Children talk about living with problem drug and alcohol use.

‘She knew not to go near me in the morning ’til I had my foil, then ‘mummy would play’. In the mornings the sickness was the worst … I’d just be telling her to get away. Once I had the gear [drugs] into me I’d be the best mother on the earth.’ These words were spoken by a mother of a four-year-old girl interviewed as part of a research study in Ireland published last year. It is quoted in a new EMCDDA thematic paper on European children’s experiences and perceptions of drug and alcohol issues, published to mark International Children’s Day on 1 June.1 The purpose of the paper is to enhance drug policies and interventions for children and young people by highlighting children’s and young people’s perspectives and their needs. Comprising quotations selected from research studies and governmental and non-governmental reports in 14 EU countries, including Ireland, the thematic paper gives voice to four main issues: o living with harmful parental drinking or drug taking (neglect, violence, abuse, stigma or shame), o being separated from parents and looked after by relatives, foster carers or institutions, o experiences and perceptions of alcohol and drug consumption, and o experiences and perceptions of interventions to address alcohol and drug consumption. The authors consulted three Irish sources2 and used quotations from them to highlight issues associated with living with parents engaging in harmful substance use, and children’s and young people’s own experience of substance use. For example, an Irish child care worker is quoted on the effect of living with a parent engaging in harmful substance use: ‘They become adults very young; they’re like the carer to their parent. They actually know, you can see it in them, that they know when their parent isn’t well … it seems to be a constant worry.’ Looking back, a young Irish woman who had been abused by a member of her extended family during her childhood recalled her teenage years: ‘I turned 15 that January, I just went wild then you know after that like. I did have problems at home … Like when I was growing up, that would have been the start of it, but then I just used to go wild you know with the problems and the issues that I did have, I’d end up going drinking and taking drugs, you know, and not having any, no self-respect or anything for myself.’ In concluding the report, the authors make several observations: o given the complexity and diversity of children’s experiences, correspondingly flexible and holistic interventions need to be developed; o more qualitative drug and alcohol research is needed if Europe is to understand the real needs of children and young people and to implement fully the United Nations Convention on the Rights of the Child (UNCRC); o large numbers of parents with alcohol problems may generate more problems overall for children in the EU than the smaller number of children affected by parents with illicit drug problems; o the quotations highlight children’s extreme vulnerability, and yet also their desire and capacity to ‘cope’ with difficulties and to make rational judgements about their own situation based on objective information and personal experience; o while quality care and other drug and alcohol interventions are needed to grant children in the EU their right to ‘harmonious development and protection from harmful influences’, abuse, neglect and exploitation, the root cause for many children facing both drug and alcohol problems are poverty and social exclusion. 1. Olszewski D, Burkhart G and Bo A (2010) Children’s voices: experiences and perceptions of European children on drug and alcohol issues. Thematic paper. Luxembourg: The Publications Office of the European Union. Available at www.emcdda.europa.eu 2. The three Irish research studies used in the EMCDDA thematic paper were Bates T, Illback RJ, Scanlan F and Carroll L (2009) Somewhere to turn to, someone to talk to. Dublin: Headstrong – The National Centre for Youth Mental Health; Mayock P (2000) Choosers or losers: influences on young people’s choices about drugs in inner-city Dublin. Dublin: Children’s Research Centre, TCD; Mayock P and Carr N (2008) Not just homelessness … A study of ‘out of home’ young people in Cork city. Dublin: Children’s Research Centre, TCD. These three research reports are available at www.drugsandalcohol.i

Mapping multimorbidity in individuals with schizophrenia and bipolar disorders: evidence from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register

OBJECTIVES: The first aim of this study was to design and develop a valid and replicable strategy to extract physical health conditions from clinical notes which are common in mental health services. Then, we examined the prevalence of these conditions in individuals with severe mental illness (SMI) and compared their individual and combined prevalence in individuals with bipolar (BD) and schizophrenia spectrum disorders (SSD). DESIGN: Observational study. SETTING: Secondary mental healthcare services from South London PARTICIPANTS: Our maximal sample comprised 17 500 individuals aged 15 years or older who had received a primary or secondary SMI diagnosis (International Classification of Diseases, 10th edition, F20-31) between 2007 and 2018. MEASURES: We designed and implemented a data extraction strategy for 21 common physical comorbidities using a natural language processing pipeline, MedCAT. Associations were investigated with sex, age at SMI diagnosis, ethnicity and social deprivation for the whole cohort and the BD and SSD subgroups. Linear regression models were used to examine associations with disability measured by the Health of Nations Outcome Scale. RESULTS: Physical health data were extracted, achieving precision rates (F1) above 0.90 for all conditions. The 10 most prevalent conditions were diabetes, hypertension, asthma, arthritis, epilepsy, cerebrovascular accident, eczema, migraine, ischaemic heart disease and chronic obstructive pulmonary disease. The most prevalent combination in this population included diabetes, hypertension and asthma, regardless of their SMI diagnoses. CONCLUSIONS: Our data extraction strategy was found to be adequate to extract physical health data from clinical notes, which is essential for future multimorbidity research using text records. We found that around 40% of our cohort had multimorbidity from which 20% had complex multimorbidity (two or more physical conditions besides SMI). Sex, age, ethnicity and social deprivation were found to be key to understand their heterogeneity and their differential contribution to disability levels in this population. These outputs have direct implications for researchers and clinicians

Cutaneous Symptoms and Rashes in Patients with HIV-Positive Infections (A review article)

Identifying the cutaneous symptom associated with HIV positive disease and investigating the kind of rashes can be helpful in early diagnosis of the disease. The extensity of skin disorders in HIV infection is widespread. Examination of the skin of these patients can be a good indicator of the status of the immune system as well as the patient's psychological status and also in early diagnosis can make a worthy help. We carried out a literature search (From 1990 to 2016) related to this issue through Google Scholar, Pub-MED, Scopus, Science Direct, and Iran DOC, by using keywords cutaneous symptoms, HIVpositive, skin infection, warts, early diagnosis. Among 124 articles only 51 papers were related to skin infections. Review of the associated research, investigation the skin infections in HIV patients and early diagnosis made a great help in the treatment process, particularly in people with high-risk behaviors which leads to diagnosis the HIV in the early stages. The results of this study suggest the importance of cutaneous symptom in patients with HIV infection and early diagnosis to start the medical procedures

Safety of tattoos and permanent make-up. Adverse health effects and experience with the Council of Europe Resolution (2008)1.

In the last decades, the proportion of the tattooed population has been increasing all over the world, particularly in the young generations. Concerns about the possible health problems associated to tattoos and permanent make up (PMU) have also grown together with the number of tattoo/PMU applications and removals. The Council of Europe Resolution (CoE ResAP)(2008)1 [1], on requirements and criteria for the safety of tattoos and permanent make-up, is a non-binding internationally recognised benchmark that was taken as a reference for the development of national legislation adopted in a number of European countries. The European Commission launched the 18-month project "Tattoos - Permanent Makeup" with the aim of collecting data about the use, the ingredients, the European Union (EU) market and the possible health problems associated to tattoo and permanent make-up inks. This project is divided into 4 Work Packages: 1) preparatory work; 2) state of play; 3) assessment and update of the CoE ResAP(2008)1; 4) conclusions. The reports on Work Packages 1 and 2 [2, 3] are available at http://bookshop.europa.eu/. The present report is the outcome of Work Package 3 which aims to gather data about adverse health effects and complications linked to tattoo/PMU application and/or removal, risk perception and communication, data gaps and research needs, as well as to evaluate the lessons learned from the experience in implementing the recommendations of the CoE ResAP(2008)1. The information was collected through the following sources. (1) Two questionnaires were developed: one addressed to dermatologists on adverse health effects and the other one to national authorities on complications, experience with the CoE ResAP(2008)1, risk perception and communication, data gaps and research needs. They were sent to all EU Member States and European Free Trade Association (EFTA) countries and to 36 dermatologist associations in Europe with the request to circulate among their members. 14 Member States and 19 dermatologists filled-in the questionnaires. (2) A systematic review of the literature from 2003 on was carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta- Analysis) methodology. (3) The outcome of the meetings of the Consumer Safety Network Subgroup Tattoos and Permanent Make-up was taken into account. The main findings show that: It is not possible to conclude on an exact incidence of adverse health effects following tattoo/PMU applications. The majority of tattoo/PMU recipients report minor short-term discomfort and complaints during the wound healing process following the tattoo application. This could be confused with other more serious complications and makes the accurate calculation difficult. Short term complications, such as skin infections, may appear some days after the tattoo placing, or within weeks, for allergic reactions. In the long run chronic inflammatory dermatoses may develop, sometimes after decades. The precise frequency of microbiological (mainly bacterial, more rarely viral) contamination through inks, tools or procedures used in the tattoo application remains unknown, though it has been generally estimated at up to 5% of the tattoo-recipients in the case of bacterial infections. The vast majority of tattoo/PMU adverse reactions are due to delayed and unpredictable hypersensitivity, involving allergy and/or autoimmunity. Direct causal relationship between tattooing and (skin) cancer has been so far neither proved nor excluded. However, tattoos may blur and hence delay a melanoma diagnosis. They can also interfere with diagnosis imaging, and should be avoided in patients with prior cardiac, blood or autoimmune pathologies, inter alia. Similarly, also the process of tattoo removal is associated with side effects. The modern removal techniques, based on the use of Q-switched lasers, have improved the safety, efficiency and selectivity of the removal procedure, still side effects might occur, especially when incorrect parameters are applied to the laser device. The frequency of skin pigmentation disorders following laser therapy have been encountered in 5-15% of patients. Henna based preparations are not permanently injected in the skin and therefore they cannot be considered as tattoos. However, as the use of henna for temporary body decoration has become also widespread it has been included in this report for completeness. Henna has been used for centuries for body painting and it is generally well tolerated. When p-phenylendiamine (PPD) is added to make the painting darker, side effects due to sensitisation to PPD have been reported in the literature. The majority of the national authorities who replied to the questionnaire indicate that, in order to improve the safety of tattoo/PMU inks and practices, it would be necessary to update the list of recommendations in the CoE ResAP(2008)1. In particular, suggestions were put forward to include additional substances to the negative lists and to modify and/or introduce new limits. Other suggestions were to add new labelling requirements, such as the period of maximum durability after opening, to envisage the compilation of a register of complaints and to include information on the ink and tool sterilisation methods. Furthermore, several Member States pointed out the need to establish Good Manufacturing Practices for tattoo/PMU inks, to control products sold on-line, to establish compulsory training for tattooists, to enhance the collaboration among manufacturers and authorities and to ban backyard tattooing. Risk communication has been addressed by means of information campaigns targeted to various audiences and using a variety of means in nine Member States, out of the twelve who filled-in this section of the questionnaire. Beside this, national authorities generally agreed on the need to organise further actions to reach tattooists and potential clients, particularly adolescents, to give them the correct instruments to be able to take an informed decision. Actually risk perception is based on the information given by the tattooist (e.g. via an informed consent form), or received through parents or friends, or read in mass media and internet. In addition, some studies estimated the level of knowledge of possible health risks among students, either school or university ones. In general, infectious risks were better known that non-infectious ones, even though the level of knowledge was in many cases only superficial and, for example, not specifically linked to the transmittable agents of possible infections or to the various possible noninfectious risks. These evidences support the need of further additional information campaigns. Data gaps and research needs were identified, such as development of guidelines for risk assessment of tattoo/PMU products, harmonised analytical methods, data on normal usage of and exposure to tattoo inks, including their characteristics (physical-chemical properties, chemical composition, ingredients' purity and concentration). In order to carry out a risk assessment of tattoo/PMU inks, data are missing on absorption, distribution, metabolism and excretion (ADME) of ingredients, including migration in the body of pigments and their (photo)-degradation products, DNEL (Derived No Effect Level), as well as chemical and toxicological properties of ingredients. Moreover, several authors considered that, although costly, prospective cohort studies should be conducted to investigate the association between tattoos and (skin) carcinogenesis.JRC.E.7-Knowledge for Security and Migratio

Medical consequences of pathogenic CNVs in adults: Analysis of the UK Biobank

Background: Genomic CNVs increase the risk for early-onset neurodevelopmental disorders, but their impact on medical outcomes in later life is still poorly understood. The UK Biobank allows us to study the medical consequences of CNVs in middle and old age in half a million well-phenotyped adults. Methods: We analysed all Biobank participants for the presence of 54 CNVs associated with genomic disorders or clinical phenotypes, including their reciprocal deletions or duplications. After array quality control and exclusion of first-degree relatives, we compared 381 452 participants of white British or Irish origin who carried no CNVs with carriers of each of the 54 CNVs (ranging from 5 to 2843 persons). We used logistic regression analysis to estimate the risk of developing 58 common medical phenotypes (3132 comparisons). Results and conclusions: Many of the CNVs have profound effects on medical health and mortality, even in people who have largely escaped early neurodevelopmental outcomes. Forty-six CNV–phenotype associations were significant at a false discovery rate threshold of 0.1, all in the direction of increased risk. Known medical consequences of CNVs were confirmed, but most identified associations are novel. Deletions at 16p11.2 and 16p12.1 had the largest numbers of significantly associated phenotypes (seven each). Diabetes, hypertension, obesity and renal failure were affected by the highest numbers of CNVs. Our work should inform clinicians in planning and managing the medical care of CNV carriers

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury