Risk Of Harm Research Articles

Co-use of psychedelics with other substances: Findings from the global psychedelic survey.

While most psychedelic substances are considered to carry a relatively low risk of acute or long-term harm, co-use with other psychoactive substances may increase health and social harm. Using a large international survey of adults who use psychedelics, we sought to comprehensively characterize psychedelic co-use. We used data from the 2023 Global Psychedelic Survey, a web-based survey of adults ⩾21 with lifetime use of psychedelics. We explored patterns of co-use (prevalence, secondary substances used, timing, and motives of co-use) and examined sociodemographic and psychedelic use-related characteristics associated with co-use overall and by specific psychedelics. In total, 5370 respondents were included in this analysis, of whom 3228 (56.3%) reported typically co-using at least one of the 11 psychedelic substances of interest, with co-use lowest for ayahuasca (14.8%) and highest for nitrous oxide (54.5%). Cannabis and alcohol were the most common secondary substances. Depressants were the only secondary substance class that increased in use following psychedelic experiences. Greater experience with psychedelics was significantly associated with co-use, as was using for recreational purposes or to reduce/substitute the use of other substances. Personal exploration and therapeutic purposes for psychedelic use were negatively associated with co-use. In this detailed analysis of psychedelic co-use, we observed high rates of co-use with certain psychedelics, specifically when used recreationally. Our findings highlight psychedelic-specific consumers for whom harm reduction messaging around co-use practices may be best tailored. Further research is justified to assess whether specific patterns of co-use might reduce or increase potential harms.

Alcohol related emergencies among adolescents admitted in a referral acute-care center for adults in Genoa, northwest Italy

Abstract Background As a result of underage drinking, adolescents have an increased risk of physical, mental, emotional, and social harm. Methods In order to assess the emergencies for alcohol use, data of the emergency department (ED) of San Martino Hospital - the referral acute-care center for adults in Genoa, Northwest Italy - was analyzed retrospectively. 330 records of 320 adolescents visiting the ED between 2014 and 2023 were considered. Results The median age of access was 16 (IQR 2), 54.8% were males, 17.4% had foreign nationalities, and the average blood alcohol concentration (BAC) was 1.8 g/L (SD 0.7), with 14.7% testing positive for other substances (6.1% benzodiazepines and 11.2% other drugs). 16.8%, 46.6% and 36.6% were assigned an emergency, urgent, and not-urgent acuity code. 2.8% had a repeated episode, 3.4% had to be removed for inappropriate behavior, 7.8% left spontaneously, 13.1% were hospitalized for additional care (5.5% in the Psychiatry ward). The average length of stay was 1.24 days (SD 5.86). Multivariable logistic regression showed that higher age, an emergency code and the use of other substances were positively associated with hospitalization [ORs 1.74 (95%CI 1.1-2.7), p 0.01; 7.1 (95%CI 2.2-22.4) p < 0.001; and 15.6 (95%CI 6.8-35.6) p < 0.001, respectively]. Admission in Psychiatry, in particular, was strongly associated with the use of other substances [OR 11.8 (95%CI 3.8-36.6), p < 0.001]. Multivariable linear regression showed that, in comparison with other access reasons, accidents and decreased consciousness were associated with higher BAC [beta 0.6 (95%CI 0.1-1.1), p 0.01; beta 0.8 (95%CI 0.3-1.2) p < 0.001]. Length of stay, however, was associated with lower BAC [beta -0.2 (95%CI -0.3 -0.01), p 0.04]. Conclusions In Italy, binge drinking affects 120,000 adolescents aged 11-17. Our findings highlight the harm of this practice and support the need for prompt interventions to reduce the onset and prevalence of adolescent alcohol use.

Advancing urban health in Portugal: exploring liveability and its association with mental morbidity

Abstract Background As cities face challenges posed by urbanisation, it becomes essential to understand how city planning can contribute to protecting public health. In this study, we aimed to assess the liveability of different areas in Lisbon, Portugal, by developing a liveability index at the parish level. Secondly, we aimed to explore its association with hospitalisation due to mental disorders. Methods The liveability index was built based on the World Health Organisation’s Urban Health Index methodology. We obtained data on liveability related to housing, socio-economic conditions and access to services (e.g. healthcare) from the 2011 census and other open data sources for Lisbon’s parishes (n = 22). Data on hospital admissions due to mental disorders was sourced at the parish level from the national database for hospital morbidity for the period 2013-2016 and sex-age-standardised. Binomial negative regression was employed to estimate the association between the liveability index tertiles and observed hospital admissions. We used the expected number of hospitalisations as the offset variable and tested for spatial autocorrelation among the regression residuals. Results Our analysis showed that living in the most liveable parishes is associated with a significant decrease in the standardised admission ratio due to mental disorders, compared to living in the least liveable areas (Incidence Relative Ratio=0.643; 95% CI: 0.427, 0.967). We did not observe any geographical pattern in the regression residuals (Moran’s I= -0.035, p = 0.427). Conclusions Our findings show disparities in liveability among Lisbon’s parishes and identify a protective association between living in higher liveability areas and hospital admissions due to mental disorders. This work should prompt further studies concerning this subject to inform urban planning policies to improve liveability and equally reduce the risk of mental health-related harm within cities. Key messages • A spatial index to assess liveability in urban areas was developed. The association between the liveability of Lisbon’s parishes and hospital admissions due to mental disorders was explored. • We found a significant protective association between higher liveability and hospital admissions due to mental disorders. This work is relevant to inform the implementation of urban planning policies.

Assessments, assumptions and ableism: examining court-ordered parenting capacity assessments of parents with intellectual disability and cognitive difficulties

ABSTRACT Background Parental intellectual disability is considered a risk factor for child removal internationally. In New South Wales, Australia, authorised clinicians are court appointed experts who assess parenting and cognitive capacity in child protection matters. Method This study examined a sample of 20 assessment orders requesting parenting capacity and cognitive capacity assessments and corresponding authorised clinician reports. Results Authorised clinicians were requested to assess whether parental intellectual disability and cognitive impairment posed the risk of harm to children. Clinicians assessed parents as either “able with support” or “unable” to provide adequate care to their child. Conclusion Our findings highlight the law’s conceptualisation of risk, parenting capacity, and cognitive impairment in binary terms (i.e., risk or no risk, able or unable), which in turn limits casework planning and clinicians’ framing of parents’ abilities. We provide recommendations to improve fair and equitable assessment processes for parents with cognitive difficulties, as well as access to timely and appropriate services.

When is ‘the end of the road’ reached? Observing the presumption of parental involvement through systems theory

ABSTRACT In 2014 the Children Act 1989 was amended to include a presuption that involvement of a parent in a child’s life will further the child’s welfare unless there is evidence of the risk of harm. Kaganas published two seminal articles which concluded that the government’s ideological rationale for introducting the presumption of parental involvement not only failed to materialise but had some unintended, possibly detrimental, consequences for mothers. This article examines the operation and effects of the presumption of parental involvement in recent years based on an analysis of private law family court judgments between July 2020 and December 2023. Drawing on Luhmann’s theory of autopoietic social systems, it examines the possibilities for and limitations on using law to drive social change beyond the operations of the legal system itself. It concludes that the statutory presumption has failed to serve its stated purpose and has even had the unintended consequence of generating legal communications about the risks of parental involvement. From a feminist perspective, it concludes that positive changes observed in the family court response to domestic and child abuse are an achievement, in light of the limits on steering society, at least until something changes in the unknowable future.

Children’s Rights and Online Age Assurance Systems

Abstract Age assurance is a way to prevent children accessing content, products or services that are potentially harmful to them, ranging from gambling services or alcohol or tobacco or, increasingly, certain products and services online. Now that children’s lives are mediated by digital technologies, policymakers are deliberating over the legal, technical and practical challenges. These have been little examined from the perspective of children’s rights. By combining legal and social research methods, this article examines the legal requirements for age assurance in Europe, assesses compliance by companies and reveals the consequences for family life. In law and practice, we show that age assurance is often ineffective in protecting children from online risk of harm. Further, as currently implemented it risks children’s other rights – to non-discrimination, privacy, to be heard, and their civil rights and freedoms, and remedy. We identify promising directions for the use of age assurance in child online protection, focusing on European policy, regulators and civil society actors.

Congenital Cytomegalovirus Infection: Update on Screening, Diagnosis and Treatment: Scientific Impact Paper No. 56.

Cytomegalovirus (CMV) is the most common cause of viral infection in newborn babies, and affects 1 in 200 of all live born infants in high-income countries; and 1 in 71 in low- and middle-income countries. It is a major cause of hearing loss and brain damage. Women may get CMV infection for the first time during pregnancy (primary infection) or may experience 'non-primary' infection, either by reactivation of previous CMV infection or by a new infection with a different strain of the virus. The most common source of infection to pregnant women is the saliva and urine of young children. Therefore, all pregnant women, especially those in regular contact with young children, should be informed about hygiene-based measures to reduce the risks, e.g. handwashing. The UK National Screening Committee recommends against universal antenatal or newborn screening for CMV. Testing for CMV is usually offered only to women who develop symptoms of influenza, glandular fever or hepatitis (liver inflammation) during pregnancy, or for those whom a routine ultrasound scan detects fetal anomalies that suggests possible CMV infection. The risk of harm to the fetus is greatest following primary CMV infection of the woman in early pregnancy, and appears to be very low following infection after 12 weeks of pregnancy. Babies with CMV infection at birth may have jaundice, a rash, enlarged liver or spleen, a small brain, or be small for their gestational age. Around 1 in 8 babies born with CMV infection will have clinically detectable signs at birth. The rest will not have any features detectable by clinical examination alone. Therefore, all infants with CMV infection at birth should be followed up at a minimum of up to 2 years of age or later, depending upon the disease status, to check hearing and brain development. Following primary CMV infection in the first 12 weeks of pregnancy, if the woman starts taking the antiviral medicine valaciclovir (valacyclovir) it reduces the risk of the baby becoming infected. Where CMV infection of the fetus in the womb has been confirmed (by amniocentesis, for example), regular ultrasound scans should be offered every 2-3 weeks until birth. Detailed assessment of the fetal brain is an essential part of these scans. Where maternal CMV infection occurs, but fetal infection is not confirmed, repeated ultrasound scans of the fetus should be offered every 2-3 weeks until birth. In infected fetuses, as well as ultrasound scans, an MRI scan of the brain should be offered at 28-32 weeks of gestation (and sometimes repeated 3-4 weeks later) to assess for any signs of harm to the fetal brain. All babies born to women with confirmed or suspected CMV infection should be tested for CMV with a urine or saliva sample within the first 21 days of life. In newborns with symptomatic CMV infection at birth, treatment with antiviral medicine (valganciclovir or ganciclovir) can reduce hearing loss in 5 out of 6 babies, and improve long-term brain development outcomes in some. There is no licensed vaccine for CMV.

Felicity Kaganas: asking the woman question in family law

ABSTRACT This contribution to the special issue considers Felicity Kaganas as a feminist socio-legal scholar who persistently ‘asked the woman question’ in family law. It focuses on one of her important articles, ‘When it comes to contact disputes, what are family courts for?’ . After summarising her argument concerning the evolution of the family courts’ approach to contact disputes, it examines her critique of a problem-solving approach, in light of the recent introduction of the Pathfinder pilot courts, following the recommendations of the Ministry ofJustice report, Assessing risk of harm to children and parents inprivate law children cases (2020).

