Risk Factors for Suicide Reattempt among Adolescents and Young Adults: The Role of Psychiatric Disorders.

Suicidal behaviour among young people is a serious public health concern. Each suicide attempt is related to further suicide attempts and completed suicide. This study aims to explore risk factors associated with repeated suicide attempt among adolescents and young adults. The cohort included 510 patients aged 12-29 years residing in Piedmont Region in North-Western Italy, who had been admitted to hospital or emergency department with a diagnosis of suicide attempt between 2010 and 2020. Cox regression models were used to evaluate potential risk factors for repeated suicide attempt. During the 11-years follow-up, 20.6% of adolescents and young adults repeated suicide attempt, 24.8% of females and 12.3% of males. Nearly 90% of youth who attempted suicide had a diagnosis of psychiatric disorder. After adjustment, younger age of onset of suicidal behaviour, and diagnosis of schizophrenia, bipolar disorder, depressive disorder, anorexia nervosa and personality disorder were significantly associated with repeated suicide attempt. The early identification of patients at higher risk of repetition of suicidal behaviour is of crucial importance. Better understanding of risk factors and effective treatment of mental disorders could help suicide prevention to reduce the burden of the problem among young people. Special attention should be paid during the initial months following discharge from hospital or emergency department, when suicide reattempt risk is very high.

Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy.

PURPOSE: Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS: The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS: During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS: The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.

Does parental permissiveness toward cigarette smoking and alcohol use influence illicit drug use among adolescents? A longitudinal study in seven European countries.

PURPOSE: Adolescents' perceptions of parental norms may influence their substance use. The relationship between parental norms toward cigarette and alcohol use, and the use of illicit substances among their adolescent children is not sufficiently investigated. The purpose of this study was to analyze this relationship, including gender differences, using longitudinal data from a large population-based study. METHODS: The present study analyzed longitudinal data from 3171 12- to 14-year-old students in 7 European countries allocated to the control arm of the European Drug Addiction Prevention trial. The impact of parental permissiveness toward cigarettes and alcohol use reported by the students at baseline on illicit drug use at 6-month follow-up was analyzed through multilevel logistic regression models, stratified by gender. Whether adolescents' own use of cigarette and alcohol mediated the association between parental norms and illicit drug use was tested through mediation models. RESULTS: Parental permissive norms toward cigarette smoking and alcohol use at baseline predicted adolescents' illicit drug use at follow-up. The association was stronger among boys than among girls and was mediated by adolescents' own cigarette and alcohol use. CONCLUSION: Perceived parental permissiveness toward the use of legal drugs predicted adolescents' use of illicit drugs, especially among boys. Parents should be made aware of the importance of norm setting, and supported in conveying clear messages of disapproval of all substances.

Correlates of alcohol experimentation and drunkenness episodes among secondary-school students in Nigeria.

Background: Alcohol is the most used substance among adolescents in Nigeria. While risk factors for alcohol use among adolescents are well documented in Europe and the US, they have received less attention in the literature on African countries. This study aimed to investigate the factors associated with alcohol experimentation and drunkenness episodes in a national sample of Nigerian adolescents. Methods: A total sample of 4,078 secondary-school students participated in the survey during the school year 2015-2016. The survey involved 32 secondary schools of six geopolitical zones (South-South, South-West, South-East, North-Center, North-West, and North-East) and two metropolitan cities (Abuja and Lagos) of Nigeria. Sociodemographic characteristics, parental alcohol use and permissiveness, friends' alcohol use, risk perceptions and beliefs were investigated as correlates of alcohol experimentation and drunkenness episodes through multilevel, mixed-effect logistic regression models. Results: The prevalence of alcohol experimentation was 34.0%, while the prevalence of drunkenness episodes was 13.4%. Results showed that male gender, family structure different from both parents' families, parental and friends' alcohol use, parental permissiveness to drink, low risk perceptions on drinking alcohol, and positive beliefs on consequences of alcohol use were associated with an increased probability of alcohol experimentation and drunkenness episodes. Family affluence and one-parent family structure were related to an increased probability of alcohol experimentation but not of drunkenness episodes. Conclusions: The majority of risk factors analyzed in this study generalize across drinking-behavior outcomes. Since the young population is dominant in Nigeria, alcohol use could become a big public health problem in the near future. High investment in adolescents' well-being by addressing the factors that contribute to drinking behavior might help to reduce the burden of the problem. Evidence-based prevention curriculum addressing knowledge, risk perceptions, beliefs on consequences of alcohol use, and parental behaviors should be implemented as widely and early as possible.

Do the socioeconomic context and the European geographical area modify parental influences on smoking experimentation among adolescents?

Adolescent smoking is a major public health problem. While the socioeconomic status (SES) of the neighbourhood and that of the family are known to play a role in smoking onset and progression, it is not clear whether it modifies the association between parental influences and adolescent behaviour. The purpose of this study is to investigate family correlates of adolescent smoking experimentation and to explore the modifying role of socioeconomic context and European geographical area in a sample of European adolescents. This is a secondary analysis of the baseline survey of the European Drug Addiction Prevention (EU-Dap) trial which took place in seven European countries and involved 7079 students. School SES was used as indicator of socioeconomic context. European countries were aggregated in two geographical areas: North-Central and South. The associations between parental, family factors, and adolescents smoking experimentation were analysed through multilevel mixed-effect logistic regression models, stratified by school SES and European geographical area. Parental smoking, permissiveness towards tobacco, family conflicts, problematic relationships, low connectedness, and low parental control were significantly associated with adolescent smoking experimentation. Paternal smoking was a stronger correlate of adolescent smoking in low SES schools, while maternal smoking in high SES schools. Parental permissiveness was a stronger correlate in low SES schools. Family conflicts and low parental control were correlates only in low SES schools. The associations did not substantially differ between European geographical areas, with the exception of parental smoking that was a stronger correlate in the North, and parental control that was a correlate only in the South of Europe. To reduce inequalities in tobacco-related outcomes, prevention efforts in low socioeconomic contexts appear to be a public health priority. Parental smoking, permissiveness, family relationships, and connectedness should be addressed in preventive programs.

Psychopathology of addiction: May a SCL-90-based five dimensions structure be applied irrespectively of the involved drug?

BACKGROUND: We previously found a five cluster of psychological symptoms in heroin use disorder (HUD) patients: 'worthlessness-being trapped', 'somatic-symptoms', 'sensitivity-psychoticism', 'panic-anxiety', and 'violence-suicide'. We demonstrated that this aggregation is independent of the chosen treatment, of intoxication status and of the presence of psychiatric problems. METHODS: 2314 Subjects, with alcohol, heroin or cocaine dependence were assigned to one of the five clusters. Differences between patients dependent on alcohol, heroin and cocaine in the frequency of the five clusters and in their severity were analysed. The association between the secondary abuse of alcohol and cocaine and the five clusters was also considered in the subsample of HUD patients. RESULTS: We confirmed a positive association of the 'somatic symptoms' dimension with the condition of heroin versus cocaine dependence and of the 'sensitivity-psychoticism' dimension with the condition of alcohol versus heroin dependence. 'Somatic symptoms' and 'panic anxiety' successfully discriminated between patients as being alcohol, heroin or cocaine dependents. Looking at the subsample of heroin dependents, no significant differences were observed. CONCLUSIONS: The available evidence coming from our results, taken as a whole, seems to support the extension of the psychopathological structure previously observed in opioid addicts to the population of alcohol and cocaine dependents.

The impact of psychopathological subtypes on retention rate of patients with substance use disorder entering residential therapeutic community treatment.

BACKGROUND: A specific psychopathology of addiction has been proposed and described using the self-report symptom inventory (SCL-90), leading to a 5-factor aggregation of psychological/psychiatric symptoms: 'worthlessness and being trapped', 'somatic symptoms', 'sensitivity-psychoticism', 'panic-anxiety' and 'violence-suicide' in various populations of patients with heroin use disorder (HUD) and other substance use disorders (SUDs). These clusters of symptoms, according to studies that have highlighted the role of possible confounding factors (such as demographic and clinical characteristics, active heroin use, lifetime psychiatric problems and kind of treatment received by the patients), seem to constitute a trait rather than a state of the psychological structure of addiction. These five psychopathological dimensions defined on the basis of SCL-90 categories have also been shown to be correlated with the outcomes of a variety of agonist opioid treatments. The present study aims to test whether the 5-factor psychopathological model of addiction correlates with the outcome (retention rate) of patients with SUDs entering a therapeutic community (TC) treatment. METHODS: 2016 subjects with alcohol, heroin or cocaine dependence were assigned to one of the five clusters on the basis of the highest SCL-90 factor score shown. Retention in treatment was analysed by means of the survival analysis and Wilcoxon statistics for comparison between the survival curves. The associations between the psychopathological subtypes defined by SCL-90 categories and length of retention in treatment, after taking into account substance of abuse and other sociodemographic and clinical variables, were summarized using Cox regression. RESULTS: Patients with cocaine use disorder (CUD) showed poorer outcomes than those with heroin dependence (HUD). Prominent symptoms of "worthlessness-being trapped" lead to a longer retention in treatment than in the case of the other four prominent psychopathological groups. At the multivariate level, age, detoxified status and total number of psychopathological symptoms proved to influence outcome negatively, especially in CUD. Somatic symptoms and violence-suicide symptoms turned out to correlate with dropout from residential treatment. CONCLUSIONS: The SCL-90 5-factor dimensions can be appropriately used as a prognostic tool for drug-dependent subjects entering a residential treatment.

Gender Differences in Heroin Addiction and Treatment: Results from the VEdeTTE Cohort.

BACKGROUND: Gender differences strongly affect heroin addiction, from risk factors to patterns of consumption, access to treatments, and outcomes. OBJECTIVES: To investigate gender differences in the VEdeTTE cohort of heroin addicts. METHODS: VEdeTTE is a cohort of 10,454 heroin users enrolled between 1998 and 2001 in 115 public drug treatment centres in Italy. Clinical and personal information were collected at intake through a structured interview. Treatments were recorded using a standardized form. Gender differences were explored with regard to characteristics at intake, treatments, and retention in methadone maintenance and therapeutic community. Cox Proportional models were carried out to identify risk factors for treatment abandon. RESULTS: Compared with men, at their first access to treatment women with drug addiction were younger, more frequently married, legally separated, divorced or widow, unemployed though better educated, HIV+; more frequently they lived with their partner and sons. They reported a higher use of sedatives, but a lower use of alcohol; more frequently they had psychiatric comorbidity, including depression, self-injuries, and suicide attempts. Psychotherapy was more frequently prescribed to women, pharmacological treatments to men. Methadone maintenance was less frequently abandoned by women. Drug abuse severity factors predicted abandon of methadone among women. High methadone doses and the combination with psychotherapy improved treatment retention in both genders. Low education level and severity factors among women and young age among men predicted abandon of therapeutic community. CONCLUSIONS: Gender differences in the VEdeTTE cohort suggest the need of a gender sensitive approach to improve treatment outcomes among heroin addicts.

Psychopathological symptoms of patients with heroin addiction entering opioid agonist or therapeutic community treatment.

BACKGROUND: The relationship between substance use disorders and psychiatric pathology is still an open question. The main aim of the present study was to verify whether the five psychopathological dimensions identified through the SCL-90 tool in a previous study carried out on patients with heroin addiction entering an outpatient opioid agonist treatment (OAT) were also observable in those entering a residential treatment community (TC). Further aims were to look at differences in the psychopathological profiles of patients entering a TC versus an OAT treatment and at the correlation between gender and the observed psychopathology. METHODS: A confirmatory factor analysis was performed on the results of SCL-90 filled by 1,195 patients with heroin dependence entering TC treatment. It replicates the extraction method previously used on 1,055 OAT patients with heroin addiction by using a principal component factor analysis (PCA). The association between the kind of treatment received (TC or OAT), gender, and the psychopathological dimensions was assessed through logistic regression and general linear model (GLM) analysis. RESULTS: The PCA carried out on the SCL-90 results of patients entering a TC yielded a five-factor solution, confirming the same dimensions observed in patients entering an OAT: 'worthlessness and being trapped', 'somatization', 'sensitivity-psychoticism', 'panic anxiety', and 'violence-suicide'. The logistic regression analysis showed a statistically significant association between 'somatization' and 'violence-suicide' severity score and OAT. GLM analysis showed that psychopathological factorial scores for 'worthlessness-being trapped', 'somatic symptoms', and 'panic anxiety' dimensions were more severe in OAT vs TC male patients and in TC vs OAT female ones. 'Violence suicide' followed the same severity pattern for males, but did not differ in TC vs OAT females, while 'sensitivity-psychoticism' did not differ in OAT vs TC patients. The five dimensions did not differ in OAT males vs females. CONCLUSIONS: Our research appears to confirm the existence of a specific aggregation of psychological/psychiatric features within the category of individuals with heroin addiction. It also shows a correlation between the dominant psychopathological subgroup and the assignment to TC versus OAT. Further research is needed to clarify the differences between the five psychopathological subgroups and their determinants.

