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Kehoe K, Morden E, Zinyakatira N, Heekes A, Jones HE, Walter SR, Jacobs T, Murray J, Buys H, Redaniel MT, Davies MA. Lower respiratory tract infection admissions and deaths among children under 5 years in public sector facilities in the Western Cape Province, South Africa, before and during the COVID-19 pandemic (2019 - 2021). S Afr Med J 2024; 114:e1560. [PMID: 38525574 DOI: 10.7196/samj.2024.v114i3.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/27/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in the implementation of strict public health and social measures (PHSMs) (including mobility restrictions, social distancing, mask-wearing and hand hygiene), limitations on non-essential healthcare services, and public fear of COVID-19 infection, all of which potentially affected transmission and healthcare use for other diseases such as lower respiratory tract infections (LRTIs). OBJECTIVE To determine changes in LRTI hospital admissions and in-facility mortality in children aged <5 years in the Western Cape Province during the pandemic. METHODS We conducted a retrospective analysis of LRTI admissions and in-facility deaths from January 2019 to November 2021. We estimated changes in rates and trends of LRTI admissions during the pandemic compared with pre-pandemic period using interrupted time series analysis, adjusting for key characteristics. RESULTS There were 36 277 children admitted for LRTIs during the study period, of whom 58% were male and 51% were aged 28 days - 1 year. COVID-19 restrictions were associated with a 13% step reduction in LRTI admissions compared with the pre-COVID-19 period (incidence rate ratio (IRR) 0.87, 95% confidence interval (CI)) 0.80 - 0.94). The average LRTI admission trend increased on average by 2% per month during the pandemic (IRR 1.02, 95% CI 1.02 - 1.04). CONCLUSIONS The COVID-19 surges and their associated measures were linked to declining LRTI admissions and in-facility deaths, likely driven by a combination of reduced infectious disease transmission and reduced use of healthcare services, with effects diminishing over time. These findings may inform future pandemic response policies.
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Affiliation(s)
- K Kehoe
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa; Population Health Sciences, Bristol Medical School, University of Bristol, UK; Health Intelligence Directorate, Western Cape Government Health and Wellness, South Africa.
| | - E Morden
- Health Intelligence Directorate, Western Cape Government Health and Wellness, South Africa; Division of Public Health Medicine, School of Public Health, University of Cape Town, South Africa.
| | - N Zinyakatira
- Health Intelligence Directorate, Western Cape Government Health and Wellness, South Africa; Division of Public Health Medicine, School of Public Health, University of Cape Town, South Africa.
| | - A Heekes
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government Health and Wellness, South Africa.
| | - H E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, UK.
| | - S R Walter
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - T Jacobs
- Health Intelligence Directorate, Western Cape Government Health and Wellness, South Africa.
| | - J Murray
- Department of Paediatrics & Neonatology, Paarl Hospital, Western Cape Government Health and Wellness, Paarl, South Africa.
| | - H Buys
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Western Cape Government Health and Wellness, Cape Town, South Africa.
| | - M T Redaniel
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - M-A Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government Health and Wellness, South Africa.
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Wachman EM, Saia K, Bressler J, Werler M, Carter G, Jones HE. Case Series of Individuals Treated with Naltrexone during Pregnancy for Opioid and/or Alcohol Use Disorder. J Addict Med 2024:01271255-990000000-00287. [PMID: 38354121 DOI: 10.1097/adm.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE There is a lack of knowledge about the relative safety and efficacy of naltrexone for the treatment of pregnant individuals with opioid and/or alcohol use disorder, including the range of outcomes, in both the pregnant individual and the infant, over the course of peripartum period. Our objective was to describe these outcomes in a cohort of pregnant individuals on naltrexone. METHODS In this prospective case series, 7 pregnant individuals with opioid use disorder (OUD) or alcohol use disorder (AUD) treated with naltrexone were followed from pregnancy through 12 months after delivery. Clinical treatment protocols and outcomes related to safety and efficacy during pregnancy, delivery, and the postpartum period are described. RESULTS There were 4 pregnant individuals with OUD and 3 with AUD, of which 3 were managed with oral and 4 with extended-release naltrexone. The mean gestational age at study enrollment was 21.7 (SD, 12) weeks. Of the 7 participants, there was no return to nonprescribed opioid use and 2 who experienced a return to alcohol use over the course of the study. All individuals delivered vaginally at a mean of 37 weeks gestation without any peripartum pain difficulties. Five of the individuals (71.4%) remained on naltrexone 12 months after delivery. There were no reported fetal anomalies and one preterm delivery. None of the infants developed neonatal opioid withdrawal syndrome. CONCLUSIONS For pregnant individuals with OUD or AUD treated with naltrexone, there were low rates of return to nonprescribed use and reassuring pregnant person and infant outcomes to 12 months postpartum.
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Affiliation(s)
- Elisha M Wachman
- From the Department of Pediatrics, Boston Medical Center, Boston MA (EMW, JB); Department of Obstetrics and Gynecology, Boston Medical Center, Boston MA (KS); Boston University School of Public Health, Boston MA (MW); Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (GC, HEJ)
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Morrison TM, Schiff DM, Olson A, Hunter RG, Agarwal J, Work EC, Muftu S, Shrestha H, Boateng J, Werler MM, Carter G, Jones HE, Wachman EM. Hair Cortisol Concentrations in Opioid-Exposed versus Nonexposed Mother-Infant Dyads. Am J Perinatol 2023. [PMID: 38160676 DOI: 10.1055/s-0043-1778008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To pilot measurement of hair cortisol concentration (HCC) in pregnant women with opioid use disorder and their infants over time and study the potential utility of hair cortisol as a biomarker of chronic stress in this population. STUDY DESIGN In this pilot prospective cohort study of mother-infant dyads with and without prenatal opioid exposure, we obtained mother-infant HCCs at delivery and again within 1 to 3 months' postpartum. HCCs were compared between the opioid and control groups and between the two time points. RESULTS There were no significant differences between opioid and control group maternal or infant HCCs at either time point. However, within the opioid-exposed group, there was a significant increase in infant HCCs across the two time points. CONCLUSION This pilot study describes our experience with the measurement of HCCs in opioid-exposed mother-infant dyads. KEY POINTS · Maternal stress impacts fetal and child health.. · Many stressors in pregnant women with opioid use disorder.. · Hair cortisol may be a useful stress biomarker..
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Affiliation(s)
- Tierney M Morrison
- Department of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Davida M Schiff
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Abigael Olson
- Department of Obstetrics and Gynecology, Boston University, Boston, Massachusetts
| | - Richard G Hunter
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts
| | - Joel Agarwal
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Erin C Work
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Serra Muftu
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Hira Shrestha
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Jeffery Boateng
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ginny Carter
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Hendree E Jones
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Work EC, Muftu S, MacMillan KDL, Gray JR, Bell N, Terplan M, Jones HE, Reddy J, Wilens TE, Greenfield SF, Bernstein J, Schiff DM. Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder. Matern Child Health J 2023; 27:104-112. [PMID: 37253899 PMCID: PMC10229393 DOI: 10.1007/s10995-023-03672-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Some states, including Massachusetts, require automatic filing of child abuse and neglect for substance-exposed newborns, including infants exposed in-utero to clinician-prescribed medications to treat opioid use disorder (MOUD). The aim of this article is to explore effects of these mandated reporting policies on pregnant and postpartum people receiving MOUD. METHODS We used modified grounded research theory, literature findings, and constant comparative methods to extract, analyze and contextualize perinatal experiences with child protection systems (CPS) and explore the impact of the Massachusetts mandated reporting policy on healthcare experiences and OUD treatment decisions. We drew from 26 semi-structured interviews originally conducted within a parent study of perinatal MOUD use in pregnancy and the postpartum period. RESULTS Three themes unique to CPS reporting policies and involvement emerged. First, mothers who received MOUD during pregnancy identified mandated reporting for prenatally prescribed medication utilization as unjust and stigmatizing. Second, the stress caused by an impending CPS filing at delivery and the realities of CPS surveillance and involvement after filing were both perceived as harmful to family health and wellbeing. Finally, pregnant and postpartum individuals with OUD felt pressure to make medical decisions in a complex environment in which medical recommendations and the requirements of CPS agencies often compete. CONCLUSIONS FOR PRACTICE Uncoupling of OUD treatment decisions in the perinatal period from mandated CPS reporting at time of delivery is essential. The primary focus for families affected by OUD must shift from surveillance and stigma to evidence-based treatment and access to supportive services and resources.
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Affiliation(s)
- Erin C Work
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA.
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA.
- Department of Social Welfare, UCLA Luskin School of Public Affairs, 337 Charles E. Young Dr. E., Los Angeles, CA, 90095, USA.
| | - Serra Muftu
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA
| | - Kathryn Dee L MacMillan
- Division of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, 02114, USA
- Division of Pediatric Hospital Medicine, MassGeneral Hospital for Children, 55 Fruit St, Boston, MA, 02114, USA
| | - Jessica R Gray
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Division of Pediatrics, MassGeneral for Children, Boston, USA
| | - Nicole Bell
- Living in Freedom Together-LIFT Inc, Worcester, MA, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21202, USA
| | - Hendree E Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC, USA
| | - Julia Reddy
- Gillings School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Shelly F Greenfield
- Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA
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Deflorimonte C, Glissendorf V, Hofer J, Cai A, Iannella N, Boateng JO, Carter G, Saia KA, Jones HE, Wachman EM. National Provider Survey: Use of Naltrexone for Pregnant Individuals with Substance Use Disorders. J Addict Med 2023; 17:736-738. [PMID: 37934548 PMCID: PMC10873530 DOI: 10.1097/adm.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES A national survey evaluated the availability of naltrexone as a treatment for alcohol use disorder and/or opioid use disorder for pregnant individuals. Provider perceptions of barriers to treatment with naltrexone during pregnancy were also examined. METHODS Sites were selected from a national registry of naltrexone prescribers (N = 5208). A 10% sampling of sites within 150 miles of each state's capital was selected (n = 2073). Survey of 11 questions included availability of naltrexone for pregnant individuals, standard practices for treating pregnant individuals already on naltrexone, and barriers to treatment. Survey responses were summarized to identify top barriers and national trends in service availability. RESULTS Of the 236 sites contacted, 78 (33.1%) completed the survey. There was significant geographic variation in number of available sites, with Northeast United States having the most sites. Of the 78 responding sites, only 23 (35.9%) offered naltrexone for pregnant individuals. The most common barriers to prescribing naltrexone included the following: sites without pregnant patients (15.6%), lack of national guidelines in using naltrexone for pregnant patients (14.1%), providers' discomfort with prescribing naltrexone during pregnancy due to safety concerns (9.4%), and providers' discomfort due to inexperience (4.7%). CONCLUSIONS Accessibility of naltrexone and related care for pregnant individuals with alcohol use disorder and opioid use disorder varies greatly across the United States with numerous barriers and educational gaps identified. Additional research and resources are needed to expand naltrexone treatment access for pregnant individuals.
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Affiliation(s)
- Chloe Deflorimonte
- From the Department of Pediatrics, Boston Medical Center, Boston, MA (CD, NI, JOB, EMW); Boston University School of Public Health, Boston, MA (VG); Boston University Chobanian and Avedisian School of Medicine, Boston, MA (JH, AC); UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC (GC, HEJ); and Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA (KAS)
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Knittel AK, Swartzwelder RA, Zarnick S, Tsujimoto TM, Horne T, Lin FC, Edwards J, Amos E, Alexander J, Thorp J, Jones HE. Neonatal Outcomes after Medications for Opioid Use Disorder during Pregnancy in a State Women's Prison Facility, 2016-2019. J Addict Med 2023; 17:587-591. [PMID: 37788614 PMCID: PMC10593980 DOI: 10.1097/adm.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Although medications for opioid use disorder improve both maternal and neonatal outcomes, little is known about opioid-exposed infants born during episodes of incarceration. The study sought to examine birth outcomes for infants born with opioid exposure during perinatal incarceration. METHODS Participants were identified from clinic rosters in a Southeastern women's prison (2016-2019). Included infants born to pregnant people with opioid use disorder incarcerated in the study facility at the time of delivery. We abstracted hospital length of stay, neonatal opioid withdrawal syndrome (NOWS) severity, and discharge plan from hospital records and report descriptive statistics, analysis of variance F tests, and chi-square tests to compare outcomes by opioid exposure type. RESULTS There were 125 infants born after exposure to methadone (n = 34), buprenorphine (n = 15), oxycodone (n = 22), or no opioid medication (n = 54) during prenatal incarceration. Most infants exposed to methadone or buprenorphine had difficulty with eating, sleeping, or consoling (97% and 80%), and 59% and 47% were treated with medication for NOWS, respectively. The majority with prenatal opioid exposure required intervention for NOWS symptoms after their birthing parent was discharged to the prison. The average hospital length of stay was different for infants with no opioid, methadone, buprenorphine, and oxycodone exposure during incarceration (4, 15, 12, and 9 days, respectively, P < 0.001). CONCLUSIONS Neonatal hospitalization experiences of infants with perinatal opioid exposures during maternal incarceration mirror those of similarly exposed infants born outside the context of incarceration, except for hospital length of stay. Consideration of avoiding separation of the parent-infant dyad may be needed to improve outcomes for these infants.
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Affiliation(s)
- Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Rita A Swartzwelder
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Samantha Zarnick
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Tamy Moraes Tsujimoto
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Timeli Horne
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Feng Chang Lin
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Elton Amos
- North Carolina Department of Public Safety, Raleigh, NC
| | | | - John Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hendree E Jones
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Weller SA, Armstrong SR, Bailey S, Burnell HT, Burt EL, Cant NE, Cawthorne KR, Chester M, Choules JE, Coe NA, Coward L, Cox VL, Emery ER, Evans CP, Finn A, Halford CM, Hamblin KA, Harrison GV, Hartley MG, Hudson C, James B, Jones HE, Keyser E, Lonsdale CL, Marshall LE, Maule CE, Miles JA, Newstead SL, Nicholls M, Osborne C, Pearcy AS, Penny LD, Perrot R, Rachwal P, Robinson V, Rushton D, Stahl FM, Staplehurst SV, Stapleton HL, Steeds K, Stephenson K, Thompson IJ, Thwaite JE, Ulaeto DO, Waters N, Wills DJ, Wills ZS, Rees C, Hutley EJ. Development and operation of the defence COVID-19 lab as a SARS-CoV-2 diagnostic screening capability for UK military personnel. BMJ Mil Health 2022; 170:e002134. [PMID: 35878971 PMCID: PMC10958320 DOI: 10.1136/military-2022-002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the face of the COVID-19 pandemic, the Defence Science and Technology Laboratory (Dstl) and Defence Pathology combined to form the Defence Clinical Lab (DCL), an accredited (ISO/IEC 17025:2017) high-throughput SARS-CoV-2 PCR screening capability for military personnel. LABORATORY STRUCTURE AND RESOURCE The DCL was modular in organisation, with laboratory modules and supporting functions combining to provide the accredited SARS-CoV-2 (envelope (E)-gene) PCR assay. The DCL was resourced by Dstl scientists and military clinicians and biomedical scientists. LABORATORY RESULTS Over 12 months of operation, the DCL was open on 289 days and tested over 72 000 samples. Six hundred military SARS-CoV-2-positive results were reported with a median E-gene quantitation cycle (Cq) value of 30.44. The lowest Cq value for a positive result observed was 11.20. Only 64 samples (0.09%) were voided due to assay inhibition after processing started. CONCLUSIONS Through a sustained effort and despite various operational issues, the collaboration between Dstl scientific expertise and Defence Pathology clinical expertise provided the UK military with an accredited high-throughput SARS-CoV-2 PCR test capability at the height of the COVID-19 pandemic. The DCL helped facilitate military training and operational deployments contributing to the maintenance of UK military capability. In offering a bespoke capability, including features such as testing samples in unit batches and oversight by military consultant microbiologists, the DCL provided additional benefits to the UK Ministry of Defence that were potentially not available from other SARS-CoV-2 PCR laboratories. The links between Dstl and Defence Pathology have also been strengthened, benefitting future research activities and operational responses.
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Affiliation(s)
- Simon A Weller
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - S R Armstrong
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - S Bailey
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - H T Burnell
- Operations Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - E L Burt
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - N E Cant
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - K R Cawthorne
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - M Chester
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - J E Choules
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - N A Coe
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - L Coward
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - V L Cox
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - E R Emery
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - C P Evans
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - A Finn
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - C M Halford
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - K A Hamblin
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - G V Harrison
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - M G Hartley
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - C Hudson
- Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
| | - B James
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - H E Jones
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - E Keyser
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - C L Lonsdale
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - L E Marshall
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - C E Maule
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - J A Miles
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - S L Newstead
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - M Nicholls
- Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
| | - C Osborne
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - A S Pearcy
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - L D Penny
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - R Perrot
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - P Rachwal
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - V Robinson
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - D Rushton
- Platform Systems Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - F M Stahl
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - S V Staplehurst
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - H L Stapleton
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - K Steeds
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - K Stephenson
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - I J Thompson
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - J E Thwaite
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - D O Ulaeto
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - N Waters
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - D J Wills
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - Z S Wills
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - C Rees
- CBR Division, Defence Science and Technology Laboratory Porton Down, Salisbury, UK
| | - E J Hutley
- Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
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Gertner AK, Clare HM, Powell BJ, Gilbert AR, Jones HE, Silberman P, Shea CM, Domino ME. A mixed methods study of provider factors in buprenorphine treatment retention. International Journal of Drug Policy 2022; 105:103715. [DOI: 10.1016/j.drugpo.2022.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
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Jones HE, Morrison I, Hurding S, Wild S, Anand A, Shenkin SD. 709 IMPACT ON HEALTHCARE UTILISATION OF A GENERAL PRACTITIONER-LED MODEL OF CARE FOR PATIENTS WITH FRAILTY. Age Ageing 2022. [DOI: 10.1093/ageing/afac035.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Primary care has a significant role to play in the identification and management of frailty. MidMed is a new dedicated GP-led service developed by a large practice in Midlothian for patients living at home with moderate or severe frailty. MidMed comprises a full-time GP performing a comprehensive geriatric assessment (CGA) adapted for primary care. Patients receive direct access to all appointments with the named GP. The aim of this study was to assess the impact of MidMed on healthcare utilisation in this patient group.
Methods
Patients with moderate or severe frailty at the MidMed practice were identified by the electronic Frailty Index (>0.24). After 16 months, patients who had been accepted into MidMed (MidMed group) were compared with those yet to be enrolled and who continued to receive usual care (non-MidMed group). Routinely collected data were used to identify outcomes including unscheduled hospital admissions, primary care consultations, continuity of care, outpatient attendances and mortality. Adjusted rate ratios were estimated using regression models.
Results
510 patients with moderate or severe frailty were identified (290 in MidMed, 220 in non-MidMed). Patients in each group were just as likely to have at least one hospital admission per year but those in MidMed had a reduced risk of further hospital admission compared to the non-MidMed group (adjusted RR 0.46 [95%CI 0.30–0.71]). MidMed was also associated with statistically significant higher usage of primary care (adjusted RR 1.52, [95%CI, 1.30–1.75]) and better continuity of care. There was no difference in mortality or the number of outpatient appointments when adjusted for co-variates.
Conclusion
A GP-led service for frailty is associated with lower risk of hospital readmission and improved continuity of care. Further studies are now required to better understand why use of such primary care services increase and whether this changes over time.
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Affiliation(s)
| | | | | | - S Wild
- The Usher Institute, University of Edinburgh
| | - A Anand
- The Centre for Cardiovascular Science, University of Edinburgh
| | - S D Shenkin
- The Usher Institute, University of Edinburgh
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10
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Shahzad S, Jones HE, Begum N, Zia A. Urdu translation and psychometric properties of WHO-Five Wellbeing Index among male patients with substance use disorders in Pakistan. Journal of Substance Use 2021. [DOI: 10.1080/14659891.2021.2006338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Salman Shahzad
- Institute of Clinical Psychology, Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Hendree E. Jones
- Obstetrics and Gynecologic, University of North Carolina System, Chapel Hill, North Carolina, USA
| | | | - Ayesha Zia
- Institute of Clinical Psychology, Clinical Psychology, University of Karachi, Karachi, Pakistan
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11
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Knittel AK, Zarnick S, Thorp JM, Amos E, Jones HE. Medications for opioid use disorder in pregnancy in a state women's prison facility. Drug Alcohol Depend 2020; 214:108159. [PMID: 32683223 PMCID: PMC7977476 DOI: 10.1016/j.drugalcdep.2020.108159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) improves both maternal and neonatal outcomes for pregnant women with opioid use disorder (OUD). Although correctional policies often state that incarcerated pregnant women with OUD should receive MOUD, implementation data is scant. Our aims were to 1) quantify the extent to which pregnant women in a Southeastern prison received MOUD during their incarceration; 2) to describe the medications and doses used during incarceration and frequency of MOUD referral after incarceration; and 3) identify associations between maternal characteristics and receipt of MOUD in order to identify points of intervention for clinical policy change. METHODS We conducted a retrospective chart review of pregnant women with OUD in a North Carolina state women's prison from 2016-2018. We collected MOUD, demographic, custody, pregnancy, and pre-incarceration substance use data. We used descriptive statistics, chi square tests, and logistic regression. RESULTS There were 179 pregnant women with OUD. During incarceration, 11.7 % received buprenorphine, 17.8 % methadone, 22.8 % oxycodone, and 47.8 % did not receive any opioid medications. Of those who received buprenorphine, methadone, and no MOUD, respectively, 65 %, 51.2 %, and 3.2 % were referred for community MOUD. Women were more likely to receive MOUD during incarceration if they had received MOUD pre-incarceration. CONCLUSIONS There was significant unmet need for MOUD and MOUD referral among pregnant women imprisoned in North Carolina from 2016-2018. Our findings suggest that the initial assessment for MOUD and referral to a community MOUD provider may represent opportunities to improve MOUD access for this population.
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Affiliation(s)
- Andrea K. Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - John M. Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elton Amos
- North Carolina Department of Public Safety, Raleigh, NC
| | - Hendree E. Jones
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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12
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Guille C, Jones HE, Abuhamad A, Brady KT. Shared Decision‐Making Tool for Treatment of Perinatal Opioid Use Disorder. Psychiatr res clin pract 2019; 1:27-31. [PMID: 36101566 PMCID: PMC9176026 DOI: 10.1176/appi.prcp.20180004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/17/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Constance Guille
- Departments of Psychiatry and Behavioral Sciences
- Departments of Obstetrics and GynecologyMedical University of South CarolinaCharleston
| | - Hendree E. Jones
- UNC HorizonsDepartment of Obstetrics and GynecologyUniversity of North Carolina at Chapel HillDepartment of Psychiatry and Behavioral SciencesSchool of MedicineJohns Hopkins UniversityBaltimore
| | - Alfred Abuhamad
- Department of Obstetrics and GynecologyEastern Virginia Medical SchoolNorfolk
| | - Kathleen T. Brady
- Departments of Psychiatry and Behavioral Sciences
- Ralph H. Johnson Veterans Administration Medical CenterCharlestonS.C
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13
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Rhodes KM, Mawdsley D, Turner RM, Jones HE, Savović J, Higgins JPT. Label-invariant models for the analysis of meta-epidemiological data. Stat Med 2017; 37:60-70. [PMID: 28929507 PMCID: PMC5724693 DOI: 10.1002/sim.7491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/27/2017] [Accepted: 08/20/2017] [Indexed: 11/06/2022]
Abstract
Rich meta‐epidemiological data sets have been collected to explore associations between intervention effect estimates and study‐level characteristics. Welton et al proposed models for the analysis of meta‐epidemiological data, but these models are restrictive because they force heterogeneity among studies with a particular characteristic to be at least as large as that among studies without the characteristic. In this paper we present alternative models that are invariant to the labels defining the 2 categories of studies. To exemplify the methods, we use a collection of meta‐analyses in which the Cochrane Risk of Bias tool has been implemented. We first investigate the influence of small trial sample sizes (less than 100 participants), before investigating the influence of multiple methodological flaws (inadequate or unclear sequence generation, allocation concealment, and blinding). We fit both the Welton et al model and our proposed label‐invariant model and compare the results. Estimates of mean bias associated with the trial characteristics and of between‐trial variances are not very sensitive to the choice of model. Results from fitting a univariable model show that heterogeneity variance is, on average, 88% greater among trials with less than 100 participants. On the basis of a multivariable model, heterogeneity variance is, on average, 25% greater among trials with inadequate/unclear sequence generation, 51% greater among trials with inadequate/unclear blinding, and 23% lower among trials with inadequate/unclear allocation concealment, although the 95% intervals for these ratios are very wide. Our proposed label‐invariant models for meta‐epidemiological data analysis facilitate investigations of between‐study heterogeneity attributable to certain study characteristics.
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Affiliation(s)
- K M Rhodes
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - D Mawdsley
- University of Manchester, Manchester, UK
| | - R M Turner
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,MRC Clinical Trials Unit, University College London, UK
| | - H E Jones
- School of Social and Community Medicine, University of Bristol, UK
| | - J Savović
- School of Social and Community Medicine, University of Bristol, UK.,NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J P T Higgins
- School of Social and Community Medicine, University of Bristol, UK
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14
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Jansson LM, Velez M, McConnell K, Spencer N, Tuten M, Jones HE, King VL, Gandotra N, Milio LA, Voegtline K, DiPietro JA. Maternal buprenorphine treatment and fetal neurobehavioral development. Am J Obstet Gynecol 2017; 216:529.e1-529.e8. [PMID: 28188773 DOI: 10.1016/j.ajog.2017.01.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/04/2016] [Accepted: 01/31/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Gestational opioid use/misuse is escalating in the United States; however, little is understood about the fetal effects of medications used to treat maternal opioid use disorders. OBJECTIVE The purpose of this study was to determine the effect of maternal buprenorphine administration on longitudinal fetal neurobehavioral development. STUDY DESIGN Forty-nine buprenorphine-maintained women who attended a substance use disorder treatment facility with generally uncomplicated pregnancies underwent fetal monitoring for 60 minutes at times of trough and peak maternal buprenorphine levels. Data were collected at 24, 28, 32, and 36 weeks gestation. Fetal neurobehavioral indicators (ie, heart rate, motor activity, and their integration [fetal movement-fetal heart rate coupling]) were collected via an actocardiograph, digitized and quantified. Longitudinal data analysis relied on hierarchic linear modeling. RESULTS Fetal heart rate, heart rate variability, and heart rate accelerations were significantly reduced at peak vs trough maternal buprenorphine levels. Effects were significant either by or after 28 weeks gestation and tended to intensify with advancing gestation. Fetal motor activity and fetal movement-fetal heart rate coupling were depressed from peak to trough at 36 weeks gestation. Polysubstance exposure did not significantly affect fetal neurobehavioral parameters, with the exception that fetuses of heavier smokers moved significantly less than those of lighter smokers at 36 weeks gestation. By the end of gestation, higher maternal buprenorphine dose was related to depression of baseline fetal cardiac measures at trough. CONCLUSION Maternal buprenorphine administration has acute suppressive effects on fetal heart rate and movement, and the magnitude of these effects increases as gestation progresses. Higher dose (≥13 mg) appears to exert greater depressive effects on measures of fetal heart rate and variability. These findings should be balanced against comparisons to gestational methadone effects, relatively good outcomes of buprenorphine-exposed infants, and recognition of the benefits of medication-assisted treatment for pregnant women with opioid use disorders in optimizing pregnancy outcomes.
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Affiliation(s)
- Lauren M Jansson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Martha Velez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Krystle McConnell
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nancy Spencer
- Johns Hopkins Bayview Hospital, Department of Nursing, Baltimore, MD
| | - Michelle Tuten
- University of Maryland School of Social Work, Baltimore, MD
| | - Hendree E Jones
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD; University of North Carolina Chapel Hill, Department of Obstetrics and Gynecology
| | - Van L King
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neeraj Gandotra
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lorraine A Milio
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristin Voegtline
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Joyce AR, Zedler BK, Amick HR, Murrelle EL, Jones HE. Response to Smith and Brogly et al. commentaries on Zedler et al. Addiction 2016; 111:2131-2133. [PMID: 28075535 DOI: 10.1111/add.13608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | - Hendree E Jones
- UNC Horizons, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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16
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Hallifax RJ, Yousuf A, Jones HE, Corcoran JP, Psallidas I, Rahman NM. Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review. Thorax 2016; 72:1121-1131. [PMID: 27803156 PMCID: PMC5738542 DOI: 10.1136/thoraxjnl-2015-207967] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 11/23/2022]
Abstract
Objectives Spontaneous pneumothorax is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence. This study comprehensively reviews the existing literature regarding chemical pleurodesis efficacy. Design We systematically reviewed the literature to identify relevant randomised controlled trials (RCTs), case–control studies and case series. We described the findings of these studies and tabulated relative recurrence rates or ORs (in studies with control groups). Meta-analysis was not performed due to substantial clinical heterogeneity. Results Of 560 abstracts identified by our search strategy, 50 were included in our systematic review following screening. Recurrence rates in patients with chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc poudrage (four studies (n=249)) provided recurrence rates of between 2.5% and 10.2% with the only RCT suggesting an OR of 0.10 compared with drainage alone. In comparison, talc administration during video-assisted thoracic surgery (VATS) from eight studies (n=2324) recurrence was between 0.0% and 3.2%, but the RCT did not demonstrate a significant difference compared with bleb/bullectomy alone. Minocycline appears similarly effective post-VATS (recurrence rates 0.0–2.9%). Prolonged air leak and recurrence prevention using tetracycline via chest drain (n=726) is likely to provide recurrence rates between 13.0% and 33.3% and autologous blood patch pleurodesis (n=270) between 15.6% and 18.2%. Conclusions Chemical pleurodesis postsurgical treatment or via thoracoscopy appears to be most effective. Evidence for definitive success rates of each agent is limited by the small number of randomised trials or other comparative studies.
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Affiliation(s)
- R J Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Yousuf
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - H E Jones
- Faculty of Health Sciences, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - I Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - N M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
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Abstract
Drug use during pregnancy is a significant risk factor for compromised child development. National statistics reveal that many pregnant women smoke tobacco (18%), drink alcohol (9.8%), and use illicit drugs (4%). Animal and clinical data show that prenatal alcohol and tobacco exposure have direct deleterious consequences on child development. Recent large multicenter studies have failed to show that prenatal cocaine or heroin exposure causes devastating child consequences when environmental variables are controlled. However, prenatal exposure to both licit and illicit drug use mostly occurs in the presence of environmental and contextual risk factors that together can impede healthy outcomes. Thus, treating these addiction disorders while addressing other lifestyle factors in a comprehensive way is critical.
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19
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Doyle RM, Alber DG, Jones HE, Harris K, Fitzgerald F, Peebles D, Klein N. Term and preterm labour are associated with distinct microbial community structures in placental membranes which are independent of mode of delivery. Placenta 2014; 35:1099-101. [PMID: 25458966 DOI: 10.1016/j.placenta.2014.10.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
Infection is considered a possible trigger for preterm labour, supported by evidence showing the presence of bacteria in the placenta and placental membranes from preterm births. In this study, 16S rDNA pyrosequencing was used to identify bacteria in placental membranes. Caesarean sections and vaginal deliveries at term were found to harbour common genera. Mycoplasma hominis, Aerococcus christensenii, Gardnerella vaginalis and Fusobacterium nucleatum were either only present in preterm membranes or in greater abundance than at term. These data support previous studies that used either targeted qPCR or broad-range 16S rDNA PCR and cloning but not a recent microbiome analysis of placental tissue using high-throughput sequencing.
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Affiliation(s)
- R M Doyle
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - D G Alber
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - H E Jones
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - K Harris
- Microbiology Department, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom.
| | - F Fitzgerald
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
| | - D Peebles
- Department of Maternal and Fetal Medicine, Institute for Womens Health, University College London, London, United Kingdom.
| | - N Klein
- Infection, Inflammation and Rheumatology Section, Institute of Child Health, London, United Kingdom.
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20
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Salt TE, Jones HE, Copeland CS, Sillito AM. Function of mGlu1 receptors in the modulation of nociceptive processing in the thalamus. Neuropharmacology 2013; 79:405-11. [PMID: 24373900 PMCID: PMC3989022 DOI: 10.1016/j.neuropharm.2013.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/23/2013] [Accepted: 12/16/2013] [Indexed: 01/07/2023]
Abstract
As postsynaptic metabotropic subtype 1 (mGlu1) receptors are present in the thalamus, we have investigated the effect of potentiating and antagonising mGlu1 receptors on responses of thalamic neurones to noxious sensory stimulation. Extracellular recordings were made in vivo with multi-barrel iontophoretic electrodes from single neurones in the thalamus of urethane-anaesthetised rats. Responses to iontophoretic applications of the Group I mGlu agonist 3,5-dihydroxy-phenylglycine (DHPG) were selectively potentiated by co-application of the mGlu1 positive allosteric modulator Ro67-4853, whereas they were selectively reduced upon co-application of the mGlu1 receptor orthosteric antagonist LY367385. This indicates that thalamic DHPG responses are mediated primarily via mGlu1 receptors, consistent with the high postsynaptic levels of this receptor in the thalamus. Furthermore, potentiation of DHPG responses by Ro67-4853 were greater when the initial DHPG response was of a low magnitude. Ro67-4853 also potentiated responses of thalamic neurones to noxious thermal stimulation, whilst having little effect on the baseline activity of nociceptive neurones. By contrast, nociceptive responses were reduced by LY367385. In a further series of experiments we found that inactivation of somatosensory cortex by cooling resulted in a reduction of thalamic nociceptive responses. These results underline the importance of mGlu1 receptors in the processing of sensory information in the thalamus, particularly with respect to nociceptive responses. Furthermore, the involvement of mGlu1 receptors may reflect the activity of descending cortico-thalamic afferents. Pharmacological potentiation of mGlu1 receptors enhances nociceptive responses of thalamic neurones. Antagonism of mGlu1 receptors reduces nociceptive responses of thalamic neurones. Inactivation of somatosensory cortex reduces nociceptive responses of thalamic neurones. This suggests a role for mGlu1 receptors and cortico-thalamic pathways in nociceptive processing.
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Affiliation(s)
- T E Salt
- Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, United Kingdom.
| | - H E Jones
- Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - C S Copeland
- Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - A M Sillito
- Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, United Kingdom
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21
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Holbrook AM, Jones HE, Heil SH, Martin PR, Stine SM, Fischer G, Coyle MG, Kaltenbach K. Induction of pregnant women onto opioid-agonist maintenance medication: an analysis of withdrawal symptoms and study retention. Drug Alcohol Depend 2013; 132:329-34. [PMID: 23523131 PMCID: PMC3732530 DOI: 10.1016/j.drugalcdep.2013.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/24/2012] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Induction onto buprenorphine during pregnancy may be more challenging than induction onto methadone. This study explores factors predicting withdrawal intensities and compares trajectories of withdrawal during the induction phase between opioid-dependent women randomly assigned to methadone or buprenorphine. METHODS A secondary analysis was conducted on data from 175 opioid-dependent pregnant women inducted onto buprenorphine or methadone subsequent to stabilization on morphine sulfate. ANOVA analyses were conducted to determine differences between mean peak CINA scores by medication and completion status. General linear mixed models were fitted to compare trajectories of CINA scores between methadone and buprenorphine conditions, and between study dropouts and completers within the buprenorphine condition. RESULTS Both buprenorphine and methadone patients experienced withdrawal categorized as minimal by the CINA scoring system. Significant differences in mean peak CINA scores for the first 72 hours of induction were found between the methadone (4.5; SD=0.4) and buprenorphine conditions (6.9; SD=0.4), with buprenorphine patients exhibiting higher mean peak CINA scores [F (3, 165)=9.70, p<0.001]. The trajectory of CINA scores showed buprenorphine patients exhibiting a sharper increase in mean CINA scores than methadone patients [F (1, 233)=8.70, p=0.004]. There were no differences in mean peak CINA scores [F (3, 77)=0.08, p=0.52] or in trajectory of CINA scores [F (1, 166)=0.42, p=0.52] between buprenorphine study dropouts and completers. CONCLUSION While mean peak CINA score was significantly higher in the buprenorphine condition than the methadone condition, neither medication condition experienced substantial withdrawal symptoms. Further research on factors related to successful induction to buprenorphine treatment in pregnant women is needed.
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Affiliation(s)
- Amber M Holbrook
- Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Hendree E. Jones
- RTI International Research Triangle Park, NC 27709 USA
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224 USA
| | - Sarah H. Heil
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT 05405 USA
| | - Peter R. Martin
- Departments of Psychiatry and Pharmacology, Vanderbilt University, Nashville, TN 37212 USA
| | - Susan M. Stine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48207 USA
| | - Gabriele Fischer
- Center of Public Health and Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 AUSTRIA
| | - Mara G. Coyle
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI 02905 USA
| | - Karol Kaltenbach
- Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107 USA
- Department of Psychiatry and Human Behavior, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107 USA
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Chang M, Jones HE, Dzuba IG, Ballagh S, Irwin T, Marx PA, Pau KYF, Veazey R, Winikoff B. P2.192 Vaginal Epithelial Thickness and Serum Hormone Levels by Body Mass Index at the Luteal and Follicular Phases of the Menstrual Cycle. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Jones HE, Holloway IW, Pressman E, Meier J, Westhoff CL. Women's preferences for testing and management of sexually transmitted infections among low-income New York City family planning clients. Int J STD AIDS 2013; 24:455-60. [DOI: 10.1177/0956462412473888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary High prevalence of chlamydia in the USA persists despite efforts to annually screen women under the age of 26. Tailoring sexually transmitted infection (STI) services to client preferences may strengthen existing programmes. We report women's preferences for STI services from a family planning clinic in New York City serving low-income women. Seventy-eight percent (995/1275) of eligible women participated, with a mean age of 26 (SD±7). Ninety-one percent self-identified as Latina. Nineteen percent reported a past STI. Women preferred self-collection (65%) for testing to a speculum exam (20%); 15% had no preference. Women with a previous STI were more likely to prefer a pelvic exam to women with no previous STI (50% versus 32%, P < 0.01). Nearly all women (94%) preferred informing a sex partner about a positive STI test themselves, but 88% were willing to bring expedited partner therapy to a partner. Women were more likely to prefer third party partner notification if their last partner was casual rather than a main partner (14% versus 3%, respectively, P < 0.01). Forty-four percent of participants worried about physical violence after partner notification. Self-collecting specimens for screening was widely acceptable. Partner notification strategies should be based on understanding partnership status, including fears of violence.
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Affiliation(s)
- H E Jones
- Division of Family Planning & Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center
- CUNY School of Public Health, Hunter College, 2180 Third Avenue, New York, NY
| | - I W Holloway
- Division of Family Planning & Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center
- Department of Social Welfare, University of California, Los Angeles, CA, USA
| | - E Pressman
- Division of Family Planning & Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center
| | - J Meier
- Division of Family Planning & Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center
| | - C L Westhoff
- Division of Family Planning & Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center
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Jones HE, Andolina IM, Grieve KL, Wang W, Salt TE, Cudeiro J, Sillito AM. Responses of primate LGN cells to moving stimuli involve a constant background modulation by feedback from area MT. Neuroscience 2013; 246:254-64. [PMID: 23644057 PMCID: PMC3696733 DOI: 10.1016/j.neuroscience.2013.04.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/30/2022]
Abstract
We investigated the influence of area MT feedback on LGN cell responses to visual stimuli. We used focal GABA micro-iontophoresis to reversibly block area MT cell responses. Inactivating area MT feedback produced clear and reversible changes in LGN cell responses. Effects were observed across magno, parvo and koniocellular LGN cell types.
The feedback connections from the cortical middle temporal (MT) motion area, to layer 6 of the primary visual cortex (V1), have the capacity to drive a cascaded feedback influence from the layer 6 cortico-geniculate cells back to the lateral geniculate nucleus (LGN) relay cells. This introduces the possibility of a re-entrant motion signal affecting the relay of the retinal input through the LGN to the visual cortex. The question is whether the response of LGN cells to moving stimuli involves a component derived from this feedback. By producing a reversible focal pharmacological block of the activity of an MT direction column we show the presence of such an influence from MT on the responses of magno, parvo and koniocellular cells in the macaque LGN. The pattern of effect in the LGN reflects the direction bias of the MT location inactivated. This suggests a moving stimulus is captured by iterative interactions in the circuit formed by visual cortical areas and visual thalamus.
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Affiliation(s)
- H E Jones
- Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom.
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Zule WA, Poulton WE, Coomes CM, Mansergh G, Charania M, Wechsberg WM, Jones HE. Results of a pilot study to reduce methamphetamine use and sexual risk behaviors among methamphetamine-using men who have sex with men (MSM) not currently in treatment. J Psychoactive Drugs 2013; 44:351-8. [PMID: 23457885 DOI: 10.1080/02791072.2012.736794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Methamphetamine use, which has been linked to unprotected anal intercourse and incident HIV infection, is an important contributor to HIV transmission among men who have sex with men (MSM). The purpose of this study was to develop and pilot test a single-session motivational interviewing (MI) intervention for reducing HIV risk among an out-of-treatment sample of MSM who use methamphetamine. MSM who use methamphetamine (n = 39) were recruited in 2008 and 2009 in North Carolina. They completed baseline data collection and a single-session MI intervention. Eighty percent completed a follow-up interview two months after enrollment. Men reported reductions in methamphetamine use during the previous 60 days from an average of 9.4 days at baseline to 3.3 days at follow-up (p < 0.05) and unprotected anal intercourse from an average of 4.8 sex partners during the previous 60 days at baseline to 2.9 at follow-up (p < 0.05). Self-reported unprotected anal intercourse at last sex with a nonprimary partner decreased significantly (from 81% at baseline to 25% at follow-up; p = 0.001). These results suggest that a single-session MI intervention may be useful for reducing methamphetamine use and sexual risk among MSM who use methamphetamine, especially in settings where multisession interventions are not feasible.
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Affiliation(s)
- William A Zule
- Substance Abuse Treatment Evaluations and Interventions Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 7709-2194, USA.
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Tuten M, Fitzsimons H, Chisolm MS, Nuzzo PA, Jones HE. Contingent incentives reduce cigarette smoking among pregnant, methadone-maintained women: results of an initial feasibility and efficacy randomized clinical trial. Addiction 2012; 107:1868-77. [PMID: 22716774 PMCID: PMC3439534 DOI: 10.1111/j.1360-0443.2012.03923.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/17/2012] [Accepted: 04/18/2012] [Indexed: 11/30/2022]
Abstract
AIMS This study examined the feasibility and efficacy of behavioral incentives for reducing cigarette smoking among pregnant methadone-maintained patients. DESIGN Participants (n = 102) were assigned randomly to: (i) contingent behavioral incentives (CBI: n = 42); (ii) non-contingent behavioral incentives (NCBI: n = 28); or (iii) treatment as usual (TAU: n = 32). SETTING Study procedures were implemented at the Center for Addiction and Pregnancy in Baltimore, MD. PARTICIPANTS Study participants were pregnant, methadone-maintained women enrolled in substance use disorder treatment. MEASUREMENTS Baseline carbon monoxide (CO) levels were calculated for each participant. Subsequently, breath samples were tested three times weekly to measure changes in smoking behavior. CBI participants received incentives for target reductions from baseline: any reduction (week 1); 10% reduction (weeks 2-4), 25% reduction (weeks 5-7), 50% reduction (weeks 8-9), 75% reduction (week 10-11); and abstinence [CO < 4 parts per million (p.p.m.)] (week 12 until delivery). NCBI participants received incentives independent of smoking CO measurement results. TAU participants received no incentives, the standard treatment at the program. FINDINGS CBI condition participants submitted significantly lower mean CO values than the NCBI and TAU conditions over the course of the intervention (P < 0.0001). Nearly half (48%) of the CBI participants met the 75% smoking reduction target and one-third (31%) met the abstinence target at week 12. In contrast, none of the NCBI met either the 75% or abstinence targets. Only 2% of the TAU participants met the 75% reduction and none of the TAU participants met the abstinence targets. These smoking behavior reductions did not yield significant differences in birth outcomes. CONCLUSIONS Cigarette smoking may be reduced significantly among pregnant, methadone-maintained women through the use of contingent reinforcement for gradual reductions in breath carbon monoxide levels.
