Substance use disorders: a comprehensive update of classification,epidemiology, neurobiology,clinical aspects,treatment and prevention

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.     

Patterns of parasitism among conopid flies parasitizing bumblebees

The effects of host size and host species on the prevalence and fitness of conopid flies (Diptera: Conopidae) parasitizing bumblebees (Hymenoptera: Apidae) were investigated. Field data from nine sites across south‐western Alberta, Canada, showed that conopids parasitized, on average, 12.3% of workers and 3.5% of male bees. In general, bee mass was a better predictor of host use and conopid offspring size than bee species. Host mass could not, however, explain the very low prevalence of conopids in the long‐tongued bumblebee, Bombus californicus Smith, or in male bees in general. Conopids predominately infested bees of intermediate size, and as a result, occurred most commonly in the intermediately sized species, B. flavifrons Cresson. Host quality, in terms of conopid offspring size, increased as a non‐linear function of bee size. The results are discussed with respect to the impact of conopids on bumblebee populations, and the relation between host quality and patterns of host use.     

Non‐target habitat exploitation by Trichogramma brassicae (Hym. Trichogrammatidae): what are the risks for endemic butterflies?

Abstract 1 Trichogramma brassicae Bezdenko is inundatively released against the European corn borer in Switzerland. Because parasitoids dispersing from the release fields might pose a threat to native butterflies, the searching efficiency of T. brassicae was investigated in nontarget habitats. 2 In field studies, T. brassicae was released at rates of 120 000 females/ha. Parasitism of sentinel Ephestia kuehniella egg clusters was 1.6–3.6% in meadows and 2.0–4.0% in flower strips. The respective figures were 57.6–66.7% and 19.2–46.9% in maize, significantly higher than the parasitism rates in the nontarget habitats. Experiments carried out in small field cages confirmed these results: Again, significantly higher parasitism rates were found in maize compared to meadows and flower strips, and also compared to hedgerows (in sleeve cages). 3 To elucidate potential factors underlying the low searching efficiency in nontarget habitats, the behaviour of individual T. brassicae females was investigated on four meadow plants comparatively to maize and a filter paper control. Mean (±SE) walking speed on maize was 2.2 ± 0.2 mm/s, similar to three of the plants tested and filter paper but significantly higher than on Trifolium pratense (0.85 mm/s). A higher turning rate was found on T. pratense, Viola wittrockiana and Plantago lanceolata, in contrast to the longer leaved maize and Alopecurus pratensis. The number of wasps leaving the plant within the observation period differed significantly between plant species, and was twice as high for T. pratense (and the filter paper control) compared to the other plant species. 4 In a choice experiment carried out in a climate cabinet with all five host plant species in cages, we obtained the highest parasitism rates on maize and the lowest parasitism on T. pratense, thus confirming the behavioural observations. 5 In conclusion, there is evidence for a decreased searching efficiency on plants in nontarget habitats compared to maize. However, the data explain only part of the differences found between parasitism in maize compared to nontarget habitats. Other factors, such as the structural complexity of a habitat, may also play a role. We conclude that the risk for butterfly populations in the tested nontarget habitat due to mass released T. brassicae is low.     

Birth Weight and Its Relationship to Size Attained and Relative Fat Distribution at 7 to 12 Years of Age

The relationship between birth weight and relative subcutaneous fat distribution at school age was considered in 131 boys and 106 girls 7 to 12 years of age. Relative fat distribution at school age was estimated with the ratio of the subscapular to triceps skinfolds (S/T) for the total sample, and with the ratio of the sum of two trunk (subscapular, midaxillary) to the sum of two extremity (triceps, medial calf) skinfolds (T/E) for subsamples of 102 boys and 63 girls. There were no sex differences in the S/T ratio (mm/mm), boys 0.62 ± 0.15, girls 0.63 ± 0.18; T/E ratio (mm/mm), boys 0.58 ± 0.13, girls 0.59 ± 0.16; and BMI (kg/m²), boys 17.1 ± 2.4, girls 16.9 ± 2.2. Second order partial correlations, controlling for age and the BMI or age and sum of skinfolds, between birth weight and the skinfold ratios are, respectively, ?0.22 and ?0.20 (p<0.01) for S/T and ?0.29 and ?032 (p<0.01) for T/E in girls, and ?0.18 and ?0.17 (p<0.05) for S/T and ?0.06 and ?0.6 for T/E in boys. Though low, the correlations suggest that as birth weight decreases proportionally more subcutaneous fat is accumulated on the trunk than on the extremities, more so in females than in males. Results of stepwise multiple regression analyses indicate that birth weight accounts for from 2% to 8% of the variance in relative subcutaneous fat distribution at school age.     

