•Fentanyl epidemic has reached San Francisco since 2016.•First West Coast city to show significant increases in fentanyl deaths.•Fentanyl use is replacing heroin use.•Drug diversion of medicinal ...opioids have reduced in recent years.
Opioid-use disorders have led to a nationwide epidemic of accidental overdoses in the United States. In recent years this opioid epidemic has worsened due to the increased availability of fentanyl in the illicit drug market. The increase in fentanyl-related deaths is well known on the U.S. East Coast, however, limited comprehensive information of mortality data exists from major West Coast cities.
Following comprehensive medico-legal death and toxicological investigations, a retrospective cohort study was performed on all accidental opioid overdose deaths (AOOD) from 2009 – 2019 in San Francisco. The sex, age and race of decedents, location, and date and time of death were described and statistically compared by the type of opioid(s) causing death.
Since 2016, fentanyl deaths started to replace heroin deaths leading to a sharp increase in fatal overdoses involving fentanyl, surpassing heroin and/or medicinal opioids by 2018. Fentanyl contributed to between 3% and 12% of deaths per year from 2009 to 2015, and between 20% and 73% per year from 2016 to 2019. White and Black males represented 91.5% of all AOOD. Age groups younger than 45 died using fentanyl and heroin significantly more often than older populations (60.7% of ≤45 vs. 40.7% of >45 year-olds, χ2p<0.001).
This study shows an upward trend in fentanyl fatal accidental overdoses in recent years in a major West Coast U.S. city. These patterns appear to follow patterns seen in eastern states, albeit with an approximate 3-year delay, and may be indicative of other western populations. The described observations provide detailed demographic, chronological and toxicological information to public health and policy-making agencies for drug harm reduction measures.
The reduction of free sugars has been identified as a priority issue internationally. A range of public health initiatives have been recommended, including the provision of information and support ...for sugar reduction. To inform these approaches, it is important to know what people actually do in real world settings to reduce their consumption. This study documents and defines the range of consumer-based behaviour change strategies for sugar reduction. A total of 1145 strategies were extracted from 47 internet sources (i.e., consumer, popular and professional). Using a pragmatic content analysis, hundreds of strategies were organized into 25 discrete categories of strategies. Categories were grouped into the Rubicon Model of Action Phases and classified as pre-decisional (i.e., decisional balance, feedback, realisation, seek knowledge and information), post-decisional (i.e., action planning, coping planning, set goal intention, sugar guidelines) and actional phase. Actional strategies were the most prolific and included avoidance, consumption control, consumption planning, environmental restructuring, healthy eating focus, maintain readiness, professional support, refocusing, self-monitoring, social support, substance substitution, tapering, address underlying issues, urge management, well-being and withdrawal management. There was one post-actional strategy which was associated with self-evaluation (i.e., reviewing a change attempt in order to plan for the future). Four categories of strategies differed according to the source. Substance substitution was substantially less frequently discussed by consumers than professionals and few professional sites acknowledged or advised strategies to manage the struggle of maintaining readiness following a change attempt. Hundreds of individual strategies are discussed or promoted in online settings, and more information is needed on the effectiveness of these self-initiated approaches.
In Bigen Africa Services (Pty) Ltd v City of Cape Town (WC) (unreported) case number 18681/2020 of 1 June 2021, the Western Cape High Court found that the inclusion of a local office as a ...pre-qualification criterion in tenders for professional water and sanitation services fell afoul of section 217(1) of the Constitution. This provision requires all organs of State to contract for goods or services in accordance with a system that is fair, equitable, transparent, competitive and cost-effective. The court's reasoning on this point can be critiqued on the basis that it conflated distinct tests for determining the materiality of a deviation. However, the case raises broader concerns around the pre-eminence of audit over operational logic in the water and sanitation sector, and the use of state self-review to resolve the conflict.
•COVID-19 has impacted on the configuration of addiction treatment in New Zealand.•Increased internet gambling, gaming, pornography, and social media presentations.•Appointments during lockdown ...periods were frequent and shorter in duration.•Distance based delivery benefits many clients but remains a barrier for some clients.•Access could be improved by providing internet and equipment for video conferencing.
COVID-19 public health measures, including lockdowns, have disrupted psychological service delivery for substance use and behavioural addictions. This study aimed to examine how addictions treatment had been affected by COVID-19 related factors from the perspective of addiction and mental health service providers. Participants (n = 93) were experienced service managers and clinicians in New Zealand who completed an online survey. Clinicians reported increased presentations for problems related to internet gambling (n = 57, 61%), gaming (n = 53, 57%), social media use (n = 52, 56%), and pornography (n = 28, 30%). A qualitative analysis of responses generated six themes. Themes included service management and increased administrative burden, and service delivery reconfiguration. Access improved for some clients because of convenience and reduced structural barriers. However, online service delivery was problematic for those with unstable or no internet access and devices that could not support video conferencing and/or lack of safe, confidential or private spaces at home. Increased client complexity and restricted in-person care prompted changes to focus, and content of clinical interventions, and some respondents offered more frequent but shorter appointments. Clinicians who provided services by phone or email, rather than video conferencing, reported treatment was less effective, with reduced rapport and engagement a contributing factor. The New Zealand addictions sector has responded to COVID-19 by increasing treatment access through distance-based options. Maintaining multifaceted models of care that are agile to rapidly changing environments presents unique challenges but is critical to addressing the needs of people impacted by addiction.
The lack of potable water, poor hygiene practices and inefficient sanitation systems in developing countries pose a risk to human health. Pit latrines aim to break the link between human faecal waste ...and human contact by serving as improved sanitation. The eThekwini Municipality has developed a programme that employs workers to empty pits every 3 to 5 years. This study aimed to find a cost-effective, easy way of disinfecting household surfaces and inactivating Ascaris eggs using household disinfectants, so that transmission of helminths is minimised when pits are emptied. Disinfectants tested in this study were based on sodium hypochlorite or carbolic acid. Experiments simulated inactivation of Ascaris eggs by wiping contaminated surfaces with disinfectants and by soaking small spills in disinfectants. Samples were processed using standard helminth egg enumeration methods for soil and sludge. Wiping of contaminated surfaces removed Ascaris eggs, facilitating egg transfer but not egg inactivation. Prolonged exposure to disinfectants, at concentrations of 50% and above, were required to inactivate eggs. Sodium hypochlorite-based disinfectants were the most successful for inactivation, whilst those based on carbolic acid were mostly ineffective. It is recommended that faecal sludge spills are soaked in a sodium hypochlorite-based disinfectant and contaminated surfaces be wiped with a sodium hypochlorite-based disinfectant-saturated cloth, which should then be soaked for 1 h in a similar disinfectant solution (50% dilution) to inactivate any eggs picked up on the cloth.
Background and aims. Sugar is a potentially addictive substance that is consumed in such high levels the World Health Organisation has set recommended consumption limits. To date there are no ...empirically tested brief interventions for reducing sugar consumption in adult populations. The current study aimed to preliminarily assess the feasibility of recruitment, retention, and intervention engagement and impact of a brief intervention. Methods. This pre-post study recruited 128 adults from New Zealand to complete a 30-day internet-delivered intervention with in-person and email coaching. The intervention components were derived from implementation intention principles whereby the gap between intention and behaviour was targeted. Participants selected sugar consumption goals aligned with WHO recommendations by gender. To meet these goals, participants developed action plans and coping plans and engaged in self-monitoring. Facilitation was provided by a coach to maintain retention and treatment adherence over the 30 days. Results. Intervention materials were rated as very useful and participants were mostly satisfied with the program. The total median amount of sugar consumed at baseline was 1,662.5 g (396 teaspoons per week) which was reduced to 362.5 g (86 teaspoons) at post-intervention evaluation (d = 0.83). The intervention was associated with large effects on reducing cravings (d = 0.59) and psychological distress (d = 0.68) and increasing situational self-efficacy (d = 0.92) and well-being (d = 0.68) with a reduction in BMI (d = 0.51). Conclusion. This feasibility study indicates that a brief intervention delivering goal setting, implementation planning, and self-monitoring may assist people to reduce sugar intake to within WHO recommendations.
Abstract
Just-In-Time Adaptive Interventions (JITAIs) are emerging “push” mHealth interventions that provide the right type, timing, and amount of support to address the dynamically-changing needs ...for each individual. Although JITAIs are well-suited to the delivery of interventions for the addictions, few are available to support gambling behaviour change. We therefore developed
GamblingLess: In-The-Moment
and
Gambling Habit Hacker
, two smartphone-delivered JITAIs that differ with respect to their target populations, theoretical underpinnings, and decision rules. We aim to describe the decisions, methods, and tools we used to design these two treatments, with a view to providing guidance to addiction researchers who wish to develop JITAIs in the future. Specifically, we describe how we applied a comprehensive, organising scientific framework to define the problem, define just-in-time in the context of the identified problem, and formulate the adaptation strategies. While JITAIs appear to be a promising design in addiction intervention science, we describe several key challenges that arose during development, particularly in relation to applying micro-randomised trials to their evaluation, and offer recommendations for future research. Issues including evaluation considerations, integrating on-demand intervention content, intervention optimisation, combining active and passive assessments, incorporating human facilitation, adding cost-effectiveness evaluations, and redevelopment as transdiagnostic interventions are discussed.
The Mekong delta is recognised as one of the world's most vulnerable mega-deltas, being subject to a range of environmental pressures including sea level rise, increasing population, and changes in ...flows and nutrients from its upland catchment. With changing climate and socioeconomics there is a need to assess how the Mekong catchment will be affected in terms of the delivery of water and nutrients into the delta system. Here we apply the Integrated Catchment model (INCA) to the whole Mekong River Basin to simulate flow and water quality, including nitrate, ammonia, total phosphorus and soluble reactive phosphorus. The impacts of climate change on all these variables have been assessed across 24 river reaches ranging from the Himalayas down to the delta in Vietnam. We used the UK Met Office PRECIS regionally coupled climate model to downscale precipitation and temperature to the Mekong catchment. This was accomplished using the Global Circulation Model GFDL-CM to provide the boundary conditions under two carbon control strategies, namely representative concentration pathways (RCP) 4.5 and a RCP 8.5 scenario. The RCP 4.5 scenario represents the carbon strategy required to meet the Paris Accord, which aims to limit peak global temperatures to below a 2 °C rise whilst seeking to pursue options that limit temperature rise to 1.5 °C. The RCP 8.5 scenario is associated with a larger 3–4 °C rise. In addition, we also constructed a range of socio-economic scenarios to investigate the potential impacts of changing population, atmospheric pollution, economic growth and land use change up to the 2050s. Results of INCA simulations indicate increases in mean flows of up to 24%, with flood flows in the monsoon period increasing by up to 27%, but with increasing periods of drought up to 2050. A shift in the timing of the monsoon is also simulated, with a 4 week advance in the onset of monsoon flows on average. Decreases in nitrogen and phosphorus concentrations occur primarily due to flow dilution, but fluxes of these nutrients also increase by 5%, which reflects the changing flow, land use change and population changes.
Water quality along the Mekong River System
(Phosphorus mg/l Left and Nitrate-N mg/l right) Display omitted
•Climate will alter Mekong flows and seasonal patterns•Flooding will increase in the lower Mekong•Droughts will increase as Dam development increases•Socioeconomic effects will enhance nutrient fluxes into the delta•Eutrophication and increased delta flooding will occur
The internet can deliver scalable and accessible treatments for addiction and sexual health. This study investigated reasons for changing pornography use and the feasibility and impact of a brief ...internet-delivered intervention. The intervention delivered goal setting and goal review, action and coping planning, self-monitoring, social support and shaping knowledge through the provision of information on how others have reduced their pornography use. Participants (n = 84) were predominantly from Australia or New Zealand and spent an average of 6.9 (SD = 6.6) hours per week viewing pornography. Reasons to reduce were addiction related (i.e., tolerance, repeated attempts to change, mood modification and negative affect such as guilt, shame, hiding) and decrements to mental health, relationships, achievement, and sexual satisfaction. Participants who enrolled in the intervention (n = 25) selected an abstinence goal (76%) and developed plans associated with avoidance of sites, people or devices and urge management. Barriers to action plans were related to temptation, triggers, and sub-optimal plan implementation. Post-treatment evaluation (n = 14) indicated reduced frequency (d = 1.04) and days spent viewing pornography (d = 0.83) as well as improved self-efficacy, mental well-being, and psychological distress. The study indicates that a brief intervention may be feasible for addressing problematic pornography use.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background and aims
Despite the over‐representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening ...instruments within mental health services. The primary aim was to compare the classification accuracy of nine brief problem gambling screening instruments (two to five items) with a reference standard among patients accessing mental health services.
Design
The classification accuracy of nine brief screening instruments was compared with multiple cut‐off scores on a reference standard.
Setting
Eight mental health services in Victoria, Australia.
Participants
A total of 837 patients were recruited consecutively between June 2015 and January 2016.
Measurements
The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen (BPGS) (two‐ to five‐item versions), NODS‐CLiP, NODS‐CLiP2, Brief Biosocial Gambling Screen (BBGS) and NODS‐PERC. The Problem Gambling Severity Index (PGSI) was the reference standard.
Findings
The five‐item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low‐risk, moderate‐risk or problem gambling) (sensitivity = 0.803, specificity = 0.982, diagnostic efficiency = 0.943). Several shorter instruments adequately detected both problem and moderate‐risk, but not low‐risk, gambling: two three‐item instruments (NODS‐CLiP, three‐item BPGS) and two four‐item instruments (NODS‐PERC, four‐item BPGS) (sensitivity = 0.854–0.966, specificity = 0.901–0.954, diagnostic efficiency = 0.908–0.941). The four‐item instruments, however, did not provide any considerable advantage over the three‐item instruments. Similarly, the very brief (two‐item) instruments (Lie/Bet and two‐item BPGS) adequately detected problem gambling (sensitivity = 0.811–0.868, specificity = 0.938–0.943, diagnostic efficiency = 0.933–0.934), but not moderate‐risk or low‐risk gambling.
Conclusions
The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the five‐item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate‐risk/problem gambling) can employ the NODS‐CLiP or the three‐item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the two‐item BPGS.
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