxicity. Whether this approach is associated with reduced risk of infectious complications is unclear. The aim of the current study was to evaluate the infectious complications in a series of 32 consecutive adult patients who received NST at our institution. Peripheral blood stem cell grafts (n=30) or marrow grafts (n=2) were infused from human leukocyte antibody (HLA)‐matched sibling (n=30), partially matched related (n=1), or unrelated (n=1) donors. Neutropenia developed in two‐thirds of patients and lasted 16 days. Acute graft‐versus‐host disease (GVHD) grade II to IV was observed in 25% of patients, whereas 35% of patients had signs of extensive chronic GVHD. Twenty‐two patients (69%) had at least one significant infectious episode. Bacteremia occurred in 19% of patients (n=5 gram‐positive, n=1 gram‐negative microorganisms). Cytomegalovirus (CMV) infection was observed in 10 out of 28 (36%) evaluable patients; 4 of these had recurrent or persistent CMV antigenemia requiring a second‐line treatment, but eventually the viremia cleared. No patients experienced CMV disease. Fungal infections were documented in five (16%) patients, comprising invasive fungal infections in two cases and mucosal fungal infections in three. Four patients died of transplant‐related causes, and three of these died before day +100. Infection was considered the primary cause of death in one patient (pulmonary aspergillosis) and contributed to death in another two. The actuarial probability of nonrelapse mortality at 100 days was 10% (95% confidence interval, 3–26%). Our preliminary results suggest that NST is associated to a low incidence of bacteremia or fungal and viral infections. Whether these findings would translate into an improved overall survival needs to be confirmed in larger prospective studies.
Increase of crevicular interleukin 1b under academic stress at experimental gingivitis sites and at sites of perfect oral hygiene
Authors: Deinzer R. , Förster P. , Fuck L. , Herforth A. , Stiller‐Winkler R. , Idel H.
Published: October 2003

Abstract. This study analyses the effects of academic stress on crevicular interleukin‐1b (Il‐1β) both at experimental gingivitis sites and at sites of perfect oral hygiene. Il‐1β is thought to play a predominant role in periodontal tissue destruction. 13 medical students participating in a major medical exam (exam group) and 13 medical students not participating in any exam throughout the study period (control group) volunteered for the study. In a split‐mouth‐design, they refrained from any oral hygiene procedures in two opposite quadrants for 21 days (experimental gingivitis) while they maintained perfect hygiene levels at the remaining sites. Crevicular fluid was sampled for further Il‐1b analysis at teeth 5 and 6 of the upper jaw at days 1, 5, 8, 11, 14, 18 and 21 of the experimental gingivitis period. Exam students showed significantly higher Il‐1b levels than controls both at experimental gingivitis sites (area under the curve, exam group: 1240.64±140.07; control group: 697.61±111.30; p=0.004) and at sites of perfect oral hygiene (exam group: 290.42±63.19; control group: 143.98±42.71; p=0.04). These results indicate that stress might affect periodontal health by increasing local Il‐1β levels especially when oral hygiene is neglected.
Microbiological features and crevicular fluid aspartate aminotransferase enzyme activity in early onset periodontitis patients
Authors: Kuru Bahar , Yilmaz Selçuk , Noyan Ülkü , Acar Okan , Kadýÿr Tanju
Published: October 2003

Abstract. Gingival crevicular fluid (GCF) reflects the immune and inflammatory reactions and the specific host‐microbe interactions that lead to periodontal diseases. Aspartate aminotransferase enzyme (AST) is one of the components of GCF that is released as a result of cell death. In this study, periodontal sites (4 sites/patient) with a probing depth of ≥5 mm in early onset periodontitis (EOP) patients were first examined for the AST levels in GCF by the PeriogardTM periodontal tissue monitor.To be eligible for the study, each of the patients had at least 1 AST positive site with clinical inflammatory changes (AST+, CIC+) and 1 AST negative site with no or minimum clinical inflammatory changes (AST−, CIC−). In 15 EOP patients who met the entry criteria, 30 AST+, CIC+ sites (1st group) and 19 AST−, CIC− sites (2nd group) were evaluated for microbiological variables. Certain microbial species, including Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia were detected more frequently (p<0.001, p<0.001 and p<0.05, respectively) in the 1st group, while gram‐positive facultative organisms such as Actinomyces species were found more often (p<0.001) in the 2nd group. Parallel to the AST levels, the 2nd group had a lower number of total bacteria and proportion of obligate anaerobic and capnophilic micro‐organisms than the first group (p<0.05 and p<0.05, respectively). Within the scope of this study, AST activity and microbiological data were found in agreement in the examined groups. These findings are encouraging and indicate the need for further studies to evaluate the ability of the AST test to differentiate the microbial flora of progressing sites and those that are inflamed, but not progressing.
A cross‐sectional study into the prevalence of root caries in periodontal maintenance patients
Authors: Reiker Jurgen , Van Der Velden Ubele , Barendregt Dick S. , Loos Bruno G.
Published: October 2003

