Stakeholder ownership: a theoretical framework for cross national understanding and analyses of stakeholder involvement in issues of substance use, problem use and addiction

This project contributes to understanding of the role of different stakeholder groups in the formulation and implementation of policy in the addictions field in Austria, Denmark, Finland, Italy, Poland and the UK. It comprises a number of case studies which draw on a range of theoretical frameworks to examine stakeholder dynamics at international, national and local levels. Mainly qualitative methods were used: interviews, policy and documentation analyses, webcrawler network analysis, and simple surveys; one case study was based on a survey only. The case studies fall into four main categories: three focus on controversial issues in drug treatment policy and practice – opioid substitution treatment, drug consumption rooms, and heroin assisted treatment; three look at stakeholder activity in alcohol control and public health; one pilot case study considers the potential role of researchers in the development of a scientific network around gambling; and one looks at the role of nurses in implementing brief interventions. In addition, themes explored across case studies included the role of evidence and stakeholder activity, drug users as stakeholders, and the role of external stakeholders on national policy. Professional stakeholders at implementation level and families and drug users as stakeholders are also considered. The case studies revealed that, in many instances, the addictions field is characterised by tensions between groups, by entrenched relationships between some addiction-specific stakeholder groups and powerful political stakeholders, and by the dominance of some forms of evidence over other forms of knowledge. Science and scientists are only influential in policy terms if their scientific findings ‘fit’ with the wider political context. Nevertheless, at least within the European context, there are opportunities for new stakeholder groups to emerge and gain policy salience and there are opportunities for stakeholders to challenge prevailing frames of understanding the addictions and prevailing modes of responding to problems of substance misuse and addiction

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Digitalization of the last mile of a humanitarian supply chain

The digitalization of humanitarian supply chains allows overcoming one of the greatest difficulties faced by NGOs and governments in managing health equipment in crisis situations: the visibility of stocks and consumption at the end of the chain. This paper presents the design process of the health equipment inventory management system developed to support the humanitarian crisis related to the Syrian refugees in Lebanon. The prototype was tested at the pharmacy of the ICRC Weapon-wounded Trauma and Training Centre in Tripoli, Lebanon, where it was demonstrated to be easy to use and able to facilitate the work related to the management of medicament stocks and orders

Determinants of risky substance use and risky gambling

First paragraph: That certain behaviour in a particular situation entails high risks is a perception that does not require human consciousness; indeed, perceiving or failing to perceive risk has been through the eons a sure means of Darwinian selection. A mouse that sees the shadow of an owl will take action ( or freeze to evade notice) because of the immediate risk. Throughout human history, people have taken risks into account in how they behave. The risks have sometimes been tangible, as in the risk of injury in falling off a cliff, and sometimes intangible and a matter of belief, as in the risk of eternal damnation for doing something sinful. Often the calculation of risk combines elements that are tangible and measurable, and elements that are a matter of morals or conviction. Positivist research in the field of substance use and gambling behaviour is driven to measure the inherent risk of such behaviours. This quantification uses statistical methods to estimate the probability of outcomes for a specific variable. For example, we can calculate 'relative risk: which is the ratio of the probability of an event occurring (e.g. developing liver cirrhosis or having a car crash) in an exposed group (e.g. heavy drinkers) to the probability of the event occurring in a comparison, nonexposed group (e.g. non- or moderate drinkers). However, the exact level of consumption at which use become risky or harmful has been modified over time, in response to changing knowledge and societal perspectives. For example, in the context of alcohol brief interventions (a short, structured conversation about alcohol consumption that seeks in a non-confrontational way to motivate and support an individual to think about and/or plan a change in their drinking behaviour) the definition of risky drinking was set by the WHO at an average of more than 20 (women) or 40 (men) grams of alcohol per day (Heather, 2006), even if more recent publications tend to lower such limits to around 12 and 25 grams (Schi.itze et al., 2011).  Additional co-authors: Rosie Lees, Gert-Jan Meerkerk, Laura Schmidt, Dike van de Mheen, and Reinout Wiers