#Neurodevelopmental #Abnormalities in #Children With In Utero #Zika Virus Exposure Without Congenital Zika Syndrome (JAMA Pediatr., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

JAMA Pediatr. 2020 Jan 6. doi: 10.1001/jamapediatrics.2019.5204. [Epub ahead of print]

Neurodevelopmental Abnormalities in Children With In Utero Zika Virus Exposure Without Congenital Zika Syndrome.

Mulkey SB1,2,3, Arroyave-Wessel M1, Peyton C4, Bulas DI1,5, Fourzali Y6, Jiang J1, Russo S1, McCarter R1, Msall ME7, du Plessis AJ1,2,3, DeBiasi RL1,2,8, Cure C9.

Author information: 1 Children’s National Hospital, Washington, DC. 2 Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC. 3 Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC. 4 Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois. 5 Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, DC. 6 Sabbag Radiologos, Barranquilla, Colombia. 7 Kennedy Research Center on Neurodevelopmental Disabilities, University of Chicago Comer Children’s Hospital, Chicago, Illinois. 8 Department of Tropical Medicine and Infectious Disease, The George Washington University School of Medicine and Health Sciences, Washington, DC. 9 BIOMELAB, Barranquilla, Colombia.

 

Abstract

IMPORTANCE:

The number of children who were born to mothers with Zika virus (ZIKV) infection during pregnancy but who did not have apparent disability at birth is large, warranting the study of the risk for neurodevelopmental impairment in this population without congenital Zika syndrome (CZS).

OBJECTIVE:

To investigate whether infants without CZS but who were exposed to ZIKV in utero have normal neurodevelopmental outcomes until 18 months of age.

DESIGN, SETTING, AND PARTICIPANTS:

This cohort study prospectively enrolled a group of pregnant women with ZIKV in Atlántico Department, Colombia, and in Washington, DC. With this cohort, we performed a longitudinal study of infant neurodevelopment. Infants born between August 1, 2016, and November 30, 2017, were included if they were live born, had normal fetal brain findings on magnetic resonance imaging and ultrasonography, were normocephalic at birth, and had normal examination results without clinical evidence of CZS. Seventy-seven infants born in Colombia, but 0 infants born in the United States, met the inclusion criteria.

EXPOSURES:

Prenatal ZIKV exposure.

MAIN OUTCOMES AND MEASURES:

Infant development was assessed by the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA) and the Alberta Infant Motor Scale (AIMS) at 1 or 2 time points between 4 and 18 months of age. The WIDEA and AIMS scores were converted to z scores compared with normative samples. Longitudinal mixed-effects regression models based on bootstrap resampling methods estimated scores over time, accounting for gestational age at maternal ZIKV infection and infant age at assessment. Results were presented as slope coefficients with 2-tailed P values based on z statistics that tested whether the coefficient differed from 0 (no change).

RESULTS:

Of the 77 Colombian infants included in this cohort study, 70 (91%) had no CZS and underwent neurodevelopmental assessments. Forty infants (57%) were evaluated between 4 and 8 months of age at a median (interquartile range [IQR]) age of 5.9 (5.3-6.5) months, and 60 (86%) underwent assessment between 9 and 18 months of age at a median (IQR) age of 13.0 (11.2-16.4) months. The WIDEA total score (coefficients: age = -0.227 vs age2 = 0.006; P < .003) and self-care domain score (coefficients: age = -0.238 vs age2 = 0.01; P < .008) showed curvilinear associations with age. Other domain scores showed linear declines with increasing age based on coefficients for communication (-0.036; P = .001), social cognition (-0.10; P < .001), and mobility (-0.14; P < .001). The AIMS scores were similar to the normative sample over time (95% CI, -0.107 to 0.037; P = .34). Nineteen of 57 infants (33%) who underwent postnatal cranial ultrasonography had a nonspecific, mild finding. No difference was found in the decline of WIDEA z scores between infants with and those without cranial ultrasonography findings except for a complex interactive relationship involving the social cognition domain (P < .049). The AIMS z scores were lower in infants with nonspecific cranial ultrasonography findings (-0.49; P = .07).

CONCLUSIONS AND RELEVANCE:

This study found that infants with in utero ZIKV exposure without CZS appeared at risk for abnormal neurodevelopmental outcomes in the first 18 months of life. Long-term neurodevelopmental surveillance of all newborns with ZIKV exposure is recommended.

PMID: 31904798 DOI: 10.1001/jamapediatrics.2019.5204

Keywords: Zika Virus; Zika Congenital Infection; Psychiatry; Neurology.

