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Immens MH, Ekker MS, Verburgt E, Verhoeven JI, Schellekens MM, Hilkens NA, Boot EM, Van Alebeek ME, Brouwers PJ, Arntz RM, Van Dijk GW, Gons RA, Van Uden IW, den Heijer T, de Kort PL, de Laat KF, Van Norden AG, Vermeer SE, Van Zagten MS, Van Oostenbrugge RJ, Wermer MJ, Nederkoorn PJ, Kerkhoff H, Rooyer FA, Van Rooij FG, Van den Wijngaard IR, Klijn CJ, Tuladhar AM, Ten Cate TJ, de Leeuw FE. Trigger factors in patients with a patent foramen ovale-associated stroke: A case-crossover study. Int J Stroke 2024:17474930241242625. [PMID: 38497344 DOI: 10.1177/17474930241242625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) is a congenital anatomical variant which is associated with strokes in young adults. Contrary to vascular risk factors and atherosclerosis, a PFO is present from birth. However, it is completely unknown how an anatomical structure that is already present at birth in a large proportion of the population can convert into a PFO that causes stroke in a few. Recent studies reported a significant association between certain trigger factors and ischemic stroke in young adults. This study aims to investigate these triggers in PFO-associated stroke. METHODS The ODYSSEY study, a multicenter prospective cohort study between 2013 and 2021, included patients aged 18-49 years experiencing their first-ever ischemic event. Participants completed a questionnaire about exposure to potential trigger factors. A case-crossover design was used to assess the relative risks (RR) with 95% confidence intervals (95% CI). The primary outcome was the RR of potential trigger factors for PFO-associated stroke. RESULTS Overall, 1043 patients completed the questionnaire and had an ischemic stroke, of which 124 patients had a PFO-associated stroke (median age 42.1 years, 45.2% men). For patients with PFO-associated stroke, the RR was 26.0 (95% CI 8.0-128.2) for fever, 24.2 (95% CI 8.5-68.7) for flu-like disease, and 3.31 (95% CI 2.2-5.1) for vigorous exercise. CONCLUSION In conclusion, flu-like disease, fever, and vigorous exercise may convert an asymptomatic PFO into a stroke-causing PFO in young adults. DATA ACCESS STATEMENT The raw and anonymized data used in this study can be made available to other researchers on request. Written proposals can be addressed to the corresponding author and will be assessed by the ODYSSEY investigators for appropriateness of use, and a data sharing agreement in accordance with Dutch regulations will be put in place before data are shared.
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Affiliation(s)
- Maikel Hm Immens
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmee Verburgt
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mijntje Mi Schellekens
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nina A Hilkens
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther M Boot
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Paul Jam Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gert W Van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Rob Ar Gons
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Inge Wm Van Uden
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Paul Lm de Kort
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - K F de Laat
- Department of Neurology, Haga Hospital, The Hague, The Netherlands
| | | | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marian Sg Van Zagten
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - F A Rooyer
- Department of Neurology, Zuyderland Hospital, Sittard-Geleen, The Netherlands
| | - Frank G Van Rooij
- Department of Neurology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Catharina Jm Klijn
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Jf Ten Cate
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Schwartz C, Tooley L, Knight R, Steinberg M. Queering poppers literature: A critical interpretive synthesis of health sciences research on alkyl nitrite use and Canadian policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103546. [PMID: 34920219 DOI: 10.1016/j.drugpo.2021.103546] [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: 07/23/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Poppers (alkyl nitrites) are vasodilators used by many gay, bisexual, and other men who have sex with men (GBMSM) to relieve pain, enhance pleasure, and facilitate penetration during sex. In 2013, the Canadian government cracked down on the sale of poppers products, however prevalence of poppers use among GBMSM in Canada remains high. Poppers have been studied by medical researchers since the 1980s, yet qualitative and community-based research to inform federal policy, remains somewhat less common. METHODS We conducted a critical interpretive synthesis (CIS) to better understand poppers health literature using the medical model of health as a point of reference. Analysis was performed using inductive and deductive methods including reflexive note-taking, mind-mapping, and close coding. 153 publications were identified to inform this review of which 5 were chosen for coding based on a purposive sampling framework. RESULTS Our findings are unified within a theoretical construct we term responsibility. Responsibility is a construct we use to describe the bias we identified in health sciences literature regarding poppers use that tends to exaggerate the necessity for poppers cessation, and devalue both the benefits of poppers use and the perspectives and experiences of people who use poppers. The emphasis on individual behavior change within the literature appears to be motivated less by objective measures or assessments of health risks and outcomes, and more by harmful stereotypes that position gay men and people who use drugs as inherently irresponsible. CONCLUSION We conclude by discussing how these findings have important implications for the review of current policy on poppers sales in Canada which remains influenced by a literature base prejudiced by factors such as homophobia, heteronormativity, and drug stigma, and recommend areas for future work.
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Affiliation(s)
- Cameron Schwartz
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada; Community-Based Research Centre, 1007-808 Nelson St, Vancouver, BC V6Z 2H2, Canada.
| | - Len Tooley
- Community-Based Research Centre, 1007-808 Nelson St, Vancouver, BC V6Z 2H2, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Malcolm Steinberg
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
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Garg S, Taylor J, El Sherief M, Kasson E, Aledavood T, Riordan R, Kaiser N, Cavazos-Rehg P, De Choudhury M. Detecting risk level in individuals misusing fentanyl utilizing posts from an online community on Reddit. Internet Interv 2021; 26:100467. [PMID: 34804810 PMCID: PMC8581502 DOI: 10.1016/j.invent.2021.100467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Opioid misuse is a public health crisis in the US, and misuse of synthetic opioids such as fentanyl have driven the most recent waves of opioid-related deaths. Because those who misuse fentanyl are often a hidden and high-risk group, innovative methods for identifying individuals at risk for fentanyl misuse are needed. Machine learning has been used in the past to investigate discussions surrounding substance use on Reddit, and this study leverages similar techniques to identify risky content from discussions of fentanyl on this platform. METHODS A codebook was developed by clinical domain experts with 12 categories indicative of fentanyl misuse risk, and this was used to manually label 391 Reddit posts and comments. Using this data, we built machine learning classification models to identify fentanyl risk. RESULTS Our machine learning risk model was able to detect posts or comments labeled as risky by our clinical experts with 76% accuracy and 76% sensitivity. Furthermore, we provide a vocabulary of community-specific, colloquial words for fentanyl and its analogues. DISCUSSION This study uses an interdisciplinary approach leveraging machine learning techniques and clinical domain expertise to automatically detect risky discourse, which may elicit and benefit from timely intervention. Moreover, our vocabulary of online terms for fentanyl and its analogues expands our understanding of online "street" nomenclature for opiates. Through an improved understanding of substance misuse risk factors, these findings allow for identification of risk concepts among those misusing fentanyl to inform outreach and intervention strategies tailored to this at-risk group.
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Affiliation(s)
- Sanjana Garg
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - Jordan Taylor
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - Mai El Sherief
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | | | - Raven Riordan
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | - Munmun De Choudhury
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
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