What role does compassion have on quality care ratings? A regression analysis and validation of the SCQ in emergency department patients.

OBJECTIVE: To examine the unique contribution of patient reported experiences of compassion to overall patient quality care ratings. Additionally, we assess whether patients' reported experiences of compassion in the emergency department differed between sociodemographic groups. METHODS: Provincial data for this cross-sectional study were collected from 03/01/2022 to 09/05/2022 from 14 emergency departments in Alberta, Canada. Data from 4501 emergency department patients (53.6% women, 77.1% White/European) were analyzed. The primary outcome was patients' overall quality care ratings during their most recent ED visit. Measures included in the hierarchical stepwise regression included demographics, and those drawn from the Emergency Department Patient Experience of Care (EDPEC) questionnaire: single and multi-item measures of patient information (e.g., patient perceptions health) and patient experience (e.g., physician communication), and compassion (e.g., Sinclair Compassion Questionnaire; SCQ-ED). RESULTS: Data from 4501 ED patients were analysed. Stepwise hierarchical linear multiple regression indicated that of 21 included variables, compassion most strongly predicted overall quality care ratings (b=1.61, 95% CI 1.53-1.69, p<.001, f2=.23), explaining 19% unique variance beyond all other measures. One-way ANOVAs indicated significant demographic differences in mean compassion scores, such that women (vs. men) reported lower compassion (MD=-.15, 95% CI=-.21, -.09, p<.001), and Indigenous (vs. White) patients reported lower compassion (MD=-.17, 95% CI =-.34, -.01, p=.03). CONCLUSIONS: Compassion was identified as a key contributor to ED overall quality care ratings, and experiences of compassion varied as a function of demographics. Patient-reported compassion is an indicator of quality care that needs to be formally integrated into clinical care and quality care assessments.

Brucella melitensis Rev.1 vaccination generates a higher shedding risk of the vaccine strain in Alpine ibex (Capra ibex) compared to the domestic goat (Capra hircus).

Epidemiological investigations implemented in wild and domestic ruminants evidenced a reservoir for Brucella in Capra ibex in the French Alps. Vaccination was considered as a possible way to control Brucella infection in this wildlife population. Twelve ibexes and twelve goats were allocated into four groups housed separately, each including six males or six non-pregnant females. Four to five animals were vaccinated and one or two animals were contact animals. Half of the animals were necropsied 45 days post-vaccination (pv), and the remaining ones at 90 days pv. Additional samples were collected 20 and 68 days pv to explore bacterial distribution in organs and humoral immunity. Neither clinical signs nor Brucella-specific lesions were observed and all vaccinated animals seroconverted. Brucella distribution and antibody profiles were highly contrasted between both species. Proportion of infected samples was significantly higher in ibex compared to goats and decreased between 45 and 90 days pv. Two male ibex presented urogenital excretion at 20 or 45 days pv. The bacterial load was higher 45 days in ibexes compared to goats, whereas it remained moderate to low 90 days pv in both species with large variability between animals. In this experiment, differences between species remained the main source of variation, with low impact of other individual factors. To conclude, multiplicative and shedding capacity of Rev.1 was much higher in ibex compared to goats within 90 days. These results provide initial information on the potential use in natura of a commercial vaccine.

Cannabis Use among People Entering Drug Treatment in Europe: A Growing Phenomenon?

This paper explores European and national trends in specialised drug treatment entry for cannabis-related problems. The analysis is based on data for the years 2003-2014 from 22 European countries. Between 2003 and 2014, the overall number and proportion of primary cannabis-related first-time entrants increased significantly. A joinpoint regression analysis indicates that the overall increase of cannabis treatment entries is continuous, although country-related differences are observed. Possible explanations for the increase and different time trends are discussed including an increase in cannabis prevalence and cannabis-related problems, changes in risk perception, increases in cannabis potency, changes in referral practices and increased availability and accessibility of treatment services.

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

Digital Interventions for Problematic Cannabis Users in Non-Clinical Settings: Findings from a Systematic Review and Meta-Analysis.

BACKGROUND: Existing cannabis treatment programs reach only a very limited proportion of people with cannabis-related problems. The aim of this systematic review and meta-analysis was to assess the effectiveness of digital interventions applied outside the health care system in reducing problematic cannabis use. METHODS: We systematically searched the Cochrane Central Register of Controlled Trials (2015), PubMed (2009-2015), Medline (2009-2015), Google Scholar (2015) and article reference lists for potentially eligible studies. Randomized controlled trials examining the effects of internet- or computer-based interventions were assessed. Study effects were estimated by calculating effect sizes (ESs) using Cohen's d and Hedges' g bias-corrected ES. The primary outcome assessed was self-reported cannabis use, measured by a questionnaire. RESULTS: Fifty-two studies were identified. Four studies (including 1,928 participants) met inclusion criteria. They combined brief motivational interventions and cognitive behavioral therapy delivered online. All studies were of good quality. The pooled mean difference (x0394; = 4.07) and overall ES (0.11) give evidence of small effects at 3-month follow-up in favor of digital interventions. CONCLUSIONS: Digital interventions can help to successfully reduce problematic cannabis use outside clinical settings. They have some potential to overcome treatment barriers and increase accessibility for at-risk cannabis users.

Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction†.

BACKGROUND: Supervised injectable heroin (SIH) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation. AIMS: To synthesise published findings for treatment with SIH for refractory heroin-dependence through systematic review and meta-analysis, and to examine the political and scientific response to these findings. METHOD: Randomised controlled trials (RCTs) of SIH treatment were identified through database searching, and random effects pooled efficacy was estimated for SIH treatment. Methodological quality was assessed according to criteria set out by the Cochrane Collaboration. RESULTS: Six RCTs met the inclusion criteria for analysis. Across the trials, SIH treatment improved treatment outcome, i.e. greater reduction in the use of illicit 'street' heroin in patients receiving SIH treatment compared with control groups (most often receiving MMT). CONCLUSIONS: SIH is found to be an effective way of treating heroin dependence refractory to standard treatment. SIH may be less safe than MMT and therefore requires more clinical attention to manage greater safety issues. This intensive intervention is for a patient population previously considered unresponsive to treatment. Inclusion of this low-volume, high-intensity treatment can now improve the impact of comprehensive healthcare provision.

The impact of COVID-19 pandemic on health-related quality of life of adults visiting emergency departments and primary care settings in Alberta.

OBJECTIVES: To examine the impact of COVID-19 pandemic on health-related quality of life (HRQL) of adults visiting emergency departments (ED) and primary care (PC) settings in Alberta, Canada, and explore whether this impact varies across demographic subgroups. METHODS: Data from two repeated cross-sectional surveys that measured HRQL using EQ-5D-5L were used; "pre-COVID" Sept 2019-Feb 2020 (ED, N=5927; PC, N=317), "Wave-1" Mar 2020-Aug 2020 (ED, N=4781; PC, N=375), and "Wave-2" Sept 2020-Jan 2021 (ED, N=4443; PC, N=327). RESULTS: In the ED sample, there were decrements in mild-extreme problems of 3.7% in mobility and 4.1% in usual activities from pre-COVID to wave 2. There were very minor changes in mild-extreme problems in self-care (decrement=1.3%), pain/discomfort (decrement=2.6%), and anxiety/depression (decrement=0.9%). In the PC sample, there were increases of 4.8% in mild-extreme pain/discomfort and 10.7% in anxiety/depression from pre-COVID to wave 2. Despite these changes, HRQL of both samples pre-COVID and during waves 1 and 2 was worse than that of the general Alberta population. There were no significant variations in the impact of COVID-19 pandemic on HRQL across age, sex, and income subgroups in the ED survey; however, such variations were observed in the PC survey whereby younger adults, females, and those with high income had the largest HRQL deteriorations. CONCLUSION: The impact of COVID-19 pandemic on HRQL was minimal in adults seeking ED care, but more pronounced in those seen in PC, especially in terms of mental health. Policies around COVID-19 should take into account the needs of certain groups of the population, especially women and young people.

RéSUMé: OBJECTIFS: Examiner l'impact de la pandémie de COVID-19 sur la qualité de vie liée à la santé (QVLS) des adultes visitant les services d'urgence (SU) et les établissements de soins primaires (SP) en Alberta, au Canada, et déterminer si cet impact varie selon les sous-groupes démographiques. MéTHODES: Les données de deux enquêtes transversales répétées qui ont mesuré la QVL à l'aide de l'EQ-5D-5L ont été utilisées; « pré-COVID ¼ septembre 2019-février 2020 (SU, N=5 927; SP, N=317), « Vague-1 ¼ mars 2020-août 2020 (SU, N=4 781; SP, N=375) et « Vague-2 ¼ septembre 2020-janvier 2021 (SU, N=4 443; SP, N=327). RéSULTATS: Dans l'échantillon du SU, il y a eu des diminutions des problèmes légers à extrêmes de 3,7 % dans la mobilité et de 4,1 % dans les activités habituelles de la période pré-COVID à la vague 2. Il y a eu des changements très mineurs dans les problèmes légers à extrêmes dans les soins personnels (diminution = 1,3 %), douleur/gêne (diminution=2,6 %) et anxiété/dépression (diminution=0,9 %). Dans l'échantillon SP, il y a eu des augmentations de 4,8 % de la douleur/gêne légère à extrême et de 10,7 % de l'anxiété/de la dépression de la période pré-COVID à la vague 2. Malgré ces changements, la QVLS des deux échantillons avant la COVID et pendant les vagues 1 et 2 était pire que celle de la population générale de l'Alberta. Il n'y avait pas de variations significatives de l'impact de la pandémie de COVID-19 sur la QVLS selon l'âge, le sexe et les sous-groupes de revenu dans l'enquête SU; cependant, de telles variations ont été observées dans l'enquête SP, où les jeunes adultes, les femmes et les personnes à revenu élevé présentaient les plus fortes détériorations de la QVLS. CONCLUSION: L'impact de la pandémie de COVID-19 sur la QVLS était minime chez les adultes cherchant des SU, mais plus prononcé chez ceux observés dans le SP, en particulier en termes de santé mentale. Les politiques autour de COVID-19 devraient prendre en compte les besoins de certains groupes de la population, en particulier les femmes et les jeunes.

Self-reported health-related quality of life of the general population in Alberta, Canada during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has impacted various aspects of people's life and wellbeing around the world. This study aimed to examine the impact of the COVID-19 pandemic on health-related quality of life (HRQL), measured by the EQ-5D-5L, amongst the general population in the province of Alberta, Canada, and explore whether the impact varied across population subgroups based on age, gender, and dwelling. METHODS: Data came from two waves of a repeated cross-sectional population-based survey, the COVID-19 Experiences and Impact Survey, administered by the Health Quality Council of Alberta. The first data collection (survey 1: n = 8790) was during May/June 2020 and the second (survey 2: n = 9263) during Oct 2020. We examined the comparability of weighted survey data and their representativeness to Alberta's general population. We then explored between-survey differences in EQ-5D-5L index, EQ-VAS and dimension responses, and differences across subgroups within each survey. We compared HRQL of the pooled sample (survey 1&2) with the Alberta population norms data from the pre-pandemic period. RESULTS: Mean EQ-5D-5L index and EQ-VAS scores were 0.81 (0.15) and 72.54 (18.57), and 0.82 (0.14) and 71.98 (18.96) in surveys 1 and 2, respectively. The anxiety/depression dimension had the most reported problems (survey 1: 69.5%, survey 2: 70.2%). Respondents aged 16-24 or 75 and older, who identified themselves as a woman, or residing in urban areas had significantly lower EQ-5D-5L index scores compared to their counterparts in both surveys. Between-survey differences were not substantially different. Comparing the pooled sample with the pre-pandemic Alberta population norms, EQ-5D-5L index scores (0.82 vs. 0.84) and EQ-VAS scores (72.26 vs. 77.40) were significantly lower, and respondents aged 16-44, women, or urban residents were more impacted. More problems were reported in the anxiety/depression (69.9% vs. 37.2%) and usual activities dimensions (40.5% vs. 26.0%) during the pandemic period, especially for respondents aged 16-44, women, and those residing in urban areas. CONCLUSIONS: Lower HRQL was reported during the COVID-19 pandemic compared to pre-pandemic HRQL in this population, with anxiety/depression and usual activities affected the most. People who were younger, women, and residing in urban areas were most impacted. The government responses to COVID-19 policies during population outbreaks should consider the needs of Albertans in these particular groups.

Large variation in measures used to assess outcomes of opioid dependence treatment: A systematic review of longitudinal observational studies.

ISSUES: Treatment outcomes for drug users are critical for informing policy and therapeutic practice. The coherence of outcomes, changes and drug use measures from observational studies on opioid use treatment were reviewed. APPROACH: Systematic review of the literature for longitudinal observational studies, from 1980 through November 2015, in all languages, with data on treated opioid users, using Pubmed, the Cochrane Library and additional strategies (e.g. Pubmed function 'related citations' and checking reference lists of eligible studies). KEY FINDINGS: Twenty-seven studies were included (11 countries, 85 publications, recruitment 1962-2009). Baseline n was >65 686 and median follow-up 34.5 months (21 studies) or 51.4 person-months (10 studies). Eight outcome domains were identified: 'drug use' (21/27 studies), 'crime' (13), 'health' (13), 'treatment-related' outcomes (16), 'social functioning' (13), 'harms' (8), 'mortality' (13) and 'economic estimates' (2 studies). All studies using drug use outcomes included a binary (abstinence) category in at least one measure. Studies typically reported outcomes on less than half (on average 3.7 or 46%) of the eight outcome domains, while the average was 5.1 (64%) in seven studies initiated since 2000. IMPLICATIONS AND CONCLUSION: Wide variation exists in outcome measures found in longitudinal observational studies of treatment of opioid users. This reduces replicability of studies and suggests a lack of common expectations on treatment success. Future studies should consider using all or most of eight outcome domains identified (excluding economic analyses if unfeasible), non-binary measures and amount/value of drugs used and consensus meetings with joint ownership of scientific, treatment and patient communities.

New psychoactive substances: Current health-related practices and challenges in responding to use and harms in Europe.

BACKGROUND: The availability of new psychoactive substances (NPS) in Europe has rapidly increased over the last decade. Although prevalence levels of NPS use remain low in the general European population, there are serious concerns associated with more problematic forms of use and harms in particular populations and settings. It has thus become a priority to formulate and implement effective public health responses. However, considerable knowledge gaps remain on current practices as well as on the challenges and needs of European health professionals who are responding to use and harms caused by these substances. The aim of this study was to explore current health responses to NPS, and highlight key issues in order to inform planning and implementation of adequate responses. METHODS: This scoping study was based on a targeted multi-source data collection exercise focusing on the provision of health and drug interventions associated with NPS use and harms, in selected intervention settings across Europe. RESULTS: Findings revealed that in the absence of specific evidence, health professionals across most intervention settings rely primarily on acquired expertise with traditional drugs when addressing NPS-related harms. This study also identified a gap in the availability and access to timely and reliable information on NPS to users and health professionals. Health professionals in sexual health settings and custodial settings in contact with certain risk groups reported particular challenges in responding to NPS-related harms. CONCLUSION: Immediate investments are required in expanding substance identification capabilities, competence building among professionals and dissemination of risk information among relevant stakeholders. The risks of neglecting under-served risk populations and failure to address the information needs of health professionals and users on NPS harms in a context of rapid changing drug markets in Europe may have unforeseeable consequences at societal level.

The drug situation in Europe: an overview of data available on illicit drugs and new psychoactive substances from European monitoring in 2015.

AIM: A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015. METHODS: The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools. RESULTS: The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15-34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014. CONCLUSIONS: Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014.

Cost of disorders of the brain in Europe 2010.

BACKGROUND: The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people. AIMS: To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country. METHODS: The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010. RESULTS: The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US. DISCUSSION: This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges. RECOMMENDATIONS: Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.