Merci Ujeneza, Jessica Tardif, Erin Thompson, Adina Badea, Alexis Morales, Cole Altomare-Jarczyk, Traci C. Green, Rachel Serafinski, Michelle McKenzie, Ju Nyeong Park
Introduction
The illicit drug supply constantly fluctuates, with new adulterants and unexpected mixtures creating uncertainty. Point-of-care drug-checking services are vital in reducing overdose risk and other harms by providing real-time analysis, harm reduction education and links to care. This study aimed to characterise the local drug supply using Fourier transform infrared (FTIR) spectroscopy, complemented by Liquid Chromatography-Quadrupole time-of-flight Mass Spectrometry (LC-QToF-MS) for additional context, from drug residues collected through a drug-checking program within a Rhode Island harm reduction site.
Methods
From January to May 2023, 100 samples were analysed using FTIR and sent for additional qualitative and semi-quantitative testing via LC-QToF-MS. Substances detected by both methods were summarised by prevalence, mixture composition and alignment with self-reported drug categories.
Results
Fentanyl (53%) and cocaine (48%) were the most prevalent substances detected by FTIR, followed by xylazine (10%) and methamphetamine (8%). Cross-category analysis revealed cocaine in 36% of opioid-reported samples and fentanyl in 3% of self-reported cocaine samples, underscoring the mixed nature of the supply. We found the local fentanyl supply (n = 57) showed high variability, with 15 additional components detected by FTIR, including xylazine (19.3%).
Discussion and Conclusions
These findings provide a snapshot of the unpredictable and highly mixed nature of the Rhode Island drug supply defined by stimulant-opioid overlaps, xylazine adulteration and the presence of cocaine across drug categories. By pairing real-time FTIR with laboratory-based analysis, we provided actionable information back to service users while also uncovering deeper patterns in local drug trends.
{"title":"Point-Of-Care Drug-Checking: Assessing the Rhode Island Drug Supply Using FTIR Spectroscopy to Detect Fentanyl, Xylazine and Other Substances","authors":"Merci Ujeneza, Jessica Tardif, Erin Thompson, Adina Badea, Alexis Morales, Cole Altomare-Jarczyk, Traci C. Green, Rachel Serafinski, Michelle McKenzie, Ju Nyeong Park","doi":"10.1111/dar.70037","DOIUrl":"10.1111/dar.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The illicit drug supply constantly fluctuates, with new adulterants and unexpected mixtures creating uncertainty. Point-of-care drug-checking services are vital in reducing overdose risk and other harms by providing real-time analysis, harm reduction education and links to care. This study aimed to characterise the local drug supply using Fourier transform infrared (FTIR) spectroscopy, complemented by Liquid Chromatography-Quadrupole time-of-flight Mass Spectrometry (LC-QToF-MS) for additional context, from drug residues collected through a drug-checking program within a Rhode Island harm reduction site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January to May 2023, 100 samples were analysed using FTIR and sent for additional qualitative and semi-quantitative testing via LC-QToF-MS. Substances detected by both methods were summarised by prevalence, mixture composition and alignment with self-reported drug categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fentanyl (53%) and cocaine (48%) were the most prevalent substances detected by FTIR, followed by xylazine (10%) and methamphetamine (8%). Cross-category analysis revealed cocaine in 36% of opioid-reported samples and fentanyl in 3% of self-reported cocaine samples, underscoring the mixed nature of the supply. We found the local fentanyl supply (<i>n</i> = 57) showed high variability, with 15 additional components detected by FTIR, including xylazine (19.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>These findings provide a snapshot of the unpredictable and highly mixed nature of the Rhode Island drug supply defined by stimulant-opioid overlaps, xylazine adulteration and the presence of cocaine across drug categories. By pairing real-time FTIR with laboratory-based analysis, we provided actionable information back to service users while also uncovering deeper patterns in local drug trends.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"1866-1874"},"PeriodicalIF":2.6,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matheus De Carlos Oliveira, Marília Mendes-Sousa, Luís Eduardo Soares-Santos, Juliana Y. Valente, Sheila C. Caetano, Zila M. Sanchez
Issues
This systematic review of community-based environmental prevention strategies seeks to understand their characteristics, examine their effectiveness and identify challenges for preventing alcohol use among adolescents.
Approach
A comprehensive search was conducted in MEDLINE/PubMed, Scopus and PsycINFO through December 2024. Eligible studies were randomised or quasi-experimental designs targeting individuals under 21 years, evaluating environmental interventions (regulatory, physical or economic) with outcomes related to underage alcohol consumption and access. Two reviewers independently selected studies, extracted data and assessed risk of bias using the RoB 2 and ROBINS-I tools.
