Markets for Prescription Stimulants: Doctors, Dealers and Daily peers

Denne artikel er baseret på etnografisk feltarbejde blandt studerende som tager ADHD lægemidler som optimering - også kaldet study drugs. Artiklen fokuserer specifikt på, hvordan study drugs bliver tilgængelige for de studerende. Det empiriske materiale viser, at der er tre primære måder at få fat i study drugs på; som vennetjeneste, som ordineret medicin og som stoffer til salg. Ved at dykke ned i hvordan studerende opsøger disse study drugs bliver det tydeligt, at de forskellige markeder for study drugs ikke blot er måder at anskaffe sig medicin til optimering på, men i høj grad er udtryk for den moral, der forbindes med denne optimeringspraksis. Teoretisk diskuterer artiklen brugen af study drugs som en optimeringsteknologi, der på mange måder er forbundet med det moderne samfund og neoliberale værdier. Samtidig viser artiklen også, at der er begrænsninger ved denne type analyse, og at ved at fokusere på moral bliver det tydeligt, at studerende samtidigt både kan orientere sig med og imod de neoliberale værdier.The use of ADHD medication for enhancement purposes among student populations is by now a well-known phenomenon, particularly in North America but by now also inmany other parts of the world. However, we lack knowledge about how these prescription stimulants become accessible to students and therefore the aim of this article is to shed lighton how students gain access to study drugs. The article is based on ethnographic fieldwork conducted in New York City and Copenhagen among a total of 30 students, as well as study counselors, university teachers, psychiatrists, drug dealers and the police. The empirical material suggests three main markets for study drugs, namely, through daily peers, doctors and dealers. The analysis shows that there are different moral dilemmas connected to the different ways of accessing study drugs, but that it is not the drug as such that is the object of moral negotiation but rather the way of acquiring and using them. The study drug markets are thus an expression of which story the students want to tell about themselves, and which person they are or want to become in our contemporary consumer culture

The application of novel analytic methods to gain new insights in historically well-studied areas of perinatal epidemiology

Due to rapid growth in computing power, the collection of high dimensional and complex datasets is increasingly feasible. To reap their full benefit, novel analytic strategies may be required. Application of such methods remains limited in certain epidemiologic research areas. The overarching aim of this dissertation was to apply novel analytic strategies with close ties to causal inference and statistical learning theory to gain new insights into well-studied areas of perinatal epidemiology. In Study 1, we explored whether the association between short interpregnancy intervals (i.e., the end of one pregnancy to the start of the next) and increased risk of preterm birth may be due to residual confounding in three populations (n=693 American Indian and n=728 white women from the Northern Plains, U.S., and n=783 mixed ancestry women from the Western Cape, South Africa). Using data from the prospective Safe Passage cohort (2007-2015), we applied propensity score methods to control for a variety of sociodemographic and reproductive factors. A third-to-half of women with <6 months intervals had propensity scores that largely did not overlap with those of women with 18-23 months intervals. Since the propensity score models included factors related to both interpregnancy interval and preterm birth, these findings suggest the possibility of strong confounding in all three populations. The pooled associational estimate with preterm birth was attenuated in the propensity score trimmed and weighted data (risk ratio 1.4, 95% CI 0.75-2.6) compared with the crude results (risk ratio 1.7, 95% CI 1.1-2.7). However, the sample size and precision were reduced after propensity score trimming, and several covariates remained imbalanced. The data demonstrated the complexity of the processes leading to interpregnancy interval length. These issues may have been difficult to identify without comprehensive confounder data and with other methods, such as traditional regression adjustment. In Study 2, we examined the relative importance of timing (first trimester versus second/third trimesters) and degree of gestational weight gain in relation to infant size at birth (small-and-large-for-gestational age) among women with obesity using data from a medical records-based case-cohort study (Pittsburgh, PA, 1998-2010). We operationalized serial antenatal weight measurements as above, below, or within the current recommended ranges for U.S. pregnancies, i.e., 0.2-2.0 kg total gain in the first trimester and 0.17-0.27 kg per week in the second and third trimesters (based on group based trajectory modeling). Data were analyzed by obesity class (n=1290 in the class I subcohort, n=1247 class II, n=1198 class III). Our findings supported the current clinical guidelines, except for women with class III obesity. Among women with class III obesity, lower than recommended gain in the second and third trimesters was associated with decreased risk of having a large-for-gestational age infant (adjusted risk ratio 0.76, 95% CI 0.51-1.1), while not increasing small-for-gestational age (SGA) risk (adjusted risk ratio 1.0, 95% CI 0.63-1.7). Our results were in agreement with findings from several other studies of women with obesity using other methodologies to operationalize gestational weight gain. In Study 3, we used hierarchical clustering to explore latent groups of placental pathology features. We also investigated whether the placental clusters, in addition to birthweight percentiles, were beneficial to explain the variability of select adverse pregnancy outcomes. Data were from the Safe Passage Study (same as Study 1, n=2005). We identified one cluster with low prevalence of abnormalities (60.9%) and three clusters that mapped well to the expert consensus-based Amsterdam criteria: severe maternal vascular malperfusion (5.8%), fetal vascular malperfusion (11.1%), and inflammation (22.1%). The clusters were weakly-to-moderately associated with certain antenatal risk factors, pregnancy complications, and neonatal outcomes. Birthweight percentiles plus the placental clusters was better able to explain the variance of select adverse outcomes, compared with using small-for-gestational age only. This study serves as proof-of-concept that machine learning methods, and placental data, may aid in the identification and etiologic study of certain adverse pregnancy outcomes. In sum, all three studies support that the application of novel analytic methods to high-dimensional datasets may expand our understanding of certain causal questions, even ones that have been broached before, although, as seen in Study 2, such research may not always yield novel insights