Abstract. The aim of this cross‐sectional study was to investigate cross‐sectionally the prevalence and several risk indicators of root caries in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11–22 years ago. These patients were part of a routine 3–6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffering capacity, mutans streptococci counts and Lactobacilli were also scored. From the total of 45 study subjects, 37 patients (82%) showed root lesions (root caries and/or root fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 root lesions per patient (range 0–19) in the present study. 10 patients had active root caries lesions. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibulair sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with >106mutans streptococci/ ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross‐sectional study in periodontal maintenance patients indicate that: (1) root caries can be regarded as a complication in periodontal maintenance patients; (2) the individual number of root lesions correlate with individual dental plaque scores; (3) a high number of root lesions is associated with high counts of salivary mutans streptococci; (4) no relation between root caries and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiene instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high‐risk patients.
Periodontal probing depth and subgingival temperature in smokers and non‐smokers
Authors: Trikilis Nicholas , Rawlinson Andrew , Walsh Trevor F.
Published: October 2003

Abstract. The aim of this study was to investigate the difference in subgingival temperature between smokers and non‐smokers at different probing depths, and the effect of probing depth on subgingival temperature for smokers and non‐smokers. 20 smokers and 20 non‐smokers, with adult periodontitis, and retained upper anterior teeth were included. Initially sublingual temperatures were recorded, followed by subgingival temperature, pocket probing depth, and bleeding upon probing measurements at 3 buccal points at probing depths of 2, 3, 4, 5, and 6 mm for each of the anterior teeth. Sublingual temperatures were consistently higher than subgingival temperatures. The subgingival temperature measurements of pockets which bled upon probing, were subtracted from the sublingual temperature to produce temperature differentials (DT), independent of individual body temperature, that were compared between smokers and non‐smokers. The relationship between probing depth and DT was examined in, and between, smokers and nonsmokers for bleeding sites. DT was found to decrease linearly with the increase of probing depth, suggesting a subsequent increase of subgingival temperature. Smokers were found to have significantly increased DT (suggesting lower subgingival temperatures) compared to non‐smokers, at probing depths of 2, 3, 4, and 5 mm. The differences in DT for sites 6 mm in depth were not statistically significant between the 2 groups. It is concluded that for maxillary buccal anterior sites, there is a decrease of temperature differentials with an increase of probing depth at bleeding sites for both smokers and non‐smokers. Smokers had higher temperature differentials compared to non‐smokers, at probing depths of 2, 3, 4 and 5 mm.
Lake Chivero: A management case study
Authors: Magadza C. H. D.
Published: October 2003

Lake Chivero in Zimbabwe was shown to be hypereutrophic. Historical data showed that the eutrophication process had been arrested in the late 1970s. However, a combination of poor planning, multiplicity of jurisdiction, mismatch between rate of urbanization and waste management investment, recent changes in the local climate and a permissive, immature political system that called for no public accountability resulted in environmental management breakdown leading to hypereutrophication of the lake. The case of Lake Chivero is presented as an example of a wider global issue regarding the status of environmental management in competition with other priorities in emerging democracies.
A general management model to optimize lake liming operations
Authors: Håkanson Lars
Published: October 2003

One of the most common ways to combat the ecosystem effects of acid rain is liming, which can be performed in many ways, such as lake liming, wetland liming, full‐scale drainage area liming, and by dosers in tributaries. This study presents results from extensive liming operations in many Swedish lakes. A practically useful management model for planning and predicting the outcome of liming is presented. The model is based on a validated, general dynamic model for radiocaesium, which has also been used with very good results for radiostrontium, different metals and phosphorus. In this work, the model is applied for calcium from liming. Lake liming can be regarded as a tracer experiment to test the dynamic model. A few of the lakes have been used for the calibrations of the model, and then the model has been validated (blind‐tested) using 68 lakes for pH and 17 lakes for calcium concentrations. Results were very good or good in 97% of the cases for pH and 94% of the cases for calcium. Controls in the two lakes where the dynamic model did not give good pH predictions revealed that these two lakes were fertilized and limed a few years before this study started. If those conditions are accounted for, the model would give good results in these cases also. The model also includes submodels to calculate initial pH, and how this is related to catchment area and lake morphometric conditions, as well as target pH and how this is related to initial pH, and the large‐scale, long‐time influences of deposition of sulphur and other acidifying compounds from the burning of fossil fuels. In order to make the model practically useful, only variables readily accessible from maps and standard monitoring programmes have been accepted as driving variables (such as lake area and mean depth). This work also presents critical model tests (sensitivity and uncertainty analyses using Monte Carlo techniques). These tests have demonstrated that the critical part determining the predictive success of the model is related to the final calculation step where the calculated calcium concentration is transformed into a change in lake pH. It has also been demonstrated that more detailed characterizations of the catchment areas by means of drainage area zonation or Geographical Information System techniques will not increase the predictive accuracy of initial pH values, and that most lakes in the northern part of Sweden were excessively limed to pH values higher, or much higher, than the ‘natural’ or target pH. This is a waste of resources as there are many lakes, especially in the southern part of the country, which need to be limed.
Management criteria for lake ecosystems applied to case studies of changes in nutrient loading and climate change
Authors: Håkanson Lars , Ostapenia Alexander , Parparov Arkady , Hambright K. David , Boulion Viktor V.
Published: October 2003

