Change in injecting behaviour among people treated for hepatitis C virus: The role of intimate partnerships.

Injecting behaviour in people who inject drugs is the main risk factor for hepatitis C virus (HCV) infection. Psychosocial factors such as having a partner who injects drugs and living with other drug users have been associated with increases in injecting risk behaviour. This study aimed to investigate changes in injecting behaviour during treatment for HCV infection whilst exploring the role of psychosocial factors on patients' injecting behaviour. Eradicate-C was a single-centred clinical trial (ISRCTN27564683) investigating the effectiveness of HCV treatment within the injecting drug-using population between 2012 and 2017. A total of 94 participants completed up to 24 weeks of treatment, with social and behavioural measures taken at different intervals throughout treatment. Data for 84 participants were analysed retrospectively to explore mechanisms of potential behavioural changes which had occurred during treatment. Injecting frequency reduced significantly between baseline (week 1) and every 4-weekly interval until week 26. Not being on opiate substitution therapy (OST) was associated with a statistically significant decrease in injecting frequency, χ2 (1) = 10.412, P = 0.001, as was having a partner who also used drugs, in particular when that partner was also on treatment for HCV infection, Z = -2.312, P = 0.021. Treating a hard-to-reach population for HCV infection is not only possible, but also bears health benefits beyond treatment of HCV alone. Enrolling couples on HCV treatment when partners are sero-concordant has shown enhanced benefits for reduction in injecting behaviour. Implications for practice are discussed.

The pain of low status: the relationship between subjective socio-economic status and analgesic prescriptions in a Scottish community sample.

There is a strong positive relationship between objective measures of socio-economic status (OSS) and general health. However, there is an increasing interest in the relationship between health and subjective socio-economic status (SSS), which describes one's perceived rank in relation to the rest of the society, based on factors such as income, occupation and education. While the relationship between SSS and general health is well established, the relationship between SSS and pain has received little attention. Gathering both self-report questionnaire data and General Practitioner medical data from a large representative community sample in Scotland between 2012 and 2013 (N = 1824), we investigated the relationship between SSS and prescriptions for analgesic drugs. We found that higher levels of SSS significantly predicted lower odds of participants having been prescribed at least one analgesic drug in the previous six months. We obtained this result even after controlling for OSS-related variables (education, occupational status and geographical location) and demographic variables (age and gender). This suggests that, just like the relationship between SSS and general health, SSS has important effects on pain that go beyond the influence of OSS.

Greater number of group identifications is associated with lower odds of being depressed: evidence from a Scottish community sample.

PURPOSE: Group identification has been shown to be associated with reduced risk of depression, but this research has important limitations. Our aim was to establish a robust link between group identification and depression whilst overcoming previous studies' shortcomings. METHODS: 1824 participants, recruited from General Practice throughout Scotland, completed a questionnaire measuring their identification with three groups (family, community, and a group of their choice), as well as their intensity of contact with each group. They also completed a self-rated depression measure and provided demographic information. Their medical records were also accessed to determine if they had been prescribed antidepressants in the previous 6 months. RESULTS: The number of group identifications was associated with both lower self-rated depression and lower odds of having received a prescription for antidepressants, even after controlling for the number of contact-intensive groups, level of education, gender, age, and relationship status. CONCLUSIONS: Identifying with multiple groups may help to protect individuals against depression. This highlights the potential importance of social prescriptions, where health professionals encourage a depressed patient to become a member of one or more groups with which the patient believes he/she would be likely to identify.

Clinical normative data for eating disorder examination questionnaire and eating disorder inventory for DSM-5 feeding and eating disorder classifications: a retrospective study of patients formerly diagnosed via DSM-IV.

Normative data for measures of eating disorder (ED) psychopathology provide a fundamental description of a presentation and a means to establish clinically significant change following an intervention. Clinical norms for the ED population are lacking and out of date following the publication of Diagnostic and Statistical Manual of Mental Health Disorders (DSM) 5. This study aimed to show that scores from the Eating Disorder Examination Questionnaire (EDE-q) and the Eating Disorder Inventory (EDI) differ across ED diagnosis groups and provide norm data for DSM-5 ED diagnoses. Patients (n = 932) presenting to an out-patient service over 5 years were retrospectively re-diagnosed based on DSM-5 criteria. Statistical analysis showed a significant difference on most subscale scores of the EDE-q and the EDI across diagnosis. Means, standard deviations and percentile ranks are presented by diagnosis. The norms detailed contribute to improving the accuracy with which scores are interpreted when using DSM-5 and aid with the assessment of clinically significant change following treatment.

Characteristics and rates of mental health problems among Indian and White adolescents in two English cities.

BACKGROUND: Sampling techniques for national surveys have constrained the statistical power in estimating prevalence rates of child mental health problems in minority ethnic groups. AIMS: To establish the prevalence rates of mental health problems in ethnic Indian adolescents in England and compare these with matched White adolescents living in the same areas. METHOD: A cross-sectional survey with oversampling of Indian adolescents aged 13-15 years of age. RESULTS: The sample size was 2900 (71% response rate) with 1087 (37%) Indian and 414 (14%) White adolescents. Ethnically Indian adolescents had lower rates of all types of mental health problems (5% v. 13% and 21% v. 30% for abnormal Strengths and Difficulties Questionnaire and Short Mood and Feelings Questionnaire scores, respectively) and substance misuse (18% v. 57%, 5% v.15% and 6% v. 9% for regular alcohol, smoking and drug use, respectively), with the exception of eating disorders, compared with their White counterparts. The odds of an abnormal score on the mental health questionnaires were worse for White compared with Indian children irrespective of sociodemographic variables. CONCLUSIONS: Factors relating to how Indian adolescents are parented or their social support networks may be influencing their mental health and may warrant further investigation.

Log D7.4 and plasma protein binding of synthetic cannabinoid receptor agonists and a comparison of experimental and predicted lipophilicity.

The emergence of new synthetic cannabinoid receptor agonists (SCRAs) onto the illicit drugs market continues to cause harm, and the overall availability of physicochemical and pharmacokinetic data for new psychoactive substances is lacking. The lipophilicity of 23 SCRAs and the plasma protein binding (PPB) of 11 SCRAs was determined. Lipophilicity was determined using a validated chromatographic hydrophobicity index (CHI) log D method; tested SCRAs showed moderate to high lipophilicity, with experimental log D7.4 ranging from 2.48 (AB-FUBINACA) to 4.95 (4F-ABUTINACA). These results were also compared to in silico predictions generated using seven commercially available software packages and online tools (Canvas; ChemDraw; Gastroplus; MoKa; PreADMET; SwissADME; and XlogP). Licenced, dedicated software packages provided more accurate lipophilicity predictions than those which were free or had prediction as a secondary function; however, the latter still provided competitive estimates in most cases. PPB of tested SCRAs, as determined by equilibrium dialysis, was in the upper range of the lipophilicity scale, ranging from 90.8% (ADB-BUTINACA) to 99.9% (BZO-HEXOXIZID). The high PPB of these drugs may contribute to reduced rate of clearance and extended durations of pharmacological effects compared to lesser-bound SCRAs. The presented data improve understanding of the behaviour of these drugs in the body. Ultimately, similar data and predictions may be used in the prediction of the structure and properties of drugs yet to emerge on the illicit market.

Large-scale evaluation of ion mobility spectrometry for the rapid detection of synthetic cannabinoid receptor agonists in infused papers in prisons.

Synthetic cannabinoid receptor agonists (SCRAs), colloquially known as "spice," are commonly used in prisons and enter establishments via the mail in the form of infused papers. Many prisons use benchtop ion mobility spectroscopy (IMS) instruments to screen mail and seized materials for the presence of SCRAs and other controlled substances. The selectivity and sensitivity of Rapiscan Itemiser® 3E and Itemiser® 4DN Ion Trap Mobility Spectroscopy™ (ITMS™) systems were evaluated using 21 SCRA reference standards. Some differences in the SCRA reduced mobility (K0 ) values were observed between this study and those reported previously using IMS detection systems, particularly for cumyl and quinolinyl SCRAs (e.g., 5F-PB-22, Cumyl-4CN-BINACA, and 5F-Cumyl-PEGACLONE), although this was found to have little effect at an operational level. Operational reliability of the systems was evaluated by analyzing 392 paper and card samples with known drug content. ITMS™ system results (e.g., detect or nondetect) were in agreement with gas chromatography-mass spectrometry (GC-MS) analysis in up to 95% of samples tested. Overall, this study found the ITMS™ systems tested to be effective instruments when deployed for the rapid detection of SCRA-infused papers. Used effectively and with up-to-date substance libraries, they will help reduce the supply of SCRAs into prisons and identify emerging threats as they arise. Several emerging SCRAs (5F-MPP-PICA, 5F-EMB-PICA, and 4F-MDMB-BICA) were detected for the first time in Scottish prisons between May and August 2020 as a result of routine monitoring, and all were detected using the ITMS™ systems tested.

Greater number of group identifications is associated with healthier behaviour: Evidence from a Scottish community sample.

OBJECTIVES: This paper investigates the interplay between group identification (i.e., the extent to which one has a sense of belonging to a social group, coupled with a sense of commonality with in-group members) and four types of health behaviour, namely physical exercise, smoking, drinking, and diet. Specifically, we propose a positive relationship between one's number of group identifications and healthy behaviour. DESIGN: This study is based on the Scottish portion of the data obtained for Wave 1 of the two-wave cross-national Health in Groups project. Totally 1,824 patients from five Scottish general practitioner (GP) surgeries completed the Wave 1 questionnaire in their homes. METHODS: Participants completed measures of group identification, group contact, health behaviours, and demographic variables. RESULTS: Results demonstrate that the greater the number of social groups with which one identifies, the healthier one's behaviour on any of the four health dimensions considered. CONCLUSIONS: We believe our results are due to the fact that group identification will generally (1) enhance one's sense of meaning in life, thereby leading one to take more care of oneself, (2) increase one's sense of responsibility towards other in-group members, thereby enhancing one's motivation to be healthy in order to fulfil those responsibilities, and (3) increase compliance with healthy group behavioural norms. Taken together, these processes amply overcompensate for the fact that some groups with which people may identify can actually prescribe unhealthy behaviours.

Mental health service use by adolescents of Indian and White origin.

BACKGROUND: Despite the available epidemiological evidence on the prevalence of mental health problems in childhood and adolescence, there is limited knowledge on whether there are differences in the level of need and service utilisation by young ethnic minority groups. METHODS: Adolescents of 13-15 years from nine schools in two English cities in which children of Indian ethnicity were over-represented (n=2900), completed rating scales on different types of mental health problems, contacts with services and informal supports. RESULTS: Indian adolescents scored significantly lower on general mental health and depression symptoms. They were also less likely than White adolescents to self-report having mental health problems, even for a similar level of need. Among those with mental health scores within the clinical range, Indian adolescents were less likely to have visited specialist services. Instead, they were more likely to first approach family members, teachers or general practitioners. CONCLUSIONS: Rather than a blanket approach being applied to policy and service planning to meet the needs of diverse communities of young people, more specific evidence needs to be gained about patterns of referrals of minority groups and their strategy of accessing supportive adults.

Care and environment in midwife-led and obstetric-led units: a comparison of mothers' and birth partners' perceptions.

BACKGROUND: Health-care design recognises the importance of people-environment interactions, and maternity units have responded by encouraging 'homely' environments. Birthing women and birth partners have been separately surveyed about their experiences of the maternity environment and midwifery care, but not to date as dyads. METHOD(S): Postal return survey of mothers and birth partners from nine maternity units (six midwife-led; three obstetric-led) in England, at eight days postnatally in 2004-5. Questions concerned participants' general and specific impressions of the unit environment and of the care given. A repeated measures analysis of variance was used to explore interactions between mothers and partners and different types of unit. The Wilcoxon signed rank test was used for skewed satisfaction scores. Loglinear models were used to analyse mothers' and partners' cited comments, factoring in types of unit. FINDINGS: 515 Dyads responded (response rate 50%). Mothers and partners were generally positive, but *mothers were more so. They rated the birth surroundings (Z = -8.083; p < 0.001) and the midwifery care (Z = -7.177; p < 0.001) more highly than their partners; these findings were significant in both types of unit. Loglinear analysis found that mothers especially were more likely to find midwife-led units 'homely' (Z = 2.496; p = 0.013), 'calming' (Z = 9.61; p < 0.001): and 'clean' (Z = 4.08, p < 0.001). Obstetric-led units were more likely to be thought 'stuffy' (Z = -3.51, p < 0.001). Partners were more likely to agree that there was a lack of privacy (Z = 3.401; p = 0.001), and that there was a lack of facilities for them, particularly within obstetric-led units. CONCLUSIONS: Although generally positive, birth partners were significantly less positive than the birthing mothers about a range of environmental and care variables. The primary focus is and should be the birthing woman, but the partner nevertheless has an interactive role to play, and improving his experience may assist this function.

Self-rated "no-" and "low-" risk pregnancy: a comparison of outcomes for women in obstetric-led and midwife-led units in England.

BACKGROUND: Debate in the United Kingdom about place of birth often concerns obstetric-led units and midwife-led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife-led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self-rated pregnancy risk level was "none" or "low." METHODS: Self-completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6-month period. RESULTS: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife-led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric-led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01). CONCLUSIONS: Since these mothers' self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes.