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  • ISSN: 2373-9363
    Early Online
    Volume 6, Issue 1
    Research Article
    Ephrem Desta, Mathiwos Soboka, Desta Workneh, and Bosena Tebeje Gashaw*
    Background: The use of substances, especially by medical interns may have an impact on behavior, safety and efficiency of the future doctors. However, despite a growing number of substance users, little attention has been given by the research community in Ethiopia. This study examined the prevalence of substance use and associated factors among medical intern students.
    Materials and methods: A cross sectional study design was employed in all medical interns of Jimma University enrolled in the year of 2014/2015, using census survey data collection method. Analysis was done using descriptive statistics and chi-square test on SPSS version 20:0 soft ware. P-value less than 0.05 considered statistically significant.
    Results: The life time, in the last 12 months and current prevalence of substance use was 48.4, 47.8, and 43.0%, respectively; and the major reasons reported were: to get personal pleasure, peer pressure and to get relief from tension. Ethnicity (X2, 8.04; P=0.04), religion (X2, 31.05; P = 0.001), having friends who use substance/s (X2, 32.07; P = 0.001), were significantly associated with the current use of substance/s. Likewise, residence (X2, 5.00; P= 0.02), ethnicity (X2, 8.06; P= 0.04), having friends who use substance/s (X2, 40.32; P < 0.001) and coming from an area where substance/s is/are commonly used (X2, 5.15; P = 0.02), were significantly associated with the lifetime use of substances.
    Conclusion: The prevalence of substance use among intern students was considerably high. Early exposure to substances often predicts future substance use, abuse and dependence with its medical, psycho-social and economic consequences. This necessitates strategic interventions aimed at reducing this problem without delay.
    Graham Barr, Leanne Scott*, and Peter Collins
    This paper develops a measure of player vulnerability in games of chance where the player has control over betting strategy. The measure was specifically developed in a completely general form for the game of Roulette as played on electronic betting terminals, but can be applied to other games of chance. In the case of Roulette, the metric captures both the quantum of bet and, crucially, the specific type of bet. The generalised form of the measure accommodates any chosen bet that can be placed in Roulette. The paper gives the derivation of the measure, which is termed Vulnerability to Large Losses (VLL), and demonstrates the interpretation of VLL in a probabilistic context, indicating how it captures the notion of player vulnerability. The use of the VLL measure as a means of tracking and characterising the betting behaviour of individual gamblers is demonstrated. The VLL measure allows one to track the playing behaviour of a gambler over the course of an extended session of gambling and allows one to see how their playing style varies across time. It can then be used to directly interrogate a variety of propositions about gambling strategies or behaviour, and it is postulated that VLL has excellent potential to be used as a general metric to monitor player betting behaviour across time for a range of betting games.
    Editorial
    Brian L. Ackerman*
    There are 2 fundamentally different and opposing parts of our psyches, one of which is healthy, the other is unhealthy. In order to become mentally and spiritually well, we have to become aware of our 'double nature', which I refer to as learning to see double, and then create a hierarchy between the two sides, such that our unhealthy psyches are relegated to a one-down, subservient position to our healthy psyches.
    Short Communication
    Christine E. Barron*, Jessica Moore, Grayson Baird, Erica Hardy, Amy Goldberg
    Child sex trafficking (CST) victims are at risk for HIV infection due to a convergence of both social and biological factors. However, sparse recommendations and guidelines exist for providers on the provision of HIV non-occupational post-exposure prophylaxis (nPEP) for CST patients. We evaluated whether pediatricians would provide HIV nPEP in a clinical vignette where a patient disclosed ongoing involvement in CST. Participants were relatively divided regarding whether they would provide HIV nPEP; 58.8% responded yes and 41.2% responded no. This highlights the need for medical guidelines to address the complex and case specific considerations of providing nPEP to these victims.
