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Musa Obadia P, Pyana Kitenge J, Carsi Kuhangana T, Kalenga Ilunga G, Billen J, Kayembe-Kitenge T, Haufroid V, Mukalay wa Mukalay A, Ris L, Banza Lubaba Nkulu C, Nemery B, Enzlin P. Erectile dysfunction in copper and cobalt miners: a cross-sectional study in the former Katanga province, Democratic Republic of the Congo. Sex Med 2023; 11:qfad052. [PMID: 37869070 PMCID: PMC10588613 DOI: 10.1093/sexmed/qfad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Aim We aimed to investigate factors that are possibly associated with erectile dysfunction (ED) in metal miners in the former Katanga province of the Democratic Republic of the Congo. Methods In a cross-sectional study of 138 miners and 139 controls (bakers), we administered questionnaires to obtain sociodemographic and occupational data and to assess male sexual function (International Index of Erectile Function [IIEF]) and marital relation quality (Revised Dyadic Adjustment Scale). Furthermore, we measured trace metals in blood and urine, as well as testosterone and thyroid hormones in serum. Outcomes Outcomes included the prevalence of questionnaire-derived ED and the relation of ED with individual characteristics, serum testosterone, and environmental factors. Results Miners were on average 4 years older than bakers (mean ± SD, 37.5 ± 6.9 vs 33.3 ± 5.7 years). Miners had significantly lower scores than bakers on the IIEF (median [IQR], 66 [49-73] vs 73 [66-74]) and the 3 domains of the Revised Dyadic Adjustment Scale (consensus, satisfaction, cohesion). Free testosterone was significantly lower in miners than bakers (ng/dL; 8.11 [6.90-10.10] vs 10.52 [8.83-12.58]; P ˂ .001). In miners, sex hormone-binding globulin correlated positively with blood Pb and urinary Cd. In a multivariable analysis, mild to moderate ED or moderate ED (IIEF-erectile function score ≤18) was significantly associated with having a mining-related job (adjusted odds ratio [aOR], 2.6; 95% CI, 1.3-5.3), work seniority ˃5 years (aOR, 2.3; 95% CI, 1.1-4.6), alcohol consumption (aOR, 2.8; 95% CI, 1.2-6.7), and aphrodisiacs use (aOR, 4.2; 95% CI, 2.2-8.0). Mediation analysis showed that marital relationship partially mediated the relation between work seniority >5 years in mining and ED. Clinical Implications The high prevalence of ED found in artisanal mine workers indicates that work-related factors should be considered as possibly contributing, directly or indirectly, to sexual dysfunction in men. Strengths and Limitations Strengths include being the first epidemiologic study documenting ED with validated questionnaires and its possible determinants, including exposure to toxic metals, among young artisanal miners vs a suitable control group. Limitations are the cross-sectional design with convenience sampling and absence of objective confirmation of ED. Conclusion As compared with controls, miners reported poorer sexual function and lower quality of their marital relationship, and they had lower free testosterone levels, which may be due to their high exposure to trace metals.
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Affiliation(s)
- Paul Musa Obadia
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - Joseph Pyana Kitenge
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Unité de Santé au travail et Santé environnementale, Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Trésor Carsi Kuhangana
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Ecole de Santé Publique, Université de Kolwezi, 07301 Kolwezi, Democratic Republic of the Congo
| | - Georges Kalenga Ilunga
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Jaak Billen
- Department of Laboratory Medicine, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Tony Kayembe-Kitenge
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Institut Supérieur des Techniques Médicales, 4748 Lubumbashi, Democratic Republic of the Congo
| | - Vincent Haufroid
- Toxicology and Applied Pharmacology, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Abdon Mukalay wa Mukalay
- Unité d’Epidémiologie clinique et Pathologies tropicales, Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Laurence Ris
- Département de Neurosciences, Faculté de Médecine, Université de Mons, 7000 Mons, Belgium
| | - Célestin Banza Lubaba Nkulu
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - Paul Enzlin
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
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Mostafa T, Alghobary MF. Recreational Use of Oral PDE5 Inhibitors: The Other Side of Midnight. Sex Med Rev 2021; 10:392-402. [PMID: 34903486 DOI: 10.1016/j.sxmr.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nowadays, Oral phosphodiesterase type 5 inhibitors (PDE5Is) are widely used for the treatment of erectile dysfunction (ED). However, these drugs have become abused among some men for recreational use to enhance their sexual performance. OBJECTIVE To shed a light on the recreational use of oral PDE5Is. METHODS A literature review was performed in the PubMed, Medline Medical Subject Heading, Science Direct, Scopus, Cochrane Library, EMBASE, CINAHL, Academic Search Complete, Google scholar, Egyptian Knowledge Bank (EKB) databases, Medline, Embase, and Chem ID using the keywords; sexual health, erectile dysfunction, recreational use/abuse, phosphodiesterase type 5 inhibitors, sildenafil, tadalafil, vardenafil, avanafil, and adverse effects. RESULTS Overall, 52 studies were retained for review out of 166 papers. Twenty-two studies that assessed the prevalence of the problem were investigated including 25,279 men from different countries. Most of these studies were cross-sectional studies that depend on multiple questionnaires representing the extent as well as the attitude of the recreational use of PDE5Is. CONCLUSION Oral PDE5Is have become used among some men for recreational use to enhance their sexual performance. To counteract the possible side effects of such abuse, the media, as well as health authorities, should be aware of the potential adverse effects of such abuse and strengthen the regulatory activity to protect the customers from such risks. Mostafa T, Alghobary MF. Recreational Use of Oral PDE5 Inhibitors: The Other Side of Midnight. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Taymour Mostafa
- Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt.
