Related Harms Research Articles

Lack of medication reviews in primary care contribute to patient deaths – thematic review of prevention of future deaths reports 2019-2023

Abstract Introduction With over 1 billion items dispensed in primary care each year, practices need robust systems to review repeat prescriptions and safeguard patients.1 The Care Quality Commission have reviewed areas of harm in relation to medicines.2 In general practice, errors in monitoring and review of repeat prescriptions create potential for harm and in some circumstances, death. When reviewing medicines-related patient deaths, coroners may write prevention of future deaths reports (PFDs) to highlight matters of concern to a person or organisation who may have power to act.3 Aim This retrospective case series aims to review coroners’ PFD reports over a 5-year period, with a focus on medicines-related deaths. The review will identify key themes, the most commonly prescribed medicines and any relevant patient demographics. Changes will be suggested to practice for any areas of concern or trends identified. Methods PFDs published on the judiciary website between 1st January 2019 and 31st December 2023 which reported on medication-related deaths were screened.3 Those relating to repeat prescribing were selected for analysis. Inductive thematic analysis was used to assess PFDs and identify where failures in repeat prescribing processes contributed to medication-related deaths. The “Matters for Concern” were reviewed by three research collaborators, who independently coded the data and identified the key themes. Following the initial screening process, demographic data (if known), relevant coroner notes, and available information on the drug(s) which contributed to patient deaths were extracted from the PFDs and recorded in a data table in Microsoft Excel. Ethical approval was not required as the research used publicly available information. Results 24 of 4781 PFDs related to repeat prescribing. The majority reported were female patients (67%, p<0.05) with average age of 48. Although the geographic distribution of PFDs was varied, a substantial proportion were published in Greater Manchester (9/24 38%). 76% of named medications were opioid analgesics, mentioned significantly more than any others (p<0.05). One third of the included PFDs described polypharmacy or repeat prescriptions taken alongside acute or over-the-counter medications. 57 matters of concern were raised by coroners, from which three key themes were identified: errors or discrepancies at the point of a transfer of care; the ability to obtain repeat prescriptions from multiple medication sources and a lack of robust medication review. Absence of medication review occurred most frequently (15/24 reports, 63%). Discussion This study identified where risks lie in repeat prescribing processes, with lack of robust medication reviews being most commonly linked to patient deaths. Inherently high-risk medicines, opioid analgesics, were most commonly described and should be prioritised for review. The average age was 48, suggesting older age may not be a risk factor in itself, but the contribution of polypharmacy was emphasised in the reports. The sample size was small and the time to extract the information from the reports impacted on the length of the study period chosen. However, pharmacy teams in general practice have an essential role to play in supporting medication reviews. Development of guidance to support repeat prescribing will also help to better safeguard patients receiving repeat medication.

Nineteenth-century narratives of addiction: Relational harm and the child as witness

Through close reading of medical and cultural texts, this article demonstrates how the narrativisation of relational harm underpinned the emerging categorisation of ‘addiction’ in the 19th century: excessive consumption was conceived through its detrimental impact upon others, and more specifically, upon the family. The problem was portrayed as physiological, psychological, and social: ‘addiction’ could not be located securely within a single individual, nor was it conceived simply as a social vice. While other societal themes emerge in the medical writing of the period, such as the relationship between drinking and criminality, and the visibility of drinking in the working-classes, these are not presented as proto-diagnostic criteria in the same way as relational harm. In theorising addiction, medicine relied upon rhetorical devices and narrative modes, and authors and artists took an active role in defining the terms of the debate around drinking, drug use, and gambling. Charles Dickens and George Cruikshank represent childhood through the adult's compulsive behaviour, which the child witnesses, while the adult's behaviour itself is conceived as harm directed towards child. The article demonstrates how 21st-century attitudes, particularly located in the fields of psychiatric diagnosis and child protection social work, echo debates established by 19th-century narratives, arguing that that the disease model of addiction was closely associated with the medico-legal production of childhood. Nineteenth-century narratives of addiction therefore anticipate late 20th- and 21st-century attitudes regarding the impact of parental substance use upon children.

