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BACKGROUND: Although there is interest in wearables and smartphone technologies for remote outcome monitoring, little is known regarding the willingness of hip osteoarthritis (OA) and/or total hip arthroplasty (THA) patients to authorize and adhere to such treatment. METHODS: We developed an Institutional Review Board-approved questionnaire to evaluate patient perceptions of remote monitoring technologies in a high-volume orthopedic center. Forty-seven THA patients (60% female; mean age: 66 years) and 50 nonoperative OA hip patients (52% female; mean age: 63 years) participated. Patient perceptions were compared using Pearson's chi-squared analyses. RESULTS: THA patients were similarly interested in the use of smartphone apps (91% vs 94%, P = .695) in comparison to nonoperative hip OA patients. THA patients were more receptive to using wearable sensors (94% vs 44%, P < .001) relative to their nonoperative counterparts. THA patients also expressed stronger interest in learning to use custom wearables (87% vs 32%, P < .001) vs nonoperative patients. Likewise, the majority of THA patients were willing to use Global Positioning System technology (74% vs 26%, P < .001). THA patients also expressed willingness to have their body movement (89%), balance (89%), sleep (87%), and cardiac output (91%) tracked using remote technology. CONCLUSION: Overall, we found that THA patients were highly receptive to using wearable technology in their treatments. Nonoperative OA hip patients were generally unreceptive to using smart technologies, with the exception of smartphone applications. This information may be useful as utilization of these technologies for patient care continues to evolve.
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Artroplastia de Quadril , Osteoartrite do Quadril , Dispositivos Eletrônicos Vestíveis , Idoso , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Smartphone , Tecnologia , Resultado do TratamentoRESUMO
Fused Filament Fabrication (FFF) as an Additive Manufacturing (AM) method for Polyetheretherketone (PEEK) has established a promising future for medical applications so far, however interlayer delamination as a failure mechanism for FFF implants has raised critical concerns. A one-dimensional (1D) heat transfer model (HTM) was developed to compute the layer and interlayer temperatures by considering the nature of 3D printing for FFF PEEK builds. The HTM was then coupled with a non-isothermal healing model to predict the interlayer strength through thickness of a FFF PEEK part. We then conducted a parametric study of the primary temperature effects of the FFF system, including the print bed, nozzle, and chamber temperatures, on layer healing. The heat transfer component of the model for the FFF PEEK layer healing assessment was validated separately. An idealized PEEK cube design (10x10x10 mm3) was used for model development and 3D printed in commercially available industrial and medical FFF machines. During the printing and cooling processes of FFF, thermal videos were recorded in both printers using a calibrated infrared camera. Thermal images were then processed to obtain time-dependent layer temperature profiles of FFF PEEK prints. Both the theoretical model and experiments confirmed that the upper layers in reference to the print bed exhibited higher temperatures, thus higher healing degrees than the lower layers. Increasing the print bed temperature increased the healing of the layers allowing more layers to heal 100%. The nozzle temperature showed the most significant effect on the layer healing, and under certain nozzle temperature, none of the layers healed adequately. Although environment temperature had less impact on the lower layers closer to the print bed, 100% healed layer number increased when the chamber temperature increased. The model predictions were in good agreement with the experimental data, particularly for the mid-part of FFF PEEK cubes printed in both FFF machines.
