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Health Promotion International Jun 2024From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable... (Review)
Review
From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable correlates of substance use prevention [e.g. health literacy (HL)], which, if embedded in interventions, may improve uptake and outcomes. Hence, this study conducted a scoping review to answer the question: What is known from the existing literature about the relationship between HL and substance use correlates and behaviors in adolescents? Five electronic databases and the bibliography of review articles were searched and a total of 1770 records were identified. After removing duplicates and engaging in three levels of screening to identify studies that included adolescents ≤ 25 years old and assessed the relationship between general HL (vs. behavior/disease-specific health knowledge) and substance use behaviors and correlates, 16 studies were retained. Studies assessed alcohol-related (n = 11), tobacco-related (n = 12), electronic vapor product use-related (n = 4), cannabis-related (n = 1), and amphetamines/methamphetamines-related (n = 1) outcomes. Studies spanned Africa, Asia, Europe, and North and Central America. Most studies included substance use as an outcome and found an inverse relationship between HL and use. Few studies examined substance use correlates (e.g. risk perception). There were no longitudinal or intervention studies. This review highlighted that the topic of adolescent HL and its relationship with substance use remains inadequately researched. Notable gaps for future studies include intervention and longitudinal designs, expansion of outcomes (e.g. more studies on marijuana, prescription drug misuse, vaping, substance use-related correlates), and examining HL as a mediator or moderator of substance use and its correlates.
Topics: Humans; Adolescent; Health Literacy; Substance-Related Disorders; Adolescent Behavior; Health Knowledge, Attitudes, Practice
PubMed: 38943527
DOI: 10.1093/heapro/daae074 -
Giornale Italiano Di Nefrologia :... Jun 2024IgA nephropathy (IgAN) is a fairly common association with alcoholic liver disease. However, IgA vasculitis (IgAV) is quite an uncommon association with alcoholic liver...
IgA nephropathy (IgAN) is a fairly common association with alcoholic liver disease. However, IgA vasculitis (IgAV) is quite an uncommon association with alcoholic liver cirrhosis and only a handful of cases have been reported in literature. Secondary IgAN usually presents in a docile manner, progressing slowly in about 5-25 years. It is usually responsive to steroid therapy, very rarely progressing to End-Stage Renal Disease. Here, we present a man in his late 50s, a known hypertensive and alcohol related liver-cirrhotic, who presented to our hospital with rash and rapidly progressive renal failure (RPRF). He was diagnosed with IgA nephritis with IgA vasculitis (IgAVN). His diagnosis was confirmed with skin and renal biopsy. He was started on renal replacement therapy for his renal failure and began oral steroid therapy. After administration of steroid therapy for 6 months, the patient recovered and was dialysis independent with stable renal parameters.
Topics: Humans; Male; Glomerulonephritis, IGA; Middle Aged; Disease Progression; Liver Diseases, Alcoholic; IgA Vasculitis; Vasculitis
PubMed: 38943330
DOI: 10.69097/41-03-2024-09 -
Harm Reduction Journal Jun 2024Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are...
Economic evaluation of the effect of needle and syringe programs on skin, soft tissue, and vascular infections in people who inject drugs: a microsimulation modelling approach.
BACKGROUND
Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID.
METHODS
We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks.
RESULTS
The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72-0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95-0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87-0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97-0.99) for non-purulent SSTVI.
CONCLUSIONS
Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.
Topics: Humans; Substance Abuse, Intravenous; Needle-Exchange Programs; Cost-Benefit Analysis; Soft Tissue Infections; Quality-Adjusted Life Years; Vascular Diseases; Skin Diseases, Infectious; Canada; Computer Simulation; Harm Reduction; Female; Male; Adult; Models, Economic
PubMed: 38943164
DOI: 10.1186/s12954-024-01037-3 -
The Lancet. Public Health Jul 2024Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer...
BACKGROUND
Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence.
METHODS
We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors.
FINDINGS
10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses.
INTERPRETATION
Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence.
FUNDING
European Union's EU4Health programme.
