Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach

Background Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites—commonly known as safe injection facilities—in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health. Methods We developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood. Results In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site’s services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered. Conclusions Mathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.

Predicting the Impact of Placing an Overdose Prevention Site in Philadelphia: A Mathematical Modeling Approach

Background: Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites - commonly known as safe injection facilities - in proximity of locations with the highest rates of overdose. As urban centers in the United States are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to present compelling evidence of impact and safety. Methods: We developed a mathematical model to describe the movement of opioid users to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia, and ran simulations to describe the effect of placing a site in the Kensington neighborhood.Results: In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in disproportionate benefits for white users. Simulations also predict that direct effects from overdose reversal in the overdose prevention site are small (about 6 fewer fatalities per year per 30 spots at the overdose prevention site without other effects). However, fatalities and nonfatal overdoses are predicted to decrease substantially when indirect effects from site safety and education of users are considered. Conclusions: Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an opioid prevention site in a particular location. To fully understand the impact of site placement, it is recommended to include both direct and indirect effects in analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact.

Effects of pollution on adolescent mental health: a systematic review protocol

Background Whilst there is little uncertainty about the deleterious impact of pollution on human and planetary health, pollution’s impact on adolescent mental health is less well understood. This is particularly true for young people in underdeveloped and developing world contexts, about whom research is generally lacking. Furthermore, although adolescent resilience continues to be a research priority, little attention has been paid to adolescent pathways of resilience in the face or aftermath of pollution exposure. The objective of this study will be to examine the associations between pollution and mental health in 10- to 24-year-olds (i.e. adolescents). Methods We designed and registered a study protocol for a systematic review of studies which link pollution and mental health in adolescents. We will include observational studies (e.g. cohort, case-control, time series analyses) that assess the associations between exposure to any form of pollution and the mental health of 10- to 24-year-olds. The primary outcome will be symptoms associated with neurodevelopmental disorders; disruptive, impulse-control, and conduct disorders; depressive disorders; anxiety disorders; substance disorders; and schizophrenia. No secondary outcomes will be considered. Literature searches will be conducted in multiple electronic databases (from inception onwards), including PubMed, MEDLINE, SCOPUS, Web of Science, CINAHL, PsycINFO, SciELO, ERIC, and Africa-Wide. Two investigators will independently screen all citations, full-text articles, and abstract data. The methodological quality (or bias) of included studies will be appraised using appropriate tools. We will provide a narrative synthesis of the evidence. Discussion This systematic review will evaluate the evidence on the associations between pollution and the mental health of 10- to 24-year-olds. Our findings will be of potential interest to multiple audiences (including adolescent patients/clients, their families, caregivers, healthcare professionals, scientists, and policy makers) and could be used to develop prevention and intervention strategies as well as focus future research. Results will be published in a peer-reviewed journal. Systematic review registration PROSPERO CRD42020176664

Psychological morbidity among adults with cerebral palsy and spina bifida

Background Very little is known about the risk of developing psychological morbidities among adults living with cerebral palsy (CP) or spina bifida (SB). The objective of this study was to compare the incidence of and adjusted hazards for psychological morbidities among adults with and without CP or SB. Methods Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnostic code for CP or SB (n = 15 302). Adults without CP or SB were also included (n = 1 935 480). Incidence estimates of common psychological morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Results Adults living with CP or SB had a higher 4-year incidence of any psychological morbidity (38.8% v. 24.2%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for any psychological morbidity [hazard ratio (HR): 1.60; 95% CI 1.55–1.65], and all but one psychological disorder (alcohol-related disorders), and ranged from HR: 1.32 (1.23, 1.42) for substance disorders, to HR: 4.12 (3.24, 5.25) for impulse control disorders. Conclusions Adults with CP or SB have a significantly higher incidence of and risk for common psychological morbidities, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce the risk of disease onset/progression in these higher-risk populations.

Headache associated with systemic infection, intoxication, or metabolic derangement

This chapter discusses headaches attributed to exposure to a substance, disorders of homeostasis, high altitude, airplane travel, diving, sleep apnoea, dialysis, cardiac cephalalgia, hypertension, metabolic derangement, and systemic infection.

Sociological and Psychological Factors on Prohibited Substances Abuse in Rehabilitation Centre of Medan City, Indonesia

INTRODUCTION: Prohibited substances issue and their abuse have become a scourge for people in Indonesia. This situation creates concern for every level of society since this is very influential to damage and can even eliminate generations at a later time. AIM: This study aims to determine the characteristics of age, education, psychological and social problems related to substance dependence experienced by individuals with substance disorders who undergo rehabilitation in Medan, Indonesia. METHODS: This study is a cross-sectional analytic, in which the sample of this study was individuals who underwent rehabilitation in the Rehabilitation Center in Medan City who fulfilled the inclusion and exclusion criteria. A structured interview was carried out with the MINI ICD-10 on part M. disorders related to psychoactive substances. Furthermore, to see the level of dependence, WHO ASSIST questionnaire (The Alcohol, Smoking and Substance Involvement Screening Test) was used. RESULTS: This study discovered that subjects with age above 21 years were the most dominant of the prohibited substance users group as many as 87 people (69%), Batak tribe with 73 people (57.9%), residence originating from outside the city with 70 people (55.6%), Unmarried with 87 people (70.2%), education level is medium (junior high school) with 117 people (92.9%) and work as many as 77 people (61.1%). The study also found that the most dominant number of prohibited substances users were single users of methamphetamine and a combination of two substances, each of which was 49 people (38.9%). There is no relationship between social factors and patterns of prohibited substance use. Also, the most dominant users of prohibited substances who undergo rehabilitation are those based on family and police (involuntary admission). Finally, as many as 70 people used methamphetamine require intensive intervention. CONCLUSION: This study shows that social and demographic factors are not related to the pattern of prohibited substance use.

The Mental Health of Young Canadians Who Are Not Working or in School

Objective: Recent studies suggest that youth who have a mental health problem are more likely to be NEET—not in education, employment, or training—but findings remain mixed, and evidence from Canada is limited. We examined this association across a range of mental and substance disorders in a representative sample of Canadian youth. Method: Data were from the 2012 Canadian Community Health Survey–Mental Health ( n = 5622; ages 15-29). The survey identified past-year mental (depression, bipolar, generalized anxiety) and substance (alcohol, cannabis, other drugs) disorders from a structured interview and included questions on suicidal ideation. We classified as NEET respondents who were not in school or employed in the past week. Logistic regression models tested the associations between mental and substance disorders and NEET status, adjusted for sociodemographic, health, and geographic variables. Results: About 10% of youth were NEET. Being NEET was associated with past-year depression (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.06 to 2.63); bipolar (OR = 2.31; 95% CI, 0.98 to 5.45), generalized anxiety (OR = 2.65; 95% CI, 1.37 to 5.12), and drug use (OR = 3.22; 95% CI, 1.33 to 7.76) disorders; and suicidal ideation (OR = 1.75; 95% CI, 0.99 to 3.09) but was not associated with alcohol (OR = 1.03; 95% CI, 0.63 to 1.69) or cannabis (OR = 0.97; 95% CI, 0.47 to 2.00) disorders. Conclusions: Poor mental health was associated with being NEET in Canadian youth. Efforts targeting NEET should include provisions for mental health. Moreover, youth mental health initiatives should consider educational and employment outcomes. Further longitudinal and intervention studies are warranted.

Multiple substance use among patients attending treatment for substance-related problems in Switzerland

Purpose The purpose of this paper is to estimate the share of multiple substance disorders among clients entering treatment for substance-related problems, to identify the most frequent combinations of the substances involved and to investigate the profiles of the clients involved. Design/methodology/approach Data were taken from the Swiss treatment monitoring system act-info applied among inpatient and outpatient facilities (reporting years 2013–2015). All cases with information on multiple substance disorders, according to a definition close to the diagnosis F19 from the ICD-10 classification of disease were included. The measurements comprised designated primary substance, existing multiple substance use disorder, substances involved and basic socio-demographics. Findings From 10,009 clients included in the study, 1,653 (16.5 per cent) were reported as having multiple substance use disorders. A great variety of substance combinations was identified and alcohol was found in the majority of them. Practical implications Treatment strategies targeting accurately substance-related disorders as a whole complex should be promoted. In particular the alcohol-related aspect of the disorder should not be neglected when the focus is on illegal drugs. Originality/value Multiple substance use was until recently not sufficiently documented in treatment monitoring systems. A recent version of the European treatment demand indicator (TDI) has introduced the notion of “polydrug use problem” as complementary information to the primary substance, which remains the key variable for reporting treatment demand. This study represents a first attempt to explore systematically this new data.

Mental disorders among college students in the World Health Organization World Mental Health Surveys

BackgroundAlthough mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years.MethodThe World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18–22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI).ResultsOne-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders; 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders.ConclusionsMental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.