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BACKGROUND: Although 2-stage exchange arthroplasty is the preferred surgical treatment for periprosthetic joint infection (PJI) in the United States, little is known about the risk of complications between stages, mortality, and the economic burden of unsuccessful 2-stage procedures. METHODS: The 2015-2019 Medicare 100% inpatient sample was used to identify 2-stage PJI revisions in total hip and knee arthroplasty patients using procedural codes. We used the Fine and Gray sub-distribution adaptation of the conventional Kaplan-Meier method to estimate the probability of completing the second stage of the 2-stage PJI infection treatment, accounting for death as a competing risk. Hospital costs were estimated from the hospital charges using "cost-to-charge" ratios from Centers for Medicare and Medicaid Services. RESULTS: A total of 5094 total hip arthroplasty and 13,062 total knee arthroplasty patients had an index revision for PJI during the study period. In the first 12 months following the first-stage explantation, the likelihood of completing a second-stage PJI revision was 43.1% (95% confidence interval [CI] 41.7-44.5) for hips and 47.9% (95% CI 47.0-48.8) for knees. Following explantation, 1-year patient survival rates for hip and knee patients were 87.4% (95% CI 85.8-88.9) and 91.4% (95% CI 90.6-92.2), respectively. The median additional cost for hospitalizations between stages was $23,582 and $20,965 per patient for hips and knees, respectively. Hospital volume, Northeast or Midwest region, and younger age were associated with reduced PJI costs (P < .05). CONCLUSION: Although viewed as the most preferred, the 2-stage revision strategy for PJI had less than a 50% chance of successful completion within the first year, and was associated with high mortality rates and substantial costs for treatment failure.
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Artrite Infecciosa , Artroplastia de Quadril , Infecções Relacionadas à Prótese , Idoso , Artrite Infecciosa/cirurgia , Artroplastia de Quadril/efeitos adversos , Custos Hospitalares , Hospitais , Humanos , Medicare , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Dual mobility (DM) articulations were introduced for total hip arthroplasty to reduce the risk of instability for patients who have a high risk of dislocation. The use of DM constructs in both primary and revision total hip arthroplasty has been steadily increasing, leading to concerns regarding potential risks of fretting corrosion, polyethylene wear, metal release, and failure due to component positioning. METHODS: A total of 56 retrieved DM constructs were collected. The inner and outer polyethylene liner surfaces were assessed for 7 damage mechanisms, and fretting corrosion was evaluated for the femoral stem, head, and modular liner. Three polyethylene liners with the greatest amounts of embedded debris were examined using scanning electron microscopy. Energy-dispersive X-ray spectroscopy was used to determine the elemental content of the debris. Acetabular cup orientation was analyzed radiographically using the EBRA (Einzel-Bild-Roentgen-Analyse) method. RESULTS: The devices were revised most frequently for infection (36%), loosening (21%), and instability/dislocation (18%). The most common polyethylene damage mechanisms were scratching, pitting, burnishing, and embedded debris, and no difference in total damage was found between primary and revision cases. Scanning electron microscopy/energy-dispersive X-ray spectroscopy revealed that debris morphology and composition were consistent with porous titanium coating, resulting from cup loosening or broken screws and augments. A total of 71% and 50% of the constructs were determined to be within the Lewinnek safe zone for inclination and anteversion, respectively. CONCLUSION: The most notable mechanisms of surface damage were due to third-body debris, especially for the polyethylene surfaces which articulate against cobalt-chromium femoral heads and acetabular liners. Scratching of the femoral head and the metal liner from this debris may support the clinical use of ceramic for DM bearing surfaces in the future.
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Artroplastia de Quadril , Prótese de Quadril , Artroplastia de Quadril/efeitos adversos , Corrosão , Prótese de Quadril/efeitos adversos , Humanos , Polietileno , Desenho de Prótese , Falha de PróteseRESUMO
BACKGROUND: Instability remains the most common complication after revision total hip arthroplasty (THA) and presents a unique treatment dilemma for the orthopedic surgeon. Dual mobility (DM) bearing articulations have been used in France since the 1970s, but have only become more widely adopted in the United States over the last decade. The purpose of this symposium was to discuss the role for DM bearings in revision THA. METHODS: We reviewed the existing literature on outcomes after DM bearing articulations in revision THA. We also report several case examples of the use of DM in difficult revision THA cases, including acetabular bone loss, failed constrained liner, and adverse local tissue reaction. Finally, we briefly discuss the limitations associated with the use of DM. RESULTS: Several large retrospective series demonstrate that DM bearings reduce the incidence of dislocation after revision THA when compared with conventional single bearing THA. Specific complications related to DM bearings including polyethylene wear, loosening, intraprosthetic dislocation, and corrosion remain a concern, but appear to have drastically improved over time with modern implant designs. CONCLUSION: Contemporary DM designs have been established as an effective bearing option to reduce instability in revision THA, although concerns do exist. High-quality prospective studies are necessary to further define the role this bearing option has in the coming years.
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Artroplastia de Quadril , Luxação do Quadril , Prótese de Quadril , Artroplastia de Quadril/efeitos adversos , França , Luxação do Quadril/epidemiologia , Luxação do Quadril/etiologia , Luxação do Quadril/prevenção & controle , Prótese de Quadril/efeitos adversos , Humanos , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Estados UnidosRESUMO
Additive manufacturing (AM) is a potential application for polyetheretherketone (PEEK) spinal interbody fusion cages, which were introduced as an alternative to titanium cages because of their biocompatibility, radiolucency and strength. However, AM of PEEK is challenging due to high melting temperature and thermal gradient. Although fused filament fabrication (FFF) techniques have been shown to 3D print PEEK, layer delamination was identified in PEEK cages printed with a first generation FFF PEEK printer [1]. A standard cage design [2] was 3D printed with a second generation FFF PEEK printer. The effect of changing layer cooling time on FFF cages' mechanical strength was investigated by varying nozzle sizes (0.2 mm and 0.4 mm), print speeds (1500 and 2500 mm/min), and the number of cages printed in a single build (1, 4 and 8). To calculate the porosity percentage, FFF cages were micro-CT scanned prior to destructive testing. Mechanical tests were then conducted on FFF cages according to ASTM F2077 [2]. Although altering the cooling time of a layer was not able to change the failure mechanism of FFF cages, it was able to improve cages' mechanical strength. Printing a single cage per build caused a higher ultimate load than printing multiple cages per build. Regardless of the cage number printed per build, cages printed with bigger nozzle diameter achieved higher ultimate load compared to cages printed with smaller nozzle diameter. Printing with a bigger nozzle diameter resulted in less porosity, which might have an additional affect on the interlayer delamination failure mechanism.
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BACKGROUND: The purpose of this study is to determine the preferred sampling location for tissue analysis in total knee arthroplasty (TKA) and to evaluate metal concentrations, inflammatory cytokines, component damage, and tissue metallosis. METHODS: Twenty TKA systems were collected at necropsy along with tissue samples from 5 distinct locations. Inductively coupled plasma mass spectrometry (ICP-MS) analysis was performed to determine cobalt (Co), chromium (Cr), and titanium (Ti) concentrations. Synovial fluid cytokine analysis was preformed using a Magnetic Luminex Screening Assay. Femoral components were assesed for damage and tissues were visually scored for metallosis. RESULTS: The median metal concentrations were 16 ppb for Co, 46 ppb for Cr, and 9.8 ppb for Ti. There was no association between the tissue collection site and the metal concentration for Co (P = .979), Cr (P = .712), or Ti (P = .854). Twelve of 20 of the necropsy-retrieved TKAs had metallosis, but there was no correlation between Co (P = .48), Cr (P = .89), or Ti (P = .60) concentration and metallosis. Increased Co was associated with decreased tumor necrosis factor alpha (ρ = -0.56, P = .01) and interleukin 1 beta (ρ = -0.48, P = .03). Increased Cr was associated with decreased tumor necrosis factor alpha (ρ= -0.47, P = .03), interleukin 6 (ρ= -0.43, P = .04), and macrophage inflammatory protein 3 alpha (ρ= -0.47, P = .03). CONCLUSION: We observed elevated Co, Cr, and Ti concentrations in tissue from necropsy-retrieved TKA. Our findings did not support the hypothesis that tissue metal concentrations were associated with inflammatory cytokines. The results of this research will be useful for the design of future prospective studies.
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Artroplastia do Joelho , Artroplastia do Joelho/efeitos adversos , Cromo , Cobalto , Humanos , Metais , Estudos ProspectivosRESUMO
BACKGROUND: In order to improve oxidation resistance, antioxidants such as vitamin-E are added to polyethylene used in the bearing surfaces of orthopedic components. Currently, little is known about the efficacy of this treatment in vivo. This study therefore reports on the reasons for revision, surface damage mechanisms, and oxidation of retrieved vitamin E-stabilized highly crosslinked polyethylene (HXLPE) for total knee arthroplasty. METHODS: We examined 103 retrieved knee inserts fabricated from vitamin E (VE)-stabilized HXLPE and 67 fabricated from remelted HXLPE as a control. The implantation times were 1.2 ± 1.3 and 1.5 ± 1.3 years for the VE and control cohorts, respectively. The inserts were evaluated for 7 surface damage mechanisms using a semiquantitative scoring method and analyzed for oxidation using Fourier-transform infrared spectroscopy. Reasons for revision were also assessed using operative notes created at time of retrieval. RESULTS: Both groups were revised primarily for instability, infection, and loosening. Burnishing, pitting, and scratching were the most common damage mechanisms observed, with the VE cohort demonstrating less surface damage than the control. Measured oxidation for the cohort was low, with a median oxidation index of 0.09 ± .05 for the articulating surface, 0.05 ± 0.06 for the backside, 0.08 ± 0.06 for the anterior/posterior surfaces, and 0.08 ± 0.05 for the stabilizing post. As compared to the control cohort, oxidation tended to be less for the VE group at the articulating (P < .001) and backside (P = .003) surfaces, although the median differences were minimal and may not be clinically significant. CONCLUSION: The results indicate positive fatigue damage resistance and oxidation resistance for the retrieved VE-stabilized total knee arthroplasty inserts.
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Antioxidantes/farmacologia , Prótese do Joelho , Polietileno/química , Falha de Prótese/etiologia , Vitamina E/farmacologia , Idoso , Artroplastia do Joelho/instrumentação , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Oxirredução , Desenho de Prótese , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
BACKGROUND: Clinical concern exists regarding fretting corrosion and material loss from taper junctions in orthopedic devices, with previous research focusing on the modular components from total hip arthroplasty. Comparatively little has been published regarding the fretting corrosion and material loss in modular knee devices. The purpose of this study is to evaluate fretting corrosion damage and quantify material loss for conical total knee arthroplasty taper interfaces. METHODS: Stem tapers of 166 retrieved modular knee devices were evaluated for fretting corrosion using a semiquantitative scoring method. High precision profilometry was then used to determine volumetric material loss and maximum wear depth for a subset of 37 components (implanted for 0.25-18.76 years). Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to characterize the observed damage. RESULTS: Mild to severe fretting corrosion was observed on the majority of tapers, with 23% receiving a maximum visually determined damage score of 4. The median rate of volumetric material loss was 0.11 mm3/y (range 0.00-0.76) for femoral components (both cone and bore taper surfaces combined) and 0.01 mm3 (range 0.00-8.10) for tibial components. Greater rates of material loss were associated with mixed metal pairings. There was a strong correlation between visual fretting corrosion score and calculated material loss (ρ = 0.68, P < .001). Scanning electron microscopy revealed varying degrees of scratching, wear, fretting corrosion, and instances of cracking with morphology not consistent with fretting corrosion, wear, or fatigue. CONCLUSION: Although visual evidence of fretting corrosion damage was prevalent and correlated with taper material loss, the measured volumetric material loss was low compared with prior reports from total hip arthroplasty.
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Artroplastia do Joelho/instrumentação , Prótese de Quadril , Falha de Prótese , Idoso , Corrosão , Feminino , Humanos , Masculino , Teste de Materiais , Metais , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Fraturas Periprotéticas , Desenho de Prótese , Espectrometria por Raios X , Tíbia/ultraestruturaRESUMO
Background: Club drug users are high risk and vulnerable population for adverse drug-related consequences and sexual risk behaviors. Few investigations have addressed the possible interrelationship between early trauma and PTSD among young club drug using populations. Objective: Exposure to traumatic experiences - especially in childhood, has been linked to risk behaviors exposure and substance use disorder. This study aimed to assess and compare drug use patterns and the presence of childhood sexual abuse (CSA) experiences among ecstasy and LSD users with and without Posttraumatic Stress Disorder (PTSD). Method: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals. The Global Appraisal of Individual Needs questionnaire was used as the primary assessment instrument. Participants were from 18 to 39 years of age, had used ecstasy and/or LSD in the 90 days prior to the interview, and were not in treatment for alcohol and other drug problems. Results: Out of the 240 participants, 123 (51.2%) presented PTSD symptoms. Those presenting PTSD were younger, less educated, with lower income, and presented higher drug use severity than those without PTSD symptoms. Moreover, a higher prevalence of sexual risk behavior was verified among those with PTSD. There was an association between PTSD symptoms and CSA history, where 64.2% of individuals with PTSD also presented CSA, compared to 47% among those without PTSD (p = .028). Individuals with co-occurring history of CSA and PTSD symptoms reported earlier use of ecstasy, LSD, and cocaine compared to individuals with a history of CSA but without PTSD. Conclusions: In the present study, participants with a history of PTSD demonstrate a history of CSA, as well as pronounced severity in several areas - precocity of use, severity of addiction, and greater exposure to situations of sexual risk. Thus, a cycle of traumatization may be established through early potential trauma, which can remain unprocessed and contribute to earlier and more severe substance use and sexual risk behaviors. Identification of PTSD symptoms and risk for HIV and other STIs among young club drug users is critical to address focused treatment approaches for this vulnerable population.
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Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Usuários de Drogas/psicologia , Drogas Ilícitas , Assunção de Riscos , Comportamento Sexual/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: We analyzed whether the total hospital cost in a 90-day bundled payment period for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) total hip arthroplasty (THA) bearings was changing over time, and whether the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of US$325. METHODS: A total of 245,077 elderly Medicare patients (65+) who underwent primary THA between 2010 and 2015 were identified from the United States Medicare 100% national administrative hospital claims database. The total inpatient cost, calculated up to 90 days after index discharge, was computed using cost-to-charge ratios, and hospital payment was analyzed. The differential total inpatient cost of C-PE and COC bearings, compared to metal-on-polyethylene (M-PE), was evaluated using parametric and nonparametric models. RESULTS: After adjustment for patient and clinical factors, and the year of surgery, the mean hospital cost up to 90 days for primary THA with C-PE or COC was within ±1% of the cost for primary THA with M-PE bearings (P < .001). From the nonparametric analysis, the median total hospital cost was US$296-US$353 more for C-PE and COC than M-PE. Cost differentials were found to decrease significantly over time (P < .001). CONCLUSION: Patient and clinical factors had a far greater impact on the total cost of inpatient THA surgery than bearing selection, even when including readmission costs up to 90 days after discharge. Our findings indicate that the cost-effectiveness thresholds for ceramic bearings relative to M-PE are changing over time and increasingly achievable for the Medicare population.
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Artroplastia de Quadril/economia , Artroplastia de Quadril/instrumentação , Cerâmica , Análise Custo-Benefício , Prótese de Quadril/economia , Desenho de Prótese/economia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Medicare , Metais , Polietileno/economia , Mecanismo de Reembolso , Reoperação/economia , Estados UnidosRESUMO
Recent advances in additive manufacturing technology now enable fused filament fabrication (FFF) of Polyetheretherketone (PEEK). A standardized lumbar fusion cage design was 3D printed with different speeds of the print head nozzle to investigate whether 3D printed PEEK cages exhibit sufficient material properties for lumbar fusion applications. It was observed that the compressive and shear strength of the 3D printed cages were 63-71% of the machined cages, whereas the torsion strength was 92%. Printing speed is an important printing parameter for 3D printed PEEK, which resulted in up to 20% porosity at the highest speed of 3000 mm/min, leading to reduced cage strength. Printing speeds below 1500 mm/min can be chosen as the optimal printing speed for this printer to reduce the printing time while maintaining strength. The crystallinity of printed PEEK did not differ significantly from as-machined PEEK cages from extruded rods, indicating that the processing provides similar microstructure.
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BACKGROUND: Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time. METHODS: Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends. RESULTS: The unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P = .63) or TKA (P = .96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P < .001) and TKA (hazard ratio = 0.97; P < .001). CONCLUSION: Despite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade.
