Parental supply of alcohol in childhood and risky drinking in adolescence: Systematic review and meta-analysis

© 2017 by the authors. Licensee MDPI, Basel, Switzerland. Whether parental supply of alcohol affects the likelihood of later adolescent risky drinking remains unclear. We conducted a systematic review and meta-analysis to synthesize findings from longitudinal studies investigating this association. We searched eight electronic databases up to 10 September 2016 for relevant terms and included only original English language peer-reviewed journal articles with a prospective design. Two reviewers independently screened articles, extracted data and assessed risk of bias. Seven articles met inclusion criteria, six of which used analytic methods allowing for meta-analysis. In all seven studies, the follow-up period was ≥12 months and attrition ranged from 3% to 15%. Parental supply of alcohol was associated with subsequent risky drinking (odds ratio = 2.00, 95% confidence interval = 1.72, 2.32); however, there was substantial risk of confounding bias and publication bias. In all studies, measurement of exposure was problematic given the lack of distinction between parental supply of sips of alcohol versus whole drinks. In conclusion, parental supply of alcohol in childhood is associated with an increased likelihood of risky drinking later in adolescence. However, methodological limitations preclude a causal inference. More robust longitudinal studies are needed, with particular attention to distinguishing sips from whole drinks, measurement of likely confounders, and multivariable adjustment

Combating escalating harms associated with pharmaceutical opioid use in Australia: The POPPY II study protocol

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Introduction Opioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms. Methods and analysis We will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use. Ethics and dissemination This study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement

Factors associated with concurrent illicit use of opiates and crack/cocaine among opiate-users in Treatment: Implications for treatment services in England.

Background: The aim of this study was to identify factors associated with concurrent illicit drug use of opiates and crack/cocaine use among individuals receiving of opioid medication-assisted treatment (MAT) in one English rural/urban County Council area. Methods: 776 opiate users in treatment were assessed using the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) assessment tool. The tool encompasses three domains and 14 subdomains covering addiction severity, recovery strengths and coexisting health and social needs. Data were opportunistically matched to the National Drug Treatment Monitoring System (NDTMS) and the Treatment Outcome Profile (TOP). Two backward stepwise logistic regression models were run to discern the nature of concurrent illicit drug use. Results: Addiction severity (Odds Ratio [OR] 12.55, Confidence interval [CI] 6.49–24.27), low recovery strengths (OR 2.30, CI 1.30–4.07) and no ‘urge/control’ (OR 27.45, 13.18–57.16) were strongly associated with concurrent use. Individuals with moderate psychological needs were more likely to be abstinent (OR 2.97, CI 1.67–5.29) compared to those with no need. Abstaining from injecting (OR 2.38, CI 1.15–4.93), alcohol consumption (OR 1.55, CI 1.05–2.30), increasing age (OR 1.03, CI 1.01-1.06) and increased quality-of-life (OR 1.05, CI 1.00–1.10) were associated with abstinence from concurrent use. Conclusion: Practitioner assessments with self-report data offer unique perspectives on service users’ holistic needs. Interventions addressing concurrent use during MAT should consider managing urges and control of illicit Class A use, injecting and alcohol consumption within a stepped-care approach. Packages for developing recovery strengths supporting psychological need and enhancing quality-of-life is recommended

Age at first alcohol-related hospital separation or emergency department presentation and rate of re-admission: A retrospective data linkage cohort of young Australians

Introduction: Alcohol is a leading risk factor for death and disease in young people. We compare age-specific characteristics of young people who experience their first (‘index’) alcohol-related hospitalisation or emergency department (ED) presentation, and whether age at index predicts 12-month rates of readmission. Methods: We used a retrospective linked-data cohort of 10,300 people aged 12–20 years with an index alcohol-related hospital and/or ED record in New South Wales, Australia from 2005 to 2013. Age group (early adolescent [12–14 years], late adolescent [15–17 years], young adult [18–20 years]) and diagnosis fields were used in logistic regression analyses and to calculate incidence rates with adjustment for year of index event, sex, socioeconomic disadvantage and residence remoteness. Results: People who experienced their index event in early adolescence (adjusted relative risk ratio [ARRR] 0.45 [95% confidence interval 0.39, 0.52]) or late adolescence (ARRR 0.82 [0.74, 0.90]) were less likely to be male compared to young adults. Early adolescents (ARRR 0.60 [0.51, 0.70]) and late adolescents (ARRR 0.84 [0.76, 0.93]) were less likely to have a hospitalisation index event. Early adolescents (adjusted incidence rate ratio 1.40 [1.15, 1.71]) and late adolescents (adjusted incidence rate ratio 1.16 [1.01, 1.34]) were more likely than young adults to have a subsequent 12-month non-poisoning injury ED presentation. Discussion and Conclusions: We identified preventable hospital events in young people who have previously experienced an alcohol-related ED presentation or hospitalisation, with age-specific characteristics and outcomes that can be used to inform future health policy and service planning

Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy:a systematic review and meta-analysis

