Journal of Public Health Research (PAGEPress Publications)
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Misuse of prescription and illicit drugs among high-risk young adults in Los Angeles and New York
Get PDFBackground. Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods. Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results. In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurred before heroin and initiation of prescription stimulants happened prior to illicit stimulants. NY participants more frequently misused oxycodone, heroin, and cocaine, and LA participants more frequently misused codeine, marijuana, and methamphetamine. Combining prescription and illicit drugs during drug using events was commonly reported in both sites. Opioids and tranquilizers were used as substitutes for other drugs, e.g., heroin, when these drugs were not available. Conclusion. Patterns of drug use among high-risk young adults in Los Angeles and New York appear to be linked to differences in local markets in each city for illicit drugs and diverted prescription drugs
What is behind the seeming cessation of the increase in sleep medicine consumption in Finland during the last years?
Get PDFIn Finland, between 2003 and 2010 and parallel to the increase in the prevalence of insomnia-related symptoms among the general population, there has been a cessation of growth and even a decrease in the consumption of traditional hypnotics. The reasons behind this seemingly paradoxical situation are not known. We analyzed trends over the period 2000-2010 in the estimated consumption of traditional hypnotics and some new drugs that are destined for use in insomnia treatment. We used the annual wholesale statistical database compiled by the Finnish Medicine Agency, FIMEA, and data from the Finnish Drug Prescription Register. We found evidence to support two parallel trends in Finnish outpatient care. First, there seems to be a trend in which physicians increasingly comply with official guidelines for insomnia treatment, which partly accounts for the decrease in the consumption of traditional hypnotics. Second, at the same time, the first trend seems to be resulting in an increasing trend to treat insomnia patients with some new drugs that were not originally developed for insomnia treatment by prescribing these non-hypnotic drugs in small, sub-clinical doses. The current trend in practice may have contradictory effects on the treatment of insomnia. The long-term consequences of using low doses of drugs other than hypnotics to treat insomnia are not known and the situation should, therefore, be followed-up in subsequent studies. However, pharmacological treatment should never be a substitute for non-pharmacological treatments of insomnia
Modernity in medicine and hygiene at the end of the 19th century: the example of cremation
Get PDFMedicine in the second half of the nineteenth century takes on some characteristics of modernity. These characteristics are worthy of our attention because they help us to understand better some of the current problems of hygiene and public health. One of the topics that was most discussed in the scientific-academic milieu of the second half of the nineteenth century was cremation. There was a poetic precedent: the cremation of Percy Bysse Shelley (1792-1822). The earliest apparatus to completely destroy the corpse was made in Italy and Germany in the 1870s. As far as hygiene was concerned, the reasons for cremation were not to pollute the water-bearing strata and an attempt to streamline the cemetery structure. As in an apparent schizophrenia, scientists of the day worked to both destroy and preserve corpses. There is also the unusual paradox that when the first cremations took place, the corpses were first preserved then to be destroyed later. The catholic world (mainly in Italy) and forensic scientists opposed cremation. It was left to the hygienists to spread the practice of cremation. An analysis of scientific literature shows us that if we leave out the related forensic and ethical problems, recent years have seen attention paid to any harmful emissions from crematoria equipment which have poured into the environment. Another issue is the assessment of inadvertent damage which may be caused by the condition of the corpse. Some topics, however, such as the need for preventive autopsies (first proposed in 1884 in Milan) are still a subject of debate, and seem to pass virtually unchanged from one generation to the next
Tuberculosis in Quebec: a review of trends
Get PDFThe aim of this research was to conduct a thorough review on the literature of tuberculosis in Canada and the Province of Quebec. To achieve this aim, an exhaustive literature review of tuberculosis in the Province of Quebec was undertaken. Data was collected with the goal of creating an epidemiological and public health evidence base to forecast the spread of tuberculosis. A keyword search strategy was used to find relevant articles from the peer-reviewed literature using the electronic search engine PubMed and a search of other relevant federal and provincial government databases. Twenty-nine peer-reviewed publications and twenty government reports containing information about the incidence or prevalence of tuberculosis in the Province of Quebec were included in the analysis. An analysis of the data revealed that while tuberculosis rates have been decreasing in both Canada and Quebec with an overall incidence below 3 per 100,000 of population in 2007, among immigrants and the Inuit communities in Quebec, the incidence and prevalence of the disease still remains high and reached 18 per 100,000 and 100 per 100,000, respectively in 2007. In general, while tuberculosis does not pose a significant burden to the general population, it does continue to affect certain sub-groups disproportionately, including select immigrants and Inuit communities in Quebec. Efforts to ensure that cost-effective healthcare interventions are delivered in a timely fashion should be pursued to reduce the associated morbidity and mortality of tuberculosis in the Province of Quebec
Measuring the health of populations: explaining composite indicators
Get PDFIndicators that summarise the health status of a population and that provide comparable measures of a population disease burden are increasingly vital tools for health policy decision making. Decisions concerning health systems across the world are greatly affected by changes in disease profiles and population dynamics, and must develop the capacity to respond to such changes effectively within the resources of each nation. Decisions must be based on evidence of the patterns of diseases, their risk factors and the effectiveness of alternative interventions. This paper focuses on the main approaches used for developing summary measures that include mortality and morbidity occurring in a population. It discusses the rationale for composite measures and reviews the origins of each main approach. The paper also examines methodological differences among these approaches making explicit the value choices that each entails, outlines the advantages and limitations of each measure, and shows how they relate to one another
Misuse (and abuse?) of the concept of empowerment: the case of online offer of predictive direct-to-consumer genetic tests
Get PDFoai:ojs.www.jphres.org:article/2Using the field of direct-to-consumer genetic tests as a case in point, this paper argues against the misuse of the term empowerment, and calls for a regulation of its usage. The misleading assumption under certain current usages of the concept of empowerment is that it is enhanced by the provision of health information. While the ‘information-empowerment’ correlation is misleading, if not wrong, the feeling of being empowered imposes an increasing burden of critical thinking on those people (patients and consumers) who have to evaluate that information and act for the benefit of their health
Medical error disclosure: a pressing agenda for Public Health researchers
Get PDFMedical errors are not a prevalent discussion topic in the current public health literature. However, their impact on patient lives across the world is alarming. In the United States alone, more than 1.3 million patients are harmed every year by medical treatments that are intended to help them. About three quarters of these adverse events are caused by preventable human error....
Label, nudge or tax? A review of health policies for risky behaviours
Get PDFThis work proposes a critical, non systematic, review of the three main lines of health policy interventions to deal with risky behaviours, such as over-eating, smoking, sedentary lives, and excess alcohol drinking, namely: i) the release of information on health risks and consequences; ii) the use of financial incentives; and iii) direct policy intervention in markets, through regulation and taxation. First, the health and economic impact of the risky behaviours epidemics are briefly described. Then a critical review follows on the evidence existing on the effectiveness of each type of intervention. The review will also highlight the public health approach staying beyond each type of policy on risky behaviours and critically consider them within the context of more general health and social policy interventions
Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners
Get PDFBackground. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment
Binge drinking and psychoactive drug use in a cohort of European youths
Get PDFBackground. TEN-D by Night is an international, multicentre, cross-sectional portal survey conducted on a large sample of young people in six European countries. This paper aims to investigate the alcohol and psychoactive drug consumption of this sample, with a focus on the prevalence of binge drinking and the poly-drug habits of the TEN-D cohort. Design and Methods. The study population consisted of 4695 young people attending recreational sites on weekend nights. The intervention included two questionnaires and two psychoactive substance detection tests performed at the entry and exit of the recreational sites. A multivariate logistic regression model was used to predict the probability of binge drinking. Results. Binge drinking was reported by 20% of the males and 13% of the females (P=0.001) before entry into the recreational sites and by 18% of the males and 11% of the females before entry into the clubs (P<0.001). Poly-drug use was reported by 71% of the males and 66% of the females. Living with a parent (OR 1.57; P=0.01), seeking employment (OR 1.66; P=0.005) and cannabis consumption (several times per month and several times per week, OR 1.94 and 3.66, respectively, P<0.05) were associated with binge drinking. Conclusions. Our survey showed that it is possible to identify individuals and groups at higher risk of binge drinking. This identification would allow for a focus on specific targets and would facilitate the redesign of prevention programmes. The increased use of psychoactive substances among youths should be studied extensively to promote successful prevention campaigns