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Artrite Infecciosa/mortalidade , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/mortalidade , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/etiologia , Feminino , Humanos , Incidência , Masculino , Medicare , Modelos de Riscos Proporcionais , Infecções Relacionadas à Prótese/etiologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Tapentadol, a Schedule II opioid with a combination of µ-opioid activity and norepinephrine reuptake inhibition, is used for the management of moderate to severe acute and chronic pain. Its dual mechanism of action is thought to reduce opioid-related side effects that can complicate pain management. Since approval, tapentadol has been tracked across multiple outcomes suggesting abuse liability, and a pattern of relatively low, although not absent, abuse liability has been found. This retrospective cohort study further details the abuse liability of tapentadol as an active pharmaceutical ingredient (API) when immediate-release as well as extended-release formulations were on the market together (fourth quarter of 2011 to second quarter of 2016). Tapentadol (API) was compared with tramadol, hydrocodone, morphine, oxycodone, hydromorphone, and oxymorphone across Poison Center, Drug Diversion, and Treatment Center Programs Combined data streams from the Researched Abuse, Diversion and Addiction-Related Surveillance system. Findings suggest the public health burden related to tapentadol to date is low, but present. Event rates of abuse per population-level denominators were significantly lower than all other opioids examined. However, when adjusted for drug availability, event rates of abuse were lower than most Schedule II opioids studied, but were not the lowest. Disentangling these 2 sets of findings further by examining various opioid formulations, such as extended-release and the role of abuse-deterrent formulations, is warranted. PERSPECTIVE: This article presents the results from an examination of tapentadol API across the Researched Abuse, Diversion and Addiction-Related Surveillance System: a broad and carefully designed postmarketing mosaic. Data to date from Poison Center, Drug Diversion, and Treatment Centers combined suggest a low, but present public health burden related to tapentadol.
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Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tapentadol/efeitos adversos , Dor Crônica/tratamento farmacológico , Feminino , Humanos , Masculino , Oxicodona/efeitos adversos , Estudos RetrospectivosRESUMO
Abstract Background This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. Method This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. Results Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). Conclusion Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.
Resumo Introdução Este estudo examinou os padrões de uso de drogas e os sintomas psiquiátricos de ansiedade e depressão entre brasileiros não heterossexuais usuários de ecstasy e/ou LSD e comparou os achados com aqueles relatados por seus pares heterossexuais. Método Este estudo transversal empregou amostragens direcionadas e abordagens de mapeamento etnográfico através de entrevistas presenciais realizadas em bares e festivais de música eletrônica usando uma versão adaptada e semiestruturada do questionário de Avaliação Global de Necessidades Individuais. A amostra incluiu 240 adultos jovens do sexo masculino e feminino que haviam usado ecstasy e/ou LSD nos 90 dias anteriores à entrevista e que não estavam em tratamento para abuso de álcool e drogas. Resultados Dos 240 sujeitos incluídos (idade média: 22,9±4,5 anos), 28,7% eram homossexuais ou bissexuais. A análise de regressão multivariada mostrou que a prevalência de sintomas de depressão nos últimos 12 meses no grupo não heterossexual foi 37% superior à dos heterossexuais [razão de prevalência (RP) = 1,79; intervalo de confiança de 95% (IC95%) 1.03-3.11; p=0,037]. Conclusão Estratégias devem ser desenvolvidas para avaliar e abordar as necessidades individuais, e as abordagens de tratamento devem ser adaptadas para sintomas depressivos em usuários de drogas jovens e não heterossexuais.
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Humanos , Masculino , Feminino , Adulto Jovem , Ansiedade/etnologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Depressão/etnologia , Minorias Sexuais e de Gênero/psicologia , Psicotrópicos/administração & dosagem , Brasil , Estudos Transversais , Análise Multivariada , Inquéritos e Questionários , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Heterossexualidade/psicologia , Dietilamida do Ácido Lisérgico/administração & dosagemRESUMO
BACKGROUND: This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. METHOD: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. RESULTS: Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). CONCLUSION: Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.
