OBJECTIVE: Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people.
METHODS: This study was a retrospective analysis of routinely collected data set in residential- and community-based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies\' (NADA) database were used. Included individuals were aged 10-24 years and accessed treatment between 2012 and 2023 (n = 17 474).
METHODS: Variables included client-related characteristics, service characteristics and baseline measures of clinical severity [Kessler-10 (K10), EUROHIS-QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion.
RESULTS: Rates of treatment completion were highest among adolescents in community-based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community-based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth-specific services was associated with higher treatment completion rates among adults in community-based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts.
CONCLUSIONS: In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity.

暂无摘要。

Although alcohol and other drug use is increasingly the focus of policy and research efforts, there are challenges identifying and applying evidence-based strategies to minimise harms for alcohol and other drugs in health care and community settings. These challenges include limited available research, variability across settings, and lack of \'fit\' between research evidence and their intended settings. In this commentary, we describe a novel approach to develop and evaluate tailored, sustainable strategies to enhance the uptake of evidence-based activities into health services and community settings. Our approach involves four key principles: (i) identifying evidence-based alcohol and other drug harm minimisation strategies; (ii) partnering with local experts to identify and tailor strategies; (iii) implementing strategies into existing practice/infrastructure to build in sustainability; and (iv) using sustainable co-designed outcome measures including value-based health-care principles to measure uptake, feasibility and acceptability, health outcomes and economic implications. We propose that this approach offers a way forward to enhance the relevance and suitability of research in health services and community settings and has potential to be applied in other sectors.

Recent increases in pediatric and adolescent opioid fatalities mandate an urgent need for early consideration of possible opioid exposure and specific diagnostic and management strategies and interventions tailored to these unique populations. In contrast to adults, pediatric methods of exposure include accidental ingestions, prescription misuse, and household exposure. Early recognition, appropriate diagnostic evaluation, along with specialized treatment for opioid toxicity in this demographic are discussed. A key focus is on Naloxone, an essential medication for opioid intoxication, addressing its unique challenges in pediatric use. Unique pediatric considerations include recognition of accidental ingestions in our youngest population, critical social aspects including home safety and intentional exposure, and harm reduction strategies, mainly through Naloxone distribution and education on safe medication practices. It calls for a multifaceted approach, including creating pediatric-specific guidelines, to combat the opioid crisis among children and to work to lower morbidity and mortality from opioid overdoses.

In Ethiopia, noncommunicable diseases (NCDs) represent 18.3% of premature mortality, consume 23% of the household expenditures, and cost 1.8% of the gross domestic product. Risk factors such as alcohol, khat, and cannabis use are on the rise and are correlated with a substantial portion of NCDs. Associated NCDs include depression, anxiety, hypertension, coronary heart disease, and myocardial infarction. The multi-faceted nature of mental health and substance abuse disorders require multi-dimensional interventions. The article draws upon participant observation and literature review to examine the policies, delivery models, and lessons learned from the Federal Ministry of Health (FMOH) experience in integrating Mental Health and Substance Abuse (MH/SA) services into primary care in Ethiopia. In 2019, FMOH developed national strategies for both NCDs and mental health to reach its population. Ethiopia integrated MH/SA services at all levels within the government sector, with an emphasis on primary health care. FMOH launched the Ethiopian Primary Health Care Clinical Guidelines, which includes the delivery of NCD services, to standardize the care given at the primary health care level. To date, the guidelines have been implemented by over 800 health centers and are expected to improve the quality of service and health outcomes. Existing primary care programs were expanded to include prevention, early detection, treatment, and rehabilitation for MH/SA. This included training and leveraging an array of health professionals, including traditional healers and those from faith-based institutions and community-based organizations. A total of 244 health centers completed training in the Mental Health Gap Action Programme (mhGAP). In 2020, 5,000 urban Health Extension Workers (HEWs) participated in refresher training, which includes mental health and NCDs. A similar curriculum for rural health workers is in development. Ethiopia\'s experience has many lessons learned about stakeholder buy-in, roles, training, logistics, and sustainability that are transferable to other countries. Lessons include that \"buy-in\" by leaders of public health care facilities requires consistent and persistent nurturing. Ensure the gradual and calibrated integration of MH/SA services so that the task-sharing will not be viewed as \"task dumping.\" Supervision and mentorship of the newly trained is important for the delivery of quality care and acquisition of skills.

UNASSIGNED: To assess the effects of alcohol and illicit drug use in young adults (age 18-35) with type 1 diabetes (T1D) on flash glucose monitor sensor glucose (SG) readings.
UNASSIGNED: Twenty young adults with T1D were enrolled from a tertiary referral hospital outpatient department in Melbourne, Australia for a 6-week prospective observational study using flash glucose monitoring (FGM). Glucometrics comparing substance using days (SUEDs) to those without substance use (non-SUEDS) were analysed. The primary outcomes were the difference in mean SG values, its standard deviation and minutes/24-h period out of range (SG <3.9 mmol/L or >10.0 mmol/L) between matched SUEDs vs non-SUEDs. An interaction model with the primary effect of HbA1c on SG values was also performed.
UNASSIGNED: There were no differences in the primary outcome measures between SUEDS and non-SUEDs. However, there were differences in the regression coefficients for HbA1c and glucometrics between non-SUEDs and SUEDs for mean SG, time out of range and time with SG > 10 mmol/L. This difference was also identified between non-SUEDS and days of ≥40 g alcohol for mean SG.
UNASSIGNED: While there was no difference between glucometrics for SUEDs and non-SUEDs on primary outcomes, HbA1C was found to be a less reliable predictor of glucose patterns in the 24-h period following substance use than control days. Young adults with T1D need to monitor and respond to their glucose levels following substance use and engage in harm minimisation practices irrespective of baseline glucose control.

OBJECTIVE: The purpose of this paper is to review systematically the available literature relating to the implementation of peer education to promote health and healthy behaviour in prisons.
METHODS: The authors undertook a narrative systematic review of Medline, EMBASE, CINAHL, Psychinfo, Web of Science and Cochrane databases. Relevant journals and reference lists were hand searched for relevant articles to be included in the review. Of the abstracts found, full-text papers were retrieved for those papers deemed as possibly fulfilling the inclusion criteria of the review.
RESULTS: A total of 3,033 abstracts were identified leading to 46 full-text articles being retrieved, of which ten were included in the review. Peer education in prisons can have an impact on attitudes, knowledge, and behaviour intention regarding HIV risk behaviour. The research findings were inconclusive for the impact of peer education upon illicit drug use and injecting practice. There was a paucity of research evaluating the impact of peer education upon mental ill health, obesity, diet, smoking, or self-management of chronic physical diseases.
CONCLUSIONS: Peer education is effective in reducing risk of HIV transmission. It is possible that peer education for mental health issues is stigmatising, presenting an opportunity for further research activity. The impact of peer education upon illicit drug use practice, obesity, diet, smoking, and self-management of chronic physical diseases also presents further research opportunities. Research evaluating models of active peer educator involvement in health service delivery and organisation is also lacking.

暂无摘要。