CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Kidneys are vulnerable to chemical agent-induced injuries. Children (neonates and infants) are a particular at risk age group because they have renal functions less developed than that of adults. The exposure of children to medicines considered to be nephrotoxic agents - namely the aminoglycosides, nonsteroidal anti-inflammatory drugs (NSAID) and angiotensin converting enzyme (ACE) inhibitory drugs - should be avoided whenever possible. Hospitalized children are pointed out to be the group at greatest risk of nephrotoxicity due to their high level of exposure to these medicines as well as the frequent and improper use of non standardized medicines in this age range. To determine the prevalence of use of potentially-nephrotoxic drugs (PND) and the frequency of concomitant risk factors in hospitalized children younger than 2 years old in a medical ward in a pediatric hospital in Fortaleza, Brazil. A prospective, observational, follow-up study was developed. All children younger than 2 years old admitted to the general ward were included and followed-up. Sociodemographic data, pathological and pharmacotherapeutic antecedents were recorded, as well as information about the use of drugs and the attendance of risk factors for nephrotoxicity associated with aminoglycosides, NSAID and ACE inhibitors. Also, the occurrence of adverse events was identified. Data was taken from medical records and interviews with the mothers of the children. Statistical analysis involved cumulative frequency, cumulative percentage, central tendency measures, Student âtâ test and ANOVA. During the study period (September/2005 to March/2006), 120 admissions were recorded. Three patients were excluded because of incomplete data. The results represented 117 admissions that affected 103 different children. The prevalence of the use of PND was 96,6%. A total of 1065 drugs were used, 69% with potential intrinsic nephrotoxicity based on available literature. The mean number of PND used was 6,3  4,0 per patient. The PND most frequently used were: metamizole (10,1%), ranitidine (6,2%) and prednisone (5,1%). Around 18% of children used aminoglycosides, 65,8% and 4,3% had taken NSAID and ACE inhibitory drugs respectively. A total of 368 risk factors for nephrotoxicity were detected (3,5Â1,8 risk factors/patient). The most frequent factors were: the use of at least one PND (30,7%), the use of 2 or more PND (28,3%) and the use of NSAID concomitantly with that of potassium-rich salt substitutes(10%).The PND use was considered high when compared with published data from this studied age group. The frequency of risk factors for nephrotoxicity also reached considerable levels. It would be important to know if there exist safer therapeutic alternatives and what preventative measures could be adopted in each case. The contribution of a clinical pharmacist to a safe pharmacotherapy for hospitalized children would be a strategy for reducing PND-associated risk. / Os rins sÃo bastante vulnerÃveis a danos produzidos por agentes quÃmicos. Dentre as substÃncias nefrotÃxicas estÃo os medicamentos, os quais merecem destaque devido à ampla exposiÃÃo aos mesmos. Alguns grupos, como aminoglicosÃdeos, antiinflamatÃrios nÃo-esteroidais (AINE) e inibidores da enzima conversora de angiotensina (IECA) sÃo muito conhecidos pelo seu potencial nefrotÃxico intrÃnseco. As crianÃas menores (neonatos e lactentes) sÃo dignas de atenÃÃo especial no que se refere a essa questÃo, porque freqÃentemente usam medicamentos e, alÃm disso, a capacidade funcional de seus rins à menor do que a dos adultos. A melhor maneira de tratar a questÃo da nefrotoxicidade à prevenindo-a. Determinar a prevalÃncia de uso de medicamentos potencialmente nefrotÃxicos (MPN) e observar a presenÃa de condiÃÃes que favorecem ao desenvolvimento da nefrotoxicidade (fatores de risco) em crianÃas menores de dois anos de idade internadas em enfermaria geral de um hospital pediÃtrico em Fortaleza â Brasil. Estudo observacional, prospectivo, de seguimento de pacientes. Todas as crianÃas menores de dois anos admitidas na enfermaria âEâ foram incluÃdas e monitorizadas. InformaÃÃes sociodemogrÃficas, antecedentes patolÃgicos e farmacolÃgicos foram registrados, bem como informaÃÃes sobre o uso de medicamentos, presenÃa de fatores de risco para nefrotoxicidade associada a aminoglicosÃdeo, AINE e IECA, e ocorrÃncia de eventos adversos. Os dados foram coletados dos prontuÃrios mÃdicos e atravÃs de entrevista com os responsÃveis pelas crianÃas, sendo analisados estatisticamente usando medidas de freqÃÃncia, tendÃncia central e os testes âtâ de Students e Anova. Durante o perÃodo de estudo (setembro/2005 a marÃo/2006), ocorreu um total de 120 admissÃes na enfermaria; trÃs dos pacientes foram excluÃdos do estudo porque tinham dados incompletos. Os resultados se referem a 117 admissÃes correspondentes a 103 crianÃas. A prevalÃncia de uso de MPN foi de 96,6%. Do total de 1065 itens de prescriÃÃo consumidos, 68,6% tinham potencial nefrotÃxico intrÃnseco. O nÃmero mÃdio de MPN utilizados foi 6,3  4,0 por paciente. Dentre os MPN mais usados estavam: dipirona (10,1%), ranitidina (6,2%) e prednisona (5,1%). Dois por cento das crianÃas usaram aminoglicosÃdeos, 7,3% usaram AINE e 0,8% utilizaram IECA. Foram detectados 368 fatores de risco para nefrotoxicidade, com uma mÃdia de 3,15  1,8 fatores de risco/paciente. Os fatores de risco mais freqÃentes foram: uso de, no mÃnimo, um MPN (30,7% do total de fatores); uso de 2 ou mais MPN concomitantemente (28,3%) e o uso de AINE concomitante ao uso de suplementos de potÃssio (10%). O uso de MPN na faixa etÃria estudada foi considerado elevado. A freqÃÃncia de fatores de risco para nefrotoxicidade tambÃm ocorreu em nÃveis preocupantes. Seria importante conhecer se existiam alternativas mais seguras em cada caso e que medidas preventivas poderiam ser adotadas. A inclusÃo do farmacÃutico clÃnico na atenÃÃo a crianÃas hospitalizadas seria uma estratÃgia com grande potencial de impacto na reduÃÃo de riscos associados aos MPN.

Master of Public Health - MPH / Background: Drugs are essential components of the health system and their rational use is vital to delivering quality and efficient healthcare services. However, inappropriate prescribing is a common rational drug use problem globally, particularly in developing countries including Nigeria. Despite measures to address this problem, inappropriate drug use continues to be a major public health problem in Nigeria. Aim: This study assessed rational drug use (RDU), with a focus on rational prescribing and factors affecting it, among primary healthcare providers working in primary healthcare facilities of a LGA in Northwestern Nigeria. Methods: The study was a cross sectional descriptive study and it included retrospective review of patient encounters and interviews with prescribing healthcare providers in sampled health facilities. Stratified random sampling method was used to select 20 public primary healthcare facilities and 30 patient encounters were drawn by systematic random sampling from each facility. One hundred and sixty three prescribing healthcare providers in the health facilities were also included in the study. Adapted WHO's drug use study tools and a structured self-administered questionnaire were used to collect data. Data were analysed using Statistical Package for Social Sciences (SPSS Version 17) software and presented as contingency table with chi square test used to test for relationship between variables with statistical significance taken at p < 0.05. Ethical approval was obtained from the University of the Western Cape Research Ethics Committee and Kaduna State Ministry of Health, and permission from local stakeholders. Confidentiality of individual patients, healthcare providers and health facilities data was maintained. Results: The prescribing staff at the selected facilities were predominantly Nurses/Midwives and community health assistants with SCHEWs constituting the majority (60.8%). More than half (54.4%) of providers did not know about the concept of RDU. Similarly, the computed knowledge score of RDU revealed that the majority (74.4%) had poor knowledge of the concept. Knowledge was significantly associated with duration of service, providers' previous training in rational drug use and professional status (p<0.05), with the CHOs having better knowledge of RDU compared with other professional cadres. High antibiotic use (68.3% in retrospective review and 82.9% in survey) and injection use (9.5% in retrospective review and 12% in survey) were found in the study with significant proportions of providers admitting that all cases of URTI should receive antibiotics (72.3% ) and that patients could be prescribed injections if they requested for it (35.3%). The Standing Order was the main source of information for the majority (50.6%) of providers and it served as the major influence affecting prescribing practices. Conclusion: This study revealed a poor understanding and knowledge of RDU among healthcare providers. High antibiotic and injection use also reflected providers' poor attitude to rational prescribing of these commodities. To improve prescribing practices at the PHC level, adequate staff skill mix, including physicians should be established. Since RDU knowledge was associated with prior training, curriculum development towards RDU and opportunities for in-service training should be provided to build prescribers capacity, in addition to instituting a system of rational drug use monitoring. Further research into rational drug use among different cadres of PHC healthcare providers is also recommended.

This thesis focuses on how the deviance and criminality associated with illegal drugs are negotiated by adult recreational drug takers. The empirical research incorporates twenty-six interviews with people aged between 30 and 59, who have taken drugs within the past year. The participant group comprised equal numbers of males and females in a variety of jobs in the private, public, and voluntary sector. Some were parents and many were in long-term partnerships. The analysis of the interviews employed discursive psychology, which is a form of discourse analysis that focused upon how drug taking is justified, reasoned and described by the participants. As a result of this analysis, six frameworks were formulated, which describe how drug use is legitimised by the participants. These are: the reformed hedonism; the planned celebration; the drug cultures; the socialisation; the moderation; and the situational opportunity frameworks. Each of the frameworks is unique and demonstrates differences in: drug taking choices and preferences, the social context in which drugs are taken, and how drug use is controlled and maintained within adult life. These frameworks are not representations of drug taking ‘identities’; nor are they designed to unearth the ‘truth’ about drug consumption patterns, but they illustrate how participants present themselves with reference to their behaviour. The thesis also introduces a newly developed concept termed, drugscrimination. This is where participants make reference to a level of unacceptable drug taking behaviour, which is out of control, dysfunctional and driven by the desire for extreme intoxication. Drugscrimination is a is ‘technique of neutralisation’ (Matza and Sykes, 1957) whereby participants justify their own drug use by outlining it as less risky than other types of drug taking behaviour. The participants did not view their own behaviour as morally wrong, nor were they widely condemned for it by their friends and family. Participants were mostly concerned about the impact knowledge of their drug use could have on their jobs and careers. In addition, parents with young children were concerned others would question their ability to effectively parent their children. Different discourses are utilised to reason opinions about the correct societal response to drugs. These relate to the discourses of: addiction, freedom, acceptance, tolerance, and conformity. Each discourse can be used to either support or reject drug law and policy, which demonstrates the complexities of understanding drug use in society. Participants feel they should be able to make their own rational decisions about their behaviour; however these should be responsible choices, which are respectful of individual health and well-being, and should not negatively impact others in society.

Hepatitis C infection (HCV) continues to disproportionately affect Hispanics/Latinos in the United States. Hispanic/Latino intravenous drug users (IDUs), because of their risky injection and sexual behaviors, are prone to HCV infection and rapid transmission of the virus to others via several routes. With a prevalence rate of approximately 75% among IDUs, it is imperative that transmission of HCV be prevented in this population. This study aims to examine the associations between demographic, injection and sexual risk factors to HCV infection in a group Hispanic/Latino IDUs in Miami-Dade County, Florida. Preliminary unadjusted results in this sample reveal that age (OR=4.592, p=0.004), weekly injection (OR=5.171, p=0.000), daily injection frequency (OR=3.856, p=0.000) and use of a dirty needle (OR=2.320, p= 0.006) were all significantly associated with HCV infection. Being born outside the U.S. was significantly negatively associated with HCV infection (OR=0.349, p=0.004). Additionally, having two or more sex partners in the past three months (OR=0.472, p=0.014) was negatively associated with HCV infection. After adjusting for all other variables, older age (AOR=7.470, p=0.006), weekly injection (AOR=3.238, p=0.007) and daily injection frequency (AOR=2.625, p=0.010) were all significantly associated with HCV infection. Being born outside the U.S. (AOR=0.369, p=0.019) was a significant protective factor for HCV infection, along with having two or more sex partners in the past three months (AOR=0.481, p=0.037). When analyzing the significant variables in a backward regression model, having 2 or more sex partners in the past three months was not significant at the p

AbstractThis study provides a comprehensive literature review of the recent peer-review and journal articles pertaining to illegal drug use in South Africa. Potential articles pertaining to South African illicit drug use published between 1994 and April 2019 were identified through an exhaustive literature pursuit. Forty-two articles, which were thematically analyzed, identifying socio-cultural and socio-demographic factors associated with illegal drug use. The results show that adolescents, youths and being of black African race were the most population groups abusing illicit drugs in South Africa, women were the least population group disturbed by illegal drug use and that this behaviour declined with education among female learners. The review uncovered important factors associated with illegal drug use. These include the easy availability of drugs, weak parental control, violence and poverty and unemployment. In addition, there have not been many studies in other races and social classes. Furthermore, most of the studies reviewed were done in major cities like Cape Town and Johannesburg, which makes this research challenging to be generalized. This study recognized gaps in the literature reviewed and alluded to possibilities for future practical research. This study proposes the delivery of ‘evidence-based strategies’ which focuses more on the distribution of evidence-based approaches and policies that are designed to meet the clear needs of communities. In addition, South Africa should implement longitudinal research about drug user life histories. Keywords: Criminology, Illegal drug use, Literature review, Socio-demographic, Socio-cultural, South Africa.

Opioids are scheduled by the propensity for misuse and abuse with a high rate of dependency and risk of fatal overdose. Opioids can be divided into different classes, including, natural, synthetic, and semi-synthetic. Opiates are naturally occurring and come directly from the opium poppy plant; whereas the semi synthetics opioids are chemical modifications of the poppy plant. Synthetic opioids attach to the opioid receptor but contain no part of the poppy plant. The increased variety and frequency in opioid prescriptions contributed to an opioid epidemic in the United States which is still on going. According to the CDC, the opioid epidemic has occurred in three waves. The first wave of the epidemic began in the 1990’s with the increase in opioid prescription pain medication overdoses. The second wave began around 2010 when heroin overdoses became more prevalent. This was followed by a sharp uptick in fentanyl deaths beginning around the year 2013, indicating the start of the third wave. The opioid epidemic has had a huge cost to society, not just due to deaths but also because of lost productivity, medical expenses and judicial system costs (Florence, Zhou, Luo, & Xu, 2016). To best design and implement strategies to combat this issue, an understanding of the population effected is needed. Since many public health policies are implemented at the regional level, knowing the characteristics and demographics of the epidemic at the local level is important. This study evaluates trends in drug related death cases in the Florida District 6 Medical Examiner Office (MEO) from the calendar years 2011 through 2016. Specifically, it focuses on opioids and the role of fentanyl in overdose related mortality. Additional attention is given to fentanyl and fentanyl analog related deaths. Fentanyl analogs present challenges from an analytical toxicology perspective. Fentanyl analogs can be difficult to detect. Two sets of data from each calendar year were obtained from the MEO. This data was collated, standardized and then statistically analyzed. It was determined that there was not a significant difference in month of the year or the day of the week that drug related fatalities occurred. The time of day was statistically significant with more drug related mortalities occurring during the hours of 8:00am and 4:00pm. When assessing mortality rates, Pinellas and Pasco county demonstrated differences. Pasco county has higher overall mortality for opioid related deaths. Pinellas county has almost twice the number of the opioid, fentanyl, related overdose fatalities. Racial demographics, divided into White, Black, and Asian populations, demonstrated that the White population is disproportionally affected by fentanyl drug related mortality. Binary logistic regression showed that fentanyl and heroin tend to co-occur, and that ethanol, hydrocodone, methadone, morphine, and oxycodone do not usually co-occur with fentanyl in drug related fatalities. These data help elucidate trends in the opioid epidemic at a regional level. There are differences between Pinellas and Pasco county; with the former having more fentanyl related drug deaths and the latter having more opioid related drug deaths over the six years analyzed. An interesting result is derived from the binary logistic regression. It is shown here that fentanyl and heroin tend to co-occur together. It is also shown that ethanol, hydrocodone, morphine, oxycodone, and methadone do not co-occur with fentanyl related overdose cases. Notably, methadone has the strongest negative association with fentanyl related overdoses.

This study provides a descriptive profile of substance use behavior and the prevalence of suicide indicators (thought about, considered, and planned) among rural middle school students and examines the association between substance use and suicidal indicators among middle school students participating in the Coordinated School Health Program in a rural state. During April and May 2004, 10,273 middle school students completed the middle school Youth Risk Behavior Survey. This study found that a large percentage of students had initiated substance use behavior, with the greatest number of students having tried cigarettes (40.9% females and 42.7% males), followed by alcohol use (37.2% females and 41.3% males). Additionally, suicidal ideation and behavior were prevalent. Significant associations were found between substance use and suicidal ideation and behavior among middle school students. Prevention programs for adolescent suicide should be implemented during the middle school years and should focus on preventing substance use given its relationship to suicide.

Indiana University-Purdue University Indianapolis (IUPUI)

Indiana University-Purdue University Indianapolis (IUPUI) / To maximize beneficial outcomes for babies and mothers in substance misuse situations, it is necessary to understand the current societal factors and the stigma that healthcare providers may be imposing on the families. More than 5% of all pregnancies are affected by prenatal substance misuse prompting a public health crisis. The negative effects from drug misuse on the growing baby ranges from neonatal abstinence syndrome (NAS), mental retardation, behavioral abnormalities, and neurological deficits. The exposure also causes lengthy hospitalizations for babies and high financial costs. The provider must balance their own feelings and beliefs about substance misuse in pregnancy while simultaneously providing appropriate and supportive care to the mother. However, health-related stigma can occur as providers must care for both mother and baby, in an often stressful work environment. This research explored structural stigma, which broadly encompassed the policies and cultural practices, towards women with prenatal substance misuse among providers in a maternal/fetal healthcare unit. The study, with 117 participants from an area hospital system, examined several variables including the attitudes, perceptions, and stigma among healthcare providers towards prenatal substance misuse. A factorial MANOVA and descriptive analysis was used to assess the data. Among the findings, a significant difference was found between the type of employment discipline and a practitioner’s attitudes and level of structural sigma. Direct Care Nurses had an increased negative attitude towards women with prenatal substance misuse. Additionally, there was a strong correlation (r=0.612) between the cause of substance misuse and a healthcare provider’s attitudes towards prenatal substance misuse. If the provider believed substance misuse stemmed from a moral flaw or failing, he/she had a more negative attitude towards women with prenatal substance misuse. The current study identified the potential stigma and attitudes among healthcare providers and offered insight into the practice methods within the healthcare setting. Specifically, a three-tiered protocol to improve the culture, education, and practice within the hospital setting emerged.

Hepatitis C virus (HCV) is a major public health concern with significant morbidity and mortality. New HCV infection is primarily associated with intravenous drug use. With the ongoing opioid crisis, the incidence of injection drug use and new HCV infection has risen. From 2010 to 2019, the number of estimated infections increased by 387% which is largely attributed to the opioid epidemic and injection drug use (CDC Viral Hepatitis 2019). In 2011 the treatment of HCV was revolutionized with the introduction of direct acting agents which revolutionized the treatment of HCV. Despite guidelines recommending treatment for PWID infected with chronic HCV there are a number of reasons this population is not commonly offered treatment. A growing body of literature has shown that PWID can be successfully treated and attain SVR even in the presence of ongoing drug use. This thesis was prepared by search of pertinent literature to analysis and arguments and evidence for and against the treatment of HCV in those with active injection drug use. / Urban Bioethics