Nutrition and Physical Activity Program to Attenuate Obesity and Promote Physical and Metabolic Fitness in Elementary School Children

Obesity and low levels of physical and metabolic fitness are risk factors for cardiovascular disease and diabetes. The purpose of this investigation was to attenuate obesity and improve physical and metabolic fitness in elementary school children. Schools have the opportunity, mechanisms, and personnel in place to deliver nutrition education, fitness activities, and a school food service that is nutritious and healthy. Cohorts from grades 3 to 5 in two school districts in rural Nebraska (Intervention/Control) participated in a 2-year study of physical activity and modified school lunch program. Data collection for aerobic capacity, body composition, blood chemistry, nutrition knowledge, energy intake, and physical activity was at the beginning and end of each year. Int received enhanced physical activity, grade specific nutrition education, and a lower fat and sodium school lunch program. Con continued with a regular school lunch and team sports activity program. At year 2, Int lunches had significantly less energy (9%), fat (25%), sodium (21%), and more fiber (17%). However, measures of 24-hour energy intake for Int and Con showed significant differences for sodium only. Physical activity in the classroom was 6% greater for Int compared to Con (p < 0.05) but physical activity outside of school was ?16 % less for Int compared to Con (p < 0.05). Body weight and body fat were not different between schools for normal weight or obese children. No differences were found for cholesterol, insulin, and glucose; however, HDL cholesterol was significantly greater and cholesterol/HDL was significantly less for Int compared to Con (p < 0.05). It appears that compensation in both energy intake and physical activity outside of school may be responsible for the lack of differences between Int and Con.     

Environmental risk assessment of releases of transgenic plants containing virus-derived inserts

Sequences derived from the genomes of plant viruses are being used to provide virus resistance in transgenic crop plants. Although the environmental hazards associated with the release of such plants have been discussed widely, it has not been possible to reach generally acceptable conclusions about their safety. A case-by-case approach to the risk assessment of real examples is recommended as a means of building up confidence and of indicating areas of uncertainty. A logical framework for risk assessment is suggested, a key feature of which is identification of the viruses in the release environment that may infect the transgenic plants. Each of these is considered in relation to each of the three main classes of hazard (transcapsidation, recombination and synergism), and the risk associated with each event is analysed.     

Natural Occurrence ofChondrostereum purpureumin Relation to Its Use as a Biological Control Agent in Canadian Forests

The incidence of natural fructification ofChondrostereum purpureumwas estimated quantitatively on southern Vancouver Island during two winter seasons in randomly located 1000-m²plots and compared with potential added fructification that might occur as a result of using the fungus to control stump-sprouting of hardwood weeds in young forest stands. Fructification was surveyed in forests as well as in urban or agricultural areas by estimating the surface areas of woody substrates covered with basidiocarps. In addition to random plots, estimates were made also in locations where the fungus would be expected to occur (woodpiles, silvicultural thinnings, and killed trees). Basidiocarps were found throughout the area in various types of forest cover as well as in urban or agricultural situations. The amount of added fructification through the use of the fungus as a biological control agent was determined from inoculated plots as well as from calculated stump-surface areas developed from published stand-density data. Added fructification was multiplied by a factor representing the maximum biological control frequency in order to compare added fructification with natural fructification values. From the various calculations, it was determined that the added fructification ofC. purpureumis of the same order of magnitude as naturally occurring levels or even lower. In addition, there is a distinct geographical separation between predominantly forestry and predominantly settled areas where fruit and ornamental trees are cultivated. Accordingly, it was concluded that using the fungus as a biological control agent in forestry is not likely to pose a significant threat to fruit growing and commercial forests.     

Human Interindividual Variability in Cancer Risks—Technical and Management Challenges

Existing risk assessment procedures for carcinogens are intended to be “conservative” in the uncertainty dimension—giving estimates that are expected to be higher than true risks for typical people. However, these procedures do not consider the likely variability in susceptibility among individual people. This paper updates previous estimates of the likely extent of this variability for metabolically activated, genetically-acting carcinogens based on recent information on human interindividual variability in metabolic activation, detoxification, and DNA repair. The resulting expected skewness of cancer risk distributions is estimated using Monte Carlo simulations of both variability and uncertainty.

Some risk management implications are:

1. When evaluating the fairness of a particular risk distribution, managers need to gain familiarity with a three-dimensional characterization—X level of risk, for the Yth percentile individual (addressing variability) with Z degree of confidence (addressing uncertainty).

2. To the extent that variability distributions are skewed (e.g., with a long tail extending to high values) population mean risks will tend to exceed risks for median individuals. Together with the skewness in uncertainty distributions, this implies that “expected value” estimates of aggregate population risks—the estimates of interest for cost benefit analyses—are likely to be closer to traditional upper confidence limit risk estimates than has often been assumed in the past.

Defining risk: Normative considerations

The public thinks about (i.e., defines) environmental human health risks in different terms than the “experts.”; And because the manner in which we conceive of risk goes a long way in determining how risk management is conceived and carried out, any definition of risk has important normative elements. I argue that environmental policy based on the public's conception of risk fails to adequately protect fundamental human rights to health and liberty, by taking undue account of certain psychological factors that enter into the public's perception of risk. A survey of some of these factors is offered in an attempt to determine their policy relevance. The traditional scientific conception of risk, although not adequate to entirely define risk policy, serves as an important anchor for the protection of these rights by focusing on the probability or number of adverse health effects.