Substance Abuse Research Articles

A Review of Drug Abuse, Misuse, and Related Laboratory Challenges.

Various definitions can be considered for drugs and substance abuse. According to the National Institute on Abuse, the use of an over-the-counter drug in a different way than that prescribed to experience or arouse emotion is a simple form of drug abuse. The World Health Organization (WHO) also defines drug abuse as the persistent or sporadic use of drugs that are incompatible or unrelated to acceptable medical practice. With the increasing non-therapeutic use of prescription drugs, serious related consequences have also increased. Therefore, there is a need to know more precisely about the types of substances and drug abuse, which is the most important part of diagnosis and recognizing the tests that cause false positive and negative results. The purpose of this review article is to collect and summarize the most important and more common types of drugs of abuse and review the drugs that cause false results in screening tests. In addition, the most common detection methods of the drug will be reviewed and the advantages and drawbacks of each method will be discussed. In this article, we aimed to point out all the facts about the emerging problems in drug abuse, the methods of screening, and the possible false results in addition to troubleshooting strategies.

Alleviating salinity stress in Cyamopsis tetragonoloba L. seedlings through foliar application of silicon or melatonin in arid and semi-desert environments

Salinity stress can be deemed as an important challenge extremely affecting crop growth as well as development. Therefore, it is important to improve its tolerance to salinity stress, in arid as well as semiarid regions. Thus, this experiment explored the influence of foliar usage of plant growth-stimulating substances with different concentrations (C: control, melatonin (M1: 100, M2: 200 and M3:400 µM) and silicon (Si1: 5.4, Si2: 10.8 and Si3: 16.2 mM)) on some physiological as well as biochemical attributes of Cyamopsis tetragonoloba L. (guar) seedlings under five salinity levels (S1: no-salt treatment, S2: 5, S3: 10, S4: 15 and S5: 20 dS m−1). With increasing salinity, shoot dry weight, Fv/Fm, F′v/F′m, ΦPSII, qp, qL, Rfd, ETR, photosynthetic pigments, membrane stability index, as well as relative water content were gradually reduced in salt-stressed guar, as comparison is made to the non-saline conditions. However, foliar usage of plant growth-stimulating substances was effective in improving guar tolerance to salinity by elevating the DPPH radical scavenging capacity and anthocyanin, thus enhancing membrane stability index, improving the electron's transport rate, reducing electrolyte leakage and decreasing the damage affecting the reaction center of PSII, as comparison is made with control. Such positive effects were exhibited in elevating growth under salinity stress. Si3 treatment demonstrated the best response under salinity stress, as compared with the other treatments. Consequently, foliar usage of silicon or melatonin in salt-stressed guar seedlings can serve an efficient method to improve salt tolerance under salinity stress in arid and semiarid regions.

Genomic instabilities in hepatocellular carcinoma: biomarkers and application in immunotherapies.

Hepatocellular carcinoma (HCC) is one of the deadliest cancers. For patients with advanced HCC, liver function decompensation often occurs, which leads to poor tolerance to chemotherapies and other aggressive treatments. Therefore, it remains critical to develop effective therapeutic strategies for HCC. Etiological factors for HCC are complex and multifaceted, including hepatitis virus infection, alcohol, drug abuse, chronic metabolic abnormalities, and others. Thus, HCC has been categorized as a "genomically unstable" cancer due to the typical manifestation of chromosome breakage and aneuploidy, and oxidative DNA damage. In recent years, immunotherapy has provided a new option for cancer treatments, and the degree of genomic instability positively correlates with immunotherapy efficacies. This article reviews the endogenous and exogenous causes that affect the genomic stability of liver cells; it also updates the current biomarkers and their detection methods for genomic instabilities and relevant applications in cancer immunotherapies. Including genomic instability biomarkers in consideration of cancer treatment options shall increase the patients' well-being.

