The role of alcohol in deaths presenting to the Coroner’s Service in Cork city and county.

A retrospective study was conducted in order to determine the prevalence and concentration of alcohol in post-mortem blood samples sent for toxicological analysis in Cork City and County in 2003 and 2004. Post mortem reports of these deaths were reviewed for the presence or absence of alcohol at the time of autopsy, blood alcohol concentration (BAC) at time of death, age and sex of the decedents. Of samples sent for blood alcohol analysis (BAA), 38.4% were positive for alcohol. Significant differences were found between the proportions of alcohol positive cases by cause of death. Alcohol positive cases were significantly younger (44.3 ± 17.8 years) than alcohol negative cases (51.9 ± 19.4years) and fifty two percent of drivers were positive for alcohol at the time of death. Awareness of the harmful and potentially fatal effects of alcohol should continue to be raised within the community, so as to prevent future fatalities

Impact of childhood experience and adult well-being on eating preferences and behaviours

OBJECTIVES: To examine the relative contribution of childhood experience, measured by childhood violence and childhood happiness, and adult well-being on adult eating preferences and behaviours, independent of proximal factors such as current deprivation. DESIGN: A cross-sectional, stratified, randomised sample survey using retrospective measures of childhood violence and happiness and self-reported measures of current well-being. SETTING: The North West Region of England between September 2012 and March 2013. PARTICIPANTS: Individuals aged 18–95-year-olds from randomly selected households (participation was successful for 90% of eligible households and 78% of the total visited addresses; n=11 243). OUTCOMES: Dichotomised measures for preference of healthy foods or ‘feel good’ foods and low or high daily fruit and vegetable consumption. RESULTS: After correcting for demographics, combined categories for childhood experience and dichotomised measures of adult well-being were found to be significantly related to adult food preferences and eating behaviours. Participants with unhappy and violent childhoods compared to those with happy and non-violent childhoods had adjusted ORs (95% CI, significance) of 2.67 (2.15 to 3.06, p<0.001) of having low daily fruit and vegetable intake (two or less portions) and 1.53 (1.29 to 1.81, p<0.001) of choosing ‘feel good’ foods over foods which were good for their long term health. CONCLUSIONS: Daily intake of fruit and vegetables, linked to non-communicable diseases, and preference for ‘feel good’ foods, linked to obesity, are affected by childhood experience and adult well-being independent of demographic factors. Preventative interventions which support parent–child relationships and improve childhood experience are likely to reduce the development of poor dietary and other health-risk behaviours

Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England

Background: Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. Methods: A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and representations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent representation versus no re-presentation. Results: The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation. Conclusion: Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration

Party package travel: alcohol use and related problems in a holiday resort: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>People travelling abroad tend to increase their use of alcohol and other drugs. In the present study we describe organized party activities in connection with young tourists' drinking, and the differences between young people travelling with and without organized party activities.</p> <p>Methods</p> <p>We conducted ethnographic observations and a cross-sectional survey in Sunny Beach, Bulgaria.</p> <p>Results</p> <p>The behaviour of the guides from two travel agencies strongly promoted heavy drinking, but discouraged illicit drug use. Even after controlling for several potential confounders, young people who travelled with such "party package travel agencies" were more likely to drink 12 or more units when going out. In univariate analyses, they were also more likely to get into fights, but were not more likely to seek medical assistance or medical assistance for an accident or an alcohol-related problem. After controlling for confounders, the association between type of travel agency and getting into fights was no longer significant. Short-term consequences of drinking in the holiday resort did not differ between party package travellers and ordinary package travellers.</p> <p>Conclusion</p> <p>There may be a small impact of party package travels on young people's drinking. Strategies could be developed used to minimise the harm associated with both party package travel and other kinds of travel where heavy substance use is likely to occur.</p

Harms from other people's drinking: an international survey of their occurrence, impacts on feeling safe and legislation relating to their control.

OBJECTIVE: To examine factors associated with suffering harm from another person's alcohol consumption and explore how suffering such harms relate to feelings of safety in nightlife. DESIGN: Cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media. SUBJECTS: Individuals (participating November 2014-January 2015) aged 18-34 years, reporting alcohol consumption in the past 12 months and resident in a country providing ≥250 respondents (n=21 countries; 63 725 respondents). MAIN OUTCOME MEASURES: Harms suffered due to others' drinking in the past 12 months, feelings of safety on nights out (on the way out, in bars/pubs, in nightclubs and when travelling home) and knowledge of over-serving laws and their implementation. RESULTS: In the past 12 months, >40% of respondents suffered at least one aggressive (physical, verbal or sexual assault) harm and 59.5% any harm caused by someone drunk. Suffering each category of harm was higher in younger respondents and those with more harmful alcohol consumption patterns. Men were more likely than women to have suffered physical assault (9.2% vs 4.7; p<0.001), with women much more likely to suffer sexual assault or harassment (15.3% vs 2.5%; p<0.001). Women were more likely to feel unsafe in all nightlife settings, with 40.8% typically feeling unsafe on the way home. In all settings, feeling unsafe increased with experiencing more categories of aggressive harm by a drunk person. Only 25.7% of respondents resident in countries with restrictions on selling alcohol to drunks knew about such laws and 75.8% believed that drunks usually get served alcohol. CONCLUSIONS: Harms from others' drinking are a threat to people's health and well-being. Public health bodies must ensure that such harms are reflected in measures of the societal costs of alcohol, and must advocate for the enforcement of legislation designed to reduce such harms

New WHO Violence Prevention Information System, an interactive knowledge platform of scientific findings on violence.

Scientific information on violence can be difficult to compile and understand. It is scattered across websites, databases, technical reports and academic journals, and rarely addresses all types of violence. In response, in October 2017 WHO released the Violence Prevention Information System or Violence Info, an online interactive collection of scientific information about the prevalence, consequences, risk factors and preventability of all forms of interpersonal violence. It covers homicide, child maltreatment, youth violence, intimate partner violence, elder abuse and sexual violence

Effectiveness of interventions to increase hepatitis C testing uptake among high-risk groups: a systematic review

Background: People who inject drugs are at the greatest risk of acquiring hepatitis C virus infection in many high-income countries, including those in Europe. Our review examined the effectiveness of interventions aimed at increasing hepatitis C virus testing uptake. Methods: We undertook a systematic review of controlled studies. Searches of 13 databases were supplemented with citation searching, and manual searches of reference lists and websites. Studies of interventions that aimed to increase testing uptake among high-risk groups were included. Testing uptake was our primary outcome measure of interest and secondary outcomes were engagement in follow-up services and treatment. A narrative synthesis was undertaken. Results: Eight controlled studies were included. Three studies examined interventions in primary care; one examined dried blood spot testing as an alternative method of testing, and two examined outreach provision. Two further studies examined interventions to improve hepatitis C management. Targeted case finding in primary care, support and training for primary care practitioners, offering alternative testing and provision of outreach testing all increased uptake of testing; however, intervention effects were variable. Conclusions: Evidence from the available studies suggests that increases in testing uptake can be achieved. Careful attention needs to be paid to the resource implications associated with implementation of interventions in primary care settings and also of the potential for interventions to improve outcomes once a positive diagnosis has been made. Further research on the cost-effectiveness of the intervention approaches examined in this review is required

Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population

This report is one in a series of reports examining the prevalence of Adverse Childhood Experiences (ACEs) in the Welsh adult population and their impact on health and well-being across the life course. Substantial proportions of the Welsh population reported suffering abuse, neglect and other ACEs during their childhood with 47% reporting having experienced at least one ACE and 14% experiencing four or more ACEs. This report focuses on: alcohol use, drug use, violence, sexual behaviour, incarceration, smoking and poor diet

Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood.

BACKGROUND: Interpersonal violence is a leading cause of death and disability globally, has immediate and long-term impacts on individuals' health and wellbeing, and impacts global health care expenditures and national economies. A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global research has demonstrated that childhood adversity increases risk of a range of poor outcomes across the lifecourse. This study examined the association between being a victim of child abuse and the risk of physical assault (PA), intimate partner violence (IPV), and sexual violence (SV) victimisation in adulthood. METHODS: Data from a nationally representative survey of household residents (adults aged 16 to 59 years; n = 21,845) was analysed. Types of child abuse examined included physical, sexual, and psychological abuse and witnessing domestic violence. Logistic regressions examined the independent relationships between child abuse types, experiencing multiple types, and adulthood violence outcomes. RESULTS: Most individual types of child abuse were significantly associated with each adulthood violence outcome, after controlling for sociodemographics and other abuse types. Compared to individuals who experienced no abuse in childhood, those who experienced one form of abuse were over twice as likely to experience PA in the past year and three times as likely to have experienced IPV and/or SV since age 16 years, whilst individuals who experienced multiple types were three, six, and seven times more likely to experience PA, IPV, and SV, respectively. After controlling for sociodemographics and multi-type childhood victimisation, the type or combination of types which remained significant differed by violence outcome; child psychological and physical abuse were significantly associated with IPV; psychological and sexual abuse with SV; and psychological abuse with PA. CONCLUSIONS: Prevention of child abuse is an important goal, and evidence from the current study suggests such efforts will have a downstream effect on preventing interpersonal violence across the lifecourse. With adulthood victimisation likely to compound the already detrimental effects of childhood abuse, and given that many associated outcomes also represent adversities for the next generation, breaking the cycle of violence should be a public health priority