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Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear.
To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment.
Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score.
The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92–2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61–5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01–0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89–2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms.
Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.
Cannabis is the most commonly used substance among patients in methadone maintenance treatment (MMT) for opioid use disorder. Current treatment programmes neither screen nor manage cannabis use. The recent legalisation of cannabis in Canada incites consideration into how this may affect the current opioid crisis.
Investigate the health status of cannabis users in MMT.
Patients were recruited from addiction clinics in Ontario, Canada. Regression analyses were used to assess the association between adverse health conditions and cannabis use. Further analyses were used to assess sex differences and heaviness of cannabis use.
We included 672 patients (49.9% cannabis users). Cannabis users were more likely to consume alcohol (odds ratio 1.46, 95% CI 1.04–2.06, P = 0.029) and have anxiety disorders (odds ratio 1.75, 95% CI 1.02–3.02, P = 0.043), but were less likely to use heroin (odds ratio 0.45, 95% CI 0.24–0.86, P = 0.016). There was no association between cannabis use and pain (odds ratio 0.98, 95% CI 0.94–1.03, P = 0.463). A significant association was seen between alcohol and cannabis use in women (odds ratio 1.79, 95% CI 1.06–3.02, P = 0.028), and anxiety disorders and cannabis use in men (odds ratio 2.59, 95% CI 1.21–5.53, P = 0.014). Heaviness of cannabis use was not associated with health outcomes.
Our results suggest that cannabis use is common and associated with psychiatric comorbidities and substance use among patients in MMT, advocating for screening of cannabis use in this population.
This study exploits a new long-run data set of daily bid and offered exchange rates in spot and forward markets from 1919 to the present to analyze carry returns in fixed and floating currency regimes. We first find that outsized carry returns occur exclusively in the floating regime, being zero in the fixed regime. Second, we show that fixed-to-floating regime shifts are associated with negative returns to a carry strategy implemented only on floating currencies, robust to the inclusion of volatility risks. These shifts are typically characterized by global flight-to-safety events that represent bad times for carry traders.
Health Technology Assessment (HTA) and regulatory decisions involve value judgements. As patient groups, industry, and regulatory agencies conduct more preference studies to quantify these judgements, a better understanding of the methods and practices is needed. Currently, there is no systematic mapping of the use of preference data in Europe. This study aimed to identify (i) the use of quantitative preference data by all relevant HTA bodies and regulatory authorities of the European Union (EU) member states, and (ii) key standards and guidelines.
This study used a mixed method approach based on a systematic literature review, survey and subsequent interviews with decision makers and experts.
A total of 62 survey responses were received. Many respondents reported that their agencies were responsible for supporting more than one type of decision, with 69.0 percent supporting approval decisions, 64.3 percent supporting reimbursement decisions, 61.9 percent supporting pricing decisions, and 64.2 percent supporting guideline development. Respondents reported that their agencies supported these decisions in multiple ways: 78.6 percent by assessing health technologies; 54.8 percent by appraising health technologies; 45.2 percent by compiling an HTA report; 7.1 percent by conducting primary research; 9.5 percent by conducting secondary research. More than 40 percent (42.9 percent) of agencies had the final say on one of the decisions of interest – approval, reimbursement, or pricing. Of the 31 countries studied, 71 percent (n = 22) used quantitative preference data in their reimbursement and pricing decisions. Of those, 86 percent (n = 19) used general population preferences to inform the estimation of quality-adjusted life years (QALY) as part of cost utility analysis.
Much of this use of preference data can be understood within the standard framework of economic analysis adopted by many HTA agencies; either in in the form of: standard ways to estimate QALYs; ways to broaden the impacts of technologies captured in the QALY; or ways to weigh health gain with other decision-making criteria, such as disease severity or innovativeness.
The mitigation hierarchy is a decision-making framework designed to address impacts on biodiversity and ecosystem services through first seeking to avoid impacts wherever possible, then minimizing or restoring impacts, and finally by offsetting any unavoidable impacts. Avoiding impacts is seen by many as the most certain and effective way of managing harm to biodiversity, and its position as the first stage of the mitigation hierarchy indicates that it should be prioritized ahead of other stages. However, despite an abundance of legislative and voluntary requirements, there is often a failure to avoid impacts. We discuss reasons for this failure and outline some possible solutions. We highlight the key roles that can be played by conservation organizations in cultivating political will, holding decision makers accountable to the law, improving the processes of impact assessment and avoidance, building capacity, and providing technical knowledge. A renewed focus on impact avoidance as the foundation of the mitigation hierarchy could help to limit the impacts on biodiversity of large-scale developments in energy, infrastructure, agriculture and other sectors.
Symptoms of anxiety relating to Parkinson's disease (PD) occur commonly and include symptomatology associated with motor disability and complications arising from PD medication. However, there have been relatively few attempts to profile such disease-specific anxiety symptoms in PD. Consequently, anxiety in PD is underdiagnosed and undertreated. The present study characterizes PD-related anxiety symptoms to assist with the more accurate assessment and treatment of anxiety in PD.
Ninety non-demented PD patients underwent a semi-structured diagnostic assessment targeting anxiety symptoms using relevant sections of the Mini International Neuropsychiatric Interview (MINI-plus). In addition, they were assessed for the presence of 30 PD-related anxiety symptoms derived from the literature, the clinical experience of an expert panel and the PD Anxiety-Motor Complications Questionnaire (PDAMCQ). The onset of anxiety in relation to the diagnosis of PD was determined.
Frequent (>25%) PD-specific anxiety symptoms included distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and PD medication complications, and were experienced more commonly in patients meeting DSM-IV criteria for an anxiety disorder. The onset of common anxiety disorders was observed equally before and after a diagnosis of PD. Patients in a residual group of Anxiety Not Otherwise Specified had an onset of anxiety after a diagnosis of PD.
Careful characterization of PD-specific anxiety symptomatology provides a basis for conceptualizing anxiety and assists with the development of a new PD-specific measure to accurately assess anxiety in PD.
The power of business is a very important issue for understanding the operation of democracy, but establishing the nature and extent of its power is not easy. We acknowledge that this is, in large part, an empirical problem and requires a more sophisticated conceptual framework to address it. Attempting to address this, the recent literature on the power of business has increasingly focused on the role of structure, agents and ideas. However, too little attention has been paid to how these concepts are defined and conceptualized. We argue that it is crucial to: specify the structures (economic/political/social) which we see as affecting the role of business; identify the agents, collective and individual, involved and how they interact; and specify which ideas are playing a role, at what level of generality and how these different ideas at different levels of generality interact. This article explores these issues through a critical consideration of the extant literature in order to provide a more developed framework for future empirical analysis.
The extensive territorial waters of Australia and New Zealands (NZ) (over 8 million km2 for Australia and a further 4 million km2 for NZ) are home to approximately 49 species of whales and dolphins, 11 species of seals and the dugong. Within Australia, at least eight species are listed as threatened, though there is insufficient information on a further 25 to determine their conservation status, while in NZ eight species are listed as threatened. The relationship between humans and Australasia’s marine mammals is culturally diverse and has changed significantly in recent years. Dugongs and stranded whales have been important both spiritually and as a source of nutrition to some Aborigines and Torres Strait Islanders for thousands of years; seals and whales had a similar role for Maori in NZ. In recent history, exploitation of baleen whales, elephant seals and fur seals was an important driver for much of the earliest European settlement of Australasia. The success of the whaling and sealing industries came at the expense of marine mammal populations, leading to the near extirpation of many species by the mid twentieth century. In more recent decades there has been a fundamental shift in public attitudes towards marine mammals, in particular the great whales and dolphins. All marine mammals are protected within Australia and NZ waters. Traditional hunting of dugongs is legal in Australia for Native Title holders.
We present a diagnostic glacier flowline model parameterized and constrained by new velocity data from ice-surface GPS installations and speckle tracking of TerraSAR-X satellite images, newly acquired airborne-radar data, and continental gridded datasets of topography and geothermal heat flux, in order to better understand two outlet glaciers of the East Antarctic ice sheet. Our observational data are employed as primary inputs to a modelling procedure that first calculates the basal thermal regime of each glacier, then iterates the basal sliding coefficient and deformation rate parameter until the fit of simulated to observed surface velocities is optimized. We find that the two glaciers have both frozen and thawed areas at their beds, facilitating partial sliding. Glacier flow arises from a balance between sliding and deformation that fluctuates along the length of each glacier, with the amount of sliding typically varying by up to two orders of magnitude but with deformation rates far more constant. Beardmore Glacier is warmer and faster-flowing than Skelton Glacier, but an up-glacier deepening bed at the grounding line, coupled with ice thicknesses close to flotation, lead us to infer a greater vulnerability of Skelton Glacier to grounding-line recession if affected by ocean-forced thinning and concomitant acceleration.