Aim: To systematically review and meta‐analyse studies of neurodevelopmental outcome of children born to mothers prescribed methadone in pregnancy. Method: MEDLINE, Embase, and PsycINFO were searched for studies published from 1975 to 2017 reporting neurodevelopmental outcomes in children with prenatal methadone exposure. Results: Forty‐one studies were identified (2283 participants). Eight studies were amenable to meta‐analysis: at 2 years the Mental Development Index weighted mean difference of children with prenatal methadone exposure compared with unexposed infants was −4.3 (95% confidence interval [CI] −7.24 to −1.63), and the Psychomotor Development Index weighted mean difference was −5.42 (95% CI −10.55 to −0.28). Seven studies reported behavioural scores and six found scores to be lower among methadone‐exposed children. Twelve studies reported visual outcomes: nystagmus and strabismus were common; five studies reported visual evoked potentials of which four described abnormalities. Factors that limited the quality of some studies, and introduced risk of bias, included absence of blinding, small sample size, high attrition, uncertainty about polydrug exposure, and lack of comparison group validity. Interpretation: Children born to mothers prescribed methadone in pregnancy are at risk of neurodevelopmental problems but risk of bias limits inference about harm. Research into management of opioid use disorder in pregnancy should include evaluation of childhood neurodevelopmental outcome

A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes

Background: Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. Method: A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. Results: A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). Conclusion: There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors

Verbal Learning and Memory in Cannabis and Alcohol Users: An Event-Related Potential Investigation

Aims: Long-term heavy use of cannabis and alcohol are known to be associated withmemory impairments. In this study, we used event-related potentials to examine verballearning and memory processing in a commonly used behavioral task.Method: We conducted two studies: first, a small pilot study of adolescent males,comprising 13 Drug-Naive Controls (DNC), 12 heavy drinkers (HD) and 8 cannabis users(CU). Second, a larger study of young adults, comprising 45 DNC (20 female), 39 HD (16female), and 20 CU (9 female). In both studies, participants completed a modified verballearning task (the Rey Auditory Verbal Learning Test, RAVLT) while brain electrical activitywas recorded. ERPs were calculated for words which were subsequently rememberedvs. those which were not remembered, and for presentations of learnt words, previouslyseen words, and new words in a subsequent recognition test. Pre-planned principalcomponents analyses (PCA) were used to quantify the ERP components in these recalland recognition phases separately for each study.Results: Memory performance overall was slightly lower than published norms usingthe standardized RAVLT delivery, but was generally similar and showed the expectedchanges over trials. Few differences in performance were observed between groups; anotable exception was markedly poorer delayed recall in HD relative to DNC (Study 2).PCA identified components expected from prior research using other memory tasks. Atencoding, there were no between-group differences in the usual P2 recall effect (larger forrecalled than not-recalled words). However, alcohol-related differences were observed ina larger P540 (indexing recollection) in HD than DNC, and cannabis-related differenceswere observed in a smaller N340 (indexing familiarity) and a lack of previously seen > newwords effect for P540 in Study 2.Conclusions: This study is the first examination of ERPs in the RAVLT in healthycontrol participants, as well as substance-using individuals, and represents an importantadvance in methodology. The results indicate alterations in recognition memoryprocessing, which even if not manifesting in overt behavioral impairment, underline thepotential for brain dysfunction with early exposure to alcohol and cannabis

Over 1200 drugs-related deaths and 190,000 opiate-user-years of follow-up : relative risks by sex and age-group

Heroin users/injectors' risk of drugs-related death by sex and current age is weakly estimated both in individual cohorts of under 1000 clients, 5000 person-years or 50 drugs-related deaths and when using cross-sectional data. A workshop in Cambridge analysed six cohorts who were recruited according to a common European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) protocol from drug treatment agencies in Barcelona, Denmark, Dublin, Lisbon, Rome and Vienna in the 1990s; and, as external reference, opiate-user arrestees in France and hepatitis C diagnosed ever-injectors in Scotland in 1993-2001, both followed by database linkage to December 2001. EMCDDA cohorts recorded approximately equal numbers of drugs-related deaths (864) and deaths from other non-HIV causes (865) during 106,152 person-years of follow-up. External cohorts contributed 376 drugs-related deaths (Scotland 195, France 181) and 418 deaths from non-HIV causes (Scotland 221, France 197) during 86,417 person-years of follow-up (Scotland 22,670, France 63,747). EMCDDA cohorts reported 707 drugs-related deaths in 81,367 man-years {8.7 per 1000 person-years, 95% CI: 8.1 to 9.4} but only 157 in 24,785 person-years for females {6.3 per 1000 person-years, 95% CI: 5.4 to 7.4}. Except in external cohorts, relative risks by current age-group were not particularly strong, and more modest in Poisson regression than in cross-sectional analyses: relative risk was 1.2 (95% CI: 1.0-1.4) for 35-44 year olds compared to 15-24 year 3 olds, but 1.4 for males (95%CI: 1.2-1.6), and dramatically lower at 0.44 after the first year of follow-up (95% CI: 0.37-0.52)