The aim of this paper is twofold: to present and discuss practically useful management criteria from different perspectives of lake management (fishery, recreation, conservation, monitoring of water quality and use of water for irrigation and drinking), and to put these criteria into the context of a holistic lake ecosystem model, LakeWeb, which accounts for production, biomasses, predation and abiotic/biotic feedbacks related to nine key functional groups of organisms constituting the lake ecosystem. These are phytoplankton, benthic algae, macrophytes, bacterioplankton, herbivorous zooplankton, predatory zooplankton, zoobenthos, prey fish and predatory fish. The LakeWeb model also includes a mass‐balance model for phosphorus and calculates bio‐uptake and retention of phosphorus in these groups of organisms. It also includes submodels for the depth of the photic zone and lake temperature. The LakeWeb model is driven by few and readily accessible driving variables and it has been extensively tested and shown to capture fundamental lake foodweb interactions very well, which should lend credibility to the scenarios discussed in this paper regarding the conditions in Lake Batorino, Belarus. The LakeWeb model offers a tool to address important, often very complex, scientific problems in a realistic manner. The first scenario describes the changes after 1990 when there was a drastic reduction in the use of fertilizers in agriculture because of political changes and the corresponding changes in lake characteristics and foodweb structures utilizing the given management criteria. The second scenario describes, for comparative purposes, the probable alterations in the lake foodweb related to global climatic changes; in this case, warming and increased temperature variations. This study indicates that there are several similarities between eutrophication and increases in temperatures, which are discussed in this paper along with the mechanistic reasons related to such changes by using a set of general management criteria.
Seasonal and spatial variation in algal growth potential and growth‐limiting nutrients in a shallow endorheic lake: Lake Pátzcuaro (Mexico)
Authors: Bernal‐Brooks Fernando W. , Dávalos‐Lind Laura , Lind Owen T.
Published: October 2003

The present research focused on the functional role of the phytoplankton of an economically important endorheic tropical lake from the perspective of algal growth bioassays. The algal growth potential of the lake water was compared for littoral and pelagic sites during the wet and dry seasons. Algal growth potentials at open waters reached minimum and maximum values following the seasonal alternation of dilution (by rain) and concentration (by evaporation) respectively. Conversely, at southern littoral stations high algal growth responses related to the availability of nutrients from point contamination sites. There was no such effect at nearby offshore sites or elsewhere in the lake which suggests filtration and competitive interactions for these nutrients between phytoplankton and littoral macrophytes. Nitrogen and phosphorus both acted consistently as limiting nutrients at open waters by colimitation. Nitrogen to phosphorus ratios seemed to approach equilibrium where limitation easily shifted to one element or the other temporally and spatially.
Anoxygenic phototrophic bacteria and aerobic phototrophs in Normans Lagoon, a ‘billabong’ adjacent to the Murray River, south‐eastern Australia
Authors: Gribben Deborah L. , Rees Gavin N. , Croome Roger L.
Published: October 2003

The development and demise of substantial populations of bacteriochlorophyll (BChl) a and d containing phototrophs are documented within the bottom waters of a billabong (oxbow lake) in south‐eastern Australia. The observation of such populations within a freshwater body is unusual, illustrating an unexpected source of organic carbon within the floodplain ecosystem of one of Australia's principal rivers. Values of up to 1086 µg L−1 BChl a and 490 µg L−1 BChl d were recorded during an 11 month study of physico‐chemical parameters, algae and bacteria. An unusual density stratification was observed within the billabong, fostered by an increase in bivalent ions at depth, and leading to persistent anoxia below 0.75 m depth over summer. A marked vertical distribution was observed for both algae and bacteria, that for the bacteria being lost with a mixing event in late March. The presence of up to 74 µg L−1 BChl a at the surface of the billabong during the summer months is ascribed to entrainment of bacteria within bubble plumes rising from the sediments.
Exploring the association between cannabis use and depression
Authors: Degenhardt Louisa , Hall Wayne , Lynskey Michael
Published: October 2003

Aim  To examine the evidence on the association between cannabis and depression and evaluate competing explanations of the association.

