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This study aimed to identify socio-cultural factors facilitating initiation of opium use among drug users in Darab, Iran. A qualitative study using in-depth interviews was conducted. The study began in June 2006 and included 76 drug users, aged 20-43, of whom 95% (72) were male, and 5% (4) were female. The five most common factors facilitating initiation of drug use were revealed to be: lack of hobbies, treatment of general medical problems, modeling, peer networks, and cultural norms. Partner pressure was a common complaint among women in this study. Cultural factors perceived to facilitate initiation of drug use revealed in this study have not been fully addressed by current prevention and rehabilitation programs. Programs can be targeted at social and family levels to alter drug use culture.

Abstract Background Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial. Currently, no systematic review has examined the impact of beta-blockers on mortality in COPD. Methods We systematically searched electronic bibliographic databases including MEDLINE, EMBASE and Cochrane Library for clinical studies that examine the association between beta-blocker use and all cause mortality in patients with COPD. Risk ratios across studies were pooled using random effects models to estimate a pooled relative risk across studies. Publication bias was assessed using a funnel plot. Results Our search identified nine retrospective cohort studies that met the study inclusion criteria. The pooled relative risk of COPD related mortality secondary to beta-blocker use was 0.69 (95% CI: 0.62-0.78; I2=82%). Conclusion The results of this review are consistent with a protective effect of beta-blockers with respect to all cause mortality. Due to the observational nature of the included studies, the possibility of confounding that may have affected these results cannot be excluded. The hypothesis that beta blocker therapy might be of benefit in COPD needs to be evaluated in randomised controlled trials.

Abstract Background We examined trends in AIDS-defining illnesses (ADIs) among individuals receiving highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada to determine whether declines in ADIs could be contributing to previously observed improvements in life-expectancy among HAART patients in BC since 1996. Methods HAART-naïve individuals aged ≥ 18 years who initiated treatment in BC each of the following time-periods 1996 - 1998; 1999 - 2001; 2002 - 2004; 2005 - 2007 were included. The proportion of participants with reported ADIs were examined for each time period and trends were analyzed using the Cochran-Armitage Trend Test. Cox proportional hazards models were used to examine factors associated with ADIs. Results A total of 3721 individuals (81% male) initiated HAART during the study period. A total of 251 reports of ADIs were received from 214 unique patients. These occurred in a median of 4 months (IQR = 1-19 months) from HAART initiation. The proportion of individuals with a reported ADI did not change significantly from 4.6% in the earliest time period to 5.8% in the latest period (p = 0.181 for test of trend). There were no significant declines in any specific ADI over the study period. Multivariable Cox models found that individuals initiating HAART during 2002-04 were at an increased risk of ADIs (AHR = 1.55; 95% CI 1.04-2.32) in comparison to 1996 - 98, but there were no significant differences in other time periods. Conclusions Trends in reported ADIs among individuals receiving HAART since 1996 in BC do not appear to parallel improvements in life-expectancy over the same period.

Background: Telemedicine for primary care in British Columbia is an unstudied phenomenon in the published literature. Even though patient care by means of telecommunications and information technology has many potential benefits for patients, care providers, and the health care system, there is a lack of information on the current use of telemedicine and the demographic characteristics of users in primary care, both in Canada and BC. Methods: We reviewed anonymized patient data provided by Quality Health Technology, the largest primary care telemedicine provider in BC. Descriptive statistics were used to analyze demographic characteristics and health service use by regional district from September 2013 to October 2015. The top 10 medical concerns were determined by analyzing the ICD-9 and Society of General Practitioners diagnostic codes used for billing each consultation. Results: Telemedicine users increased in number over the 2-year study period from 8282 in the first year to 17 149 in the second year. Close to two-thirds of users were female and the mean age of users was 31.5 (14.5) years. The average number of telemedicine consultations per patient was 4.6. The majority of users were located in Greater Vancouver (51.5%) followed by the Peace River (23.7%) and Fraser Valley (7%) regional districts. The highest rate of use was in Peace River, with 52 users per 1000 residents. Medical concerns included anxiety/depression (12.6%), contraception (8.3%), and skin conditions (6.0%). Conclusions: The majority of telemedicine users receiving primary care in BC during the study period were younger than 50 and were distributed throughout the province. Northern BC had the highest rate of telemedicine use, while anxiety/depression and contraception were the most common medical concerns. [ABSTRACT FROM AUTHOR]

Given the extent of social dysfunction associated with drug use with the contribution of the law, we examined the current situation of drug use and effect of law enforcement in four Middle Eastern countries of Pakistan, Afghanistan, Iran and Turkey. This article provides a review of literature on prevalence of substance use in each country and looks at the current drug policy in each of Pakistan, Afghanistan, Iran and Turkey (PAIT), to the extent that data is available. It also examines and compares law enforcement and supply/demand reduction policies among PAIT counties. Possible methods of reducing the human and societal harms, based on the regional analysis are presented. [ABSTRACT FROM AUTHOR]

