The effect of alcohol marketing on people with, or at risk of, an alcohol problem: A rapid literature review

There is a comprehensive evidence base demonstrating the relationship between alcohol marketing and underage drinking. Far less is known about the impact of alcohol marketing on other potentially vulnerable populations, such as people with, or at risk of, an alcohol problem. For the purposes of this review, this includes people with an alcohol use disorder, in recovery from an alcohol use disorder, and hazardous and harmful drinkers. This report presents findings from a rapid review that aimed to answer the following research questions: • What is the effect of alcohol marketing on drinking behaviour in adults with, or at risk of, an alcohol problem? • What are the psychological and neurological effects of alcohol marketing in adults with, or at risk of, an alcohol problem? A rapid review of primary studies was conducted with the aim of exploring the effect or potential effect of alcohol marketing on people with, or at risk of an alcohol problem, as defined above. Studies were eligible for inclusion in this review if their populations were defined within the paper as being with, or at risk of an alcohol problem, taking into account the possibility of different definitions in different settings. Studies were only included if results or outcomes were presented separately for at least one of the populations of interest. Binge drinkers were not included as a population of interest in this review. Studies covering different aspects of the ‘marketing mix’ (the four Ps of promotion, place, product, and price) were included, with the exception of alcohol outlet density, labelling and non-branded alcohol cues. Children and adolescents were excluded from the review. Quantitative and qualitative study designs were eligible for inclusion. Outcomes related to alcohol use were included, as well as psychological indicators such as awareness of or noticing marketing, appeal or perception of alcohol advertisements, alcohol craving, intentions to consume alcohol, symptoms of alcohol dependence and alcohol-related emotions and cognitions. Searches for relevant literature were conducted through three peer-reviewed electronic literature databases (from inception to November 2021), reference list scanning and citation tracking of included studies, grey literature searching of relevant websites, and enquiries through expert networks. We undertook a narrative synthesis of included papers, grouping studies together by population (participants with harmful or hazardous consumption levels of alcohol and those recovering from an alcohol use disorder) and by type of study (quantitative; qualitative). The review included 11 studies, which focused on participants recovering from an alcohol use disorder (AUD, 6 studies) and those with hazardous or harmful consumption levels of alcohol (5 studies). Seven studies used a quantitative design and four used a qualitative design. Of the quantitative studies, three were crosssectional studies and four were experimental studies. A limited number of studies have investigated the effect of alcohol advertising in harmful/hazardous drinkers. In experimental studies, one included study found no effect of adverts on actual alcohol consumption, but found that alcohol advertising could influence positive alcohol-related emotions and cognitions among heavy drinkers. Another found that individuals who exhibit greater risky alcohol use are more likely to express intentions to consume alcohol upon exposure to beer than water ads. Finally, one study found shorter reaction times in problem drinkers relative to non-problem drinkers when exposed to non-branded alcohol images in a study where participants were instructed to respond as quickly as possible to ‘go’ stimuli whilst refraining from responding to ‘no-go’ stimuli with branded and unbranded alcohol pictures as stimuli. Two cross-sectional studies highlighted the potential risks of alcohol advertising for heavy drinkers: one found that drinkers reporting symptoms of alcohol problems were more likely to notice alcohol brands in magazines and newspapers, while another found that among students, heavy drinkers perceived alcohol adverts as more appealing; however, due to the observational designs used, neither of these studies were able to make causal inferences about the effect of alcohol advertising. Similarly, a small number of quantitative studies have investigated the effects of advertising on drinkers in recovery. Only two studies were found, both of which suggest a relatively small effect of alcohol advertising in this population. One crosssectional study reported that more than three quarters of participants (77%) recalled seeing alcohol marketing in the last six months, with 24% reporting that alcohol marketing was influential. The most influential factors affecting the purchase of a specific alcohol product included price, accessibility, the brand and alcohol percent. Using an experimental design, a further study reported increased craving after exposure to alcohol advertisements and this measure showed a positive association with the number of alcohol-dependence symptoms. In absolute terms, however, craving was relatively low. In three interview studies, respondents indicated that alcohol advertisements triggered a desire to drink, particularly those which contained the participants’ preferred drink and even where the advertisements were perceived negatively. Some reported that they viewed advertisements as being responsible for their relapse. Television was cited as being a particularly powerful medium, with feelings that television intruded into their own home. One study further reported that music and party scenes were particularly troubling in terms of creating an association with good times. Participants in both studies reported negative emotions associated with viewing alcohol advertisements, including loss, lack of belonging, anger, sadness, guilt and exclusion from the norm. Participants in these studies reported needing to use strategies to avoid alcohol advertising, either through turning off and avoiding adverts or recalling the negative aspects of alcohol use. The retail environment was also identified in one further qualitative study as being challenging for drinkers in recovery. High visibility of alcohol, especially in small shops where it is harder to avoid alcohol products, and in-store advertising were identified as risks to recovery. • Taken together, the findings of the studies included in this review suggest that an effect of alcohol marketing in people with, or at risk of, an alcohol problem is likely. • Several studies report effects of alcohol marketing such as influences on positive alcohol-related emotions and cognitions and alcohol craving, which may translate into effects on alcohol consumption. There is also evidence that alcohol marketing is perceived to act as a trigger by people in recovery from alcohol problems and pose a risk to recovery. • This review demonstrates that the impact of alcohol marketing on people with or at risk of an alcohol problem should be a concern for marketing regulators and a focus for future research. • Future research should include longitudinal and experimental studies to determine whether alcohol advertisement has a causal effect on alcohol use in people with or at risk of an alcohol problems, including the differential effects between these groups and of different types of marketing

Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis

Objective: To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. Design: A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. Setting: Any developed country healthcare setting. Participants: Patients, healthcare professionals, managers, payers and academics. Intervention: Experiences and views of oral and intravenous bisphosphonates. Results: Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people’s perception of bisphosphonate acceptability. Conclusion: By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment

Two-Dimensional QCD in the Wu-Mandelstam-Leibbrandt Prescription

We find the exact non-perturbative expression for a simple Wilson loop of arbitrary shape for U(N) and SU(N) Euclidean or Minkowskian two-dimensional Yang-Mills theory regulated by the Wu-Mandelstam-Leibbrandt gauge prescription. The result differs from the standard pure exponential area-law of YM_2, but still exhibits confinement as well as invariance under area-preserving diffeomorphisms and generalized axial gauge transformations. We show that the large N limit is NOT a good approximation to the model at finite N and conclude that Wu's N=infinity Bethe-Salpeter equation for QCD_2 should have no bound state solutions. The main significance of our results derives from the importance of the Wu-Mandelstam-Leibbrandt prescription in higher-dimensional perturbative gauge theory.Comment: 7 pages, LaTeX, REVTE

Polarimetry of 16Ngs produced in mu --capture on 16O nuclei

A polarimetry technique based on stack targets and /3-'/-coincidences has been applied to the 16N nuclei produced in the ground state capture of negative muons on lb0 nuclei. The performance of the polarimeter and the first measurements of /3-asymmetry due to the longitudinal nuclear polarization are discussed

Assessing the effectiveness of bisphosphonates for the prevention of fragility fractures: an updated systematic review and network meta-analyses

Bisphosphonates have been found to be effective in preventing fragility fractures. However, their comparative effectiveness in populations at risk has yet to be defined. In light of recent clinical trials, we aimed to compare four bisphosphonates (alendronate, ibandronate, risedronate, and zoledronate) and to identify which are the most effective for the prevention of fragility fractures. This is an update of a systematic review previously published as part of a NICE HTA report. We conducted a systematic review and network meta-analysis, updating the estimates regarding the comparative effectiveness of the aforementioned bisphosphonates. Studies identified from published and unpublished sources between 2014 and 2021 were added to the studies identified in the previous review. Screening, data extraction and risk of bias assessment were independently undertaken by two reviewers. Outcomes were fractures, femoral neck bone mineral density (BMD), mortality, and adverse events. We identified 25 additional trials, resulting in a total population of 47,007 participants. All treatments had beneficial effects on fractures versus placebo with zoledronate being the most effective treatment in preventing vertebral fractures HR = 0.38 (95%CrI: 0.28, 0.49). Zoledronate HR = 0.71 (95%CrI: 0.61, 0.81) and risedronate HR = 0.70 (95%CrI: 0.53, 0.84) were found to be the most effective treatments in preventing non-vertebral fractures. All treatments were associated with increases in femoral neck BMD versus placebo with zoledronate being the most effective treatment MD = 4.02 (95%CrI: 3.2, 4.84). There was a paucity of data regarding hip and wrist fractures. Depending on its cost-effectiveness, zoledronate could be considered a first-line option for people at increased risk of fragility fractures

Self-help educational booklets for the prevention of smoking relapse following smoking cessation treatment: a randomized controlled trial.

AIMS: Most people who quit smoking for a short term will return to smoking again in 12 months. We tested whether self-help booklets can reduce relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. DESIGN: A parallel-arm, pragmatic individually randomized controlled trial. SETTING: Smoking cessation clinics in England. Participants People who stopped smoking for 4 weeks after receiving cessation treatment in stop smoking clinics. INTERVENTION: Participants in the experimental group (n=703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n=704) received a leaflet currently used in practice. MEASUREMENTS: The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self-reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. FINDINGS: There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75-1.16; P=0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for relapse and using strategies to handle urges to smoke were less likely to relapse. CONCLUSIONS: In people who stop smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to smoking did not reduce relapse

Comparing medication adherence in patients receiving bisphosphonates for preventing fragility fractures: a comprehensive systematic review and network meta-analysis

Background: Bisphosphonates are effective in preventing fragility fractures; however, high rates of adherence are needed to preserve clinical benefits. Objective: To investigate persistence and compliance to oral and intravenous bisphosphonates (alendronate, ibandronate, risedronate, and zoledronate). Methods: Searches of 12 databases, unpublished sources, and trial registries were conducted, covering the period from 2000 to April 2021. Screening, data extraction, and risk of bias assessment (Cochrane Collaboration risk-of-bias tool 1.0 & ROBINS-I) were independently undertaken by two study authors. Randomised controlled trials (RCTs) and observational studies that used prescription claim databases or hospital medical records to examine patients’ adherence were included. Network meta-analyses (NMA) embedded within a Bayesian framework were conducted, investigating users’ likelihood in discontinuing bisphosphonate treatment. Where meta-analysis was not possible, data were synthesised using the vote-counting synthesis method. Results: Fifty-nine RCTs and 43 observational studies were identified, resulting in a total population of 2,656,659 participants. Data from 59 RCTs and 24 observational studies were used to populate NMAs. Zoledronate users were the least likely to discontinue their treatment HR = 0.73 (95%CrI: 0.61, 0.88). Higher rates of compliance were observed in those receiving intravenous treatments. The paucity of data and the heterogeneity in the reported medication possession ratio thresholds precluded a NMA of compliance data. Conclusions: Users of intravenously administered bisphosphonates were found to be the most adherent to treatment among bisphosphonates’ users. Patterns of adherence will permit the more precise estimation of clinical and cost-effectiveness of bisphosphonates. Trial registration: PROSPERO 2020 CRD42020177166

Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial.

Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training's effectiveness. Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention's preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient-Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Uncontrolled design and self-selecting sample. Definitive trial determining intervention effects. This trial is registered as ISRCTN12826685 (closed to recruitment). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in ; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. 'De-escalation' is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use 'containment' interventions (measures to prevent harm through restricting a person's ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient's concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention

Test of CPT Symmetry and Quantum Mechanics with Experimental data from CPLEAR

We use fits to recent published CPLEAR data on neutral kaon decays to $\pi^+\pi^-$ and $\pi e\nu$ to constrain the CPT--violation parameters appearing in a formulation of the neutral kaon system as an open quantum-mechanical system. The obtained upper limits of the CPT--violation parameters are approaching the range suggested by certain ideas concerning quantum gravity.Comment: 9 pages of uuencoded postscript (includes 3 figures

Why honey is effective as a medicine. 1. Its use in modern medicine

Honey has been used as a medicine for thousands of years and its curative properties are well documented. However, modern medicine turned its back on honey and it is only now, with the advent of multi-resistant bacteria, that the antibiotic properties of honey are being rediscovered