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Pramod Regmi, Edwin van Teijlingen, Vanora Hundley, Professor Padam Simkhada, Sheetal Sharma, Preeti Mahato
Health Prospect Vol 15, No 1, 2016.
In 2000, the United Nations (UN) adopted eight MillenniumDevelopment Goals (MDGs), three of these focused on health although several other MDGs included health-related components such as nutrition and sanitation (1). Overall progress towards the MDGs has been inspiring and specifically the health-related targets, e.g. MDG4 (reduce child mortality), MDG5 (improve maternal health) and MDG6 (combat HIV/ AIDS, malaria and other diseases) have been promising. For example, the global maternal mortality ratio (MMR) has fallen by 44% (from 341 in 2000 to 216 per 100,000 live births in 2015) and under-five mortality in the same period dropped by 53% (2). Despite these achievements, the world has failed to meet these MDG targets for both maternal mortality and under-five mortality, a fact recognised by maternal health practitioners, policy-makers and researchers across the globe (3). Moreover, progress has not advanced equally across the globe, for instance, improvements in MMR have been better in Southeast Asia (69% reduction) and the Western Pacific (64% reduction) (2).
A Comparative Exploration of Community Pharmacists’ Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom.
Tara Carney, John Wells, Michael Bergin, Siphokazi Dada, Michelle Foley, Padraig McGuiness, Professor Marie Claire Van Hout
INTERNATIONAL JOURNAL OF MENTAL HEALTH AND ADDICTION, 14(4), 351-369. doi:10.1007/s11469-016-9640-z, 2016.
Abstract: Misuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over-the-counter (OTC) and prescribed codeine. A qualitative design comprising six focus groups (n = 45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine-containing products and the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer–pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine and difficulties in relationships between pharmacists and prescribers. A number of recommendations were put forward as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and potential ways to deal with misuse and dependence.
Not in the vein: ‘missed hits’, subcutaneous and intramuscular injections and associated harms among people who inject psychoactive drugs in Bristol, United Kingdom
Professor Vivian Hope, J. V. Parry, Fortune Ncube, Matthew Hickman
Int J Drug Policy. 2016 Feb; 28:83-90, 2016.
Abstract: BACKGROUND: The extent of intentional or accidental subcutaneous and intramuscular injections and the factors associated with these have rarely been studied among people who inject drugs, yet these may play an important role in the acquisition bacterial infections. This study describes the extent of these, and in particular the factors and harms associated with accidental subcutaneous and intramuscular injections (i.e. 'missed hits'). METHODS: People who inject drugs were recruited using respondent driven sampling. Weighted data was examined using bivariate analyses and logistic regression. RESULTS: The participants mean age was 33 years (31% aged under 30-years), 28% were women, and the mean time since first injection was 12 years (N=329). During the preceding three months, 97% had injected heroin, 71% crack-cocaine, and 16% amphetamines; 36% injected daily. Overall, 99% (325) reported that they aimed to inject intravenously; only three aimed to inject subcutaneously and one intramuscularly. Of those that aimed to inject intravenously, 56% (181) reported ever missing a vein (for 51 this occurred more than four times month on average). Factors associated with 'missed hits' suggested that these were the consequence of poor vascular access, injection technique and/or hygiene. 'Missed hits' were twice as common among those reporting sores/open wounds, abscesses, or redness, swelling and tenderness at injection sites. CONCLUSION: Intentional subcutaneous and intramuscular injections are rare in this sample. 'Missed hits' are common and appear to be associated with poor injection practice. Interventions are required to reduce risk through improving injecting practice and hygiene.
The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review
Professor Marie Claire Van Hout, R Brennan, John Wells
Health and Social Care in the Community, 25(5), 1459-1531. doi:10.1111/hsc.12326, 2016.
Abstract: Injecting use of image and performance-enhancing drugs (IPED) in the general population is a public health concern. A wide and varied range of IPED are now easily accessible to all through the online market. A comprehensive literature review was undertaken according to Critical Appraisal Skills Programme (CASP) guidelines for systematic review, to identify the relevant literature. No date restrictions were placed on the database search in the case of human growth hormone melanotan I and II, and oil and cosmetic injectables. In the case of anabolic androgenic steroids search dates were restricted to January 2014-2015. Publications not in English and with a lack of specificity to the topic were excluded. The review yielded 133 relevant quantitative and qualitative papers, clinical trials, clinical case presentations and editorials/reports. Findings were examined/reviewed under emergent themes which identified/measured extent of use, user profiling, sourcing, product endorsement, risk behaviours and health outcomes in users. Motivation for IPED use may be grounded in appearance, pursuit of health and youth, and body image disturbance. IPED users can practice moderated use, with pathological use linked to high-risk behaviours, which may be normalised within IPED communities. Many IPED trajectories and pathways of use are not scientifically documented. Much of this information may be available online in IPED specific discussion forums, an underutilised setting for research, where uncensored discourse takes place among users. This review underscores the need for future internet and clinical research to investigate prevalence and patterns of injecting use, and to map health outcomes in IPED users. This paper provides community-based clinical practice and health promotion services with a detailed examination and analysis of the injecting use of IPED, highlighting the patterns of this public health issue. It serves to disseminate updated publication information to health and social policy makers and those in health service practice who are involved in harm reduction intervention.
Professor Marie Claire Van Hout, John Wells
ADDICTION, 111(4), 748-749. doi:10.1111/add.13262, 2016.
Evelyn Hearne, Professor Marie Claire Van Hout
SUBSTANCE USE & MISUSE, 51(1), 73-84. doi:10.3109/10826084..1082595, 2016.
Abstract Communal online folk pharmacology fuels the drive for short cuts in attaining muscle enhancement, fat loss, and youthful skin.
Simon Russell, Professor Karen Hughes, Professor Mark Bellis
BMJ Open, 2016.
Abstract: Objectives: To examine the relative contribution of childhood experience, measured by childhood violence and childhood happiness, and adult well-being on adult eating preferences and behaviours, independent of proximal factors such as current deprivation. Design: A cross-sectional, stratified, randomised sample survey using retrospective measures of childhood violence and happiness and self-reported measures of current well-being. Setting: The North West Region of England between September 2012 and March 2013. Participants: Individuals aged 18–95-year-olds from randomly selected households ( participation was successful for 90% of eligible households and 78% of the total visited addresses; n=11 243). Outcomes: Dichotomised measures for preference of healthy foods or ‘feel good’ foods and low or high daily fruit and vegetable consumption. Results: After correcting for demographics, combined categories for childhood experience and dichotomised measures of adult well-being were found to be significantly related to adult food preferences and eating behaviours. Participants with unhappy and violent childhoods compared to those with happy and non-violent childhoods had adjusted ORs (95% CI, significance) of 2.67 (2.15 to 3.06, p<0.001) of having low daily fruit and vegetable intake (two or less portions) and 1.53 (1.29 to 1.81, p<0.001) of choosing ‘feel good’ foods over foods which were good for their long term health. Conclusions: Daily intake of fruit and vegetables, linked to non-communicable diseases, and preference for ‘feel good’ foods, linked to obesity, are affected by childhood experience and adult well-being independent of demographic factors. Preventative interventions which support parent–child relationships and improve childhood experience are likely to reduce the development of poor dietary and other health-risk behaviours.
Suzanne Nielsen, Professor Marie Claire Van Hout
Non-medical and illicit use of psychoactive drugs pp 59-75, 2016.
Abstract: Codeine is a widely used analgesic, that is available for sale in pharmacies over the counter (OTC) in a number of countries including the UK, South Africa, Ireland, France and Australia. In these countries with OTC codeine sales there has been emerging concerns about misuse of and dependence on codeine containing combination analgesics, with increasing numbers of people presenting for help with codeine dependence at primary care and addiction treatment services. This has led to many countries reviewing availability of codeine in OTC available preparations, and considering possible measures to reduce harms from misuse of OTC codeine containing combination analgesics.
Preeti Mahato, Pramod Regmi, Edwin van Teijlingen, Professor Padam Simkhada, Catherine Angell, Brijesh Sathian
Nepal Journal of Epidemiology 5(4): 518–519, 2015.
A massive earthquake hit Nepal in April followed by a strong aftershock in May. The earthquake had an impact in 31 districts out of the 75 districts of the country and total death toll reached 9,000, injured 23,000 and damaged 900,000 houses. Recent global and regional publications have indicated growing public health concerns and rebuilding infrastructures following the earthquake [2,3,4]; however none of the articles have focused on reproductive health care services, particularly on birthing centres in Nepal.
Stipulating citizen’s fundamental right to healthcare: Inference from the Constitution of Federal Republic of Nepal 2015
Professor Padam Simkhada, Pramod Regmi, Puspa Pant, Edwin van Teijlingen, Brijesh Sathian
Nepal Journal of Epidemiology Volume 5, No 4, 2015.
Nepal has a great opportunity to learn from, and collaborate with, non-governmental development partners and private sectors, and from other governments and organizations around the world, but we must move promptly.