Key Findings
Regulatory strategies were the most frequent (94%; 15/16), followed by physical strategies (37%; 6/16). The most reported outcome was a reduction in alcohol availability (62%; 10/16), followed by a general reduction in consumption (37%; 6/16). Although 69% (11/16) of the studies reported positive effects, heterogeneity in study designs and terminology limited comparability. It is crucial to note that community mobilisation, although not an environmental strategy per se, was described in 81% (13/16) of the studies.
Implications
The analysis indicates that the effectiveness and sustainability of environmental interventions are strongly associated with their integration with community mobilisation. This synergy, however, introduces methodological complexity, making it difficult to analyse components in isolation and to standardise evaluation.
Conclusions
The findings reaffirm the value of environmental interventions, particularly regulatory ones, in preventing alcohol use among adolescents. The most promising model is multicomponent, combining actions that modify the environment with robust processes of community participation, forming an adaptable and holistic framework to promote sustainable outcomes.
{"title":"Community-Based Environmental Interventions to Prevent Alcohol Use in Adolescents: A Systematic Review","authors":"Matheus De Carlos Oliveira, Marília Mendes-Sousa, Luís Eduardo Soares-Santos, Juliana Y. Valente, Sheila C. Caetano, Zila M. Sanchez","doi":"10.1111/dar.70038","DOIUrl":"10.1111/dar.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Issues</h3>\u0000 \u0000 <p>This systematic review of community-based environmental prevention strategies seeks to understand their characteristics, examine their effectiveness and identify challenges for preventing alcohol use among adolescents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>A comprehensive search was conducted in MEDLINE/PubMed, Scopus and PsycINFO through December 2024. Eligible studies were randomised or quasi-experimental designs targeting individuals under 21 years, evaluating environmental interventions (regulatory, physical or economic) with outcomes related to underage alcohol consumption and access. Two reviewers independently selected studies, extracted data and assessed risk of bias using the RoB 2 and ROBINS-I tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>Regulatory strategies were the most frequent (94%; 15/16), followed by physical strategies (37%; 6/16). The most reported outcome was a reduction in alcohol availability (62%; 10/16), followed by a general reduction in consumption (37%; 6/16). Although 69% (11/16) of the studies reported positive effects, heterogeneity in study designs and terminology limited comparability. It is crucial to note that community mobilisation, although not an environmental strategy per se, was described in 81% (13/16) of the studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications</h3>\u0000 \u0000 <p>The analysis indicates that the effectiveness and sustainability of environmental interventions are strongly associated with their integration with community mobilisation. This synergy, however, introduces methodological complexity, making it difficult to analyse components in isolation and to standardise evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings reaffirm the value of environmental interventions, particularly regulatory ones, in preventing alcohol use among adolescents. The most promising model is multicomponent, combining actions that modify the environment with robust processes of community participation, forming an adaptable and holistic framework to promote sustainable outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"2041-2056"},"PeriodicalIF":2.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Griffiths, Charles Parry, Atul Ambekar, Balasingam Vicknasingam, Abel Basutu, Bronwyn Myers, Alessandra Bo, Paul Dietze, Ken Douglas, Nadine Ezard, Mauricio Fiore, Marya Hynes, Christopher M. Jones, Pamela Kent, Jane Mounteney, Kamran Niaz, Klaudia Palczak, Antonio Pascale, Amy Peacock, Marta Rychert, Lela Sturua, Yong-an Zhang
<p>Globalisation, developments in information technology, and social and demographic changes are profoundly impacting the modern world [<span>1</span>]. They have also resulted in an illicit drug market that is more dynamic, complex and globally connected [<span>2</span>]. Drug consumption patterns are rapidly changing, with synthetic drugs, controlled psychoactive substances and poly substance use all playing a greater role [<span>3</span>]. These developments are impacting both the nature and the scale of associated health problems. Moreover, there are concerns that the pace of change may be rapidly growing in those parts of the world in which our current capacity to collect information is least developed [<span>4</span>]. Approaches to drug monitoring need to be timelier, better coordinated across jurisdictions and more digitally enabled to keep pace with the challenges we are facing in this area [<span>5</span>]. These were the conclusions from a recent informal technical meeting on the state of global drug surveillance held in the margins of the Lisbon Addictions 2024 Conference. A group of experts from different parts of the world met to critically review current monitoring capacity and to discuss what developmental actions were needed to better meet the needs of policy and practice in this area. The meeting focused on sharing innovations in methodology and insights on drug trends and new developments. The experts reviewed the current drug situation in South America, the Caribbean, North America, Africa, Europe, Asia and Oceania. From this meeting, it was evident that despite considerable heterogeneity in monitoring capacity, all regions now faced similar challenges in respect to the need to develop systems that could rapidly respond to the growing sophistication of drug markets and complexity in drug consumption patterns.