    Review Article
    Ezio Carboni*, Elena Carboni, and Dragana Jadzic
    Although the relevant research investment in understanding the mechanism of action of cocaine and its role in altering brain circuits and behaviour, an efficacious therapy for cocaine addiction has not been found yet. Thus, cocaine use, dependence, abuse and addiction are still a relevant health, social, and economical problem. Cocaine interacts with three different monoamine transporters and increases the extracellular level of dopamine, norepinephrine and serotonin in many brain areas as well in periphery. The aim of this review is to evaluate the interaction of cocaine with the dopamine transporter (DAT) but also with the norepinephrine transporter (NET) and the serotonin transporter (SERT) in several brain areas. In addition, it will be discussed some of the receptor interaction the are involved in the complex alteration of brain circuitry that in turns produces the feeling and the behaviours sought by addicted. The areas that will be considered are: i) the prefrontal cortex (PFC), being the area in which the process of decision making is elaborated; ii) the NAcc shell because its involvement in the reinforcing and motivational properties of cocaine; iii) the bed nucleus of stria terminal is (BNST), due to its involvement in the stress response and in the relapse of cocaine consumption. It will be also considered the effect of prenatal exposure to cocaine and the target role of monoamine transporters in the search of a therapy for cocaine addiction.
    Review Article
    Donald E. Nowak Jr*
    This review looks at research from 1991 to the present in regard to college student-athlete gambling addiction and disorder issues with an emphasis on prevalence rates, motivations, and comorbid disorders as well as NCAA national studies and derivative research. Subsets of the college student-athlete population, namely, minority athletes are also examined. PsycINFO, PsycARTICLES, ERIC, SPORTDiscus, MEDLINE, and Dissertation Abstracts International (ProQuest) were searched for possible contributions to this review. Student-athletes and male student-athletes in particular, are vulnerable to disordered gambling problems, which, if not addressed by university administration and athletic departments, can result in severe negative consequences for the student-athlete. The research shows, for the most part, that student-athletes have a higher rate of pathological gambling than non-athletes, though the rate of normal gambling behavior is about the same. Additionally, it appears that athletes in certain high profile team sports (football, basketball, etc.) as well as athletes belonging to a minority group are more likely to report problems with gambling than their counterparts. Recommendations for working with student-athletes with a gambling disorder as well as directions for future research in this burgeoning area are offered, including screening for the disorder by mental health professionals and counselors, as well as training for coaches and financial aid personnel.
    Yahya Muhammed Bah*
    In the Gambia like all nations, drug abuse is seen as a social and health problem that has many serious implications for the physical, social, psychological and intellectual development of the victims more especially, the children. Therefore, it continues to be a concern to families, community leaders, educators, social workers, health care professionals, academics, government and its development partners. Though there some studies on drug abuse, there is none on children and drug abuse focusing on the street children the most vulnerable category. Street children are hypothesized to be more at risk of any epidemic including drug abuse. This study sought to determine the risk and prevalence of drug abuse among street children focusing on those in the car parks. The research was focused on six critical areas: level of knowledge of drug abuse, perception towards it, level of knowledge of the causes of it in the community and among street children, level of knowledge of negative impacts of it, level of knowledge of the preventive methods; and level of knowledge of the support services and treatments needed by victims. A structured questionnaire was used to collect the data from thirty five participants (i.e. one driver and six casual apprentices from each of the five car parks) were interviewed. The data was presented and analysed using tables and percentage. The findings revealed among other things, that there is high level of awareness of drug abuse but the feelings towards it is mixed. Like other children, street children are abusing drugs mainly due to peer influence with the ultimate objective of getting high to relief stress, group recognition, trusted by peers, etc. Similarly, participants are highly aware of the negative impacts encompassing fighting, stealing, mental illness, etc. To finance the behaviour, victims are engaged in all types of dangerous antisocial behavior including romantic ones exposing them to a range of diseases including STIs and HIV/AIDS. Marijuana is the most commonly abused drug. Though in the minority, some have started experimenting cocaine/coke, hashish; and heroin. While participants have good knowledge of the critical methods to fight drug abuse, the support services needed by victims, victims are mostly reluctant to seek the services not only because they are hard to find but fear societal stigmatization, exclusion and discrimination and professionals maltreatments.
    Research Article
    Michael J. Mello*, Julie R. Bromberg, Hale Wills, Barbara A. Gaines, Garry Lapidus, Megan L. Ranney, Anthony Spirito, Christina Parnagian, and Janette Baird
    Introduction: Alcohol screening, brief intervention and referral to treatment is mandated within the level 1 pediatric trauma center. However, data on the prevalence of alcohol and drug use among admitted pediatric trauma patients is limited. Our study objective was to describe substance use and related negative consequences in admitted adolescent trauma patients across three pediatric level 1 trauma centers.
    Methods: This surveillance study was nested within a study on electronically delivered parenting skills education to parents of admitted adolescents (12-17 years) screening positive for alcohol or drug use. Enrolled adolescents completed baseline assessments to examine demographics, substance use and related negative consequences. Thirty-seven parent-adolescent dyads enrolled in the intervention study.
    Results: Participants were eligible if they received a positive CRAFFT score or a positive biological screen for alcohol or drug use at time of the hospital admission. Of those enrolled into the study, 9 (24%) reported no substance use in the prior 12 months in our assessment battery. Of the remaining 28 patients, 6 (16%) reported using only alcohol, 10 (27%) only marijuana, 9 (24%) both alcohol and marijuana, and 3 (8%) alcohol and marijuana with other drugs in the past 12 months. Negative consequences reported varied between those who reported alcohol use only and those who reported marijuana use only with physical consequences of use most often being reported by those using alcohol (hangover, vomiting), and psychosocial consequences (getting into trouble with parents, doing something later regret) by those who used only marijuana.
    Conclusion: These findings support the use of laboratory screening and screening questionnaires for all adolescent trauma admissions to capture a complete picture of alcohol and drug use.
    Short Communication
    Jennifer C. Elliott*, Noga Shalev, Deborah S. Hasin
    Aims: Given the efficacy of new medications for Hepatitis C virus (HCV), we aimed to determine whether drinking relates to HCV treatment access among the high-risk group of individuals with HIV/HCV co-infection.
    Methods: We sampled 210 patients in a sexual health clinic; of these, 39 reported HIV/HCV co-infection (79.49% male; 56.41% Black). Patients completed a self-report survey on drinking and treatment history.
    Results: Those drinking despite health problems reported less HCV treatment (p=0.035). Drinking despite health problems did not relate to whether HCV treatment was recommended by providers, and binge drinking did not relate to either HCV outcome. Drinking was unrelated to HIV treatment.
    Conclusions: HIV/HCV co-infected individuals drinking despite health problems are in urgent need of attention, to reduce drinking and increase engagement in treatment. Drinking despite health problems may serve as an effective screening question to identify HIV/HCV co-infected drinkers who are most at risk of being untreated.
    Abhinav Gupta*, Anil Kumar Gupta, and Mrinalini Darswal
    Consequent upon orders of Juvenile Justice Committee of Delhi High Court, Health Department of Delhi Government has taken some novel initiates to build up capacity of public health facilities for management of children & adolescents suffering from Drug/substance abuse. A total number of 60 beds have been earmarked in seven Delhi Government hospitals/institutions. A process to recruit appropriately trained staff has been undertaken to operationlize the centres. In the last 6 months, 65 Medical Officers and 101 Nursing Officers have been imparted 2 days hands-on-training on prevention & management of substance abuse in children and adolescents. During 1st April, 2016 to 31st Dec, 2017, 401children & adolescents in the age group 5-18 years (average 14.5 years) with different types of substance abuse have been admitted at the juvenile drug treatment facilities established. Most of the cases were brought to drug treatment centers by an NGO Society for Promotion of Youth & Masses (SPYM). Poly-substance abuse (53.9%) was noted as most common form of substance abuse followed by dependence on inhalants (29.7%), tobacco (10.9%) and cannabis (5.2%). Amongst children with Polysubstance abuse most of children were addicted to tobacco & or inhalant & or cannabis & or opioid & or alcohol in different combinations. Management of the cases included pharmacological and non pharmacological management. Follow up of cases was done at level of referring institutions; however, the same need to be strengthened. Steps have also been taken to limit the access of inhalants to vulnerable children & adolescents by issuing a Gazette Notification on 28st July 2017. District Task Force Committees have been constituted under Deputy Commissioner (Revenue) & Deputy Commissioner (Police) for execution and monitoring of the said Gazette Notification of Delhi Government. The efforts may go a long way in addressing the menace of drug/substance abuse in children & adolescents in Delhi.
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