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Affiliation(s)
- Michelle Tuten
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Salt TE, Jones HE, Andolina IM, Copeland CS, Clements JTC, Knoflach F, Sillito AM. Potentiation of sensory responses in ventrobasal thalamus in vivo via selective modulation of mGlu1 receptors with a positive allosteric modulator. Neuropharmacology 2011; 62:1695-9. [PMID: 22178704 PMCID: PMC3657174 DOI: 10.1016/j.neuropharm.2011.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 12/15/2022]
Abstract
Metabotropic glutamate subtype 1 (mGlu1) receptor is thought to play a role in synaptic responses in thalamic relay nuclei. The aim of this study was to evaluate the positive allosteric modulator (PAM) Ro67-4853 as a tool to modulate thalamic mGlu1 receptors on single thalamic neurones in vivo. Ro67-4853, applied by iontophoresis onto ventrobasal thalamus neurones of urethane-anaesthetised rats, selectively enhanced responses to the agonist (S)-3,5-dihydroxy-phenylglycine (DHPG), an effect consistent with mGlu1 potentiation. The PAM was also able to enhance maintained responses to 10 Hz trains of sensory stimulation of the vibrissae, but had little effect on responses to single sensory stimuli. Thus Ro67-4853 appears to be a highly selective tool that can be useful in investigating how mGlu1 receptor potentiation can alter neural processing in vivo. Our results show the importance of mGlu1 in sensory processing and attention mechanisms at the thalamic level and suggest that positive modulation of mGlu1 receptors might be a useful mechanism for enhancing cognitive and attentional processes.
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Affiliation(s)
- T E Salt
- Department of Visual Neuroscience, UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London EC1V 9EL, United Kingdom.
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Jones HE, Pressman EJ, Bell DL, Kerns JL, Lykes ST, Garth J, Westhoff CL. Managing chlamydia infections in young men: results from an audit of a public men's clinic in New York City. Int J STD AIDS 2011; 22:581-4. [DOI: 10.1258/ijsa.2011.010462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Research on management of Chlamydia trachomatis (CT) among men has largely been neglected. Findings from an audit of 284 CT-infected men from 2004 to 2005 attending a young men's clinic primarily serving Latino men in New York City, NY, USA, are presented. Ninety-nine percent received treatment, with 81% treated within 14 days of a positive test. Three percent reported no partner in the last three months, 17% were referred by a CT-positive partner and 24% were missing partner information. Among the rest, 18% received expedited partner therapy, 4% directly observed therapy, 12% partner referral and 65% did not receive documented partner management. Of the 34% who had a post-treatment visit at least three months after their index visit, only 36% received a test for re-infection. Among primarily Latino men in an urban clinic in New York City, a high proportion of CT cases were treated in a timely manner. However, documentation of partner management was often lacking and few CT cases received tests for re-infection.
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Affiliation(s)
- H E Jones
- Department of Obstetrics and Gynecology, Columbia University Medical Center
- Biostatistics and Epidemiology Program, CUNY School of Public Health, Hunter College
| | - E J Pressman
- Department of Obstetrics and Gynecology, Columbia University Medical Center
- Heilbrunn Department of Population and Family Health, Columbia University
| | - D L Bell
- Heilbrunn Department of Population and Family Health, Columbia University
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - J L Kerns
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - S T Lykes
- Heilbrunn Department of Population and Family Health, Columbia University
| | - J Garth
- New York Presbyterian Hospital, New York, NY, USA
| | - C L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Medical Center
- Heilbrunn Department of Population and Family Health, Columbia University
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Shah AN, Jones HE, Sinha MD, Morrison DA. Hypertensive chorioretinopathy with Elschnig spots in a 3-year-old child. Eye (Lond) 2011; 25:394-5. [PMID: 21212802 DOI: 10.1038/eye.2010.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Heil SH, Jones HE, Arria A, Kaltenbach K, Coyle M, Fischer G, Stine S, Selby P, Martin PR. Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat 2010; 40:199-202. [PMID: 21036512 DOI: 10.1016/j.jsat.2010.08.011] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 08/25/2010] [Indexed: 11/26/2022]
Abstract
The aim of this study was to estimate the prevalence of unintended pregnancy and its three subtypes (mistimed, unwanted, and ambivalent) among opioid-abusing women. In the general population, 31%-47% of pregnancies are unintended; data on unintended pregnancy in opioid- and other drug-abusing women are lacking. Pregnant opioid-abusing women (N = 946) screened for possible enrollment in a multisite randomized controlled trial comparing opioid maintenance medications completed a standardized interview assessing sociodemographic characteristics, current and past drug use, and pregnancy intention. Almost 9 of every 10 pregnancies were unintended (86%), with comparable percentages mistimed (34%), unwanted (27%), and ambivalent (26%). Irrespective of pregnancy intention, more than 90% of the total sample had a history of drug abuse treatment, averaging more than three treatment episodes. Interventions are sorely needed to address the extremely high rate of unintended pregnancy among opioid-abusing women. Drug treatment programs are likely to be an important setting for such interventions.
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Affiliation(s)
- Sarah H Heil
- Department of Psychiatry and Psychology, University of Vermont, Burlington, VT 05401, USA.
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Wechsberg WM, Jones HE, Zule WA, Myers BJ, Browne FA, Kaufman MR, Luseno W, Flisher AJ, Parry CDH. Methamphetamine ("tik") use and its association with condom use among out-of-school females in Cape Town, South Africa. Am J Drug Alcohol Abuse 2010; 36:208-13. [PMID: 20560840 DOI: 10.3109/00952990.2010.493592] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about the association between methamphetamine use and sexual risk behaviors among young South African women between 13 and 20 years of age. OBJECTIVE To examine the association between methamphetamine use and condom use among out-of-school South African female adolescents. METHODS Black and Coloured female adolescents were interviewed and categorized into methamphetamine user (n = 261) or non-user (n = 188) groups. RESULTS Methamphetamine use was reported by 58% of the total sample. Higher methamphetamine rates were found among young Coloured females (87%) than among young Black females (11%). In a multiple logistic regression analysis that adjusted for relevant confounders and included an interaction term for race and methamphetamine use, Coloured female methamphetamine users were over six times more likely than other participants to report not using a condom the last time they had sex (OR = 6.21; 95% CI = 1.21, 31.94). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Efforts are needed to reduce methamphetamine use and related sexual risk among adolescent females in Coloured communities and to prevent the spread of methamphetamine use in Black African communities.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Program, RTI International, Research Triangle Park, North Carolina 27709-2194, USA.
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Jones HE, Heil SH, O'Grady KE, Martin PR, Kaltenbach K, Coyle MG, Stine SM, Selby P, Arria AM, Fischer G. Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples. Am J Drug Alcohol Abuse 2010; 35:375-80. [PMID: 20180667 DOI: 10.1080/00952990903125235] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is known about the prevalence and severity of smoking in pregnant opioid dependent patients. OBJECTIVES To first characterize the prevalence and severity of smoking in pregnant patients screened for a randomized controlled trial, Maternal Opioid Treatment: Human Experimental Research (MOTHER), comparing two agonist medications; and second, to compare the MOTHER screening sample to published samples of other pregnant and/or patients with substances use disorders. METHODS Pregnant women (N = 108) screened for entry into an agonist medication comparison study were retrospectively compared on smoking variables to samples of pregnant methadone-maintained patients (N = 50), pregnant opioid or cocaine dependent patients (N = 240), non-pregnant methadone-maintained women (N = 75), and pregnant non-drug-addicted patients (N = 1,516). RESULTS Of screened patients, 88% (n = 95) smoked for a mean of 140 months (SD = 79.0) starting at a mean age of 14 (SD = 3.5). This rate was similar to substance use disordered patients and significantly higher compared to general pregnant patients (88% vs. 22%, p < .001). CONCLUSION AND SCIENTIFIC SIGNIFICANCE Aggressive efforts are needed to reduce/eliminate smoking in substance-abusing pregnant women.
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Affiliation(s)
- H E Jones
- Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA.
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Lippman SA, Sucupira MCA, Jones HE, Luppi CG, Palefsky J, van de Wijgert JHHM, Oliveira RLS, Diaz RS. Prevalence, distribution and correlates of endocervical human papillomavirus types in Brazilian women. Int J STD AIDS 2010; 21:105-9. [PMID: 20089995 DOI: 10.1258/ijsa.2009.008436] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We determined the prevalence, distribution and correlates of human papillomavirus (HPV) types in 386 mixed-income, sexually active women in São Paulo, Brazil. Endocervical samples were tested for HPV DNA with L1 primers MY09 and MY11; negative and indeterminate samples were retested using GP 5+/6+ consensus primers. HPV was detected in 35% of all women; high-risk/probable high-risk types in 20%; low-risk types in 7%; and an indeterminate type in 10%. Twenty-five HPV types were found overall: 17 (probable) high-risk types and eight low-risk types. Approximately one-third (29%) of women with HPV infection were positive for type 16 or 18 and 36% were positive for types 6, 11, 16 or 18. The presence of (probable) high-risk HPV was associated with younger age, more lifetime sex partners and abnormal vaginal flora. Additional studies mapping the distribution of HPV types worldwide are necessary to prepare for vaccination programmes and direct future vaccine development.