</p><p>More specifically, the group concluded that there is now greater diversity in the range of drugs being used, with both long-established synthetic drugs like methamphetamine as well as more novel substances—now playing a more prominent role. A characteristic of many modern drug markets is that producers are constantly innovating, leading to the appearance of new substances which can elude routine detection using existing approaches [<span>6</span>]. At the same time, the simultaneous use of multiple drugs continues to complicate monitoring efforts and challenge public health responses [<span>7, 8</span>]. Interactions between drugs commonly used together can have important implications for public health, but tracking trends in patterns of poly-substance use is methodologically challenging [<span>9</span>]. Relying on self-reported data alone has become more problematic as consumers may be unaware of or misinformed about the drug or drug combinations they are consuming [<span>3</span>]. As a result, some regions have expanded their established approaches to drug monitoring to include forensic or toxicological chemical
{"title":"The Need to Revitalise Drug Use Monitoring to Keep Pace With a More Dynamic, Digitally Enabled and Globally Connected Drug Market","authors":"Paul Griffiths, Charles Parry, Atul Ambekar, Balasingam Vicknasingam, Abel Basutu, Bronwyn Myers, Alessandra Bo, Paul Dietze, Ken Douglas, Nadine Ezard, Mauricio Fiore, Marya Hynes, Christopher M. Jones, Pamela Kent, Jane Mounteney, Kamran Niaz, Klaudia Palczak, Antonio Pascale, Amy Peacock, Marta Rychert, Lela Sturua, Yong-an Zhang","doi":"10.1111/dar.70029","DOIUrl":"10.1111/dar.70029","url":null,"abstract":"<p>Globalisation, developments in information technology, and social and demographic changes are profoundly impacting the modern world [<span>1</span>]. They have also resulted in an illicit drug market that is more dynamic, complex and globally connected [<span>2</span>]. Drug consumption patterns are rapidly changing, with synthetic drugs, controlled psychoactive substances and poly substance use all playing a greater role [<span>3</span>]. These developments are impacting both the nature and the scale of associated health problems. Moreover, there are concerns that the pace of change may be rapidly growing in those parts of the world in which our current capacity to collect information is least developed [<span>4</span>]. Approaches to drug monitoring need to be timelier, better coordinated across jurisdictions and more digitally enabled to keep pace with the challenges we are facing in this area [<span>5</span>]. These were the conclusions from a recent informal technical meeting on the state of global drug surveillance held in the margins of the Lisbon Addictions 2024 Conference. A group of experts from different parts of the world met to critically review current monitoring capacity and to discuss what developmental actions were needed to better meet the needs of policy and practice in this area. The meeting focused on sharing innovations in methodology and insights on drug trends and new developments. The experts reviewed the current drug situation in South America, the Caribbean, North America, Africa, Europe, Asia and Oceania. From this meeting, it was evident that despite considerable heterogeneity in monitoring capacity, all regions now faced similar challenges in respect to the need to develop systems that could rapidly respond to the growing sophistication of drug markets and complexity in drug consumption patterns.</p><p>More specifically, the group concluded that there is now greater diversity in the range of drugs being used, with both long-established synthetic drugs like methamphetamine as well as more novel substances—now playing a more prominent role. A characteristic of many modern drug markets is that producers are constantly innovating, leading to the appearance of new substances which can elude routine detection using existing approaches [<span>6</span>]. At the same time, the simultaneous use of multiple drugs continues to complicate monitoring efforts and challenge public health responses [<span>7, 8</span>]. Interactions between drugs commonly used together can have important implications for public health, but tracking trends in patterns of poly-substance use is methodologically challenging [<span>9</span>]. Relying on self-reported data alone has become more problematic as consumers may be unaware of or misinformed about the drug or drug combinations they are consuming [<span>3</span>]. As a result, some regions have expanded their established approaches to drug monitoring to include forensic or toxicological chemical","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"45 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Winifred Asare-Doku, Amy Peacock, Stella Settumba, Tammy Abbott, Kate Wilson, Adam Craig, Jioji Ravulo, George Economidis, Litea Meo-Sewabu, Catherine D'Este, Poshan Thapa, Christopher Doran, Sally Nathan, Emily Waller, Trevor Satour, Lorraine Tulele, Michael Farrell, Anthony Shakeshaft
The Australian Government launched the kava pilot program to ease import regulations on kava, aiming to strengthen cultural and economic ties between Australia and Pacific Island countries. Implemented in two phases, personal importation in 2019 and commercial importation in 2021, the program was accompanied by a concurrent evaluation. The evaluation examined the health, social, cultural and economic impacts of the pilot program on the Australian community. Findings indicate support for the program; however, ongoing monitoring is necessary, especially among groups at risk of harm.
{"title":"Assessing the Early Impact of the Change in the Kava Importation Policy in Australia","authors":"Winifred Asare-Doku, Amy Peacock, Stella Settumba, Tammy Abbott, Kate Wilson, Adam Craig, Jioji Ravulo, George Economidis, Litea Meo-Sewabu, Catherine D'Este, Poshan Thapa, Christopher Doran, Sally Nathan, Emily Waller, Trevor Satour, Lorraine Tulele, Michael Farrell, Anthony Shakeshaft","doi":"10.1111/dar.70039","DOIUrl":"10.1111/dar.70039","url":null,"abstract":"<p>The Australian Government launched the kava pilot program to ease import regulations on kava, aiming to strengthen cultural and economic ties between Australia and Pacific Island countries. Implemented in two phases, personal importation in 2019 and commercial importation in 2021, the program was accompanied by a concurrent evaluation. The evaluation examined the health, social, cultural and economic impacts of the pilot program on the Australian community. Findings indicate support for the program; however, ongoing monitoring is necessary, especially among groups at risk of harm.</p>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"1827-1830"},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many drug health services receive activity-based funding (ABF), which is reliant on accurate data collection to ensure appropriate reimbursement and quality care. This article reports results of a qualitative study commissioned by NSW Health about drug health services clinical staff's experiences in meeting ABF data entry requirements.
Methods
Semi-structured interviews were conducted with drug health services clinical staff (n = 10) to investigate their experiences in meeting ABF data entry requirements.
Results
Participants identified some benefits of an ABF model, but they described many technical and conceptual barriers to complying with ABF data reporting requirements. These included making frequent data entry errors, activity categories not aligning with their interpretation of the work they did, and not always knowing what activities attracted funding.
Discussion and Conclusions
Practical measures to improve compliance include training and quality assurance opportunities, enhanced managerial and administrative support, database enhancements and increased collaboration between clinicians and technicians. Implementing these measures could result in more accurate funding for services and improve patient care.
{"title":"Activity-Based Funding in Alcohol and Other Drug Treatment Services: Clinical Staff Perspectives and Practice Implications","authors":"Ciara Smyth, Kaniz Fatema, kylie valentine, Raquel Lowe, Brett Ross, Eltham Cook, Gilbert Whitton","doi":"10.1111/dar.70033","DOIUrl":"10.1111/dar.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Many drug health services receive activity-based funding (ABF), which is reliant on accurate data collection to ensure appropriate reimbursement and quality care. This article reports results of a qualitative study commissioned by NSW Health about drug health services clinical staff's experiences in meeting ABF data entry requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with drug health services clinical staff (<i>n</i> = 10) to investigate their experiences in meeting ABF data entry requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants identified some benefits of an ABF model, but they described many technical and conceptual barriers to complying with ABF data reporting requirements. These included making frequent data entry errors, activity categories not aligning with their interpretation of the work they did, and not always knowing what activities attracted funding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Practical measures to improve compliance include training and quality assurance opportunities, enhanced managerial and administrative support, database enhancements and increased collaboration between clinicians and technicians. Implementing these measures could result in more accurate funding for services and improve patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"1932-1939"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olajumoke A. Olateju, Tyler Varisco, Scott Weiner, Douglas Thornton
Introduction
Buprenorphine is effective for opioid use disorder (OUD), yet adherence remains suboptimal. This study aimed to identify adherence trajectories, explore their predictors, and assess their association with opioid overdose risk and healthcare costs.
Methods
A retrospective cohort study was conducted using the Merative MarketScan Commercial Database, which includes a nationally representative sample of individuals with private, employer-sponsored health insurance in the United States. We included adults (≥ 16 years) with OUD who initiated and completed at least 30 consecutive days of buprenorphine treatment between July 2017 and June 2019, with a 180-day follow-up. Group-based trajectory modelling identified distinct adherence patterns. Multinomial logistic regression examined predictors of adherence trajectories. A discrete-time survival model estimated the association between adherence and opioid overdose risk, while generalised linear models assessed healthcare costs. Sensitivity analyses, including E-value calculations, evaluated residual confounding.
Results
Among the 5107 individuals (median [Q1-Q3] age in years: 37 [26–47]; 3185 [62.4%] male), three distinct buprenorphine adherence trajectories were identified in the follow-up period: consistent adherence (CA, 49.5%), slow-declining adherence (SDA, 28.0%) and rapidly-declining adherence (RDA, 22.5%) trajectory groups. The mean (95% CI) time to buprenorphine discontinuation among all beneficiaries was 153 (151–155) days. Compared to the CA group, SDA and RDA groups had 2.74 (95% CI 2.71–2.77) and 3.81 (95% CI: 3.76–3.86) times higher opioid overdose risk and $13,670 (95% CI $7644–$19,695) and $19,431 (95% CI $13,632–$25,229) higher healthcare spending, respectively.
Discussion and Conclusions
Consistent adherence to buprenorphine was associated with a lower risk of opioid overdose and reduced healthcare expenditures.
丁丙诺啡对阿片类药物使用障碍（OUD）有效，但依从性仍不理想。本研究旨在确定依从性轨迹，探索其预测因素，并评估其与阿片类药物过量风险和医疗费用的关系。方法：使用Merative MarketScan商业数据库进行回顾性队列研究，该数据库包括具有全国代表性的美国私人雇主赞助的健康保险个人样本。我们纳入了在2017年7月至2019年6月期间开始并完成至少连续30天丁丙诺啡治疗的OUD成人（≥16岁），并进行了180天的随访。基于群体的轨迹模型确定了不同的依从模式。多项逻辑回归检验了依从性轨迹的预测因子。离散时间生存模型估计了依从性与阿片类药物过量风险之间的关系，而广义线性模型评估了医疗成本。敏感性分析，包括e值计算，评估残留混淆。结果：5107例患者（中位年龄[Q1-Q3]: 37岁[26-47岁]，男性3185例[62.4%]）在随访期间发现了三种不同的丁丙诺啡依从性轨迹：一致依从性（CA, 49.5%）、缓慢下降依从性（SDA, 28.0%）和快速下降依从性（RDA, 22.5%）轨迹组。在所有受益人中，丁丙诺啡停药的平均（95% CI）时间为153（151-155）天。与CA组相比，SDA组和RDA组的阿片类药物过量风险分别高出2.74倍（95% CI 2.71-2.77）和3.81倍（95% CI 3.76-3.86），医疗支出分别高出13,670美元（95% CI 7644- 19,695美元）和19,431美元（95% CI 13,632- 25,229美元）。讨论和结论：持续坚持丁丙诺啡与阿片类药物过量风险降低和医疗支出减少有关。
{"title":"Buprenorphine Adherence Trajectories and Their Impact on Opioid Overdose and Healthcare Costs","authors":"Olajumoke A. Olateju, Tyler Varisco, Scott Weiner, Douglas Thornton","doi":"10.1111/dar.70035","DOIUrl":"10.1111/dar.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Buprenorphine is effective for opioid use disorder (OUD), yet adherence remains suboptimal. This study aimed to identify adherence trajectories, explore their predictors, and assess their association with opioid overdose risk and healthcare costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using the Merative MarketScan Commercial Database, which includes a nationally representative sample of individuals with private, employer-sponsored health insurance in the United States. We included adults (≥ 16 years) with OUD who initiated and completed at least 30 consecutive days of buprenorphine treatment between July 2017 and June 2019, with a 180-day follow-up. Group-based trajectory modelling identified distinct adherence patterns. Multinomial logistic regression examined predictors of adherence trajectories. A discrete-time survival model estimated the association between adherence and opioid overdose risk, while generalised linear models assessed healthcare costs. Sensitivity analyses, including E-value calculations, evaluated residual confounding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 5107 individuals (median [Q1-Q3] age in years: 37 [26–47]; 3185 [62.4%] male), three distinct buprenorphine adherence trajectories were identified in the follow-up period: consistent adherence (CA, 49.5%), slow-declining adherence (SDA, 28.0%) and rapidly-declining adherence (RDA, 22.5%) trajectory groups. The mean (95% CI) time to buprenorphine discontinuation among all beneficiaries was 153 (151–155) days. Compared to the CA group, SDA and RDA groups had 2.74 (95% CI 2.71–2.77) and 3.81 (95% CI: 3.76–3.86) times higher opioid overdose risk and $13,670 (95% CI $7644–$19,695) and $19,431 (95% CI $13,632–$25,229) higher healthcare spending, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Consistent adherence to buprenorphine was associated with a lower risk of opioid overdose and reduced healthcare expenditures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"1907-1919"},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sameer Imtiaz, Sami Aftab Abdul, Huan Jiang, Cayley Russell, Farihah Ali, Iesha Henderson, Bernard Le Foll, Tara Elton-Marshall, Brooke Kinniburgh, Jürgen Rehm
Introduction
Canada is in the midst of a crisis featuring drug poisonings. Decriminalisation of personal possession of select illegal drugs was implemented in British Columbia, Canada on 31 January 2023 as one element of a public health response to reduce drug-related harms. We evaluated the short-term impacts of decriminalisation on paramedic responses to opioid poisonings and drug poisoning deaths to detect if there were early signals of change.
Methods
We sourced population-based monthly counts of drug poisonings from the provincial emergency services provider and coroners service to compute total and sex-specific age-standardised rates per 100,000 (January 2015–December 2023 [97 months pre-decriminalisation and 11 months post-decriminalisation]). Generalised additive models in an interrupted time series design were used to evaluate the short-term impacts of decriminalisation on rates of paramedic responses to opioid poisonings and drug poisoning deaths.
Results
Decriminalisation was not associated with an immediate effect (β [95% confidence interval; CI] −0.078 [−0.318, 0.163]) or trend change (β [95% CI] −0.022 [−0.082, 0.037]) in the total rate of paramedic responses to opioid poisonings, nor was it associated with an immediate effect (β [95% CI] −0.165 [−0.477, 0.147]) or trend change (β [95% CI] −0.010 [−0.082, 0.062]) in the total rate of drug poisoning deaths. These findings were consistent after stratification by sex.
