BACKGROUND: Hepatitis B virus infection poses a global health challenge, particularly in low- and middle-income African countries. Illicit drug use exacerbates the problem, with drug users having a higher HBV infection risk and maintaining a quiet transmission pool. This study aimed to determine HBV infection prevalence, immune status, and risk factors among illegal drug users in Enugu State, Nigeria.
METHODS: A cross-sectional study was conducted in Enugu State, using privileged access interviewer methods to enroll drug users. Pre-tested structured questionnaires were administered after informed consent was obtained. Blood samples were tested for HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb using immunochromatographic rapid test kits. Statistical analysis was performed using SPSS version 25.
RESULTS: One hundred drug users were recruited into the study. Overall, 7% of the drug users had HBV infection. 61% were found to be susceptible to HBV infection, 15% showed serological evidence of immunity from HBV vaccination and 1% developed natural immunity from HBV exposure. Significant risk factors for HBV infection were age less than 20 years, young age (≤ 20 years) at drug initiation, being single, injecting drugs more than or equal to 20 times per month and injecting with used syringes.
CONCLUSIONS: This study shows high intermediate endemicity of HBV infection among drug users, low vaccination uptake, and high susceptibility to HBV infection. This calls for the urgent inclusion of drug users in national HBV vaccination campaigns and the adoption of the World Health Organization\'s recommendations on the prevention of viral hepatitis among people who inject drugs.

BACKGROUND: The online pharmacy market is growing, with legitimate online pharmacies offering advantages such as convenience and accessibility. However, this increased demand has attracted malicious actors into this space, leading to the proliferation of illegal vendors that use deceptive techniques to rank higher in search results and pose serious public health risks by dispensing substandard or falsified medicines. Search engine providers have started integrating generative artificial intelligence (AI) into search engine interfaces, which could revolutionize search by delivering more personalized results through a user-friendly experience. However, improper integration of these new technologies carries potential risks and could further exacerbate the risks posed by illicit online pharmacies by inadvertently directing users to illegal vendors.
OBJECTIVE: The role of generative AI integration in reshaping search engine results, particularly related to online pharmacies, has not yet been studied. Our objective was to identify, determine the prevalence of, and characterize illegal online pharmacy recommendations within the AI-generated search results and recommendations.
METHODS: We conducted a comparative assessment of AI-generated recommendations from Google\'s Search Generative Experience (SGE) and Microsoft Bing\'s Chat, focusing on popular and well-known medicines representing multiple therapeutic categories including controlled substances. Websites were individually examined to determine legitimacy, and known illegal vendors were identified by cross-referencing with the National Association of Boards of Pharmacy and LegitScript databases.
RESULTS: Of the 262 websites recommended in the AI-generated search results, 47.33% (124/262) belonged to active online pharmacies, with 31.29% (82/262) leading to legitimate ones. However, 19.04% (24/126) of Bing Chat\'s and 13.23% (18/136) of Google SGE\'s recommendations directed users to illegal vendors, including for controlled substances. The proportion of illegal pharmacies varied by drug and search engine. A significant difference was observed in the distribution of illegal websites between search engines. The prevalence of links leading to illegal online pharmacies selling prescription medications was significantly higher (P=.001) in Bing Chat (21/86, 24%) compared to Google SGE (6/92, 6%). Regarding the suggestions for controlled substances, suggestions generated by Google led to a significantly higher number of rogue sellers (12/44, 27%; P=.02) compared to Bing (3/40, 7%).
CONCLUSIONS: While the integration of generative AI into search engines offers promising potential, it also poses significant risks. This is the first study to shed light on the vulnerabilities within these platforms while highlighting the potential public health implications associated with their inadvertent promotion of illegal pharmacies. We found a concerning proportion of AI-generated recommendations that led to illegal online pharmacies, which could not only potentially increase their traffic but also further exacerbate existing public health risks. Rigorous oversight and proper safeguards are urgently needed in generative search to mitigate consumer risks, making sure to actively guide users to verified pharmacies and prioritize legitimate sources while excluding illegal vendors from recommendations.

