Alcohol consumption, wealth and health

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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

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

Lifecourse transitions, gender and drinking in later life

Older people consume less alcohol than any other adult age group. However, in recent years survey data on alcohol consumption in the United Kingdom have shown that while younger age groups have experienced a decline in alcohol consumption, drinking behaviours among the elderly have not reduced in the same way. This paper uses data from the English Longitudinal Study of Ageing to analyse both the frequency and quantity of older adult's alcohol consumption using a lifecourse approach over a ten-year period. Overall drinking declined over time and the analysis examined how socio-economic characteristics, partnership, employment and health statuses were associated with differences in drinking behaviours and how these changed over time. Higher wealth and level of education were associated with drinking more and drinking more frequently for men and women. Poorer self-rated health was associated with less frequent consumption and older people with poor and deteriorating health reported a steeper decline in the frequency of alcohol consumption over time. Men who were not in a partnership drank more than other men. For women, loss of a partner was associated with a steeper decline in drinking behaviours. These findings have implications for programmes to promote responsible drinking among older adults as they suggest that, for the most part, characteristics associated with sustaining wellbeing in later life are also linked to consuming more alcohol

Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England

ObjectivesIn 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General Practice (GP)—greater community pharmacy provision reduces GP prescribing. This study aimed to examine predictors of GP and pharmacy EHC activity, describing them using path analysis. From this, commissioners and policy-makers may understand ways to influence this.Study designCross-sectional study of routinely recorded data, obtained through freedom of information requests to local authorities.SettingCommunity pharmacies and general practices in England, UK.ParticipantsAll local authorities in England were included in the study (147 areas). The study population were all girls, adolescents and women aged 12–55. Of the 147 areas, data from 80 local authorities were obtained covering an eligible female population of 9 380 153.Primary and secondary outcome measuresCorrelation between community pharmacy and GP EHC activity.ResultsData from 80 local authorities were analysed, representing 60% of the eligible female population in England. A significant negative correlation was found between rates of community pharmacy provision and GP prescribing (−0.458, p&lt;0.000). Community pharmacy provision and the proportion of pharmacies commissioned were significantly correlated (0.461, p&lt;0.000). A significant correlation was found between increased deprivation and community pharmacy provision (0.287, p=0.010). Standardised total effects on GP prescribing were determined from path analysis including community pharmacy provision (ß=−0.552) and proportion of pharmacies commissioned (ß=−0.299). If all community pharmacies were commissioned to provide EHC, GP EHC prescriptions could decrease by 15%.ConclusionCommunity pharmacy EHC provision has a significant influence on GP EHC prescribing. Increasing the proportion of commissioned community pharmacies should have a marked impact on GP workload. The methodology affords the possibility of examining relationships surrounding other commissioned service activity across different settings and their impact on linked care settings.</jats:sec

Multi-objective shop floor scheduling using monitored energy data

Modern factories will become more and more directly connected to intermittent energy sources like solar systems or wind turbines as part of a smart grid or a self-sufficient supply. However, solar systems or wind turbines are not able to provide a continuous energy supply over a certain time period. In order to enable an effective use of these intermittent energy sources without using temporary energy storages, it is necessary to rapidly and flexibly adapt the energy demand of the factory to the constantly changing requirements of the energy supply. The adaption of the energy demand to the intermittent supply results in different energy-related objectives for the production system of the factory, such as reducing energy consumption, avoiding power peaks, or achieving a power use within the available power supply. Shop Floor Scheduling can help to pursue these objectives within the production system. For this purpose, a solution methodology based on a meta-heuristic will be described for Flexible Job Shop Scheduling taking into account different energy- as well as productivity-related objectives

Decision support in addiction: the development of an e-health tool to assess and prevent risk of fatal overdose. The ORION project

Background and Objective. The application of e-health technology to the field of substance use disorders is at a relatively early stage, and methodological quality is still variable. Few have explored the extent of utilization of communication technology in exploring risk perception by patients enrolled in substance abuse services. The Overdose RIsk InfOrmatioN (ORION) project is a European Commission funded programme, aimed to develop and pilot an e-health psycho-educational tool to provide information to drug using individuals about the risks of suffering a drug overdose. Methods. In this article we report on phase 1 (risk estimation), phase 2 (design), and phase 3 (feasibility) of the ORION project. Results. The development of ORION e-health tool underlined the importance of an evidence-based intervention aimed in obtaining reliable evaluation of risk. The ORION tool supported a decision making process aimed at influencing the substance users' self-efficacy and the degree to which the substance users' understand risk factors. Therefore its innovative power consisted in translating risks combination into a clear estimation for the user who will then appear more likely to be interested in his/her risk perception. Conclusion. Exploratory field testing and validation confirmed the next stage of evaluation, namely, collection of routine patient samples in study clinics. The associations between risk perception of overdose, engagement with the ORION tool and willingness to alter overdose risk factors, in a clinical setting across various EU member states will further confirm the ORION tool's generalisability and effectiveness.PostprintPeer reviewe

Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records

Background: The nature of symptoms in the prodromal period of first episode psychosis (FEP) remains unclear. The objective was to determine patterns of symptoms recorded in primary care in the 5-years before FEP diagnosis. Methods: The study was set within 568 practices contributing to a UK primary care health record database (Clinical Practice Research Datalink). Patients aged 16-45 years with a first coded record of FEP, and no antipsychotic prescription more than one year prior to FEP diagnosis (n=3,045) were age, gender and practice matched to controls without FEP (n=12,180). 55 symptoms recorded in primary care in the previous 5 years, categorised into eight groups (mood-related, ‘neurotic’, behavioural change, volition change, cognitive change, perceptual problem, substance misuse, physical symptoms), were compared between cases and controls. Common patterns of symptoms prior to FEP diagnosis were identified using latent class analysis. Results: Median age at diagnosis was 30 years, 63% were male. Non-affective psychosis (67%) was the most common diagnosis. Mood-related, ‘neurotic’, and physical symptoms were frequently recorded (>30% of patients) before diagnosis, and behavioural change, volition change, and substance misuse were also common (>10%). Prevalence of all symptom groups was higher in FEP patients than controls (adjusted odds ratios 1.33-112). Median time from first recorded symptom to FEP diagnosis was 2-2.5 years except perceptual problem (70 days). The optimal latent class model applied to FEP patients determined three distinct patient clusters. ‘No or minimal symptom cluster’ (49%) had no or few symptoms recorded; ‘affective symptom cluster’ (40%) mainly had mood-related and ‘neurotic’ symptoms; and ‘multiple symptom cluster’ (11%) consulted for three or more symptom groups before diagnosis. The multiple symptom cluster were more likely to have drug-induced psychosis, be female, obese, and have a higher morbidity burden. Affective and multiple symptom clusters showed a good discriminative ability (C-statistic 0.766; sensitivity 51.2% and specificity 86.7%) for FEP, and many patients in these clusters had consulted for their symptoms several years before FEP diagnosis. Conclusions: Distinctive patterns of prodromal symptoms may help alert general practitioners to those developing psychosis, facilitating earlier identification and referral to specialist care, thereby avoiding potentially detrimental treatment delay