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BMJ Open Nov 2016Research suggests that individual and environmental resilience protective factors may be associated with adolescent substance use; however, the associations between a...
OBJECTIVES
Research suggests that individual and environmental resilience protective factors may be associated with adolescent substance use; however, the associations between a broad range of such factors and use of various types of substances have not been examined. The study aimed to determine the association between a comprehensive range of adolescent individual and environmental resilience protective factors and measures of tobacco, alcohol and illicit substance use.
DESIGN
Cross-sectional study.
SETTING
32 Australian secondary schools.
PARTICIPANTS
Grade 7-10 students (aged 11-17 years).
MEASURES
Data regarding 14 student individual and environmental resilience protective factors and seven substance use measures (tobacco, alcohol, marijuana, other illicit drug use) were obtained via an online self-report survey. Adjusted multivariate logistic regression analyses examined the association between all student resilience protective factors and seven substance use measures.
RESULTS
Inverse univariate associations were found for 94 of 98 relationships examined (n=10 092). Multivariate analyses found: consistent inverse associations between 2 of 14 protective factors and all substance use measures ('goals and aspirations', 'prosocial peers'); inverse associations between 4 protective factors with multiple substance use measures ('home support' (5 of 7), 'school support' (3 of 7), 'self-awareness' (2 of 7), 'community meaningful participation' (2 of 7)); positive associations between 2 resilience protective factors with multiple measures of substance use ('community support' (3 of 7), 'peer caring relationships' (5 of 7)) and 6 protective factors not to be associated with any substance use measure.
CONCLUSIONS
Despite individual relationships between the majority of resilience protective factors and substance use types, the protective benefit of such factors for adolescent substance use was limited to only a small number of such factors when considered collectively. Such results suggest that interventions seeking to reduce adolescent substance use may need to target specific protective factors to address specific types of substance use.
TRIAL REGISTRATION NUMBER
ACTRN12611000606987, Results.
Topics: Adolescent; Adolescent Behavior; Child; Cross-Sectional Studies; Female; Humans; Logistic Models; Male; Marijuana Smoking; Multivariate Analysis; New South Wales; Protective Factors; Resilience, Psychological; Schools; Self Report; Students; Tobacco Smoking; Underage Drinking
PubMed: 27888175
DOI: 10.1136/bmjopen-2016-012688 -
Journal of Substance Use and Addiction... Mar 2023Ongoing recovery from addiction often happens outside of formal "treatment" settings. Collegiate recovery programs (CRPs) have existed in higher education institutions...
Ongoing recovery from addiction often happens outside of formal "treatment" settings. Collegiate recovery programs (CRPs) have existed in higher education institutions in the United States since the 1980s as part of vital "recovery ready ecosystems" (Ashford et al., 2020) for those with educational aspirations. Aspiration often begins with inspiration and Europeans are now beginning their own journeys with CRPs. In this narrative piece, I use my own lived experience of addiction and recovery through a life course that highlights mechanisms of change that are entwined with academia. This life course narrative maps well on to extant literature on recovery capital and illuminates some of the stigma-based boundaries that still stand in the way of progress in this field. The hope is that this narrative piece will inspire aspirations for both individuals and organizations thinking about setting up CRPs in Europe, and further a field, and also inspire people in recovery to consider education as an aspiration for their continued growth and healing.
Topics: Humans; Behavior, Addictive; Ecosystem; Educational Status; Schools
PubMed: 36880901
DOI: 10.1016/j.josat.2022.208949 -
Computers & Education Jan 2021While the hype around Massive Open Online Courses (MOOCs) has subsided in the past few years, such environments provide a rich opportunity to explore ongoing questions...
While the hype around Massive Open Online Courses (MOOCs) has subsided in the past few years, such environments provide a rich opportunity to explore ongoing questions at the intersection of teaching, learning, and technology. This paper explores how a set of facilitation teams described enacting their learner-centered pedagogical aspirations through MOOC platforms. Drawing on in-depth interviews, we present a set of six facilitator actions: "giving up control," "distributing facilitation," "being live," "amplifying," "modeling," and "being explicit." We discuss these actions as emerging from the negotiation between existing pedagogical aspirations and the realities of a new medium, highlighting how they involve facilitators both stepping (making space for and foregrounding learner expertise and perspectives) and stepping (intervening and directing as a facilitator). This research contributes to the ongoing work of articulating the substance and specificity of teaching in learner-centered pedagogy and the persistent challenges of enacting that pedagogy in massive, online spaces.
