Heroin Treatment - New Alternative : proceedings of a seminar held on 1 November 1991, Ian Wark Theatre, Backer House, Canberra

The meeting today grows out of a study conducted jointly by the National Centre for Epidemiology and Population Health and the Australian Institute of Criminology in the early part of this year. That study was prompted by an invitation from the Chairman of the ACT Legislative Assembly’s Select Committee on HIV, Illegal Drugs and Prostitution - Mr Michael Moore - who invited us to examine the feasibility of a trial of the controlled availability of opioids in the ACT. Dr Gabriele Bammer, who directed that investigation, will be setting the scene for us by describing its conclusions at the outset of the day’s discussions. We hope that from that baseline we can move forward in the course of the day to explore the implications of those conclusions and to discuss whether or not it is appropriate to extend the feasibility study to the next stage. So our objective today is to explore the medical, health, social and law enforcement implications of evaluating, in the ACT, new approaches to the treatment of heroin dependent individuals. Drug policy is a highly political issue, any action to change the way we manage drug dependent people in the ACT has political implications for the ACT and for other parts of Australia as well. So I am delighted that we have representatives from drug and law enforcement agencies from most states of Australia here today and that many of the people who will frame attitudes to the proposed ACT trial will have an opportunity to discuss these issues in an open and uninhibited way.The meeting has been assisted by a grant from the ACT Government

Regional variation in alcohol consumption in the Northern Territory

Regional variation is studied in per capita consumption of alcohol and the types of beverages consumed in the Northern Territory of Australia in order to estimate the relative contributions to consumption by Aboriginal and non-Aboriginal people. Per capita consumption estimates were based on wholesale purchases of alcohol by licensee and Census population data. Mean levels and the percentages of each beverage type consumed were compared between regions and through time. Estimates of per capita levels of consumption between Aboriginal and non-Aboriginal segments of the population were based on reports of the proportion of frequent and occasional drinkers in each group and the ratio of onsumption among Aboriginal and non-Aboriginal drinkers. Mean quarterly per capita consumption was higher in both the Lower Top End (4.22 litres) and the Central NT (4.04 litres), and less in the Barkly (3.44 litres) than in the Top End (3.55 litres). Over the four-year period, consumption in the Top End rose 6.4%, but dropped 22.5% in the Barkly. In the Lower Top End and the Central NT a larger percentage of alcohol was consumed as cask wine than in the Top End. Before licensing restrictions were introduced, this was also the case iri the Barkly. In the NT, per capita consumption among Aboriginal people is approximately 1.97 times, and among nonAboriginal people about 1.43 times, the national average. It is concluded that lcohol consumption in the NT is greater than in Australia as a whole and there is significant regional variation. The problem is not simply an Aboriginal problem, and a broad range of strategies including a component to address regional variation - is required to reduce it

One portion size of foods frequently consumed by Korean adults

This study aimed to define a one portion size of food items frequently consumed for convenient use by Koreans in food selection, diet planning, and nutritional evaluation. We analyzed using the original data on 5,436 persons (60.87%) aged 20 ~ 64 years among 8,930 persons to whom NHANES 2005 and selected food items consumed by the intake frequency of 30 or higher among the 500 most frequently consumed food items. A total of 374 varieties of food items of regular use were selected. And the portion size of food items was set on the basis of the median (50th percentile) of the portion size for a single intake by a single person was analyzed. In cereals, the portion size of well polished rice was 80 g. In meats, the portion size of Korean beef cattle was 25 g. Among vegetable items, the portion size of Baechukimchi was 40 g. The portion size of the food items of regular use set in this study will be conveniently and effectively used by general consumers in selecting food items for a nutritionally balanced diet. In addition, these will be used as the basic data in setting the serving size in meal planning

Fifteen-minute consultation: An evidence-based approach to research without prior consent (deferred consent) in neonatal and paediatric critical care trials

What do we mean by research without prior consent (deferred consent)? Emergency research with critically unwell children is vital to make sure that the most ill and injured children benefit from evidence-based healthcare.1 Ethical guidance require that consent be sought from parents (or legal representatives) on behalf of their children2 before research is initiated, yet concerns about problems in seeking parents’ consent when their child is critically ill have been a significant barrier to conducting clinical trials.3 ,4 Taking time out to seek informed consent before starting treatment will often be difficult to justify as delaying any intervention in an emergency could diminish a child's chances of recovery. Parents will usually be highly distressed in a critical care situation, and many will struggle to make an informed decision about research in the limited time available. Many countries have legislated to permit variations to informed consent and allow progress in research to develop critical care treatments.5–7 While the details vary, a common feature is that informed consent is not requested before the patient receives the intervention being researched.8 In the USA, the Food and Drug Administration (FDA) Exception from Informed Consent (EFIC) essentially ‘waives’ informed consent, although practitioners must show that they have attempted to contact legal representatives and tried to provide the opportunity to ‘opt out’ of a trial.5 ,9 The FDA's detailed guidance aims to assist researchers in implementing EFIC,10 ,11 although the accompanying public consultation requirements have led to varied practice and costly delays in setting up trialsCATCH was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 08/13/47). CONNECTwas funded by Wellcome Trust (WT095874MF) and supported by the MRC Network of Hubs for Trials Methodology Research (MR/L004933/1- R/N42)

Public health research outputs from efficacy to dissemination: a bibliometric analysis

<p>Abstract</p> <p>Background</p> <p>More intervention research is needed, particularly 'real world' intervention replication and dissemination studies, to optimize improvements in health. This study assessed the proportion and type of published public health intervention research papers over time in physical activity and falls prevention, both important contributors to preventable morbidity and mortality.</p> <p>Methods</p> <p>A keyword search was conducted, using Medline and PsycINFO to locate publications in 1988-1989, 1998-1999, and 2008-2009 for the two topic areas. In stage 1, a random sample of 1200 publications per time period for both topics were categorized as: non-public health, non-data-based public health, or data-based public health. In stage 2 data-based public health articles were further classified as measurement, descriptive, etiological or intervention research. Finally, intervention papers were categorized as: efficacy, intervention replication or dissemination studies. Inter-rater reliability of paper classification was 88%.</p> <p>Results</p> <p>Descriptive studies were the most common data-based papers across all time periods (1988-89; 1998-1999;2008-2009) for both issues (physical activity: 47%; 54%; 65% and falls 75%; 64%; 63%), increasing significantly over time for physical activity. The proportion of intervention publications did not increase over time for physical activity comprising 23% across all time periods and fluctuated for falls across the time periods (10%; 21%; 17%). The proportion of intervention articles that were replication studies increased over the three time periods for physical activity (0%; 2%; 11%) and for falls (0%; 22%; 35%). Dissemination studies first appeared in the literature in 2008-2009, making up only 3% of physical activity and 7% of falls intervention studies.</p> <p>Conclusions</p> <p>Intervention research studies remain only a modest proportion of all published studies in physical activity and falls prevention; the majority of the intervention studies, are efficacy studies although there is growing evidence of a move towards replication and dissemination studies, which may have greater potential for improving population health.</p

The relationship between alcohol consumption and related harm among young university students

Issue addressed: Research has shown that Australian university students consume alcohol at a higher level than their peers from the general population and are therefore more likely to witness and experience alcohol-related harm. This study measured the prevalence of alcohol consumption among 18–24-year-old university students and the association between alcohol consumption and witnessed and experienced harms. Methods: A random cross-sectional sample of university students aged 18–24 years (n = 2466) was recruited via the University Survey Office and through random intercept at campus market day. All participants completed an online survey that included the Alcohol Use Disorders Identification Test, Alcohol Problems Scale and an additional scale measuring witnessed harm. Results: Principal Components Analysis revealed three factors within the Alcohol Problems Scale; i.e. Criminal and Aggressive Behaviour, Health and Emotional Harms and Sexual Harms. Students who consume alcohol at high-risk levels were significantly more likely to score highly on each factor, 1.6 times more likely to experience harm and 1.1 times more likely to witness harm than students who consume alcohol at low-risk levels. Conclusions: The positive association between alcohol consumption and alcohol-related harm supports previous findings. This study adds previous research through the categorisation of harm into factors

A review of public opinion towards alcohol controls in Australia

<p>Abstract</p> <p>Background</p> <p>Increasing concern about the negative impact of alcohol on the Australian community has renewed calls for tighter regulatory controls. This paper reviews levels of and trends in public support for liquor control regulations, regulation of alcohol promotions, and alcohol pricing and taxation reforms in Australia between 1998 and 2009.</p> <p>Methods</p> <p>Six electronic databases and twenty public health and alcohol organisation websites were searched for research literature, reports and media releases describing levels of public support for alcohol controls. Only studies which randomly selected participants were included.</p> <p>Results</p> <p>Twenty-one studies were included in the review. The majority of the Australian public support most proposed alcohol controls. Levels of support are divided between targeted and universal controls.</p> <p>Conclusions</p> <p>Implementation of targeted alcohol policies is likely to be strongly supported by the Australian public, but universal controls are liable to be unpopular. Policy makers are provided with insights into factors likely to be associated with higher public support.</p

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration: This study is registered as PROSPERO CRD42016039494. Funding: The National Institute for Health Research Health Technology Assessment programme

EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids (CEF); Scientific Opinion on Flavouring Group Evaluation 9, Revision 4 (FGE.09Rev4): Secondary alicyclic saturated and unsaturated alcohols, ketones and esters containing secondary alicyclic alcohols from chemical group 8 and 30, and an ester of a phenol derivative from chemical group 25

&lt;p&gt;The Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids of the European Food Safety Authority was requested to evaluate 21 flavouring substances in the Flavouring Group Evaluation 9, Revision 4, using the Procedure in Commission Regulation (EC) No 1565/2000. The present revision of FGE.09 includes the assessment of four additional flavouring substances, p-menthan-3-one [FL-no: 07.059], 2,6,6-trimethylcyclohex-2-en-1-one [FL-no: 07.202], l-piperitone [FL-no: 07.255] and menthol 1-and 2-propylene glycol carbonate [FL-no: 09.843]. None of the substances were considered to have genotoxic potential. The substances were evaluated through a stepwise approach (the Procedure) that integrates information on structure-activity relationships, intake from current uses, toxicological threshold of concern, and available data on metabolism and toxicity. The Panel concluded that the 20 substances [FL-no: 02.070, 02.075, 02.135, 02.167, 06.136, 07.059, 07.202, 07.203, 07.255, 09.154, 09.355, 09.520, 09.618, 09.619, 09.621, 09.843, 09.870, 09.929, 09.935 and 09.949] do not give rise to safety concerns at their levels of dietary intake, estimated on the basis of the MSDI approach. For the remaining candidate substance [FL-no: 07.207], additional toxicity data are requested (further metabolism and/or toxicity studies). Besides the safety assessment of these flavouring substances, the specifications for the materials of commerce have been considered. Specifications including complete purity criteria and identity for the materials of commerce have been provided for all candidate substances.&lt;/p&gt