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Kim JN, Oh JJ, Park DS, Hong YK, Yu YD. Influence of Alcohol on Phosphodiesterase 5 inhibitors Use in Middle- to Old-Aged Men: A Comparative Study of Adverse Events. Sex Med 2019; 7:425-432. [PMID: 31444051 PMCID: PMC6963111 DOI: 10.1016/j.esxm.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Some previous studies reported recreational use of phosphodiesterase type 5 (PDE-5) inhibitors by ingesting the medicine with alcohol in patients with erectile dysfunction, but the rate of misuse in general population has never been researched. AIM To investigate the frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population. We secondarily analyzed the influence of alcohol on PDE-5 inhibitor. METHODS 325 men with erectile dysfunction (age 34-78) who received PDE-5 inhibitors at a single medical institution from January 2016-February 2018 were included in the study. All patients fulfilled a survey questionnaire assessing (i) average alcohol consumption amount, (ii) previous use of PDE-5 inhibitors with alcohol and purpose of concomitant alcohol use, (iii) and background knowledge about PDE-5 inhibitors' side effects. MAIN OUTCOMES MEASURES The main outcome measure was frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population. RESULTS Overall 148 patients committed concomitant alcohol use (group 1), and 177 patients did not (group 2). No significant differences were observed between 2 groups regarding types of PDE-5 inhibitors used and underlying disease. Group 2 had significantly more patients with the correct knowledge concerning concomitant alcohol use than group 1 (24.9% vs 13.5%). Group 1 had more patients with average alcohol consumption >15 drinks/week (64.8% vs 14.1%). The reasons for concomitant alcohol use were curiosity (35.1%), enhancing sexual desire (27%) and recommendation from friends (16.9%). Group 1 showed significantly greater complications, including headache (23.6% vs 7.3%) and facial flushing (69.6% vs 12.4%), than group 2. 1 patient in group 1 experienced severe chest discomfort and underwent coronary artery angiography, but no severe obstructive lesion was observed. CONCLUSION 45.5% of middle- to old-age men committed concomitant use of PDE-5 inhibitor with alcohol because of recreational purpose, and this alcohol abuse might lead to severe complications, including chest discomfort and dizziness. Kim JN, Oh JJ, Park DS, et al. Influence of Alcohol on Phosphodiesterase 5 inhibitors Use in Middle- to Old-Aged Men: A Comparative Study of Adverse Events. Sex Med 2019;7:425-432.
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Affiliation(s)
- Jong Nyeong Kim
- Department of Urology, CHA Medical University, College of Medicine, Bundang CHA Hospital, Seongnam, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Soo Park
- Department of Urology, CHA Medical University, College of Medicine, Bundang CHA Hospital, Seongnam, Korea
| | - Young Kwon Hong
- Department of Urology, CHA Medical University, College of Medicine, Bundang CHA Hospital, Seongnam, Korea
| | - Young Dong Yu
- Department of Urology, CHA Medical University, College of Medicine, Bundang CHA Hospital, Seongnam, Korea.
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Nicolini Y, Tramacere A, Parmigiani S, Dadomo H. Back to Stir It Up: Erectile Dysfunction in an Evolutionary, Developmental, and Clinical Perspective. JOURNAL OF SEX RESEARCH 2019; 56:378-390. [PMID: 29932774 DOI: 10.1080/00224499.2018.1480743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this review, we analyze erectile dysfunction (ED) in the context of sexual selection. We highlight that ED is a specific human male characteristic linked to the loss of the baculum or penile bone and results from a range of physical and psychological factors. We discuss evolutionary interpretations that consider dysfunctional penile erection as an honest signal of a low-quality male. We further emphasize the importance of considering psychosocial context and early attachment dynamics for understanding the etiology of some types of ED. Finally, we suggest that the integration of developmental factors for understanding the emergence of this sexual disorder is instrumental for the calibration of more effective therapies.
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Affiliation(s)
- Ylenia Nicolini
- a Unit of Neuroscience, Department of Medicine and Surgery , University of Parma
| | - Antonella Tramacere
- b Lichtenberg-Kolleg/The Göttingen Institute for Advanced Study and the German Primate Center/Leibniz Institute for Primate Research , Georg-August-Universität Göttingen; Max Planck for the Science of Human History , Jena , Germany
| | - Stefano Parmigiani
- c Evolutionary and Functional Biology Unit, Department of Chemistry , Life Sciences and Sustainability, University of Parma
| | - Harold Dadomo
- a Unit of Neuroscience, Department of Medicine and Surgery , University of Parma
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Bruening A, Perez M, Josephs J. Overall Mental Health and Misuse of Erectile Dysfunction Medication Among Sexual Minority Men. Subst Use Misuse 2019; 54:1825-1833. [PMID: 31107124 DOI: 10.1080/10826084.2019.1613433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Research has noted that rates of recreational use of erectile dysfunction medication (EDM) are particularly high among men who have sex with other men. Though previous research has investigated recreational EDM use in relation to substance use, its association with other general mental health symptoms and diagnoses remains unexamined. Objectives: To address the paucity of research on EDM misuse, the current study examined prevalence rates of EDM misuse among sexual minority men and its association with last 12-month and 30-day mental health symptoms and diagnoses. Method: A secondary analysis of 7,658 sexual minority undergraduate and graduate male students recruited as part of the American College of Health Association's National College Health Assessment was performed. Results: Results indicated that 2.2% of sexual minority men reported misuse of EDMs within the last 12 months. Last 12-month EDM misuse was significantly associated with a number of mental health symptoms and diagnoses in the last 12 months and last 30 days. Most notably, small to moderate effects were found for misuse of other prescribed medications, such as antidepressants, painkillers, and sedatives, and diagnosis of substance use within the last 12 months. Small effects were found for sedatives and steroid misuse in the last 30 days. Conclusion: Results suggest that worse mental health, particularly substance use, is associated with EDM misuse among sexual minority men. As such, further research in this area is needed.
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Affiliation(s)
- Amanda Bruening
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Marisol Perez
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Jamie Josephs
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
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Yafi FA, Sharlip ID, Becher EF. Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction. Sex Med Rev 2017; 6:242-252. [PMID: 28923561 DOI: 10.1016/j.sxmr.2017.08.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/31/2017] [Accepted: 08/06/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Phosphodiesterase type 5 inhibitors (PDE5Is) have demonstrated efficacy in the treatment of erectile dysfunction (ED). Although historically found to have limited drug-related adverse events, emerging data have suggested that PDE5Is might be associated with melanoma or recurrence of prostate cancer after radical prostatectomy. AIM To summarize the literature on the safety of PDE5Is. METHODS A literature review was performed through PubMed from 1990 through 2016 regarding ED. Keywords used for the search were erectile dysfunction, phosphodiesterase type 5 inhibitors, sildenafil, vardenafil, tadalafil, avanafil, safety, side effects, and adverse events, among others. MAIN OUTCOME MEASURES Visual, auditory, cardiovascular, renal, hepatic, priapic, and oncologic outcomes associated with the intake of PDE5Is for the treatment of ED, in addition to drug interactions, abuse, overdose, and the phenomenon of counterfeit medications. RESULTS PDE5Is are safe drugs for the management of ED. Although recent studies have shown an increased risk of non-arteritic ischemic optic neuropathy with PDE5Is, the magnitude of that risk is small. The possibility that PDE5Is cause sensorineural hearing loss remains uncertain. PDE5Is display a safe cardiovascular profile if used according to the Princeton III Consensus guidelines. There appears to be an association between PDE5I use and melanoma but the absence of a mechanism of causation raises doubt that the association is cause and effect. PDE5Is do not increase the risk of biochemical recurrence after prostate cancer management. PDE5I abuse and use of counterfeit medications present serious global health concerns. CONCLUSION Current data strongly support the efficacy, tolerability, and overall safety of PDE5Is for the treatment of ED. PDE5Is probably cause a small increase in the risk of non-arteritic ischemic optic neuropathy. Evidence on increased rates of melanoma and prostate cancer recurrence is weak and controversial. PDE5Is should still be considered first-line therapy for the treatment of most etiologies of ED. Yafi FA, Sharlip ID, Becher EF. Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction. Sex Med Rev 2018;6:242-252.
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Affiliation(s)
- Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA.
| | - Ira D Sharlip
- Department of Urology, University of California, San Francisco, CA, USA
| | - Edgardo F Becher
- Division of Urology, University of Buenos Aires, Buenos Aires, Argentina
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Duarte DV, Restrepo-Méndez MC, Silveira MFD. Prevalence of erectile dysfunction oral drugs use in a city of southern Brazil. CIENCIA & SAUDE COLETIVA 2017; 22:2763-2770. [PMID: 28793090 DOI: 10.1590/1413-81232017228.24952015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 03/23/2016] [Indexed: 12/25/2022] Open
Abstract
The last decade has seen a breakthrough in the treatment of erectile dysfunction (ED) with the advent of phosphodiesterase-5 inhibitors. There are few population-based observational studies on the prevalence of use of these drugs. We conducted a cross-sectional population-based study in the city of Pelotas (Brazil). Our sample comprised 1,082 men aged 20 years or older who answered a confidential and self-administered questionnaire. Prevalence of EDD use was 5% (IC95% = 4%;7%). ED and advanced age were strongly associated with a higher prevalence of EDD use. ED prevalence in men who used EDD was 68%, which was much higher than the one found in the entire sample (27%). The use of EDD was more frequently reported among separated men, respondents with higher level of education and those without ED. A high proportion of respondents (68%) did not seek medical advice on the use of EDD. Sildenafil was the most commonly used drug (38%) but non-regulated and non-evidence-based drugs were also frequently used (14%). Prevalence of EDD use is higher among individuals with ED, opposing to the notion of recreational use of EDD.
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Affiliation(s)
- Daniel Vanti Duarte
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal de Pelotas. Av. Duque de Caxias 250, Fragata. 96030-001 Pelotas RS Brasil.
| | - María Clara Restrepo-Méndez
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal de Pelotas. Av. Duque de Caxias 250, Fragata. 96030-001 Pelotas RS Brasil.
| | - Mariângela Freitas da Silveira
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal de Pelotas. Av. Duque de Caxias 250, Fragata. 96030-001 Pelotas RS Brasil.
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Bn AK, M S, J SR, Dr P. Sexual dysfunction in women with alcohol dependence syndrome: A study from India. Asian J Psychiatr 2017; 28:9-14. [PMID: 28784408 DOI: 10.1016/j.ajp.2017.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/05/2017] [Accepted: 03/05/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To study the prevalence, typology and specified demographic and clinical correlates of SD among female patients seeking treatment for alcohol dependence syndrome (ADS). MATERIALS AND METHODS 40 women with ADS and 40 matched healthy controls (HC) were assessed for SD using a Sexual Dysfunction Checklist (SDC) and Arizona Sexual Experience Questionnaire (ASEX). RESULTS In women with ADS, 55% had one or more SD as per ASEX, most common being low sexual desire (55%) followed by inability to reach orgasm (52.5%), and dissatisfaction with orgasm (50%). As per SDC, low sexual desire (55%), anorgasmia (52.5%) and dissatisfaction with own sexual function (45%) were the most common SD noted. In comparison with HC, the prevalence of SD in patients with ADS was significantly higher in all domains. Low educational qualification, initiation of alcohol at earlier age, longer duration of alcohol consumption and dependence and sever dependence appeared to be the most significant predictors of developing SD. CONCLUSION SD rates are higher among patients with ADS compared to HC and all domains of sexual functioning are affected. Clinicians need to routinely assess sexual functioning and plan for gender sensitive, multidimensional treatment.
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Affiliation(s)
- Anil Kumar Bn
- Department of Psychiatry, Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, India.
| | - Shalini M
- Department of General Medicine, Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, India.
| | - Sanjay Raj J
- Department of Psychiatry, Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, India.
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Sildenafil citrate (Viagra) reduces surface roughness of human erythrocytes: Atomic-force-microscopic study. J Microsc Ultrastruct 2016; 4:63-68. [PMID: 30023211 PMCID: PMC6014212 DOI: 10.1016/j.jmau.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/26/2015] [Accepted: 11/28/2015] [Indexed: 11/24/2022] Open
Abstract
Sildenafil citrate (Viagra) is used to treat erectile dysfunction and pulmonary arterial hypertension. The objective of this study was to analyze the action of sildenafil citrate on normal human erythrocytes in vitro at a concentration (2.5 mg/mL) higher than the prescribed for clinical conditions. Imaging of drug-treated erythrocytes was done using an atomic-force microscope in contact mode in air. Data analysis was performed using the scanning probe-microscopy software WSxM. The study revealed that the drug causes hemolysis of erythrocytes at high concentration in vitro at room temperature. The ghosts (membranes) of erythrocytes with reduced cell size and deformed shape were observed using atomic force-microscope imaging at low magnification. In addition, the high-magnification images revealed alterations in the nanostructural features of the erythrocyte membrane. There was a complete loss of characteristic membrane-architecture pattern. The root-mean-square surface roughness of the cell membrane after drug treatment was measured and found to be significantly less than that of erythrocytes in the native state. Sildenafil citrate causes hemolysis of erythrocytes in vitro at high concentration with significant alterations in morphometric properties, like change in cell shape, reduction in cell dimension, and disruption of membrane cytoarchitecture, along with a severe drop in membrane root-mean-square surface roughness.
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Abstract
BACKGROUND There is anecdotal evidence of misuse of erectile dysfunction medication, particularly to counteract some of the unwanted effects of recreational drugs on erectile function. However, there is little data from the United Kingdom (UK). AIM To evaluate the prevalence of sildenafil misuse in a UK population that has previously been shown to have high recreational drug use. DESIGN Questionnaire survey. METHODS Individuals attending nightclubs catering for the men who have sex with men (MSM) community in South London were asked about lifetime and last year use of recreational drugs and sildenafil. RESULTS 313 individuals were surveyed over four nights in 2013: 282 (90.1%) were males and 248 (79.2%) were MSM. Last year use of recreational drugs was high: mephedrone (74.1%), cocaine (61.3%), MDMA/Ecstasy (59.2%), GHB/GBL (52.8%), cannabis (51.8%), and ketamine (50%). 136 (49.1%) MSM versus 6 (18.8%) non-MSM clubbers had misused sildenafil in the last year (p < .001). Amongst the MSM clubbers, 232 (93.5%) had heard of sildenafil, 161 (64.9%) reported misuse of sildenafil in their lifetime and 133 (53.6%) had misused sildenafil in the last year. CONCLUSION This study demonstrates a high prevalence of sildenafil misuse in a population who are heavy users of recreational drugs; it is not likely that this young population have underlying erectile dysfunction as a reason for legitimate sildenafil use. There is the potential for interaction with other recreational drugs used including cocaine and volatile nitrites. Further work is required in to determine the extent and reason for the misuse.
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Affiliation(s)
- Wui Ling Chan
- a Emergency Department, Tan Tock Seng Hospital , Singapore
| | - David Michael Wood
- b Guy's and St Thomas' NHS Foundation Trust, Clinical Toxicology, St Thomas' Hospital , London , United Kingdom
| | - Paul Ivor Dargan
- b Guy's and St Thomas' NHS Foundation Trust, Clinical Toxicology, St Thomas' Hospital , London , United Kingdom
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Grover S, Mattoo SK, Pendharkar S, Kandappan V. Sexual dysfunction in patients with alcohol and opioid dependence. Indian J Psychol Med 2014; 36:355-65. [PMID: 25336765 PMCID: PMC4201785 DOI: 10.4103/0253-7176.140699] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
There are limited numbers of studies which have evaluated the sexual dysfunction (SD) in patients with alcohol and opioids dependence. This article reviews the existing literature. Electronic searches were carried out using the PubMed, Google Scholar, and ScienceDirect to locate the relevant literature. Subjects addicted to heroin or on methadone maintenance treatment (MMT) or buprenorphine maintenance treatment (BMT) show higher rates of SD in comparison to the general population. SD rates have ranged 34-85% for heroin addicts, 14-81% for MMT, 36-83% for BMT, and 90% for naltrexone maintenance. The rates of SD in alcohol-dependent population have ranged 40-95.2%, with rates being consistently much higher in alcohol-dependent population than in the healthy controls or social drinkers. The common SDs reported have been erectile dysfunction followed by premature ejaculation, retarded ejaculation and decreased sexual desire among men, and dyspareunia and vaginal dryness among women. This review suggests that long-term use of alcohol and opioids are associated with SD in almost all domains of sexual functioning. There is a need to increase the awareness of clinicians about this association as many times SD in patients with substance abuse lead to poor treatment compliance and relapse. Further, there is a need to carry out more number of studies to understand the relationship in a better way.