"Unplugged," a European school-based program for substance use prevention among adolescents: overview of results from the EU-Dap trial.

The EU-Dap study aimed to develop and evaluate a school-based curriculum for the prevention of substance use among young people. The school curriculum, "Unplugged," is based on social influence approach and addresses social and personal skills, knowledge, and normative beliefs. It consists of 12 one-hour interactive sessions delivered by teachers. Its effectiveness was evaluated through a randomized trial involving 7,079 pupils of seven European countries. Unplugged was effective in reducing cigarette smoking, episodes of drunkenness, and the use of cannabis at short term. This association, however, was confined to boys, with age and self-esteem as possible explanations of this difference. Beneficial effects associated with the program persisted at fifteen-month follow-up for drunkenness, alcohol-related problems, and cannabis use, and were stronger among adolescents in schools of average low socioeconomic level. These results are of scientific importance and may inform the adoption of effective public health interventions at population level.

Tranexamic acid for reducing blood transfusions in arthroplasty interventions: a cost-effective practice.

BACKGROUND: Tranexamic acid (TXA) administered during arthroplasty intervention can prevent blood loss and blood transfusions. The purpose of the present study is to evaluate the benefit of TXA administration on blood transfusion rates in patients undergoing joint arthroplasty, and to perform cost-benefit analysis. METHODS: The study population included 100 patients admitted for arthroplasty intervention between 1st June 2008 and 31st October 2008 who did not receive TXA, and 98 patients admitted between 1st June 2009 and 31st October 2009 receiving TXA during the intervention. Blood transfusion was the main outcome. Risk factors for transfusion were evaluated in logistic regression models. Costs of autologous blood donation, TXA administration, autotransfusion and homologous blood transfusion were used to perform a cost-benefit evaluation. RESULTS: In the multivariate adjusted analysis, high preoperative haemoglobin level and TXA administration were significantly associated with a reduced risk of transfusion. Seventy-five percent of patients not receiving TXA required at least one transfusion versus 40.8% of patients receiving TXA, with a reduction of 45.6%. The mean number of blood units transfused was reduced of 26%. The reduction in transfusions was higher in hip arthroplasty. Among patients receiving TXA, the reduction in Hb level was lower both at days 1 and 2 after the intervention. The mean saving related to TXA administration was of 138 per patient. CONCLUSIONS: The administration of TXA during arthroplasty intervention reduces the need of transfusion among patients undertaking arthroplasty interventions and can be considered a cost-effective practice for the National Health System.

Evaluation of Effectiveness of the Unplugged Program on Gambling Behaviours among Adolescents: Study Protocol of the Experimental Controlled Study "GAPUnplugged".

Gambling risk behaviour is an emerging problem among adolescents. "Unplugged" is an effective Social Influence curriculum for preventing substance use among students. This study aims to develop and test a new component focused on gambling added to the Unplugged program. Schools of Piedmont region and Rome city were invited to participate in the study. A self-completed anonymous questionnaire including questions on socio-demographic characteristics, addictive behaviours, beliefs, attitudes and risk perceptions about gambling, normative perceptions, parental practices, school climate, refusal skills, impulsiveness, self-esteem, antisocial behaviours and sensation seeking was prepared for baseline and follow-up surveys. The protocol of the study was submitted and approved by the Novara Ethical Committee and registered in ClinicalTrials.gov (NCT05630157, Protocol ID: 080.742, 11/17/2022). Twenty-nine schools accepted to participate in the study. Sixty-three classes (1325 students) satisfied the eligibility criteria for intervention and were allocated to the intervention arm, and the other 61 (1269 students) were allocated to the control arm. Because of drop-out, absentees, refusals, and invalid questionnaires, data on 1874 students (998 in the intervention and 876 in the control arm), were available for the analysis at baseline. Data management of follow-up questionnaires is in progress. Results of the present study will be useful to clarify the effectiveness of prevention interventions in reducing gambling behaviours among adolescents. Moreover, this will be the first experience of evaluating a new component focused on a different risk behaviour, added to a curriculum previously shown as effective on other risk behaviours.

Exposure to aircraft and road traffic noise and associations with heart disease and stroke in six European countries: a cross-sectional study.

BACKGROUND: Although a number of studies have found an association between aircraft noise and hypertension, there is a lack of evidence on associations with other cardiovascular disease. For road traffic noise, more studies are available but the extent of possible confounding by air pollution has not been established. METHODS: This study used data from the Hypertension and Environmental Noise near Airports (HYENA) study. Cross-sectional associations between self-reported 'heart disease and stroke' and aircraft noise and road traffic noise were examined using data collected between 2004 and 2006 on 4712 participants (276 cases), who lived near airports in six European countries (UK, Germany, Netherlands, Sweden, Greece, Italy). Data were available to assess potential confounding by NO2 air pollution in a subsample of three countries (UK, Netherlands, Sweden). RESULTS: An association between night-time average aircraft noise and 'heart disease and stroke' was found after adjustment for socio-demographic confounders for participants who had lived in the same place for ≥ 20 years (odds ratio (OR): 1.25 (95% confidence interval (CI) 1.03, 1.51) per 10 dB (A)); this association was robust to adjustment for exposure to air pollution in the subsample. 24 hour average road traffic noise exposure was associated with 'heart disease and stroke' (OR: 1.19 (95% CI 1.00, 1.41), but adjustment for air pollution in the subsample suggested this may have been due to confounding by air pollution. Statistical assessment (correlations and variance inflation factor) suggested only modest collinearity between noise and NO2 exposures. CONCLUSIONS: Exposure to aircraft noise over many years may increase risks of heart disease and stroke, although more studies are needed to establish how much the risks associated with road traffic noise may be explained by air pollution.

Methods for synthesizing findings on moderation effects across multiple randomized trials.

This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy.

BACKGROUND: Suicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population. METHOD: The cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age. RESULTS: During the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age. CONCLUSIONS: Patients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.

Personality disorders among patients accessing alcohol detoxification treatment: prevalence and gender differences.

BACKGROUND: Alcohol abuse and dependence are frequently associated with psychiatric disorders and personality disorders (PDs) with differences among gender. However, only few studies investigated gender differences in PDs among alcoholics. The aim of this study was to investigate PDs in a sample of patients accessing inpatient alcohol detoxification treatment and to describe gender differences in prevalence and comorbidity of PDs. METHODS: The study population consisted of 206 patients entering alcohol detoxification treatment in a specialized clinic in Italy. At enrollment, patients filled in the Millon Clinical Multiaxial Inventory-III for the assessment of PDs. RESULTS: The sample consisted of 150 males and 56 females. Twenty-five percent of males vs 12.5% of females had 1 PD; 16% vs 23%, 2 PDs; and 46% vs 48%, more than 3 PDs. A statistically significant higher proportion of females got high scores on avoidant (21.4% vs 9.3%), self-defeating (50.0% vs 24.0%), and borderline scales (42.9% vs 25.3%). Depressive, self-defeating, and borderline PDs were frequently associated both to other PDs and among each other, particularly among females. CONCLUSIONS: Borderline PD is confirmed to be more frequent among females than among males accessing alcohol detoxification treatment. More studies are needed to clarify prevalence and associations of PDs, prognosis, and gender differences in alcoholics patients.

Exposure modifiers of the relationships of transportation noise with high blood pressure and noise annoyance.

In the cross-sectional hypertension and exposure to noise near airports study the relationship between road traffic noise, aircraft noise and hypertension and annoyance was investigated. The data collection comprised a variety of potentially exposure modifying factors, including type of housing, location of rooms, window opening habits, use of noise-reducing remedies, shielding due to obstacles, lengths of exposure. In the present paper the quantitative role of these factors on the relationship between road and aircraft noise exposure and outcomes was analyzed. Multiple logistic and linear regression models were calculated including these co-factors and related interaction terms with noise indicators, as well as stratified analyses. Type of housing, length of residence, location of rooms and the use of noise reducing remedies modified the relationship between noise and hypertension. However, the effects were not always in the direction of a stronger association in higher exposed subjects. Regarding annoyance, type of housing, location of rooms, noise barriers, window opening habits, noise insulation, the use of noise reducing remedies, hours spent at home during daytime were significant effect modifiers. The use of noise-reducing remedies turned out to be indicators of perceived noise disturbance rather than modifiers reducing the annoyance.

[Gamma-hydroxybutyrate (GHB) for mid/long term treatment of alcohol dependence: a systematic review]. / Il gamma-idrossibutirrato (GHB) nel trattamento a medio/lungo termine della dipendenza da alcol: una revisione sistematica.

AIM: Gamma-hydroxybutyric acid (GHB) is used to treat alcohol withdrawal syndrome (AWS) at short term, and to reduce alcohol relapses among alcohol dependent subjects at mid-term. The objective of this paper is to synthesize results of a Cochrane review on efficacy of GHB for treating alcohol dependence at mid-term. METHODS: The search strategy was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL and on the Cochrane Library. Pharmaceutical companies were contacted and references of papers were checked in order to identify unpublished studies. Randomized controlled trials (RCT), clinical controlled trials (CCT), and controlled prospective studies (CPS) were considered. Three authors blindly evaluated the quality of the studies and extracted the data. RESULTS: Seven RCT studies evaluating efficacy of GHB for treating alcohol dependence at mid-term were included in the review; all were conducted in Italy. GHB appears to be more effective than placebo on alcohol abstinence (RR 2.63; 1.22-5.71), controlled drinking (RR 2.43; 1.07-5.54), relapses to heavy drinking (RR 0.37; 0.21-0.63), and number of daily drinks (MD -4.60; -6.18,-3.02). GHB appears to be more effective than naltrexone on alcohol abstinence (RR 1.78; 1.21-2.62) but not on other outcomes. The effect on Alcohol Craving Scale favours GHB vs placebo (MD -4.50; -5.81,-3.19), vs naltrexone (MD -1.90; -2.45,-1.35) and vs disulfiram (MD -1.40; -1.86,-0.94). Side effects are similar to naltrexone and disulfiram. DISCUSSION: The low number of available studies, the low sample size and the low quality of the included studies limit the validity of the results and suggest the need of conducting new high-quality randomized trials with appropriate sample size.

Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study.

OBJECTIVES: Studies on the health effects of aircraft and road traffic noise exposure suggest excess risks of hypertension, cardiovascular disease and the use of sedatives and hypnotics. Our aim was to assess the use of medication in relation to noise from aircraft and road traffic. METHODS: This cross-sectional study measured the use of prescribed antihypertensives, antacids, anxiolytics, hypnotics, antidepressants and antasthmatics in 4,861 persons living near seven airports in six European countries (UK, Germany, the Netherlands, Sweden, Italy, and Greece). Exposure was assessed using models with 1 dB resolution (5 dB for UK road traffic noise) and spatial resolution of 250×250 m for aircraft and 10×10 m for road traffic noise. Data were analysed using multilevel logistic regression, adjusting for potential confounders. RESULTS: We found marked differences between countries in the effect of aircraft noise on antihypertensive use; for night-time aircraft noise, a 10 dB increase in exposure was associated with ORs of 1.34 (95% CI 1.14 to 1.57) for the UK and 1.19 (1.02 to 1.38) for the Netherlands but no significant associations were found for other countries. For day-time aircraft noise, excess risks were found for the UK (OR 1.35; CI: 1.13 to 1.60) but a risk deficit for Italy (OR 0.82; CI: 0.71 to 0.96). There was an excess risk of taking anxiolytic medication in relation to aircraft noise (OR 1.28; CI: 1.04 to 1.57 for daytime and OR 1.27; CI: 1.01 to 1.59 for night-time) which held across countries. We also found an association between exposure to 24hr road traffic noise and the use of antacids by men (OR 1.39; CI 1.11 to 1.74). CONCLUSION: Our results suggest an effect of aircraft noise on the use of antihypertensive medication, but this effect did not hold for all countries. Results were more consistent across countries for the increased use of anxiolytics in relation to aircraft noise.

Effects of the "Unplugged" school-based substance use prevention program in Nigeria: A cluster randomized controlled trial.

BACKGROUND: School-based programs are the most convenient interventions to tackle substance use among youth. "Unplugged" is a Social Influence universal school curriculum developed and tested in the "EU-Dap" project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of "Unplugged" was evaluated through a cluster randomized controlled trial. METHODS: The program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14.2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effect on alcohol use. RESULTS: Unplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use. CONCLUSIONS: Unplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported.