Greater Risk Of Harm Research Articles

The effects of alcohol use on smoking cessation treatment with nicotine replacement therapy: An observational study

IntroductionConcurrent users of tobacco and alcohol are at greater risk of harm than use of either substance alone. It remains unclear how concurrent tobacco and alcohol use affects smoking cessation across levels of alcohol use and related problems. This study assessed the relationship between smoking cessation and levels of alcohol use problems. Methods59,018 participants received nicotine replacement therapy through a smoking cessation program. Alcohol use and related symptoms were assessed using the Alcohol Use Disorders Identification Test (AUDIT-10) and the AUDIT-Concise (AUDIT-C). The primary outcome was 7-day point prevalence cigarette abstinence (PPA) at 6-month follow-up. We evaluated the association between alcohol use (and related problems) and smoking cessation using descriptive methods and mixed-effects logistic regression. Results7-day PPA at 6-months was lower in groups meeting hazardous alcohol consumption criteria, with the lowest probability of smoking abstinence observed in the highest risk group. The probability of successful tobacco cessation fell with increasing levels of alcohol use and related problems. Adjusted predicted probabilities were 30.3 (95 % CI = 29.4, 31.1) for non-users, 30.2 (95 % CI = 29.4, 31.0) for low-risk users, 29.0 (95 % CI = 28.1, 29.9) for those scoring below 8 on the AUDIT-10, 27.3 (95 % CI = 26.0, 28.6) for those scoring 8–14, and 24.4 (95 % CI = 22.3, 26.5) for those scoring 15 or higher. ConclusionHeavy, hazardous alcohol use is associated with lower odds of successfully quitting smoking compared to low or non-use of alcohol. Targeting alcohol treatment to this group may improve tobacco cessation outcomes.

Side effects of COVID-19 vaccines in the middle eastern population.

The COVID-19 pandemic has caused severe worldwide health concerns since its first description as the SARS-COV-2 virus in December 2019. The wide dissemination of this virus, together with the lack of treatment, prompted vaccine development within a short period of time to elicit a protective immunity against COVID-19. Due to their rapid development, potential subsequent side effects of COVID-19 vaccines were overlooked, which might lead to many health concerns. This is especially true for patients at a greater risk of harm from COVID-19, such as pregnant women, children, and patients with pre-existing chronic diseases. In this review, we provide a summary of common to rare side effects of administrated COVID-19 vaccines in a Middle Eastern population. We have found that the distinction between side effects from COVID-19 vaccines in terms of frequency and severity is attributed to the differences in study populations, gender, and age. Pain at the injection site, fever, headache, fatigue, and muscle pain were the most common reported side effects. Vaccinated subjects with previous COVID-19 infection exhibited an equivalent neutralizing response after just one dose compared to two doses of vaccine. Consequently, individuals who experienced more side effects had significantly higher antibody levels. This indicates that having better immunity correlates with higher antibody levels, leading to a higher frequency of vaccine side effects. Individuals with underlying comorbidities, particularly having known allergies and with illnesses such as diabetes and cancer, might be more prone to post-vaccination side effects. Studies of a high-risk population in Middle Eastern countries are limited. Future studies should be considered to determine long-term side effects, side effects after booster doses, and side effect differences in cases of heterologous and homologous vaccination for better understanding and proper handling of high-risk populations and patients who experience these side effects.

Psychological Distress and Its Mediating Effect on Experiences of Online Risk: The Case for Vulnerable Young People

There is strong evidence showing that vulnerable children and adolescents, such as children who are carers for their family, in care themselves, or who have a physical disability or special educational needs, are at greater risk of mental health problems and poor social wellbeing. Recent research indicates this heterogenous but vulnerable group is also disadvantaged online and may be at greater risk of harm. This study aimed to examine participants’ vulnerability (vulnerable vs. non-vulnerable), psychological distress, parental e-safety support, and online lives, specifically their experiences of online risk. The roles of psychological distress and parental e-safety support were explored as possible mediators and moderators, respectively, for the relationship between vulnerability and online risk. Survey data was collected from 15,278 participants (11–17 years old; M = 12.60, SD = 1.44), 46.6% identified as females, 46.6% identified as males and 6% identified as “other”. Participants were recruited from schools/colleges in different parts of England, of whom 3,242 were categorised as vulnerable. Using Analysis of Variance (ANOVA) the results showed that, when compared to the non-vulnerable participants, the vulnerable groups (single or multiple vulnerabilities) experienced more psychological distress and online risks. They also received less e-safety support from parents or carers. Furthermore, mediation and moderated mediation analysis showed that the relationship between vulnerability and online risk was significantly and partially mediated by psychological distress. Parental e-safety support was found to moderate the relationship between psychological distress and online risk and between vulnerability and online risk. In conclusion, the results demonstrated that vulnerability offline is mirrored online. Psychological interventions and parental e-safety support are required to navigate the internet safely. Children’s services and practitioners should consider online risks in their assessments and interventions.

Has the pandemic exacerbated alcohol harm?

Men have always been at greater risk of harm than women from alcohol use, but the pandemic may have exacerbated the problem. Healthcare professionals can support public health colleagues in calling for government‐led initiatives to tackle alcohol availability.

NHS Scotland tenders for £66m pharmacogenomics decision support service

NHS Scotland is tendering for a £66m pharmacogenomics and pharmaceutical clinical decision support service to safely identify patients at greatest risk of harm from polypharmacy. The aim of the service is to enable prescribers to develop an efficient, safe and effective medicines regimen that is tailored to meet the patient’s changing needs, in order to […]

More evidence for worse COVID-19 outcomes in people with HIV

More evidence for worse COVID-19 outcomes in people with HIV

Precision Medicine and Adverse Drug Reactions Related to Cardiovascular Drugs.

Cardiovascular disease remains the leading global cause of death. Early intervention, with lifestyle advice alongside appropriate medical therapies, is fundamental to reduce patient mortality among high-risk individuals. For those who live with the daily challenges of cardiovascular disease, pharmacological management aims to relieve symptoms and prevent disease progression. Despite best efforts, prescription drugs are not without their adverse effects, which can cause significant patient morbidity and consequential economic burden for healthcare systems. Patients with cardiovascular diseases are often among the most vulnerable to adverse drug reactions due to multiple co-morbidities and advanced age. Examining a patient’s genome to assess for variants that may alter drug efficacy and susceptibility to adverse reactions underpins pharmacogenomics. This strategy is increasingly being implemented in clinical cardiology to tailor patient therapies. The identification of specific variants associated with adverse drug effects aims to predict those at greatest risk of harm, allowing alternative therapies to be given. This review will explore current guidance available for pharmacogenomic-based prescribing as well as exploring the potential implementation of genetic risk scores to tailor treatment. The benefits of large databases and electronic health records will be discussed to help facilitate the integration of pharmacogenomics into primary care, the heartland of prescribing.

Using Positive Empathy Interventions to Reduce Stigma Toward People Who Inject Drugs.

People who inject drugs are often the target of stigma that puts this already at-risk group at greater risk of harm. Past research has shown that holding stigmatizing views of people who inject drugs increases risky behaviors and is a barrier to their engagement in important medical and public health interventions. One explanation is that the negativity surrounding the group causes increased levels of anticipated emotional exhaustion, discouraging positive engagement. However, there has been minimal research focused on addressing this negativity to reduce levels of held stigma against people who inject drugs. We hypothesized that giving people an imagined positive contact exercise about people who inject would lead to a reduction in stigma, since exposure to positive empathy may create new mental associations between stigmatized groups and more positive emotions and experiences. Secondarily, we hypothesized that positive empathy strategies would be more effective than traditional informational or learning based techniques, and that the latter would be more effective than a control condition. Our sample consisted of 375 participants recruited online. Participants were assigned to one of three study conditions: a positive empathy condition, an informational learning condition, or a control condition, and completed a posttest social distance measure. Results demonstrated that subjects exposed to the positive empathy stigma reduction condition experienced a significant reduction in held stigma while participants exposed to traditional informational learning techniques showed no significant reduction in held stigma. Positive empathy-based stigma interventions should be further researched as a promising avenue to reduce the effects of drug-related stigma.

A Retrospective Analysis of Typologies of Animal Abuse Recorded by the SPCA, Hong Kong.

Simple SummaryStatistical data are necessary to inform public debate on effective animal protection legislation. This retrospective study of 254 animal cruelty complaints recorded by the SPCA (Hong Kong) between 2013 and 2019 identified the gender and age of abusers, their relationship with the owner of the animal (where the owner was not the suspect) and the circumstances of the abuse. Animals are primarily at risk of harm from their male owners and owners’ family members. Most cases involved traumatic physical injury to dogs, with 30% of cases involving animals being killed by the defendant or having to be euthanised within 24 h of rescue, due to the level of cruelty inflicted upon them. The second most common typology of abuse involved neglect, with 27% of cases involving animals that had died from neglect or required euthanasia within 24 h of rescue. Most neglect cases involved animals being abandoned inside private premises without food/water. Abuse motivated by commercial profit was dominated by the breeding of dogs and cats for the pet trade. Dogs collected from strays were the most commonly hoarded species. Recognising the types of abuse and the species most at risk can inform legislation intended to protect animals.We conducted a retrospective study of 254 suspected cruelty offences recorded by the Hong Kong Society for the Prevention of Cruelty to Animals (SPCA) between January 2013 and December 2019. Cases were categorised into four types of abuse: active maltreatment, passive neglect, commercial exploitation and hoarding. Attributes of defendants, relationship with the owner of the animal (where the owner was not the defendant) and the circumstances of the abuse (species of animal, number of animals involved, type of harm, need for medical care, number of animals seized) were recorded for each case. The majority of prosecuted cases involved traumatic physical injury to dogs, with 30% causing the death of animals. The second most common type of harm prosecuted was neglect, with 27% of cases causing death. The majority of neglect cases involved dogs abandoned inside private premises without food/water. The median number of animals hoarded was 47, with dogs the most common species. The majority of hoarders had collected their animals from strays. The largest hoarding cases (>100 animals) were operating as animal rescue shelters. Strategies to address cruelty to animals in Hong Kong can be informed by an understanding of which species are at greater risk of harm and in what circumstances this harm might occur.

How should we conduct pandemic vaccination?

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed?In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term.

Managing the misuse potential and risk of psychological harm from gabapentinoids in primary care in New Zealand.

Gabapentinoid prescribing is increasing in New Zealand. International evidence suggests that this prescribing trend is followed by increasing harms, including misuse, dependence, overdose, and psychological harms including suicidal thoughts or behaviours. However, there is limited guidance for prescribers on how to manage these potential harms. Here, we summarise the current international literature and identify three main risk factors that can be used for screening purposes when considering prescribing a gabapentinoid, to identify patients that may be at greater risk of harm. Based on current knowledge of harms, we provide guidance to prescribers on monitoring patients taking gabapentinoids. Finally, we summarise the evidence regarding tapering, and highlight key knowledge gaps including other interventions, referral, and data from primary care populations.

Appropriate polypharmacy: a barometer for integrated care

PurposePolypharmacy, the concurrent use of multiple medicines by one individual, is a common and growing challenge driven by an ageing population and the growing number of people living longer with chronic conditions. Up to 11% of unplanned hospital admissions in the UK are attributable to, mostly avoidable, harm from medicines. However, this topic is not yet central to integrated practice. This paper reviews the challenge that polypharmacy presents to the health and care system and offers lessons for integrated policy and practice.Design/methodology/approachTwo commonly encountered scenarios illustrate the relevance of addressing inappropriate polypharmacy to integrated practice. An overview of the literature on polypharmacy and frailty, including two recent large studies of policy and practice in Europe, identifies lessons for practitioners, managers, policy makers and commissioners.FindingsComprehensive change strategies should extend beyond pharmacist led deprescribing initiatives. An inter-professional and systems thinking approach is required, so all members of the integrated team can play their part in realising the value of holistic prescribing, appropriate polypharmacy and shared decision making.Practical implicationsAwareness and education about polypharmacy should be embedded in inter-professional training for all practitioners who care for people with multimorbidity or frailty.Originality/valueThis paper will help policy makers, commissioners, managers and practitioners understand the value of addressing polypharmacy within their integrated services. Best practice national guidance developed in Scotland illustrates how to target resources so those at greatest risk of harm from polypharmacy can benefit from effective pharmaceutical care as part of holistic integrated care.

