Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients

BACKGROUND: Screening and brief intervention (SBI) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care settings. Although the SBI approach has shown promise for alcohol use, relatively little is known about its effectiveness for illicit drug use. We are evaluating the SBI approach for drug use using a rigorous randomized controlled trial. The purpose of the report is to describe the overall trial and its programmatic and methodological strengths with a focus on health educator (HE) selection and training. In addition, the baseline characteristics of the recently enrolled multiethnic cohort are described. METHODS/DESIGN: A randomized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group. Selection of bicultural paraprofessional HEs—their training in research concepts, comorbid mental health issues, special treatment of marijuana use, and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation—are among the features described. The HEs enrolled, consented, and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units. To be eligible, a participant needed to be an adult (age ≥18 years), an English or Spanish speaker, awake and able to give consent, and reachable by telephone to schedule a six-month follow-up interview. DISCUSSION: A comprehensive HE training protocol combined with rigorous, ongoing process measurement resulted in skill mastery in many areas and a successful participant recruitment period. Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited. This trial will be among the first to provide information about the effectiveness of SBI for illicit drug use. Outcome analysis has not yet been completed, but demonstrated programming and design successes have implications for future research and service delivery. TRIAL REGISTRATION: http://NCT0168322

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227

A Cluster of Trace-Concentration Methamphetamine Identifications in Racehorses Associated with a Methamphetamine-Contaminated Horse Trailer: A Report and Analysis

Three low concentration methamphetamine “positive” tests were linked to use of a methamphetamine-contaminated trailer to transport the affected horses. This incident establishes methamphetamine as a human-use substance that can inadvertently enter the environment of racing horses, resulting in urinary methamphetamine “positives;” an interim regulatory cut-off of 15 ng/mL for methamphetamine in post-race urine is proposed

Sequence variation, evolutionary constraint, and selection at the CD163 gene in pigs

Abstract Background In this work, we investigated sequence variation, evolutionary constraint, and selection at the CD163 gene in pigs. A functional CD163 protein is required for infection by porcine reproductive and respiratory syndrome virus, which is a serious pathogen with major impacts on pig production. Results We used targeted pooled sequencing of the exons of CD163 to detect sequence variants in 35,000 pigs of diverse genetic backgrounds and to search for potential stop-gain and frameshift indel variants. Then, we used whole-genome sequence data from three pig lines to calculate: a variant intolerance score that measures the tolerance of genes to protein coding variation; an estimate of selection on protein-coding variation over evolutionary time; and haplotype diversity statistics to detect recent selective sweeps during breeding. Conclusions Using a deep survey of sequence variation in the CD163 gene in domestic pigs, we found no potential knockout variants. The CD163 gene was moderately intolerant to variation and showed evidence of positive selection in the pig lineage, but no evidence of recent selective sweeps during breeding

Evaluating the potential roles of body dissatisfaction in exercise avoidance

Body dissatisfaction is linked to poor physical health, even after actual markers of health have been controlled for. This link is likely due to body dissatisfaction influencing health behaviors—more specifically, cardiovascular exercise. Modifiable reasons for this link have yet to be determined. We conducted a prospective study to evaluate whether active avoidance of exercise may explain the association of body dissatisfaction with exercise, and, if so, whether perceived barriers to exercise account for the association of body dissatisfaction and exercise avoidance. Baseline measures were collected via survey; physical activity was measured over time, via self-report. As expected, avoidance mediated the prospective relationship between dissatisfaction and exercise. Additionally, the relationship between body dissatisfaction and avoidance was mediated by embarrassment and fatigue. Interventions that boost body satisfaction and/or address perceptions of fatigue and embarrassment may be needed for individuals with body dissatisfaction to be more likely to participate in exercise-related programs

Evaluating the potential roles of body dissatisfaction in exercise avoidance

Body dissatisfaction is linked to poor physical health, even after actual markers of health have been controlled for. This link is likely due to body dissatisfaction influencing health behaviors—more specifically, cardiovascular exercise. Modifiable reasons for this link have yet to be determined. We conducted a prospective study to evaluate whether active avoidance of exercise may explain the association of body dissatisfaction with exercise, and, if so, whether perceived barriers to exercise account for the association of body dissatisfaction and exercise avoidance. Baseline measures were collected via survey; physical activity was measured over time, via self-report. As expected, avoidance mediated the prospective relationship between dissatisfaction and exercise. Additionally, the relationship between body dissatisfaction and avoidance was mediated by embarrassment and fatigue. Interventions that boost body satisfaction and/or address perceptions of fatigue and embarrassment may be needed for individuals with body dissatisfaction to be more likely to participate in exercise-related programs.This article is published as More, Kimberly R., L. Alison Phillips, and Miriam H. Eisenberg Colman. "Evaluating the potential roles of body dissatisfaction in exercise avoidance." Body Image 28 (2019): 110-114. DOI: 10.1016/j.bodyim.2019.01.003. Posted with permission.</p