Risk Of Harm Research Articles

Conveying Risks of Harm in Alzheimer Disease by Amyloid Lowering

This Viewpoint discusses how data gaps in published research impede clinicians’ ability to clearly discuss the risks and benefits of amyloid-lowering drugs for treating Alzheimer disease.

Smart Vehicle Load Management with Arduino Sensors

In the context of road safety, vehicle overloading remains a persistent concern, posing a risk of accidents, infrastructure damage, and potential harm to human life. This project introduces an innovative solution for mitigating this issue through an Arduino-based smart vehicle load management The system incorporates load cell, Ultrasonic sensor, an LCD display, and a buzzer to effectively detect and prevent vehicle overloading, contributing to improved road safety. The smart vehicle load management with arduino sensors is designed to monitor the weight distribution on a vehicle using strategically placed load cells and detect variations in vehicle obstacle detection through Ultrasonic sensors. Upon detecting an overload condition, the system promptly triggers a response by stopping the motor, which prevents further loading, and immediately displays a warning on the LCD screen. Simultaneously, it activates an audible alert through the buzzer. This rapid reaction not only averts potential accidents resulting from overloading but also extends the vehicle's operational life by minimizing wear and tear. The Arduino-based Vehicle Overload Detection System represents a cost-effective and efficient approach to addressing the critical issue of vehicle overloading. Its monitoring capabilities, coupled with instant warnings and alerts, establish it as a valuable tool in enhancing road safety and reducing the risks associated with overloading.

Vicarious trauma among legal practitioners and judicial officers

The term ‘vicarious trauma’ refers to a range of cumulative and harmful effects from exposure to the trauma of others and is now recognised as a category of causation in the diagnostic criteria of post-traumatic stress disorder. Legal practitioners may be exposed to the risk of harm from vicarious trauma in a number of occupational contexts. This article reviews recent case authority, including a 2023 prosecution of Court Services Victoria for failing to provide a safe workplace in the Coroners Court of Victoria and the High Court decision in Kozarov v Victoria (2022) and the Victoria Court of Appeal decision in Bersee v Victoria (2022). It considers measures that should be taken to provide a workplace for both legal practitioners and judicial officers that is as safe and without risks to health as is reasonably practicable.

Harm from the drinking of people you know: A range of effects from different relationships.

To describe the range of effects experienced due to the drinking of people respondents know and analyze risk and protective factors for harm from the drinking of partners and household members, other relatives and friends and co-workers. Surveys of 2574 participants' experiences were obtained from two samples: 1000 people responded to random digitally dialled Australian mobile calls and 1574 participants responded from the Life in AustraliaTMpanel survey. Respondents were asked whether they had been negatively affected in the previous 12 months by the drinking of persons they knew who were 'a heavy drinker or drank a lot sometimes' and the nature of these harms. Weighted logistic regressions were used to analyze differences in rates of key negative outcomes from known others' drinking by gender, age and socio-economic status. Almost two thirds [60.2%; 95% confidence interval (CI) = 57.7%-62.7%] of participants reported having heavy drinkers in their lives and 21.8% (95% CI = 19.8%-23.9%) reported being negatively affected by the drinking of people they knew well in some way. Participants reported a gamut of effects, including, most commonly, adverse social effects: having to transport relatives and friends who had been drinking, role failure and faults, being emotionally hurt or neglected, serious arguments, family problems, having to care for drinkers and verbal abuse. Less commonly, respondents reported physical or sexual harm, property damage, financial stress and threats from others' drinking. Women (odds ratio = 1.49; 95% CI = 1.13-1.95), younger people, rural, Australian-born (vs. respondents born overseas in non-English speaking countries) and more frequent drinkers were more likely to report harm from a drinker they knew than their counterparts after adjusting for other variables in the model. Australians appear to be commonly adversely affected by the drinking of people they know. Harms from known drinkers are more likely to be experienced by women than men, particularly from the people they live with and other relatives.

Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design.

Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity. To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self. This was a four-phase ABC plus community follow-up (D) mixed methods n=1 single case experimental design. Four idiographic measures were collected daily across four phases; the baseline (A) was during PICU admission, the first treatment phase (B) was behavioural on the PICU, the second treatment phase (C) was cognitive on an acute ward and the follow-up phase (D) was conducted in the community. Four nomothetic measures were taken on admission, on discharge from the PICU, discharge from the acute ward and then at 4-week follow-up. The participant was also interviewed at follow-up using the Change Interview. Compared with baseline, the behavioural and the cognitive interventions appeared effective in terms of improving calmness, optimism and rumination, but the effects on sociability were poor. There was evidence across idiographic and nomothetic outcomes of a relapse during the follow-up phase in the community. Eleven idiographic changes were reported in the interview and these tended to be unexpected, related to the therapy and personally important. Single case methods can be responsive to tracking the progress of patients moving through in-patient pathways and differing modules of evidence-based interventions. There is a real need to implement robust outcome methodologies on PICUs to better evaluate the psychological aspects of care in this context.

Top 4 Research Studies of the month for Italian Primary Care Physicians: April 2024.

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) In children and adults with acute conjunctivitis, antibiotic drops increase the likelihood that a patient will experience clinical recovery. Damage appears to be minimal for all agents other than fusidic acid (therefore, fusidic acid should be avoided). Since most patients improve without antibiotics, the benefit is modest, and there is a risk of antibiotic resistance, we would avoid them for patients with milder symptoms, especially immunocompetent adults. 2) A high quality randomized controlled trial was recently conducted on more than 4000 adult patients with recurrent episodes of subclinical atrial fibrillation. Trialists found that there was approximately 1 fewer ischemic stroke and 1 more major bleed for every 250 persons treated with apixaban instead of aspirin, but in people treated with apixaban major bleeding was also significantly more likely. This seems like a decision that requires an informed patient and shared decision-making. 3) In an intriguing but somewhat limited network meta-analysis, probiotics were equally or more effective than treatment with any antidepressant except escitalopram. Given the low advantage of standard treatments over placebo, probiotic treatment might be offered to patients who are reluctant to use antidepressants. 4) A recent meta-analysis showed that amyloid-targeting monoclonal antibodies do not provide any clinical meaningful benefits for patients with Alzheimer disease. Instead, they are associated with concerning risks of harm, most notably cerebral hemorrhage identified on imaging studies. The balance of risk versus benefit demonstrated thus far doesn't justify the use of these costly (over US$ 20,000 annually) drugs.

The social-structural contexts of cannabis consumption and harm reduction among young Nigerian women

BackgroundYoung women remain under-represented in the research literature on young people's cannabis use. This study explored cannabis use and harm reduction practices of young Nigerian women. MethodsThe study draws on 19 in-depth interviews conducted with young women aged 21–35 years who were recruited through time-location sampling in Uyo, Nigeria. Interview transcripts were subjected to thematic coding and analysis. ResultsAccounts highlighted a rapid progression from occasional consumption during hang-outs to regular and heavy consumption for most participants. Frequent and heavy cannabis use, shaped by trauma, stress and mental health problems linked to participants’ marginal social locations, established a context of risk for health harms. The participants sought to reduce harms by attempting to reduce frequency and quantity of cannabis consumed, often with limited success. They also micro-dosed to monitor drug effects, avoided mixing cannabis with more potent drugs, sought out cannabis strains with lower THC as well as consuming privately to reduce social harms such as violence and police arrest associated with using in street milieus. On the other hand, cannabis consumption was seen as helping to reduce harms by providing a relatively safer and less addictive alternative to drugs such as heroin and pharmaceutical opioids, preventing high-risk sexual exchanges often associated with opioid withdrawal among women, and relieving pain. ConclusionsCannabis was consumed recreationally at first, and harmful consumption patterns developed from using cannabis to treat the psychological symptoms of structural inequalities. The analysis supports the social-structural production of drug-related harms, foregrounding the importance of structural-level interventions for creating an enabling environment for safer consumption.

The Evolving International Climate Change Regime: Mitigation, Adaptation, Reflection

The complex international regime for climate change has evolved over the past three decades, from the Framework Convention on Climate Change and the Kyoto Protocol through the Paris Agreement and beyond. We assess this evolution from the 1990s to the 2020s, and its potential future evolution from the 2020s to the 2050s, across three main policy strategies: mitigation, adaptation, and reflection. In its first three decades, the regime has focused predominantly on the mitigation of net emissions and on engaging all major emitting countries in that effort. More recently, as progress on mitigation has been slow and as the impacts of climate change have risen around the world, the regime has begun to address adaptation. The next three decades may see the rise of a third strategy, reflection, if actors (collectively or unilaterally) perceive an urgent need to alleviate peak climate damages through fast-acting but controversial and risky climate interventions known as sunlight reflection methods or solar radiation modification (SRM). Several major international groups have recently issued reports on SRM, yet the international climate change regime has not yet constructed a governance regime for assessment or management of SRM. We recommend and outline comprehensive risk-risk tradeoff analyses of SRM to help avoid harmful countervailing risks. We suggest the development of an adaptive governance regime, starting early and embracing iterative and inclusive learning and updating over time. We urge that among the first key steps should be the development of a transparent international monitoring system for SRM. Such a monitoring system could provide early warning and help deter any unilateral SRM, assess the intended and unintended global and regional impacts of any research or eventual deployment of SRM, foster collective deliberation and reduce the risk of international conflict over SRM, help attribute adverse side effects of SRM to assist those adversely affected, and aid learning to improve the system adaptively over time. Thus, any reflection (of sunlight) should involve ongoing reflection (analysis and revision). Such an SRM monitoring regime is needed before SRM might be deployed, and can be developed at the same time that the focus of current efforts remains on mitigation and adaptation.

The dual-process approach to human sociality: Meta-analytic evidence for a theory of internalized heuristics for self-preservation.

[Correction Notice: An Erratum for this article was reported in Vol 126(5) of Journal of Personality and Social Psychology (see record 2025-05381-001). The last entry in the Roch et al. (2000) row in Table 3 should appear instead as load decreases taking. All versions of this article have been corrected.] Which social decisions are influenced by intuitive processes? Which by deliberative processes? The dual-process approach to human sociality has emerged in the last decades as a vibrant and exciting area of research. Yet a perspective that integrates empirical and theoretical work is lacking. This review and meta-analysis synthesizes the existing literature on the cognitive basis of cooperation, altruism, truth telling, positive and negative reciprocity, and deontology and develops a framework that organizes the experimental regularities. The meta-analytic results suggest that intuition favors a set of heuristics that are related to the instinct for self-preservation: people avoid being harmed, avoid harming others (especially when there is a risk of harm to themselves), and are averse to disadvantageous inequalities. Finally, this article highlights some key research questions to further advance our understanding of the cognitive foundations of human sociality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A strategic solution to preventing the harm associated with ambulance handover delays.

Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised. A two-phase strategic quality improvement project was implemented at the authors' acute trust. Ambulance handover data from between 2 November 2020 and 26 July 2021 provided a benchmark for the project. The first phase was implemented between 2 November 2021 and 26 July 2022 and aimed to reduce 60-minute ambulance handover delays. The second phase was implemented between 2 November 2022 and 26 July 2023 and aimed to eradicate 60-minute ambulance handover delays and improve overall performance. Phase one resulted in a 32% reduction in 60-minute ambulance handover delays. Phase two resulted in a 97% reduction in 60-minute ambulance handover delays. Over the course of the project there was a 24% increase in handovers completed within 15 minutes. This project demonstrates how strategic planning and collaboration between healthcare teams can reduce the potential for avoidable patient harm, while simultaneously promoting workforce well-being and retention.

Predatory Monetization Schemes in Free-To-Play Mobile Game

Abstract: Predatory monetization techniques in video games refer to payment methods that hide or delay the actual price of a game until after participants have invested financially and emotionally. to it. As gaming and gambling become more comparable, such programs raise the risk of financial harm for people who have Internet gaming disorder. A video game publisher may benefit from a specific video game product through a process known as video game monetization. Though game monetization tactics differ, especially when games are developed for many platforms or genres, the goal is usually the same: to recompense copyright holders, game designers, and other stakeholders.

Colorectal Cancer Detection via Metabolites and Machine Learning.

Today, colorectal cancer (CRC) diagnosis is performed using colonoscopy, which is the current, most effective screening method. However, colonoscopy poses risks of harm to the patient and is an invasive process. Recent research has proven metabolomics as a potential, non-invasive detection method, which can use identified biomarkers to detect potential cancer in a patient's body. The aim of this study is to develop a machine-learning (ML) model based on chemical descriptors that will recognize CRC-associated metabolites. We selected a set of metabolites found as the biomarkers of CRC, confirmed that they participate in cancer-related pathways, and used them for training a machine-learning model for the diagnostics of CRC. Using a set of selective metabolites and random compounds, we developed a range of ML models. The best performing ML model trained on Stage 0-2 CRC metabolite data predicted a metabolite class with 89.55% accuracy. The best performing ML model trained on Stage 3-4 CRC metabolite data predicted a metabolite class with 95.21% accuracy. Lastly, the best-performing ML model trained on Stage 0-4 CRC metabolite data predicted a metabolite class with 93.04% accuracy. These models were then tested on independent datasets, including random and unrelated-disease metabolites. In addition, six pathways related to these CRC metabolites were also distinguished: aminoacyl-tRNA biosynthesis; glyoxylate and dicarboxylate metabolism; glycine, serine, and threonine metabolism; phenylalanine, tyrosine, and tryptophan biosynthesis; arginine biosynthesis; and alanine, aspartate, and glutamate metabolism. Thus, in this research study, we created machine-learning models based on metabolite-related descriptors that may be helpful in developing a non-invasive diagnosis method for CRC.

The benefits of using a Shared Lives type community response to support survivors of domestic abuse with disabilities and older survivors

PurposeThis paper aims to introduce the concept of using the well-established Shared Lives approach to support survivors of domestic abuse with complex needs including those with learning and physical disabilities, older people and carers.Design/methodology/approachSurvivors with complex needs are often excluded from traditional domestic abuse support services thus increasing their risk and making recovery impossible. Using the Shared Lives approach in suitable cases could address gaps in provision and improve the outcomes for survivors with disabilities, older survivors and carers.FindingsThe paper draws on evidence from reports and research about the experiences of these cohorts of survivors to explain how the Shared Lives approach could increase support options for specific categories of survivors.Practical implicationsUsing the Shared Lives approach to support cohorts of victims/survivors who experience barriers to accessing support could improve outcomes for these people, reduce risk of serious harm and improve quality of life.Originality/valueWith the recent recommendation from Association of Directors of Adult Social Services around increasing use of Shared Lives, this paper provides one potential way to meet this recommendation.

A qualitative study exploring how undergraduate pharmacy students undertake a drug allergy history

Abstract Introduction If antimicrobial resistance (AMR) is not controlled, a post-antibiotic era could result in common infections and minor injuries becoming fatal. One way to combat AMR is the ‘de-labelling’ or removal of incorrect antibiotic allergy labels. At least 92% of labels corresponding to penicillin allergy are incorrect when tested.[1] This means that patients may not be receiving the correct antibiotic treatment and take longer to recover. Therefore, taking an accurate allergy history is important. Pharmacists routinely take drug allergy histories. From 2026, pharmacy students in England will graduate as prescribers, highlighting the importance of drug allergy knowledge and skills. Aim To explore how undergraduate pharmacy students undertake a drug allergy history. Methods A qualitative study utilising a constructivist approach involving a low-fidelity simulation followed by a one-to-one face-to-face semi-structured interview was conducted. Final year undergraduate Master of Pharmacy students of an English school of pharmacy were recruited via email and word-of-mouth to take part in this study. Following informed consent, participants simulated taking a drug allergy history with a student researcher. The simulation was audio-recorded and then played back to the participant as a cue for a subsequent audio-recorded semi-structured interview that explored their thought-process when taking a drug allergy history. All audio-recordings were transcribed verbatim. Transcripts were analysed using reflexive thematic analysis.[2] Results Nine participants took part in the study. The simulation and interview lasted seven minutes on average. Four themes were generated through the analysis. Theme 1: taking drug allergy history is learnt mainly through practice-based learning. Theme 2: nature, type and severity of allergic reactions information were deemed important for making clinical judgements. Theme 3: skills for taking drug allergy history are underdeveloped despite having knowledge. Theme 4: real patient contact exposure is needed to translate learning into practice. Most participants remembered learning about taking drug allergy history through practice-based learning sessions such as workshops, objective structured clinical examinations (OSCEs) and hospital placements. Participants seemed to follow a set of ‘rules’ when undertaking the simulation. For example, they stopped asking questions about allergies and decide not to dispense penicillin when they were informed that the patient was allergic to penicillin. Most participants recognised the risk of serious harm to patients if they made a mistake about patient allergies, and the need to have more real-world experiences to help translate their learning into practice. Conclusion Pharmacy students appeared to have the theoretical knowledge about drug allergies, but they were not yet able to make an appropriate clinical judgement in real-world situations. An increase in real-world clinical experience such as patient consultations in work-based placements can provide pharmacy students with valuable opportunities. By knowing how to undertake an accurate allergy history, fewer people will be inaccurately labelled as allergic, promoting antimicrobial stewardship. To our knowledge, this is the first study investigating how United Kingdom undergraduate pharmacy students undertake a drug allergy history. Our participants studied in one pharmacy school and undergraduate pharmacy students studying in other pharmacy schools may have different experiences around drug allergy history taking.

The health risks of generative AI-based wellness apps.

Artificial intelligence (AI)-enabled chatbots are increasingly being used to help people manage their mental health. Chatbots for mental health and particularly 'wellness' applications currently exist in a regulatory 'gray area'. Indeed, most generative AI-powered wellness apps will not be reviewed by health regulators. However, recent findings suggest that users of these apps sometimes use them to share mental health problems and even to seek support during crises, and that the apps sometimes respond in a manner that increases the risk of harm to the user, a challenge that the current US regulatory structure is not well equipped to address. In this Perspective, we discuss the regulatory landscape and potential health risks of AI-enabled wellness apps. Although we focus on the United States, there are similar challenges for regulators across the globe. We discuss the problems that arise when AI-based wellness apps cross into medical territory and the implications for app developers and regulatory bodies, and we outline outstanding priorities for the field.

A national audit of prescribing in Child and Adolescent Mental Health Services (CAMHS)

Abstract Introduction Specialist Child and Adolescent Mental Health Services (CAMHS) provide essential support to the mental well-being of young people. Concerns regarding CAMHS delivery in Ireland have been brought to the fore since 2022 and the publication of the Maskey report; this report presented the findings from a review into the care delivered in one region of Ireland and highlighted risk of harm to children and young people due to deviation from clinical best practice.[1] Following the report’s publication, a national audit of CAMHS prescribing practice was requested by the Minister for Mental Health and Older People. Aim To conduct an audit of prescribing in CAMHS nationally and determine adherence to defined audit standards. Methods Every community CAMHS team in Ireland were requested to self-complete the audit on a random sample of 50 children under their care between 1st July 2021 and 31st December 2021, and prescribed medication during this period. An audit tool was developed by the audit team, based on issues identified in the Maskey report, and was sent electronically to each CAMHS team. The tool gathered data on demographics of children, disorders treated, medications prescribed, patient monitoring and communication. Adherence to six audit standards was evaluated. These standards were: i)involvement of a consultant in prescribing. ii)consent to medication by parent/guardian. iii)baseline physical assessment. iv)ongoing physical monitoring. v)communication with general practitioner. vi)follow-up review appointment arranged. The target for each standard was set at 95%. Data were analysed using the software STATA Version 17.0[2] Results The audit sample comprised 3528 children, representing 74 CAMHS teams nationally. More males were included in the sample (n=1955, 55.4%). The median age was 15 years, with a range of 4-17 years. -The majority of children (70.6%) were taking one medication, 24.2% were prescribed two medications and 4.6% were prescribed three medications. -54% of children were prescribed ADHD medications; 41.9% were prescribed an anti-depressant, 10.9% were prescribed an antipsychotic. -Most medications were prescribed within recommended dose ranges. -95% of prescribing was done under consultant supervision. -89% of children had consent to medication documented. -90% of children had baseline physical monitoring conducted prior to prescribing. -92% of children had ongoing physical monitoring conducted. -90% had documented communication with the child’s general practitioner. -98% of children had follow-up review appointments arranged. Conclusion This audit of 3528 children from 74 CAMHS teams is the first of its kind to highlight nationally the broad complexity in prescribing practices in CAMHS in Ireland. These data add to the limited literature on the nature of illnesses treated by CAMHS and the need for services. The work has several strengths and limitations; a key strength is that 100% compliance was achieved in terms of participation of community CAMHS teams, a limitation is that external validation of the data was not undertaken as it was not feasible in the timeframe available. Several recommendations, at national and community health organisation level, were derived from the results of this audit.

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

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

Climate Change and Cholera: A Review Exploring the Association Between Storm Severity and Global Human Vibrio spp. Incidence.

Current global meteorological evidence suggests that climate change is a direct contributor to the increased severity of weather events, such as hurricanes and typhoons, putting billions of people at increased risk of physical harm, property damage, and destructive flooding. When flood water becomes stagnant, communities are more susceptible to a multitude of infectious diseases, ranging from mosquito-borne parasites to bacterial infections. In the case of Vibrio spp., a bacterial pathogen class with an infamous history of waterborne illness, recent data has demonstrated the ability for salt water, fresh water, and brackish water replication, creating ideal conditions for spread after a tropical cyclone. Vibrio spp. infections, specifically species V. vulnificus, V. parahaemolyticus, and V. cholerae, have shown significant upticks in the number of global cases, with some species increasing in incidence by more than 8-fold in the last 40 years. These outbreaks are contained mainly in areas susceptible to large-scale storm events and primarily occur during or immediately following the conclusion of local storm seasons, suggesting a potential correlation between the presence of tropical weather events and increases in the number of human Vibrio infections. In this review, we present a compilation of sources from tropical cyclone-susceptible areas, including the Americas, Asia, Africa, and Oceania, containing evidence demonstrating that recent outbreaks of Vibrio spp. are correlated with an increase in the severity of storms. Many of the included studies used modeling to forecast future trends of vibriosis and, therefore, directly link the effects of climate change with detrimental impacts to human global health.

Occupational patterns of opioid-related harms comparing a cohort of formerly injured workers to the general population in Ontario, Canada.

The role of work-related injuries as a risk factor for opioid-related harms has been hypothesized, but little data exist to support this relationship. The objective was to compare the incidence of opioid-related harms among a cohort of formerly injured workers to the general population in Ontario, Canada. Workers' compensation claimants (1983-2019) were linked to emergency department (ED) and hospitalization records (2006-2020). Incident rates of opioid-related poisonings and mental and behavioural disorders were estimated among 1.7 million workers and in the general population. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) were calculated, adjusting for age, sex, year, and region. Compared to the general population, opioid-related poisonings among this group of formerly injured workers were elevated in both ED (SIR = 2.41, 95% CI = 2.37-2.45) and hospitalization records (SIR = 1.54, 95% CI = 1.50-1.59). Opioid-related mental and behavioural disorders were also elevated compared to the general population (ED visits: SIR = 1.86, 95% CI = 1.83-1.89; hospitalizations: SIR = 1.42, 95% CI = 1.38-1.47). Most occupations and industries had higher risks of harm compared to the general population, particularly construction, materials handling, processing (mineral, metal, chemical), and machining and related occupations. Teaching occupations displayed decreased risks of harm. Findings support the hypothesis that work-related injuries have a role as a preventable risk factor for opioid-related harms. Strategies aimed at primary prevention of occupational injuries and secondary prevention of work disability and long-term opioid use are warranted.

Ethical considerations for nurse practitioners conducting research in populations with opioid use disorder.

People with opioid use disorder (OUD) are a vulnerable population who face unique risks of harm when participating in research. Despite a long-standing dialogue, written research codes of ethics, and institutional review board oversight for the conduct of ethical research in vulnerable populations, protections for study populations with OUD is rarely mentioned. Nurse practitioners who conduct research using participants with OUD, especially when recruiting their own patients (i.e., dual role), must be aware of the unique ethical considerations necessary to protect their patients and participants from increased risks. This article explores vulnerabilities and influences that can affect participant recruitment and consent, imbalances in the distribution of risk and benefits to participants participating in research, and the concerns of coercions, undue influence, and unjustifiable pressure contributing to vulnerabilities. Strategies to reduce the risks of influences that are of concern in the vulnerable population of research participants with opioid disorder are suggested. The goal of this article was to raise awareness of the unique potential risks of harm when using people with OUD as research participants and to explore strategies to minimize potential risks of various levels of influence in this vulnerable population.