Iran has the highest rate of opium addiction per capita in the world. The aim of this study was to examine the outcome of substance use among a cohort of drug users living in a rural area in Southern Iran. A semi-structured interview was conducted at baseline and at each follow-up visit on 211 substance users. Of the total of 211 drug users, 145 were non-injection drug users (non-IDUs) and 66 were injection drug users (IDUs). The most common method of drug use among all participants was revealed to be opium smoking. Other methods of choice were injection drug use (IDUs) and opium ingestion among 31% and 20% of participants, respectively. From the total of 211 participants in this cohort, on average (SD), each drug user gave up drugs 3.2 (2.7) times over the study period. Among those who were non-IDUs at the base line visit (145), 17 (12%) were abstinent for more than 6 months compared to 9 of 66 non-IDUs (14%) at the end of the study. By the end of the study period, 9 of 145 non-IDUs switched to non-IDUs while 11 of 66 IDUs (17%) switched to non-IDUs (chi-square = 5.78; p = 0.016). One main reason for a higher rate of transition among IDUs was mentioned by them as observing the deaths of several IDUs in their community that were a result of overdose. [ABSTRACT FROM AUTHOR]

Marijuana and its extracts are derived from Cannabis sativa, a type of hemp plant that contains active compounds called cannabinoids. As with many drugs, regular use of marijuana can result in dependence. Cannabis dependence is defined as a problematic pattern of use leading to clinically significant impairment or distress. Symptoms of dependence include using cannabis in larger amounts or over a longer period than was prescribed or intended, making unsuccessful efforts to cut down or control cannabis use, and spending time in activities necessary to obtain, use, or recover from cannabis effects. Signs and symptoms of withdrawal include irritability, anger, anxiety, difficulty sleeping, abdominal pain, fever, chills, and severe headache. Once an accurate diagnosis of marijuana dependence has been made, pharmacological and psychosocial treatment options can be considered. Although a literature review indicates insufficient evidence for a single broadly and consistently effective pharmacological treatment for cannabinoid dependence, adjunctive treatment for nausea, anxiety, and insomnia can be helpful. Replacement therapy and short-term dose tapering with synthetic cannabinoids may also be used to manage withdrawal symptoms. Studies of motivational enhancement therapy, cognitive-behavioral therapy, and contingency management for treating marijuana dependence have shown promising results. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common visceral cancer in men. Many studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of prostate cancer. We systematically searched all relevant databases (MEDLINE, EMBASE, The Cochrane Collaboration, CINAHL, Database of Abstracts of Review of Effects and ACP Journal Club) to March 2008. We also explored bibliographies of the articles, pertinent journals and conferences. We selected relevant articles according to predefined inclusion criteria by 2 independent reviewers. We used both fixed and random-effect models for meta-analysis. We performed subgroup and sensitivity analysis based on predefined variables. From 962 extracted articles, 20 met the inclusion criteria with a total of 25 768 participants. All the studies had an observational design. There was a statistically significant protective effect for NSAIDs on risk of prostate cancer (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.86-0.97). Subgroup analysis did not show any effect of study design or quality score on the results. There was a small but statistically significant protective effect for acetylsalicylic acid (ASA) (OR 0.95, 95% CI 0.91-1.00). Exposure to non-ASA NSAIDs was associated with a slightly reduced likelihood of prostate cancer (OR 0.92, 95% CI 0.85-1.00). With the available data, we were not able to determine an optimum dosage for NSAIDs. We conclude that taking NSAIDs may reduce the risk of prostate cancer. Nevertheless, the effect is small. [ABSTRACT FROM AUTHOR]

During orthopedic procedures, the tourniquets used to maintain bloodless surgical fields cause ischemia and then reperfusion (I/R), leading to oxidative muscle injury. Established methods exist neither for monitoring orthopedic I/R nor for predicting the extent of tourniquet-associated oxidative injury. To develop a predictive model for tourniquet-associated oxidative muscle injury, this study combined real-time near-infrared spectroscopy (NIRS) monitoring of I/R with Western blotting (WB) for oxidized proteins. We hypothesized strong correlations between NIRS-derived I/R indices and muscle protein oxidation. In 17 patients undergoing ankle fracture repair, a thigh tourniquet was inflated on the injured limb (300 mmHg). Using a continuous-wave (CW) NIRS setup, oxygenated (O2Hb), deoxygenated (HHb), and total (tHb) hemoglobin were monitored bilaterally (tourniquet versus control) in leg muscles. Leg muscle biopsies were collected unilaterally (tourniquet side) immediately after tourniquet inflation (pre) and before deflation (post). Average ischemia duration was 43.2 ± 14.6 min. In post-compared to pre-biopsies, muscle protein oxidation (quantified using WB) increased 172.3%± 145.7% (P<0.0005). Changes in O2Hb and tHb were negatively correlated with protein oxidation (respectively: P=0.040, R2=0.25 and P=0.003, R2=0.58). Reoxygenation rate was positively correlated with protein oxidation (P=0.041, R2=0.25). These data indicate that using CW NIRS, it is possible to predict orthopedic tourniquet-associated muscle oxidative injury noninvasively.