Impact of Sensitization During Adolescence on Subsequent Drug Response: A Study of Resensitization

Adolescents and young adults are the primary consumers of drugs of abuse (including prescriptions drugs); yet, most of the preclinical research aimed at understanding the effects of these drugs has been performed in adult animal models. Drug use during adolescence is particularly problematic because it is a major predictor of later drug abuse and dependence during adulthood. Although there is growing evidence for age differences in behavioral responses to drugs of abuse in rats, the long lasting impact of drug exposure has rarely been investigated using adolescent rats. Repeated exposure to a wide range of drugs has been shown to produce an enduring change in behavior termed sensitization. Behavioral sensitization refers to the progressive increase in the psychomotor effects of drugs following repeated administration, and this phenomenon is thought to contribute to addiction. The current study examined the effects of drugs of abuse on locomotor activity. Drugs tested were from three major classes: a psychomotor stimulant (methamphetamine, METH), an opiate (oxycodone, OXY), and a dissociative (phencyclidine, PCP). Rats were treated repeatedly during adolescence for 7 days, followed by a second 7-day regimen during adulthood. We hypothesized that animals exposed chronically to drugs as adolescents would show enhanced sensitization as adults. As expected, chronic treatment during adolescence induced locomotor sensitization. However, the follow-up treatment in adulthood yielded mixed results. Although there was evidence of an impact of adolescent treatment for all three drugs, in no case was sensitization greater in adults sensitized as adolescents. For METH and PCP, sensitization in adulthood was reduced in animals previously sensitized as adolescents (relative to animals that were not exposed to drugs as adolescents) whereas for OXY sensitization was not different. These results suggest that exposure to METH, PCP and OXY during adolescence leads to persistent changes, or lack of changes as seen with OXY, in the responses to these drugs in adulthood. These findings have implications for adolescent use of these three major drug classes, and the impact that early drug use may have on adult behavior.Psycholog

Evaluation of opioid disposal process for home hospice patients

Considering the national opioid epidemic and its impact on thousands of lives, the importance of appropriate management of controlled substances in the home hospice setting is paramount. Family members tend to be the primary caregivers for home hospice patients, and hospice nurses are the front line for providing education on opioid disposal. As such, the importance of effective and consistent education is essential in minimizing the risks of misuse and diversion

Evaluation of opioid disposal process for home hospice patients

Considering the national opioid epidemic and its impact on thousands of lives, the importance of appropriate management of controlled substances in the home hospice setting is paramount. Family members tend to be the primary caregivers for home hospice patients, and hospice nurses are the front line for providing education on opioid disposal. As such, the importance of effective and consistent education is essential in minimizing the risks of misuse and diversion

Cryptococcal Antigen Testing in an Integrated Medical System: Eastern Wisconsin

Cryptococcosis is a serious environmentally acquired endemic fungal infection commonly associated with immunocompromised hosts. Little is known regarding frequency or distribution in Wisconsin. We explored the geodemographic and clinical features of patients tested with cryptococcal antigen tests (CrAg) — previously shown to be \u3e90% sensitive and \u3e90% specific — within a large health care system located in eastern Wisconsin. To examine this, we retrospectively analyzed 1465 CrAg tests on 1211 unique patients (female: 50.2%; white race: 73.9%; mean age: 53.7 ± 16.5 years). At least one CrAg result was positive in 23 of 1211 patients (1.9%). From these, 21 of 23 were immunocompromised. Positive patients were disproportionately male (82.6%) and nonwhite (3.8% of those tested vs 1.2% of whites tested); P \u3c 0.01 for both. These associations remained in multivariable models. Positive patients were not significantly older (59.1 vs 53.6 years; P = 0.07). Overall, 17 separate zip codes had at least one positive case. Positive patients were more prevalent in the zip codes that included the city of Milwaukee (11 of 377 [2.9% of those tested] vs 12 of 834 [1.4% of all those tested in the remaining area of the state]), but this difference was not statistically significant. No other case clustering or close proximity to waterways was observed (41% were less than 162 m from green space, similar to historical controls). Overall, male sex, nonwhite race/ethnicity, and immunocompromised status, not zip code, were statistically associated with positive CrAg

Cryptococcal antigen testing in an integrated medical system: eastern Wisconsin

Context: Cryptococcosis is a serious environmentally-acquired endemic fungal infection causing meningitis, pneumonia and disseminated disease in usually immunocompromised hosts. Environmental associations of the pathogenic species include certain trees, soils, bird guano and sites such as parks. Little is known regarding the frequency or distribution of cryptococcosis in Wisconsin. Cryptococcal antigen detection tests (CrAg), more than 90% sensitive and specific, are frequently used to screen patients with likely disease. Objective: Explore the geodemographic and clinical features of Wisconsin patients tested with CrAg. Study Design: Retrospective review of CrAg-tested patients. Descriptive statistics were compared with chi-square or t-tests; binary logistic regression was used for multivariable analysis. Setting: Large Eastern Wisconsin medical system. Patients:All patients having CrAg performed 2013-April, 2017. Results: A total of 1465 CrAg (741 on serum, 723 on CSF, 1 other) were performed on 1211 unique patients (50.2% female, 73.9% White, mean age 53.7 +/-16.5) during this time. At least one CrAg was positive in 23/1211 patients (1.9%); 4 cases had pneumonia only; 21/23 were immunocompromised (6 transplant patients, 5 HIV, 4 malignancy, 3 steroid use, 2 diabetes, 1 combined deficiency). Positive patients were more likely to be male (82.6%) non-White (12/23 [3.8% of those tested] vs 11/23 [1.2% of those tested]), and these associations (both p Conclusion: Among ill CrAg-tested patients, male gender and non-White race/ethnicity, not natural environmental features, predicted positive tests

Vitamin D Level Testing in an Urban Midwest Clinic: To Test or Not to Test?

Vitamin D deficiency (VDD) is significantly higher among urban populations in the U.S. Midwest, with African Americans being disproportionately affected. There is ongoing debate surrounding who and how often individuals should be screened for VDD. This study aimed to understand the prevalence of VDD, associated risk factors, and discrepancies in testing at an urban-based internal medicine residency clinic. Data were retrospectively collected on all adult patients seen by the clinic during 2018 and descriptive statistical analysis performed. Among 3976 total patients (mean age: 53 years), 18% (n = 698) had vitamin D levels analyzed, with deficiency found in 71% of those tested. Mean age of the tested cohort was 59 years, and women (68%) and African Americans (72%) were found more likely to be tested. Women and patients with certain medical conditions were more likely to be tested (P \u3c 0.02 for all) but were not more likely to have VDD. Individuals with a diagnosis of chronic kidney disease were less likely to have VDD (P = 0.002). Vitamin D levels typically showed improvement after retesting. A low testing rate could contribute to missed diagnoses. Overall, this study revealed that differences in rate of testing do not necessarily correlate to patients’ demographical risk of VDD. Clinicians may benefit from a standardized vitamin D testing protocol