PubMed: 33071438
DOI: 10.1016/j.compedu.2020.104042 -
Scientific Reports Dec 2022Smoke emissions produced by firearms contain hazardous chemicals, but little is known if their properties change depending on firearm and ammunition type and whether...
Smoke emissions produced by firearms contain hazardous chemicals, but little is known if their properties change depending on firearm and ammunition type and whether such changes affect toxicity outcomes. Pulmonary toxicity was assessed in mice exposed by oropharyngeal aspiration to six different types of smoke-related particulate matter (PM) samples; (1) handgun PM, (2) rifle PM, (3) copper (Cu) particles (a surrogate for Cu in the rifle PM) with and without the Cu chelator penicillamine, (4) water-soluble components of the rifle PM, (5) soluble components with removal of metal ions, and (6) insoluble components of the rifle PM. Gun firing smoke PM was in the respirable size range but the chemical composition varied with high levels of Pb in the handgun and Cu in the rifle smoke. The handgun PM did not induce appreciable lung toxicity at 4 and 24 h post-exposure while the rifle PM significantly increased lung inflammation and reduced lung function. The same levels of pure Cu particles alone and the soluble components from the rifle fire PM increased neutrophil numbers but did not cause appreciable cellular damage or lung function changes when compared to the negative (saline) control. Penicillamine treated rifle PM or Cu, slightly reduced lung inflammation and injury but did not improve the lung function decrements. Chelation of the soluble metal ions from the rifle fire PM neutralized the lung toxicity while the insoluble components induced the lung toxicity to the same degree as the rifle PM. The results show that different firearm types can generate contrasting chemical spectra in their emissions and that the rifle PM effects were mostly driven by water-insoluble components containing high levels of Cu. These findings provide better knowledge of hazardous substances in gun firing smoke and their potential toxicological profile.
Topics: Animals; Mice; Particulate Matter; Firearms; Penicillamine; Hazardous Substances; Chelating Agents; Water; Lung
PubMed: 36456643
DOI: 10.1038/s41598-022-24856-5 -
Annals of the Royal College of Surgeons... Sep 2018Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid...
Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid gel. Its main use is to reduce spillages. If ingested, this substance presents significant risk of asphyxiation. There have been 15 reported cases of Vernagel ingestion in 6 years and 1 death from asphyxiation. We present the case of an elderly patient who was admitted following a fall. He accidentally ingested a sachet of Vernagel during the early hours of the morning. An urgent rigid panendoscopy was performed and the material was evacuated using suction aspiration. Patients should be supervised when using Vernagel on the ward, to avoid ingestion. Ear, nose and throat doctors should be aware of Vernagel and its properties. Owing to the risk of airway obstruction, excellent coordination between the anaesthetist and surgeon is crucial, and prompt management is required.
Topics: Acrylic Resins; Aged; Asphyxia; Endoscopy; Foreign Bodies; Humans; Male; Risk Factors; Suction
PubMed: 29909673
DOI: 10.1308/rcsann.2018.0104 -
World Journal of Surgery May 1996Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early... (Review)
Review
Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early EN possible. Jejunal tube-feeding has advantages over gastric tube-feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO-donating substances and chewing of nitrate-rich food, such as lettuce or spinach, can be useful. Oral and mucosa-protective lipids are recommended. H2 blockers and saliva-inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such as Pseudomonas. Food antioxidants such as glutathione, vitamin E, and beta-carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so-called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa-reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa-adhering Lactobacillus plantarum 299.
Topics: Energy Intake; Enteral Nutrition; Food, Formulated; Gastric Acid; Humans; Intestinal Absorption; Intestinal Mucosa; Multiple Organ Failure; Nutritional Requirements; Saliva
PubMed: 8662138
DOI: 10.1007/s002689900075 -
ALTEX 2016The recent advent of microphysiological systems - microfluidic biomimetic devices that aspire to emulate the biology of human tissues, organs and circulation in vitro -... (Review)
Review
The recent advent of microphysiological systems - microfluidic biomimetic devices that aspire to emulate the biology of human tissues, organs and circulation in vitro - is envisaged to enable a global paradigm shift in drug development. An extraordinary US governmental initiative and various dedicated research programs in Europe and Asia have led recently to the first cutting-edge achievements of human single-organ and multi-organ engineering based on microphysiological systems. The expectation is that test systems established on this basis would model various disease stages, and predict toxicity, immunogenicity, ADME profiles and treatment efficacy prior to clinical testing. Consequently, this technology could significantly affect the way drug substances are developed in the future. Furthermore, microphysiological system-based assays may revolutionize our current global programs of prioritization of hazard characterization for any new substances to be used, for example, in agriculture, food, ecosystems or cosmetics, thus, replacing laboratory animal models used currently. Thirty-six experts from academia, industry and regulatory bodies present here the results of an intensive workshop (held in June 2015, Berlin, Germany). They review the status quo of microphysiological systems available today against industry needs, and assess the broad variety of approaches with fit-for-purpose potential in the drug development cycle. Feasible technical solutions to reach the next levels of human biology in vitro are proposed. Furthermore, key organ-on-a-chip case studies, as well as various national and international programs are highlighted. Finally, a roadmap into the future is outlined, to allow for more predictive and regulatory-accepted substance testing on a global scale.
Topics: Animal Testing Alternatives; Animals; Cell Line; Hazardous Substances; Lab-On-A-Chip Devices; Stem Cells; Toxicity Tests
PubMed: 27180100
DOI: 10.14573/altex.1603161 -
Journal of Addiction MedicineGaps in addiction medicine training are a reason for poor substance use care in North America. Hospital addiction medicine consult services (AMCS) provide critical...
OBJECTIVES
Gaps in addiction medicine training are a reason for poor substance use care in North America. Hospital addiction medicine consult services (AMCS) provide critical medical services, including screening and treatment of substance use disorders. Although these programs often feature an educational component for medical learners, the impact of AMCS teaching on objective knowledge and career aspirations in addiction medicine has not been well described.
METHODS
The authors report findings from two sequential studies conducted at a large academic hospital in Vancouver, Canada. The first study assessed the impact of an AMCS clinical rotation on medical trainee addiction medicine objective knowledge using an online survey of 6 true/false questions before and after the rotation. The second study examined the impact of an AMCS rotation on career aspirations using 4 seven-point Likert-type questions. One-sample t tests on mean differences (MD) with Benjamini-Hochberg adjustment for multiple comparisons were employed for statistical analyses.
RESULTS
Between May 2017 and June 2018, knowledge scores were significantly higher postrotation (MD = 4.78, standard deviation [SD] = 19.5, P = 0.034) among 115 medical trainees. Between July 2018 and July 2019, aspirations to practice addiction medicine were significantly more favorable postrotation (MD = 3.48, SD = 3.15, P < 0.001) among 101 medical trainees.
CONCLUSIONS
AMCS rotations appear to improve addiction medicine knowledge and aspirations to practice addiction medicine among medical trainees. Larger-scale evaluations and outcomes research on integrating substance use disorders teaching in these settings will help move the discipline forward.
Topics: Addiction Medicine; Hospitals, Urban; Humans; Internship and Residency; Referral and Consultation; Substance-Related Disorders
PubMed: 33758117
DOI: 10.1097/ADM.0000000000000830 -
Kidney Diseases (Basel, Switzerland) Oct 2016Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease in Western countries. The prevalence is between 2.4/10,000 and... (Review)
Review
BACKGROUND
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease in Western countries. The prevalence is between 2.4/10,000 and 3.9/10,000. ADPKD represents a systemic disease resulting in deterioration in renal function. Until now, mutations in two genes and have been identified. Recently, the European Medicines Agency (EMA) approved the use of the vasopressin V2 receptor antagonist tolvaptan to slow the progression of cyst development and renal insufficiency connected with ADPKD in adult patients with chronic kidney disease stages 1-3 at initiation of treatment with evidence of rapidly progressing disease. Whereas the EMA approved the release of tolvaptan, the US Food and Drug Administration (FDA) requested further data on side effects and the selection of patient cohorts who may benefit from treatment.
SUMMARY
This review focused on advances in the management and treatment of ADPKD in Western countries.
KEY MESSAGE
ADPKD represents the fourth most common cause of end-stage renal disease (ESRD) in Western countries. ADPKD is a multisystemic disease characterized by the progressive development of bilateral renal cysts, resulting in enlargement of the kidney volume due to cystic formations, hypertension, hematuria, and loss of renal function. ADPKD is associated with high inter- and intrafamilial variability in disease appearance and progression. Patients with mutations typically have a more severe phenotype than those with mutations. ADPKD is under intensive investigation. Vasopressin and the associated cyclic adenosine monophosphate-related signaling pathways have been demonstrated to be important contributors to cyst growth in ADPKD. Supportive treatments are recommended with the aim of reducing morbidity and mortality associated with disease manifestations. In the past years, several agents have been investigated in ADPKD patients, including mTOR inhibitors, somatostatin analogs, statins, and vasopressin V2 receptor antagonists.
FACTS FROM EAST AND WEST
(1) ADPKD is diagnosed globally by ultrasound detection of kidney enlargement and presence of cysts. Recent analyses of variants of the and genes by next-generation sequencing in Chinese and Western ADPKD patients might lead to the development of reliable genetic tests. (2) Besides lifestyle changes (low-salt diet, sufficient fluid intake, and no smoking), blood pressure control is the primary nonspecific treatment recommended by Kidney Disease - Improving Global Outcomes (KDIGO) for ADPKD patients. How low the blood pressure target should be and what the means of achieving it are remain open questions depending on the severity of chronic kidney disease and the age of the patients. In a recent Chinese study, diagnostic needle aspiration and laparoscopic unroofing surgery successfully improved infection, pain, and hypertension. Peritoneal dialysis was found to be a feasible treatment for most Chinese ADPKD patients with ESRD. In most Western centers, patients without contraindication are selected for peritoneal dialysis. Kidney transplantation with concurrent bilateral nephrectomy was successful in relieving hypertension and infection in Chinese ADPKD patients. In Western countries, sequential surgical intervention with kidney transplantation after nephrectomy, or the other way round, is preferred in order to reduce risks. (3) The vasopressin 2 receptor antagonist tolvaptan was approved in Europe, Canada, Japan, and Korea to slow down progression of kidney disease in ADPKD patients. Tolvaptan is not yet approved in the USA or in China. mTOR pathway-targeting drugs are currently under evaluation: mTOR inhibitors could slow down the increase in total kidney volume in a cohort of Western and Japanese ADPKD patients. Western studies as well as an ongoing study in China failed to show benefit from rapamycin. A study performed in Italy indicates protective effects of the somatostatin analog octreotide in ADPKD patients. Western and Chinese studies revealed a potential beneficial effect of triptolide, the active substance of the traditional Chinese medicine (Lei Gong Teng) to prevent worsening in ADPKD patients.
PubMed: 27921039
DOI: 10.1159/000449394 -
Infant and Child Development 2022In May 2021, a reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) was introduced in the U.S. Senate. This reauthorization substantially amends...
In May 2021, a reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) was introduced in the U.S. Senate. This reauthorization substantially amends provisions concerning infants affected by prenatal substance exposure and decidedly shifts the policy from a child safety- to a public health-focused approach to achieve the larger goals of healthy and safe child development and caregiver recovery from substance use disorder. Despite its honorable aspirations, no research has tested whether CAPTA "works". To advance scholarship on this policy, we summarize the service needs for this population and clarify how the CAPTA reauthorization aims to address these needs. We then apply a health utilization theory to understanding the mechanisms of effect on maternal-child outcomes. Based on this theoretical analysis, we discuss directions for future research.
PubMed: 38288357
DOI: 10.1002/icd.2309