Methods  A search of Medline, Psychinfo and EMBASE databases was conducted. All references in which the terms ‘cannabis’, ‘marijuana’ or ‘cannabinoid’, and in which the words ‘depression/depressive disorder/depressed’, ‘mood’, ‘mood disorder’ or ‘dysthymia’ were collected. Only research studies were reviewed. Case reports are not discussed.

Results  There was a modest association between heavy or problematic cannabis use and depression in cohort studies and well‐designed cross‐sectional studies in the general population. Little evidence was found for an association between depression and infrequent cannabis use. A number of studies found a modest association between early‐onset, regular cannabis use and later depression, which persisted after controlling for potential confounding variables. There was little evidence of an increased risk of later cannabis use among people with depression and hence little support for the self‐medication hypothesis. There have been a limited number of studies that have controlled for potential confounding variables in the association between heavy cannabis use and depression. These have found that the risk is much reduced by statistical control but a modest relationship remains.

Conclusions  Heavy cannabis use and depression are associated and evidence from longitudinal studies suggests that heavy cannabis use may increase depressive symptoms among some users. It is still too early, however, to rule out the hypothesis that the association is due to common social, family and contextual factors that increase risks of both heavy cannabis use and depression. Longitudinal studies and studies of twins discordant for heavy cannabis use and depression are needed to rule out common causes. If the relationship is causal, then on current patterns of cannabis use in the most developed societies cannabis use makes, at most, a modest contribution to the population prevalence of depression.
Reliability and validity of the Tobacco Craving Questionnaire and validation of a craving‐induction procedure using multiple measures of craving and mood
Authors: Singleton Edward G. , Anderson Lynn M. , Heishman Stephen J.
Published: October 2003

Aims  To determine the reliability and validity of the Tobacco Craving Questionnaire (TCQ) and the validity of imagery scripts to elicit self‐reported tobacco craving.

Design  Active imagery of three auditory scripts that described no‐, low‐ and high‐intensity of smoking urge.

Participants  Current cigarette smokers (24 men, 24 women) not attempting to quit or reduce smoking.

Measurements  After each imagery condition, participants completed the 47‐item TCQ, a Mood Form and Visual Analog Scale (VAS) questions.

Findings  Reliability of measures was demonstrated by internal consistency and unidimensionality of the four TCQ factors across imagery conditions. Criterion‐related validity was demonstrated by an orderly increase in scores on the TCQ and VAS craving measures as a function of craving intensity of the imagery scripts. Increases in effect size parameters and parallel decreases in the stability of test–retest reliability for all craving measures indicated the validity of the imagery procedure. Convergent and discriminant validity were established by the craving scripts increasing self‐reported craving, the no‐craving (positive‐affect) script increasing positive mood, the no‐craving script not affecting craving and the craving scripts not affecting positive mood.

Conclusions  Findings further demonstrated the reliability and validity of the TCQ as a multi‐factorial instrument to assess the construct of tobacco craving and suggested that the lability of craving, rather than inconsistency and instability in its measurement, was responsible for observed effects.
Tracking drinking behaviour from age 15–19 years
Authors: Andersen Anette , Due Pernille , Holstein Bjørn E. , Iversen Lars
Published: October 2003

Aims  The aim of this paper was to assess (1) changes in drinking behaviour over time among Danish adolescents and (2) use of which alcoholic beverages and what drinking patterns would have the strongest predictive effect on later alcohol consumption.

Design, setting, participants  The population was a random sample of 15‐year‐olds (baseline 1990, response rate 86%, n= 847) with a first follow‐up 4 years later (response rate 85%, n= 729).

Measurements  Alcohol intake was assessed by experience of drunkenness, quantity and frequency of consumption. Thresholds recommended by the Danish National Board of Health were used to discriminate high from low intake.

Findings  At 19 years of age at least 80% drank alcohol monthly, and 24% of the men and 11% of the women had an alcohol intake above the recommended national limits, i.e. 21 weekly units of alcohol for men and 14 for women. Consumption of alcoholic beverages at age 15 increased the risk of drinking alcohol weekly at the age of 19 [odds ratio (OR)‐values from 1.11 to 3.53]. Drunkenness among the 15‐year‐old boys and the use of spirits of the 15‐year‐old girls showed the strongest predictive relationship with excessive consumption at age 19 [OR = 2.44, confidence interval (CI): 1.38–4.29, respectively, OR = 1.97, CI: 1.15–3.38].

