Fasting Blood Glucose and Insulin Level in Opium Addict versus Non-Addict Individuals

Abstract Background: Many of lay person believe that opium lowers blood glucose. However some studies show the opposite results. In this study, we tried to evaluate the effect of opium on blood glucose and insulin resistance. Methods: This comparative study including 53 addicts in case groups who used opium just in the form of smoking and 55 non-addicts in a control group, took part in the study, after proving not to be opium users. After taking blood samples, their fasting blood glucose (FBG), fasting blood insulin and lipid profiles were evaluated. Furthermore, insulin resistance index was analyzed via the homeostatic model assessment of insulin resistance (HOMA-IR) formula with the cut-off points of 7.2 and 7.1. Findings: Age and gender were not significantly different between the groups. There was no significant difference regarding the prevalence of insulin resistance between the two groups, according to the cut-off points of 7.1 and 7.2 (P = 0.196 and P = 0.248, respectively). Mean insulin resistance index was not significantly different between the two groups (P = 0.325). In the case group, fasting blood insulin was considerably lower (P = 0.025) and fasting blood sugar (FBS) was significantly higher (P = 0.016) than the control group. Conclusion: According to the level of insulin and FBS in addicts, it does not seem that opium has a significant effect on reducing the blood glucose and insulin resistance. Keywords: Opium addiction, Blood sugar, Insulin resistanc

Methadone Treatment in Iranian Opiate Addicts: A Preliminary Report

Abstract Background: This study aimed to investigate the initial dosage of methadone and factors affecting it in maintenance therapy. Methods: This cross-sectional, descriptive-analytic study was conducted on 157 individuals referring to a methadone maintenance therapy (MMT) clinic. The initial dosage of methadone was 20-45 mg which was adjusted during the treatment based on each patient's evaluation. Three groups were formed according to methadone dosage (less than 30 mg, between 30-50 mg, and more than 50 mg). Findings: Significant relations were observed between increased methadone dosage in the initial phase and marital status (P = 0.03), injection (P = 0.03), medical comorbidity (P = 0.009), and borderline personality disorder (P < 0.001). Conclusion: Further studies with larger sample size and including the history of previous detoxification, substance abuse, omission of self-recording, evaluation of women’s addiction and MMT program performance with counseling support should be performed

The Role of Gender in Nurse-Resident Interactions: A mixed-methods study

Background: Gender disparities continue to persist within the medical field. Adverse effects of gender bias are well documented, including among trainees in Emergency Medicine (EM). The extent to which gender bias affects interprofessional interactions is not well understood. Objectives: The study aimed to understand perceptions and experiences of gender bias in interactions between emergency medicine (EM) residents and emergency department (ED) nurses. Methods: This mixed-methods study involved eight key informant interviews and two focus groups, and an anonymous electronic survey administered to EM residents and nurses at two teaching hospitals. Quantitative analysis included descriptive statistics and between-group comparisons using Student t-tests and two-sample Wilcoxon rank-sum. Qualitative analysis used a inductive and thematic content analysis. Results: Most participants identified gender as an important factor in ED interprofessional relationships. Key themes emerging from qualitative data include differential treatment and communication styles based on gender. 134 individuals completed the survey: 104 nurses (29% response rate), 30 residents (53% response rate). Females more frequently reported experiencing interprofessional gender bias than males [mean 30.9 (95% CI 25.6-36.2) vs 17.6 (95%CI 10.3-24.9)]. Residents of both genders reported witnessing interprofessional gender bias more frequently than nurses [mean 58.7 (95%CI 48.6-68.7) vs 23.9 (95%CI 19.4-28.4)]. Residents, compared to nurses, more frequently felt gender bias affects job satisfaction (p=0.002) and patient care (p=0.001). These differences were largely driven by female residents’ responses. Conclusion/impact: Gender plays a significant role in shaping interprofessional interactions in the ED. Gender bias in interprofessional interactions contributes to workplace dissatisfaction, particularly for female residents. Initiatives to establish equitable relationships across the gender spectrum in EM are needed to address interprofessional gender bias.https://jdc.jefferson.edu/sexandgenderhealth/1033/thumbnail.jp

