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Ketamine use in a large global sample: Characteristics, patterns of use and emergency medical treatment.
No full textBACKGROUND: Ketamine's popularity has surged globally in the past decade, especially among young men. Emergency department visits due to its toxicity remain relatively rare, often linked to co-occurring use of other substances. AIMS: Using data from the Global Drug Survey (GDS) 2018, this study explored the correlates associated with lifetime and past-year ketamine use, and estimated the socio-demographic characteristics, usage patterns and experiences of respondents seeking emergency medical treatment (EMT) after ketamine use. METHODS: Secondary analysis of GDS 2018, an online cross-sectional survey on drug use patterns conducted between November 2017 and January 2018. RESULTS: The survey received 130,761 valid responses, with 5.93% reporting lifetime ketamine use, of which 57.70% used ketamine within the past year. Predominantly, respondents were from Germany, England and Denmark. Within the past year, 8.55% met the criteria for ketamine dependence. Respondents who used ketamine in their lifetime tended to be young (mean (x̄) = 27.37 years), men, heterosexual and of white ethnicity. Younger age (x̄ = 24.84 years), gay sexual orientation, student status, past-year use of other drugs and no lifetime mental health diagnosis were associated with past-year ketamine use. Among 4477 respondents reporting past-year ketamine use, 120 adverse events were reported, with less than 0.10% prompting EMT seeking. CONCLUSION: The study reveals frequent ketamine use but low harm occurrence, underscoring the complex interplay between ketamine use, substance use and dependence, and related factors. This underscores the need to reassess EMT priorities, implement tailored harm reduction strategies and incorporate comprehensive screening for addressing ketamine and substance dependence challenges
Understanding the acceptability of COVID-19 antigen rapid diagnostic tests: A multi-country qualitative study.
Get PDFAccessible and timely diagnostic testing was essential during the COVID-19 pandemic to control the virus's spread and mitigate severe outcomes. However, real-time polymerase chain reaction tests, although sensitive incur high costs and prolonged turnaround times, and face implementation challenges in many resource-constrained settings. Antigen rapid diagnostic tests (Ag-RDT), which can be administered either by providers or as self-tests, are accessible and low-cost alternatives. We conducted this study to assess the acceptability of Ag-RDT in different use cases and delivery models in Malawi, Nigeria, and Zimbabwe. We implemented a qualitative study drawing on Louart's theoretical framework for the acceptability of technological healthcare innovations. In-depth interviews (n = 228) were conducted with community members, healthcare workers and providers to explore participants' experiences with Ag-RDT COVID-19 testing. Data were analysed using NVivo 14 software, applying an inductive thematic approach centred on the constant comparison method across countries, participant groups, and delivery models. The study revealed that Ag-RDT COVID-19 testing was acceptable across the three settings due to speed, non-invasiveness, and simplicity in sample collection compared to the real-time polymerase chain reaction alternative. Ag-RDT was integrated into existing healthcare systems with minimal disruption and used effectively across different use cases and populations. Participants particularly valued the self-testing option for its privacy, reduced stigma and convenience. However, acceptability was somewhat affected by the timing of the intervention, as it was implemented toward the end of the COVID-19 pandemic when many individuals no longer perceived testing as a priority. COVID-19 Ag-RDT testing was an acceptable complementary methodology to PCR testing in Malawi, Nigeria and Zimbabwe. The findings emphasise the need for strategic investment in accessible diagnostic technologies that complement existing molecular diagnostics, particularly supporting decentralised testing and rapid response capabilities in resource-constrained settings while maintaining robust surveillance systems
Emergence of novel sublineages of Mycobacterium tuberculosis in Pakistan
Get PDFINTRODUCTION: Understanding the distribution and prevalence of different M. tuberculosis lineages can help public health authorities and researchers track the spread of tuberculosis (TB). Some lineages are thought to be more virulent, transmissible, and prone to drug resistance. Here, we sought to find the major lineages and sublineages of M. tuberculosis circulating in Pakistan.
METHODS: A total of 396 whole-genome sequencing datasets were retrieved from NCBI and TB research centers.
RESULTS: In the current study, only four lineages and 21 sublineages have been detected in 396 genomic isolates in which lineages 3 (n = 274/396, 69.19 %) was the predominant, followed by lineage 4 (77/396, 19.4 %), lineage 2 (31/396, 7.8 %), and lineage 1 (14/396, 3.5 %). Lineage 3 was the most common, in which sublineage 3.1.1 (n = 254/274, 93.79 %) was dominant, followed by sublineage 3.1.2.1 (n = 11/274, 4 %) and 3.1.2 (n = 8/274, 2.9 %). 8 sublineages are likely reported for the first time in Pakistan based on current genomic surveillance including sublineage 3.1.2.1 (n = 11/274, 4 %). There were 14 sublineages in lineage 4, of which sublineage L4.5 (23/77, 29.8 %) was the most common, followed by sublineage 4.9 (22/77, 28.5 %).
CONCLUSION: Collectively, these observations highlight Lineage 3's ability to acquire first-line drug resistance continued transmission. Its predominance in the current study highlights the urgent need for lineage-specific diagnostics, enhanced drug susceptibility testing and tailored therapeutic regimens. The detection of diverse Mtb sublineages, including L3.1.2.1 and various sublineages of L4 (e.g., 4.1.1.1, 4.1.2.1, 4.3.4.2, and 4.6.2.2), signifies advancement in understanding the genetic landscape of TB in the region
Lancet Countdown on health and climate change in Africa: an international collaboration for locally led research and action.
Get PDFClimate change inflicts substantial economic damage on developing African nations, threatening progress towards the UN Sustainable Development Goals. There are synergies between actions needed to tackle climate change and other ongoing development priorities for Africa, including infectious disease control, facilitating clean energy access, reducing air pollution, tackling malnutrition and food insecurity, and providing universal health coverage. Action to protect human health against climate change needs to be integrated into all systems that are responsible for delivering essential services and implementing policies across all sectors that underpin the attainment of key development priorities for Africa. These systems include the Sustainable Development Goals and the African Union's 2063 Agenda for building The Africa We Want, and the ongoing negotiations and work programmes in the UN Framework Convention on Climate Change. Adequate stocktaking of and access to robust data and scientific evidence is needed to support this effort and guide priorities for policies that protect and promote health and for monitoring progress over time. In response to this need, the Lancet Countdown is launching a new initiative to bring together a transdisciplinary research collaboration to help build regional capacity, strengthen existing networks, generate evidence, and mobilise data across numerous domains at the climate change and health nexus in Africa
Adherence to the Mediterranean Diet Across the League of Arab States: A Systematic Review.
Get PDFPurpose: The Mediterranean diet (MD) is associated with significant health benefits. However, adherence varies considerably, influenced by sociocultural and geographical factors. This review was designed to synthesize existing evidence on the prevalence of MD adherence in different Arab countries and identify sociodemographic, cultural, and behavioral factors associated with adherence. Methodology: Sixteen databases were searched to identify relevant articles, using MeSH search terms related to MD and its applicable terms, adherence, and the names of the 22 Arab countries. Findings: Out of approximately 2400 articles searched, nine articles were selected, investigating adherence to the MD across Arab League countries and exploring the impact of geographic location on dietary practices. Examined Arab populations showed generally moderate adherence to the MD. Wide variability was observed in adherence levels among the different Arab countries. This variability arises from a complex interplay of factors, including access to specific foods, economic considerations, cultural traditions, and the influence of globalization on dietary habits. Our review highlights the role of these factors in contributing to the observed heterogeneity in MD adherence across the Arab League, examining the prevalence of various MD assessment tools and their respective strengths and limitations within this specific context. Conclusions: The findings underscore the need for culturally sensitive and geographically tailored strategies that enhance adherence to the MD's protective effects across all countries in the Arab League
Visualising treatment effects in low-vision settings: proven and potential endpoints for clinical trials of inherited retinal disease therapies
Get PDFInherited retinal diseases are a devasting and incurable cause of blindness which frequently affect patients at a young age, and developing effective treatments has been an important research priority in recent decades. Treatments must be validated in randomised-control trials, which involve measuring benefit according to prospectively defined endpoints. A wide variety of conventional clinical endpoints and emerging anatomical, physiological, and functional biomarkers may be selected. Different options may be better or worse at capturing clinically significant differences and identifying real differences between experimental groups. This review provides an overview of some proven and potential endpoints for randomised-control trials involving inherited retinal disease patients. Clinical endpoints and biomarkers are discussed, and the work required to validate biomarkers for use in trials is outlined. Unlike in general medicine, ophthalmological clinical endpoints may all be conceptualised as surrogates for maintained vision. Selecting optimal endpoints is essential to ensure that treatments are assessed fairly, such that resources are directed towards interventions that stand to truly benefit patients with inherited retinal diseases
Genomic changes of Lassa virus associated with mammalian host adaptation.
Get PDFBACKGROUND: Lassa virus (LASV) causes a severe haemorrhagic fever in humans, with estimates of 100,000 to 300,000 infections annually in endemic regions and accounting for around 5000 deaths. The natural reservoir is the Mastomys rat, but through zoonotic transmissions humans are accidental hosts. Regular outbreaks continue to exert pressures on public health systems, with its ability to cause nosocomial infections posing risks to healthcare workers. It is a concern that larger outbreaks and introduction of LASV to new territories will intensify, including risk of adaptation to new mammalian host reservoirs. RESULTS: To evaluate genetic changes in LASV during adaptation to a new host, a guinea pig model of infection was utilised. Initial infection with LASV stocks cultured from cell culture resulted in only mild or subclinical disease. To study the susceptibility in naïve animals, the virus was serially passaged which increased clinical signs during disease progression ultimately resulting in severe disease. An RNAseq and consensus mapping approach was undertaken to evaluate nucleotide changes in LASV genome from each animal at each passage. CONCLUSIONS: During adaptation to guinea pigs, no significant new mutations occurred. Instead, a selection pressure on two genes of the L segment was observed resulting in their increased frequency in the genome population during passaging
A vaccine emergency-when to overrule parental refusal of vaccination at birth for prevention of vertical transmission of hepatitis B virus?
Get PDFHepatitis B virus (HBV) is a potentially chronic infection that can be transmitted from mother to child with the risk of developing cirrhosis, liver failure and hepatocellular carcinoma. There is a safe and effective vaccine to prevent vertical transmission that is recommended to be given as soon as possible after birth and within 24 hours.When a woman with HBV refuses the birth dose of HBV vaccine for her baby, infectious diseases and safeguarding teams are asked to provide urgent opinions on whether this crosses the threshold for triggering child protection mechanisms.We consider a low-infectivity HBV vertical transmission scenario where there is parental refusal of HBV vaccination and focus on ethical arguments for and against overruling parental refusal in the child's best interests. As an additional resource for clinical and safeguarding teams, we also include the anonymised transcript of the only available UK court judgement to our knowledge that addresses the issue of decline of HBV vaccine to prevent vertical transmission.We propose a dialogue process for managing scenarios where a pregnant woman with HBV has concerns about vaccinating her baby when born, which is the basis of the current UK Health Security Agency guidance
Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system.
Get PDFIndonesia's National Health Insurance system - the Jaminan Kesehatan Nasional (JKN) - is one of the largest single-payer health insurance schemes in the world, aiming to provide equitable and affordable healthcare to a population of over 280 million. Since its launch in 2014, the JKN has achieved near-universal enrolment, covering 98 % of Indonesians in 2024. However, progress towards universal health coverage - understood as access to the health services people need, when and where they need them, without financial hardship - has been hindered by financing deficits and operational hurdles faced by healthcare providers. In this paper, we examine critical issues affecting the implementation of JKN through the analysis of 20 in-depth interviews and a focus group discussion with government officers and health sector managers at the national and provincial level. Data analysis was guided by a framework combining health systems building blocks and dimensions of access to services. The findings highlight persistent challenges despite the JKN's wide coverage, including difficulties among informal sector workers in paying premiums, regional disparities in service access and health workforce distribution, inefficiencies in provider payment mechanisms, and weak information systems for tracking subsidised members. Interviews also revealed a growing financial and administrative strain on hospitals linked to frequent regulatory changes. To address these issues, we recommend three priority reforms: (1) implement sliding-scale subsidies for informal sector workers; (2) improve provider payment models by introducing cost-sharing for elective services; and (3) adopt participatory policymaking processes to ensure reforms are sustainable and inclusive
Polysubstance Use Among the Homeless In Germany: A Nationwide, Cross-Sectional Multicenter Study.
Get PDFBACKGROUND: The number of people experiencing homelessness (PEH) in Germany reached 440 000 in 2024, double the total from 2022. Representative data on substance use among PEH is largely lacking. In this study, we estimate the prevalence of substance use among PEH and identify subgroups at risk of polysubstance use. METHODS: A cross-sectional study of 674 PEH was conducted in four German metropolitan areas in 2021. All PEH were interviewed and provided blood samples in homeless support facilities. Toxicological analysis of serum samples revealed the presence of 22 substances, which were grouped as alcohol, central nervous system (CNS) stimulants, narcotic analgesics, and cannabis. Polysubstance use was defined as the detection of substances belonging to at least two of these groups. RESULTS: The toxicological analyses revealed that 35% of PEH had no recent substance use (95% confidence interval [31; 39]), while 34% had recently engaged in polysubstance use ([30; 38]). Alcohol was the most prevalent substance (39% [35; 43]), followed by CNS stimulants (30% [27; 34]), cannabis (28% [24; 32]), and narcotic analgesics (18% [15; 21]). Polysubstance use was linked to younger age, prior incarceration, current tobacco use, and geographical location. CONCLUSION: In Germany today, the number of PEH is growing, substance availability is widespread, and drug-related deaths are on the rise. It is, therefore, vitally important to continue monitoring the situation and to provide targeted support to those who need it