High Rates Of Substance Abuse Research Articles

An exploration of the understandings of drug use from young drug users’ perspectives in the Western Cape: implications for primary prevention

ABSTRACTThe high rate of substance abuse among youth in South Africa is a clear indication of the level to which this issue has infiltrated the South African society. Drug abuse at an early age has been associated with problems, such as risky sexual behaviours, health problems, depression, crime, and ultimately drug addiction, which often occur at a later stage. There are many interrelated reasons and risk factors for drug use among youth and studies have mostly focussed on familial and other broader social environments such as peer/neighborhood factors for use. Less attention has been focussed on the internal or psychological factors at play in the lives of young users. This study aimed to fill this gap by exploring young drug users’ perceptions of the internal or psychological factors cited as their reasons for drug use. A better understanding of the internal risk factors that influence adolescent drug use is crucial for the development of effective prevention strategies. A qualitative method of inquiry was applied to gather in-depth data from a purposive sample of 41 young (14–19 years of age) drug users, at five drug treatment centres in the Western Cape. The findings of this study revealed that internal factors such as a permissive and/or positive attitude towards drugs, a deficit in social skills; a lack of self-esteem, and poor/maladaptive coping mechanisms were at play in the lives of the adolescents in this study. Implications for primary prevention were considered, as these findings underscore the need to consider these internal risk factors when developing interventions to reduce adolescent drug abuse.

The MINDBODYSTRONG Intervention for New Nurse Residents: 6-Month Effects on Mental Health Outcomes, Healthy Lifestyle Behaviors, and Job Satisfaction.

In 2017, the National Academy of Medicine convened its Action Collaborative for Clinician Well-being and Resilience in an effort to stem the epidemic levels of burnout, depression, and suicide among healthcare clinicians. Nurses report higher rates of substance abuse, depression, and suicide than the national average. Newly licensed registered nurses (NLRNs) report high levels of burnout and stress. Suboptimal health in nurses is linked to medical errors. Few studies address the mental health and lifestyle behaviors of NLRNs or provide evidence-based solutions to improve these outcomes. This study evaluated the 6-month effects of the MINDBODYSTRONG for Healthcare Professionals program on the mental health, healthy lifestyle behaviors, and job satisfaction of NLRNs participating in a nurse residency program. A two-group randomized controlled trial was conducted with 89 NLRNs at a large, Midwestern academic medical center. The intervention group received eight 30- to 35-min weekly sessions as part of the MINDBODYSTRONG program, a cognitive behavioral skill-building program incorporating strategies to improve mental and physical health. The control group acted as the attention control group receiving eight weekly 30- to 35-min debriefing sessions as part of the normal nurse residency program. Data were collected at baseline, immediately postintervention, 3months postintervention, and 6months postintervention. The intervention group scored better on mental health outcomes, healthy lifestyle behaviors, and job satisfaction at 6months postintervention than the control group. Significant improvements were found for depressive symptoms and job satisfaction; there were moderate to large positive effects for the MINDBODYSTRONG program on all variables. The MINDBODYSTRONG program sustained its positive effects across time and has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle behaviors, and job satisfaction in NLRNs.

Impact of the Opioid Epidemic on Heart Transplantation: Donor Characteristics and Organ Discard

The national opioid epidemic has expanded the donor pool for heart transplantation, but concerns remain regarding infectious risk and allograft function. This study compared donor and recipient characteristics, outcomes, and reasons for organ discard between overdose-death donors (ODDs) and donors with all other mechanism of death. Data on adult cardiac transplants from 2010 to 2017 were provided by the Scientific Registry of Transplant Recipients. Cardiac allografts used in multiple organ transplantations were excluded. Recipient and donor characteristics and organ discard were analyzed with regard to ODDs. Kaplan-Meier curves and log-rank tests described mortality survival. A total of 1,710 of 15,904 (10.8%) cardiac transplantations were from ODDs, approximately a 10-fold increase from 2000 (1.2%). ODDs were more frequently older than 40 years of age (87.2% vs 70.1%; p < 0.001), had higher rates of substance abuse, were more likely hepatitis Cpositive (1.3% vs 0.2%; p < 0.001), and less frequently required inotropic support at the time of procurement (38.4% vs 44.8%; p < 0.001). Overall survival was not different between the groups (p= 0.066). Discarded ODD allografts were more likely to be hepatitis C positive (30.8% vs 5.3%; p < 0.001) and to be identified as conveying increased risk by the Public Health Services (63.3% vs 13.2%; p < 0.001), but they were less likely to be discarded because of a diseased organ state (28.2% vs 36.1%; p < 0.001). Rates of ODDs have increased corresponding with the worsening opioid epidemic. Even though ODDs have higher rates of hepatitis C, cardiac allograft quality indices are favorable, and recipient outcomes are similar when compared with non-ODDs, a finding indicating that greater use of this donor pool may be appropriate.

Medical complications of homelessness: a neglected side of men's health.

Homelessness is an increasing societal and health issue associated with high rates of substance abuse and mental health disorders. Homeless people die more often and at a younger age than others. To identify health needs and improve healthcare for homeless men. A physician-led clinic was established on-site at the Mission Australia Centre in Sydney, incorporating: (i) liver screening, including portable fibroscan testing, and on-site treatment of hepatitis C; (ii) a mental health clinic, staffed by a psychiatrist; and (iii) a nurse-led clinic to follow up medical issues and deliver vaccinations. Patient data were recorded prospectively to determine what medical problems were encountered so as to drive future healthcare planning. A total of 257 men was assessed between November 2011 and December 2017. In that time, 561 men resided at the Centre. Of these 257 men who attended the clinic, 61% were <45 years old; 69% were current and 8% former smokers; 62% had a history of chronic alcoholic abuse and 66% other substance abuse; 64% had one or more of depression, anxiety, psychosis or another mental health disorder and 44% had metabolic syndrome features, 38% cardiovascular disease, 29% hepatitis C and 21% a respiratory disorder. The main health needs of homeless men fall into the categories of mental health; cardiovascular, respiratory and metabolic disorders and addictions and hepatitis C. Establishing on-site clinics at homeless shelters with expertise to address these issues will likely improve the well-being of these men, reduce hospital admissions and prolong their lives.

3550 Understanding Racial Disparities in Hepatocellular Carcinoma Treatments and Outcomes

OBJECTIVES/SPECIFIC AIMS: Black patients with hepatocellular carcinoma (HCC) receive fewer curative therapies and have higher mortality than other groups. Reducing this disparity will require an in-depth understanding of patient comorbidities, tumor characteristics, and social determinants of health. Our objectives are to a) perform a multi-center retrospective cohort study of black and white patients diagnosed with HCC in the Indianapolis area. b) prospectively enroll black and white patients with HCC to collect clinical characteristics as well as data on the social determinants of health. METHODS/STUDY POPULATION: A retrospective chart review of patients with a diagnosis of HCC from 2010-2017 from five area Indianapolis hospitals will be performed. Demographics, comorbidities, liver disease severity, and tumor characteristics will be collected using the Indiana Network for Patient Care database and compared between black and white patients. Concomitantly, a prospective cohort of black and white patients will be enrolled and surveyed to collect data on socioeconomic status and income adequacy, literacy, functional status, substance abuse history, social support, activation, and adherence. The primary outcomes are the receipt of curative therapies for HCC including liver transplantation, resection or ablation. The secondary outcome is mortality. Multivariable logistic regression models will be used to explore disparities seen in the primary and secondary outcomes. RESULTS/ANTICIPATED RESULTS: These preliminary results include Indiana University Hospital (IUH) findings; a multicenter analysis is underway. The IUH cohort included 1,032 (86%) white and 164 (14%) black patients. Black and white patients had similar Model for End-Stage Liver Disease and Child-Pugh scores. There was a trend toward larger tumor size (5.3 cm vs. 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients—a disparity that was not attenuated (odds ratio [OR], 0.43; 95% confidence interval [CI]: 0.21-0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation than white patients. Survival was similar between the two groups. DISCUSSION/SIGNIFICANCE OF IMPACT: Racial differences in patient and tumor characteristics were small in our single center analysis and did not explain the disparity in liver transplantation. This analysis however only reflects 25% of patients diagnosed with HCC in the Indianapolis metropolitan, highlighting the need for a multicenter study. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity and highlight the need for a prospective study that can explore these and other social factors.

Status of substance abuse literacy in manufacturing and production sites in Iran: Results from a nationwide survey.

Background: Due to highly risk-taking behaviors such as alcohol and drug use status of health literacy at workplace is a major concern for health policy makers. Substance abuse literacy (SAL) includes the individuals’ skills to obtain, understand and use substance-relevant health information. This will help to establish a healthy communication in a workplace setting and developing professional knowledge on workplace safety regulations, risky approaches and behaviours that may hurt the community workers. Since poor SAL status would inevitably cause serious harms to both community workers’ health and facilities this study aimed to determine the status of SAL among manufacturing and production workers in Iran. Methods: This is a nationwide cross-sectional survey conducted on 13,600 subjects who were selected through simple randomization into 380 workplaces in 31 provinces of Iran during February 2015 to January 2016. Data were collected through an author-made structured questionnaire by some trained interviewers. The study tool was developed using the literature and then sent to some experts for approving internal validity; minor changes were applied. Internal reliability test in 30 samples yielded Cronbach’s alpha of 0.82. All the questionnaires were administered at the participants’ workplaces following obtaining their consent on releasing blinded information. Results: Given that the score range was from 1 to 5, the mean for SAL in substance abuse was 4.04, so that the highest and lowest means were related to East Azerbaijan (4.22±0.74) and Hormozgan (3.69±0.73) provinces, respectively. Conclusion: This study revealed that the Iranian workers SAL status was fairly high despite the reported high rate of substance abuse (30%) among Iranian workforces. This apparently contradictory finding could be resolved using Syndemics in which refers to clustering of several issues in a society that contribute to and result from socioeconomic and cultural factors and inequalities. Therefore, it is still necessary for policy makers and other researchers to take this issue into consideration in Iranian manufacturing and production plants.

Mental health and psychosocial support program for people of tribal origin in Wayanad: Institute of Mental Health and Neurosciences model

Mental health of people of tribal origin in Wayanad is a great cause of concern since there is limited accessibility of mental health services. Our pilot visits to the interior tribal colonies of Wayanad reveal many cases of untreated psychosis and high rates of substance abuse, especially alcohol and tobacco. To improve their mental health access and utilization, Institute of Mental Health and Neurosciences, Kozhikode, recently initiated a novel community mental health program in selected tribal colonies at Wayanad. This pilot program contains a situational analysis, training of grass root-level workers, awareness program, and mental health and psychosocial support services through a multidisciplinary mobile team.

Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden.

Black patients have higher mortality and are less likely to receive liver transplantation for hepatocellular carcinoma (HCC) than white patients. Reasons for these disparities have not been fully elucidated. Comorbid disease, liver disease severity, cirrhosis etiologies, and tumor characteristics were compared between black and white patients with HCC seen at the Indiana University Academic Medical Center from January 2000 to June 2014. Logistic regression was used to investigate the primary outcome, which was liver transplantation. Log‐rank testing was used to compare survival between the two groups. Subgroup analysis explored reasons for failure to undergo liver transplantation in patients within Milan criteria. The cohort included 1,032 (86%) white and 164 (14%) black patients. Black and white patients had similar Model for End‐Stage Liver Disease (MELD) and Child‐Pugh scores (CPSs). There was a trend toward larger tumor size (5.3 cm versus 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer (BCLC) staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients; this was a disparity that was not attenuated (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21‐0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation compared to white patients. Survival was similar between the two groups. Conclusion: Racial differences in patient and tumor characteristics were small and did not explain the disparity in liver transplantation. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity in this cohort.

Self-inflicted burn injuries: Etiologies, risk factors and impact on institutional resources

IntroductionSelf-inflicted burns are a rare cause of injury, accounting for only 1.0% of burns in the United States. While rare, the physical and psychosocial ramifications of these injuries are lasting. The goal of this study was to examine the etiologies, risk factors and outcomes of self-inflected burns in an urban setting. MethodsRecords of all patients presented to a regional burn center from July 2011 to June 2015 were reviewed. Those who sustained a self-inflected burn were identified and included in this study. Demographic data, psychiatric history, previous self-harm records, insurance status, injury circumstance, burn characteristic [location and total body surface area (TBSA)], need for excision and grafting, graft-take and duration of hospital stay and costs were reviewed. This group was then compared to a cohort of 166 patients with non-intentional burn during the same time frame matched for age and TBSA%. ResultsThere were 34 patients with a mean (SD) age of 31 (15.2) who sustained a self-inflicted burn during the study period. The mean TBSA% was 2.8 (SD=5.1), with most injuries in the upper and lower extremities. Fifty three percent of the patients presented with altered mental status secondary to either psychiatric illness or intoxication. Twenty-four percent of incidents were claimed as suicide attempts and suicidal ideation was present in 47% of cases. Twenty-six percent of patients with a previous psychiatric diagnosis were not on a psychiatric medication prior to incident. There was record of previous self-harm in 26% of patients. When compared to control group of 166 patient with non-intentional burn, patients with self-inflicted burn had higher rates of substance abuse (35% vs. 13%, p<0.05), longer stay in the hospital (11.3 vs. 5.3 days, p<0.01), longer stay in the intensive care unit (1.8 vs. 0.2 days, p<0.01), and lower rates of insurance (15% vs. 42%, p<0.001). These patients also exhibited a higher need for excision and grafting (41% vs. 20%, p<0.01). ConclusionsPatients with self-inflected burn have a higher rate of previous self-harm behavior, psychiatric comorbidities and substance abuse. These patients are more likely to require surgical excision and grafting and expanded institutional resources compared to those with non-intentional burn with similar degree and size of burn. Increased counseling of at-risk populations may help to decrease this potentially preventable method of injury.

Primary Hip and Knee Arthroplasty in a Safety Net Hospital: Substance Abuse and Other Factors Affecting Short-term Complications

BackgroundArthroplasty outcomes and patient risk factors have not been studied in detail in safety net hospital settings. This study examines the relationship between selected risk factors and short-term complications in such a population, including a large subgroup with treated substance abuse. MethodsThis retrospective cohort study contains 486 consecutive patients after primary hip and knee arthroplasty. One hundred three of these had a history of substance abuse and completed a 1-year sobriety pathway preoperatively. Primary outcomes included the presence of any complication, deep infection, and reoperation. Bivariable analyses were used to compare outcomes with demographic and health risk factors. A multivariate analysis was performed to identify independent risk factors. ResultsAdverse outcomes were more common in patients with higher rates of substance abuse, mental illness, and infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Substance abuse alone was not an independent risk factor for the occurrence of complications, but infections with HIV and HCV were. In the substance abuse subgroup, with its higher prevalence of risk factors, complications were more frequent (31.1% vs 16.4%, P = .0009), and, in particular, deep infections (5.8% vs 1.8%, P = .0256). ConclusionsSpecific risk factors were associated with short-term complications in safety net arthroplasty patients. Despite having completed a preoperative sobriety pathway, substance abuse patients had more complications than did others. However, substance abuse alone was not an independent risk factor for adverse surgical outcomes. Other factors, notably HCV and HIV infection that were more common in patients with substance abuse, were most closely associated with adverse outcomes.

Psychosocial Factors that Shape Substance Abuse and Related Mental Health of Women Military Veterans who Use Community-Based Services

ABSTRACTBackground: Women Veterans who use the Veterans Health Administration (VA) have high rates of substance abuse and poorer health than non-Veteran women. Less is known about the psychosocial needs of women Veterans who seek care in non-VA settings. Objectives: We provide a grounded description of factors that impact substance abuse, mental health, and related quality of life of women Veterans who use non-VA community-based health and social services. Methods: Utilizing a mixed methods design, we conducted semi-structured in-person interviews with 22 women Veterans in Los Angeles in 2013–2015. Results: The current health of these women Veterans was shaped by substance abuse and several other factors, including: histories of trauma (in childhood, during military service) and discrimination, and associated mental health conditions; post-military socio-economic stressors; shifting social roles and adverse social support; and lost personal identity after military service. Psychosocial factors collectively underscore areas in which delivery of health and social services to women Veterans being treated in non-VA settings could be improved: (1) diffuse, implement, and sustain evidence-based gender-sensitive substance abuse treatment; (2) address traumas contributing to poor health; (3) recognize stress proliferation processes erode women's capacity to access healthcare or cope with stressors in healthy ways; (4) champion women Veterans who embody resilience and thereby can help others to form empowered personal identities of health and wellness. Conclusion: Findings can inform interventions and services that ameliorate vulnerability to substance abuse and other health risks among women Veterans.

Evaluation of childhood trauma with respect to criminal behavior, dissociative experiences, adverse family experiences and psychiatric backgrounds among prison inmates

ObjectiveTo evaluate childhood trauma in relation to criminal behavior, dissociative experiences, adverse family experiences during childhood and psychiatric backgrounds among prison inmates. MethodsIn total, 200 prison inmates were included in this questionnaire-based study. Data on demographic characteristics, adverse family experiences during childhood and psychiatric backgrounds were collected via face-to-face interviews, and a psychometric evaluation was conducted using the Childhood Trauma Questionnaire (CTQ-28) and Dissociative Experiences Scale (DES). ResultsSeveral historical items were more common in females than in males including family history of psychiatric disease (23.0% vs. 13.0%, p = 0.048), a personal history of psychiatric disease (51.0% vs. 29.0%, p < 0.001), and previous suicide attempts (49.0% vs. 25.0%, p < 0.001). In male inmates, in contrast, there were higher rates of substance abuse (48.0% vs. 29.0%, p < 0.001) and previous convictions (50.0% vs. 25.0%, p < 0.001). Males had a younger age at first crime (24.9 ± 8.9 years vs. 30.3 ± 9.2 years, p < 0.001), whereas females had higher rates of violent crimes (69.2% vs. 30.8% p < 0.001) and higher CTQ total scores (51.9 ± 20.9 vs. 46.2 ± 18.9, p = 0.04). A significant relationship of CTQ total score was noted with age at first offense (β = 0.772, p < 0.001) but not with sentence length (β = 0.075, p = 0.292). There were also possible mediating roles of psychiatric problems, adverse family experiences and DES in the relationship between CTQ and age at first offense. ConclusionIn conclusion, our findings revealed a high prevalence of and significant associations among childhood trauma, dissociative experiences, adverse family experiences and psychiatric problems in a cohort of incarcerated females and males. A psychiatric background, childhood trauma characterized by sexual abuse and violent crimes were found to be predominant in female prison inmates, whereas a criminal background with a younger age at first offense and frequent previous convictions, substance use and sexual crimes were more prevalent among male prison inmates. Our findings indicate a potential link between childhood traumatization and criminal behavior in terms of subsequent offending but not in terms of severity of the subsequent offense.

Recreational Drug and Psychosocial Profile in Chronic Hepatitis C Patients Seeking Antiviral Therapy

Background and aims. Practitioners treating hepatitis C (HCV) provide healthcare to a special population with high rates of substance abuse and psychiatric disorders. We investigated the psychosocial profile in HCV patients and tested what variables affect commencement of antiviral therapy.Material and methods. Recreational drug use (RDU), marijuana (THC), alcohol use, and psychiatric history were initially investigated with a questionnaire prior to history and physical. Following an educational intervention, we reinterrogated patients for RDU and THC use, and revision of initial statement was documented. Variables affecting commencement of antiviral therapy were analysed with logistic regression.Results. Out of 153 patients, 140 (92%) answered the questionnaire. Intervention increased total yield by 6%, however, 39% (11/28) of those initially denying use revised their statement. Drug screening identified 9 more patients with RDU/THC use. Half of patients consuming alcohol were heavy drinkers, and psychiatric disease was identified in 54%. Only 73 (48%) of 139 patients eligible for antivirals received treatment. Multivariable analysis revealed that younger patients (OR = 1.04, 95% CI 1.01-1.08), and those testing positive on drug screen (OR = 0.41, 95% CI 0.19-0.92) were less likely to be treated. Denial by insurance and loss to follow-up were the most common reasons for not starting antiviral treatment.Conclusion. Substance abuse is highly prevalent among HCV patients, and it is difficult to tell prior from current users. Integral care of HCV patients should include a diligent screen for substance abuse and rehabilitation referral, aiming to increase the pool of patients eligible for antiviral therapy. This can only be achieved through a multidisciplinary approach.

Assessing the Impact of American Indian Peer Recovery Support on Substance Use and Health

Peer Recovery Support (PRS) is emerging as a key intervention for communities and individuals as they address high rates of substance abuse and limited recovery resources. American Indian populatio...

The needs of children who have parents suffering from severe mental disorders

ObjectiveMental illness in parents is a biological and environmental risk factor to which young people are exposed. Living with a parent suffering from a mental disorder may have a variety of detrimental consequences, including: (a) the reversal of caregiving (“parentification”); (b) the exposure to an adverse environment, where developmental needs of the child (emotional and practical) might be repeatedly neglected (lack of communication, high expressed emotion, etc.); (c) stigma and discrimination. We will provide a review of needs of these children and of possible interventions. MethodsSystematic searches located studies reporting and assessing met and unmet needs of these children. ResultsYoung people living in such families often have problems of internalizing and externalizing symptoms, cognitions of shame, guilt, and loneliness, perceptions of lacking social support and social acceptance. Children who have mentally ill parents are up to two and a half times more likely to experience poorer mental health outcomes than their peers. Compared to peers, children of parents with mental disorders are also at risk of poorer intellectual and social outcomes, of affect dysregulation, of behavioral problems, of impaired attention and reduced overall adaptive functioning, of higher rates of substance abuse and multiple diagnosis and finally of low occupational status, health risk behaviour and antisocial behavior. ConclusionsGiven the high toll paid by children having parents suffering from severe mental disorders, it is urgent to develop, test and implement structured programmes to help these children cope with stressful circumstances and improve their resilience.

Knowledge of High School Learners Regarding Substance Use Within High School Premises in the Buffalo Flats of East London, Eastern Cape Province, South Africa

ABSTRACTSouth Africa has a high rate of substance abuse among youths both in and out of school with East London in the Eastern Cape Province experiencing an increase in young people ages 20 years and below seeking treatment for substance abuse. The purpose of the study was to explore the knowledge of high school learners (grades 10 to 12) regarding substance use within their school premises. The objectives of the study were to assess knowledge of substance use within school premises among Buffalo Flats high school learners; assess the knowledge of learners regarding policies, rules, and regulations for preventing substance use within school premises; and determine learners' views regarding measures that should be taken to prevent substance use within school premises. A descriptive study design was used and a total of 146 learners participated by completing a self-administered questionnaire. The results revealed that learners were aware of substance use and users within their school premises. Alcohol, tobacco, and marijuana were identified as substances commonly used by learners at school with restrooms and sports grounds as main areas where substance use take place. There was limited knowledge of the South African policies, rules, and regulations in relation to substance use within school premises among learners. There is a need to create awareness among Buffalo Flats students about policies and regulations related to substance use, dangers of substances, and prevention of substance abuse.

Gambling and Problem Gambling among Canadian Urban Aboriginals.

To assess the prevalence of gambling and problem gambling in urban Aboriginals in the Canadian Prairie provinces and to determine the predictors of problem gambling. In total, 1114 Aboriginals living in 15 cities in Alberta, Saskatchewan, and Manitoba were recruited via posters and direct solicitation at Native Friendship Centres, shopping malls, and other locations where Aboriginals congregated. They each completed a self-administered 5- to 10-minute survey. Urban Aboriginals in the present sample were found to have a much higher level of gambling participation than the general Canadian public, especially for electronic gambling machines, instant lotteries, and bingo. Their intensity of participation in terms of number of formats, frequency of play, and gambling expenditure was also very high. This, in turn, is an important contributing factor to their very high rate of problem gambling, which was found to be 27.2%. Problem gambling was higher in males, unemployed people, and cities having the highest proportion of their population consisting of urban Aboriginals. Urban Aboriginal people appear to have some of the highest known rates of problem gambling of any group in Canada. This is attributable to having many more risk factors for problem gambling, such as a greater level of participation in gambling, greater participation in continuous forms of gambling (e.g., electronic gambling machines), younger average age, higher rates of substance abuse and mental health problems, and a range of disadvantageous social conditions (e.g., poverty, unemployment, poor education, cultural stress) that are conducive to the development of addictive behaviour.

Identification of child sexual abuse and prevention of psychiatric morbidity

Child sexual abuse (CSA) is a hidden and under-reported problem in psychiatry. CSA has been studied in various epidemiological data based studies and has been found to be a significant risk factor for the development of psychiatric illness in later life. Depression, suicide and suicidal attempts as well as self-injurious behaviour have all been reported to be significantly greater in patients than have been exposed to CSA versus those who have not been exposed to the same. There are studies that demonstrate higher rates of substance abuse, body image disturbances, eating disorders and cluster B personality traits in patients that have been exposed to CSA. The paper looks at the available data on lifetime occurrence of psychiatric disorders in patients that have been exposed to CSA. The various mechanisms by which CSA exposure can lead to psychiatric disorders in adulthood are discussed and the need for identification, assessment and clinically evaluating the presence of CSA in patients in routine clinical practice is highlighted.

Social, psychological, and sexual aspects among couples seeking marital therapy in a sample in Cairo 2013-2014

Aim The aim of the study was to describe and reveal an association of social, psychological, and sexual aspects among couples seeking marital therapy. Background There are scanty data in Egypt on social, psychological, and sexual aspects among couples seeking marital therapy. Participants and methods Fifty couples attending the marital counseling clinic in the psychological medicine hospital in Cairo between June 2013 and June 2014 were assessed. Informed consent was given by couples, who were assessed on the basis of the following: (a) psychiatric interview; (b) General Health Questionnaire (GHQ); (c) ICD-10 symptom checklist (positive score on GHQ); (d) structured assessment of personality (negative score on GHQ); (e) sexual function questionnaire; (f) marital silence scale; (g) marital conflicts scale. Statistical analysis was carried out using SPSS version 16. Results At least one or both partners of all couples had a positive score on GHQ. Women showed higher rates of positive score on GHQ than did men. Personality disorders and accentuated traits were highly prevalent in the study sample. Women showed higher rates of depressive episodes, whereas men showed higher rates of substance abuse. Marital conflicts are directly associated with education level and inversely associated with age; marital silence is inversely associated with education level and directly associated with age. Conclusion Marital conflicts and silence are associated with the presence of psychiatric morbidity. Age and level of education are associated with marital conflict and silence.

Prevalence of Hepatitis-C Viral Infection among Opioid Dependent Injectable Drug Users: A Study Conducted at Swami Vivekananda Drug De-Addiction and Treatment Centre, Amritsar

Background: Injecting drug use is a major route of hepatitis C virus(HCV) infection in north India especially Punjab with very high rates of substance abuse. The present study was attempted to study the prevalence of hepatitis C among the injectable drug users, which is more important in a country like India where viral hepatitis is estimated to be among the top ten causes of deaths. Methods and findings: A study was conducted in 2014-2015(FEB-FEB).The subjects included were 1162 IDUs who were opioid dependent as diagnosed by ICD-10 and confirmed for opioid in urine with help of Instant-View opiates (300) urine cassette test and IDU status was confirmed by observing injection marks on body parts. After that every patient was subjected to blood sampling for anti HCV antibodies using immunoassay technique and opioid dependent IDUs positive for anti HCV antibodies were interviewed regarding demographics, injecting and sexual behaviours. Seroprevalence of HCV was found to be 38.12 % (443 positives). Out of 443 positives about 98.6% were males, 63% were of rural background, 60% were married and 43% unemployed. Majority was between the age group of 25-30 years age (58%). Conclusion: Our study shows a high seroprevalence of HCV in IDUs. The study helps us to evaluate various aspects associated with Hepatitis C infection in Punjab. The need of the hour is to increase awareness about HCV among the public and practicing physicians.