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People who inject drugs, particularly opioids, are a growing population, especially in North Philadelphia. This population is at high risk for medical complications that require hospitalization. While hospitalized, this population poses unique challenges to the healthcare system, including high costs and readmission rates, as well as stress and burnout among providers and staff. These patients are at high risk of discharges against medical advice because of complicated social factors as well as inadequate recognition of pain and withdrawal. As the opioid epidemic evolves, previous strategies for managing these patients, which traditionally relied on referral to psychiatry or social work in addition to symptomatic treatment, need to be re-evaluated. Ethically, the decision-making capacity of these patients is frequently called into question, and there is a difficult-to-strike balance between respecting their autonomy and acting with beneficence to provide the best care. There are also public health concerns that come into play. Better acknowledgment of the issues that this population faces, and better management of pain and withdrawal, may improve their outcomes, as well as reduce provider stress and burnout. / Urban Bioethics

The effectiveness of a shor-term prevention program to increase drug refusal behavior in elementary school children was assessed. Fifty-seven third grade children were randomly assigned to one of three groups: rehearsal-plus, traditional, and control. Children in the rehearsal-plus group were taught drug knowledge, assertiveness skills, decision making skills, and specific drug refusal techniques in the context of a skills-based strategy. This procedure included behavioral training and elaborative rehearsal. The traditional group targeted the same components, drug knowledge, assertiveness skills, decision making skills, and drug refusal skills, and employed a general educational-based approach to enhance children's functioning. Training occurred in three socially validated situations corresponding to settings where children are likely to be offered drugs. Assessment was carried out at pre- and post-test phases. It was hypothesized that children in the rehearsal-plus group would outperform those in the traditional and control groups on targeted responses. The results suggest that the rehearsal-plus procedure was most effective in enhancing desired behavior. / Master of Science

Au Canada, 13 % de la population consomme des drogues illicites et il est estimé qu’un jeune sur trois consomme régulièrement du cannabis. Cela génère un fardeau social, coûtant 46 milliards de dollars et entraînant l’hospitalisation de 275 000 personnes. La compréhension des facteurs de risque et des processus menant au développement d’une consommation problématique du cannabis et des autres substances chez les jeunes s’avère ainsi critique. Bien que plusieurs facteurs individuels et environnementaux soient impliqués dans le développement d’une consommation problématique du cannabis et des autres substances, l’adversité à l’enfance et le tempérament impulsif sont identifiés comme deux facteurs de risque importants pour le développement d’une consommation problématique. Cependant, aucune étude n’existe dans la prédiction spécifique des problèmes de consommation du cannabis. L’objectif principal de cette étude a été d’examiner le rôle de l’adversité et de l’impulsivité à l’enfance dans la prédiction d’une consommation problématique du cannabis et des autres substances à l’âge de 24 ans chez des Québécois suivis depuis de leur naissance, et ce dans le cadre d’une étude de cohorte longitudinale. Une relation a été trouvée entre l’adversité à l’enfance et la consommation problématique des substances autres que le cannabis. On retrouve également l’impact de l’impulsivité en tant que facteur de risque pour la consommation problématique des substances autres que le cannabis. Dû à l’absence de résultat significatif quant à la consommation problématique du cannabis, davantage d’études sont nécessaires afin d’explorer son lien avec l’adversité à l’enfance et l’impulsivité. / In Canada, 13% of the population uses illicit drugs and it is estimated that one individual out of three regularly between the ages of 16 to 25 consume cannabis on a regular basis. This creates a social burden, costing $46 billion and leading to the hospitalization of 275,000 individuals. Understanding the risk factors and processes leading to the development of cannabis and other substance use problems in young adult is therefore critical. While it is evident that several individual and environmental factors are involved in the development of cannabis and other substance use problems, childhood adversity and impulsivity have been identified as two important risk factors for the development of problematic cannabis and other substance use. However, there are no studies that examines the specific prediction of cannabis use problems. Thus, the main objective of this study was to examine the role of childhood adversity and impulsivity in the prediction of cannabis use problems in Quebec young adults at age 24, followed since birth in a longitudinal cohort study. A relationship was found between childhood adversity and problematic use of substances other than cannabis at age 24. We also found the impact of impulsivity as a risk factor for problematic consumption of substances other than cannabis. Due to the lack of significant results regarding problematic cannabis use, more studies are needed to explore the link between problematic cannabis use, childhood adversity and impulsivity.