Challenging Vavřička: Questioning Compatibility of the Mandatory Tetanus Vaccination with ECHR.

The compatibility of mandatory vaccinations with human rights has become a very current issue with the COVID-19 pandemic and the Vavřicka ruling by the European Court of Human Rights. This ruling has faced criticism for not conducting examinations related to disease and vaccines based on direct scientific evidence. In this analysis, an assessment will be made based on direct scientific evidence about tetanus and its vaccine. The prevailing reason for mandatory tetanus vaccination is to protect the health of the vaccinated individual. Competent adults have the right to refuse treatment. This rule also applies to preventive medical interventions, including tetanus vaccination. As a rule, parents are entitled to give consent for medical interventions on their children. If an immediate and serious threat permanently endangers the minor’s life, medical intervention can be carried out against the parents’ will. The limitation of parental autonomy is more disputed when the minor’s life is not immediately threatened. With respect to tetanus vaccination as a preventive medical intervention, it does not eliminate an immediate and serious risk of harm. As a result, interference with the parent’s discretion on tetanus vaccination as a preventive medical intervention should be evaluated for its compatibility with the current legal approach to medical interventions on minors and patient rights. Keywords: best interest, mandatory vaccination, preventive medical intervention, right to reject a medical intervention, vaccine refusal, tetanus Acknowledgments: Z.T. wrote Part II: Information on Tetanus, M.S.P. wrote the rest of the paper. Elif Akdag was involved in formatting the footnotes. Funding: The authors were leading and core researchers in the project named “GETTING READY FOR THE NEXT PAN- DEMIC: Questioning Vaccine Mandates over COVID-19 and Childhood Vaccinations.” This project was funded by a grant from The Scientific and Technological Research Council of Türkiye (Grant Number: 122K378) and Altinbas University (Grant Number: PB2021-HUKUK-1). Conflicts of Interest: none

FEATURES OF THE PAPILLARY PATTERN OF THE MIDDLE AND PROXIMAL PHALANGES OF THE FINGERS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Cardiovascular diseases remain the most pressing healthcare problem in most countries of the world in the 21st century, despite the continuous improvement of diagnostic and treatment methods for cardiac patients. Today, the mortality rate for patients within a year after myocardial infarction remains quite high at 9.1%. Despite the large number of scientific papers, most of the available information sources reflect the possibility of using dermatoglyphs of the palms and distal phalanges as diagnostic markers for predicting the susceptibility to AMI and practically do not cover the possibility of using dermatoglyphs of the middle and proximal phalanges, although they also have a powerful prognostic potential. The material of our study were dermatoglyphs of the middle and proximal phalanges of the fingers obtained from 167 male subjects aged 35-69 years. The subjects were divided into 2 groups. Group 1 (83) included men with a history of AMI by questionnaire; Group 2 (84) included men who had never had AMI. The criteria for inclusion in the study groups were voluntary consent, absence of genetic pathology, endocrine and musculoskeletal system pathology, age over 35 and under 69 years. Exclusion criteria were refusal to participate in the study at any stage, presence of genetic pathology, endocrine and musculoskeletal system pathology, age under 35 and over 69 years. The scope and methods of the research do not contradict the basic principles of the Helsinki Declaration on Biometric Research (1974), adapted at the 41st International Assembly in Hong Kong (1989), in which a person is the subject of research. The research was conducted in compliance with the following basic principles: respect for the individual, information of the individual, and assessment of the risk of harm and benefit. Results and discussion. The dermatoglyphic parameters on the middle phalanges that determine the susceptibility to AMI in men with a high level of reliability are: Lu, Lr, Hdu, Hdr, Adu, Adsr, ApNu, ApNr, ApLr, DaN, Vu, Vr, Vm, Dhu, Fu, Fr, NdNu, Lsr, на PPh: Hdu, Adu, Adsu, Adsr, ApNr, ApNsu, Ladu, Ladr, ApLu, ApLr, DaN, DaLu, DaLr, Vu, Vr, Vm, Dhu, Dhr, Fu, Fr, Cl, NdNr, Npu, Dn, ApNpu, ApNpr, Vms, Lsu, Lsr; on the proximal phalanges are present: Ladr, Dhr, Ladu, ApNpr, Dn, Cl, ApLu, Vm, DaN, ApLr, Fr, ApNpu, Lsu, Adsr, Dhu, Hpu, ApNr, NdAdu. The result of the analysis was the construction of a model that allowed us to predict the susceptibility of men to AMI based on the use of dermatoglyphic parameters of the middle phalanges of the fingers with a probability of more than 68 % and dermatoglyphs located on the proximal phalanges with a probability of about 79 %. Conclusion. The incidence of AMI is a medical and social problem. The incidence of this disease among young working-age population is increasing every year and entails a number of negative consequences, including high mortality, disability and others. Therefore, the search for new diagnostic criteria for predicting the susceptibility to AMI, which can form the basis of screening tests, remains relevant. We have established prognostic markers (dermatoglyphs of the middle and proximal phalanges of the fingers): Vu, Vm, Hdr, Lr, Adsr, ApNu, Vr, NdNu, Hdu, Lsr, S, ApNr, Adu, Adr, Lsu, Npr, Lu, Dhu. The obtained results may play a significant role in the future as one of the factors of prevention of AMI development.

Radicalisation in adolescents: mental health considerations for violent extremism.

To outline current understanding and recommended mental health and psychiatric considerations for radicalisation and violent extremism among adolescents. Overview of recent research regarding violent extremism in adolescents and relationships with mental illness and other psychosocial determinants. Relevant international and Australasian research is outlined, with an emphasis on adolescents. Psychiatric considerations, intervention and policy implications will be explored. Adolescents who become radicalised form a heterogenous group with complex, multifaceted needs from mental disorder, familial, societal and/or environmental contributions. Thus, assessment and management need to be individualised. Mental health clinicians working with at-risk and radicalised adolescents should maintain a high index of suspicion for mental illness (particularly psychosis and depressive disorder) and neurodevelopmental disorder. Identified psychiatric conditions warrant prioritised mental health treatment. There may be a relationship between specific psychopathology and certain ideological beliefs and behaviours. Radicalised adolescents pose challenges with risk of serious harm to others, presentation complexity, multifactorial contributors and associations with varied psychopathology. All adolescents at risk of radicalisation or who are radicalised, should receive comprehensive mental health assessment and prompt assertive treatment of identified psychiatric conditions.

Undesirably risky affairs: resuscitating the desire-based approach to risk as harm

This paper engages with the longstanding debate over whether being exposed to a risk of harm amounts to harm itself (what I call ‘risk-harm’). The dominant view has been that those exposed to risks of harm do not suffer harm. In this paper, I defend the widely unpopular subjectivist account of risk-harm – according to which those exposed to unwanted risks of harm can suffer harm – against prominent objections that have been levied against it. The first section sets out to renew and strengthen the appeal of the account in light of recent developments in the surrounding literature. The second section defends the account against arguably its most formidable objection, namely the claim that there is no such thing as risk-harm. The third section wraps up by parrying some prominent general objections, which highlight potentially undesirable upshots to accepting the existence of risk-harm.

Unmasking biases and navigating pitfalls in the ophthalmic artificial intelligence lifecycle: A narrative review.

Over the past 2 decades, exponential growth in data availability, computational power, and newly available modeling techniques has led to an expansion in interest, investment, and research in Artificial Intelligence (AI) applications. Ophthalmology is one of many fields that seek to benefit from AI given the advent of telemedicine screening programs and the use of ancillary imaging. However, before AI can be widely deployed, further work must be done to avoid the pitfalls within the AI lifecycle. This review article breaks down the AI lifecycle into seven steps-data collection; defining the model task; data preprocessing and labeling; model development; model evaluation and validation; deployment; and finally, post-deployment evaluation, monitoring, and system recalibration-and delves into the risks for harm at each step and strategies for mitigating them.

6487 Hypercalcemia In Pregnancy Due To An Ectopic Parathyroid Adenoma: A Diagnostic Dilemma

Abstract Disclosure: S.S. Patel: None. M.B. Sharma: None. Introduction: Hypercalcemia is a rare complication of pregnancy, with the most common cause being primary hyperparathyroidism due to a parathyroid adenoma. Ultrasound is the primary modality used for localization, as sestamibi and computed tomography (CT) carry the risk of potential harm to the fetus. We present the case of hypercalcemia in a pregnant female that failed to resolve after two gland parathyroidectomy, necessitating a sestamibi parathyroid scan to localize an ectopic parathyroid adenoma. Case: A 40-year-old pregnant woman at 12 weeks of gestation presented with hypercalcemia, with a corrected calcium level of 12.5 mg/dL (8.7-10.4 mg/dL). She complained of nausea and vomiting but denied any personal or family history of hypercalcemia. Further evaluation revealed primary hyperparathyroidism as the etiology, with Intact PTH of 429.2 pg/mL (18.5-88.0 pg/mL), ionized calcium of 1.45 mmol/L (1.12-1.32 mmol/L), 25-OH vitamin D of 16.4 ng/mL (30-100 ng/mL), phosphorus of 1.3 mg/dL (2.4-5.1 mg/dL), and creatinine of 0.71 mg/dL (0.5-0.8 mg/dL). Notably, her calcium level had been 19.2 mg/dL two weeks earlier during an episode of hyperemesis gravidarum. Hypercalcemia proved relatively resistant to treatment with intravenous hydration and subcutaneous calcitonin. Ultrasound of the neck failed to reveal a parathyroid adenoma. The patient then underwent surgical neck exploration, during which two parathyroid glands were removed, resulting in an intraoperative PTH drop from 440 to 340 pg/mL. Postoperative calcium levels remained elevated at 12.9 mg/dL, prompting the resumption of treatment. Oral sodium and potassium phosphate was added to bind dietary calcium. After an extensive multidisciplinary discussion, a 99mTc-sestamibi parathyroid scan with a lower dose of sestamibi and without CT was recommended. This revealed an ectopic parathyroid adenoma in the anterior mediastinum. Surgical removal of the ectopic parathyroid adenoma in the second trimester finally led to a significant intraoperative PTH drop from 315 to 28 pg/mL. The postoperative course was complicated by hypocalcemia and hypomagnesemia, requiring calcium, vitamin D, and magnesium supplements. These complications resolved over the following days. The patient remained normocalcemic for the remaining pregnancy and delivered a healthy male infant at 34 weeks. Conclusion: Hypercalcemia in pregnancy is associated with fetal and maternal complications, warranting adequate management and close follow-up. The use of 99mTc-sestamibi parathyroid scan is typically not recommended in pregnancy due to concern for fetal harm; however, there are a few studies showing no association with increased birth defects or adverse pregnancy outcomes at low radiotracer doses. Hence, a sestamibi parathyroid scan can be considered during pregnancy to localize an adenoma after a careful review of the benefits versus risks. Presentation: 6/2/2024

The Impact of Training on Use of Force by Police in an English police force; Evidence from a Pragmatic Stepped Wedge Randomised Controlled Trial

We aim to test the impact of a new national curriculum for public and personal safety training (PPST) developed by the College of Policing, which aims to reduce the use of force by police. We conduct a large-scale Stepped Wedge Pragmatic Controlled Trial with a single police force and 1843 participating police officers. Officers were assigned to be trained during a particular week of the year. We find statistically significant reductions in the use of force by police officers as a result of the training. These effects are a reduction of between 8.0% and 10.9% in the propensity to use force in a given week compared to the counterfactual. The effect is accompanied by a significant reduction in the likelihood of injury to civilians, and no rise in the risk of harm to officers. We conclude that the PPST curriculum appears effective at reducing use of force by police in a large scale, robust trial

Explore the effect of magnesium oxide nanoparticles decorated graphene oxide hybrid nanofillers reinforced polyaniline ternary nanocomposites on optical, thermal, and dielectric properties

The Neem (Azadirachta indica) leaves utilized for the synthesis of magnesium oxide nanoparticles (MgONPs) are readily available and pose little risk of harm. The MgONPs@GO hybrid nanofillers are synthesized through in situ method and is reinforced with polyaniline (PANI) to enhance its electrical characteristics and thermal stability. The UV-visible spectroscopy demonstrates the formation of a charge transfer complex in the PANI/MgONPs@GO ternary nanocomposites. The presence of functional groups in the PANI/MgONPs@GO ternary nanocomposites was detected using Fourier transform infrared (FTIR) spectroscopy. The crystalline phases of the PANI/MgONPs@GO ternary nanocomposites were validated using x-ray diffraction (XRD) investigation. The scanning electron microscopy (SEM) technique was used to investigate the nanostructured morphology of the PANI/MgONPs@GO ternary nanocomposites. The thermogravimetric analysis (TGA) revealed that the PANI/MgONPs@GO ternary nanocomposites exhibited greater thermal stability compared to the pure PANI. The AC conductivity (σ ac), dielectric permittivity (ε′), and dielectric loss (tanδ) of PANI/MgONPs@GO ternary nanocomposites exhibit a substantial increase compared to pure PANI.

Risk of opioid-related harms by occupation within a large cohort of formerly injured workers in Ontario, Canada: findings from the Occupational Disease Surveillance System

ObjectiveWorking-age individuals have been disproportionately affected by the opioid crisis, prompting interest in the potential role of occupation as a contributor. This study aimed to estimate the risk of opioid-related...

Gestational diabetes mellitus: ensuring healthy futures

Gestational diabetes mellitus is the most common medical condition in pregnancy, disproportionately affecting overweight or obese women and those from non-White populations. The lack of standardised screening and diagnostic consensus contributes to varying prevalence. Conventional risk factor-based screening can leave women undiagnosed, leading to increased risk of harm. If diet and lifestyle modifications fail to achieve glycaemic targets, prompt treatment should be initiated to manage glucose levels. A planned birth is crucial to ensure the best outcomes. Postpartum, women need screening for type 2 diabetes and other cardiometabolic risk factors, enrollment in diabetes prevention programmes, and counselling on the increased risk of future cardiometabolic disease for themselves and their offspring, highlighting the importance of ongoing prevention and management strategies.

Effects of doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections on gonorrhoea prevalence and antimicrobial resistance among men who have sex with men in the USA: a modelling study

Doxycycline post-exposure prophylaxis (PEP) has been shown to be efficacious for the prevention of bacterial sexually transmitted infections, but resistance implications for Neisseria gonorrhoeae remain unknown. We aimed to use a mathematical model to investigate the anticipated impact of doxycycline PEP on the burden of gonorrhoea and antimicrobial resistance dynamics in men who have sex with men (MSM) in the USA. Using a deterministic compartmental model, characterising gonorrhoea transmission in a US MSM population comprising three sexual activity groups defined by annual partner turnover rates, we introduced doxycycline PEP at various uptake levels (10-90%) among those with high sexual activity. Infections were stratified by symptom status and resistance profile (ie, susceptible, ceftriaxone-resistant, tetracycline-resistant, or dual-resistant), with ceftriaxone the treatment for active infection. As resistance to tetracycline, not doxycycline, is monitored and reported nationally, we used this as a proxy for doxycycline PEP resistance. We compared the 20-year prevalence, incidence rates, and cumulative incidence of gonococcal infection, resistance dynamics (time to 5% prevalence of ceftriaxone resistance, 5% prevalence of dual resistance, and 84% prevalence of tetracycline resistance), and antibiotic consumption with baseline (ie, no doxycycline PEP). Uptake of doxycycline PEP resulted in substantial reductions in the prevalence and incidence of gonorrhoea, but accelerated the spread of tetracycline resistance. The maximum reduction in prevalence over 20years compared with no uptake ranged from 40·3% (IQR 15·3-83·4) with 10% doxycycline PEP uptake to 77·4% (68·4-84·9) with 90%uptake. Similarly, the maximum reduction in the incidence rate ranged from 38·6% (14·1-83·6) with 10% uptake to 77·6% (68·1-84·7) with 90% uptake. Cumulative gonococcal infections were reduced by a median of 14·5% (IQR8·4-21·6) with 10% uptake and up to 46·2% (26·5-59·9) with 90% uptake after 5years, and by 6·5% (3·4-13·0) with 10% uptake and 8·7% (4·3-36·2) with 90% uptake by 20years. In almost all scenarios explored, doxycycline PEP lost clinical effectiveness (defined as 84% prevalence of tetracycline resistance) within the 20-year period, but itslifespan ranged from a median of 12·1years (IQR 9·9-15·7) with 10% uptake to 1·6years (1·3-1·9) with 90%uptake. Doxycycline PEP implementation had minimal impact on extending the clinical lifespan of ceftriaxone monotherapy (5·0years [IQR 4·0-6·2]), with the median time to 5% prevalence of resistance ranging from 4·8years (3·9-6·0) for 90% uptake to 5·0years (4·1-6·2) for 10% uptake. Similarly, the median time to 5%prevalence of dual resistance to ceftriaxone and tetracycline ranged from 4·8years (3·9-6·0) for 90% uptake to 5·8years (4·8-7·4) for 10% uptake. Median decrease in ceftriaxone consumption for high doxycycline PEP uptake levels compared with baseline ranged from 41·7% (27·0-54·3) for 50% uptake to 50·2% (29·3-62·7) for 90% uptake at 5years, but dropped to 11·8% (6·9-32·0) for 50% uptake and 12·1% (7·0-41·6) for 90% uptake after 20years. Notwithstanding the clear benefits of doxycycline PEP for other sexually transmitted infections, for Ngonorrhoeae, model findings suggest that doxycycline PEP is an effective but impermanent solution for reducing infection burden, given eventual selection for resistant strains. This finding presents a challenge for policy makers considering strategies for doxycycline PEP implementation and oversight: the need to balance the clear, short-term clinical benefits with the risk of harm via antimicrobial resistance. US Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases.

Appropriateness of Using Numeric Rating Scales to Assess Risk Perceptions for Individuals with Limited Health Numeracy

ObjectiveNumeric rating scales (NRSs) could be inappropriate for assessing constructs such as risk perception if individuals with limited health numeracy (LHN) have difficulty expressing their perceptions on such scales. This paper compares the psychometric functioning of numerical risk perception ratings for an e-cigarette obtained from LHN individuals, comparing them to those from individuals with adequate health numeracy (AHN). MethodsIn a randomized trial of a risk-related message (not evaluated here), participants (N=12,557) used NRSs to rate their perception of (1) overall risk of harm (from 0%-100% harmful to health), and (2) likelihood (0-100%) of suffering four tobacco-related diseases from using e-cigarettes; and used a 4-point adjectival scale (‘not at all harmful’ to ‘very harmful’) to rate the harm of using e-cigarettes. Based on the Newest Vital Sign (NVS), 29% of participants were classified as LHN. ResultsNumeric ratings of e-cigarette harm in LHN and AHN groups showed a nearly identical and equally strong relationship to verbal perceived risk ratings. Analyses of disease-specific ratings as a unidimensional scale demonstrated configural, metric, and scalar invariance between ratings from LHN and AHN individuals. ConclusionLHN individuals are able to make meaningful ratings using numeric scales, comparable to those from AHN individuals.