Impacts of Mothers’ Occupation Status and Parenting Styles on Levels of Self-Control, Addiction to Computer Games, and Educational Progress of Adolescents

Abstract Background: Addiction to computer (video) games in adolescents and its relationship with educational progress has recently attracted the attention of rearing and education experts as well as organizations and institutes involved in physical and mental health. The current research attempted to propose a structural model of the relationships between parenting styles, mothers’ occupation status, and addiction to computer games, self-control, and educational progress of secondary school students. Methods: Using multistage cluster random sampling, 500 female and male secondary school students in Kerman (Iran) were selected and studied. The research tools included self-control, parenting styles, and addiction to computer games questionnaires and a self-made questionnaire containing demographic details. The data was analyzed using exploratory factor analysis, Cronbach’s alpha coefficient and route analysis (in LISREL). Findings: We found self-control to have a linking role in the relationship between four parenting styles and educational progress. Mothers’ occupation status was directly and significantly correlated with addiction to computer games. Although four parenting styles directly and significantly affected addiction to computer games, the findings did not support the linking role of addiction to computer games in the relationship between four parenting styles and educational progress.\ud Conclusion: In agreement with previous studies, the current research reflected the impact of four parenting styles on self-control, addiction to computer games, and educational progress of students. Among the parenting styles, authoritative style can affect the severity of addiction to computer games through self-control development. It can thus indirectly influence the educational progress of students. Parents are recommended to use authoritative parenting style to help both self-management and psychological health of their children. The employed mothers are also recommended to have more supervision and control on the degree and type of computer games selected by their children

Prevalence of Human Immunodeficiency Virus Infection among Injection Drug Users Released from Jail

Abstract Background: Injecting drug users (IDUs) and prisoners are considered to be highly vulnerable to human immunodeficiency virus (HIV) infection in Iran. This study was carried out to determine the prevalence of HIV infection among IDUs released from jail in Bahar (Hamadan, Iran). Methods: In a cross-sectional study, 118 IDUs who were prisoners during 2001-07 were evaluated. Their demographic and personal characteristics were assessed by a questionnaire. In order to determine HIV-positive individuals, blood samples were obtained from the participants and tested by enzyme-linked immunosorbent assay and Western blot technique. Findings: Overall, 20.3% of the subjects had used non-sterile injecting equipment during their imprisonment. The prevalence of HIV infection among the studied population was 4.2%. Conclusion: As the prevalence of HIV among IDUs released from jail is high, it is necessary for prison authorities to take measures against the increase in the prevalence of HIV among this group

Enucleation of Eye Using Finger Following Cannabis Consumption: A Case Report

Abstract Background: Enucleation is a topic discussed in psychiatry which is a self-injury matter. Enucleation is observed as psychotic disorder due to substance abuse. In people with mental disorders who also have substance use leading to hallucinations and delusions, unusual eye evacuation were reported. In most cases, enucleation was done using sharp tools. Case Report: This report describes a man suffering from psychosis after consuming hashish and has attempted to evacuate his eyes with his finger. Discussion: Given the increasing prevalence of hashish use by young people, and false beliefs about the use of hashish in order to withdraw other substances, preventive methods and education for young and vulnerable people are suggested. Keywords: Eye enucleation, Substance use, Hashis

The Relationship between Childhood Maltreatment and Opiate Dependency in Adolescence and Middle Age

Abstract Background: Child maltreatment is a global phenomenon with possible serious long-term consequences. The present study aimed to determine the relationship between childhood maltreatment and opiate dependency in older age. Methods: In this study, 212 opiate dependent individuals and 216 control subjects were selected consecutively. The data collection instrument was a questionnaire which consisted of background variables, General Health Questionnaire-12 (GHQ-12), and Childhood Trauma Questionnaire (CTQ). The questionnaires were anonymously completed by both groups in a private environment after obtaining informed consents. Findings: The mean age in the addicts and non-addicts were 31.4 ± 6.7 and 30.8 ± 7.5, respectively (P = 0.367). Moreover, 84.4% of the opiate abusers and 76.9% percent of the control group were male (P = 0.051). The mean score of CTQ in the study and control groups were 47.2 ± 1.0 and 35.8 ± 0.6, respectively (P < 0.001). The frequency of all types of abuse and neglect were higher in the addicted group. While 70.3% of the study group reported at least one type of childhood maltreatment, this figure was as low as 33.8% in the control group (P < 0.001). After adjusting the two groups for differing background characteristics and the GHQ-12 score, emotional abuse (OR = 5.06), physical neglect (OR = 1.96), and sexual abuse (OR = 1.89) were proved to have significant relationships with addiction to opiates. Conclusion: The frequency of all types of childhood maltreatment in the group addicted to opiates was higher than the control group. Emotional abuse, physical neglect, and sexual abuse had significant effects after adjusting other variables

Suicide in Narcotic Drugs Dependents

Abstract Background: The problem of addiction is one of the four global crises. These patients are more vulnerable to mental disorders. This study aimed to examine the risk of suicide in drug dependent patients. Methods: In this cross-sectional study, patients who referred for addiction treatment were selected and the control group was chosen among their companions who did not have narcotic drugs dependence. Suicide risk was assessed through California Suicide Risk Assessment Questionnaire. Beck’s Depression Inventory questionnaire was used to assess the depression level. Findings: The comparison of average education (P < 0.01) and the unemployment rate (P = 0.03) and previous attempted suicide (P = 0.01) between the narcotic drug dependent group and control group showed a statistically significant difference. Suicide risk score (P < 0.01) and depression score (P < 0.01) differences were statistically significant. The average scores of depression score in addicts was significantly associated with their previous attempted suicide (P = 0.01). In the control group, there was a significant association in suicide score and depression score with their previous attempted suicide (P < 0.01). Suicide score were compared based on the depression degree in both groups and statistically significant differences were found (P < 0.01). Conclusion: The suicide risk and depression in drug addicts are more than general population and they are closely related to each other

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model

Abstract Background: Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Methods: Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Findings: Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). Conclusion: There was a gap between the clients’ expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients’ views regarding service quality in addiction treatment clinics. Keywords: Service quality, Patient satisfaction, Substance dependency, Treatmen

