Assessing Maternal Satisfaction: Patient-Centered Care, Hospital Environment, and Information-Seeking in Chanika Hospital in Tanzania.

This study examined the impact of patient-centered care, satisfaction with the hospital environment, and maternal information-seeking on maternal healthcare satisfaction in Tanzania. A total of 707 mothers who delivered at Chanika Hospital in Tanzania were surveyed using a structured questionnaire. Multiple regression analyses were conducted to identify factors related to maternal satisfaction. Only 9.9% of the participants reported that they "usually" or "always" felt involved in treatment decisions. High levels of satisfaction were found for hospital cleanliness (93.6%) and safety (94.9%). However, there was a significant gap in satisfaction regarding the adequacy of water quality for medical services, with only 8.1% expressing satisfaction. Limited use of digital platforms was observed in terms of information-seeking behavior for fetal development, with only 19.5% of the participants using the internet and 14.3% using mobile apps. Patient-centered experiences with healthcare providers, especially midwives, had a significant positive impact on maternal satisfaction (ß = 0.11, p = 0.021). Other significant variables were satisfaction with the hospital environment (ß = 0.25, p < 0.001) and satisfaction with hospital water (ß = 0.13, p < 0.001). It is recommended that healthcare improvements focus on patient-centered experiences and water quality for drinking and medical services to improve patient satisfaction.

Living arrangements and metabolic syndrome: a national cross-sectional study in the Republic of Korea.

BACKGROUND: This study investigated the relationship between living arrangements and metabolic syndrome (MetS) risk in the adult population in the Republic of Korea. METHODS: The samples were derived from the data collected during the second year of the seventh Korea National Health and Nutrition Examination Survey. The study targeted a total of 6,265 adults who were aged 20 years and above, and multiple logistic regression analysis was conducted. Living arrangements were classified into 4 categories: single-person households, 1-generation households, 2-generation households, and other family types. MetS was identified by the presence of at least 3 out of the 5 National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: For men, the odds ratio (ORs) for MetS in 1- and 2-generation households, compared to single-person households, were 0.92 (95% confidence interval [CI], 0.55-1.54) and 0.97 (95% CI, 0.58-1.62), respectively. The OR for other types of households was 0.96 (95% CI, 0.79-1.17). For women, the OR for MetS in 1- and 2-generation households, compared to single-person households, were 1.52 (95% CI, 1.15-2.01) and 1.29 (95% CI, 1.01-1.67), respectively. CONCLUSION: Our study suggests that a national strategy involving tailored interventions for women living in high-risk conditions is necessary to reduce the risk of MetS in Korean women.

Trends in Human Immunodeficiency Virus-Related Knowledge and Stigma among Men Who Have Sex with Men in the Republic of Korea from 2012 to 2022.

To evaluate the trends in human immunodeficiency virus (HIV)-related knowledge and stigma among men who have sex with men (MSM) in the Republic of Korea between 2012 and 2022, five cross-sectional surveys were conducted. Though general knowledge of HIV infections is high, some misconceptions persist. The initial set of five questions in the survey maintained consistent levels of understanding throughout the five recurring surveys. Notably, the study found a consistent decrease in personal stigma toward people with HIV/AIDS (PWHA) within the MSM community in Korea. The increasing willingness of individuals to engage in social interaction with HIV-positive individuals, ranging from dining to cohabitation, indicated a positive change in societal attitudes. It is crucial to implement active policies such as counseling, testing, education, promotion, and the creation of preventive programs to improve knowledge about HIV and reduce stigma.

Development and Validation of a Questionnaire for Assessing Drug Use Motives in the General Population in South Korea.

Drug use is increasing in South Korea, necessitating evidence-based policy interventions. However, there is a dearth of reliable tools for identifying the personal and psychological factors that drive drug use among Korean adults. In this study, we developed and validated an instrument based on a motivational model to measure drug use motivation in the Korean context. A survey was administered online to 250 Korean adults aged 19-59. Of the initial 37 potential items evaluated, 23 were retained after exploratory factor analysis. Based on their relevance and factor loadings, the final scale consisted of 15 items distributed across five distinct factors: enhancement, coping, social, positive expectancy, and negative expectancy. Confirmatory factor analysis validated the strong fit of the five-factor model. Criterion-related validity was demonstrated by the significant correlations between the five factors and the selected criterion variables. This instrument can be used in research initiatives related to drug addiction and can provide basic data for policy interventions intended to curb drug addiction problems in South Korea. The novelty and broad applicability of this instrument make it invaluable for exploring the psychological underpinnings of drug use in South Korea.