Conclusions  Alcohol consumption as early as the age of 15 predicted weekly alcohol consumption and alcohol intake exceeding the recommended amount 4 years later. Young teenagers’ high alcohol consumption was not just a passing phenomenon. It was a behaviour that tracked into young adulthood, leaving the adolescents at increased risk of being long‐term, large‐scale consumers.
Stopping smoking can cause constipation
Authors: Hajek Peter , Gillison Fiona , McRobbie Hayden
Published: October 2003

Setting Constipation is mentioned occasionally as a possible tobacco withdrawal symptom, but no systematic data have been published on this issue.

Design Smokers’ clinic patients provided ratings of their level of constipation on three occasions prior to their quit date, and then weekly after they stopped smoking. The total of 1067 participants maintained at least 1 week of continuous abstinence and provided usable data.

Findings The three precessation ratings of constipation were stable. After cessation of smoking, the ratings increased significantly (P < 0.01). In 514 patients who maintained continuous abstinence for 4 weeks and provided complete data, constipation peaked at 2 weeks but remained elevated over the whole period. The net proportion of patients affected was 17%, including 9% who were symptom‐free at baseline and became very or extremely constipated. In patients on nicotine replacement the increase in constipation, although significant, was less than in patients on bupropion.

Conclusions Clinicians treating smokers need to be aware of a possibility that one in six quitters develop constipation, and that for about one in 11 the problem can be severe. Descriptions of tobacco withdrawal syndrome should include constipation.
Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in Swedish antenatal clinics
Authors: Göransson Mona , Magnusson Åsa , Bergman Hans , Rydberg Ulf , Heilig Markus
Published: October 2003

Aims  Maternal alcohol consumption is a major health hazard for the fetus. Sweden has an extensive system of public antenatal care clinics, whose mission is to detect and prevent this type of health hazards. However, very few cases of alcohol consumption during pregnancy are detected. The aim of this study was to examine the prevalence of hazardous or harmful alcohol consumption during pregnancy in a consecutive series of Swedish pregnant females.

Design, setting, participants and measurements  The Alcohol Use Disorders Identification Test (AUDIT) was used to collect anonymous data from consecutive pregnant subjects admitted during 1 year to an antenatal clinic in Stockholm, and signing up for parental education offered routinely (n = 1327). Data were obtained from 1101 subjects, typically in pregnancy week 30. A complete AUDIT form was filled out referring to alcohol use during the year prior to pregnancy. A separate form with the consumption items from AUDIT was filled out to report behaviour during pregnancy.

Findings  For the year preceding pregnancy, 17% of subjects reported AUDIT scores of 6 or higher, indicating hazardous or harmful alcohol use in women. Few individuals reported scores of 13 or higher (indicating abuse or dependence), but almost half the subjects (46%) reported binge drinking (six standard drinks on a single occasion) once/month or more often, and 6% reported binge drinking on every occasion of alcohol consumption. One‐third of the subjects (30%) continued regular alcohol use during pregnancy, and 6% reported consumption two to four times/month. In a logistic regression model, AUDIT scores for the year prior to pregnancy and subject age, but not education level were significant predictors of continued alcohol use during pregnancy.

Conclusions  Alcohol use during pregnancy is more extensive than has been presumed in Sweden. Simple, clinically useful screening methodology detects hazardous consumption during pregnancy in a manner which regular antenatal care does not. If this methodology can be shown to have similar sensitivity when administered under non‐anonymous conditions, it should be made part of routine antenatal care.
Illicit drug use and injection practices among drug users on methadone and buprenorphine maintenance treatment in France
Authors: Guichard Anne , Lert France , Calderon Christine , Gaigi Hind , Maguet Olivier , Soletti Jérôme , Brodeur Jean‐Marc , Richard Lucie , Benigeri Mike , Zunzunegui Maria‐Victoria
Published: October 2003

Aims  To evaluate the associations between methadone and high‐dose buprenorphine maintenance treatment and illicit drug use and injection among drug users in France.

Design  A cross‐sectional study. Data were gathered using a questionnaire administered containing closed‐ended questions.

Setting  Drug dependence clinics (DDC) and general practitioners’ (GPs) offices in three French cities.

Participants  Drug users undergoing maintenance treatment with methadone (n = 197) and buprenorphine (n = 142).

Measurements  Interviews covered the use of illicit drugs (heroin, cocaine or crack) and injection practices (illicit drugs and/or substitution drugs) during the last month, current treatment modalities, socio‐demographic and health characteristics. Bivariate analysis and multivariate logistic regressions were conducted.