——

Characteristics Associated With #US #Outpatient #Opioid Analgesic #Prescribing and #Gabapentinoid Co-Prescribing (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Characteristics Associated With U.S. Outpatient Opioid Analgesic Prescribing and Gabapentinoid Co-Prescribing

Christopher O. St. Clair, PharmD1,Natalia I. Golub, MD, PhD, MPH2,Yong Ma, PhD1,Jaejoon Song, PhD1,Scott K. Winiecki, MD1,David L. Menschik, MD, MPH1

DOI: https://doi.org/10.1016/j.amepre.2019.08.029

 

Abstract

Introduction

A considerable burden of prescription and illicit opioid-related mortality and morbidity in the U.S. is attributable to potentially unnecessary or excessive opioid prescribing, and co-prescribing gabapentinoids may increase risk of harm. Data are needed regarding physician and patient characteristics associated with opioid analgesic and opioid analgesic–gabapentinoid co-prescriptions to elucidate targets for reducing preventable harm.

Methods

Multiple logistic regression was utilized to examine patient and physician predictors of opioid analgesic prescriptions and opioid analgesic–gabapentinoid co-prescriptions in adult noncancer patients using the National Ambulatory Medical Care Survey 2015 public use data set. Potential predictors were selected based on literature review, clinical relevance, and random forest machine learning algorithms.

Results

Among the 11.8% (95% CI=9.8%, 13.9%) of medical encounters with an opioid prescription, 16.2% (95% CI=12.6%, 19.8%) had a gabapentinoid co-prescription. Among all gabapentinoid encounters, 40.7% (95% CI=32.6%, 48.7%) had an opioid co-prescription. Predictors of opioid prescription included arthritis (OR=1.87, 95% CI=1.30, 2.69). Predictors of new opioid prescription included physician status as an independent contractor (OR=3.67, 95% CI=1.38, 9.81) or part owner of the practice (OR=3.34, 95% CI=1.74, 6.42). Predictors of opioid–gabapentinoid co-prescription included patient age (peaking at age 55–64 years; OR=35.67, 95% CI=4.32, 294.43).

Conclusions

Predictors of opioid analgesic prescriptions with and without gabapentinoid co-prescriptions were identified. These predictors can help inform and reinforce (e.g., educational) interventions seeking to reduce preventable harm, help identify populations for elucidating opioid–gabapentinoid risk–benefit profiles, and provide a baseline for evaluating subsequent public health measures.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords: USA; Psychiatry; Opioids; Gabapentin; Society.

——

#Medications for #opioid use #disorders: #clinical and pharmacological #considerations (J Clin Invest., summary)

[Source: Journal of Clinical Investigation, full page: (LINK). Summary, edited.]

Viewpoint / Free access | DOI: 10.1172/JCI134708

Medications for opioid use disorders: clinical and pharmacological considerations

Nora D. Volkow and Carlos Blanco

First published November 25, 2019

___

The opioid epidemic, now in its second decade, is one of the most challenging public health crises in the US. Providing an effective response is complicated by multiple underlying causes and consequences as well as a misunderstanding of addiction and the medications used to treat it (1). Indeed, medications for opioid use disorder (MOUDs) are the most effective interventions for treating opioid addiction, but are not prescribed to many who would benefit. Here, we describe the distinction between physical dependence and addiction along with its implication for treatment, and discuss the mechanisms of action of MOUDs.

(…)

Keywords: Opioids; Illicit drugs; Society; USA.

——

#Sexual #Orientation #Disparities in #Substance Use: Investigating #Social #Stress Mechanisms in a National Sample (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample

Evan A. Krueger, PhD, MPH, MSW1, Jessica N. Fish, PhD2, Dawn M. Upchurch, PhD, LAc1

DOI: https://doi.org/10.1016/j.amepre.2019.08.034

Published online: November 20, 2019

 

Abstract

Introduction

Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders.

Methods

Using nationally representative data collected in 2012–2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019.

Results

For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally.

Conclusions

Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities.

© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Keywords: USA; Society; Psychiatry.

——

#Cognitive #Development of #Infants Exposed to the #Zika Virus in #PuertoRico (JAMA Netw Open, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

JAMA Netw Open. 2019 Oct 2;2(10):e1914061. doi: 10.1001/jamanetworkopen.2019.14061.

Cognitive Development of Infants Exposed to the Zika Virus in Puerto Rico.

Valdes V1, Zorrilla CD2, Gabard-Durnam L1, Muler-Mendez N2, Rahman ZI1, Rivera D2, Nelson CA 3rd1,3.

Author information: 1 Laboratories of Cognitive Neuroscience, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts. 2 Obstetrics and Gynecology, Maternal-Infant Studies Center, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico. 3 Harvard Graduate School of Education, Cambridge, Massachusetts.

 

Abstract

IMPORTANCE:

Existing research has established a causal link between Zika virus (ZIKV) infection and severe birth defects or consequent health impairments; however, more subtle cognitive impairments have not been explored.

OBJECTIVE:

To determine whether infants of mothers with at least 1 positive ZIKV test show differences in cognitive scores at ages 3 to 6 months and ages 9 to 12 months.

DESIGN, SETTING, AND PARTICIPANTS:

This cross-sectional study recruited infants enrolled in existing ZIKV study cohorts associated with the Maternal-Infant Studies Center and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico and from the broader San Juan metropolitan area. The study took place at the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico. Participants were recruited through convenience sampling if their mothers underwent ZIKV testing prenatally and were at the target ages during the study period. Infants who were born preterm (<36 weeks’ gestational age), with low birth weight (<2500 g), or with a known genetic disorder were excluded. Infants were tested from ages 3 to 6 months or ages 9 to 12 months from May 2018 to April 2019. Data analysis was performed from March to April 2019.

EXPOSURES:

Zika virus status was measured prenatally and in the early postnatal period using real-time polymerase chain reaction or a ZIKV IgM antibody capture enzyme-linked immunosorbent assay.

MAIN OUTCOMES AND MEASURES:

The infants’ development was assessed using the Mullen Scales of Early Learning (translated to Spanish and adapted for Puerto Rico), and assessors were blinded to each infant’s ZIKV status.

RESULTS:

A total of 65 study participants were included. The mean (SD) age of the infants at the time of cognitive testing was 8.98 (3.19) months. Most of the infants were white (55 [84.6%]) and Puerto Rican (64 [98.5%]); 38 of the infants were male (58.5%). General cognitive and domain-specific scores did not differ significantly between prenatally ZIKV-positive and ZIKV-negative infants except for receptive language score (mean difference = 5.52; t = 2.10; P = .04). Exposure to ZIKV (B = -5.69; β = -0.26 [95% CI -11.01 to -0.36]; P = .04) and a measure of Hurricane Maria exposure (time without water, B = -0.05; β = -0.27 [95% CI, -0.10 to -0.01]; P = .03) were both independently and significantly associated with receptive language scores after adjusting for key confounders.

CONCLUSIONS AND RELEVANCE:

Although infants exposed to ZIKV prenatally showed unaffected motor and visually mediated cognitive development, they did show deficits in receptive language scores. Receptive language skills were also associated with the degree of exposure to Hurricane Maria, with those who spent more time without water after the hurricane having lower receptive language scores.

PMID: 31651970 DOI: 10.1001/jamanetworkopen.2019.14061

Keywords: Zika Virus; Pediatrics; Psychiatry; Extreme Weather; Hurricanes; Society; Puerto Rico.

——

A comprehensive #analysis of #mortality-related #health #metrics associated with #mental #disorders: a nationwide, register-based cohort study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Oleguer Plana-Ripoll, PhD, Prof Carsten Bøcker Pedersen, DrMed, Prof Esben Agerbo, DrMed, Yan Holtz, MSc, Annette Erlangsen, PhD, Vladimir Canudas-Romo, PhD, Prof Per Kragh Andersen, PhD, Fiona J Charlson, PhD, Maria K Christensen, MSc, Holly E Erskine, PhD, Alize J Ferrari, PhD, Kim Moesgaard Iburg, PhD, Natalie Momen, PhD, Prof Preben Bo Mortensen, DrMed, Prof Merete Nordentoft, DrMed, Damian F Santomauro, PhD, James G Scott, PhD, Prof Harvey A Whiteford, PhD, Nanna Weye, MSc, Prof John J McGrath, MD  †, Prof Thomas M Laursen, PhD †

Published: October 24, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32316-5

 

Summary

Background

Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.

Methods

In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.

Findings

7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57–28·82] vs 12·95 deaths [12·93–12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91–1·94) for mood disorders to 3·91 (3·87–3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36–5·48) for organic disorders in females to 14·84 years (14·70–14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.

Interpretation

Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.

Funding

Danish National Research Foundation.

Keywords: Psychiatry; Society.

——

New #psychoactive #substances: challenges for #drug #surveillance, control, and public health responses (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

New psychoactive substances: challenges for drug surveillance, control, and public health responses

Amy Peacock, PhD, Raimondo Bruno, PhD, Natasa Gisev, PhD, Prof Louisa Degenhardt, PhD, Prof Wayne Hall, PhD, Roumen Sedefov, MD, Prof Jason White, PhD, Prof Kevin V Thomas, DSc, Prof Michael Farrell, MD, Paul Griffiths, MSc

Published: October 23, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32231-7

 

Summary

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.

Keywords: Illicit drugs; Society; Public Health; Psychiatry.

——