The Association of Gender Role Attitudes and Risky Drinking: Changes in the Relationship between Masculinity and Drinking in Korean Young Men.

Recently, younger men in Korean society tend not to view drinking as a proud feature of men who work. The relationship between gender role attitudes and high-risk drinking is expected to change accordingly. An online survey was conducted in January-February 2022, and the frequency of drinking, the amount of drinking, and traditional gender role attitudes, such as "men should be independent and women should take care of the children", were measured. Participants were 786 men aged between 19 and 69 years. When comparing men in their 20s and 30s with those in their 40s to 60s, the younger men reported drinking relatively high amounts of alcohol in one place, and older men had a relatively high frequency of drinking. High-risk drinking was significantly higher in the older group. Gender role attitudes were more traditional in the older group and were a predictor of high-risk drinking in older men, but there was no significant relationship between the two variables in the younger age group. The results indicate that different generations have different perceptions of how men should drink. In addition to more detailed qualitative research on drinking motivation by generation, research on whether similar changes are occurring in other countries is needed.

Do Drinking Norms, Motives, and Drinking Behaviors Differ by Age Group among Korean Women?

Background: Drinking norms and motives accumulate with drinking experience; thus, it is likely that related drinking behaviors will differ with age. This study aimed to predict drinking behaviors by age based on drinking norms and motives in a sample of Korean women. Methods: This exploratory study used a nationwide demographically stratified sample including 1057 women aged 19−59 years. Self-report questionnaires assessed participants' general drinking frequency and quantity, two drinking norms, and five dimensional motives. The data were analyzed using Spss 26. Results: Descriptive and injunctive norms were the predictors that accounted for the greatest variance in drinking frequency, quantity, binge drinking, and high-risk drinking across all age groups (p < 0.001). Descriptive norms predicted all drinking behavior better than injunctive norms and all five motives for all age groups. The effects of each of the five motives differed with age. The enhancement motive was the strongest predictor of the motives for drinking frequency, binge drinking, and high-risk drinking across all age groups. Social and conformity motives predicted only binge drinking. Conclusions: These results suggest that descriptive norms, injunctive norms, and enhancement motives predict drinking behaviors across all age groups, although the relative predictive strength of those variables differed by age.

Predictors Affecting the Elderly's Use of Emergency Medical Services.

OBJECTIVES: Elderly adults are the demographic most likely to utilize emergency medical services (EMS). This study aimed to examine the difference in EMS utilization in subgroups of the elderly population by assessing the predictors for using EMS. METHODS: Using both descriptive and logistic regression analyses, this study analyses data from the 2014 Korean Health Panel Survey (n = 3,175). RESULTS: It was observed that certain predisposing factors such as age, sex, and marital status were significant predictors of EMS utilization. However, differences in EMS need do not fully account for the original differences observed between subgroups of elderly Koreans. While health status and disability were important predictors of elderly Koreans using EMS, place of residence did not account for subgroup differences. Nonetheless, place of residence remained particularly important predictors of EMS utilization for the elderly. CONCLUSION: Emergency needs and resource availability are 2 main determinants for elderly Koreans using EMS. In addition, it was observed that the demographic subgroup profile of unmarried/divorced/separated/widowed men who were aged 75 and older was least likely to utilize EMS. Improving their resource availability to meet their EMS needs should be a top priority for national policy making to narrow elderly population subgroup differences.

Solitary and Social Drinking in South Korea: An Exploratory Study.

OBJECTIVES: This study aimed to identify differences in drinking norms, heavy drinking, and motives between types of drinkers (abstainers, solitary, and social drinkers) in a representative sample of Korean adults. METHODS: An online survey of people registered on the electoral roll were randomly invited to be part of the "National Korean Drinking Culture Study" conducted in 2018 (n = 3,015). Participants included 1,532 men and 1,469 women aged 19-60 years. Questions included the number of times they drank in the last month, what they drank, and the volume drank. The amount of pure alcohol consumed was calculated. Drinking norms, motives, and types were determined in the survey questions. RESULTS: Solitary drinkers were more likely to be divorced or separated, less educated, and marginally employed. Solitary drinking peaked in those in their 30s (18.5%) and social drinkers in their 50s (68.1%). Solitary drinkers drank more frequently compared with social drinkers (6.1 vs. 3.6 times per month, p < 0.001), and consumed a significantly larger quantity of alcohol (69.5 g vs. 46.8 g per week). Solitary drinkers were more accepting of drinking-related behaviors in diverse situations compared with social drinkers. The regression analysis revealed that personal drinking motives were the most important factor influencing the frequency and quantity of alcohol consumption in both solitary and social drinking. CONCLUSION: Solitary drinkers may be more vulnerable to alcohol abuse than social drinkers.

The Role of Social Media Content on Solitary Drinking Among Korean Adults.

This study aims to provide explanations for how exposure to social media content on solitary drinking influences the frequency and quantity of solitary drinking, and posting about solitary drinking on social networking sites (SNS). An online survey was conducted with 506 Korean adults who had consumed alcohol at least once while alone in the previous year. The study showed the following results: First, exposure to social media content related to solitary drinking was positively associated with both descriptive norms and negative alcohol expectancies, both of which increased solitary drinking and posting on SNS. Second, although social media content influenced injunctive norm perceptions, injunctive norms did not influence solitary drinking or posting on SNS. Findings suggest that correcting descriptive norms on solitary drinking may be an appropriate intervention for solitary alcohol users in Korea.

Behaviors and Culture of Drinking among Korean People.

BACKGROUND: The objective of this study was to identify behaviors and culture of drinking alcohol in Korean people. METHODS: Among a panel of subjected enrolled in existing domestic survey companies, adults aged 19 to 59 yr old who replied that their drinking frequency was more than once a month for the past one year were selected in 2017. Sample size and methods used for analysis were determined by considering demographically proportioned stratified sampling and monthly alcohol drinking rate. A total of 1,185 subjects (731 males and 454 females) responded to questionnaires. RESULTS: Most drinking behaviors were in the domain of leisure time. Drinking for two or more times a month and binge drinking were mainly concentrated in five occasions types: going out with friends (44.2%), going out with colleague (34.2%), drinking at home or friend's home with friends (32.9%), drinking at home alone (29.3%), and drinking with meals at home (27.5%). Regarding the ratio of experiences in drinking for subjects according to occupations, 'Directors/Managers' who participated in receptions of guests, either hosted by or invited thereto, had the highest percentage (64.2%), followed by 'Individual Proprietors' (56.4%). Differences between each type of occupation were found to be statistically significant (P< 0.001). CONCLUSION: The drinking culture in Korea was characterized by more social drinking than by drinking alone at home. The drinking behavior was often one-shot at a time rather than drinking a little sip. The practices of collective drinking should be improved to avoid secondary harmful effects.

Activation of the dopamine D1 receptor can extend long-term spatial memory persistence via PKA signaling in mice.

Many works have been performed to understand the mechanisms of the formation and persistence of memory. However, it is not fully understood whether the decay of long-term memory can be modulated by the activation of dopamine D1 receptor. A Barnes maze task was employed to measure long-term spatial memory. We observed that the spatial memory acquired through 3 trials per session for 4 days had begun to fade out by the 14th day and had completely disappeared by 21 days after the first probe test. The intraperitoneal administration of SKF 38393 (a dopamine D1 receptor agonist) for 7 days beginning on the 14th day after the first probe test prevented natural memory forgetting, and the intraperitoneal administration of SCH 23390 (a dopamine D1 receptor antagonist) prevented this memory persistence. In the Western blotting, the administration of SKF 38393 increased the phosphorylation levels of PKA, ERK1/2, CaMKII, and CREB in the hippocampus. In addition, such increased levels were decreased by the corresponding antagonist (SCH 23390). Moreover, the inhibition of PKA could completely reverse the preservation of spatial memory induced by dopamine D1 receptor activation. These results suggest that the activation of the dopamine D1 receptor plays a critical role in the persistence of long-term spatial memory through the PKA signaling pathway.

Knowledge and Practice on Malaria among Korean Soldiers in Nearby Demilitarized Zone in South Korea.

BACKGROUND: The aim of this study was to provide evidence for developing intervention and effective management for the prevention of malaria based on epidemiological analysis and assessment of Korean soldiers' knowledge on malaria and malaria preventive behavior. METHODS: The data were collected from 294 Korean soldiers nearby the demilitarized zone in Gyeonggi Province in 2016. Multiple regression analyses were applied for statistical analysis. RESULTS: The level of education (ß=.24, P<.001), educational experience on malaria (ß=.21, P<.001) and ranks like corporal (ß=.13, P<.05), and sergeant (ß=.13, P<.05) were observed to be associated with the level of knowledge of malaria (F=9.62, R2=.12, P<.001). Knowledge of malaria (ß=.25, P<.001) and malaria education experience (ß=.22, P<.001) were the factors that influenced malaria prevention behavior and practice (F=12.45, R2=.18, P<.001). CONCLUSION: The level of knowledge and education experience was associated with malaria prevention practice. Therefore, malaria education is very important for the soldiers in nearby DMZ for prevention of malaria. The findings provide implications for the development of intervention programs focusing on increasing the levels of knowledge and practices related to malaria.

How do Sexual Identity, and Coming Out Affect Stress, Depression, and Suicidal Ideation and Attempts Among Men Who Have Sex With Men in South Korea?

OBJECTIVES: This study investigated the status of sexual identity, perceived stigma, stress, depression, and suicidal ideation and attempts. It also examined how sexual identity and "coming out" affect stress, depression, and suicidal ideation and attempts. METHODS: Suicidal ideation, psychological health status, and health-related behaviors were assessed using the Internet to maximize the confidentiality of the participants, men who have sex with men (MSM). The data were collected from a total of 873 MSM aged between 19 years and 59 years in 2014. RESULTS: Only 20.9% of the MSM had come out (18.0% voluntarily and 2.9% by others). The prevalences of perceived stress and depression among MSM were 46.7% and 42.7%, respectively, compared with 20.1% and 7.4% among general men. Approximately 32% of the MSM reported any suicidal ideation, and 3.3% had attempted suicide in the past year. The likelihood of suicidal ideation was significantly associated with being age 30-39 years [odds ratio (OR) = 1.8], high school or less (OR = 1.6), having been outed (OR = 5.2), feeling stressed (OR = 1.8), and feeling depressed (OR = 12.4) after sociodemographic factors and other perceptions were controlled for. CONCLUSION: The present study provides evidence that MSM are at an elevated risk for suicidal ideation and attempts with high stress and depression. Some risk factors were specific to being gay or bisexual in a hostile environment.

Identifying Barriers to Human Immunodeficiency Virus Testing for Men Who Have Sex with Men in South Korea.

OBJECTIVES: The principal objective of this study was to identify the barriers to testing for men who have sex with men (MSM) in Korea, something that might prove useful in future studies of this nature. METHODS: This study was conducted at gay bars nationwide in Korea. After considering several offline locations (gay bars) where MSM candidates are commonly located, random recruitment was performed using time-location sampling. A total of 944 individuals participated in this survey. A total sample of 921 cases (23 cases were excluded) was used for analysis. A self-administered questionnaire measuring the individuals' demographics, human immunodeficiency virus (HIV)/AIDS knowledge, stigma, phobia, optimism bias, self-efficacy for condom use, and sexual practices was used. RESULTS: About 61.8% (N = 569) of respondents reported having been tested at least once in their lifetime, and 38.9% (N = 358) acknowledged being tested within the past 12 months. After adjusting for age, education, and number of partners in a logistic regression analysis, awareness of testing place [odds ratio (OR) = 4.04], exposure to HIV prevention campaign (1.54), fear (OR = 1.13), and discrimination toward people with HIV/AIDS (OR = 0.94) were the main factors associated with HIV testing. CONCLUSION: To accomplish widespread HIV testing for Korean MSM, the accessibility of testing centers and advertisement of voluntary counseling and testing to MSM are needed.

Cigarette smoke exposure during adolescence enhances sensitivity to the rewarding effects of nicotine in adulthood, even after a long period of abstinence.

Adolescence is a period of enhanced vulnerability to the motivational properties of tobacco/cigarette smoking. Several studies have suggested that smoking initiation during this period will more likely lead to long-lasting cigarette or nicotine addiction. In the present study, we investigated the influences of adolescent cigarette smoke or nicotine exposure on the rewarding effects of nicotine, particularly whether these influences persist even after a long period of abstinence. Towards this, adolescent and adult Sprague-Dawley rats were repeatedly exposed to cigarette smoke or nicotine, for 14 days, and then were subjected to a 1-month abstinence period. Thereafter, the rewarding effects of nicotine were evaluated through the conditioned place preference (CPP) and self-administration (SA) tests. Even after a 1-month abstinence period, rats pre-exposed to either nicotine or cigarette smoke demonstrated enhanced CPP for the higher dose (0.6 mg/kg) of nicotine. Notably, cigarette smoke-preexposed adolescent rats, now adults, showed CPP for both 0.2 and 0.6 mg/kg dose of nicotine. Moreover, only these rats (pre-exposed to cigarette smoke during adolescence) showed significant acquisition and maintenance of nicotine (0.03 mg/kg/infusion) SA. These results suggest that cigarette smoke exposure during adolescence enhances sensitivity to the rewarding effects of nicotine in adulthood, even after a long period of abstinence. This may be a factor in the high rates of nicotine addiction and dependence observed in smokers who started during adolescence. More importantly, our findings highlight the enduring consequences of adolescent-onset cigarette smoking and the need to protect this vulnerable population.

Epidemiological features and clinical manifestations of Lyme borreliosis in Korea during the period 2005-2012.

Lyme borreliosis is one of the most common tick-borne infections in the northern hemisphere. However, the epidemiological features and clinical manifestations of this disease in Korea are unknown. The present study is the first to investigate the characteristics of Lyme borreliosis in Korea. We traced suspected cases of Lyme borreliosis during the period 2005-2012. Of the 16 identified patients with the disease, 11 had acquired autochthonous infection within Korea, while 5 patients were infected outside Korea. The history of past exposure was investigated in 8 of the 11 patients with autochthonous infection; 5 of these 8 patients (62.5%) were suspected to have acquired the infection in the northeastern alpine region. Clinically, of 11 patients with autochthonous infection, 6 (54.5%) showed early skin manifestations, 4 (36.4%) showed neurological manifestations, and 1 (9.1%) showed acrodermatitis chronica atrophicans. In conclusion, Lyme borreliosis could be endemic in the northeastern alpine region of Korea, and neurological and early skin manifestations are likely to be the major clinical characteristics of autochthonous Lyme borreliosis in Korea.

Smoking and Alcohol Drinking Related to Experience of Harmful Shops among Korean Adolescents.

OBJECTIVES: This study was conducted in order to determine any correlation between experience of harmful shops and adolescent smoking and alcohol drinking in middle and high school students. METHODS: The survey was conducted using a self-administered questionnaire online via the homepage of the Ministry of Education student Health Information Center; 1888 and 1563 questionnaires were used for middle and high school students, respectively, for a total of 3451 questionnaires in the final analysis. The collected data were processed using SPSS version 21.0 and examined using frequency analysis and hierarchical linear regression. RESULTS: In this research, 8.3% of all participants were found to have experienced smoking and 17.0% alcohol drinking. Regarding the types of harmful shops, 81.8% said they had been to a gaming place; 21.2% to a lodging place; 16.0% to a sex and entertainment place; and 6.8% to a harmful sex industry location. Sociodemographic variables had a significant effect on adolescent smoking and alcohol drinking. Regarding environmental variables, a significant difference was observed for living with parents and school location. Among adolescent experience of harmful shops, both smoking and alcohol drinking showed a significant association with harmful sex industry locations. CONCLUSION: National government-level management and supervision on this issue will be necessary to prevent adolescent access to harmful shops, along with more studies exploring methods for implementation of policies with more systematic control of harmful shops.

Adolescent nicotine or cigarette smoke exposure changes subsequent response to nicotine conditioned place preference and self-administration.

Nicotine/cigarette addiction starts young. Indeed, most smokers started when they were adolescents. Adolescence has been implicated to be a critical period for nicotine/cigarette addiction, thus it is important to understand the consequences of such early exposure. In the present study, we sought to characterize the effects of adolescent nicotine or cigarette smoke pre-exposure on the subsequent addictive effects of nicotine. The rewarding and reinforcing effects of nicotine were evaluated in drug-naïve, nicotine pre-exposed, or cigarette smoke pre-exposed adolescent and adult rats, through the conditioned place preference (CPP) and the self-administration (SA) tests. In the CPP test, drug-naïve adolescent rats demonstrated CPP for the 0.2mg/kg dose of nicotine, while drug-naïve adult rats showed CPP for the relatively higher dose of 0.6mg/kg. Pre-exposed adolescent rats showed diminished response for the 0.2mg/kg, instead significant CPP was observed for the higher dose (0.6mg/kg) of nicotine. No significant change was observed in pre-exposed adult rats. Interestingly, cigarette smoke pre-exposed adolescent rats showed substantially higher nicotine CPP (0.6mg/kg) than to its nicotine-pre-exposed or adult counterpart. In the SA test, drug-naïve adolescent rats reliably produced stable nicotine (0.03mg/kg/infusion) self-administration, but drug-naïve adult rats did not. Surprisingly, however, nicotine or cigarette smoke pre-exposed adolescent and adult rats showed decreased nicotine self-administration. These results conform with the growing notion that adolescents are more sensitive to the addictive effects of nicotine and that nicotine or cigarette smoke exposure during this period produces complex behavioral changes which may influence subsequent response to nicotine.

Propofol pretreatment induced place preference and self-administration of the tiletamine-zolazepam combination: implication on drug of abuse substitution.

BACKGROUND: Propofol and the tiletamine-zolazepam combination are anesthetics with both sedative-hypnotic and hallucinogenic effects. In South Korea, propofol is controlled while the tiletamine-zolazepam combination is not. Thus, there is a possibility that this drug combination might be used as a substitute drug by propofol-abusers. OBJECTIVE: In the present study we evaluated whether repeated pre-exposure to propofol predisposes to the use/abuse of the tiletamine-zolazepam combination. METHODS: Rats (8-10 animals/group) were pre-treated with saline (control) or propofol at different dosages (10, 30, 60 mg/kg, i.p.), for 14 days, then conditioned place preference (CPP) and self-administration (SA) for the tiletamine-zolazepam combination were evaluated. RESULTS: Rats pretreated with saline exhibited neither CPP nor SA for the tiletamine-zolazepam combination. On the other hand, rats pretreated with propofol, in all dosages, demonstrated significant CPP and SA for the tiletamine-zolazepam combination. CONCLUSION: These results suggest that tiletamine-zolazepam combinations might be used as a "substitute drug" by abusers of propofol. The careful use, dispensation, and monitoring of tiletamine-zolazepam combinations are advocated.

Prefrontal cortical and striatal transcriptional responses to the reinforcing effect of repeated methylphenidate treatment in the spontaneously hypertensive rat, animal model of attention-deficit/hyperactivity disorder (ADHD).

BACKGROUND: Methylphenidate is the most commonly used stimulant drug for the treatment of attention-deficit/hyperactivity disorder (ADHD). Research has found that methylphenidate is a "reinforcer" and that individuals with ADHD also abuse this medication. Nevertheless, the molecular consequences of long-term recreational methylphenidate use or abuse in individuals with ADHD are not yet fully known. METHODS: Spontaneously hypertensive rats (SHR), the most validated and widely used ADHD animal model, were pretreated with methylphenidate (5 mg/kg, i.p.) during their adolescence (post-natal day [PND] 42-48) and tested for subsequent methylphenidate-induced conditioned place preference (CPP) and self-administration. Thereafter, the differentially expressed genes in the prefrontal cortex (PFC) and striatum of representative methylphenidate-treated SHRs, which showed CPP to and self-administration of methylphenidate, were analyzed. RESULTS: Genome-wide transcriptome profiling analyses revealed 30 differentially expressed genes in the PFC, which include transcripts involved in apoptosis (e.g. S100a9, Angptl4, Nfkbia), transcription (Cebpb, Per3), and neuronal plasticity (Homer1, Jam2, Asap1). In contrast, 306 genes were differentially expressed in the striatum and among them, 252 were downregulated. The main functional categories overrepresented among the downregulated genes include those involved in cell adhesion (e.g. Pcdh10, Ctbbd1, Itgb6), positive regulation of apoptosis (Perp, Taf1, Api5), (Notch3, Nsbp1, Sik1), mitochondrion organization (Prps18c, Letm1, Uqcrc2), and ubiquitin-mediated proteolysis (Nedd4, Usp27x, Ube2d2). CONCLUSION: Together, these changes indicate methylphenidate-induced neurotoxicity, altered synaptic and neuronal plasticity, energy metabolism and ubiquitin-dependent protein degradation in the brains of methylphenidate-treated SHRs, which showed methylphenidate CPP and self-administration. In addition, these findings may also reflect cognitive impairment associated with chronic methylphenidate use as demonstrated in preclinical studies. Future studies are warranted to determine the clinical significance of the present findings with regard to long-term recreational methylphenidate use or abuse in individuals with ADHD.