Addiction最新文献

Background and aims: Tobacco control policies enhance cardiovascular health at the population level, but their effects on high-risk individuals, such as those with type 2 diabetes mellitus (T2DM) or hypertension, remain unclear. This study evaluated the association between a tobacco control policy and hospital admissions for stroke and acute myocardial infarction (AMI) in hypertensive and T2DM individuals.

Design: Interrupted time series study.

Setting: Beijing, China.

Participants: 2 144 133 hypertensive and 1 446 750 T2DM patients residing in Beijing from January 2013 to June 2017.

Intervention: A comprehensive tobacco control policy package, incorporating all MPOWER components, was implemented in June 2015.

Measurements: Changes in admission rates and admissions for stroke and AMI.

Findings: Patients with T2DM showed immediate decreases in stroke [-9.4% (95% confidence interval = -13.3% to -5.3%)] and AMI [-24.3% (-31.2% to -16.7%)] admission rates after the policy. Similarly, the immediate post-policy change in stroke and AMI admission rates for hypertensive patients was -7.5% (-10.9% to -3.9%) and -23.0% (-29.2% to -16.3%), respectively. However, these reductions did not differ from those without either condition (P-interaction >0.05). For long-term trends, significant decreases were only seen for stroke [T2DM: -32.9% (-39.9% to -25.1%); hypertension: -33.3% (-39.3% to -26.7%)], but not AMI admissions, and again did not differ from those without either disease (P-interaction >0.05). Compared with healthy controls without T2DM or hypertension, patients with both conditions showed greater long-term reductions in stroke admission rates [-29.2% (-37.0% to -20.5%) vs. -14.4% (-26.3% to -0.5%), P-interaction = 0.05), whereas the opposite trend was observed for AMI admissions [7.9% (-15.9% to 38.4%) vs. -29.9% (-46.9% to -7.3%), P-interaction = 0.02].

Conclusions: Beijing's 2015 comprehensive tobacco control policy appears to be associated with reduced acute myocardial infarction and stroke admissions among high-risk groups (individuals with type 2 diabetes mellitus and hypertension), although admission rates showed no statistically significant difference between high-risk and non-high-risk populations.

Harding and colleagues [1] recent study contributes to an established body of international evidence [2-6] on the physical harms associated with ketamine use disorder (KUD), including bladder dysfunction, abdominal pain (‘K-cramps’), nasal complications from insufflation and abstinence symptoms such as cravings, low mood, anxiety and irritability. More significantly, the study offers valuable insights into attitudes toward treatment services, revealing widespread reluctance to engage and dissatisfaction among those who did. These findings underscore the need to improve awareness, accessibility and responsiveness of treatment services for individuals with KUD, ensuring they are better aligned with users' needs and expectations.

Rob Ralphs: Writing—review and editing (lead). Janine Day: Writing—review and editing (supporting). Jonathan Dewhurst: Writing—review and editing (supporting).

None.

Background and aims: In public family law cases ('care proceedings'), many mothers return to proceedings after having a child removed. Substance use disorder (SUD) is a common feature in these cases. We used a linked dataset between SUD treatment services and family court to identify: i) the prevalence and estimated time for returning to care proceedings, ii) the characteristics of mothers who returned, and iii) differences in SUD treatment service use between mothers who returned to care proceedings and those who did not.

Design: Retrospective study.

Setting: South London and Maudsley NHS Mental Health Trust (SLaM) catchment area, UK.

Participants: 480 mothers involved in care proceedings with SUD between 2007 and 2019.

Measurements: Substance use treatment records were linked to family court records. Kaplan Meier's time-to-event analysis was used to estimate the probability of returning to court and the recurrence rate. Hazard ratios (95% confidence intervals) were estimated to identify factors using Cox proportional regression analysis.

Findings: Following the completion of the first care proceeding case, one-quarter of the cohort returned to proceedings (n = 119). Of returning mothers, 58.0% returned with a new baby and 52.0% had not received SUD treatment during the first proceedings. The risk of returning was highest within five years and was positively associated with younger maternal age [adjusted hazard ratio (aHR) 0.26, 95% confidence interval (CI) = 0.11-0.61], multiple children in initial proceedings (aHR 2.07, 95% CI = 1.36-3.18) and not receiving SUD treatment during initial proceedings (aHR 0.42, 95% CI = 0.29-0.61). The number of contact events with SUD treatment was not statistically significantly associated with returning to proceedings.

Conclusion: Among mothers receiving treatment for substance use disorder and involved in care proceedings in England, nearly one in four were likely to appear in a subsequent care proceeding case.