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Ansiedade/etnologia , Depressão/etnologia , Minorias Sexuais e de Gênero/psicologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Heterossexualidade/psicologia , Humanos , Dietilamida do Ácido Lisérgico/administração & dosagem , Masculino , Análise Multivariada , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Psicotrópicos/administração & dosagem , Inquéritos e Questionários , Adulto JovemRESUMO
This article describes data on the motivations for selling ecstasy among young adults in the electronic dance music (EDM) club culture in Brazil. Individual interviews were conducted with 20 individuals recruited for their involvement in the EDM club scene. Eligible participants were aged 18-39 and reported ecstasy and/or LSD use one or more times in the past 90 days. Exclusion criteria included current treatment for drug/alcohol problems and cognitive impairment or clinically evident psychiatric disorder. Mean age was 22.92 (SD 2.77), 60% were male, 45% reported 12 or more years of education, 50% did not have a primary partner, 50% were living alone, and all had friends who also used ecstasy. Three main themes emerged: (1) "easy" transition from ecstasy user to seller; (2) desire to achieve popularity and fame; and (3) need to sell ecstasy to maintain the high cost of EDM club scene participation. This is one of the first studies of ecstasy sellers in Brazil. The results demonstrate the ease with which the participants transition from ecstasy user to seller. Given the potential health and social dangers associated with ecstasy use, public health campaigns to prevent ecstasy use and policy initiatives to limit the ecstasy supply are warranted.
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Comportamento do Adolescente , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Comércio , Dança , Tráfico de Drogas/psicologia , Usuários de Drogas/psicologia , Alucinógenos/provisão & distribuição , Motivação , Música , N-Metil-3,4-Metilenodioxianfetamina/provisão & distribuição , Adolescente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/economia , Brasil , Comércio/economia , Feminino , Alucinógenos/economia , Humanos , Entrevistas como Assunto , Estilo de Vida , Masculino , N-Metil-3,4-Metilenodioxianfetamina/economia , Pesquisa Qualitativa , Fatores Socioeconômicos , Adulto JovemRESUMO
Success of pacemakers and implantable cardioverter defibrillators may be limited by premature lead failure. Lead insulation polymers, such as polyurethane (PU) and polydimethylsiloxane (PDMS), are reported to degrade over time in vivo. PU is known to undergo oxidation, whereas PDMS undergoes surface hydrolysis. Previous studies have characterized polymer degradation in vitro, in animals or in short-term human study; however, complex effects of the biochemical and mechanical environment on the lead insulation can only be fully understood by evaluating long-term-implanted leads. Therefore, we established a retrieval program to systematically characterize the chemical and surface changes in 37 of 104 retrieved pacing and defibrillator leads, implanted for ≥5 yr. Fourier transform infrared (FTIR) spectroscopy was used for chemical analysis, and a scanning electron microscope was used for surface degradation evaluation. PDMS leads were investigated for changes in the ratio of Si-O-Si to Si-C peaks, whereas PU degradation was evaluated by changes in ether (C-O-C), carbonyl (C=O), methylene (C-H), and amino (C-N/N-H) peaks. Under SEM, PDMS showed enhanced roughness but no statistical increase in Si-O-Si bonds. PU showed uniform cracking throughout the lead body and statistical changes in each of the oxidation indicative peaks. Overall, both polymers showed surface changes in the physiological environment, but PU was the only material to show chemical changes. This work is a large-scale characterization study on long-term-implanted leads that confirmed PU oxidation but not hydrolysis of PDMS in vivo. It provides important insight for manufacturers when making design improvements and for surgeons when making decisions about lead implantation.
Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Poliuretanos , Falha de Prótese , Adulto , Idoso , Dimetilpolisiloxanos , Humanos , Pessoa de Meia-Idade , Oxirredução , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
OBJECTIVES: To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS: This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS: Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PRâ=â1.26; 95% confidence interval (CI): 1.044-1.543; pâ=â0.017) and the use of alcohol/drugs to make sex last longer (PRâ=â1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS: The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills.