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Boro S, Saikia N. The effects of substance use on non-communicable diseases among older adults aged 60 and above in the North-eastern States of India. PLoS One 2024; 19:e0307603. [PMID: 39255292 PMCID: PMC11386429 DOI: 10.1371/journal.pone.0307603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/09/2024] [Indexed: 09/12/2024] Open
Abstract
INTRODUCTION The North-eastern region of India has a relatively higher prevalence of substance use, which together with poor dietary practices and a lack of physical activity is one of the key risk factors for NCDs among older adults in the region. Understanding the prevalence of NCDs and their relationship to substance use can help develop preventive strategies and sensitization in North-eastern India. OBJECTIVE To assess the prevalence of NCDs and the strength of the association of substance abuse among the geriatric population of North-eastern states in India, for the development of preventive strategies. METHODS Data from the Longitudinal Ageing Study in India (LASI Wave-I, 2017-18) were drawn to develop this paper. The bi-variate and binary logistic regression analyses were carried out to predict the association between non-communicable diseases and substance use adjusting select socio-demographic characteristics. RESULTS The paper revealed the prevalence of NCDs among urban people (61.45%) is higher than among rural people (42.45%). Hypertension (37.29%) can be seen as the most prevalent disease among the following given NCDs followed by Diabetes (8.94%). The chances of having Cancer are nineteen times higher (OR = 19.8; C.I. = 18.82-20.83) if an individual has past smoking behaviour after controlling for socio-demographic and physical activity variables. CONCLUSION Since, the high prevalence of hypertension correlated with the high level of substance abuse, require immediate attention to develop appropriate intervention strategies for its control (substance abuse) and prevention of hypertension. In a lower middle-income country like India, preventive measures, rather than curative measures will be cost-effective and helpful.
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Affiliation(s)
- Sasanka Boro
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Nandita Saikia
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Sulaman I, Hartley S, Elvins R. Therapeutic alliance in the treatment of adolescent substance misuse: a systematic review. Child Adolesc Ment Health 2024; 29:226-241. [PMID: 37528449 DOI: 10.1111/camh.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Therapeutic alliance has been found to play an influential role in predicting outcomes for adults and adolescents in psychotherapy. However, thus far, the information concerning the impact of therapeutic alliance on outcomes for adolescents in treatment for substance misuse has not yet been critically synthesised. METHODS In accordance with PRISMA guidelines, the current review aimed to systematically collate published research investigating the association between alliance and outcomes for adolescents undergoing substance misuse treatment. Database searching produced 1083 records, with 16 studies meeting eligibility criteria. RESULTS Twelve out of the 16 studies (75%) reported significant alliance-outcome relationships, whereby higher alliance ratings predicted better treatment outcomes, as well as improved engagement and retention in treatment. In addition, the review explored the conditions whereby alliances better predict outcomes, with reference to the alliance rater, the timing of the alliance rating and comorbid diagnoses. These results, however, largely remain inconclusive. CONCLUSIONS The evidence as it stands demonstrates the importance of the therapeutic alliance in predicting outcomes for adolescents in substance misuse treatments. The implications of the review's findings and recommendations for future research are discussed.
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Affiliation(s)
- Iniyah Sulaman
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- GMMH NHS Foundation Trust, Manchester, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- CAMHS at Pennine Care NHS Foundation Trust, Manchester, UK
| | - Rachel Elvins
- Royal Manchester Children's Hospital & Salford CAMHS, Manchester, UK
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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Kleinman ME, Smith C, Yampolskaya S, Sharp A, Carlson M, Moore K. Typologies of Family Dependency Treatment Court Participants: Parental Characteristics and Differential Child Placement Outcomes. Subst Use Misuse 2024; 59:1072-1082. [PMID: 38433337 DOI: 10.1080/10826084.2024.2320378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background: Family Dependency Treatment Court (FDTC) is a problem-solving court for parents who have child welfare involvement and designed to address parental substance misuse by providing treatment and wrap-around services, with the goal of reunifying parents with their children. Objectives: This study aimed to identify different classes of FDTC parents and compare how child placement outcomes differ by class. Parental characteristics and permanent placement outcomes for 354 parents participating in a Central Florida FDTC were assessed using administrative data. An exploratory latent class analysis was conducted to classify parents. Results: Results revealed three distinct classes of FDTC participants: 1) co-occurring issues, 2) racial/ethnic minority participants, and 3) prescription opioid, meth, and heroin users. Regression analyses showed that parents with co-occurring issues were over two times more likely to achieve permanency (OR = 2.05, p < .05), and were two times less likely to terminate their parental rights (TPR) compared to the other two classes. Conclusions: Implications for tailoring FDTC procedures to parents' individual needs, combating racial/ethnic disparities in access to services and placement outcomes, and improved child welfare and placement outcomes are discussed.
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Affiliation(s)
- Mary E Kleinman
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Curtis Smith
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Svetlana Yampolskaya
- Department of Child and Family Studies, University of South Florida, Tampa, FL, USA
| | - Amanda Sharp
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Melissa Carlson
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Kathleen Moore
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
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Singh L, Chandra R, Pai M, Singh A, Mazumdar S, Singh Balhara YP, Singh PK, Singh S. How Does Tobacco Use Affect the Cognition of Older Adults? A Propensity Score Matching Analysis Based on a Large-Scale Survey. Nicotine Tob Res 2024; 26:342-352. [PMID: 37422916 DOI: 10.1093/ntr/ntad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 05/27/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Tobacco is a well-established risk factor for cancer, but its association with other morbidities needs consideration. The low-income and middle-income countries (LMICs) with unprecedented demographic transformation lack evidence on tobacco use and its impact on cognitive health. AIMS AND METHODS Using a propensity score matching approach, we utilized data from the Longitudinal Ageing Study of India. Study employed 1:1 nearest neighbor matching with the replacement methodology. We estimated the odds of the poor cognitive score and tobacco use among older adults based on five different models for ever tobacco user, former tobacco user, current tobacco user, current smokers, and current smokeless tobacco users with reference to never tobacco users. RESULTS The estimated average treatment effect for the treated and the untreated group has shown a higher likelihood of cognitive decline among ever (OR -0.26; 95%CI -0.43 to -0.09), current (OR -0.28; 95%CI -0.45 to -0.10), and former (OR -0.53; 95%CI -0.87 to -0.19) tobacco users compared to never tobacco users. The finding further suggests the odds of lower cognitive scores among older adults who were smokers (OR -0.53; 95%CI -0.87 to -0.19) and smokeless tobacco users (OR -0.22; 95%CI -0.43 to -0.01) as compared to never tobacco users. CONCLUSIONS Interventions designed to prevent the incidence of cognitive impairment should focus on limiting the use of tobacco. Strategies under the tobacco-free generation initiative should be amplified in order to prevent future generations from productivity loss, premature ageing and to promote healthy aging. IMPLICATIONS Evidence of a definitive association between tobacco consumption and cognition among older adults is sporadic in LMICs. Though tobacco is a risk factor for various diseases including cancer, the extent of its impact on cognitive health among the older population is limited. This study contributes to the existing literature by highlighting poor cognitive outcomes among older adults who smoke tobacco and/or consume smokeless tobacco as compared to never-tobacco users. Our findings emphasize the need to accelerate programmes related to tobacco-free generation in LMICs to reach a higher quality of life and healthy aging in pursuit of achieving the sustainable development goal of "good health and well-being."
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Affiliation(s)
- Lucky Singh
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Rishita Chandra
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Manacy Pai
- Department of Sociology, Kent State University, Kent, OH, USA
| | - Arpit Singh
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Sumit Mazumdar
- Centre for Health Economics, University of York, York, UK
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Centre and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Shalini Singh
- Division of Preventive Oncology & Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Schwarz T, Anzenberger J, Busch M, Gmel G, Kraus L, Krausz M, Labhart F, Meyer M, Schaub MP, Westenberg JN, Uhl A. Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland. Drug Alcohol Depend 2024; 254:111036. [PMID: 38091902 DOI: 10.1016/j.drugalcdep.2023.111036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIMS OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care. METHODS We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents. RESULTS Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020. CONCLUSIONS Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients.
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Affiliation(s)
- Tanja Schwarz
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria; Doctoral Programme Meduni Vienna, Medical University of Vienna, Spitalgasse 23, Vienna 1090, Austria.
| | - Judith Anzenberger
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria
| | - Martin Busch
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria
| | - Gerhard Gmel
- Addiction Switzerland, Lausanne, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Mental Health and Addiction Research, Munich, Germany; Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Krausz
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Florian Labhart
- Psychiatric University Clinic Basel, University of Basel, Basel, Switzerland
| | - Maximilian Meyer
- Psychiatric University Clinic Basel, University of Basel, Basel, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland
| | - Jean N Westenberg
- Addiction Switzerland, Lausanne, Switzerland; University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Alfred Uhl
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria; Sigmund Freud University Vienna, Vienna, Austria
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Adolescent connectedness and its impact on substance use in Jamaican adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bartholomew TS, Andraka-Cristou B, Totaram RK, Harris S, Doblecki-Lewis S, Ostrer L, Serota DP, Forrest DW, Chueng TA, Suarez E, Tookes HE. "We want everything in a one-stop shop": acceptability and feasibility of PrEP and buprenorphine implementation with mobile syringe services for Black people who inject drugs. Harm Reduct J 2022; 19:133. [PMID: 36463183 PMCID: PMC9719627 DOI: 10.1186/s12954-022-00721-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A recent surge in HIV outbreaks, driven by the opioid and stimulant use crises, has destabilized our progress toward targets set forth by Ending the HIV Epidemic: A Plan for America for the high-priority community of people who inject drugs (PWID), particularly Black PWID. METHODS In order to ascertain the acceptability and feasibility of using a mobile syringe services program (SSP) for comprehensive HIV prevention via PrEP and medications for opioid use disorder (MOUD), our mixed methods approach included a quantitative assessment and semi-structured qualitative interviews with Black PWID (n = 30) in Miami-Dade County who were actively engaged in mobile syringe services. RESULTS Participants felt that delivery of MOUD and PrEP at a mobile SSP would be both feasible and acceptable, helping to address transportation, cost, and stigma barriers common within traditional healthcare settings. Participants preferred staff who are compassionate and nonjudgmental and have lived experience. CONCLUSIONS A mobile harm reduction setting could be an effective venue for delivering comprehensive HIV prevention services to Black PWID, a community that experiences significant barriers to care via marginalization and racism in a fragmented healthcare system.
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Affiliation(s)
- Tyler S. Bartholomew
- grid.26790.3a0000 0004 1936 8606Division of Health Services Research and Policy, Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St., #1020, Miami, FL 33136 USA
| | - Barbara Andraka-Cristou
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA
| | - Rachel K. Totaram
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA
| | - Shana Harris
- grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Anthropology, University of Central Florida, Orlando, FL USA
| | - Susanne Doblecki-Lewis
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Lily Ostrer
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David P. Serota
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David W. Forrest
- grid.26790.3a0000 0004 1936 8606Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL USA
| | - Teresa A. Chueng
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Edward Suarez
- grid.26790.3a0000 0004 1936 8606Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Hansel E. Tookes
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
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Salvalaggio G, Dong KA, Hyshka E, McCabe C, Nixon L, Rosychuk RJ, Dmitrienko K, Krajnak J, Mrklas K, Wild TC. Impact of an addiction medicine consult team intervention in a Canadian inner city hospital on acute care utilization: a pragmatic quasi-experimental study. Subst Abuse Treat Prev Policy 2022; 17:20. [PMID: 35279178 PMCID: PMC8917626 DOI: 10.1186/s13011-022-00445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Inner city patients have a higher illness burden and need for care, but experience more unmet care needs. Hospital Addiction Medicine Consult Teams (AMCTs) are a promising emerging intervention. The objective of this study was to assess the impact of a Canadian AMCT-like intervention for inner city patients on reduction in high emergency department (ED) use, hospital admission, and inpatient length of stay. METHODS Using a community-engaged, two-arm, pre-post, longitudinal quasi-experimental study design, 572 patients reporting active substance use, unstable housing, unstable income, or a combination thereof (302 at intervention site, 270 at control sites) were enrolled. Survey and administrative health service data were collected at baseline, six months post-enrolment, and 12 months post-enrolment. Multivariable regression models tested the intervention effect, adjusting for clinically important covariables (inpatient status at enrolment, medical complexity, age, gender, Indigenous identity, shelter use, opioid use). RESULTS Initial bivariable analyses demonstrated an intervention effect on reduction in admissions and length of stay, however, this effect was no longer significant after adjusting for covariables. There was no evidence of reduction in high ED use on either bivariable or subsequent multivariable analysis. CONCLUSIONS After adjusting for covariables, no AMCT intervention effect was detected for reduction in high ED use, inpatient admission, or hospital length of stay. Further research is recommended to assess other patient-oriented intervention outcomes.
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Affiliation(s)
- Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Kathryn A Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Christopher McCabe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Institute of Health Economics, Edmonton, AB, Canada
| | - Lara Nixon
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rhonda J Rosychuk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Klaudia Dmitrienko
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Judith Krajnak
- Primary Health Care Program, Alberta Health Services, Edmonton, AB, Canada
| | - Kelly Mrklas
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services, Calgary, AB, Canada
| | - T Cameron Wild
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Varadarajan V, Ibe CA, Young JH. Effect of substance use on premature mortality among severely hypertensive African Americans. J Clin Hypertens (Greenwich) 2022; 24:475-482. [PMID: 35257472 PMCID: PMC8989759 DOI: 10.1111/jch.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022]
Abstract
Low‐income African Americans residing in impoverished neighborhoods confront myriad barriers to adhering to antihypertensive regimens. Substance use may thwart medication adherence and lifestyle modification efforts, which has implications for excess cardiovascular disease mortality. The Inner‐City Hypertension and Body Organ Damage (ICHABOD) Study was a longitudinal cohort study that evaluated causes of mortality among African Americans who lived in urban areas, had severe, poorly controlled hypertension, and were admitted to a local hospital between 1999–2001 and 2002–2004. The authors employed Cox proportional hazards models to assess mortality associated with illicit substance use, including use of heroin and cocaine, as well as by use of tobacco and alcohol. Among192 participants with poorly controlled hypertension, 30% were active illicit substance users (specifically, 22.7% heroin users, 19.8% were cocaine users, and 30.7% were both cocaine and heroin users). The mean age among substance non‐users was 52.3 years versus 48.7 years among those reporting current use. Mortality over 7.6 years of follow‐up was 52.5% among substance users and 33.8% among nonusers (p‐value, 0.01). After adjusting for potential confounders, the hazard ratio (HR) for cocaine use was 2.52 (95% confidence interval (CI) 1.38–4.59), while the HR for heroin use was 2.47 (95% CI 1.42–4.28) and the HR for both was 2.75 (95% CI 1.60–4.73). Substance use was associated with increased mortality among urban black Americans with poorly controlled hypertension. These data suggest the need for targeted interventions to support African Americans who have poorly controlled hypertension and use illicit substances, as a means of reducing excess mortality.
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Affiliation(s)
- Vinithra Varadarajan
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chidinma A Ibe
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Hunter Young
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mercer F, Miler JA, Pauly B, Carver H, Hnízdilová K, Foster R, Parkes T. Peer Support and Overdose Prevention Responses: A Systematic 'State-of-the-Art' Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12073. [PMID: 34831839 PMCID: PMC8621858 DOI: 10.3390/ijerph182212073] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
Abstract
Overdose prevention for people who use illicit drugs is essential during the current overdose crisis. Peer support is a process whereby individuals with lived or living experience of a particular phenomenon provide support to others by explicitly drawing on these experiences. This review provides a systematic search and evidence synthesis of peer support within overdose prevention interventions for people who use illicit drugs. A systematic search of six databases (CINAHL, SocINDEX, PsycINFO, MEDLINE, Scopus, and Web of Knowledge) was conducted in November 2020 for papers published in English between 2000 and 2020. Following screening and full-text review, 46 papers met criteria and were included in this review. A thematic analysis approach was used to synthesize themes. Important findings include: the value of peers in creating trusted services; the diversity of peers' roles; the implications of barriers on peer-involved overdose prevention interventions; and the stress and trauma experienced by peers. Peers play a pivotal role in overdose prevention interventions for people who use illicit drugs and are essential to the acceptability and feasibility of such services. However, peers face considerable challenges within their roles, including trauma and burnout. Future interventions must consider how to support and strengthen peer roles in overdose settings.
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Affiliation(s)
- Fiona Mercer
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Joanna Astrid Miler
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Kristina Hnízdilová
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
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12
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Experiences and challenges in mental health research and practice during COVID-19: Perspectives from emerging psychologists across five countries. Asian J Psychiatr 2021; 65:102813. [PMID: 34419720 PMCID: PMC9760268 DOI: 10.1016/j.ajp.2021.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022]
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13
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Shield KD, Rehm J. Societal development and the alcohol-attributable burden of disease. Addiction 2021; 116:2326-2338. [PMID: 33565663 DOI: 10.1111/add.15441] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/03/2020] [Accepted: 01/27/2021] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to examine if there is an interaction between alcohol use and human development in terms of their associations with alcohol-attributable health harms. DESIGN Statistical modelling of global country- and region-specific data from 2016. SETTING Global. PARTICIPANTS/CASES The units of the analyses were countries (n = 180) and regions (n = 4) based on their Human Development Index (HDI). MEASUREMENTS Alcohol-attributable harms [deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) lost] and risk relations were based on a recent study using World Health Organization (WHO) estimates for 2016. Human development was measured using the HDI, a summary score of life expectancy, education and gross national income from the United Nations Development Programme. Interactions between HDI and adult per-capita consumption (APC) affecting alcohol-attributable harms were assessed using likelihood ratio tests. Differences in alcohol-attributable harms per litre of APC between HDI groups were assessed using regression analyses and a reference group of low HDI. FINDINGS APC is associated with alcohol-attributable deaths, YLL, YLDs and DALYs lost, while HDI is associated with alcohol-attributable deaths, YLL and DALYs lost. Statistical analyses indicated there is an interaction between HDI and APC in their associations with alcohol-attributable deaths, YLL and DALYs lost per 100 000 people. The alcohol-attributable burden was highest in low HDI countries, with 11.65 [95% confidence interval (CI) = 10.75, 12.40] deaths and 495.61 (95% CI = 461.83, 569.23) DALYs lost per 100 000 people per litre of APC, and lowest in very high HDI countries, with 4.15 (95% CI = 2.46, 5.71) deaths and 200.31 (95% CI = 122.78, 265.10) DALYs lost per 100 000 people per litre of APC. However, no statistical differences between low and very high HDI groupings for these burdens were observed. CONCLUSIONS There appears to be an interaction between the Human Development Index and alcohol use in their associations with alcohol-attributable deaths, years of life lost and disability-adjusted life years lost but not with alcohol-attributable years lived with disability. Alcohol appears to have a stronger harmful impact per litre of alcohol consumed in lesser developed countries than in developed countries.
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Affiliation(s)
- Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, Moscow, Russian Federation
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14
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Patra J, Buckley C, Kerr WC, Brennan A, Purshouse RC, Rehm J. Impact of body mass and alcohol consumption on all-cause and liver mortality in 240 000 adults in the United States. Drug Alcohol Rev 2021; 40:1061-1070. [PMID: 33682957 PMCID: PMC9383267 DOI: 10.1111/dar.13265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all-cause or liver mortality. METHODS We obtained self-reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking. RESULTS Obese (≥30 kg m-2 ) adults with consumption of >40 g day-1 (women) or >60 g day-1 (men) pure ethanol were at risk of increased mortality from all-cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m-2 , each 5 kg m-2 higher BMI was associated with an elevated all-cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16-1.40) and women (1.12, [1.02-1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60-11.00]) than women (2.90, [0.50-5.30]). DISCUSSION AND CONCLUSIONS Obesity and excess alcohol are both related to all-cause and liver mortality-the latter with evidence of a supra-additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research.
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Affiliation(s)
- Jayadeep Patra
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy, Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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15
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James CL, Tynan RJ, Bezzina AT, Rahman MM, Kelly BJ. Alcohol Consumption in the Australian Mining Industry: The Role of Workplace, Social, and Individual Factors. Workplace Health Saf 2021; 69:423-434. [PMID: 33896275 DOI: 10.1177/21650799211005768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coal miners have been reported to have higher rates of risky/harmful alcohol misuse; however, it is not known if metalliferous mining employees whose working conditions differ in workplace practices, also have increased rates of risky/harmful alcohol misuse. This study aimed to examine alcohol consumption in a sample of Australian metalliferous mining workers and to examine the demographic and workplace factors associated with risky/harmful alcohol use. METHODS All employees from a convenience sample of four Australian mine sites were invited to complete a paper-based cross-sectional survey between June 2015 and May 2017. The survey contained questions relating to social networks, health behaviors, psychological distress, demographic characteristics, and risky/harmful drinking. Current alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated measure of risky and/or harmful drinking. Factors associated with risky/harmful drinking were investigated using univariate and multivariable logistic regression. FINDINGS A total of 1,799 participants completed the survey (average site response rate 95%). Overall, 94.8% of males and 92.1% of females reported using alcohol in the preceding 12 months. The odds of risky/harmful alcohol use were significantly higher in those who were male, younger, and reported higher psychological distress. CONCLUSIONS/APPLICATION TO PRACTICE This study identified that metalliferous mining employees engage in at-risk levels of alcohol consumption significantly higher than the national average despite workplace policies and practices that restrict alcohol use. Personal and workplace risk factors that may help target specific employee groups and inform the development of tailored, integrated multicomponent intervention strategies for the industry were identified.
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16
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Muhammad T, Govindu M, Srivastava S. Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross-sectional study. BMC Geriatr 2021; 21:85. [PMID: 33514331 PMCID: PMC7847155 DOI: 10.1186/s12877-021-02027-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/13/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life. METHODS The present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated. RESULTS About 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only. CONCLUSION The encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.
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Affiliation(s)
- T. Muhammad
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| | - Manideep Govindu
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| | - Shobhit Srivastava
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
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17
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Su Z, Schneider JA, Young SD. The Role of Conversational Agents for Substance Use Disorder in Social Distancing Contexts. Subst Use Misuse 2021; 56:1732-1735. [PMID: 34286669 DOI: 10.1080/10826084.2021.1949609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic and its related policies, such as social distancing orders, are affecting the ability for people with substance use disorders (SUD) to seek prevention and treatment. In this commentary, we introduce conversational agents, a type of social technology. We discuss the role of conversational agents in the prevention and treatment of SUD in social distancing contexts and the potential benefits and limitations of designing and implementing such technology in the prevention and care for patients with SUD.
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Affiliation(s)
- Zhaoyuan Su
- Department of Informatics, University of California, Irvine, California, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Sean D Young
- Departments of Emergency Medicine and Informatics, University of California, Irvine, California, USA
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18
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Yoon YH, Chen CM, Slater ME, Jung MK, White AM. Trends in Premature Deaths From Alcoholic Liver Disease in the U.S., 1999-2018. Am J Prev Med 2020; 59:469-480. [PMID: 32863077 PMCID: PMC7508789 DOI: 10.1016/j.amepre.2020.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION So-called deaths of despair-those involving drug overdoses, alcohol-related liver disease, and suicide-have been rising in the U.S. among middle-aged white, non-Hispanic adults without a college degree. Premature deaths (ages 25-69) from alcoholic liver disease were examined specifically in this study from 1999 to 2018, by sex, race/Hispanic origin, and age group. METHODS Data were drawn from the 1999-2018 Multiple Cause of Death database and bridged-race estimates of the U.S. resident population, including 281,243 alcoholic liver disease deaths or an average of 8 deaths per 100,000 population. Analyses examined alcoholic liver disease death rates for sex differences among 3 age groups (25-49, 50-59, and 60-69 years), by race and Hispanic origin, from 1999 to 2018; age-adjusted and age-specific annual percentage changes (accounted for cohorts); years of potential life lost; and age of death for sociodemographic backgrounds, alcoholic liver disease clinical courses, and comortalities. RESULTS White non-Hispanics increasingly experienced greater alcoholic liver disease mortality than black non-Hispanics and Hispanics, confirming the racial and ethnic crossover observed in previous studies. Although men consistently had higher rates of mortality, male-to-female ratios decreased in the past 2 decades and were the lowest among ages 25-49 years and especially among ages 25-34 years. Although women generally had longer life expectancies, women died of alcoholic liver disease on average about 2-3 years earlier than men. CONCLUSIONS Prevention and intervention efforts are imperative to address the narrowing sex gap and widening racial disparities in alcoholic liver disease premature deaths.
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Affiliation(s)
| | | | | | - M Katherine Jung
- National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - Aaron M White
- National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
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19
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Park SH, Kim DJ. Global and regional impacts of alcohol use on public health: Emphasis on alcohol policies. Clin Mol Hepatol 2020; 26:652-661. [PMID: 33053937 PMCID: PMC7641561 DOI: 10.3350/cmh.2020.0160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Alcohol is a well-known risk factor for premature morbidity and mortality. The per capita alcohol consumption of the world's population rose from 5.5 L in 2005 to 6.4 L in 2010 and was still at the level of 6.4 L in 2016. Alcohol-attributable deaths and disability-adjusted life years (DALYs) declined from 2000 to 2016 by 17.9% and 14.5%, respectively. However, these gains observed in the alcohol-attributable burden have proportionally not kept pace with the total health gains during the same period. In 2016, 3.0 million deaths worldwide and 132 million DALYs were attributable to alcohol, responsible for 5.3% of all deaths and 5.0% of all DALYs. These burdens are the highest in the regions of Eastern Europe and sub-Saharan Africa. The alcohol-attributable burden is particularly heavy among young adults, accounting for 7.2% of all premature mortalities. Among the disease categories to which alcohol is related, injuries, digestive diseases, and cardiovascular diseases are the leading causes of the alcohol-attributable burden. To reduce the harmful use of alcohol in a country, the 'whole of government' and 'whole of society' approaches are required with the implementation of evidence-based alcohol control policies, the pursuit of public health priorities, and the adoption of appropriate policies over a long period of time. In this review, we summarize previous efforts to investigate the alcohol-attributable disease burden and the best ways to protect against harmful use of alcohol and promote health.
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Affiliation(s)
- Seung Ha Park
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
- Institute for Liver and Digestive Diseases, Hallym University,
Chuncheon, Korea
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20
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Recent changes in trends of opioid overdose deaths in North America. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:66. [PMID: 32867799 PMCID: PMC7457770 DOI: 10.1186/s13011-020-00308-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
Background As several regulatory and environmental changes have occurred in North America, trends in overdose deaths were examined in the United States (US), Ontario and British Columbia (BC), including changes in consumption levels of prescription opioids (PO) and overdose deaths, changes in correlations between consumption levels of PO and overdose deaths and modeled differences between observed and predicted overdose deaths if no changes had occurred. Methods Consumption levels of PO included defined daily doses for statistical purposes per million inhabitants per day for the US and Canada (2001–2015). Overdose deaths included opioid overdose deaths for the US (2001–2017) and Ontario (2003–2017) and illicit drug overdose deaths for BC (2001–2017). The analytic techniques included structural break point analyses, Pearson product-moment correlations and multivariate Gaussian state space modeling. Results Consumption levels of PO changed in the US in 2010 and in Canada in 2012. Overdose deaths changed in the US in 2014 and in Ontario and BC in 2015. Prior to the observed changes in consumption levels of PO, there were positive correlations between consumption levels of PO and overdose deaths in the US (r = 0.99, p < 0.001) and Ontario (r = 0.92, p = 0.003). After the observed changes in consumption levels of PO, there was a negative correlation between consumption levels of PO and overdose deaths in the US (r = − 0.99, p = 0.002). Observed overdose deaths exceeded predicted overdose deaths by 5.7 (95% Confidence Interval [CI]: 4.8–6.6), 3.5 (95% CI: 3.2–3.8) and 21.8 (95% CI: 18.6–24.9) deaths per 100,000 people in the US, Ontario and BC, respectively in 2017. These excess deaths corresponded to 37.7% (95% CI: 31.9–43.6), 39.2% (95% CI: 36.3–42.1) and 72.2% (95% CI: 61.8–82.6) of observed overdose deaths in the US, Ontario and BC, respectively in 2017. Conclusions The opioid crisis has evolved in North America, as a sizeable proportion of overdose deaths are now attributable to the several regulatory and environmental changes. These findings necessitate substance use policies to be conceptualized more broadly as well as the continued expansion of harm reduction services and types of pharmacotherapy interventions.
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Štelemėkas M, Manthey J, Lange S, Badaras R, Breda J, Ferreira-Borges C, Rehm J. Evaluation of alcohol policy control measures is key. Addiction 2020; 115:1590-1591. [PMID: 32004391 DOI: 10.1111/add.14983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robertas Badaras
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Centre of Toxicology, Vilnius University, Vilnius, Lithuania.,Vilnius University Emergency Hospital, Vilnius, Lithuania
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
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Neufeld M, Ferreira-Borges C, Gil A, Manthey J, Rehm J. Alcohol policy has saved lives in the Russian Federation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102636. [PMID: 32417670 DOI: 10.1016/j.drugpo.2019.102636] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
Alcohol use has been determined to be one of the main risk factors of, and contributors to, premature mortality in Russia, but no formal analysis of the impact of alcohol control policies has been undertaken so far. The present contribution is a commentary on a policy impact study undertaken by the World Health Organization on the effects of alcohol control measures on mortality and life expectancy in the Russian Federation. As part of the case study, all alcohol control policies in Russia from 1990 to 2018 were examined, and periods with differing policy intensity were distinguished based on the known effectiveness of different measures. Trends in all-cause mortality during these periods, and the shifts in trends between periods, were analysed using interrupted-time series methodology. As predicted, the intensity of alcohol control policies strongly impacted all-cause mortality. The experience of the Russian Federation in reducing the burden of disease caused by alcohol is a strong argument that effective alcohol policies are essential for improving the prospects for long and healthy lives.
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Affiliation(s)
- Maria Neufeld
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation; Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada.
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
| | - Artyom Gil
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992 Moscow, Russian Federation
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada; Institute of Medical Science (IMS), University of Toronto, Room 2374, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada; Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Street, 8, b. 2, 119992 Moscow, Russian Federation
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Rehm J, Kilian C, Ferreira-Borges C, Jernigan D, Monteiro M, Parry CDH, Sanchez ZM, Manthey J. Alcohol use in times of the COVID 19: Implications for monitoring and policy. Drug Alcohol Rev 2020; 39:301-304. [PMID: 32358884 PMCID: PMC7267161 DOI: 10.1111/dar.13074] [Citation(s) in RCA: 297] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/24/2022]
Abstract
Based on a literature search undertaken to determine the impacts of past public health crises, and a systematic review of the effects of past economic crises on alcohol consumption, two main scenarios—with opposite predictions regarding the impact of the current COVID‐19 pandemic on the level and patterns of alcohol consumption—are introduced. The first scenario predicts an increase in consumption for some populations, particularly men, due to distress experienced as a result of the pandemic. A second scenario predicts the opposite outcome, a lowered level of consumption, based on the decreased physical and financial availability of alcohol. With the current restrictions on alcohol availability, it is postulated that, for the immediate future, the predominant scenario will likely be the second, while the distress experienced in the first may become more relevant in the medium‐ and longer‐term future. Monitoring consumption levels both during and after the COVID‐19 pandemic will be necessary to better understand the effects of COVID‐19 on different groups, as well as to distinguish them from those arising from existing alcohol control policies.
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Affiliation(s)
- Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - David Jernigan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, USA
| | | | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, UKE Hamburg-Eppendorf, Hamburg, Germany
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Ranabhat CL, Park MB, Kim CB. Influence of Alcohol and Red Meat Consumption on Life Expectancy: Results of 164 Countries from 1992 to 2013. Nutrients 2020; 12:nu12020459. [PMID: 32059386 PMCID: PMC7071474 DOI: 10.3390/nu12020459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background: High consumption of red meat, which is carcinogenic to humans, and misuse or abuse of alcohol drinking increase premature death and shortened life expectancy. The aim of this study was to examine the association of alcohol and red meat consumption with life expectancy (LE) by analyzing data from 164 countries using an ecological approach. Design: This was a longitudinal ecological study using data from the United Nation’s (UN) Food and Agriculture Organization (FAO) for 164 countries over the period 1992–2013. In regression analysis, the relationship of alcohol and red meat consumption with LE was estimated using a pooled ordinary least squares regression model. Alcohol and red meat consumption were measured every 5 years. Results: The consumption of alcohol and red meat in high-income countries (HIC) was about 4 times (36.8–143.0 kcal/capita/day) and 5 times (11.2–51.9 kcal/capita/day) higher than that in low-income countries (LIC). Red meat and alcohol consumption had a negative estimated effect on LE in HIC (b = −1.616 p = < 0.001 and b = −0.615, p = 0.003). Alcohol consumption was negatively associated with LE for all income groups, while positive relationships were found for all estimates associated with gross national income (GNI). Conclusions: Red meat and alcohol consumption appeared to have a negative impact on LE in high-income countries (HIC) and upper-middle-income countries (UMIC), although it had no significant association with LE in low-income countries (LIC) or lower-middle-income countries (LMIC). This study suggests reviewing the policies on the gradual reduction of alcohol abuse and the high consumption of red meat, particularly HIC and UMIC.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Gerontology Health and Welfare, Pai Chai University, Seo-gu, Daejeon 35345, Korea
- Policy Research Institute, Sanogaucharan 44600, Kathmandu, Nepal
- Global Centre for Research and Development (GCRD), Kathmandu 44600, Nepal
- Correspondence: (C.L.R.); (M.-B.P.); (C.-B.K.)
| | - Myung-Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Seo-gu, Daejeon 35345, Korea
- Correspondence: (C.L.R.); (M.-B.P.); (C.-B.K.)
| | - Chun-Bae Kim
- Institute for Poverty Alleviation and International Development, Yonsei University, 1 Yonseidae-Gil, Wonju-City 26493, Gangwon-Do, Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro Wonju-City 26426, Gandwon-do, Korea
- Hongcheon-County Hypertension and Diabetes Registration and Education Center, 5 Sinjangdae-ro Hongcheon-Gun 25135, Gandwon-do, Korea
- Correspondence: (C.L.R.); (M.-B.P.); (C.-B.K.)
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Rehm J. Alcohol Use is a Key Factor in Recent Decreases in Life Expectancy in the United States. Alcohol Clin Exp Res 2020; 44:404-406. [DOI: 10.1111/acer.14274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health Institute for Mental Health Policy Research Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
- Centre for Addiction and Mental Health Campbell Family Mental Health Research Institute Toronto Ontario Canada
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Rehm J, Shield KD. Global Burden of Alcohol Use Disorders and Alcohol Liver Disease. Biomedicines 2019; 7:E99. [PMID: 31847084 PMCID: PMC6966598 DOI: 10.3390/biomedicines7040099] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Alcohol use is a major risk factor for burden of mortality and morbidity. Alcoholic liver disease (ALD) and alcohol use disorders (AUDs) are important disease outcomes caused by alcohol use. We will describe the global mortality and burden of disease in disability-adjusted life years for ALD and AUDs, based on data from the comparative risk assessment of the World Health Organization for 2016. AUDs have a limited impact on mortality in this assessment, since alcohol poisonings are almost the only disease category directly attributable to AUDs; most other alcohol-related deaths are indirect, and the cause which directly led to the death, such as liver cirrhosis, is the one recorded on the death certificate. Burden of disease for AUDs is thus mainly due to disability resulting from alcohol use. In contrast to AUDs, ALD is one of the major lethal outcomes of alcohol use, and burden of disease is mainly due to (premature) years of life lost. Many of the negative outcomes attributable to both AUDs and ALD are due to their interactions with other factors, most notably economic wealth. To avoid alcohol-attributable morbidity and mortality, measures should be taken to reduce the AUDs and ALD burden globally, especially among the poor.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 1P8, Canada
- Institute of Medical Science, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5T 2S1, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187 Dresden, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow 119992, Russia
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 1P8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5T 2S1, Canada
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Landberg J, Hemmingsson T, Sydén L, Ramstedt M. The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence. Eur Addict Res 2019; 26:40-51. [PMID: 31747671 PMCID: PMC6979426 DOI: 10.1159/000504437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. METHODS The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25-64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. RESULTS Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20-35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. DISCUSSION/CONCLUSION Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.
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Affiliation(s)
- Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
| | - Tomas Hemmingsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lovisa Sydén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mats Ramstedt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Probst C, Rehm J. Alcohol use, opioid overdose and socioeconomic status in Canada: A threat to life expectancy? CMAJ 2019; 190:E1294-E1295. [PMID: 30397155 DOI: 10.1503/cmaj.180806] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research (Probst, Rehm), Centre for Addiction and Mental Health (CAMH); Department of Psychiatry (Rehm), University of Toronto, Toronto, Ont
| | - Jürgen Rehm
- Institute for Mental Health Policy Research (Probst, Rehm), Centre for Addiction and Mental Health (CAMH); Department of Psychiatry (Rehm), University of Toronto, Toronto, Ont.
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Chang KC, Lee KY, Lu TH, Hwang JS, Lin CN, Ting SY, Chang CC, Wang JD. Opioid agonist treatment reduces losses in quality of life and quality-adjusted life expectancy in heroin users: Evidence from real world data. Drug Alcohol Depend 2019; 201:197-204. [PMID: 31247504 DOI: 10.1016/j.drugalcdep.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study estimated the long-term changes of opioid agonist treatment (OAT) in quality of life (QOL) and quantified the quality-adjusted life years (QALY) from the loss of quality-adjusted life expectancy (QALE) in heroin users. METHODS A total of 1283 heroin users stratified by OAT were linked to the National Mortality Registry for 8 years (2006-2014) to obtain survival functions, which were extrapolated to lifetime by applying a rolling extrapolation algorithm to survival ratio between the sub-cohorts and age- and sex-matched referents simulated from vital statistics of Taiwan. We performed cross-sectional measurement of EQ-5D on 349 participants, including those with a valid state of OAT or non-OAT plus newly recruited consecutive patients, during 2015-2017 for utility values, while the QOL of referents were abstracted from the 2009 National Health Interview Survey. The QALE was calculated by summing the products of the mean QOL and survival rate throughout life. The QALE difference between the cohort and corresponding referents was the loss-of-QALE. RESULTS QOL of the OAT group was significantly better than that of the non-OAT group in every domain of the EQ-5D, which was quantified to be 0.23 for utility after controlling for other variables. After extrapolation to 70 years, the estimated QALE and loss-of-QALE were 17.8 and 18.2 QALY for OAT subjects, respectively, while those of the non-OAT group were 9.2 and 27.9 QALY. CONCLUSIONS Receiving OAT could reduce QALE lost by 9.7 QALYs compared with non-OAT after accounting for QOL differences along time and different age and sex distributions.
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Affiliation(s)
- Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, 539 Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan; Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Kuan-Ying Lee
- Jianan Psychiatric Center, Ministry of Health and Welfare, 539 Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan.
| | - Tsung-Hsueh Lu
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei 11529, Taiwan.
| | - Chia-Ni Lin
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Shuo-Yen Ting
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161 YuPin Rd., Caotun Township, Nantou 542, Taiwan.
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 901 Zhonghua Rd., Yongkang Dist., Tainan 71004, Taiwan; Department of Health Psychology, Chang Jung Christian University, No.1, Changda Rd., Gueiren District, Tainan 71101, Taiwan.
| | - Jung-Der Wang
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan; Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, 138 ShengLi Rd., North Dist., Tainan 704, Taiwan.
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Shield KD, Probst C, Rehm J. A "buck a beer," but at what cost to public health? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:512-515. [PMID: 30737723 PMCID: PMC6964542 DOI: 10.17269/s41997-019-00184-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/17/2019] [Indexed: 12/19/2022]
Abstract
Alcohol use leads to a substantial number of hospitalizations, and to increased health and social harms as well as economic costs in Ontario and across Canada. The effects of alcohol price changes on consumption and resulting harms have been firmly established; changes in the minimum price of alcohol have the greatest effect on consumption among people who for reasons of affordability consume low-priced alcoholic beverages, typically adolescents, people with lower socio-economic status, and people with harmful alcohol use. Decreases in inflation-adjusted minimum pricing in British Columbia from 2002 to 2006 have been associated with increases in deaths wholly attributable to alcohol. Furthermore, decreases in alcohol prices have been previously associated with increases in drink-driving, decreases in life expectancy, increases in road traffic injuries, violence, and alcohol poisonings, and long-term increases in deaths from infectious diseases, circulatory diseases, and digestive diseases. Based on the findings of previous studies, lowering the cost of alcohol will negatively impact the health of Ontarians and further strain a healthcare system with limited resources. Accordingly, Ontario should be strengthening alcohol policies to improve public health, including raising the minimum price of alcohol, rather than weakening alcohol policies.
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Affiliation(s)
- Kevin D Shield
- World Health Organization/Pan American Health Organization Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Charlotte Probst
- World Health Organization/Pan American Health Organization Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- World Health Organization/Pan American Health Organization Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Saxony, Germany
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Manthey J, Shield KD, Rylett M, Hasan OSM, Probst C, Rehm J. Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet 2019; 393:2493-2502. [PMID: 31076174 DOI: 10.1016/s0140-6736(18)32744-2] [Citation(s) in RCA: 431] [Impact Index Per Article: 86.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global non-communicable disease goals. We present estimates on the main indicators of alcohol exposure for 189 countries from 1990-2017, with forecasts up to 2030. METHODS Adult alcohol per-capita consumption (the consumption in L of pure alcohol per adult [≥15 years]) in a given year was based on country-validated data up to 2016. Forecasts up to 2030 were obtained from multivariate log-normal mixture Poisson distribution models. Using survey data from 149 countries, prevalence of lifetime abstinence and current drinking was obtained from Dirichlet regressions. The prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) was estimated with fractional response regressions using survey data from 118 countries. FINDINGS Between 1990 and 2017, global adult per-capita consumption increased from 5·9 L (95% CI 5·8-6·1) to 6·5 L (6·0-6·9), and is forecasted to reach 7·6 L (6·5-10·2) by 2030. Globally, the prevalence of lifetime abstinence decreased from 46% (42-49) in 1990 to 43% (40-46) in 2017, albeit this was not a significant reduction, while the prevalence of current drinking increased from 45% (41-48) in 1990 to 47% (44-50) in 2017. We forecast both trends to continue, with abstinence decreasing to 40% (37-44) by 2030 (annualised 0·2% decrease) and the proportion of current drinkers increasing to 50% (46-53) by 2030 (annualised 0·2% increase). In 2017, 20% (17-24) of adults were heavy episodic drinkers (compared with 1990 when it was estimated at 18·5% [15·3-21·6%], and this prevalence is expected to increase to 23% (19-27) in 2030. INTERPRETATION Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved, and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure. FUNDING Centre for Addiction and Mental Health and the WHO Collaborating Center for Addiction and Mental Health at the Centre for Addiction and Mental Health.
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Medical Sciences Building, University of Toronto, Toronto, ON, Canada
| | - Margaret Rylett
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; WHO Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Medical Sciences Building, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Trends in substance use and in the attributable burden of disease and mortality in the WHO European Region, 2010–16. Eur J Public Health 2019; 29:723-728. [DOI: 10.1093/eurpub/ckz064] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This paper examines changes in substance use, and compares the resulting attributable burden of disease in the WHO European Region between 2010 and 2016.
Methods
Data for 2010 and 2016 on the number of deaths, years of life lost (YLL) and disability-adjusted life years (DALYs) lost were obtained by sex and country from the 2016 Global Burden of Disease (GBD) study. Exposure data for all substances except alcohol were obtained from the same study, while alcohol data were obtained from the WHO. Proportional changes were calculated for the WHO European Region as a whole to identify trends and for sub-regions to identify which regions contributed most to trends.
Results
In the WHO European Region in 2016, substance use caused 2.1 million deaths, 48.6 million YLL and 57.9 million DALYs lost, representing 22.4, 29.0 and 20.4% of all deaths, YLL and DALYs, respectively. The substance-attributable burden of disease was higher among men than women and highest in the eastern parts of the WHO European Region. Changes in the number of deaths, YLL and DALYs lost between 2010 and 2016 were almost uniformly downward, with the largest proportional changes observed for men. Exposure to tobacco, alcohol and illicit drugs also decreased uniformly.
Conclusions
Substance use and its attributable mortality and burden of disease have decreased in the WHO European Region since 2010. However, overall levels of substance use and the resulting burden of disease in the Region remain high compared with other regions of the world.
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Rehm J, Štelemekas M, Badaras R. Research Protocol to Evaluate the Effects of Alcohol Policy Changes in Lithuania. Alcohol Alcohol 2019; 54:112-118. [PMID: 30260375 DOI: 10.1093/alcalc/agy068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022] Open
Abstract
Aims To point out the importance for public health to evaluate the past policy changes (2016-2018) in Lithuania. To present a research protocol to conduct this evaluation. Short summary The staggered implementation of key alcohol policies in Lithuania over the past two years offers the possibility to evaluate 'best buys' for alcohol policies for this country. Lithuania is the only country where all 'best buys' were implemented over a short period of time, so this evaluation will be unique. Methods Quasi-experimental design based on interrupted time-series analysis of monthly routine statistics of morbidity and mortality indicators as well as key variables on the pathway between alcohol exposure and health outcomes. Conclusions For the public health community, results of the evaluation of these policy changes will be of critical importance.
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Affiliation(s)
- J Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, Canada.,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, Dresden, Germany
| | - M Štelemekas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės st. 18, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės st. 18, Kaunas, Lithuania
| | - R Badaras
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Centre of Toxicology, Vilnius University, Šiltnamių st. 29, Vilnius, Lithuania.,Vilnius University Emergency Hospital, Šiltnamių st. 29, Vilnius, Lithuania
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Abstract
PURPOSE OF REVIEW This contribution reviews the newest empirical evidence regarding the burden of mental and addictive disorders and weighs their importance for global health in the first decades of the twenty-first century. RECENT FINDINGS Mental and addictive disorders affected more than 1 billion people globally in 2016. They caused 7% of all global burden of disease as measured in DALYs and 19% of all years lived with disability. Depression was associated with most DALYs for both sexes, with higher rates in women as all other internalizing disorders, whereas other disorders such as substance use disorders had higher rates in men. Mental and addictive disorders affect a significant portion of the global population with high burden, in particular in high- and upper-middle-income countries. The relative share of these disorders has increased in the past decades, in part due to stigma and lack of treatment. Future research needs to better analyze the role of mental and addictive disorders in shifts of life expectancy.
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35
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Rehm J. Alcohol consumption and all-cause mortality: Further implications. Drug Alcohol Rev 2018; 38:13-15. [PMID: 30588684 DOI: 10.1111/dar.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jürgen Rehm
- WHO Collaboration Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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Rehm J. Commentary on Liang et al. (2018): The potential impact of medical cannabis on public health with respect to reducing prescription opioid use and associated harm. Addiction 2018; 113:2071-2072. [PMID: 30178539 DOI: 10.1111/add.14408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jürgen Rehm
- CAMH, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,CAMH, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Medical Sciences Building, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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Rehm J. Why the relationship between level of alcohol-use and all-cause mortality cannot be addressed with meta-analyses of cohort studies. Drug Alcohol Rev 2018; 38:3-4. [PMID: 30288805 DOI: 10.1111/dar.12866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Jürgen Rehm
- WHO Collaboration Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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