Post mortem chiral analysis of MDMA and MDA in human blood and hair

Drug-related fatalities in the EU are predominantly associated with opioids. MDMA (Ecstasy) consumption results in fewer lethal intoxications despite its widespread use. This study investigates MDMA-related fatalities, focusing on enantiomer ratios of MDMA and its metabolite MDA to explore the role of metabolism in fatal outcomes.MDMA induces euphoria, increased empathy, and physiological effects such as tachycardia, hypertension, and hyperthermia. Metabolism mainly involves CYP1A2 and CYP2D6, with polymorphism of the latter influencing metabolism rates. Our institute observed several MDMA-related fatalities, which prompted an investigation into the potential role of inefficient drug metabolism in these cases.A novel quantitative chiral analysis method was developed and validated for MDMA, MDA, amphetamine and methamphetamine enantiomers in human blood. Analysis of post mortem blood samples from eleven MDMA-related fatalities exhibited a wide range of concentrations and enantiomer ratios. Variability in R/S MDMA ratios, however, could be linked to the time period of metabolism. Hair analysis revealed high MDMA concentrations in all segments, irrespective of prior drug abuse anamnesis. Therefore, hair analysis may not be suitable for the assessment of past drug use in ecstasy-related fatalities.The results indicated that elevated levels of the MDMA enantiomer are correlated with longer survival times in cases of intoxication. However, there was no clear evidence for slowed MDMA metabolism as a cause of lethal intoxications. While challenges remain due to the diversity of cases, this study contributes valuable insights into ecstasy intoxications, aiding future interpretation of post mortem analysis.

Combating drug abuse through pharmacist-led public health campaigns strategic initiatives for global prevention

The global drug abuse crisis continues to pose significant public health challenges, necessitating comprehensive prevention strategies. Pharmacists, as accessible and trusted healthcare professionals, are increasingly recognized for their pivotal role in drug abuse prevention. This paper explores pharmacist-led public health campaigns and interventions designed to mitigate drug abuse, particularly through education, outreach, and collaboration with other healthcare providers. It examines core components of effective campaigns, including targeting at-risk populations such as youth and high-risk communities. Additionally, the paper discusses global prevention strategies, addressing the cultural, economic, and legal barriers that pharmacists face while highlighting opportunities for their leadership in international drug prevention efforts. The conclusion emphasizes the need for policy recommendations to enhance the pharmacist’s role in drug abuse prevention, alongside future directions leveraging digital health technologies and international collaboration to achieve more effective global outcomes.

The Role of Artificial Intelligence (AI) and machine learning in social work practice

The integration of Artificial Intelligence (AI) and Machine Learning (ML) into social work practice is transforming the landscape of service delivery and decision-making. This paper explores how these technologies enhance case management, predictive analytics, and resource allocation in critical areas such as child welfare, mental health, and substance abuse treatment. Key trends highlighted include the use of AI-based predictive analytics to identify at-risk populations and facilitate early interventions, as well as the deployment of chatbots and virtual assistants for providing accessible mental health counselling and social support. Furthermore, the paper addresses ethical considerations and challenges associated with AI implementation, particularly the potential biases in algorithms that may affect the assessment of social needs. Additionally, the integration of AI tools into social work education and training is examined to prepare future professionals for a technology-driven environment. By analysing the current applications of Natural Language Processing (NLP) for client data analysis, AI-powered software for predictive risk assessments, and automated case management systems, this paper advocates for a balanced approach to AI adoption, ensuring that the core values of social work, such as equity and social justice, remain central to practice. Ultimately, this exploration underscores the potential of AI and ML to enhance social work outcomes while also emphasizing the necessity of ethical frameworks and ongoing training for practitioners.

The effect of drug abuse among adolescents in Nigeria: A case study of Gwagwalada, Area Council, Abuja, Nigeria

With a focus on drug addiction in teenagers, this study explores the prevalence, causes, and effects of drug addiction in Gwagwalada, Abuja, Nigeria. It provides a thorough understanding of the factors that influence drug misuse among adolescents in the area. The project intends to determine the precise chemicals being misused and investigate the social and environmental factors that contribute to drug use by looking over previous studies, consulting with experts, and gathering information from local stakeholders. Peer pressure, broken families, easy access to drugs, and a lack of opportunities are major contributing factors. The study also looks at how interpersonal violence, criminality, and economic instability are made worse in communities by teen drug use. An extensive literature review, qualitative interviews, and statistical tools like trend analysis and frequency distribution were all combined in a mixed-methods approach to determine the degree of substance abuse. The results show that drug addiction severely compromises the physical, psychological, and social well-being of youth; the main initiators of this damage are peer pressure, familial problems, and financial difficulty. The report recommends quick, comprehensive efforts to reduce drug availability, such as drug education, public awareness campaigns, and increased law enforcement. It also places a strong emphasis on improving preventative measures, addressing underlying socioeconomic issues, and giving young people the tools they need to resist peer pressure and make better decisions in life. The report urges the development of a comprehensive plan to lower drug usage among teenagers and ensure that Nigerian kids have a better future.

Impact of a qualitative assessment approach for neonatal abstinence syndrome management: experience of a European reference center

BackgroundThe management of infants at risk of neonatal abstinence syndrome (NAS) remains challenging. In 2000 Maternidade Bissaya Barreto implemented a strategy based on the qualitative assessment of neonates and in 2018 the Eat, Sleep, Console (ESC) approach, a tool based on similar concepts, was created. The aim is to assess the efficacy of a qualitative assessment of infants at risk, compare it with the ESC approach and report temporal trends of NAS in a European hospital.MethodsRetrospective cohort study of all infants of mothers with a history of drug abuse during pregnancy admitted to a tertiary European centre between January 2010 and December 2021. The therapeutical decision was guided by a qualitative assessment of the newborn’s well-being. The ESC approach was retrospectively determined. Pharmacologic treatment was used as a last resort. The clinical outcomes and therapeutic strategies employed were evaluated. Statistical association was evaluated. The incidence rate per 1000 births was calculated and temporal trend differences were identified.ResultsA total of 79 neonates at risk were included, of whom 40 (50.6%) developed NAS. Consolability was the most affected criterion (35.0%), followed by feeding difficulties (12.5%). Sleep was affected less frequently (5.0%). Overall, 37.5% of infants failed to meet at least one of the criteria. All neonates with a positive ESC failed the qualitative assessment (p = 1.000) After optimization of nonpharmacologic measures, drug therapy was still necessary in four cases (10.0% of infants with the syndrome). The incidence rate of NAS decreased from 3.9 per 1000 births in 2010 to 0.0 per 1000 births in 2021 (p = 0.025).ConclusionThe qualitative assessment of the infant based on the ability to feed, sleep and be consoled correctly identified neonates at risk and led to a significant reduction in the use of drug therapy. The incidence rate of NAS decreased during the study period.

The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis.

Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Forecasting Psychological Distress Across Waves Of The COVID-19 Pandemic: A Multi-country Longitudinal Study

Abstract The current study used a longitudinal multi-country cohort survey (N = 8013 at baseline; age (M) = 40.3, SD = 15; female 76%) to investigate whether psychological distress assessed at five waves (May-June 2020; September-October 2020; December 2020-January 2021; March-April 2021 and March-May 2022) during the COVID-19 outbreak can be forecasted by a variety of socio-demographic and psychological- and COVID-related factors assessed at baseline. Psychological distress was defined by elevated depression and/or anxiety scores (PHQ-9 and GAD-7 > = 10). Predictors included demographic characteristics (e.g., gender, age, education), infections with COVID-19, loss of income, substance abuse, domestic violence, contamination fear, basic value orientations, social support and coping strategies. A Random Forest (RF) prediction model within a machine learning context was used to estimate the association between the independent variables and the presence of psychological distress among respondents completing all waves (N = 1052). Preliminary RF results showed that psychological distress at multiple waves, both during the initial phases (2020) as well as the more protracted phases (2021 and 2022), was adequately forecasted by scores on a number of basic value orientations (e.g., lower tradition and conformity, higher security and predictability), by demographic characteristics (e.g., younger age), by the fear of being contaminated, and by lower levels of social support and higher levels of loneliness. It is concluded that during a pandemic, certain personal values may elicit more vulnerability for psychological distress than others. Effective psychological intervention strategies should encompass personal traits and values and factors such as low social support levels and feelings of loneliness to mitigate distress. These insights can help in accurately pinpointing high-risk groups for heightened distress in future public health crises.

Abstract Strengths and difficulties Lithuania

Abstract Background Most mental health disorders begin before the age of 18, peaking at 14.5 years (Solmi, 2022) and manifest as emotional and behavioural difficulties that are more frequent in institutional social care (ISC): former foster care recipients have higher rates of depression and PTSD than the general population (Pecora, 2009). The rate of children living in residential care facilities in Europe and Central Asia is double the global average (UNICEF, 2024). This study aims to assess and compare the mental health of children in ISC centers and regular high schools. Methods A cross-sectional study was conducted in ISC centres and high schools in 2022-2023. The sample size consisted of children aged 11-17 living in ISC (n = 49) or in families (n = 193). Online anonymous survey was applied to assess the prevalence of endured violence, substance use and measure mental health outcomes using the Strengths and Difficulties Questionnaire (SDQ-25). Results A total of 242 respondents (age mean 14.6, SD = 2.12) in ISC and families showed similar poor mental health rates (42% and 44%, respectively). Prosocial behaviour problems were exhibited more by boys (p < 0.05), whereas emotional symptoms were more common in families (p < 0.001): 90% normal SDQ-25 scores in ISC vs 60% in families. Enduring psychological (38% vs 60.2%) violence was more prevalent among children in families (p < 0.05); smoking - in ISC, alcohol use - in families (p < 0.05). In both groups enduring physical violence was associated with smoking and alcohol use (p < 0.05), and overall poor SDQ-25 results strongly correlated (p < 0.001, r = 0.815, r = 0.610, respectively) with hyperactivity. Conclusions A significant part of study participants reported poor mental health outcomes with most problems in relationships with peers. Mental health risk factors such as violence or substance abuse are associated with poor emotional wellbeing while being more common among children living with families. Key messages • Children living in ISC and in families demonstrate similar level of mental health problems. • Varying prevalence of substance abuse among children living in different settings highlights the importance of environmental factors when addressing the issue.

Self-reported mistreatment of Danish medical students

Abstract Background Evidence suggests that mistreatment of medical students (MS) exists and that it is associated with stress, anxiety, burnout, substance abuse etc. Mistreatment encompasses discrimination and sexual harassment and impacts MS’ ability to partake their education with increased risk of dropout. The aim of the study is therefore to explore whether Danish MS and junior physicians enrolled in the Clinical basic education (CBE) have experienced mistreatment during their studies. Methods An online survey was conducted by email and sent to 5234 MS enrolled in one of four medical Master programs in Denmark or in the CBE. Reminders were distributed by email, shared in Facebook groups, and presented during lectures, accompanied by cards with QR codes for the survey. Data collection took place during spring 2023 and 645 completed the questionnaire giving a response rate of 12 %. The questions were based on the Everyday Discrimination Scale. Descriptive statistics and multivariate logistic regression were used for data analysis. Results MS most often encounter mistreatment from physicians, other health professionals and patients during their clinical internships. They also encounter mistreatment from lecturers and peers. MS who self-identify with another ethnicity than Danish/European were 3.2 times more likely than MS identifying with Danish/European ethnicity to report mistreatment from other students (95% CI 1.76 -5.95). Men were also less likely than women to report mistreatment. The mistreatment reported by MS is predominantly based on gender, ethnicity, religion, and age. The most frequent experiences are stereotypical statements (71,8%), lack of respect (65,1%) and being ignored (54,1%). Conclusions Our results indicate that Danish MS experience mistreatment, which can potentially impact their mental health. These results underscore the need for targeted interventions to create an inclusive educational environment that fosters the well-being and success of MS. Key messages • Danish medical students often face mistreatment from peers and health professionals, and more often reported by woman and students identifying with ethnic backgrounds other than Danish/European. • Action by University management is needed to implement targeted interventions such as diversity training, as mistreatment can negatively impact students’ mental health and educational outcomes.

Public health prevention programmes for mental illness in school-age children and adolescents

Abstract Background Psychiatrists, psychotherapists and other mental health professionals have long stated the importance of adequate social groups and early intervention for the prevention of severe mental diseases. With psychiatric illness incidence increasing most in the adolescent and young adult populations, we propose the use of school-age directed public mental health initiatives to combat remaining social stigma and promote mental wellbeing, as well as educate children and adolescents in how to recognise symptoms and ask for help. Methods We conducted a systematic review on PubMed as well as government and NGO websites to identify public health initiatives in the prevention and early identification of mental illness among young individuals. Results Preliminary results show that, while certain countries have delineated guidelines on how to support students’ mental health, very few have implemented nation-wide, or even region-wide programmes that directly target prevention and education. A particular note should be made regarding substance abuse and addiction, one of the few illnesses for which many countries have already enacted in-school programmes, that however often overlook the medical aspect of such diseases. Of further note are certain local programmes aimed at offering quality and accessible care to adolescents struggling with mental diseases. Conclusions With psychiatric diseases projected to become one of the greatest contributors to the global burden of disease by 2030, and the importance of early intervention in preventing severe psychiatric illness, we advocated for European public health initiatives implemented in schools, which could be crucial in curbing the spread of mental illness. Key messages • Adolescent and young adults are those most affected by the rising prevalence of mental illness. Consequently, we advocate for in-school programmes to aid in early identification and intervention. • Early identification of mental diseases is crucial in the prevention of severe psychiatric illness, but little has been done so far in terms of public health interventions to tackle such problems.

Cardiovascular outcomes in pregnant women with congenital heart disease

Abstract Background Individuals with congenital heart disease (CHD) are at increased risk of cardiovascular complications. There is limited available data on burden of acute cardiovascular complications in pregnant women with CHD. Purpose To study the acute cardiovascular complications in pregnant women with CHD. Methods We conducted a retrospective observational analysis using the Nationwide Inpatient Sample (NIS) database. Using ICD-9 and ICD-10-CM codes, we identified pregnant women aged 18 years or older with and without CHD hospitalized between January 1st, 2010, and December 31st, 2019. The outcomes of the study were peripartum cardiomyopathy, hypertensive disorders of pregnancy (gestational hypertension, pre-eclampsia, and eclampsia), acute myocardial infarction, cardiac arrhythmias, cardiac arrest, stroke or transient ischemia, and in hospital mortality. Results During the study period, there were a total of 41,114,105 hospitalizations for pregnancy. Of these, 43,131 (0.1%) had CHD. The mean age of the population was 28 years in both CHD and non-CHD groups. The majority were white patients, followed by black patients and then Asians in both groups. There was a higher proportion of white patients in the CHD group compared to the non-CHD group. Comorbidities including diabetes mellitus, chronic pulmonary disease, chronic kidney disease, hyperlipidemia, smoking, depression, and drug abuse were higher in the CHD group compared to the non-CHD group (Table 1). Pregnant women with CHD had a significantly higher incidence of peripartum cardiomyopathy (1905 vs 89 per 100,000 pregnancy hospitalizations; p<0.001), hypertensive disorders of pregnancy (9332 vs 7802 per 100,000 pregnancy hospitalizations ; p<0.001), acute coronary syndrome (253 vs 12 per 100,000 pregnancy hospitalizations; p<0.001), cardiac arrhythmias (3480 vs 176 per 100,000 pregnancy hospitalizations; p<0.001), cardiac arrest (127 vs 6 per 100,000 pregnancy hospitalizations; p<0.001), stroke or transient ischemic attack (1648 vs 32 per 100,000 pregnancy hospitalizations; p<0.001), and venous thromboembolism (816 vs 124 per 100,000 pregnancy hospitalizations; p<0.001) (Table 2). Similarly, pregnant women with CHD had significantly higher in hospital mortality compared to pregnant women with no CHD (116 vs 11 per 100,000 pregnancy hospitalizations; p<0.001). Conclusion Pregnant women with CHD are at significantly increased risk of acute cardiovascular complications compared to those without CHD. Our study underscores the importance of close monitoring and specialized care for this high-risk population during pregnancy and delivery. Further research is warranted to better understand the risks associated with these complications and to optimize management strategies for pregnant women with CHD.Baseline CharacteristicsOutcomes

Enhancing Data Quality through Electronic Health Records in Prison Settings: Towards a Learning Health System

Abstract Utilizing electronic health records (EHRs) in prison settings offers a unique opportunity to establish a learning health system (LHS) aimed at enhancing healthcare quality for incarcerated individuals. Despite the challenges inherent in prison healthcare, leveraging EHRs can facilitate data-driven decision-making and foster continuous improvement initiatives. This study describes the results of an intervention aimed at improving EHR data quality in prisons and explores the potential to enhance the development of a robust LHS. We assessed EHR data quality in 2015 (38 prisons) and 2022 (35 prisons) in the Netherlands over six months. Data were extracted, de-identified, and analyzed across demographic, medication use, (history of) diagnosis, and healthcare usage categories. We measured indicator scores and evaluated variation between prisons in data quality. This project was commissioned by the Custodial Institutions Agency. In 2015, age and gender were recorded for 93% of prisoners, increasing to 100% in 2022. Diagnostic coding use rose from an average of 82% in 2015 to 98% in 2022, with reduced variation between prisons. Consultation frequency per inmate ranged from 3 to 13, reflecting challenges in constructing a uniform denominator due to institutional differences. Mental health problems accounted for 17.7% of recorded disease episodes in 2022. In addition, consultations were most often related to oral health (4.4%), drug abuse (3.2%), sleep (1.8%), fear of diseases (1.6%), and respiratory infections (1.5%). Our findings indicate improvements in EHR data quality in Dutch prisons between 2015 to 2022. Integrating EHR data reuse into prison healthcare systems is pivotal for realizing the vision of an LHS in correctional facilities. This study underscores the potential of advancing EHR recording habits and the reuse of EHR data to enhance healthcare quality in prison settings.

Mobile street clinics and harm reduction: pathways to provide care to homeless people in Brazil

Abstract Homeless people (HP) are defined as a heterogeneous group that lives in extreme poverty, with weakened or severed family ties, lacking access to conventional housing, and using public spaces as residence. In terms of health, mental health conditions are prominent as a primary treatment demand, with care aimed at addressing needs arising from the use of alcohol and other drugs being a priority in serving HP. In this context, mobile street clinics (MSC) provide health services directly in street environments, focusing on individuals who use alcohol and other substances through harm reduction approaches. Harm reduction is defined as a set of practices aimed at minimizing the adverse health effects of alcohol and drug use without necessarily eliminating usage. Moreover, it represents an ethical and political direction in care, confronting the logic of criminalization and compulsory abstinence, enhancing access to health care for alcohol and other drug users through strategies that foster autonomy development. In the current study, we conducted an integrative review assessing the facilitators and barriers for HP access to mental health services. Preliminary results indicated that MSC, the connection between healthcare workers and the HP they serve, and the implementation of local street-based actions were the main facilitators of access for individuals who engage in harmful use of alcohol and other drugs to mental health services. Conversely, stigma, services’ lack of adjustment to the lifestyles of homeless people, and excessive bureaucracy were identified as the principal barriers of access. MSC, through their harm reduction activities, have emerged as a potential care technology to facilitate access to health services for homeless people. This research aims to present harm reduction as an ethical and political direction of care through the actions of mobile street clinics, as a way to facilitate access to health services for the homeless people. Key messages • Homeless people require mental health care tailored to the use of alcohol and other drugs, and harm reduction strategies implemented through mobile street clinics prove to be an effective form of care. • Mobile street clinics and harm reduction are important care technologies that enhance access to health services for the homeless population.

Exposure to firearm injury and suicide in a rural Pennsylvania county: implications for mental and behavioral health.

To evaluate the association between self-reported gun violence exposures and mental health and behavioral health indicators in a rural population. Using cross-sectional survey responses from 630 residents of a rural county in Pennsylvania, logistic regression models estimate the likelihood of residents indicating moderate or severe levels of health outcomes as a function of gun violence exposure. We control for a series of variables related to gun ownership, behavior, history with firearms and demographic characteristics. Personal firearm victimization was associated with self-reported depressive symptoms and interrupted sleep. Secondary exposure to firearm violence, particularly exposure to friends attempting or completing a suicide, was associated with higher odds of reporting severe levels (14days or more in the past month) of depressive symptoms, anxiety, and poor sleep. For firearm suicide involving a friend or family member, the odds of reporting severe levels of all three outcomes are 3 times greater (OR 2.984, 95% CI 1.457-6.108). For each additional firearm exposure, the odds of experiencing severe levels of mental health and sleep difficulties are 1.4 times greater (OR 1.384, 95% CI 1.115-1.720). Cumulative exposures also increase the odds of reporting binge drinking and drug use. Firearm violence exposure was associated with adverse health indicators in this rural population. Approaches to counter the effects of cumulative firearm exposure and firearm suicide exposure, including reinvigorating community spaces and strengthening social supports, may help to reduce mental health burden in rural communities.

Accidental Detection of Cocaine in Urine in Pediatric Patients: Case Series and Literature Review

Infantile occult exposure to cocaine in domestic environments represents a complex clinical and medico-legal problem, which can be associated with abuse and neglect and with potential short- and long-term health risks for children. The authors present a retrospective study on 764 children under 14 years old who accessed the Emergency Department of IRCCS Meyer from 2016 to 2023 and were included in the GAIA (Child and Adolescent Abuse Group) protocol for suspected maltreatment and abuse, and for which a urine toxicology analysis was performed. The aim is to discuss the medico-legal implications and highlight the need for a thorough evaluation and management of such situations. Urine screening tests for substances of abuse (e.g., cocaine, opiates, etc.) were performed with an EMIT® Siemens VIVA-E drug testing system (Siemens, Newark DE) in 124 cases for which the child’s clinical condition raised suspicion of intoxication, or the family context indicated distress or substance abuse dependency. The screening results revealed the presence of cocaine and its main metabolite, benzoylecgonine, in the urine of 11 children. In one case, a single girl was brought to the Emergency Department by staff from the facility where she and her mother were staying. In most of the cases, children were brought to the Emergency Department by their parents who accessed the Emergency Department due to various clinical manifestations (drowsiness, agitation, seizures, hypotonia, diarrhea, vomiting, etc.), except for one case of eye trauma suspected to be caused by abuse or neglect by one of the parents. Three of the children did not have signs or symptoms attributable to substance exposure, whilst eight of the cases presented some of the symptoms associated with occult infant exposure to cocaine, such as neurological manifestations, seizures, gastrointestinal symptoms, and respiratory depression. The probable mode of intake was mostly through breastfeeding and continuous environmental exposure due to domestic contamination or inhalation of “crack”. In the case of a 12-hour-old infant, there was probable prenatal in utero exposure. All the children were hospitalized, some for medical reasons and others solely as a precautionary measure for proper care. In all cases, a report was made to the Prosecutors as required by the Italian Penal Code, as well as to the Court of Minor. The study highlighted the importance of a multidisciplinary approach involving pediatricians, social workers, and forensics, as well as close collaboration with the relevant authorities, as the Gaia service at IRCCS Meyer offers. The occasional detection of cocaine in cases that showed no suspicion of intoxication led to a modification of the procedure and the development of a standardized protocol at IRCCS Meyer both in terms of prevention and in the detection and interception of hidden cases, in order to intervene early and initiate the necessary care pathways (secondary prevention). This protocol includes routine toxicological urine testing in all suspected or confirmed cases of child abuse, not just in those where symptoms might suggest a suspicion of intoxication.

Reflective model assessment of adherence to COVID-19 non-pharmaceutical interventions

Abstract Background Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. We identified behavioral factors that affected NPI adherence according to Normalization Process Theory (NPT) in medical students, travel seekers, and people with substance use disorder using reflective model measurement, which previously had not been conducted. Public health officials should consider factors that influence adherence to create preventive strategies for COVID-19. Methods In a cross-sectional design, medical students and people with substance use disorders in treatment comprised a probabilistic sample, and travelers and COVID-19 suspected persons comprised a convenience sample. Participants were from Split-Dalmatia County (n = 656) in the Mediterranean and consented to self-administered surveys in 02/2021. Sociodemographic data, locus of control (LoC), and moral behavior were collected. Partial least squares structural equation modeling (PLS-SEM) was used to measure reflective assessment of NPI adherence according to NPT. Results PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined NPI adherence with excellent goodness of fit (χ2=1.292, df = 1; p = 0.297). Significant negative factors covariance estimate (-0.716) revealed an increase in adherence to the first factor, NPIs and internal LoC [0.640], as the second factor, age (≤25) and highest education level (1.362), decreased. LoC was the mechanism by which sex (MLsex=-0.017, SE = 0.007, p < 0.016) and being a student or person with substance use disorder (MLgroup=-0.008, SE = 0.003, p = 0.015) showed indirect effect on NPI adherence. Conclusions Students and people with substance use disorders more adhered to NPIs. Higher-educated younger adults with a tendency toward external LoC facilitated the normalization. Public health interventions could encourage these subgroups to act as promoters to increase NPI adherence in similar settings. Key messages • COVID-19 non-pharmaceutical interventions and psychological factors of students and people with substance abuse disorder influenced adherence. Targeted interventions could promote adherence. • Public health officials should consider that preventive strategies may be more effective in highly educated adults younger than 25 years of age.

Factors associated with over-the-counter drug misuse among young people: a narrative review

Abstract Background Over-the-counter (OTC) medications are sold directly to customers without requiring a doctor’s prescription. Misuse of OTC drugs is higher in adolescents and young adults than in the general population. This review is the first to narratively synthesize the factors associated with OTC drug misuse among adolescents and young adults (14-25 years old). Aim To identify the factors that are associated with OTC drug misuse among adolescents and young adults (14-25 years). Methods A comprehensive search of three electronic databases, including MEDLINE, PsycINFO and Web of Science, was conducted to retrieve publications between 1 January 1997 and 31 July 2023. The AXIS tool was used to aid critical appraisal. Papers were analysed using thematic analysis. Results Eight studies were eligible for inclusion in this narrative review We identified four key themes: motivational factors; health literacy; illicit drug use and socioeconomic status. Sensation-seeking and using OTC drugs for recreational purposes were associated with OTC misuse. Limited health literacy and lack of understanding of OTC drugs were significant factors for misusing OTC drugs. Greater use of OTC drugs at the same time as alcohol and other illicit drugs represented that they were at increased risk for misusing OTC drugs. Finally, adolescents and young adults with low income, from rural areas and with lower educational attainment were most likely to misuse OTC drugs. Conclusions Although over-the-counter medications (OTCs) encourage self-medication, their rising misuse has led to a public health problem to which nations worldwide are responding. Therefore, education and awareness among OTC drug users policy will be helpful further on strategies to prevent the misuse of OTC drugs. Key messages • This review identifies some of the factors for misusing OTC drugs, and education and awareness among OTC drug users policy may be helpful further in strategies to prevent the misuse of OTC drugs. • This review also identifies that changing the user habits and availability of OTC drugs policy may also be helpful in further strategies to prevent the misuse of OTC drugs.