Currently, the illegal wildlife trade is one of the most profitable illegal enterprises in the world. The aim of our study was to determine the situation with respect to wildlife trade in Slovenia, which is mainly a transit country, before changes to the Schengen borders came into effect. The volume of trade is significant but not extensive. The most common endangered species involved in illegal trade in Slovenia are the brown bear, the peregrine falcon, the date mussel, the lady\'s slipper orchid, the common snowdrop, the cyclamen, the sea turtle, the otter, and various reptile species. The smuggling of shells (date shells), ivory (ivory products), certain plants, and various hunting trophies (bears, big cats) has decreased in recent years. Nevertheless, counteracting crimes continues to be important for the conservation of some species in Slovenia, notably the lynx, and for the reduction of poaching. Improvements are needed in the detection and prevention of wildlife crime, especially in light of changes made to the Schengen borders and the consequent inclusion of new trading partners for Slovenia. The lack of people properly trained to identify, detect, and investigate wildlife crime is especially acute.

The current COVID-19 pandemic is causing health and economic crises worldwide, but consequences are worse for those emerging countries with poor sanitary conditions struggling against economic recessions. Small-scale artisanal fishers (SSAF) should be considered among the \"essential workers\" since they provide food services; however, the COVID-19 might have altered the normal livelihood and reduced people economic incomes in an already marginalized sector. This situation highlights the fishers\' vulnerability, derived from changes in fish stocks caused by climate change, pollution, overharvesting, and informal work (illegal, unreported and unregulated fishing). Therefore, the so-called \"new normality\" raises big questions about the management of coastal areas and fisheries in developing countries. As a study case, we proposed exploring SSAF from an Argentinian estuary, the Bahía Blanca estuary (SW Atlantic Ocean). Most of them are unregulated after a reconversion program carried out by the local government in 2012. After reviewing the current COVID-19 legislation for coastal fisheries and having virtual encounters with SSAF, we observed they are struggling against the economic crisis caused by the pandemic. According to our observations, imperative measures must be taken to prevent fisheries collapse in the area. In this work, we present a reference point for the post-pandemic management of fisheries that could be considered for emerging public policies.

Though coronary artery disease primarily occurs in those over the age of 40 years, younger individuals who use recreational drugs may be afflicted with coronary events. Cannabis is one such perilous agent that can cause myocardial infarction (MI) and is one of the most common psychoactive drugs used worldwide. Cannabis (also known as marijuana, weed, pot, dope or grass) is the most widely used illegal drug in the UK. The desired euphoric effects are immediate, as are life-threatening hazardous ones. In this article, we briefly describe a case series of two unique but similar cases of cannabis-induced ST-elevation MI witnessed at our hospital in quick succession. We will analyse the composite pathophysiology in acute coronary syndromes provoked by cannabis and discuss the evolving legality around the use of the drug.

In a setting with restrictive firearm laws, prevention of firearm deaths is challenging. Around 100 firearm suicides occur annually in Sweden, representing the most common manner of death from firearm use. In order to explore a possible correlation between firearm suicides and firearm availability, legality of firearm possession, and demographic and geographical factors, all firearm suicides in Sweden among adults during the years 2016-2017 were studied. Data were collected from the National Board of Forensic Medicine and the Swedish Police. In total, 221 firearm suicides were found. Most victims were male (99%) and half (49%) were ≥65 years old. Firearm suicide rates were positively correlated with firearm ownership rates in Swedish counties. Legal firearms (80%) and long-barreled firearms (76%) predominated in the overall material, but illegal firearms were common among young suicide victims (18-29 years) and in urban areas. Prevention work needs to emphasize strategies to reach firearm owners at risk of suicide. Local health and healthcare-related factors, as well as geographic and demographic factors, should be considered in tailoring such strategies.

BACKGROUND: The state of Washington legalized cannabis for adult use in 2012 and retail stores began to open in 2014. While details of the legal market have been tracked by the state, the total market for cannabis and characteristics of purchasers can only be identified through surveys.
METHODS: Six cross-sectional samples of the Privatization of Spirits in Washington (PSW) surveys were collected between January 2014 and October 2016 with two in each year. Random digit dial procedures were used to recruit a sample aged 18 and older, with 40% of cases from mobile phones. A total of 5492 respondents participated. Analyses of the population-weighted sample utilized purchasing amounts and frequencies, use frequency and related measures to estimate total and mean amounts and expenditures. Sensitivity analyses were conducted for key assumptions.
RESULTS: The market for cannabis flower is estimated to have increased from 158 metric tons and $1.23 billion in 2014 to 222 metric tons and $1.7 billion in 2016, with little change from 2014 to 2015. Purchases from legal sources, retail and dispensaries, were estimated at 69% of the total market. Daily or near daily (DND) users accounted for about 83% of sales in 2014, rising to 91% in 2016. The prevalence of past year use rose substantially from 25% in 2014 to 32% in 2016, with DND use rising from 10.2 to 11.3%. Average purchase amounts for DND users rose from 291 g in 2014 to 374 g in 2016, while mean amounts among non-DND users declined from 78 to 28.6 g.
CONCLUSIONS: The expansion of retail cannabis stores in Washington appears to have led to increased market size in 2016 with all of the increase attributed to DND users. Frequent users may be important to consider in legalization evaluations.

Snowmobilers make a grim and significant contribution to avalanche fatality statistics in Norway. However, there is limited knowledge on the behavior of this group in avalanche terrain and the factors influencing this behavior. Our study documents what snowmobilers do and not do in avalanche terrain, how their behavior relates to managing complex avalanche conditions and if there is a mismatch between avalanche competence, education and riding preferences. This ethnographic study observed snowmobiler tracks and thus avalanche terrain usage in Northern Norway during 2018 and 2019, supported by open-ended conversations with target group riders. Results show that high-marking lost popularity to technical riding, which seems to be perceived as safer despite increased exposure to complex avalanche terrain and conditions with persistent weak layers in the snowpack. The detected mismatch between preferences and avalanche knowledge/attitude will remain an obstacle to future accident prevention efforts unless behavioral changes are addressed. This study of a predominantly illegal activity sheds light on how to explore and observe hard-to-reach illegal activities and should be of interest to a wider audience from other research disciplines.

Objective. Currently, there is no set of accreditation standards for integrating the dangers of illegal online pharmacies into Doctor of Pharmacy (PharmD) curricula. As a result, many pharmacists are unable to recognize the differences between a legal and illegal online pharmacy or educate patients on the dangers of online pharmacies. The objectives of this study were to assess gaps in student pharmacists\' knowledge and to assess the impact of adding education regarding online pharmacies into PharmD programs.Methods. A pre- and postsurvey design was developed. Data were collected through an electronic questionnaire distributed to second-year pharmacy (P2) students to evaluate student knowledge gaps at baseline and after education on illegal online pharmacies.Results. A total of 102 students responded to the presurvey, with 93 (91%) consenting to participate. Out of 100 respondents to the postsurvey, 84 (84%) students consented. Approximately 87% (81/93) of respondents indicated some awareness of prescription medications being purchased online. Most students (89%, 77/86) stated that they do not believe the university has provided adequate curriculum on illegal online pharmacies and counterfeit medications. After receiving education on the relevant topics, 64% (55/85) stated they now felt their education was adequate.Conclusion. Although pharmacy students were aware of the existence of illegal online pharmacies, they were not aware of the significance of this patient safety issue or how to accurately identify suspicious websites. It is imperative that PharmD programs incorporate formal education on the risks that illegal online pharmacies pose to patient and medication safety.

The 1951 Refugee Convention and the 1967 Protocol are the only binding international instruments under which the parties of the instruments agree to protect refugees. However, there are gaps in the existing protection mechanisms for refugees at sea. Moreover, the South East Asian States are non-parties to the 1951 Refugee Convention; the States argue that they have no treaty obligation to accept Rohingya boat refugees. In this context, this article revisits the traditional view of \'soft laws\', suggesting a fresh look at \'soft laws\' regarding boat refugees. This article argues that even though the States are non-parties to international refugee law, the South East Asian States are members of the UN General Assembly, IMO, and ExCom. These international bodies have adopted numerous resolutions, guidelines and conclusions on refugee protection at sea; therefore, the States have international obligations to boat refugees according to Article 38(1)(C) of the Statute of the International Court of Justice 1945, the general principle of international law.