Knowledge and Attitude of Health Network Staff toward Illegal Drug Use

The Editor Iran has fallen victim to the dire repercussion of malady certain historical, social, and geographic influence namely the proximity with Afghanistan as the largest producer of narcotics in the world.1 With addition prevailing in Iran,2 Iran has been reported to have the highest rate of opiate (opium and heroin) use worldwide (450 mt a year).1,3,4 Available statistics, namely United Nations Office on Drugs and Crime (UNODC), has it that more than 2 million of Iranians (3.0% of population) were addicted to illegal drugs including opium, hashish, and stimulants in 2010.1,4,5 The study described attitude as “a tendency to respond positively or negatively toward a certain idea, object or person” which is “reflected in person’s emotions and behavior.” People’s attitude has a very imperative role in their future performance, this effects accumulates with the depth of knowledge, experience, and education. Supporting addicts, or those under treatment and rehabilitation is directly influenced by the knowledge and understanding of addiction, treatment efficiency and rehabilitations benefits. Assessing people’s attitude in any given time and also evaluating attitude changes through the time is one of the main components of interventional evolution, which is intended to improve attitude.6,7 Despite the key role of health care staff in promoting health goals and also their critical position in community education, there is a few study regard to their level of knowledge, attitude, and performance pertaining to drug use. This information is necessary for health care programmers to devise appropriate training programs for health care staff and their target community. We aimed to obtain these data in the study. Our study population consisted of the health care staff employed in Sarakhs Health Network, Iran. This population included health care staff (physicians, nurses, midwives, paramedical staff, and professional health workers). The self-designed questionnaire for collecting information had three parts (demographic information and history of substance use-9 questions to evaluate knowledge in Likert scale-2 questions to assess attitude in Likert scale). To assess the reliability, two steps were taken: Item analyses method and test-retest method. Cronbach’s score was measured 0.61-0.86 and 0.78-0.91 for knowledge and attitude assessment, respectively. The overall Cronbach’s alpha of questionnaire was 0.84. Before distributing questionnaires, participants were assured about the confidentiality of their responses and their choice of participation. 185 questionnaires were filled. The relations between variables were evaluated with crosstabs, Chi-square and Spearman tests by SPSS (version 11.5, SPSS Inc., Chicago, IL, USA). Mann-Whitney non-parametric test and Kruskal–Wallis were used to detect differences between means of independent variables. P < 0.05 was considered significant in all calculations. The mean age of participants was 32 ± 7.4 (22-47) years and 50.0% were male (92 people). Ethnicity of participants were as follow: 126 Fars (68.0%), 32 Zaboli (17.0%), 19 Baloch (10.0%), 5 Turk (3.0%) and 3 others (2.0%). 163 persons (88.0%) were Muslim Shiite whereas 22 persons (12.0%) were Muslim Sunny. 9 participants (5.0%) reported smoking in their history while 10 participants (5.0%) had a history of illegal drug use. The prevalence of illegal drug use in family, relatives, and acquaintances (neighbors, co-workers and friends) were 5.4, 24.9, and 48.6 percentage, respectively. The participants estimated the prevalence of addiction in society between 20.57 ± 28.24. As to the participants’ self-assessment of their own knowledge of drug addiction, a fraction of 15.7% believed their insight to be rudimentary whereas 43.9% assumed they were well aware in this respect. Participants believed that psychiatrist, physiologist, and NA were related less influential compared to family, friends and acquaintances in this respect. Most of participant’s believed that police actions have a limited role in addiction control. As to efficacy of treatment modalities, the most effective methods were respectively “hospitalization in clinic” (37.9%), “staying in camp” (25.6%), and “maintenance treatment with methadone” (21.4%) respectively. The least effective methods included: “prison” (76.0%), “outpatient care/home care” (65.9%), and “ultra rapid opioid detoxification” (51.6%). We found a significant relation between the selected item of “methadone maintenance treatment” and ethnicity (P = 0.04). This highlights the importance of education as participants’ awareness was apparently insufficient in this respect. “Addicted friend” (79.2%), “lack of appropriate support” (75.1%), and “irresistible” (73.5%) were the most potent stimuli in incompliance or relapse. These results are similar to other studies conducted in Tehran and Bam, Iran.6,8 Participants believed that glass (methamphetamine) (81.7%), heroin (crystal/crack) (81.3%), and opium (79.5%) were the most dangerous drugs for individual health. On the other hand, most of the staffs had an appropriate level of information about the side effects of most available drugs in the community. Considering participants answers, continuous and updating educational sessions on addiction-related topics, different types of illegal drugs and their harms must be planned for health care staff in their annual educational programs. It is also necessary to assess the efficacy of these educational sessions in promoting knowledge, attitude, and function afterward. This study reflects the opinion of a group of health care staff about addiction and drug misuse, but these results cannot be generalized to all the health care workers or people in the community. Ethnicity is diversity in Sarakhs, which is also applying to health care staff. Our results suggest that attention to culture and attitudes of different ethnicities and faiths absolutely essential, contributing substantially to healthcare planning. Therefore, it is suggested that similar studies should be performed, assessing other ethnicities and cultures; particularly their high-risk groups namely immigrants, with the aim of raising awareness as to the most effective means of education and mode of interaction. Health care staff has a distinguished and influential position in advancing and improving community health. With this approach, considering health care staff, an important role in community education and also their role in preventive programs, their information and attitudes about addictive drugs, preventive programs and performing educational sessions are very vital. In the last part of the questionnaire, there we included a space for opinions and suggestions. Most of the participants understood their need for more information and were keep on participating in educational programs or receiving educational material such as pamphlets, booklets, and videos. These suggestions showed health care staff high determination to participate in drug use prevention and addiction treatment programs. Conflict of Interests The Authors have no conflict of interest. Acknowledgements We appreciated vice presidency for research of Mashhad University of Medical Sciences (MUMS‎), Iran, which supported this study in different ways. Furthermore, we are grateful to all of the Sarakhs Health Network staff who participated in this study. We have special thanks for professional supports of Dr. Farhodian (Welfare and Rehabilitation Sciences University) and Addiction Research Center (ADRC) of MUMS