Risk factors for leg ulceration in people who inject drugs: A cross-sectional study.

AIMS AND OBJECTIVES: The aim of this study was to assess, for the first time in a hard-to-reach population, the risk factors for leg ulceration among PWID, with the objective of making improvements to prevention and care. BACKGROUND: An estimated 4.8 million people globally inject drugs with potential for injecting-related harm. Skin and vein damage associated with drug injecting is increasing. Leg ulceration is a chronic condition which in the UK has a prevalence of 15% among people who have injected drugs (PWID) compared with 1% in the general population. Glasgow has the highest rate of problematic drug use in Scotland with approximately 13,900 individuals, about 50% of whom are thought to inject. However, the reasons for high prevalence of leg ulceration among PWID are unknown. To support improvements in prevention and care, the dearth of evidence around risk factors for leg ulceration in PWID needs to be addressed. DESIGN: A cross-sectional survey of 200 current and former injectors recruited from drug services in Glasgow, Scotland, to measure skin problems, leg ulceration and injecting habits is reported following STROBE guidelines. Logistic regression modelling examined whether demographics and injecting habits predicted leg ulceration. RESULTS: The likelihood of leg ulceration was increased for those who injected in the groin and the leg. Additionally, injecting in the groin and leg were associated with having a DVT. CONCLUSION: The primary risk factors for leg ulceration in PWID are injecting in the groin and the legs and these are clinically linked to deep vein thrombosis. Injecting into the femoral vein is increasingly common practice for PWID and healthcare practitioners should advise injectors of the increased risk of leg ulceration and DVT and discourage injecting into these areas.

Prevalence of skin problems and leg ulceration in a sample of young injecting drug users.

BACKGROUND: Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as 'soft tissue infection' are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. METHODS: Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. RESULTS: Two hundred participants were recruited, of which 74% (n = 148) were males and 26% (n = 52) were females. The age range was 21-44 years (mean 35 years). Just under two thirds (64%, n = 127) were currently injecting or had injected within the last 6 months, and 36% (n = 73) had previously injected and had not injected for more than 6 months.Sixty per cent (n = 120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n = 30) of all participants reported having had a leg ulcer. CONCLUSIONS: This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has long-term implications for drug users and services caring for current or former injectors long after illicit drug use has ceased.

Diversionary reframing of the Great Lakes Water Quality Agreement.

The United States and Canadian governments are undertaking a periodic review of the operation and effectiveness of the 1978 Great Lakes Water Quality Agreement through extended public meetings and conference calls. The stated purpose of the Agreement is to restore and maintain the chemical, physical and biological integrity of the waters of the Great Lakes Basin Ecosystem. For a variety of motives, several interest groups have represented the water quality agreement as being instead about maintaining and restoring ecosystem integrity for the entire Great Lakes basin. Through analysis of social, economic, political and diplomatic discourses, we have discovered and described these motives. The scientific evidence of continuing injury to health and property from trans-boundary pollution convinces us that this reframing is an unwarranted diversion from the original intent.

Cancer and construction: what occupational histories in a Canadian community reveal.

From 2000 to 2002, male patients at a Canadian cancer treatment center with new-incident head-and-neck or esophageal cancers were invited to participate in a population-based study. The study population included 87 cases and 172 controls. A lifetime-history questionnaire was administered. Odds ratios (ORs) were calculated for occupational groups with a minimum of five cases, adjusted for duration of employment, age, smoking, alcohol, education, and income. A significantly increased risk was shown for construction workers (OR = 2.20; 95% CI 1.25-3.91). This investigation of a set of rare cancers over a limited time period demonstrates the feasibility of this research approach. The increased risk among construction workers supports the need for more comprehensive study of exposures in this occupational group.

Education programmes preparing independent prescribers in Scotland: an evaluation.

BACKGROUND: Nurse prescribing (NP) is part of the modernisation of the health care workforce and contributes to patient care by improving access to quality services and medication, through utilisation of advanced professional skills. Nurses and midwives need to complete additional education in order to prescribe. This paper explores pedagogical issues relevant to professional training programmes. OBJECTIVES: To assess if programmes of education for nurse prescribing in Scotland were fit for purpose, from both the student and educator perspective with recommendations for future educational delivery. DESIGN: Data were collected using several methods: a questionnaire to all course members on prescribing programmes followed by focus-groups; and interviews with programme providers. RESULTS: Nurses and midwives training as prescribers work in a wide range of healthcare settings, in different geographic environments. They tended to be experienced, educated to degree level and most are over forty years of age. Most undertook the course to develop professionally and to improve patient care. Existing provision of education for prescribing is deemed appropriate and fit for purpose. The NP programme greatly enhances pharmacological knowledge building on existing clinical experience. The nature of these programmes works well and should be retained. However, whilst the educational programmes were centrally funded, less than half of students were provided with any allocated study time from their employers preventing nurses from maximising the gain from the educational preparation for prescribing. CONCLUSIONS: Nurse and midwife generic preparation for independent nurse prescribing in Scotland greatly increases professional expertise and is appropriate and fit for purpose. As other countries beyond Scotland and the UK seek to further progress nursing roles, learning from this controlled and structured development of prescribing underpinned by evidence could be of significant benefit.

Chemical exposures of women workers in the plastics industry with particular reference to breast cancer and reproductive hazards.

Despite concern about the harmful effects of substances contained in various plastic consumer products, little attention has focused on the more heavily exposed women working in the plastics industry. Through a review of the toxicology, industrial hygiene, and epidemiology literatures in conjunction with qualitative research, this article explores occupational exposures in producing plastics and health risks to workers, particularly women, who make up a large part of the workforce. The review demonstrates that workers are exposed to chemicals that have been identified as mammary carcinogens and endocrine disrupting chemicals, and that the work environment is heavily contaminated with dust and fumes. Consequently, plastics workers have a body burden that far exceeds that found in the general public. The nature of these exposures in the plastics industry places women at disproportionate risk, underlining the importance of gender. Measures for eliminating these exposures and the need for regulatory action are discussed.