Deficiency Citations in Nursing Homes That Predominantly Serve Residents With Serious Mental Illness

Studies suggest that nursing homes (NHs) that predominantly serve residents with serious mental illness (SMI) are of worse quality due to poor resources (i.e., high Medicaid-paying census) and lower staffing. We used national Certification and Survey Provider Enhanced Reports (CASPER) data to examine the deficiencies issued to NHs from 37,800 recertification inspections of 14,582 unique NHs from 2014 to 2017. NHs were categorized into “low-SMI” and “high-SMI” facilities using the lowest and highest quartiles, respectively, of the proportion of residents in the NH with SMI. Bivariate analyses were used to assess for differences between low-SMI and high-SMI NHs in the number of deficiencies, the deficiency score (a point-based metric developed by the Centers for Medicare & Medicaid Services), and the scope and severity of deficiencies. In total, there were 245,178 deficiencies issued. In comparison to low-SMI NHs, high-SMI NHs received a greater deficiency score and more deficiencies per survey (p<.001). Deficiencies given to high-SMI NHs were associated with greater risk of harm (p<.001) and were of wider scope (p<.001). High-SMI NHs were cited 215% more often for resident abuse or neglect and 61% more often for the policies that prohibit and monitor for risk of abuse and neglect in comparison to low-SMI NHs. In conclusion, high-SMI NHs were documented for providing worse care to residents, with one particular area of concern being the heightened risk of resident abuse and neglect. Implications for policy and practice will be discussed.

Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

ObjectivePrevious prevalence estimates of POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared...

Whore phobia: The experiences of a dual‐training sex worker–psychotherapist

This paper seeks to facilitate a discussion across schools of psychotherapy and UK professional registration bodies around the controversial and misunderstood subject of being a dual-trained/training psychotherapist and sex worker. Despite its importance to a minority of practitioners and clients, the potential overlap between sex work and psychotherapy remains an understudied and underreported area. We aim to open up conversation regarding the potential of sexuality work to therapeutically benefit clients for whom talking therapy alone is insufficient. We illustrate how medical theories of pathology are linked to gender diversity and then applied by “therapeutic” communities to marginalise and suppress competing ways to provide therapeutic contact. Our dialogue highlights the practice and philosophical inconsistencies of mainstream psychotherapies' codes of ethics and conduct, which underpin how dual-trained sex worker–therapists are deemed to bring the profession into disrepute. Rather than protecting the public, perhaps some sections of the public are left at greater risk of harm because such codes of ethics are unable to respect perceived transgressive sexualities, yet are comfortable with how practitioners are paid for intimate (albeit psychological) contact. We look into psychotherapy's shadow, and show that dual-trained sex-worker–therapists have something to offer. We also suggest ways to express sexual rights and reclaim sexuality bodywork from those who can be said to seek to exert power and control over the minds and bodies of others.

Morphine alters respiratory control but not other key obstructive sleep apnoea phenotypes: a randomised trial.

Accidental opioid-related deaths are increasing. These often occur during sleep. Opioids such as morphine may worsen obstructive sleep apnoea (OSA). Thus, people with OSA may be at greater risk of harm from morphine. Possible mechanisms include respiratory depression and reductions in drive to the pharyngeal muscles to increase upper airway collapsibility. However, the effects of morphine on the four key phenotypic causes of OSA (upper airway collapsibility (pharyngeal critical closure pressure; P crit), pharyngeal muscle responsiveness, respiratory arousal threshold and ventilatory control (loop gain) during sleep) are unknown.21 males with OSA (apnoea-hypopnoea index range 7-67 events·h-1) were studied on two nights (1-week washout) according to a double-blind, randomised, cross-over design (ACTRN12613000858796). Participants received 40 mg of MS-Contin on one visit and placebo on the other. Brief reductions in continuous positive airway pressure (CPAP) from the therapeutic level were delivered to induce airflow limitation during non-rapid eye movement (REM) sleep to quantify the four phenotypic traits. Carbon dioxide was delivered via nasal mask on therapeutic CPAP to quantify hypercapnic ventilatory responses during non-REM sleep.Compared to placebo, 40 mg of morphine did not change P crit (-0.1±2.4 versus -0.4±2.2 cmH2O, p=0.58), genioglossus muscle responsiveness (-2.2 (-0.87 to -5.4) versus -1.2 (-0.3 to -3.5) μV·cmH2O-1, p=0.22) or arousal threshold (-16.7±6.8 versus -15.4±6.0 cmH2O, p=0.41), but did reduce loop gain (-10.1±2.6 versus -4.4±2.1, p=0.04) and hypercapnic ventilatory responses (7.3±1.2 versus 6.1±1.5 L·min-1, p=0.006).Concordant with recent clinical findings, 40 mg of MS-Contin does not systematically impair airway collapsibility, pharyngeal muscle responsiveness or the arousal threshold in moderately severe OSA patients. However, consistent with blunted chemosensitivity, ventilatory control is altered.

COVID-19 and Substance Use Disorder: Study Protocol for the International Society of Addiction Medicine Practice and Policy Interest Group Global Survey.

Introduction:As one of the major health problems in the present century, the COVID-19 pandemic affected all parts of the global communities and the health of substance users are potentially at a greater risk of harm. This global study has been designed and conducted by the International Society of Addiction Medicine Practice and Policy Interest Group (ISAM-PPIG) to understand better the health related issues of people with Substance Use Disorders (SUD) as well as responses of the relevant health care systems during the pandemic.Methods:This is a cross-sectional study using convenient sampling. The data gathering was carried out with two follow-up stages each two months apart through an online conducted survey prepared using Google platform. The survey started by emergence of COVID-19 as a pandemic in March 2020 and respondents were followed till September 2020 when most of the initial lockdowns by most countries are supposed to be reopened.Ethics and Dissemination:The study was approved by the ethics committee of University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. The results will be published in relevant peer reviewing journals and communicated with different international stakeholders.

Evaluation of community pharmacists’ readiness to implement the Falsified Medicines Directive (Directive 2011/62/EC): an English cross-sectional survey with geospatial analysis

ObjectivesTo evaluate the readiness to implement the Falsified Medicines Directive (FMD) by community pharmacies in England. Eight secondary objectives were assessed.SettingCommunity/retail pharmacies.ParticipantsWe invited pharmacists from 501 pharmacies to complete a...

Reflections on the Domestic Violence Disclosure Scheme (England and Wales)

The Domestic Violence Disclosure Scheme (DVDS) aims to reduce harm through improving access to background information for people with concerns about a romantic partner’s behaviour. This reduction is predicated on the disclosure recipient taking steps to ensure their safety, either by managing the situation or ending the relationship. As fewer than half of the thousands of annual applications result in disclosures, and no information is held about any subsequent steps taken by applicants or recipients, it is unclear whether or not the DVDS is actually reducing domestic violence. Nonetheless, Scotland and Northern Ireland have implemented their own variations of this policy, as have some Canadian and Australian states.&lt;br /&gt;This policy analysis draws on empirical research into the DVDS in terms of its national and local operation in order to assess the strengths and limitations of its capacity to reduce harm. The analysis outlines how the policy may be difficult to access; deflect – rather than prevent – harm; shift safeguarding responsibilities onto the most vulnerable; and be incorrectly interpreted in terms of outcome. The paper makes recommendations for improvement in order to enhance the policy’s efficacy.&lt;br /&gt;key messagesDomestic violence prevention policies which require active citizenship may be less effective at preventing victimisation.&lt;br /&gt;The monitoring of outcomes following a DVDS application/disclosure is required.&lt;br /&gt;Care needs to be taken to ensure engagement with the DVDS does not put people at a greater risk of harm.

Chapter 2 - Behavioral and psychological symptoms in Alzheimer's dementia and vascular dementia

Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent and represent a significant burden for patients and their caregivers. Early recognition and management of these symptoms is crucial as they are associated with increased risk of institutionalization, impairments in daily functioning, reduced quality of life, and more rapid progression to severe dementia. This chapter will discuss the pathophysiology, proposed diagnostic criteria, clinical features, and management of BPSD, including apathy, depression, agitation/aggression, psychosis, and sleep disturbances. Apathy and depression are the most common overall, and apathy is associated with high symptom severity likely because of its greater persistence. Symptoms such as agitation, aggression, hallucinations, and delusions may be especially distressing and dangerous to patients and caregivers. Nonpharmacologic management should be considered first-line therapy in most cases due to the modest and inconsistent evidence base for pharmacologic agents and greater risk of harm. However, the judicious use of pharmacologic agents may be warranted when symptoms are dangerous and/or severely distressing.