The problem addressed in this study is how selected universities in the South and Southwest recognize and attempt to deal with alcohol use and other drug use among students. The purpose of the study was to determine current practices and policies concerning student alcohol and drug use among the 20 selected universities. The data were obtained by means of a descriptive survey questionnaire which was mailed to 20 selected universities under the jurisdiction of the Southern Regional Accrediting Board. The instrument was designed to identify practices and programs concerning student alcohol and drug use. A copy of each institution's alcohol and drug policy was requested. The content and procedures of the programs implemented by the responding institutions were reviewed, in order to evaluate the extent and degree to which they provide for the recognition, education, intervention, and treatment for students with alcohol- or drug-use problems. Results are presented in tabular form. Of the 20 major state-supported universities which were mailed questionnaires, 75% returned usable instruments. All responding institutions felt they have an alcohol or drug problem of some magnitude, and all either have, or believe they have, some kind of policy to deal with substance use by students. All of the responding institutions also indicate that they have various programs in operation which deal with student substance use and abuse. Since this was a regional study the results are not necessarily generalizable. On the basis of the literature reviewed and the survey responses received, an authentic problem with student alcohol and drug use exists on campus. The institutions surveyed appear to recognize a problem; however, the results of this study reveal that most have yet to develop an effective or coordinated strategy to combat student alcohol and drug abuse.

In response to a NCAA ruling, North Texas State University (NTSU) launched a comprehensive drug testing, drug education and counseling program for its athletes effective August 1, 1986. This study assessed and compared NTSU student-athlete and student alcohol and drug use. In addition, attitudes toward a variety of sports-related drug topics, including mandatory athletic drug testing, were assessed and compared. The study revealed significant differences between student-athletes and students in drug use of the following: steroids, marijuana, cocaine, psychedelics, and amphetamines. Both groups favored mandatory drug testing of athletes.

Text in English / The purpose of this qualitative, explorative, descriptive and contextual study is to explore and describe the perception of secondary school learners regarding the use of illicit drugs and to propose recommendations to caregivers and school teachers that could help curb illicit drugs use. Purposive sampling was used to identify twelve secondary school learners who participated in this study. Data were collected through in-depth individual face-to-face interviews, drawings and field notes. Data analysis was done using Tesch’s descriptive method of open coding. The findings revealed that a combination of factors such as vulnerability, physical changes, psychological challenges and social challenges experienced by secondary school learners in Windhoek, Namibia, lead to illicit drugs use. The participants identified the different strategies they employed to recapture their lives from using illicit drugs and recommendations were made to caregivers and teachers on how to address these factors. / Health Studies / M.A. (Public Health)

Thesis (M.Tech.: Biomedical Technology)-Dept. of Biomedical Technology, Durban University of Technology, 2007 xxiii, 244 leaves / In 2004, it was reported that KwaZulu-Natal had the greatest number of HIV infected people, approximately 1.8 million people, of whom an estimated 450 000 were in need of antiretroviral drug therapy based on their Cluster of Differentiation 4 (CD4) counts and clinical status. Studies on the success of antiretroviral drugs in improving the quality of life in HIV infected individuals have been extensively performed and published. However, there are no published data on the effect that immune boosters have in improving the quality of life in such persons. Considering the side effects, toxicity, multi-drug regimens and drug resistance problems associated with antiretroviral therapy, alternative or supplementary therapies may play an important role in improving the quality of life in HIV infected people. Such therapy might help in situations where some patients who qualify for antiretroviral treatment are unable to access them because of several reasons such as long waiting lists, travelling costs, unwilling to take antiretroviral drugs, etc. Some patients have reservations in taking antiretroviral drugs. The stigma associated with the disease may be a major factor. The aim of this study was to investigate the change in the immune status of HIV infected patients that were on the Inochi New Medicine immune booster, as well as, to assess the safety and efficacy of this immune booster in improving the patients’ quality of life.

Public health aspects of pharmaceutical prescription patterns: Exemplified by treatments for prevention of cardiovascular disease. Louise Silwer. ISBN: 978-91-85721-18-4 ISSN: 0283-1961Main aim:To study patterns and trends of dispensed prescriptions, to explore what proportion of the population is exposed to some of the more prevalently prescribed pharmaceuticals, and to find possible ways of measuring drug-induced adverse symptoms in the population. Further, to illuminate conditions surrounding prescribing in primary prevention of cardiovascular disease. Methods: In three descriptive studies of prescription patterns, prescription data at aggregate level from a Swedish county were analysed retrospectively, and proportions were calculated. Data from the first ten years of the studies were obtained from a local prescription study, and data from another five years were local data from a national prescription survey. Data from a Danish database (OPED), with data at the individual level, were used for a prescription sequence symmetry analysis, and when Swedish national prescription data at the individual level became accessible, they were used for calculations of drug prevalence in the entire Swedish population. In a qualitative analysis of interview data, a phenomenographic approach was used. Main results: The purchase of pharmaceuticals on prescription almost doubled in the studied county in the period 1988-2002. Some common pharmaceuticals that increased to a great extent among the older part of the population were cardiovascular preventive drugs, such as antihypertensive and lipid modifying agents, and also hormone replacement therapy for women. In 2005, over half of all Swedish citizens, aged 60 or over, purchased antihypertensive or lipid modifying preparations during a six-month period. The different views that were found among GPs, regarding beliefs and practical management of primary prevention of CVD, could be interpreted as a reflection of the complexity of patient counselling in primary prevention in practice. Conclusion: The increase in dispensed prescriptions over the 15 years and the magnitude of the prevalence of the studied pharmaceuticals, such as antihypertensive, lipid modifying and hormonal treatments, which to a great extent are used by ‘healthy’ people, point to the need of following-up both beneficial and harmful consequences on public health. The prevalence of preventive treatments together with the variation in views of administration of primary prevention of cardiovascular disease, also point to the need of clarification of guidelines regarding pharmaceutical primary prevention and encouragement of therapy discussions among GPs.

Introduction: Intimate Partner Violence (IPV), also called domestic violence, is defined as any physical, psychological, or sexual violence, and emotional violence perpetrated by an intimate partner (CDC, 2016). Sexual violence or rape is defined as a sexual act committed against someone without that person’s freely-given consent (CDC, 2017). IPV is experienced among heterosexual women globally, although this phenomenon is not unique to this population. IPV also disproportionately affects young gay, bisexual, and other men who have sex with men (MSM) (Stults et al., 2016). The purpose of this study is to examine the association between IPV victimization and the increased risk of HIV and other health outcomes among YBMSM. Methods: The 6-month follow-up was conducted in Jackson, MS. A total 600 YBMSM were eligible to participant in the study. The participants were recruited from two local clinics that were focused on diagnosing and treating STI’s. Also, recruiters promoted the opportunity to enroll in the study through social media, attending bars, and nightclubs. Inclusion criteria were: 1) assigned male at birth; 2) self-identification as Black/African American; 3) 15-29 years of age; 4) attending the clinic to be tested for HIV or other STIs, 5) having engaged in anal sex with a male partner at least once in the past 6 months, and 6) the ability to speak and comprehend English. Results: The overall study sample consisted of 600 YMSM. All participants were identified as African–American. The average age of the sample was 22.6 years (SD=±3.2). Bottoms were more likely to experience rape (AOR=1.7,CI 1.1,2.6; p=.02). YBMSM who experienced IPV since enrolling in the study, as compared to those who did not experience IPV, were more likely to use marijuana, alcohol, crack, and painkillers (AOR=7.7 ,CI 5.1,11.7; p= Conclusion: These findings suggest that IPV and Rape shows a significant association with decreased condom use, decreased condom negotiation, sexual position, drug use and HIV risk among YBMSM in Jackson, MS.