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surendra K. Mattoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreyas Pendharkar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkatesh Kandappan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Involvement of nNOS/NO/sGC/cGMP signaling pathway in cocaine sensitization and in the associated hippocampal alterations: does phosphodiesterase 5 inhibition help to drug vulnerability? Psychopharmacology (Berl) 2013; 229:41-50. [PMID: 23579428 DOI: 10.1007/s00213-013-3084-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/20/2013] [Indexed: 02/07/2023]
Abstract
RATIONALE Repeated cocaine administration induces behavioral sensitization in about 50 % of treated animals. Nitric oxide could be involved in the acquisition and maintenance of behavioral cocaine effects, probably by activation of neuronal nitric oxide synthase (nNOS)/NO/soluble guanylyl cyclase (sGC)/cyclic guanosine monophosphate (cGMP) signaling pathway, since inhibition of the nNOS enzyme attenuates development of sensitization in rats. On the other hand, increased cGMP availability by phosphodiesterase 5 inhibitors has been correlated to the misuse and recreational use of these agents and also to the concomitant use with illicit drugs in humans. Hippocampus is an important brain region for conditioning to general context previously associated to drug availability, influencing drug-seeking behavior and sensitization. Moreover, cocaine and other drugs of abuse can affect the strength of glutamate synapses in this structure, lastly modifying neuronal activity in main regions of the reward circuitry. OBJECTIVE The objective of this study is to determine whether the pharmacological manipulation of nNOS/NO/sGC/cGMP signaling pathway altered changes induced by repeated cocaine exposure. RESULTS The present investigation showed a relationship between behavioral cocaine sensitization, reduced threshold to generate long-term potentiation (LTP) in hippocampal dentate gyrus, and increased nNOS activity in this structure. However, when nNOS or sGC were inhibited, the number of sensitized animals was reduced, and the threshold to generate LTP was increased. The opposite occurred when cGMP availability was increased. CONCLUSION We demonstrate a key role of the nNOS activity and NO/sGC/cGMP signaling pathway in the development of cocaine sensitization and in the associated enhancement of hippocampal synaptic transmission.
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Measham F, Wood DM, Dargan PI, Moore K. The rise in legal highs: prevalence and patterns in the use of illegal drugs and first- and second-generation “legal highs” in South London gay dance clubs. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.594704] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:597-606. [PMID: 20358273 PMCID: PMC2909482 DOI: 10.1007/s10508-010-9619-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 02/19/2010] [Accepted: 02/19/2010] [Indexed: 05/10/2023]
Abstract
Mounting evidence indicates that erectile dysfunction medications (EDMs) have become increasingly used as a sexual enhancement aid among men without a medical indication. Recreational EDM use has been associated with increased sexual risk behaviors, an increased risk for STIs, including incident HIV infection, and high rates of concomitant illicit drug use. The aim of the present study was to investigate the characteristics and associated risk factors for recreational EDM use among young, healthy, undergraduate men. A cross-sectional sample of 1,944 men were recruited from 497 undergraduate institutions within the Unites States between January 2006 and May 2007. The survey assessed patterns of EDM use, as well as demographic, substance use, and sexual behavior characteristics. Four percent of participants had recreationally used an EDM at some point in their lives, with 1.4% reporting current use. The majority of recreational EDM users reported mixing EDMs with illicit drugs and particularly during risky sexual behaviors. Recreational EDM use was independently associated with increased age, gay, or bisexual sexual orientation, drug abuse, lifetime number of sex partners, and lifetime number of "one-night stands." Recreational EDM users also reported a 2.5-fold rate of erectile difficulties compared to nonusers. Overall, recreational use of EDMs was associated with sexual risk behaviors and substance abuse; however, a relatively small proportion of undergraduates reported using EDMs. Results also suggest that a sizable portion of recreational EDM users are heterosexual men, and that use does not solely occur within the environments of venues that cater to men having sex with men.
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Affiliation(s)
- Christopher B. Harte
- Department of Psychology, University of Texas at Austin, 108 E. Dean Keeton, Austin, TX 78712, USA
| | - Cindy M. Meston
- Department of Psychology, University of Texas at Austin, 108 E. Dean Keeton, Austin, TX 78712, USA
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Bechara A, Casabé A, De Bonis W, Helien A, Bertolino MV. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med 2010; 7:3736-42. [PMID: 20722788 DOI: 10.1111/j.1743-6109.2010.01965.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In recent years, PDE5 inhibitors (PDE5i) use has become more popular among men without ED to enhance sexual performance. However, reports in the literature are scarce. AIM The aim of this study was to evaluate the recreational use of PDE5i in healthy young men. MAIN OUTCOME MEASURES We evaluated the recreational use of PDE5i among young and healthy men, their main reasons for use, how they were obtained these drugs, and the combination with alcohol or other drugs. METHODS Descriptive, transversal study consisting in 400 brief surveys with structured multiple choice and open questions. Nonprobability samples (quota samples) included young men between 18 and 30 years of age in a public area (high schools, universities, and gyms) between August and November 2009. Collecting the questionnaires in a sealed box enforced confidentiality. The survey included demographic and sexual health data and PDE5i use characteristics. For statistical analysis we used Fisher's exact and Mann-Whitney tests. RESULTS A total of 321 questionnaires were appropriate for the purposes of evaluation. Mean age and standard deviation were 25.1±3.3 years old. Regarding PDE5i use, 69 men (21.5%) mentioned trying the pill (being sildenafil the most commonly used one) at least one time in their lives and 37 (53.4%) men combined it with alcohol or drugs. Referred sources of acquisition PDE5i were 75.4% (N=52) from a friend, 17.4% (N=15) from a pharmacy/drugstore without a medical prescription, 4.3% (N=3) prescribed by a physician and 2.9% (N=2) through Internet. There were several reasons for taking PDE5i related to sexual confidence, erection quality, and better sexual performance. CONCLUSION According to our results, 21.5% of healthy men between 18 and 30 years old used PDE5i as a recreational drug, mostly associated with alcohol or other drugs without medical control. This could have led to misuse and a public health problem. Further studies are needed to evaluate not only PDE5i recreational use prevalence, but also psychosocial determinants, long term safety, misuse, and abuse related to it.
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Affiliation(s)
- Amado Bechara
- Instituto Médico Especializado, Buenos Aires, Argentina.
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Schnetzler G, Banks I, Kirby M, Zou KH, Symonds T. Characteristics, behaviors, and attitudes of men bypassing the healthcare system when obtaining phosphodiesterase type 5 inhibitors. J Sex Med 2010; 7:1237-46. [PMID: 20136707 DOI: 10.1111/j.1743-6109.2009.01674.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Men may choose to bypass the healthcare system to obtain a phosphodiesterase type 5 inhibitor (PDE5i). AIM Evaluate the characteristics and purchasing patterns of men obtaining a PDE5i without prior healthcare professional (HCP) interaction. MAIN OUTCOME MEASURES Prior HCP interaction, defined as having a prescription for any PDE5i, having a PDE5i sample from a physician, or buying the PDE5i in a retail pharmacy; and erectile dysfunction (ED, the Massachusetts Male Aging Study single-item question) were assessed. A multivariate regression analysis determined predictive factors for PDE5i purchase without prior HCP interaction. Methods. A Web-based observational study was conducted in the United Kingdom, Germany, and Italy. RESULTS Of the 11,899 participants, 1,252 (10.5% [95% CI, 10.0-11.1%]) reported PDE5i use in the last 6 months. PDE5is were obtained without prior HCP interaction by 403 users (32.3% [95% CI, 29.6-34.8%]); 65.5% of them had ED. Overall prevalence of men using PDE5is without HCP interaction was 3.0% (95% CI, 2.6-3.5%), 4.1% (95% CI, 3.5-4.6%), and 2.8% (95% CI, 2.1-3.5%) for men aged 18-34, 35-50, and >50 years, respectively (P = 0.0045). Predictive factors for obtaining a PDE5i without prior HCP interaction were embarrassment to speak to a physician (P = 0.0009) and the perception that this would be the cheapest way to get the medicine (P = 0.03). CONCLUSIONS Based on these findings, it can be estimated that approximately 6 million men in Europe might currently bypass the healthcare system to obtain a PDE5i. In addition to the risks associated with use of PDE5is from uncontrolled sources, because most of these men have ED, they also miss the opportunity for important health information or medical follow-up. HCPs should actively address ED and offer treatment to discourage men from seeking uncontrolled sources of ED medicines.
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Ponizovsky AM, Averbuch L, Radomislensky I, Grinshpoon A. A multicenter, randomized, open-labeled, parallel group trial of sildenafil in alcohol-associated erectile dysfunction: the impact on psychosocial outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2510-25. [PMID: 19826560 PMCID: PMC2760426 DOI: 10.3390/ijerph6092510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/22/2009] [Indexed: 11/17/2022]
Abstract
To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF) and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001). The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted.
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Affiliation(s)
- Alexander M. Ponizovsky
- Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591, Israel; E-Mail:
| | - Lev Averbuch
- The Department of Substance Dependence Treatment, Ministry of Health, 20 King David St., Jerusalem 91010, Israel; E-Mail:
| | - Ira Radomislensky
- Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591, Israel; E-Mail:
| | - Alexander Grinshpoon
- Tirat Carmel Mental Health Center, Ministry of Health, 17 Ha’ela St., ‘Tirat Carmel 30200, Israel Sha’ar Menashe Mental Health Center, Ministry of Health, Mobile Post Hefer 37806, Israel; E-Mail:
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Sexual health risk among dance drug users: Cross-sectional comparisons with nationally representative data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:304-10. [DOI: 10.1016/j.drugpo.2007.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 12/16/2006] [Accepted: 02/07/2007] [Indexed: 11/18/2022]
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Korkes F, Costa-Matos A, Gasperini R, Reginato PV, Perez MDC. Recreational use of PDE5 inhibitors by young healthy men: recognizing this issue among medical students. J Sex Med 2008; 5:2414-8. [PMID: 18331258 DOI: 10.1111/j.1743-6109.2008.00792.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In recent years, recreational use of phosphodiesterase type 5 (PDE5) inhibitors has become popular as a sexual enhancement aid among some men without erectile dysfunction (ED) and even among women. AIM The aim of the present study, therefore, was to investigate the recreational use of PDE5 among young and healthy men. MAIN OUTCOME MEASURES We evaluated the use of PDE5 inhibitors among young and healthy men, their main reasons for using these drugs, and their expectations regarding its effects. METHODS A survey was carried out among 167 male medical students (21.2 +/- 2.3 years, range 17-31). The surveys were divided into domains, assessing epidemiological data, use of PDE5 inhibitor, and the simplified International Index of Erectile Function (IIEF-5). RESULTS All men considered themselves with perfect erectile function. However, 9% reported previous use of PDE5 inhibitors. Of these, 46.7% had used PDE5 inhibitors more than three times, and 71.4% had mixed them with alcohol. Among this group of men, 13.3% had ED according to the IIEF-5. ED occurring with condom use, however, was twice more common, and 71.4% of the men who had taken PDE5 inhibitors thought that the drug had potential to facilitate condom use. CONCLUSION In conclusion, the use of PDE5 inhibitors by young men is more frequent than previously reported. Condom-related ED seems to be an underestimated problem, frequently solved with PDE5 inhibitors. However, potential deleterious effects might exist. Because PDE5 inhibitors are being used as non-prescribed drugs by as much as 9% of young men, further studies must evaluate the effects of these drugs in young and healthy men.
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Affiliation(s)
- Fernando Korkes
- Division of Urology of the Medical School of Santa Casa of Sao Paulo, Brazil.
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Abstract
Few studies of erectile dysfunction (ED) medications use among heterosexual drug using or abusing men have been conducted. The aims of this study were to provide information on ED medication use prevalence, method of acquisition, and sexual effects among men seeking substance abuse treatment. A single time point cross-sectional anonymous survey was completed by 297 men over the age of 18 seeking substance abuse treatment at an outpatient clinic at a Veterans Affairs Medical Center in the Pacific Northwest. Mean age of participants was 49.7 years and 59.4% self-identified as Caucasian. Alcohol (56.7%) and cocaine (26.1%) were the primary drugs of abuse. Lifetime use of ED medications was reported by 24% (95%CI = 8.6%, 39.4%) of men. Almost 69% of ED medication users reported obtaining ED medications from a physician. Fifty-nine percent of ED medication users reported taking the medications to enhance their sexual experience rather than to treat ED, which was marginally associated with stimulant use (OR = 3.86, 95%CI = 0.96, 15.54, p = .057). These results add to an emerging recognition of the need to address the health implications of ED medication use among heterosexual drug using populations.
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McCambridge J, Winstock A, Hunt N, Mitcheson L. 5-Year trends in use of hallucinogens and other adjunct drugs among UK dance drug users. Eur Addict Res 2007; 13:57-64. [PMID: 17172780 DOI: 10.1159/000095816] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS To describe and assess trends in the use of hallucinogens and other adjunct drugs over a 5-year period. DESIGN Repeated-measures cross-sectional survey. SETTING AND PARTICIPANTS Annual magazine-based survey targeting people who use drugs in dance contexts. MEASUREMENTS Lifetime use prevalence (ever used); age of first use; current use prevalence (any use within the last month), and extent of use within the last month (number of days used) for LSD, psilocybin, ketamine, GHB and nitrates. FINDINGS Prevalence increases for psilocybin, ketamine, GHB and nitrates use have been detected, with a sharp recent rise in current psilocybin use in 2002-2003 contrasting with more gradual and comprehensive evidence of increased ketamine use throughout the period 1999-2003. The declining prevalence of LSD use in general population surveys is replicated in this sentinel population study. CONCLUSIONS The rise in prevalence of hallucinogen and other adjunct drugs identified among dance drug users may be mirrored by wider prevalence increases among young people with a consequent need to study these trends carefully and to develop effective interventions, where required.
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Affiliation(s)
- Jim McCambridge
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.
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