Findings  Overall, 35.4% of respondents (34.5% in the methadone group, 36.6% in the buprenorphine group, P= 0.69) had used at least one illicit drug, 25.7% reported having injected drugs and 15.3% had injected the substitution drug. Injection was more common among buprenorphine‐maintained individuals (40.1%) than among users on methadone (15.2%) (P < 0.01). Multivariate analyses indicate that the type of substitution drug (buprenorphine versus methadone) was not associated with illicit drug use (OR = 1.1; 95% CI = 0.7–1.8). In the buprenorphine group, injection was related independently to social situation, as measured by housing (unstable versus stable housing, OR = 4.3; 95% CI = 1.6–11.5), but this was not the case in the methadone group. The risk of injection increased with buprenorphine dosage (high/low dosage OR = 6.2; 95% CI = 2.0–19.7), but this association was not observed in the methadone group.

Conclusion  Further studies comparing the benefits of these two types of treatment should be carried out, taking outcomes such as physical health, mental health and social functioning into consideration.
The effects of drinking‐driving laws: a test of the differential deterrence hypothesis
Authors: Mann Robert E. , Smart Reginald G. , Stoduto Gina , Adlaf Edward M. , Vingilis Evelyn , Beirness Douglas , Lamble Robert , Asbridge Mark
Published: October 2003

Aims  Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law in 1996, whereby a person with a blood alcohol level over the legal limit of 80 mg%, or who refused to provide a breath sample, would have his or her driver's licence suspended immediately for a period of 90 days. We test the differential deterrence hypothesis which would predict that social or lighter drinkers would be more affected by the Administrative Driver's License Suspension law than heavier drinkers.

Design  Data from the 1996 and 1997 cycles of the Ontario Drug Monitor, a general population survey of Ontario adults (monthly cross‐sectional surveys), were employed (response rate 64–67%). Analyses were restricted to drivers who reported at least some drinking during the last year (n = 3827). The total number of drinks consumed during the past 12 months was analysed with analysis of variance.

Findings  We found that the mean alcohol consumption of those who reported drinking‐driving increased significantly after the ADLS was introduced, whereas the alcohol consumption of those who did not drive after drinking remained the same.

Conclusions  The limits of this study include a lack of comparison data from regions without ADLS, a reliance on self‐report measures, possible age restrictions of the findings and the fact that only an inferential test of the differential deterrence hypothesis is permitted by the data. Despite these limitations, these findings are consistent with the prediction that lighter or more moderate drinkers will tend to stop driving after drinking completely, and thus drop out of the drinking‐driving population when the ADLS law was introduced, leaving heavier drinkers in this population. It will be important to continue to examine the dynamics of differential deterrence over a longer interval.
The Modified Reasons for Smoking Scale: factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers*
Authors: Berlin Ivan , Singleton Edward G. , Pedarriosse Anne‐Marie , Lancrenon Sylvie , Rames Alexis , Aubin Henri‐Jean , Niaura Raymond
Published: October 2003

Aims  To assess the validity of the French version of the Modified Reasons for Smoking Scale (MRSS), and to identify which smoking patterns differentiate male and female smokers, which are related to tobacco dependence (as assessed by the Fagerström Test for Nicotine Dependence, FTND), to mood (Beck Depression Inventory II), to affect (Positive and Negative Affect Schedule) and which are predictors of successful quitting.

Participants  Three hundred and thirty smokers [(mean ± SD) aged 40 ± 9 years, 145 (44%) women, mean FTND score: 6.2 ± 2], candidates for a smoking cessation programme and smoking at least 15 cigarettes/day.

Findings  Factor analysis of the 21‐item scale gave the optimal fit for a seven‐factor model, which accounted for 62.3% of the total variance. The following factors were identified: ‘addictive smoking’, ‘pleasure from smoking’, ‘tension reduction/relaxation’, ‘social smoking’, ‘stimulation’, ‘habit/automatism’ and ‘handling’. The ‘addictive smoking’ score increased in a dose‐dependent manner with number of cigarettes smoked per day; the ‘habit/automatism’ score was significantly higher, with more than 20 cigarettes per day than with ≤ 20 cigarettes per day. The reasons for smoking were different for males and females: females scored higher on ‘tension reduction/relaxation’, ‘stimulation’ and ‘social smoking’. A high level of dependence (FTND ≥ 6) was associated with significantly higher scores only on ‘addictive smoking’, the association being stronger in females. Time to first cigarette after awakening was associated with higher ‘addictive smoking’ and ‘habit/automatism’ (P < 0.001). In a multivariate logistic regression, failed quitting was predicted by higher habit/automatism score (odds ratio = 1.44, 95% CI = 1.06–1.95, P = 0.02) and greater number of cigarettes smoked per day (odds ratio = 1.03, 95% CI = 1.01–1.06, p = 0.03).

Conclusions  The questionnaire yielded a coherent factor structure; women smoked more for tension reduction/relaxation, stimulation and for social reasons than men; addictive smoking and automatic smoking behaviour were similar in both sexes and were associated strongly with a high level of nicotine dependence; the ‘habit/automatism’ score predicted failure to quit over and above cigarettes per day.
Depression and cognitive functioning in alcoholism
Authors: Uekermann J. , Daum I. , Schlebusch P. , Wiebel B. , Trenckmann U.
Published: October 2003

Aims  Studies on cognitive processes in alcoholism have reported changes with respect to executive functions and memory, which have been interpreted within the context of different neuropsychological models. The aims of the present study were to investigate (1) the validity of these models and (2) the influence of depression on cognitive functioning in alcoholism.

Design, setting and participants  In the present investigation, patients suffering from alcoholism (Alc; n = 30), patients with depression but without alcoholism (Dep; n = 28) and healthy controls (HC; n = 28) were compared on a neuropsychological test battery.

Measurements  The test battery included measurements of mood, memory and executive functions. The possible cumulative effect of alcohol and depression was analysed by comparison of depressed alcoholic patients (Dalc) and non‐depressed alcoholic patients (NDAlc).

Findings  Group comparisons revealed impairments of alcoholic patients with respect to response inhibition, reasoning and free recall, irrespective of depression. Priming, short‐term memory as well as verbal fluency abilities were unaffected. Depressive patients showed verbal fluency as well as free recall deficits. However, there was no difference in performance between depressed and non‐depressed alcoholics.

Conclusions  The specific pattern of neuropsychological deficits of the alcoholic patients supports the frontal lobe hypothesis. The results of the present investigation suggest that these deficits are not generally exacerbated by comorbid depressive symptoms. Further studies, however, are desirable to investigate the relation between executive deficits and depression in alcoholics with evidence of major depression.
Monitoring cigarette smoking prevalence in Britain in a timely fashion
Authors: Jarvis Martin J.
Published: October 2003

Background  Available estimates of cigarette smoking prevalence from the General Household Survey (GHS), the source of official smoking data in Britain, can be over a year out of date. With a number of policy initiatives being undertaken at national level, it would be useful to be able to track changes in a more timely manner.

Aims and design  We compared prevalence estimates from the Omnibus Survey, a monthly survey conducted by the Office for National Statistics, with those from the General Household Survey in order to examine whether they may provide a complementary and more timely source of cigarette smoking prevalence data.

Findings  The age and socio‐economic structure of the samples from the Omnibus and GHS surveys was very similar. When data from monthly Omnibus Surveys for the year 2000 were combined, prevalence estimates were within 1% point of those from the GHS for 2000, and overall sample sizes were also similar. The Omnibus data show a significant linear decline in prevalence between 1999 and 2002 of about 0.4% per year. This coincides with the introduction of a national strategy for reducing smoking prevalence.

Conclusions  The Omnibus Survey can be a useful additional tool for assessing changes in smoking prevalence.
A randomized trial comparing levo‐alpha acetylmethadol with methadone maintenance for patients in primary care settings in Australia
Authors: Ritter Alison J. , Lintzeris Nicholas , Clark Nicolas , Kutin Jozica J. , Bammer Gabriele , Panjari Mary
Published: October 2003

Aims  The present study aimed to compare the efficacy of levo‐alpha‐acetylmethadol (LAAM) and methadone, as measured by retention in treatment and heroin use, in a randomized trial conducted under naturalistic conditions.

Setting  This study is the first randomized trial comparing LAAM with methadone in the primary care setting. Participants were recruited through 29 medical practitioners working in specialist and generalist settings in Australia.

Participants  Existing methadone maintenance patients, aged 18 years and over and able to give informed consent, were randomized to receive either LAAM or methadone. A total of 93 patients participated.

Intervention  After being trained in the use of LAAM, existing methadone prescribers were then able to determine an individually tailored treatment regimen for each patient. The trial was an open‐label study. Methadone and LAAM dosing was supervised through local community pharmacies. Participation in ancillary services (e.g. counselling) was optional for all patients. The treatment period for the trial was 12 months.

Measurements  Baseline, 3‐, 6‐ and 12‐month interviews were conducted. Outcome measures were retention in treatment, self‐reported heroin use and serious adverse events.

Findings  There were no significant differences between LAAM and methadone on retention in treatment, nor heroin use. There was a trend for LAAM patients to have lower heroin use than methadone patients. Of the seven serious adverse events in the LAAM group, three were not drug‐related. There were two dosing errors.

Conclusions  This study demonstrates (a) the efficacy of LAAM as a treatment for heroin dependence, and (b) the capacity for LAAM to be effectively delivered in primary care settings by trained general practitioners and pharmacists. The next challenge is to resolve outstanding safety concerns with LAAM.
Exposure to drugs among pre‐teenage schoolchildren
Authors: McIntosh James , Gannon Maria , McKeganey Neil , MacDonald Fiona
Published: October 2003

Aims  To describe the nature and extent of exposure to drugs in a sample of pre‐teenage children and to examine some of the factors that might be associated with it.

Participants and design  A survey of 1202 10–12‐year‐old children based on a questionnaire administered in schools under examination‐type conditions.

Findings  A third of the children reported having been exposed to drugs in the sense of either having been in situations in which they were being used or of having been offered them. While the most common drug to which they were exposed was cannabis, considerable numbers had also been exposed to more dangerous drugs. The factors which were associated most closely with exposure were drug use by friends or family members, associating with peers who engaged in antisocial activities, the child's own involvement in problem behaviours and the regular consumption of alcohol. Boys and older children were also significantly more likely to be offered drugs.

Conclusion  A large proportion of young children are exposed to illicit drugs primarily through use of these drugs by family members and peers. There is a strong association with antisocial behaviour. Attempting to influence such exposure is challenging but may be one avenue for reducing drug use in adolescents.
Tiagabine increases cocaine‐free urines in cocaine‐dependent methadone‐treated patients: results of a randomized pilot study
Authors: Gonzalez Gerardo , Sevarino Kevin , Sofuoglu Mehmet , Poling Jim , Oliveto Alison , Gonsai Kishor , George Tony P. , Kosten Thomas R.
Published: October 2003

Aims We sought to evaluate the safety and efficacy of the GABAergic agent tiagabine in reducing cocaine use among methadone‐treated patients.

Design Ten‐week randomized double‐blind placebo‐controlled trial.

Setting Opiate Treatment Research Program, Veteran's Affairs Connecticut Healthcare System in West Haven, Connecticut, USA.

Participants The participants were 45 cocaine‐dependent methadone‐treated patients who were predominately Caucasian (75.6%), male (77.8%) and never married (53%) with an average age of 38 years (SD = 6.5).

Interventions Comparison groups received tiagabine 12 mg/day (n = 15), tiagabine 24 mg/day (n = 15) or placebo (n = 15).

Measures Baseline assessments included the Structured Clinical Interview for DSM‐IV, the Addiction Severity Index, a urine drug test, self‐reported use and opiate withdrawal scales. Urine drug tests were performed thrice weekly.

Findings Treatment retention was over 80% for all treatment groups. The sample mean (± SE) of cocaine‐free urines for the first week after study entry and before tiagabine was started was 1.16 (0.19) urines/week. During weeks 9 and 10 cocaine‐free urines increased significantly from baseline by 33% with high‐dose tiagabine (24 mg/day), by 14% with low‐dose tiagabine (12 mg/day) and decreased by 10% with placebo (hierarchical linear model,Z= 2.03;P < 0.05). Self‐reported cocaine use also decreased significantly more with active medications than with placebo.

Conclusions Tiagabine at 24 mg/day was well tolerated among these methadone‐treated patients with only one reporting headache. Tiagabine appears to be a promising GABAergic medication that moderately improves cocaine‐free urines.
Buprenorphine withdrawal syndrome in newborns: a report of 13 cases
Authors: Kayemba‐Kay’s S. , Laclyde J. P.
Published: October 2003

Aims  To assess neonatal abstinence syndrome (NAS) and neurodevelopmental outcome in infants born to addicted mothers under buprenorphine substitution therapy.

Setting  District general hospital, Angoulême, France.

Methods  Retrospective case records study of infants admitted to the neonatal intensive care unit (NICU) and/or special care baby unit (SCBU) from January 1994 to December 2000 for surveillance and/or treatment of buprenorphine NAS.

Results  Thirteen infants were born to addicted mothers under buprenorphine maintenance therapy during the study period. Eight were male and five were female; mean birth term and weight were 39 weeks gestation and 3000 g, respectively. Apgar scores were within normal limits; four infants were small for gestational age, none was dysmorphologic and none was extracted for fetal distress. NAS occurred in 11 cases (85%) and required treatment in 10 cases. Morphine chlorhydrate 0.5 mg/kg/day was administered in divided doses to seven children and gave better results than paregoric alone or in combination with diazepam. Upon follow‐up, seven children presented transient lower limbs hypertonia, jerky movements and jitteriness that lasted 3–9 months. The overall milestones acquisitions were within normal limits.

Conclusion  Buprenorphine substitution seems to be safe during pregnancy, and has had no teratogenic effects reported to date. It induces NAS of variable intensity that is less prolonged in comparison to methadone; the neurodevelopmental outcome of exposed children is normal in the majority of cases, although some presented with transient motor abnormalities that resolved completely in 85% of those recruited to our study.