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Chaudhury R, Jones HE, Wechsberg W, O'Grady KE, Tuten M, Chisolm MS. Addiction severity index composite scores as predictors for sexual-risk behaviors and drug-use behaviors in drug-using pregnant patients. Am J Drug Alcohol Abuse 2010; 36:25-30. [PMID: 20141393 DOI: 10.3109/00952990903544810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations. OBJECTIVE Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women. METHODS Pregnant women (N = 76) completing pretreatment ASI and HIV-risk questionnaires. RESULTS The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p < .001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps < .05. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Drug-using pregnant women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.
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Affiliation(s)
- R Chaudhury
- Johns Hopkins University, Baltimore, Maryland, USA
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Stine SM, Heil SH, Kaltenbach K, Martin PR, Coyle MG, Fischer G, Arria AM, Selby P, Jones HE. Characteristics of opioid-using pregnant women who accept or refuse participation in a clinical trial: screening results from the MOTHER study. Am J Drug Alcohol Abuse 2010; 35:429-33. [PMID: 20014912 DOI: 10.3109/00952990903374080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although concerns arise about the generalizability of results from Randomized Controlled Trials (RCTs), few studies systematically examine this issue. OBJECTIVES This study compared the characteristics of 427 opioid-using pregnant women who did (n = 208) and did not consent (n = 219) to enrollment in a multicenter clinical trial of agonist medications (i.e., the MOTHER study). METHODS Logistic regression models were used to compare consenters and non-consenters to examine the effect of screening variables on the likelihood of consenting. RESULTS Of nine characteristics examined, most differences did not reach statistical significance. Consenting participants were less likely than non-consenting women to be currently enrolled in a methadone maintenance program (74.5% vs. 84.5%, p =.01). CONCLUSION AND SCIENTIFIC SIGNIFICANCE These data show that the recruited sample of drug-dependent pregnant women enrolled in an intensive RCT is representative of the larger population of treated opioid-dependent patients and supports the generalizability of randomized controlled trials in this population.
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Affiliation(s)
- Susan M Stine
- Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 2761 E. Jefferson Ave., Detroit, MI 48207, USA.
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Jones HE, O'Grady K, Dahne J, Johnson R, Lemoine L, Milio L, Ordean A, Selby P. Management of acute postpartum pain in patients maintained on methadone or buprenorphine during pregnancy. Am J Drug Alcohol Abuse 2009; 35:151-6. [PMID: 19462298 DOI: 10.1080/00952990902825413] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Empirical evidence is needed to guide adequate postpartum pain relief of methadone and buprenorphine stabilized patients. OBJECTIVES To first determine the adequacy of pain control using non-opioid and opioid medication in participants stabilized on buprenorphine or methadone before a vaginal delivery. Second, to compare the amount of non-opioid and opioid medication needed for adequate pain control for buprenorphine-and methadone-maintained patients during the immediate postpartum period. METHODS Pain control adequacy and amount of non-opioid and opioid medication needed in buprenorphine- (n = 8) and methadone-maintained (n = 10) patients over the first five days postpartum were examined. RESULTS Pain ratings and number of opioid medication doses decreased over time in both medication groups. While the buprenorphine and methadone groups began with similar mean daily ibuprofen (IB) doses, the buprenorphine group decreased its IB use, while the methadone group increased its IB use. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Patients treated daily with either buprenorphine or methadone can have adequate pain control postpartum with opioid medication and IB. Pain control is dependent on the opioid-agonist medication in use at delivery, and must be individualized.
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Affiliation(s)
- Hendree E Jones
- Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Drug use relapse rates are high following residential detoxification. This study examined the aftercare plans and desired services of participants currently enrolled in residential detoxification programs. Participants completed a survey regarding their aftercare plans and services that they desired from an aftercare program. Participants (98%) reported some form of aftercare plans following detoxification. Among the services that participants endorsed wanting were individual counseling, help with finding a job, and Narcotics Anonymous (NA) meetings. With low rates of enrollment in aftercare programs, the findings of this study may be of help in determining what services will best assist individuals recovering from addiction.
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Affiliation(s)
- Michelle Tuten
- Cornerstone Treatment Research Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kacinko SL, Jones HE, Johnson RE, Choo RE, Concheiro-Guisan M, Huestis MA. Urinary excretion of buprenorphine, norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide in pregnant women receiving buprenorphine maintenance treatment. Clin Chem 2009; 55:1177-87. [PMID: 19325013 DOI: 10.1373/clinchem.2008.113712] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Buprenorphine (BUP) is under investigation as a medication therapy for opioid-dependent pregnant women. We investigated BUP and metabolite disposition in urine from women maintained on BUP during the second and third trimesters of pregnancy and postpartum. METHODS We measured BUP, norbuprenorphine (NBUP), buprenorphine glucuronide (BUP-Gluc), and NBUP-Gluc concentrations in 515 urine specimens collected thrice weekly from 9 women during pregnancy and postpartum. Specimens were analyzed using a fully validated liquid chromatography-mass spectrometry method with limits of quantification of 5 microg/L for BUP and BUP-Gluc and 25 microg/L for NBUP and its conjugated metabolite. We examined ratios of metabolites across trimesters and postpartum to identify possible changes in metabolism during pregnancy. RESULTS NBUP-Gluc was the primary metabolite identified in urine and exceeded BUP-Gluc concentrations in 99% of specimens. Whereas BUP-Gluc was identified in more specimens than NBUP, NBUP exceeded BUP-Gluc concentrations in 77.9% of specimens that contained both analytes. Among all participants, the mean BUP-Gluc:NBUP-Gluc ratio was significantly higher in the second trimester compared to the third trimester, and there were significant intrasubject differences between trimesters in 71% of participants. In 3 women, the percent daily dose excreted was higher during pregnancy than postpregnancy, consistent with other data indicating increased renal elimination of drugs during pregnancy. CONCLUSIONS These data are the first to evaluate urinary disposition of BUP and metabolites in a cohort of pregnant women. Variable BUP excretion during pregnancy may indicate metabolic changes requiring dose adjustment during later stages of gestation.
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Affiliation(s)
- Sherri L Kacinko
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD, USA
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Jones HE, Martin PR, Heil SH, Kaltenbach K, Selby P, Coyle MG, Stine SM, O'Grady KE, Arria AM, Fischer G. Treatment of opioid-dependent pregnant women: clinical and research issues. J Subst Abuse Treat 2008; 35:245-59. [PMID: 18248941 PMCID: PMC2633026 DOI: 10.1016/j.jsat.2007.10.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 10/11/2007] [Accepted: 10/28/2007] [Indexed: 12/22/2022]
Abstract
This article addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance, based on both research evidence and the collective clinical experience of the authors, which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, is provided to aid clinical decision making. The MOTHER project is a double-blind, double-dummy, flexible-dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the treatment of opioid dependence in pregnant women and their neonates. The article begins with a discussion of appropriate assessment during pregnancy and then addresses clinical management stages including maintenance medication selection, induction, and stabilization; opioid agonist medication management before, during, and after delivery; pain management; breast-feeding; and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed.
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Affiliation(s)
- Hendree E Jones
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Heil SH, Sigmon SC, Jones HE, Wagner M. Comparison of characteristics of opioid-using pregnant women in rural and urban settings. Am J Drug Alcohol Abuse 2008; 34:463-71. [PMID: 18584576 DOI: 10.1080/00952990802122358] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Historically, research on opioid use during pregnancy has occurred in urban settings and it is unclear how urban and rural populations compare. We examined socio-demographic and other variables in opioid-using pregnant women seeking treatment and screened for participation in a multi-site randomized controlled trial. Women screened in rural Burlington, Vermont (n = 54), were compared to those screened in urban Baltimore, Maryland (n = 305). Rural opioid-using pregnant women appear to have some characteristics associated with better treatment outcomes (e.g., less severe drug use, greater employment). However, they may face additional barriers in accessing treatment (e.g., greater distance from treatment clinic).
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Affiliation(s)
- Sarah H Heil
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA.
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Kacinko SL, Jones HE, Johnson RE, Choo RE, Huestis MA. Correlations of maternal buprenorphine dose, buprenorphine, and metabolite concentrations in meconium with neonatal outcomes. Clin Pharmacol Ther 2008; 84:604-12. [PMID: 18701886 DOI: 10.1038/clpt.2008.156] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For the first time, relationships among maternal buprenorphine dose, meconium buprenorphine and metabolite concentrations, and neonatal outcomes are reported. Free and total buprenorphine and norbuprenorphine, nicotine, opiates, cocaine, benzodiazepines, and metabolites were quantified in meconium from 10 infants born to women who had received buprenorphine during pregnancy. Neither cumulative nor total third-trimester maternal buprenorphine dose predicted meconium concentrations or neonatal outcomes. Total buprenorphine meconium concentrations and buprenorphine/norbuprenorphine ratios were significantly related to neonatal abstinence syndrome (NAS) scores >4. As free buprenorphine concentration and percentage free buprenorphine increased, head circumference decreased. Thrice-weekly urine tests for opiates, cocaine, and benzodiazepines and self-reported smoking data from the mother were compared with data from analysis of the meconium to estimate in utero exposure. Time of last drug use and frequency of use during the third trimester were important factors associated with drug-positive meconium specimens. The results suggest that buprenorphine and metabolite concentrations in the meconium may predict the onset and frequency of NAS.
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Affiliation(s)
- S L Kacinko
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland, USA
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Jones HE, Altini L, de Kock A, Young T, van de Wijgert JHHM. Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial. Sex Transm Infect 2007; 83:552-7. [PMID: 17901084 PMCID: PMC2598654 DOI: 10.1136/sti.2007.027060] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To test whether more women are screened for sexually transmitted infections when offered home-based versus clinic-based testing and to evaluate the feasibility and acceptability of self-sampling and self-testing in home and clinic settings in a resource-poor community. METHODS Women aged 14-25 were randomised to receive a home kit with a pre-paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self-collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrollment on sociodemographic and sexual history, and at the 6-week follow-up on feasibility and acceptability. RESULTS 626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-week follow-up visit. Forty-seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea. CONCLUSIONS Self-sampling and self-testing are feasible and acceptable options in low-income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.
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Nicholson RI, Hutcheson IR, Jones HE, Hiscox SE, Giles M, Taylor KM, Gee JMW. Growth factor signalling in endocrine and anti-growth factor resistant breast cancer. Rev Endocr Metab Disord 2007; 8:241-53. [PMID: 17486454 DOI: 10.1007/s11154-007-9033-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Growth factors provide powerful mitogenic and survival signals to breast cancer cells and it is therefore not surprising that they are able to subvert inhibitory responses to anti-hormonal drugs. In this review we discuss several mechanisms by which this may be achieved and expand our observations to encompass recently emerging anti-growth factor treatments. The information presented is underpinned by inhibitor studies that show the targeting of such mechanisms in advance of anti-hormone or anti-growth factor resistance development is able to substantially delay this event, thus pointing the way forward to intelligent combination therapies relevant to the future management of breast cancer.
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Affiliation(s)
- R I Nicholson
- Tenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Cardiff, UK.
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Velez ML, Montoya ID, Jansson LM, Walters V, Svikis D, Jones HE, Chilcoat H, Campbell J. Exposure to violence among substance-dependent pregnant women and their children. J Subst Abuse Treat 2006; 30:31-8. [PMID: 16377450 PMCID: PMC2651191 DOI: 10.1016/j.jsat.2005.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 09/21/2005] [Accepted: 09/22/2005] [Indexed: 10/25/2022]
Abstract
This study examined the prevalence of exposure to violence among drug-dependent pregnant women attending a multidisciplinary perinatal substance abuse treatment program. Participants (N = 715) completed the Violence Exposure Questionnaire within 7 days after their admission to the program. Their rates of lifetime abuse ranged from 72.7% for physical abuse to 71.3% for emotional abuse to 44.5% for sexual abuse. Their rates of abuse remained high during their current pregnancy, ranging from 40.9% for emotional abuse to 20.0% for physical abuse to 7.1% for sexual abuse. Nearly one third of the women reported having physical fights with their current partner (lifetime), and 25% of these women reported that children were present during those physical fights. A total of 30% of the women perceived a need for counseling regarding exposure to violence for themselves and 15% perceived a need for counseling for their children. Study findings confirm previous reports of high rates of abuse and violence exposure among substance-abusing pregnant women and their strong need for counseling for psychosocial sequelae. This study affirmed the value of routine screening for violence exposure in this at-risk population as well as the need to train therapists in specific strategies for helping such women address this complex array of problems.
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Affiliation(s)
- Martha L Velez
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Jones HE, Gee JMW, Barrow D, Tonge D, Holloway B, Nicholson RI. Inhibition of insulin receptor isoform-A signalling restores sensitivity to gefitinib in previously de novo resistant colon cancer cells. Br J Cancer 2006; 95:172-80. [PMID: 16819546 PMCID: PMC2360620 DOI: 10.1038/sj.bjc.6603237] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Resistance to antiepidermal growth factor (EGFR) strategies is an emerging clinical problem. Using human colorectal cancer (CRC) cells, we evaluated the involvement of the insulin receptor isoform-A (InsR-A) in de novo resistance to gefitinib, an EGFR tyrosine kinase inhibitor. Challenging the EGFR positive LoVo cells with gefitinib (1 microM) resulted in a small ( approximately 18%) inhibition of cell growth and although a modest reduction in phospho (p)EGFR Tyr845 was seen, pEGFR at residues -Tyr1068 and -Tyr1173 were unchanged. LoVo cells produced unprocessed pro-IGF-1R protein, substantial levels of IGF-II mRNA and mature InsR protein, consisting mainly of the InsR-A isoform. Insulin and IGF-II promoted cell growth and pEGFR Tyr845, Tyr1068 and Tyr1173 activity and conversely, the insulin-like growth factor-1 receptor (IGF-1R)/InsR inhibitor ABDP (1 muM) inhibited growth and reduced pEGFR activity at all three tyrosine residues. pInsR and pAkt levels were increased after gefitinib treatment. Blocking of pInsR with ABDP enabled gefitinib to markedly reduce pEGFR Tyr845, Tyr1068 and Tyr1173. Short-term gefitinib/ABDP dual treatment was more effective than either agent alone and chronic exposure to this combination resulted in total cell loss after 9 weeks, preventing acquisition of resistance to ABDP. LoVo cells with acquired resistance to ABDP were acutely sensitive to gefitinib. We concluded that InsR-A reduces sensitivity to gefitinib in LoVo CRC cells, thus its co-targeting alongside EGFR can improve the anti-tumour effect of gefitinib.
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Affiliation(s)
- H E Jones
- Tenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Cardiff, UK.
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Williamson ED, Hodgson I, Walker NJ, Topping AW, Duchars MG, Mott JM, Estep J, Lebutt C, Flick-Smith HC, Jones HE, Li H, Quinn CP. Immunogenicity of recombinant protective antigen and efficacy against aerosol challenge with anthrax. Infect Immun 2005; 73:5978-87. [PMID: 16113318 PMCID: PMC1231098 DOI: 10.1128/iai.73.9.5978-5987.2005] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Immunization with a recombinant form of the protective antigen (rPA) from Bacillus anthracis has been carried out with rhesus macaques. Rhesus macaques immunized with 25 mug or more of B. subtilis-expressed rPA bound to alhydrogel had a significantly increased immunoglobulin G (IgG) response to rPA compared with macaques receiving the existing licensed vaccine from the United Kingdom (anthrax vaccine precipitated [AVP]), although the isotype profile was unchanged, with bias towards the IgG1 and IgG2 subclasses. Immune macaque sera from all immunized groups contained toxin-neutralizing antibody and recognized all the domains of PA. While the recognition of the N terminus of PA (domains 1 to 3) was predominant in macaques immunized with the existing vaccines (AVP and the U.S. vaccine anthrax vaccine adsorbed), macaques immunized with rPA recognized the N- and C-terminal domains of PA. Antiserum derived from immunized macaques protected macrophages in vitro against the cytotoxic effects of lethal toxin. Passive transfer of IgG purified from immune macaque serum into naive A/J mice conferred protection against challenge with B. anthracis in a dose-related manner. The protection conferred by passive transfer of 500 mug macaque IgG correlated significantly (P = 0.003; r = 0.4) with the titers of neutralizing antibody in donor macaques. Subsequently, a separate group of rhesus macaques immunized with 50 mug of Escherichia coli-derived rPA adsorbed to alhydrogel was fully protected against a target dose of 200 50% lethal doses of aerosolized B. anthracis. These data provide some preliminary evidence for the existence of immune correlates of protection against anthrax infection in rhesus macaques immunized with rPA.
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Affiliation(s)
- E D Williamson
- Defence Science and Technology Laboratory Porton Down, Salisbury, Wilts. SP4 0JQ, United Kingdom.
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Jones HE, Wong CJ, Tuten M, Stitzer ML. Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers. Drug Alcohol Depend 2005; 79:119-28. [PMID: 16002021 DOI: 10.1016/j.drugalcdep.2005.01.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Revised: 01/03/2005] [Accepted: 01/03/2005] [Indexed: 10/25/2022]
Abstract
This controlled study examined the efficacy of reinforcement-based therapy (RBT) for producing enhanced abstinence outcomes over 12 months in opioid-dependent patients exiting a brief residential detoxification. Patients were randomly assigned upon completing their medically managed taper (i.e., detoxification) to RBT (N=66) or usual care (N=64) referral to community treatment programs. The 6-month RBT program offered an array of abstinence-based incentives including rent payment for recovery housing, program-led recreational activities and skills training for procuring employment. RBT produced significantly higher self-report and urinalysis-confirmed rates of abstinence from opioids and cocaine relative to usual care at 1 (42% versus 15%) and 3 (38% versus 17%) months during treatment but not at 6 or 12 months after enrollment. The RBT but not the usual care group showed significant increases in the number of days worked and the amount of legal income earned at 3, 6 and 12 months. The results of this randomized study suggest that an intensive reinforcement-based therapy that includes abstinence-based recovery housing is a promising approach; however, further research is needed to determine the role of treatment intensity and the specific efficacy of RBT's component parts.
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Affiliation(s)
- Hendree E Jones
- Cornerstone Treatment Research Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Cornerstone D-3-E, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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