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      Sex differences in substance use, health, and social functioning among opioid users receiving methadone treatment: a multicenter cohort study

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          Abstract

          Background

          Despite the growing numbers of men and women with opioid use disorder in Canada, sex-specific issues in treatment have not been re-examined in the current population of patients with opioid addiction. We aimed to evaluate sex differences in substance use, health, and social functioning among men and women currently receiving methadone treatment for opioid use disorder in Ontario, Canada.

          Methods

          We recruited 503 participants with opioid dependence disorder receiving methadone maintenance treatment. We collected data on demographics, treatment characteristics, psychiatric history, addiction severity, and drug use patterns through urinalysis. We performed adjusted univariate analyses and logistic regression to identify distinct factors affecting men and women.

          Results

          Among our sample of 54 % ( n = 266) men and 46 % women ( n = 226) with mean age 38.3 years, less than half of participants were employed (35.6 %) and married (31.8 %) and had completed a high school education (27.9 %). Compared to men, women had frequent physical and psychological health problems, family history of psychiatric illness, and childcare responsibilities and began using opioids through a physician prescription. Men had higher rates of employment, cigarette smoking, and cannabis use compared to women.

          Conclusions

          Our results have revealed different patterns of substance use, health, and social functioning among men and women currently receiving methadone treatment for opioid addiction in Ontario, Canada. This information can be used to develop an integrative treatment regimen that caters to the individual needs of men and women, as well as to inform methadone treatment protocols to include specialized services (including vocational counseling, childcare and parenting assistance, medical assistance, relationship or domestic violence counseling, etc.) and increase their availability and accessibility on a larger scale.

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          Most cited references 55

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          The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.

          The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
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            The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

            Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies
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              A simulation study of the number of events per variable in logistic regression analysis.

              We performed a Monte Carlo study to evaluate the effect of the number of events per variable (EPV) analyzed in logistic regression analysis. The simulations were based on data from a cardiac trial of 673 patients in which 252 deaths occurred and seven variables were cogent predictors of mortality; the number of events per predictive variable was (252/7 =) 36 for the full sample. For the simulations, at values of EPV = 2, 5, 10, 15, 20, and 25, we randomly generated 500 samples of the 673 patients, chosen with replacement, according to a logistic model derived from the full sample. Simulation results for the regression coefficients for each variable in each group of 500 samples were compared for bias, precision, and significance testing against the results of the model fitted to the original sample. For EPV values of 10 or greater, no major problems occurred. For EPV values less than 10, however, the regression coefficients were biased in both positive and negative directions; the large sample variance estimates from the logistic model both overestimated and underestimated the sample variance of the regression coefficients; the 90% confidence limits about the estimated values did not have proper coverage; the Wald statistic was conservative under the null hypothesis; and paradoxical associations (significance in the wrong direction) were increased. Although other factors (such as the total number of events, or sample size) may influence the validity of the logistic model, our findings indicate that low EPV can lead to major problems.
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                Author and article information

                Contributors
                baworm@mcmaster.ca
                dennisbb@mcmaster.ca
                MVarenbut@canatc.ca
                jdaiter@toxpro.ca
                dmarsh@nosm.ca
                cplater@toxpro.ca
                worster@mcmaster.ca
                mst@mcmaster.ca
                anglinr@mcmaster.ca
                pareg@mcmaster.ca
                dipika.desai@phri.ca
                thabanl@mcmaster.ca
                905-522-1155 ext. 36372 , samaanz@mcmaster.ca
                Journal
                Biol Sex Differ
                Biol Sex Differ
                Biology of Sex Differences
                BioMed Central (London )
                2042-6410
                10 November 2015
                10 November 2015
                2015
                : 6
                Affiliations
                [ ]MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario Canada
                [ ]St. George’s, University of London, London, UK
                [ ]Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada
                [ ]Peter Boris Centre for Addiction Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
                [ ]Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
                [ ]Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
                [ ]Department of Medicine, McMaster University, Hamilton, Ontario Canada
                [ ]Northern Ontario School of Medicine, Laurentian Campus, Sudbury, Ontario Canada
                [ ]Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada
                [ ]Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
                [ ]Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario Canada
                [ ]Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, Ontario Canada
                [ ]Mood Disorders Program, St. Joseph’s Healthcare, 100 West 5th Street, Hamilton, Ontario L8N 3K7 Canada
                Article
                38
                10.1186/s13293-015-0038-6
                4640383
                © Bawor et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2015

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