Alcohol consumption, wealth and health

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Preventing opioid overdoses in Europe:a critical assessment of known risk factors and preventative measures

This report is the outcome of a project into opioid overdoses. The remit was to focus on finding practical methods of overdose prevention. In order to fulfil this remit, a critical review of existing knowledge on overdose prevention was conducted. The report adds value to existing information by developing a methodology to classify and analyse risk and protective factors stratified by those involved (drug users, observers and organisations). The report then assesses the extent to which risk and protective factors can be potentially modified at different levels, e.g. individual, treatment setting, organisational and strategic. The report therefore has the potential to be updated as new information emerges

Validating estimates of problematic drug use in England

<p>Abstract</p> <p>Background</p> <p>UK Government expenditure on combatting drug abuse is based on estimates of illicit drug users, yet the validity of these estimates is unknown. This study aims to assess the face validity of problematic drug use (PDU) and injecting drug use (IDU) estimates for all English Drug Action Teams (DATs) in 2001. The estimates were derived from a statistical model using the Multiple Indicator Method (MIM).</p> <p>Methods</p> <p>Questionnaire study, in which the 149 English Drug Action Teams were asked to evaluate the MIM estimates for their DAT.</p> <p>Results</p> <p>The response rate was 60% and there were no indications of selection bias. Of responding DATs, 64% thought the PDU estimates were about right or did not dispute them, while 27% had estimates that were too low and 9% were too high. The figures for the IDU estimates were 52% (about right), 44% (too low) and 3% (too high).</p> <p>Conclusion</p> <p>This is the first UK study to determine the validity estimates of problematic and injecting drug misuse. The results of this paper highlight the need to consider criterion and face validity when evaluating estimates of the number of drug users.</p

What can Jane Goodall teach us about addiction?

In 2017, Jane Goodall, the well-known primatologist, wrote a letter to the United States Food and Drug Administration criticising the use of animals to test brain-based theories of addiction. She reasoned that we already know about addiction by observing humans. Several scientists countered that research with humans cannot answer important questions about understanding, preventing, and treating addiction. This commentary draws on epidemiology, psychology, psychodynamic models, learning theories and existentialism. It highlights effective prevention and treatment approaches that are not based on brain models of addiction. Jane Goodall’s letter, has, perhaps unwittingly, provided a focal point for reconsidering what kind of research is required to further our understanding of addiction

Alternating Anaerobic and Aerobic Reactors in Series for Biological Nutrient Removal - Treatability Study for Durham County Triangle Wastewater Treatment Plant

The Durham County Triangle Wastewater Treatment Plant faces new wastewater effluent restrictions with the renewal of the plant's National Pollutant Discharge Elimination System (NPDES) permit. The North Carolina Department of Environment, Health and Natural Resources, Division of Environmental Management (NCDEM), that administers the enforcement of NPDES in North Carolina, imposed more stringent effluent requirements on five-day biochemical oxygen demand (BOD5), ammonia nitrogen (NH3-N), total phosphorus (TP), fecal coliform, residual chlorine and dissolved oxygen (DO). The new effluent TP restrictions, along with recent prohibition of wastewater sludge wasting into landfills in North Carolina and potential agricultural application of waste sludge, motivated Durham County to investigate additional nutrient removal alternatives. The Biological Nutrient Removal (BNR) approach, in contrast to chemical removal of phosphorus, demonstrates potential for lowering operation and maintenance costs and reducing sludge production. Also, BNR proves more suitable for land application of sludge because it does not employ potentially harmful chemicals. This report describes a laboratory investigation of the feasibility of physical, operational and hydraulic modifications to the extended aeration basins of the Triangle Wastewater Treatment Plant for enhanced biological phosphorus removal, nitrification and denitrification, combined with effective carbonaceous oxidation. The Durham County Engineering Office funded this project to investigate the feasibility of using BNR technology at the Durham County Triangle WWTP. The focus of the study is the conversion of the existing extended aeration tanks to alternating anaerobic and aerobic sections for the purpose of facilitating BNR.Master of Science in Environmental Engineerin

Generating Individual Patient Preferences for the Treatment of Osteoarthritis Using Adaptive Choice-Based Conjoint (ACBC) Analysis.

INTRODUCTION: To explore how adaptive choice-based conjoint (ACBC) analysis could contribute to shared decision-making in the treatment of individual patients with osteoarthritis (OA). METHODS: In-depth case study of three individuals randomly selected from patients with OA participating in an ACBC analysis exercise. Eleven members of a research users' group participated in developing an ACBC task on medication preferences for OA. Individual medication priorities are illustrated by the detailed analysis of ACBC output from three randomly selected patients from the main sample. RESULTS: The case study analysis illustrates individual preferences. Participant 1's priority was avoidance of the four high-risk side effects of medication, which accounted for 90% of the importance of all attributes, while the remaining attributes (expected benefit; way of taking medication; frequency; availability) accounted only for 10% of the total influence. Participant 3 was similar to participant 1 but would accept a high risk of one of the side effects if the medication were available by prescription. In contrast, participant 2's priority was the avoidance of Internet purchase of medication; this attribute (availability) accounted for 52% of the importance of all attributes. CONCLUSIONS: Individual patients have preferences that likely lead to different medication choices. ACBC has the potential as a tool for physicians to identify individual patient preferences as a practical basis for concordant prescribing for OA in clinical practice. Future research needs to establish whether accurate knowledge of individual patient preferences for treatment attributes and levels translates into concordant behavior in clinical practice

Experiential learning in public health: evaluation of a health promotion campaign assessment for pharmacy students

Description: Students in small groups designed, delivered and evaluated real-life health promotion campaigns in the local community. A peer assessed component was included from the fifth cohort onwards. Evaluation: Six successive cohorts of pharmacy students anonymously completed an evaluation questionnaire after finishing the assessment. Descriptive and inferential statistical analyses were undertaken on the data. The results showed that consistently more respondents reported the assessment as a positive experience than a negative experience. Significantly more respondents reported peer assessment as being useful and group members equally contributing to campaign planning in the cohorts with peer assessment compared to the pre-peer assessment cohorts, but peer assessment did not significantly affect enjoyment ratings. Respondents’ reported enjoyment of the assessment was significantly associated with agreement that it prepared them for health promotion in practice. Conclusions: Pharmacy students perceived the health promotion campaign assessment as appropriately challenging and enjoyable preparation for health promotion in practice

Central nervous system (CNS) medications and polypharmacy in later life : cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA)

OBJECTIVES: Many central nervous system (CNS) medications are considered potentially inappropriate for prescribing in older people; however, these medications are common in polypharmacy (≥5 medicines) regimens. This paper aims to determine the prevalence of CNS drug classes commonly taken by older people. Furthermore, this paper aims to determine whether polypharmacy and other factors, previously found to be associated with overall polypharmacy, are associated with the most common CNS drug classes. DESIGN: Cross-sectional study. SETTING: English Longitudinal Study of Ageing (wave 6). PARTICIPANTS: 7730 participants (≥50 years). MAIN OUTCOME MEASURES: Adjusted Odds Ratios (OR) and 95% confidence intervals (CI) for CNS drug classes. RESULTS: 31% of the sample were currently taking ≥5 medications (polypharmacy), of whom 58% (n=1362/2356) were taking CNS medicines as part of their regimen. The most common CNS drug classes in polypharmacy regimens were non-opioid analgesics, opioid analgesics, tricyclic and related antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) (34.6%, 13.2%, 10.9% and 10.4%, respectively). Compared with people currently taking 1-4 prescribed medicines, polypharmacy was associated with adjusted ORs of 5.71 (95% CI: 4.29 to 7.61, p<0.01) for opioid analgesics, 3.80 (95% CI: 3.25 to 4.44, p<0.01) for non-opioid analgesics, 3.11 (95% CI: 2.43 to 3.98, p<0.01) for TCAs and 2.30 (95% CI: 1.83 to 2.89, p<0.01) for SSRIs. Lower wealth was also associated with the aforementioned CNS drug classes. CONCLUSION: Opioid and non-opioid analgesics were the most prevalent classes of CNS medicines in this study. Polypharmacy is strongly associated with the aforementioned classes of analgesics. Polypharmacy is also associated with TCAs and SSRIs, although to a lesser extent than for analgesics. For all CNS medicine classes, polypharmacy may need to be considered in relation to reducing the risk of potential adverse events. After adjustment, lower wealth is associated particularly with analgesics, highlighting that socioeconomic factors may play a role in the prescribing of CNS medicines. These findings provide a baseline for future research into this area