No description available.

Background: The paediatric craniocervical junction has anatomical, physiological and biomechanical properties that make this region unique to that of the adult spine, vulnerable to injury, and contribute to the complexity of management. Traditionally, on-lay fusion with external Halo immobilisation has been used. Instrumented fusion offers intra-operative reduction and immediate stability. Methods: A retrospective review of a single surgeon’s prospectively maintained database was conducted for all cases of paediatric patients that had undergone a fusion involving the occipito-atlanto-axial region. Case notes were reviewed and a radiological analysis was done. Results: Sixteen patients were managed with on-lay fusion and external immobilisation and twentyseven patients were managed with internal fixation using screw-rod constructs. The fusion rates were 80% and 90.5% respectively. Allograft bone grafting was found to be a significant risk factor for non-union. Conclusion: The screws can be safely and predictably placed as confirmed on radiological follow-up with a high fusion rate and an acceptable complication rate. Uninstrumented onlay fusion with Halo immobilization remains an acceptable alternative. Allograft in the form of bone croutons or demineralised bone matrix is a significant risk factor for non-union and posterior iliac crest graft should be used preferentially.

The purpose of this thesis is to analyze changes over time in the interactions of street-involved youth with their risk environments and to investigate how their integration into local, provincial, and federal systems and services impacts their lives, health, and substance use. This thesis employs a sequential explanatory mixed methods design and uses closed and open-ended questions collected over five waves of interviews during the longitudinal study Risky Business? Experiences of Street-Involved Youth. Quantitative (n = 50) methods of analysis include descriptive statistics and bivariate comparisons complemented by a qualitative (n = 15) thematic analysis comprised of open-ended interview questions. The risk environment framework proposed by Tim Rhodes is used to highlight structural and systemic forces informing the lives of street-involved youth, allowing for an analysis on three levels of influence (micro, meso, macro) and four types of environment (economic, physical, social, policy). Results indicate that comparatively high substance use and harms of substance use among street-involved youth decrease as they become integrated into local, provincial, and federal systems and services. Intersecting demographic and structural factors correspond with higher substance use for male youth and youth who had been involved with the foster care system during their life. Given the diversity of backgrounds and risk environment experiences, street-involved youth expressed diverse opinions and perspectives regarding the effectiveness of healthcare, harm reduction, and outreach services. Policy recommendations and suggestions for future research are suggested, with the aim of developing safer environments and environment interventions for street-involved youth that reduce substance use-related harms. / Graduate

Background: Cannabis is increasingly used for management of chronic pain; however, the benefits and harms of this therapy remain uncertain. We conducted a systematic review to inform harms associated with inhaled cannabis for chronic pain. Methods: We searched MEDLINE, EMBASE, PsychInfo, and Web of Science for non-randomized studies reporting on harms associated with inhaled cannabis use, from inception to October 6, 2021. We used random-effects models for meta-analyses and assessed the certainty of evidence using the GRADE approach. Results: We identified 29 eligible studies enrolling 174,562 participants that reported 145 adverse events. Moderate certainty evidence suggests inhaled cannabis use is probably associated with dry mouth (prevalence: 56%; 95%CI 49 to 64), thirst (prevalence: 44%; 95% CI 33 to 55), fatigue (prevalence: 38%; 95%CI 31 to 45), nausea (prevalence: 17%; 95%CI 8 to 27), increased appetite (prevalence: 13%; 95%CI 9 to 18), dizziness (prevalence: 10%; 95%CI 6 to 14), diarrhea (prevalence: 9%; 95%CI 3 to 18), confusion (prevalence: 9%; 95%CI 5 to 13), mood changes (prevalence: 8%; 95%CI 4 to 15), hallucinations (prevalence: 7%; 95%CI 4 to 10), amnesia (prevalence: 6%; 95%CI 3 to 11), impaired coordination (prevalence: 5%; 95%CI 4 to 6), and disorientation (prevalence: 3%; 95%CI 1 to 7). Moderate certainty evidence shows that, compared to non-users, inhaling cannabis is probably associated with increased risk of shortness of breath (risk difference [RD]: 7%; 95%CI 4 to 10). Conclusions: Our review found moderate certainty evidence that dry mouth, thirst, and fatigue are probably frequently experienced with inhaled cannabis use. Several other adverse events are also probable associated with inhaled cannabis use but were less common. Rigorously conducted cohort studies are needed to inform harms associated with inhaled medical cannabis for chronic pain. / Thesis / Master of Science (MSc) / Increasing recognition of harms associated with long-term opioid therapy for management of chronic pain has generated enthusiasm for alternatives, including medical cannabis which is often consumed through inhalation. This review assesses the harms associated with the use of inhaled cannabis for management of chronic pain. Among serious adverse events, we found that inhaled cannabis is likely associated with amnesia, disorientation, impaired coordination, hallucinations, confusion, dizziness, chronic wheeze, and shortness of breath. Inhaled cannabis may be associated with palpitations, paranoia, anxiety, and cannabis dependence. The effects of inhaled cannabis on lung cancer, depression, and psychosis were uncertain. Among less serious adverse events, we found that inhaled cannabis is likely associated with thirst, fatigue, increased appetite, nausea, mood changes, diarrhea, and dry mouth. Inhaled cannabis may be associated with red eyes, vomiting, phlegm, asthma, and cough. The effects of inhaled cannabis on euphoria and irritability were uncertain.

UA Open Access Publishing Fund / Background: Atlantoaxial surgical fixation is widely employed treatment strategy for a myriad of pathologies affecting the stability of the atlantoaxial joint. The most common technique used in adults, and in certain cases in children, involves a posterior construct with C1 lateral mass screws, and C2 pars or pedicle screws. This technical note aims to provide a step‑by‑step guide to this procedure using cadaveric and fluoroscopic images. Methods: An embalmed, human, cadaveric, specimen was used for this study. The subject did not have obvious occipital‑cervical pathology. Dissections and techniques were performed to mimic actual surgical technique. Photographs were taken during each step, and the critical aspects of each step were highlighted. Fluoroscopic images from a real patient undergoing C1/C2 fixation were also utilized to further highlight the anatomic‑radiographic relationships. This study was performed without external or industry funding. Results: Photographic and radiographic pictures and drawings are presented to illustrate the pertinent anatomy and technical aspects of this technique. The nuances of each step, including complication avoidance strategies are also highlighted. Conclusions: Given the widespread utilization of this technique, described step‑by‑step guide is timely for surgeons and trainees alike.

Formålet vil være å beskrive og analysere med utgangspunkt i intervjuer av seks fagmedarbeidere fra fire nordiske land om hvilken kunnskap man har om hvordan en persons rusmiddelmisbruk kan påvirke de pårørende. Funnene diksuteres mot funn i teori og empiri fra funn i dokumenter, artikler og annen forskning. Metode: Studien er gjort med 6 kvalitative intervjuer i fire nordiske land og  underlagt en hypotesegenerende analyse ved bruk av Grounded Theory. Funnene er satt inn i en diskusjon men funn fra søk i annen teori og forskning. Resultater: Hovedfunnene viser at de fire nordiske land finnes en tydelig kunnskap om hvordan en persons rusmiddelbruk kan påvirke andre i en negativ retning. Funn her viser at for hver misbruker kan i gjennomsnittet tre personer få reaksjoner og symptomer direkte knyttet til misbrukerens atferd og problemer. Om lag 80 millioner mennesker globalt har et alvorlig rusmiddelproblem og forsiktige analyser antyder at over 200 millioner pårørende globalt berøres av en annens persons rusmiddelproblemer. Det er dokumentert at det særlig er tre grupper av problemstillinger som gjøres gjeldende på pårørende. Det er særlig skader og belastninger som i indirekte og direkte gir somatoforme symptomer hos voksne og særlig belastninger som følge av skader og vold mot ektefeller/samboere og barn. Familier som lever med rusmiddelmisbruk opplever et høyt stressnivå og har tydelige spor av å leve med et høyt stressnivå. Konklusjoner: De fire nordiske land har kunnskap om hvordan pårørende blir utsatt for store psykiske og fysiske påkjenninger. I de fire nordiske land er det beregninger som viser at om lag 150 til 200 000 barn lever i familier med rusmiddelproblem i hvert av landende. Av undersøkelser her viser funn at tre av de nordiske land alle har nasjonale prosjekter på gang i 2007 med særlig fokus på barn som lever med en misbrukende foreldrer. Det er ikke funnet tydelig kunnskap om hvilke strukturelle grep som må til for å bygge opp tjenester og funksjoner som kan hjelpe eller støtte de pårørende som påvirkes av en annens rusmiddelproblem. Av funnene her kommer det fram at det mangler et tilstrekkelig kunnskapsgrunnlag for hvilke tiltak og hvilken behandling som kan ha best effekt for pårørende. / Aim: Using interviews with six professional in four Nordic countries to discuss, analyze and describe what knowledge there is about how one person’s alcohol- or drug abuse can affect others. Method: The study, using six qualitative interviews submitted with a hypothesis generating analysis, using Grounded Theory. The findings from the interviews were discussed with findings from other theory and empirical data from search in documents, articles and sciences. Results: The main finding show that in the four Nordic countries, there is an evident knowledge about how one person’s alcohol or drug abuse can affect others in a negative way. Findings show that for every person with a misuse problem, up to three others can get reactions and symptoms directly linked to the abuser’s behaviour and problems. Estimates show that more than 80 millions people globally have a serious misuse problem and cautious estimates show that more than 200 millions relatives are affected by this. There are particularly three groups of problems for affected relatives. They are harms and strains which indirectly and directly give somatoform symptoms with adults and particularly strains due to injuries and violence against spouses, partners and children. Families living with their misuse experience a high level of strains and show evident traces of living with a high level of stress. Conclusions: The four Nordic countries have knowledge about how relatives are exposed to great mental and physical strains. Estimates show that 150 to 200 000 children in each of the four Nordic countries, live in families with a misuse problem. From the search here, finding show that three out of four Nordic countries have launched a national project in 2007 with a particular focus on children living with misusing parents. There have been no evident findings of knowledge that shows what structural grip is needed in order to build services and functions that might help or support the relatives who are affected by one person’s misuse problem. From the findings here, it is also shown the lack of adequate knowledge of what efforts and treatment service that best can have effect. / <p>ISBN 978-91-85721-39-9</p>

No description available.

Alcohol is the most widely used psychoactive drug on earth and continues to be responsible for a substantial burden of death and disability. Mitigating these harms is an important focus of any healthful society. Population-level alcohol policy strategies may be employed to decrease these harms and improve population health. To assist towards these goals, this dissertation has two research objectives relating to the estimation and mitigation of alcohol harms: (1) to complete a series of studies regarding the Alcohol Total Consumption Model (TCM) and (2) to specify and test a novel alcohol health harms estimator and alcohol policy scenario modeler, the International Model of Alcohol Harms and Policies (InterMAHP). The TCM is an important theory in alcohol studies and connects alcohol policies, per capita alcohol consumption and alcohol-attributable (AA) harms in a unified social theory. In brief, policies are expected to reflect on population-level consumption, which in turn is the most important predictor of alcohol harms. The TCM theorizes that change should flow directionally through the model – a policy expected to decrease consumption would be predicted to decrease alcohol harms. This theory has been critical towards informing alcohol control policies in the past five decades. In this dissertation, a series of studies were conducted to test the assumptions of the TCM, to test their continued viability. Study A is a comprehensive systematic review and series of meta-analyses that established the link between alcohol policies influencing day/hours of sale and outlet density and per capita consumption. Study B is a primary research study that examined the direct effect of a changed alcohol policy on alcohol-related ED visits, in the context of Saskatchewan. Studies C and D establish the link between alcohol consumption and AA mortality and morbidity through mathematical specification of InterMAHP. Next, the model was applied to the exemplar of AA mortality in Canada in 2016. Last, Study E extended InterMAHP functionalities to include modeling changes in AA harms expected from potential or realized per capita consumption changes resulting from policy change. An application was provided in the context of Québec. The results of this dissertation research provide some support, in a modern context, to the relationships defined in the TCM. The findings suggest that the TCM continues to be a largely appropriate conceptual model in consideration of alcohol policy-making. InterMAHP provides global alcohol researchers with a novel model towards estimating the health harms of alcohol. / Graduate / 2020-04-09

Ghana is undertaking strenuous efforts to make organ transplantation a routine surgical procedure by the end of 2014. Thus far, some 20 test kidney transplants using living related organ donors have been carried out in Ghana. However the current practice of retrieval, retention and use of (deceased) human organs and tissues following pathological services is not done in accordance with the requirements of existing law. Also, the time of human death, its relationship with obtaining organs for transplant as well as the sociocultural sensitivity Ghanaians attach to death and dying are not explored in that context. Furthermore, there is no coherent examination of the various interests and rights recognised by Ghanaian law in deceased human bodies despite that fact that progress in medicine and biotechnology has recast the value in human biomaterials. Consequently, given that organ transplantation is new to Ghana; that there are no ethical, legal and professional governance frameworks specific to the sector; that there are concerns about a systemic culture of inappropriate retention and use of human body parts following pathological services; that there is illicit trade in human body parts (ova, sperm etc.); and that Ghana is undertaking test kidney transplants in the absence of specific ethical, legal and clinical guidance addressing the controversies surrounding the permissible uses of human organs and tissues; this doctoral thesis argues that examining these ethico-legal controversies within the Ghanaian socio-legal setting constitutes an essential step in the quest for context-appropriate and practically workable regulatory and governance frameworks for the emerging transplant sector in that country. Towards this end, the thesis discusses indigenous thinking around death (Post-mortem Personality Identity Renegotiation (PPIR)), ancestorship and the position of Ghanaian customary law on ownership interests and rights in deceased bodies and their parts and points policy makers to how the socio-legal peculiarities of the Ghanaian regulatory context could be exploited to achieve the dual aims of finding an adequate balance between, on the one hand, protecting individual, family and societal interests, and on the other hand, promoting the social utility aims of organ transplantation and science research. It concludes by proposing that i) the desired regulatory balance could be achieved through legal foresighting, and ii) that any such regulation must affirm the recognition of property interests in (deceased) bodies by Ghanaian customary law as that reflects the cultural, social and constitutional values of the regulatory context.

Disruptive technologies in the form of e-Health or electronic healthcare (the use of information technology in health) have the ability to provide positive implications to both patients and healthcare professionals. Recently, public health agencies deployed contact tracing apps with the aim of curbing the spread of COVID-19, by aiding manual contact tracing, and lifting restrictions. Despite this, their ubiquitous nature in the sector has opened doors to new threats in the area of information security and privacy, where these apps, for instance, contain security and privacy risks such as violation of the principle of least privilege, which when exploited can cause privacy harms to the user, for example, re-identification of users. In general, information security and privacy in the healthcare sector is essential due to the nature of the data they process, and the need to keep the patient safe. While this is so, the general security posture of the sector, which is poor due to its under-financing in IT security among other reasons such as the use of legacy systems, makes it vulnerable to cyber-attacks that end up with exfiltration of personal health data, among other data, for instance, relevant research data. Such data can be misused incurring privacy harm to patients that have been affected by the breach. This thesis follows an experimental approach to assess the privacy and security risks of m-Health apps, with the selected case study of these m-Health apps, that is, COVID-19 contact tracing apps. In addition, it also contributes with a theoretical approach to assessing impacts and consequences in the healthcare sector, including what harms patients could face in the event of a state-sponsored cyber-attack. In addition, the research aims at contributing to the field by proposing a sector-specific model that can be used to evaluate the impact on the privacy of patients affected by a data breach. / Störande teknologier i form av e-hälsa eller elektronisk sjukvård (användning av informationsteknologi inom hälsa) har förmågan att ge positiva implikationer för både patienter och vårdpersonal. Folkhälsomyndigheter har nyligen implementerat så kallade kontaktspårningsappar i syfte att hindra spridningen av COVID-19, genom att bidra till manuell kontaktspårning och införande av restriktioner. Trots detta har deras allmänt förekommande natur i sektorn öppnat dörrar för nya hot i områdena informationssäkerhet och personlig integritet, Där dessa appar, till exempel, innehåller säkerhets- och integritetshot såsom brott mot lägsta prioritetsprincipen (eng. principle of least privilege), som, när exploaterad, kan orsaka personlig integritets-skador för användaren, exempelvis återidentifiering av användare. Generellt kan sägas att informationssäkerhet och skydd av personlig integritet inom hälso- och sjukvården är absolut nödvändigt med tanke på egenskaperna hos de personuppgifter som behandlas, och behovet av att skydda patienten. Trots detta gäller att sektorns generella hållning , som är svag på grund av dess underfinansiering av IT-säkerhet bland andra skäl på grund av användning av gamla system, gör dem sårbara för IT-angrepp som slutar med exfiltrering av persondata, bland annat forskningsdata. Sådana data kan missbrukas och därmed orsaka skada för de patienters som drabbats. Avhandlingen argumenterar för att hälso- och sjukvårdssektorns låga kvalitet på informationssäkerhet kan leda till att säkerheten och integriteten hos hälsodata, särskilt personlig hälsodata, kan exploateras för att orsaka integritetsskador inte bara från opportunister eller hacktivister, utan också från angripare som sponsras av stater, som exempelvis Fancy Bear i fallet World Anti-Doping Agency år 2016. Det följer ett experimentellt tillvägagångssätt för att säkerställa påverkan och konsekvenser i vårdsektorn, inklusive vilka skador patienter skulle kunna möta om ett angrepp sponsrad av ett annat land skulle ägan rum. I grunden visar forskningen på de kritiska och signifikanta egenskaperna i sektorn och den påverkan en IT-angrepp skulle ha på individer och på sektorn själv. Dessutom strävar forskningen efter att bidra till området genom att föreslå en sektorspecifik modell som kan användas för att evaluera påverkan på de patienters personliga integritet som drabbats av ett dataläckage.