Beyond Pressure and Perfectionism – Student Struggles in Contemporary Denmark from the Perspectives of Educational Counsellors

This chapter explores the struggles that high school and university students in Denmark experience and try to cope with, through the perspectives of study counselors. Scholars have lately described a relation between students’ felt pressures and an increase in diagnoses such as stress, anxiety, and depression as well as increases in the non-medical use of prescription pharmaceuticals for enhancement purposes. While counselors have a unique position in the educational system as someone who is there to support the students, they are also witnesses to the changes that student populations experience over time. The chapter is based on in-depth interviews with 36 counselors at different universities and high schools in Denmark and examines how counselors cope with new developments in the educational system as well as new kinds of student challenges and struggles that go beyond issues with performance and perfection

Digitale læremidler, antropologi og et kvalitativt udgangspunkt i brugerne

Antropologer har været i felten for at tilbringe tid med, observere, deltage og interviewe elever, lærere, skolebibliotekarer og CFU-konsulenter. Målet var at skabe ny indsigt, et kvalitativt grundlag for at udvikle og teste samt at involvere projektdeltagerne

Antidepressant utilization after hospitalization with depression:a comparison between non-Western immigrants and Danish-born residents

BACKGROUND: Antidepressant (AD) therapy is recommended for patients 4–12 months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD therapy after discharge and 2) early AD discontinuation. METHODS: A cohort of immigrants from non-Western countries (n = 132) and matched Danish-born residents (n = 396) discharged after first admission with moderate to severe depression between 1 January 1996 and 31 May 2008 was followed in the Danish registries. Logistic regression models were applied to explore AD initiation within 30 days after discharge, estimating odds ratio (OR) for immigrants versus Danish-born residents. Early discontinuation was explored by logistic regression, estimating OR for no AD dispensing within 180 days after the first dispensing, and by Cox regression, estimating hazard ratio (HR) for discontinuation (maximum drug supply gap) within 180 days. RESULTS: Immigrants had higher odds for not initiating AD treatment after discharge than Danish-born residents (OR = 1.55; 95% CI: 1.01-2.38). When income was included in the model, the strength of the association was attenuated. Odds for early discontinuation was non-significantly higher among immigrants than Danish-born residents (OR = 1.80; 0.87-3.73). Immigrants also had a non-significantly higher hazard of early discontinuation (HR = 1.46; 95% CI: 0.87-2.45). Including income had only minor impact on these associations. CONCLUSION: Immigrants seem less likely to receive the recommended AD treatment after hospitalization with depression. This may indicate a need for a better understanding of the circumstances of this vulnerable group