Through an Hourglass Darkly? Navigating The Risk Landscape of the Reasonably Foreseeable Future

Abstract As refugee law has developed over time, broad authoritative principles have been espoused as interpretive aids to the refugee definition. The maxim that a well-founded fear of being persecuted entails a forward-looking appraisal of risk is one example. In some jurisdictions, such as Australia, the temporal yardstick of the reasonably foreseeable future has been introduced to guide decision-makers over the complex terrain of risk assessment. However, a close study of the case law reveals formulaic use, inconsistency and conflation of the standard with risk and its indicia—and if the standard is intended as a real risk heuristic this is far from clear or warranted. This study critically examines the reasonably foreseeable future notion in case law in Australia, including its origins as an imported, limiting standard of due diligence from other areas of international law. It signals refugee law’s vulnerability to the standard and cautions against applying the gloss of foreseeability and reasonableness as an unnecessary and obscure overlay to interpretation. It recommends instead the unadulterated real chance standard paired with narrative conventions on time, as strategies adopted in other areas of law to sensibly navigate the fraught notion of foreseeability. It proposes that the ordering of the definitional elements of well-founded fear, downstream of being persecuted, is critical to the analysis and, in simple terms, slow and deliberate thinking is required to pinpoint the temporal underpinnings of harm in relation to risk.

Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014–2024

BackgroundThis study aimed to characterise patterns of tobacco smoking and vaping among older adults (≥ 65 years) in England, to explore harm perceptions of e-cigarettes among those who smoke, and to estimate the real-world effectiveness of e-cigarettes for helping older adults to stop smoking.MethodsData were collected as part of a representative monthly cross-sectional household survey in England between April 2014 and April 2024 (n = 197,219). We analysed differences between older (≥ 65 years) and younger/middle-aged adults (18–64 years) in (a) time trends in tobacco smoking and vaping, (b) harm perceptions of e-cigarettes vs. cigarettes (adjusting for gender, socioeconomic position, and vaping status), and (c) the real-world effectiveness of e-cigarettes for smoking cessation (adjusting for gender, socioeconomic position, characteristics of the quit attempt, and use of other evidence-based cessation aids).ResultsTobacco smoking prevalence remained relatively unchanged over time among older adults (at ~ 9%; 9.5% [8.5–10.6%] in April 2014 and 8.7% [7.7–9.8%] in April 2024) but vaping prevalence increased (from 2.1% [1.6–2.7%] to 3.7% [3.0–4.6%], respectively). These trends differed from those observed among younger/middle-aged adults, among whom there was a clear decline in smoking (from 21.8% [21.0–22.7%] to 18.2% [17.3–19.0%]) and a larger increase in vaping (from 5.6% [5.2–6.1%] to 16.2% [15.3–17.0%]). Older adults were consistently less likely than younger/middle-aged adults to use e-cigarettes to support attempts to quit smoking (26.8% [17.2–39.3%] vs. 43.7% [39.6–48.0%] in April 2024). Older smokers reported greater uncertainty about the harms of e-cigarettes compared with cigarettes (ORadj = 2.48 [2.28–2.69]). E-cigarettes appeared to be effective for helping older adults to stop smoking (ORadj = 1.50 [0.96–2.34]); whether effectiveness was lower than for younger/middle-aged adults was inconclusive.ConclusionsOver the past decade, smoking prevalence has remained stable among older adults while decreasing among the rest of the adult population in England. Older adults are more unsure about the relative harms of e-cigarettes and less likely to use them to support attempts to quit smoking, despite evidence that they are effective for smoking cessation in this population.

Beyond mitigation: building a case for collective rights and remedies for digital ID-enabled harms

ABSTRACT National digital ID systems have been promoted by both private and public sector actor actors as a means of fostering economic development and individual empowerment, and of administering a growing digital welfare state. However, these digital ID systems have also been associated with different forms of injustice and remain flashpoints for the contestation of public sector digitalization and datafication initiatives. The complex, intersectional impacts that such systems may have on social exclusion and human rights have made it challenging to articulate rights-based approaches that cover the range of potential injustices or to institutionalize legal and administrative mechanisms capable of remedying violations. This paper posits two ways in which the legal contestation of digital ID has revealed potential barriers to obtaining adequate remedies for digital ID related harm. First, a core methodological challenge is the way in which powerful narratives about the capabilities of digital ID have worked in tandem with individualizing logics of databases, making it difficult to center the collective experiences of affected groups and balance competing interests. Second, is the way in which legal frameworks have structured governance of national digital ID systems, fragmenting responsibility across institutions and individuals in ways that compromise access to justice, rule of law, and pathways to remedies. In bringing together a data justice framework with insights from legal analysis, the paper seeks to assess both limitations and potential opportunities to work through existing legal frameworks to better address the collective harms of digital ID systems.

Harming the innocent: estimating the number of children affected by parental problem gambling

Abstract Background The impact of parental problem gambling on children and adolescents encompasses negative outcomes in psychological, financial, behavioral, physical health, and family relationship domains. For Germany, estimates on the number of co-affected minors are lacking. Methods Within the population-representative Germany-wide “Glücksspielsurvey 2023” (i.e., “Gambling Survey 2023”), we assessed parenthood in survey participants with gambling disorder (GD; according to DSM-5) as well as the number of minors (age <18 years) living a) together with a person with gambling disorder (shared household) or b) apart from a parent with gambling disorder (separate household). Using a “minimum maximum approach,” we performed a weighted extrapolation to estimate the number of co-affected minors in the German resident population (range 18 to 70 years of age) and the prevalence of parental GD among Germany-residing minors. Results 46.8% (n = 132) of survey participants with GD report shared households with minors and 16.3% (n = 46) separate households. The average number of minors concerned was 1.55 (SD = 0.07) in shared and 1.51 (SD = 0.13) in separate households. This translates into 480,294 to 701,766 co-affected children in shared households (3.4% to 4.9% of Germany-residing minors) and 91,742 to 124,618 co-affected children in separate households (0.6% to 0.9% of Germany-residing minors). Discussion and conclusions Taking shared and separate households into account, one in 20 Germany-residing minors is co-affected by parental GD. Acknowledging that impaired psychosocial wellbeing in the context of parental GD could persist into adulthood of co-affected minors, this issue ought to be recognized as a major public health concern. To reduce related harm, children of people with GD should be best possibly integrated into the care process by offering additional help and support strategies explicitly addressed at this vulnerable population. Key messages • Parental problem gambling significantly impacts a substantial portion of German minors, with approximately one in 20 being affected, highlighting the urgent need for attention to this issue. • Recognizing parental gambling’s long-term impact on minors, it’s crucial to implement support strategies in care to address their needs effectively.

Exploring the dynamics of alcohol use, poverty and the role of social context in Athens, Greece

Abstract Background A body of research conducted across diverse national context, including the United Kingdom, Russia, Denmark and Norway, shows a robust link between poverty and increased alcohol related harm, even after accounting for different drinking patterns. This paper examines the unexplored relationship between poverty and alcohol use in Athens, Greece, focusing on alcohol’s impact related to the familial and social life of individuals and whether this system is affected by poverty. Methods This is a 2021 cross-sectional study, with 300 adult participants of mean age 45.8. We administered four questionnaires. The participants were equally distributed above and below the poverty threshold, sampled randomly. The latter were beneficiaries of social services. The data analysis established two scoring variables: the level of dysfunction from alcohol use and the level of strength of family ties. We computed their correlation and multiple linear regressions to assess their relationships. Results Individuals not residing in poverty exhibit a higher frequency of alcohol use (81.9%) than their counterparts (57.1%), however, those living in poverty tend to consume greater quantities of alcohol per occasion (p < 0.001) and reported elevated levels of dysfunction within familial and social interactions. Conclusions This study indicates that different consumption patterns are tied to diverse socioeconomic strata, with binge drinking behaviours specifically linked to financial hardship. Also, alcohol related dysfunction and family and social dynamics are affected by poverty. Our findings show that as dysfunction attributed to alcohol use increases, participants socialize less and report lower levels of well-being. In contrast those with balanced family ties and social encounters exhibit the opposite trend. This study warrants further exploration in cities in Southern Europe. Key messages • To mitigate alcohol use, policies empowering social and familial connections are of high importance. • Uncovering poverty as a factor for binge drinking can inform prevention strategies.

The Antidemocratic Harms of Mansplaining

The neologism “mansplaining” captures an insidious dynamic in which men explain things to women that women already understand, assuming that, by virtue of being a woman, she lacks the man’s knowledge. Mansplaining has started to receive some attention in contemporary scholarship, conceptualizing the phenomenon and identifying its epistemic harm. My purpose is to consider mansplaining and its harms from the perspective of democratic theory. Setting the problem of mansplaining against the norms we expect of democracy—equality, inclusion, and recognition—I argue that mansplaining poses harms that are not only individual and epistemic but also collective and relational. I distinguish two types of mansplaining based on women’s expertise and experience to elaborate on its collective epistemic harms to decision making and its relational harm of political exclusion. Mansplaining poses further relational harms of inequality and misrecognition, undermining the equal social relations and social trust required for deliberation.

Cannabis

Objective: Almost half of U.S. states have passed recreational cannabis laws as of May 2024. While considerable evidence to date indicates cannabis may be a substitute for prescription opioids in the treatment of pain, it remains unclear if patients are treating pain with cannabis alone or concomitantly with other medications. Method: Using data from a national sample of commercially insured adults, we examine the effect of recreational cannabis legalization (through two sequential policies) on prescribing of opioids, NSAIDS, and other pain medications by implementing synthetic control estimations and constructing case-study level counterfactuals for the years 2007-2020. Results: Overall, we find recreational cannabis legalization is associated with a decrease in opioid fills among commercially insured adults in the U.S., and we find evidence of a compositional change in prescriptions of pain medications more broadly. Specifically, we find marginally significant increases in prescribing of non-opioid pain medications after recreational cannabis becomes legal in some states. Once recreational cannabis dispensaries open, we find statistically significant decreases in the rate of opioid prescriptions (13% reduction from baseline, p < .05) and marginally significant decreases in the average daily supply of opioids (6.3% decrease, p < .10) and number of opioid prescriptions per patient (3.5% decrease, p < .10). Conclusions: These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases. There appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries. The decrease in opioids and marginal increase in non-opioid pain medication may reflect patients substituting opioids with cannabis and non-opioid pain medications, either separately or concomitantly. Reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.

“You walk on glass if you are in that space”: Risks and harms of corruption in wildlife justice pathways in Uganda

Wildlife crime drives existential harms including biodiversity loss and climate change, disproportionately affecting the Global South. Criminal justice approaches dominate the public response, yet scant evidence exists on how corruption, an economic crime, undermines deterrence and exacerbates inequalities. This primary research study utilises a qualitative approach to examine the risks and harms of corruption within wildlife enforcement and justice in Uganda. Using a red-green criminological perspective and drawing upon semi-structured interviews with experts and practitioners from government and civil society, this paper identifies corruption risks in wildlife criminal justice and explores their related harms and consequences. The study finds wildlife enforcement in Uganda suffers from institutional corruption, including perverse incentives which distort targeting and resource prioritisation, leading to discrimination against low-level offenders. Furthermore, differential access to individualist corruption opportunities along the justice pathway enables wealthy or well-connected suspects to avoid sanctions, resulting in sentencing inequities. Despite resulting in differential outcomes for affluent and subsistence offenders, the study concludes that corruption in wildlife justice neutralises deterrence for both offender types. By creating impunity for elites, organised crime actors are attracted to the trade. Moreover, by amplifying sentencing inequalities, subsistence offenders are further impoverished, increasing re-offending. Corruption in wildlife justice thus drives significant long-term environmental, socioeconomic, and political harms, and erodes the rule of law.

Public health involvement in alcohol licensing decisions in the UK: a systematic review of qualitative studies

IntroductionOne approach to reducing alcohol consumption and related harm is to limit physical availability. However, a recent review found alcohol licensing decisions are not consistently associated with improved local health...

Patterns and perceptions of vaping among adults living in social housing: a representative survey in Great Britain, 2023

BackgroundVaping products are effective for helping people to stop smoking and may therefore offer a potential means to reduce high rates of smoking in socioeconomically disadvantaged groups. This study aimed to examine current patterns and perceptions of vaping among people living in social housing in Great Britain compared with those living in other housing types.MethodsData were from the Smoking Toolkit Study; a nationally-representative survey conducted in 2023 (n = 23,245). Logistic regression tested cross-sectional associations between living in social (vs. other) housing and current vaping among adults; vaping frequency, device type, nicotine concentration, and source of purchase among current vapers; use of vaping products as a smoking cessation aid among past-year smokers who tried to quit; and harm perceptions of vaping products relative to cigarettes among current smokers.ResultsCurrent vaping prevalence was twice as high among adults living in social housing (19.4%) compared with those in other housing types (10.4%; OR = 2.07, 95%CI = 1.84–2.33). This was partly explained by differences in sociodemographic characteristics and smoking status; after adjustment, the odds of being a current vaper were 33% higher (ORadj=1.33, 95%CI = 1.14–1.54). Among vapers, there were no notable differences by housing tenure in vaping frequency, main device type used, usual nicotine concentration, usual source of purchase, or use as a smoking cessation aid. However, current smokers living in social housing were more likely to think vaping is more harmful than cigarettes (31.6% vs. 21.8%; ORadj=1.61, 95%CI = 1.30–1.99).ConclusionsIn Great Britain, adults who live in social housing are more likely to vape than those who live in other housing types, even after accounting for their younger age and higher smoking rates. However, misperceptions about the relative harms of vaping products and tobacco are common among smokers living in social housing. Interventions addressing these misperceptions could help encourage more people living in social housing to switch from smoking to vaping and reduce smoking-related health inequalities.Pre-registrationThe study protocol and analysis plan were pre-registered on Open Science Framework (https://osf.io/n3mvs/).

Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep

Direct-to-patient interventions enabling transitions from long-term benzodiazepine receptor agonist (BZRA) use to cognitive behavioral therapy for insomnia (CBTI) by older adults has the potential to reduce BZRA use and related harms while improving sleep outcomes without requiring prearranged clinician involvement. To compare 2 direct-to-patient behavior change interventions with treatment as usual (TAU) on BZRA use, sleep, and other health outcomes, and uptake of CBTI techniques. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study was a 3-arm, pragmatic, open-label, minimum-contact, randomized clinical trial. The study began November 2020 and ended June 2022. Participants were randomly allocated to 1 of 3 groups, including 2 different mailed behavior change interventions or no intervention (TAU). Participants were from communities across the province of New Brunswick, Canada, and included adults 65 years and older living independently with long-term use of BZRAs and current or past insomnia. The Sleepwell package (YAWNS-1) consisted of a cover letter and 2 booklets ("How to Stop Sleeping Pills" and "How to Get Your Sleep Back"). The other package (YAWNS-2) included updated versions of the 2 booklets ("You May Be at Risk" and "How to Get a Good Night's Sleep Without Medication") used in the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study. BZRA use at 6 months was the primary measure. Secondary measures included CBTI use, sleep, insomnia, daytime sleepiness, safety, anxiety, frailty, and quality of life. A total of 1295 individuals expressed interest in the study, and 565 (43.6%) completed a baseline assessment. Participants had a mean (SD) age of 72.1 (5.7) years, a mean (SD) BZRA use duration of 11.4 (9.1) years, and 362 (64.1%) were female. Discontinuations and dose reductions of 25% or greater were highest with YAWNS-1 (50 of 191 [26.2%]; 39 of 191 [20.4%]; total, 46.6%) compared with YAWNS-2 (38 of 187 [20.3%]; 27 of 187 [14.4%]; total, 34.8%, P = .02) and TAU (14 of 187 [7.5%]; 24 of 187 [12.8%]; total, 20.3%, P < .001). YAWNS-1 also demonstrated better uptake of CBTI techniques and sleep outcomes compared with YAWNS-2 (new CBTI techniques: 3.1 vs 2.4; P =.03; sleep efficiency change: 4.1% vs -1.7%; P =.001) and reduced insomnia severity and daytime sleepiness compared with TAU (insomnia severity index change: -2.0 vs 0.3; P <.001; Epworth Sleepiness Scale change: -0.8 vs 0.3; P =.001). Results of the YAWNS NB randomized clinical trial show that, as a simple, scalable, direct-to-patient intervention, YAWNS-1 substantially reduced BZRA use and improved sleep outcomes. It could be implemented to transform insomnia care for older adults at the population level. ClinicalTrials.gov Identifier: NCT04406103.

State program enables the identification of factors associated with naloxone awareness, self-efficacy, and use for overdose reversal: A cross-sectional, observational study in an urban emergency department population

IntroductionTo assist the state of Ohio in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles to the development of prevention and educational strategies for reducing substance use disorder and related harms (e.g., promoting naloxone awareness). Naloxone awareness is a step in the naloxone cascade, which is a useful model for understanding the sequential steps laypeople must take to prepare themselves to intervene using naloxone; other steps include training and previous administration experience. Prior work has explored correlates of these steps among individuals with risky substance use, but fewer studies have focused on broader populations containing potential bystanders (e.g., family and community members). MethodsThis study was a secondary data analysis of patients from three urban emergency departments. Subsamples differed across five models (n = 479–1208) and included opioid-exposed and -naïve participants. Logistic regression characterized clinically useful sociodemographic predictors (e.g., race, ethnicity, education, employment, housing status) of naloxone awareness, self-efficacy (which relates to training), and previous-overdose administration. Two additional logistic regressions tested associations between risk factors for witnessing an opioid overdose and two cascade steps (awareness and self-efficacy). ResultsNon-White race, Hispanic ethnicity, and lower education predicted not being aware of naloxone; non-White race also predicted lower naloxone self-efficacy, and older age predicted lack of previous-overdose administration. Having family members with risky opioid use was heavily associated with awareness, while personal substance-use behaviors and previous overdose witnessing were associated with both awareness and higher naloxone self-efficacy. ConclusionsCharacteristics associated with lower likelihood of completing each cascade step highlight opportunities for targeted interventions. Specifically, findings indicated the importance of expanding naloxone education and training programs to more diverse populations and to family members of individuals with risky opioid use. Further, these findings demonstrate how a state-funded program such as SCOPE can have a positive impact on identifying strategies that may assist in reducing mortality associated with opioid overdose.

Evaluating and identifying changes in the rate of unplanned discharge among Department of Veterans Affairs (VA) facilities providing substance use disorder residential care

IntroductionQuality improvement (QI) methods play a critical role in ensuring that patients receive high-quality and timely care. Healthcare systems should use valid and reliable measures to inform QI efforts. Mental health settings including substance use disorder (SUD) residential programs have been slow to develop and incorporate quality measurement into routine practice. Unplanned discharge is of particular concern because this event is associated with harm including suicide. Healthcare systems require criteria that they can use to operationalize unplanned discharge as a quality measure in SUD residential programs. MethodsThe study included all discharges from the Department of Veterans Affairs (VA) residential SUD programs between 2018 and 2022. The study calculated crude and adjusted rates of irregular discharge. The study used the first two years of observation (2018–2019) in a logistic regression model to determine the parameter estimates for three important covariates, age, risk for homelessness, and principal diagnosis. The study tested permutations of bin size (N) and days (D) per bin to identify a single set of parameters to enable small and large facilities to have sufficient power to detect out-of-control processes (i.e., significant worsening or improvement in rates). Aligned with standard nomenclature, the study calculated the control limits based on three standard deviations (SD). Values that fell above or below three SD were statistically significant. ResultsThe cohort included 56 facilities (26,361 discharges). Irregular discharge was associated with younger age (18–40 years) and a principal diagnosis of a drug use disorder. Testing parameter values of 100 discharges (N) over 120 days (D) would yield enough power to detect modest relative changes to the irregular discharge rate for small and large facilities while testing frequently enough to make the evaluations temporally relevant. Because secular trends such as staff changes over time will impact results, the quality control method should allow for real-time feedback to those most proximal to the event. ConclusionsThe study created a set of parameters and a methodology that residential SUD programs can use to operationalize unplanned discharge locally. These data could assist programs in conducting QI work to address unplanned discharge and related harms.

Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology

BackgroundOpioid utilization and related harm have increased in recent decades, notably in Australia, the United States, Canada, and some European countries. For people who are prescribed opioids, pharmacies offer an accessible, regular point-of-contact, providing a unique opportunity to address opioid prescription drugs risks. ObjectiveThis project aimed to develop consensus-based, best practice statements for improving the safer use of prescription opioids through community pharmacy settings. MethodsThe e-Delphi technique is used to obtain consensus from experts about issues where conclusive evidence is lacking, using multiple rounds of online participation. The investigator group identified an international group of potential participants with relevant expertise who were invited to the study, and asked to identify other experts for invitation. The e-Delphi process comprised three online rounds, involving (1) statement idea generation, (2) developing statement consensus, and (3) confirming and ranking statements. ResultsA diverse group of 42 experts (76 % female, 6 countries) participated, comprising pharmacists (n = 24, 57 %), medical doctors of differing specialties (n = 12, 29 %), and/or researchers (n = 28, 67 %), with a mean of 15 years’ professional experience (SD = 8.08). Eighty-five statements were initially developed in Round 1, and 78 were supported with amendments, with suggestions to merge and remove items in Round 2, resulting in 72 final statements which were all endorsed in Round 3. Items spanned seven themes: education, monitoring outcomes and risk, deprescribing and pain management, overdose education and naloxone, opioid agonist treatment, staff education, and overarching practices. Preferred terminology was determined in Round 2 and confirmed in Round 3. ConclusionsCommunity pharmacies offer a unique opportunity to support the safer use of prescription opioids. These 72 best practice statements provide practical guidance on specific practices that pharmacists can undertake to support patients' safer use of prescription opioids and prevent or reduce harms from prescribed opioid use.

Greenwashed Cigarette Ad Text and Imagery Produce Inaccurate Harm, Addictiveness, and Nicotine Content Perceptions: Results from a Randomized Online Experiment.

The tobacco industry has a long history of circumventing regulations to present their products, inaccurately, as less harmful. Greenwashing (portraying a product as natural/eco-friendly) is increasingly used by tobacco companies and may mislead consumers to believe that certain cigarettes are less harmful than others. This study assesses the effect of some common greenwashing tactics on consumer product perceptions. We conducted an online experiment with 1,504 participants ages 18-29, randomized to view a cigarette ad manipulated for presence/absence of a combination of 4 different greenwashing techniques: greenwashed ad text, greenwashed ad imagery, recycled paper ad background, and image of greenwashed cigarette pack. Participants rated perceived absolute harm, relative harm to other cigarettes, absolute addictiveness, relative addictiveness, and relative nicotine content. Participants who viewed ads containing greenwashed text were more likely to have inaccurate perceptions about absolute harm (AOR=1.72), relative harm (AOR=3.92), relative addictiveness (AOR=2.93) and nicotine content (AOR=2.08). Participants who viewed ads containing greenwashed imagery were more likely to have inaccurate perceptions of relative harm (AOR=1.55), absolute addictiveness (AOR=1.72), relative addictiveness (AOR=1.60) and nicotine content (AOR=1.48). Forty-two percent of those who saw an ad with all greenwashed features believed the product was less harmful than other cigarettes vs. 2% of those who saw an ad without greenwashed features. We found greenwashed text and imagery produced inaccurate risk perceptions. More active U.S. Food & Drug Administration (FDA) enforcement against such greenwashing and new FDA rulemaking to prohibit unnecessary imagery in tobacco advertising and establish plain packaging requirements would help protect consumers and public health. These findings provide evidence that greenwashing tactics used by the tobacco industry increase inaccurate product risk perceptions. These tactics could be a way for the industry to make implicit modified risk claims, despite applicable U.S. Family Smoking Prevention and Tobacco Control Act prohibitions. Findings from this study support the need for prohibitions on these tactics, and the potential for such prohibitions to help protect public health.

Differences in Presenting Health Warning Labels on Hookah Venue Menus Between Immersive Virtual Reality and Online Surveys

Background Virtual reality (VR) platforms can simulate the real world, whereas online surveys are efficient settings for assessing and testing information. In this study, the effects of presenting health warning labels (HWLs) on hookah venue menus were compared between these two message-testing settings. Methods Separate studies were conducted in VR (n = 96) and online survey (n = 213) settings. Participants in both studies were randomly assigned to view menus with or without HWLs. This secondary data analysis compared outcomes between settings after propensity score weighting to account for differences in age, race, marital status, and education between studies. Results Significant between-study differences were noted for the effects of HWLs on people’s perceptions of the absolute harm of hookah smoking (p = 0.0363), the relative harm of hookah compared to cigarettes (p < 0.001), the absolute addictiveness of hookah (p < 0.001), and the relative addictiveness of hookah compared to cigarettes (p = 0.0352). When outcome variables differed significantly between the HWL and control conditions in only one of the two studies, smaller p-values were identified for the online survey setting than for the VR setting. Conclusions This study represents the first direct comparison of the effects of hookah HWLs between two message-testing settings. HWLs tested in the online survey setting were associated with larger shifts in attitudes and beliefs than those tested in the VR setting, suggesting that the effectiveness of hookah HWLs on attitudes and beliefs may be moderated by the message-testing platform. Additional real-world experiments remain necessary to determine whether either setting can accurately assess the effectiveness of HWLs.

Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. A meta-analysis was performed on all available studies that evaluated the relative benefits and harms of MYO and UEA for the management of patients suffering from UFs. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and other complications. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR 1.84; 95% CI 1.62–2.10; P < 0.01; I2 = 39%), hysterectomy rate (OR 4.04; 95% CI 3.45–4.72; P < 0.01; I2 = 59%), and symptom-severity score (OR − 4.02; 95% CI 0.82, 7.22; P = 0.01; I2 = 0%) compared to MYO at a four-year follow-up. However, UAE was associated with a lower rate of early complications (OR 0.44; 95% CI 0.20–0.95; P = 0.04; I2 = 25%), and readmission rate (OR 1.16; 95% CI 1.01–1.33; P = 0.04; I2 = 0%) compared to MYO. Furthermore, both procedures had comparable improvement in pregnancy rates and abnormal uterine bleeding. In conclusion, UAE and MYO are effective in treating symptomatic UFs but they have different outcomes. The decision on which procedure to choose should be made based on individual preferences and the physician’s expertise.

Community awareness and engagement to prevent alcohol related harm: Stakeholder priorities in West Africa

Community awareness and engagement to prevent alcohol related harm: Stakeholder priorities in West Africa