Topics: Humans; Male; Female; France; Neoplasms; Middle Aged; Retrospective Studies; Alcoholism; Adult; Aged; Risk Factors; Incidence
PubMed: 38942557
DOI: 10.1016/S2468-2667(24)00107-5 -
The Lancet. Public Health Jul 2024Overdose is the leading cause of death for people released from prison, and opioid agonist treatment is associated with reductions in mortality after imprisonment....
Estimated effects of opioid agonist treatment in prison on all-cause mortality and overdose mortality in people released from prison in Norway: a prospective analysis of data from the Norwegian Prison Release Study (nPRIS).
BACKGROUND
Overdose is the leading cause of death for people released from prison, and opioid agonist treatment is associated with reductions in mortality after imprisonment. However, few studies have explored the interplay of the potential modifiable risk factors and protective factors for mortality after release from prison. We aimed to describe all-cause mortality and overdose mortality among individuals released from Norwegian prisons during 2000-22 and to identify pre-existing risk factors associated with both types of mortality among these individuals for 6 months.
METHODS
For this prospective analysis, we used data from the Norwegian Prison Release Study (nPRIS), which includes all people in prison in Norway between Jan 1, 2000, and Dec 31, 2022; the Norwegian Cause of Death Registry; the Norwegian Prison Registry; the Norwegian Patient Registry; and Statistics Norway. All prisons in Norway that were open during this period were included. People who did not have a Norwegian personal identification number or were serving their sentence outside of prison units were excluded from this analysis. To identify pre-existing risk factors associated with all-cause and overdose mortality among people released from prison, we left-censored the observation period on Jan 1, 2010, creating a subsample of individuals. We calculated crude mortality rates (CMRs) and corresponding 95% CIs as the number of deaths per 100 000 person-years for several time periods after release. The primary outcomes were all-cause mortality and overdose mortality according to the ICD-10, assessed in all participants and analysed via two separate Cox proportional-hazards models.
FINDINGS
The total nPRIS cohort included 112 877 individuals released from prison in Norway between 2000 and 2022, 11 995 (10·6%) of whom were female and 100 865 (89·4%) of whom were male. We identified 13 004 instances of all-cause mortality and 3085 instances of overdose mortality during the 1 463 035 person-years. The estimated CMR for all-cause mortality was 889 (95% CI 874-904) per 100 000 person-years and for overdose mortality was 211 (203-218) per 100 000 person-years. Among people diagnosed with opioid use disorder before entering prison during 2010-22 (n=6830), provision of opioid agonist treatment was estimated to be associated with reductions in both all-cause mortality (hazard ratio 0·58, 95% CI 0·39-0·85) and overdose mortality (0·51, 0·31-0·82) in the 6 months after leaving prison after adjustment for sociodemographic, prison-related, and clinical characteristics.
INTERPRETATION
In people diagnosed with opioid use disorder released from Norwegian prisons, opioid agonist treatment provided while in prison was a protective factor for both all-cause and overdose mortality at 6 months. Provision of opioid agonist treatment while in prison is crucial in reducing mortality for 6 months after release and should be available to all people in prison who have treatment needs.
FUNDING
South-Eastern Norway Regional Health Authority and the Research Council of Norway.
Topics: Humans; Norway; Male; Prospective Studies; Female; Adult; Drug Overdose; Prisoners; Middle Aged; Cause of Death; Prisons; Risk Factors; Analgesics, Opioid; Young Adult; Mortality; Registries; Opiate Substitution Treatment; Adolescent
PubMed: 38942554
DOI: 10.1016/S2468-2667(24)00098-7 -
Journal of the American Board of Family... Jun 2024Clinical decision support (CDS) tools are designed to help primary care clinicians (PCCs) implement evidence-based guidelines for chronic disease care. CDS tools may...
PURPOSE
Clinical decision support (CDS) tools are designed to help primary care clinicians (PCCs) implement evidence-based guidelines for chronic disease care. CDS tools may also be helpful for opioid use disorder (OUD), but only if PCCs use them in their regular workflow. This study's purpose was to understand PCC and clinic leader perceptions of barriers to using an OUD-CDS tool in primary care.
METHODS
PCCs and leaders (n = 13) from clinics in an integrated health system in which an OUD-CDS tool was implemented participated in semistructured qualitative interviews. Questions aimed to understand whether the CDS tool design, implementation, context, and content were barriers or facilitators to using the OUD-CDS in primary care. Recruitment stopped when thematic saturation was reached. An inductive thematic analysis approach was used to generate overall themes.
RESULTS
Five themes emerged: (1) PCCs prefer to minimize conversations about OUD risk and treatment; (2) PCCs are enthusiastic about a CDS tool that addresses a topic of interest but lack interest in treating OUD; (3) contextual barriers in primary care limit PCCs' ability to use CDS to manage OUD; (4) CDS needs to be simple and visible, save time, and add value to care; and (5) CDS has value in identifying and screening patients and facilitating referrals.
CONCLUSIONS
This study identified several factors that impact use of an OUD-CDS tool in primary care, including PCC interest in treating OUD, contextual barriers, and CDS design. These results may help others interested in implementing CDS for OUD in primary care.
PubMed: 38942448
DOI: 10.3122/jabfm.2023.230308R1 -
BMJ (Clinical Research Ed.) Jun 2024
Topics: Humans; Illicit Drugs; Terminology as Topic; Language; Substance-Related Disorders
PubMed: 38942438
DOI: 10.1136/bmj.q1453 -
Interactive Journal of Medical Research Jun 2024In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health...
BACKGROUND
In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates.
OBJECTIVE
This study aims to quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison.
METHODS
In 5 German prisons, a mixed methods evaluation study was conducted to assess feasibility, acceptance, and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses quantitative data from these consultations (June 2018 to February 2019) in addition to data from a sixth prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters.
RESULTS
At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 78%). In 68% (n=294) of all encounters, the patient was asked to consult a physician again if symptoms persisted or got worse. In 26% (n=115), a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4% (n=17) of the cases. Only in 2% (n=8) of the consultations, a hospital admission was needed. Usually, hospital admissions were the result of unscheduled consultations, and the videoconferencing system was the method of communication in 88% (n=7) of these cases, while 12% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode.
CONCLUSIONS
Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary.
PubMed: 38941595
DOI: 10.2196/44906 -
Science Advances Jun 2024Functional deficits in basal ganglia (BG) circuits contribute to cognitive and motor dysfunctions in alcohol use disorder. Chronic alcohol exposure alters synaptic...
Functional deficits in basal ganglia (BG) circuits contribute to cognitive and motor dysfunctions in alcohol use disorder. Chronic alcohol exposure alters synaptic function and neuronal excitability in the dorsal striatum, but it remains unclear how it affects BG output that is mediated by the substantia nigra pars reticulata (SNr). Here, we describe a neuronal subpopulation-specific synaptic organization of striatal and subthalamic (STN) inputs to the medial and lateral SNr. Chronic alcohol exposure (CIE) potentiated dorsolateral striatum (DLS) inputs but did not change dorsomedial striatum and STN inputs to the SNr. Chemogenetic inhibition of DLS direct pathway neurons revealed an enhanced role for DLS direct pathway neurons in execution of an instrumental lever-pressing task. Overall, we reveal a subregion-specific organization of striatal and subthalamic inputs onto the medial and lateral SNr and find that potentiated DLS-SNr inputs are accompanied by altered BG control of action execution following CIE.
Topics: Animals; Neuronal Plasticity; Basal Ganglia; Substantia Nigra; Ethanol; Corpus Striatum; Male; Mice; Neurons; Alcoholism; Neural Pathways
PubMed: 38941461
DOI: 10.1126/sciadv.adm6951 -
JAMA Network Open Jun 2024
Topics: Humans; Opioid-Related Disorders; Primary Health Care; Health Knowledge, Attitudes, Practice; Female; Male; Adult; Middle Aged; Analgesics, Opioid; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 38941101
DOI: 10.1001/jamanetworkopen.2024.19094