Discussion and Conclusions
Decriminalisation of select illegal drugs was not associated with significant changes in drug poisonings in the first 11 months of its implementation. However, the direction of effects was encouraging from a public health standpoint.
{"title":"The Short-Term Impacts of Decriminalisation of Personal Possession of Select Illegal Drugs on Drug Poisonings in British Columbia, Canada (2015–2023)","authors":"Sameer Imtiaz, Sami Aftab Abdul, Huan Jiang, Cayley Russell, Farihah Ali, Iesha Henderson, Bernard Le Foll, Tara Elton-Marshall, Brooke Kinniburgh, Jürgen Rehm","doi":"10.1111/dar.70036","DOIUrl":"10.1111/dar.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Canada is in the midst of a crisis featuring drug poisonings. Decriminalisation of personal possession of select illegal drugs was implemented in British Columbia, Canada on 31 January 2023 as one element of a public health response to reduce drug-related harms. We evaluated the short-term impacts of decriminalisation on paramedic responses to opioid poisonings and drug poisoning deaths to detect if there were early signals of change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We sourced population-based monthly counts of drug poisonings from the provincial emergency services provider and coroners service to compute total and sex-specific age-standardised rates per 100,000 (January 2015–December 2023 [97 months pre-decriminalisation and 11 months post-decriminalisation]). Generalised additive models in an interrupted time series design were used to evaluate the short-term impacts of decriminalisation on rates of paramedic responses to opioid poisonings and drug poisoning deaths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Decriminalisation was not associated with an immediate effect (<i>β</i> [95% confidence interval; CI] −0.078 [−0.318, 0.163]) or trend change (<i>β</i> [95% CI] −0.022 [−0.082, 0.037]) in the total rate of paramedic responses to opioid poisonings, nor was it associated with an immediate effect (<i>β</i> [95% CI] −0.165 [−0.477, 0.147]) or trend change (<i>β</i> [95% CI] −0.010 [−0.082, 0.062]) in the total rate of drug poisoning deaths. These findings were consistent after stratification by sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Decriminalisation of select illegal drugs was not associated with significant changes in drug poisonings in the first 11 months of its implementation. However, the direction of effects was encouraging from a public health standpoint.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"1856-1865"},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natasha Reid, Jayden Logan, Yasmine Wong, Zachary Munn, Chelsea Vanderpeet, Nicole Hayes, the Australian FASD Guidelines Consortium
Introduction
The Australian Guide to the Diagnosis of fetal alcohol spectrum disorder (FASD), developed in 2016, is currently under review. This study aimed to understand how the Guide is used in practice and identify factors influencing its implementation.
Methods
A cross-sectional online survey was conducted with Australian health practitioners involved in the assessment and diagnosis of FASD. The Clinician Guideline Determinants Questionnaire was used. Quantitative data were summarised descriptively and content analysis was applied to open-ended questions.
Results
Of 333 survey sessions, 232 participants consented and 136 completed the survey. Most respondents were paediatricians (n = 54, 37%) or psychologists (n = 49, 33%). Although most clinicians felt confident using the Guide, only 44.1% agreed it clearly described the underlying evidence, and just 21% felt it adequately reflected patient preferences. Key enablers included clear, easy-to-follow guidance (n = 45, 36.3%); ease of access (n = 18, 14.5%) and familiarity with the Guide (n = 14, 11.3%). Common barriers were lack of access to appropriate clinicians, time and cost constraints (n = 25, 24.8%); concerns about the evidence base (n = 16, 15.8%); and lack of familiarity or skills (n = 8, 7.9%).
Discussion and Conclusions
Findings highlight strong clinician engagement with the 2016 Guide but also identify areas for improvement, particularly around evidence transparency and alignment with person-centred care. By engaging with stakeholders and improving guidelines based on clinician feedback, we can improve the quality of care and support for individuals with FASD and their families.
{"title":"Understanding the Determinants of Use of the Australian Guide to Diagnosis of Fetal Alcohol Spectrum Disorder: Informing the Review, Development and Dissemination of New National Clinical Practice Guidelines","authors":"Natasha Reid, Jayden Logan, Yasmine Wong, Zachary Munn, Chelsea Vanderpeet, Nicole Hayes, the Australian FASD Guidelines Consortium","doi":"10.1111/dar.70030","DOIUrl":"10.1111/dar.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Australian Guide to the Diagnosis of fetal alcohol spectrum disorder (FASD), developed in 2016, is currently under review. This study aimed to understand how the Guide is used in practice and identify factors influencing its implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional online survey was conducted with Australian health practitioners involved in the assessment and diagnosis of FASD. The Clinician Guideline Determinants Questionnaire was used. Quantitative data were summarised descriptively and content analysis was applied to open-ended questions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 333 survey sessions, 232 participants consented and 136 completed the survey. Most respondents were paediatricians (<i>n</i> = 54, 37%) or psychologists (<i>n</i> = 49, 33%). Although most clinicians felt confident using the Guide, only 44.1% agreed it clearly described the underlying evidence, and just 21% felt it adequately reflected patient preferences. Key enablers included clear, easy-to-follow guidance (<i>n</i> = 45, 36.3%); ease of access (<i>n</i> = 18, 14.5%) and familiarity with the Guide (<i>n</i> = 14, 11.3%). Common barriers were lack of access to appropriate clinicians, time and cost constraints (<i>n</i> = 25, 24.8%); concerns about the evidence base (<i>n</i> = 16, 15.8%); and lack of familiarity or skills (<i>n</i> = 8, 7.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Findings highlight strong clinician engagement with the 2016 Guide but also identify areas for improvement, particularly around evidence transparency and alignment with person-centred care. By engaging with stakeholders and improving guidelines based on clinician feedback, we can improve the quality of care and support for individuals with FASD and their families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"2080-2090"},"PeriodicalIF":2.6,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jamie Bryant, Anthony Shakeshaft, Nicholas Lintzeris, Paul Haber, Michael Farrell, Joshua Dizon, Megan Freund
Introduction
Understanding the characteristics of individuals seeking treatment for alcohol use is essential for developing effective interventions. This study aimed to: (i) describe the characteristics of individuals accessing treatment at Australian outpatient alcohol and other drug (AOD) treatment centres; and (ii) identify characteristics associated with more harmful alcohol use at treatment commencement.
Methods
Clients from 34 community-based AOD centres completed surveys on demographic, substance use, health-related quality of life and social characteristics. A linear mixed model and two negative binomial models were used to examine factors associated with higher AUDIT scores (indicting more hazardous or harmful alcohol consumption), frequency of drinking days and heavy drinking days in the last 14 days.
Results
Participants (n = 1130) were predominantly male (65%), reported concurrent drug use (62%), self-referred for treatment (57%) and wanted to cease alcohol use completely (42%) or drink moderately (39%). Female gender, unemployment, being a victim or perpetrator of violence, poorer physical and mental health, self-referral and a goal to cease alcohol use were associated with higher AUDIT scores. Those reporting home duties, retirement, disability/carer pension, student or other employment had lower AUDIT scores. Older age, poorer physical and mental health, and treatment in Western Australia and Queensland were associated with more drinking and heavier drinking days. A goal to cease alcohol use was linked to 23% and 17% lower drinking days and heavy drinking days. Self-referral was associated with more heavy drinking days.
Discussion and Conclusion
Individuals seeking treatment for AOD use have diverse needs that should inform tailored and holistic treatment.
{"title":"Factors Associated With Alcohol Use Among Individuals Commencing Treatment at Community-Based Outpatient Treatment Centres in Australia","authors":"Jamie Bryant, Anthony Shakeshaft, Nicholas Lintzeris, Paul Haber, Michael Farrell, Joshua Dizon, Megan Freund","doi":"10.1111/dar.70034","DOIUrl":"10.1111/dar.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Understanding the characteristics of individuals seeking treatment for alcohol use is essential for developing effective interventions. This study aimed to: (i) describe the characteristics of individuals accessing treatment at Australian outpatient alcohol and other drug (AOD) treatment centres; and (ii) identify characteristics associated with more harmful alcohol use at treatment commencement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clients from 34 community-based AOD centres completed surveys on demographic, substance use, health-related quality of life and social characteristics. A linear mixed model and two negative binomial models were used to examine factors associated with higher AUDIT scores (indicting more hazardous or harmful alcohol consumption), frequency of drinking days and heavy drinking days in the last 14 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants (<i>n</i> = 1130) were predominantly male (65%), reported concurrent drug use (62%), self-referred for treatment (57%) and wanted to cease alcohol use completely (42%) or drink moderately (39%). Female gender, unemployment, being a victim or perpetrator of violence, poorer physical and mental health, self-referral and a goal to cease alcohol use were associated with higher AUDIT scores. Those reporting home duties, retirement, disability/carer pension, student or other employment had lower AUDIT scores. Older age, poorer physical and mental health, and treatment in Western Australia and Queensland were associated with more drinking and heavier drinking days. A goal to cease alcohol use was linked to 23% and 17% lower drinking days and heavy drinking days. Self-referral was associated with more heavy drinking days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>Individuals seeking treatment for AOD use have diverse needs that should inform tailored and holistic treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"2066-2079"},"PeriodicalIF":2.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Increasing harms associated with nitrous oxide use have raised concerns, but limited evidence exists to inform harm reduction. This study aimed to identify how nitrous oxide is sourced, the products/forms used, awareness of health risks, engagement in harm reduction and experience of neurological symptoms.
Methods
Data were collected via annual interviews (2021–2023) with cross-sectional convenience samples of Australians who regularly used ecstasy/MDMA and/or other illicit stimulants and reported past 6-month use of nitrous oxide (2021 n = 379; 2022 n = 315; 2023 n = 284).
Results
The most commonly reported source of nitrous oxide in the past 6 months was convenience stores, followed by 24/7 delivery services. Sourcing from these retailers was also associated with heavier use. Reported use of larger cylinders (> 8 g) increased from 6% in 2021 to 26% in 2023. While most respondents demonstrated awareness of neurological risk (e.g., brain damage 63%; nerve damage 20%), only one-fifth identified the risk of Vitamin B12 depletion and 17% were unaware of any risks. Almost one-third (30%) reported limiting use per session, 36% limited frequency and 36% took no precautions. Reports of neurological symptoms rose from 5% in 2021 to 14% in 2023 among cross-sectional samples, with few (n ≤ 5) receiving treatment.
Discussion and Conclusions
Findings suggest increasing use of larger cylinders, alongside increasing neurological harms. Given the evolving regulatory and risk environment, close surveillance of usage and market trends is needed. The findings reinforce the need for balanced regulation and targeted education of retailers, clinicians and consumers to reduce harmful patterns of use and encourage early intervention.
导言：与使用一氧化二氮相关的危害日益增加引起了人们的关注，但现有的减少危害的证据有限。这项研究旨在确定一氧化二氮的来源、使用的产品/形式、对健康风险的认识、参与减少危害和神经系统症状的经历。方法：通过年度访谈（2021-2023）收集数据，这些横断面方便样本是经常使用摇头丸/MDMA和/或其他非法兴奋剂并报告过去6个月使用一氧化二氮的澳大利亚人（2021 n = 379; 2022 n = 315; 2023 n = 284）。结果：过去6个月报告的一氧化二氮最常见的来源是便利店，其次是24/7送货服务。从这些零售商那里采购也与更频繁的使用有关。据报道，大气缸（bbb80 g）的使用率从2021年的6%增加到2023年的26%。虽然大多数受访者表示意识到神经系统风险（例如，脑损伤63%；神经损伤20%），但只有五分之一的人认识到维生素B12缺乏的风险，17%的人不知道任何风险。近三分之一（30%）的人报告限制每次使用，36%的人限制频率，36%的人没有采取预防措施。在横断面样本中，神经系统症状的报告从2021年的5%上升到2023年的14%，接受治疗的病例很少（n≤5）。讨论和结论：研究结果表明越来越多地使用更大的钢瓶，同时增加神经损伤。鉴于不断变化的监管和风险环境，需要密切监测使用情况和市场趋势。研究结果表明，有必要对零售商、临床医生和消费者进行平衡的监管和有针对性的教育，以减少有害的使用模式，并鼓励早期干预。
{"title":"Nitrous Oxide Sourcing, Use and Harms: Insights From Australians Who Use Ecstasy/MDMA and Other Illicit Stimulants","authors":"Jodie Grigg, Simon Lenton, Amy Peacock, Jessamine Soderstrom, Cate King, Natalie Thomas, Rachel Sutherland","doi":"10.1111/dar.70032","DOIUrl":"10.1111/dar.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Increasing harms associated with nitrous oxide use have raised concerns, but limited evidence exists to inform harm reduction. This study aimed to identify how nitrous oxide is sourced, the products/forms used, awareness of health risks, engagement in harm reduction and experience of neurological symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected via annual interviews (2021–2023) with cross-sectional convenience samples of Australians who regularly used ecstasy/MDMA and/or other illicit stimulants and reported past 6-month use of nitrous oxide (2021 <i>n</i> = 379; 2022 <i>n</i> = 315; 2023 <i>n</i> = 284).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most commonly reported source of nitrous oxide in the past 6 months was convenience stores, followed by 24/7 delivery services. Sourcing from these retailers was also associated with heavier use. Reported use of larger cylinders (> 8 g) increased from 6% in 2021 to 26% in 2023. While most respondents demonstrated awareness of neurological risk (e.g., brain damage 63%; nerve damage 20%), only one-fifth identified the risk of Vitamin B12 depletion and 17% were unaware of any risks. Almost one-third (30%) reported limiting use per session, 36% limited frequency and 36% took no precautions. Reports of neurological symptoms rose from 5% in 2021 to 14% in 2023 among cross-sectional samples, with few (<i>n</i> ≤ 5) receiving treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Findings suggest increasing use of larger cylinders, alongside increasing neurological harms. Given the evolving regulatory and risk environment, close surveillance of usage and market trends is needed. The findings reinforce the need for balanced regulation and targeted education of retailers, clinicians and consumers to reduce harmful patterns of use and encourage early intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11318,"journal":{"name":"Drug and alcohol review","volume":"44 7","pages":"2113-2126"},"PeriodicalIF":2.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dar.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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