bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia*
Authors: Aceijas Carmen , Hickman Matthew , Donoghoe Martin C. , Burrows Dave , Stuikyte Raminta 
Published: June 2007

ABSTRACTObjective  To estimate access, activity and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia.Methods  Two data sets (‘regional’ and ‘high‐coverage sites’) were used to estimate NSP provision (availability/number of sites), NSP utilization (syringes distributed/year), needle and syringe distribution (needles/syringes distributed/IDU/year), IDU reached (number/percentage of IDU contacted/year), regular reach (five or more contacts/month) and syringe coverage (percentage of injections/IDU/year administrable with new injecting equipment).Results  Regional data set: results from 213 sites in 25 countries suggested that Czech Republic, Poland, Russia and Ukraine had > 10 NSP during 2001/2. Czech Republic, Kazakhstan, Latvia, Russia, Slovakia and Ukraine had ≥ 10 000 IDU in contact with NSP. Ten countries reached ≥ 10% of the estimated IDU population. The 25 countries distributed ∼ 17 million syringes/needles. Eight countries distributed > 0.5 million syringes/year. Syringe coverage (assuming 400 injections/IDU/year) was < 5% in 19 countries, 5–15% in five and > 15% in Macedonia. Overall syringe coverage was 1.2% and when assuming 700 injections/IDU/year it decreased to 0.7%. Syringe coverage for the IDU population in contact with NSP was ≤ 15% in 10 countries, 15–60% in 11 and > 60% in Croatia, Macedonia, Moldova and Tajikistan. Overall syringe coverage for the population in contact with NSP was 9.8%. High‐coverage data set: Soligorsk, Pskov and Sumy's NSP reached 92.3%, 92.2% and 73.3% of their estimated IDU population, respectively (regular reach: 0.2%, 1.8% and 22.7%). The distribution levels were 47.2, 51.7 and 94.2 syringes/IDU/year, respectively.Conclusion  The evidence suggests suboptimal levels of NSP implementation, programme activity and coverage. This paper provides a baseline for development of indicators that could be used to monitor NSP. Strategies to increase coverage that may go beyond NSP are urgently required, as is research into understanding how NSP can contribute to better syringe coverage among IDU.
Is attention‐deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community‐based case–control study
Authors: Szobot Claudia M. , Rohde Luis A. , Bukstein Oscar , Molina Brooke S. G. , Martins Caroline , Ruaro Pauline , Pechansky Flávio 
Published: June 2007

ABSTRACTAims  This study aims at evaluating the association between attention‐deficit/hyperactivity disorder (ADHD) and illicit substance use disorders (SUD) (marijuana, cocaine and inhalants), controlling for the association with conduct disorder (CD), in a community‐based sample of adolescents.Design  Case–control, community‐based study.Setting  A delimited geographical area in the South of Brazil, served by four public health clinics.Participants  A total of 968 male adolescents (15–20 years of age) were screened for SUD in their households. Of the subjects who were screened positive, we selected 61 cases with illicit SUD. For each case we selected, from the group which was screened negative, three controls without illicit or alcohol SUD, matched by age and proximity with the case's household.Measurements  The screening instrument was the Alcohol Smoking and Substance Screening Test (ASSIST). SUD diagnoses were assessed by the drug section of the Mini International Neuropsychiatry Interview (MINI). Other psychiatric diagnoses were based on semistructured (Schedule for Affective Disorders and Schizophrenia for School‐Age Children—epidemiological version; MINI) and clinical interviews.Findings  Adolescents with ADHD presented a significantly higher odds ratio (OR) for illicit SUD than youths without ADHD, even after adjusting for potential confounders (CD, ethnicity, religion and estimated IQ) (OR = 9.12; 95% CI = 2.84–29.31, P < 0.01).Conclusions  Our results suggest an association between ADHD and illicit SUD in Brazilian adolescents that is not mediated by CD. These findings are potentially important from a prevention perspective because treatments are available for ADHD.
Getting it right: designing adolescent‐centred smoking cessation services
Authors: MacDonald Sarah , Rothwell Heather , Moore Laurence 
Published: June 2007

ABSTRACTAims  To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services.Design  Structured qualitative interviews drawing on means‐end theory.Setting  Three youth‐clubs and two secondary schools in south‐east Wales.Participants  Twenty‐five male and female 13–18‐year‐olds, mainly daily smokers.Findings  Interviewees did not assume immediately that a smoking cessation service is something that will be available to them, and therefore they initially encountered difficulties in identifying attributes of such support. With further prompting interviewees were able to express a preference for support attributes, but these were not attributes that traditionally form part of cessation provision. Their main preference was for support from friends and family, access to nicotine replacement therapy and non‐school‐based, flexible support and guidance.Conclusion  The results re‐emphasize the inadequacies of existing cessation provision for meeting adolescent preferences and suggest that developing more adolescent‐appropriate support requires a reconceptualization of existing interventions, with service users situated at the core of intervention design. The study highlights a number of service development points for intervention planners including: rethinking the timing and location of provision; placing more emphasis on the selection of facilitators; harnessing support from friends and family; and rooting these developments in broader tobacco control strategies.
Alcohol‐specific rules, personality and adolescents' alcohol use: a longitudinal person–environment study
Authors: Van Der Vorst Haske , Engels Rutger C. M. E. , Deković Maja , Meeus Wim , Vermulst Ad A. 
Published: June 2007

ABSTRACTAims  To examine the bi‐directional associations between providing alcohol‐specific rules and adolescents' alcohol use. Further, to explore person–environment interactions, we tested whether Big Five personality traits moderate the assumed association between providing alcohol‐specific rules and adolescents' alcohol use.Design  Longitudinal data (three waves in 2 years) from 428 families, consisting of both parents and two adolescents (aged 13–16 years) were used for the analyses. Analyses were conducted on four samples: a group of older adolescents and a group of younger adolescents who already consumed alcohol, and a group of older and younger adolescents who were not drinking at baseline measurement.Findings  In general, results of structural equation modelling showed that providing clear alcohol‐specific rules lowers the likelihood of drinking initiation, regardless of the age of the youngsters. Once adolescents have established a drinking pattern, the impact of parental alcohol‐specific rules declined or even disappeared. Finally, the Big Five personality traits did not moderate the association between providing alcohol‐specific rules and adolescents' alcohol involvement.Conclusions  In sum, in particular during the initiation phase of drinking, parents could prevent the drinking of their offspring, regardless of the age or personality of their youngsters, by providing clear alcohol‐specific rules.
Physical activity in adolescence and smoking in young adulthood: a prospective twin cohort study
Authors: Kujala Urho M. , Kaprio Jaakko , Rose Richard J. 
Published: June 2007

ABSTRACTAims  To control for familial confounds, we studied the association between adolescent physical activity and later smoking in twin siblings discordant for their baseline physical activity.Design and measurements  In this prospective population‐based twin study, we asked whether persistent physical activity/inactivity in adolescence (assessed at 16, 17 and 18.5 years) predicted questionnaire‐reported daily smoking at ages 22–27. Twins who, on the three baseline questionnaires, consistently reported frequent leisure physical activity (more than three times weekly) were classified as persistent exercisers, those who exercised less than three times monthly were called persistently inactive, others were occasional exercisers.Setting  Finland.Participants  A total of 4240 individuals, including 1870 twin pairs.Findings  In analyses of individual twins, compared to persistent activity, persistent physical inactivity predicted increased risk of daily smoking (age‐ and sex‐adjusted odds ratio 5.53, 95% confidence interval 3.88–7.88, P < 0.001). The risk remained elevated even after excluding all those who had smoked 50 cigarettes or more life‐time at baseline and adjusted for educational level in adolescence. In within‐pair analyses compared to the active members of discordant twin pairs, the physically inactive co‐twins had increased risk of future daily smoking (sex‐adjusted odds ratio 3.39, 95% confidence interval 1.56–7.39, P = 0.002).Conclusions  Persistent physical inactivity in adolescence relates to adult smoking, even after familial factors are taken into account.
Enhancing the validity and utility of randomized clinical trials in addictions treatment research: I. Treatment implementation and research design
Authors: Del Boca Frances K. , Darkes Jack 
Published: June 2007

ABSTRACTPurpose  This paper is the first in a series that examines methods for improving the validity and utility of randomized clinical trials (RCTs) in addictions treatment research. The specific foci of this article are treatment implementation and research design.Scope  We begin by considering the conditions under which the RCT provides an appropriate design choice. Sections that follow discuss methodological issues with respect to RCT structure and collaborative arrangements; treatment specification, delivery and cost; experimental design; and randomization/blinding procedures. We emphasize the importance of advance planning; treatment integrity and discriminability; treatment standardization; staff training and supervision; client compliance; maintenance of between‐group equivalence across study conditions; and inclusion of appropriate comparison groups in study designs.Conclusions  Investigators are encouraged to maximize the internal validity of RCTs, but also to consider methods for enhancing external validity. The utility of addictions RCTs for advancing theory and improving clinical practice can be enhanced by investigating underlying mechanisms of action.
Goals indicate motivation to quit smoking
Authors: Peters Erica N. , Hughes John R. , Callas Peter W. , Solomon Laura J. 
Published: June 2007

ABSTRACTAims  To test if goals indicate motivation to quit smoking and predict which smokers will make a quit attempt.Design  A 28‐day natural history feasibility study of smoking cessation and reduction.Setting  The study was conducted via telephone calls and mailings.Participants  A total of 186 cigarette smokers.Measurements  At baseline participants reported one of the following goals for the next 30 days: to quit abruptly, quit gradually, reduce but not quit, or not change their smoking. They also reported motivation to quit smoking on an Intention to Quit Ladder. Throughout the study they reported their cigarette consumption via daily telephone messages.Findings  Self‐reported motivation to quit differed among goals (F = 286.6, df = 3, P < 0.01). Goals significantly predicted the likelihood of making a quit attempt in the 28 days of the study. In comparison to smokers with the goal of not changing, smokers with a goal of quitting abruptly were more likely to make a quit attempt [relative risk (RR) = 9.6, P < 0.01], as were those with a goal of quitting gradually (RR = 4.5, P = 0.01). Those with a goal of reducing only appeared to be more likely to make a quit attempt than those with a goal of not changing, but the difference was not statistically significant (RR = 3.1, P = 0.15). Smokers with a goal of quitting abruptly were more likely to make a quit attempt than those with a goal of quitting gradually (RR = 2.1, P < 0.05).Conclusions  Goals indicate not only preferred method of change but also motivation. Differences in gradual versus abrupt cessation outcomes may be due to motivational rather than methodological differences. Those who plan to quit gradually or reduce only may need additional motivational interventions.
Population drinking and liver cirrhosis mortality: is there a link in eastern Europe?
Authors: Ramstedt Mats 
Published: June 2007

ABSTRACTAims  To analyse the relationship between population drinking and liver cirrhosis mortality in eastern European countries and compare it with similar findings from western Europe.Design and measurements  Yearly data, from the approximate period 1960–2002, on liver cirrhosis mortality in total and by gender were analysed in relation to per capita alcohol consumption in nine eastern European countries divided into ‘spirits countries’ and ‘non‐spirits countries’. The Box–Jenkins technique for time–series analysis was used to estimate the impact on liver cirrhosis resulting from a 1‐litre increase in per capita consumption in terms of relative (%) and absolute effects (number of cirrhosis deaths).Findings  Cirrhosis mortality rates were related significantly to population drinking in eight of nine eastern European countries and both relative and absolute alcohol effects laid within the range of previous western European estimates. A 1‐litre increase in per capita consumption was on average estimated to cause three to four additional cirrhosis deaths per 100 000 for men and one additional death for women. The absolute effects for men were relatively high in a European perspective: stronger than in mid‐ and northern Europe and only marginally weaker in comparison with southern Europe.Conclusions  A reduction in per capita alcohol consumption would prevent many cirrhosis deaths in eastern Europe, particularly for men. It is suggested that further studies of the extent other forms of alcohol‐related mortality respond to changes in population drinking in eastern Europe would be valuable.
Borderline personality disorder and persistently elevated levels of risk in 36‐month outcomes for the treatment of heroin dependence
Authors: Darke Shane , Ross Joanne , Williamson Anna , Mills Katherine L. , Havard Alys , Teesson Maree 
Published: June 2007

ABSTRACTAims  To determine the effects of borderline personality disorder (BPD) on 36‐month outcomes for the treatment of heroin dependence.Design  Longitudinal cohort study.Setting  Sydney, Australia.Participants  A total of 429 heroin users enrolled in the Australian Treatment Outcome Study, interviewed at 36‐month follow‐up.Findings  The BPD group enrolled in significantly more different treatment episodes across follow‐up, but there was no difference in the cumulative number of treatment days received. At 36 months, there were no group differences in sustained or current heroin abstinence, daily heroin use or level of polydrug use. BPD patients maintained significantly higher levels of crime, injection‐related health problems, heroin overdose, major depression and poorer global mental health. In contrast to 12‐month follow‐up, at 36 months there were no group differences in the proportions who attempted suicide over the preceding 12 months or had recently borrowed used injection equipment.Conclusions  The clinical picture provided some cause for optimism since 12‐month follow‐up. Despite this, BPD patients maintained elevated risk levels across a number of domains. The fact that these risks were maintained indicates that this is a group that requires specific clinical attention for BPD‐related risks.
Caudal anaesthesia as a treatment for penile ischaemia following circumcision
Authors: Kaplanian S. , Chambers N. A. , Forsyth I. 
Published: June 2007

SummaryWe report an ischaemic penile glans following circumcision and a dorsal penile nerve block in a 9‐year‐old boy. Ischaemia of the glans penis is a rare complication associated independently with both circumcision and dorsal penile nerve blocks. There are a number of pathophysiological mechanisms of this ischaemia and its management is varied and not well recorded. We report the successful management of this complication using a caudal epidural block and also discuss technical aspects of penile nerve blocks.
A comparison of the disposable Ambu® AuraOnce™ Laryngeal Mask with the reusable LMA Classic™ laryngeal mask airway*
Authors: Sudhir G. , Redfern D. , Hall J. E. , Wilkes A. R. , Cann C. 
Published: June 2007

SummarySingle‐use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA Classic™ laryngeal mask airway. We performed a randomised cross‐over study comparing the Ambu® AuraOnce™ Laryngeal Mask with the LMA Classic. Fifty patients participated in the trial. Success rates for insertion at the first attempt were similar (92% with the Ambu and 84% with the LMA Classic; p = 0.22). The volumes of air required to inflate the cuff to produce a seal were similar, but the cuff pressure was lower for the Ambu Laryngeal Mask (median (IQR [range]) 18 (10–31 [0–100] cmH2O) than the LMA Classic 27 (17–50 [4–90] cmH2O; p = 0.007). Visual analogue scores for ease of insertion were 87 (73–93 [26–97]) mm for the Ambu and 84 (60–89 [18–96]) for the LMA Classic (p = 0.017). Complications were similar in both groups. We suggest that the disposable Ambu Laryngeal Mask is an acceptable alternative to the reusable LMA Classic.
Evaluation of four manikins as simulators for teaching airway management procedures specified in the Difficult Airway Society guidelines, and other advanced airway skills*
Authors: Jordan G. M. , Silsby J. , Bayley G. , Cook T. M. 
Published: June 2007

SummaryTen volunteers evaluated the performance of four currently available manikins: Airway Management TrainerTM, Airway TrainerTM, Airsim™ and Bill 1™ as simulators for the 16 procedures described in the Difficult Airway Society Guidelines (DAS techniques) and eight other advanced airway techniques (non‐DAS techniques), by scoring and ranking each manikin and procedure. Manikin performance was unequal (p < 0.0001 for both SCORE and RANK data for both DAS and non‐DAS techniques). Post hoc analysis ranked the manikins for DAS techniques as: 1st Laerdal, 2nd Trucorp, 3rd equal VBM and Ambu. For non‐DAS techniques, the ranking was: 1st equal Laerdal and Trucorp, 3rd equal VBM and Ambu. The power to discriminate for individual procedures was considerably lower but for 15 of 16 DAS techniques and 6 of 8 non‐DAS techniques, manikin performance differed significantly. Post hoc tests showed significant performance differences between individual manikins for 10 DAS procedures, with the Laerdal manikin performing best.
Systematic reviews: how they work and how to use them
Authors: Carlisle J. B. 
Published: June 2007

SummaryAt their best, systematic reviews should be the least biased summaries of the effect of healthcare interventions. However, authors can introduce both intended and unintended biases into systematic reviews. Results presented as odds ratios are often misinterpreted by readers as relative risks, meaning that the effect of the intervention is overestimated. Authors may analyse trials separately having mistaken differences in baseline risk for differences in the effect of an intervention and differences in effect between trials that have been analysed together may go undetected. In this article I discuss how a systematic review should work and how it can go wrong.
Extending low‐dose epidural analgesia in labour for emergency Caesarean section – a comparison of levobupivacaine with or without fentanyl*
Authors: Malhotra S. , Yentis S. M. 
Published: June 2007

SummaryWomen in labour receiving epidural analgesia with 15 ml bupivacaine 0.1% and 2 μg.ml−1 fentanyl followed by 10–15‐ml top‐ups as required, who needed Caesarean section, were randomly allocated to receive 20 ml levobupivacaine 0.5% over 3 min with either 75 μg fentanyl (1.5 ml) or 1.5 ml saline. Further top‐ups or inhaled or intravenous supplementation were given for breakthrough pain. Time to onset (loss of cold sensation to T4 and touch sensation to T5 bilaterally), quality of analgesia and side‐effects were recorded. The study was stopped after 112 patients had been randomly assigned, due to a unit protocol change, from midwife‐administered top‐ups to patient‐controlled epidural analgesia. Data from 51 patients given fentanyl and 54 given saline were available for analysis. There were no significant differences in onset times or supplementation between the groups, but there was more intra‐operative nausea/vomiting with fentanyl (53%) than with saline (18%; p = 0.004). We found no advantage of adding fentanyl to epidural levobupivacaine when extending epidural analgesia in women already receiving epidural fentanyl during labour and there was an increased incidence of intra‐operative nausea and vomiting. Power analysis suggested the same conclusion even had the study proceeded to completion.
What do service users think of evaluation? Evidence from family support
Authors: Cortis Natasha 
Published: June 2007

ABSTRACTProgramme evaluators increasingly strive to capture how service users experience child and family welfare programmes. Yet user involvement is rare in a more routine form of evaluation: performance measurement. This paper considers how service users' perspectives can help improve the performance indicators that inform child and family service funding, management and planning. Qualitative research, conducted in family support contexts in New South Wales, Australia, identifies five user‐defined domains upon which indicators can be based. As well as showing how parents judge service quality and outcomes, the findings also show how they experience data collection, and how they prefer to participate in the routine performance measurement and monitoring that informs child and family welfare provision.