1
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O'Brien P, Dwyer R, Gleeson D, Cook M, Room R. Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030. Int J Drug Policy 2023; 119:104115. [PMID: 37549594 DOI: 10.1016/j.drugpo.2023.104115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol. METHODS 48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments. RESULTS In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol. CONCLUSION The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.
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Affiliation(s)
- Paula O'Brien
- Melbourne Law School, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia; Centre for Social Research on Alcohol & Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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2
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Cook M, Wilkinson C, Caluzzi G, Duncan T, Dwyer R. Qualitative insights on alcohol and other drug consumption during COVID-19. Drug Alcohol Rev 2022; 41:1263-1266. [PMID: 36050290 PMCID: PMC9537884 DOI: 10.1111/dar.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Claire Wilkinson
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Tristan Duncan
- Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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3
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Cook M, Pennay A, MacLean S, Dwyer R, Mugavin J, Callinan S. Parents' management of alcohol in the context of discourses of 'competent' parenting: A qualitative analysis. Sociol Health Illn 2022; 44:1009-1026. [PMID: 35488431 PMCID: PMC9544359 DOI: 10.1111/1467-9566.13475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/06/2022] [Indexed: 05/25/2023]
Abstract
How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.
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Affiliation(s)
- Megan Cook
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
| | - Amy Pennay
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sarah MacLean
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Robyn Dwyer
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
| | - Janette Mugavin
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sarah Callinan
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
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4
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Wilkinson C, Dwyer R, Kowalski M. News media both represents and acts: Commentary on Howse et al. news media content analysis of Sydney's 'last drinks' laws. Drug Alcohol Rev 2022; 41:575-576. [PMID: 35233850 PMCID: PMC9310760 DOI: 10.1111/dar.13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Claire Wilkinson
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Michala Kowalski
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
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5
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Neale J, Farrugia A, Campbell AN, Dietze P, Dwyer R, Fomiatti R, Jones JD, Comer SD, Fraser S, Strang J. UNDERSTANDING PREFERENCES FOR TYPE OF TAKE-HOME NALOXONE DEVICE: INTERNATIONAL QUALITATIVE ANALYSIS OF THE VIEWS OF PEOPLE WHO USE OPIOIDS. Drugs (Abingdon Engl) 2022; 29:109-120. [PMID: 35813841 PMCID: PMC9268211 DOI: 10.1080/09687637.2021.1872499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Take-home naloxone (THN) is provided to non-medically trained people to reverse potential opioid overdoses. There is an increasing range of effective intramuscular (IM) and intranasal (IN) naloxone devices and this paper explores the types preferred by people who use opioids, using consumer behaviour literature to interpret the findings. Methods Data derive from two unconnected qualitative studies involving audio-recorded semi-structured interviews. Study 1 was conducted in the United States (n=21 users of non-medical/illicit opioids). Study 2 was conducted in Australia (n=42 users of non-medical/illicit or prescribed opioids). Findings Most participants preferred IN naloxone. Preferences were based on the ease, speed, safety and comfort of each device and underpinned by accounts of overdose revivals as being very rushed and frightening situations. Preferences related to complex interactions between the naloxone device ('product'); the knowledge, skills, experience and attitudes of the lay responder ('consumer'), and when, where and how naloxone was to be used ('usage situation'). Conclusions THN programs should offer choice of device when possible and nasal naloxone if resources permit. Asking people which devices they prefer and why and treating them as valued consumers of naloxone products can generate insights that improve future naloxone technology and increase THN uptake and usage.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, King’s College London, London, UK.,Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | | | - Aimee N. Campbell
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Paul Dietze
- Program on Behaviours and Health Risks, Burnet Institute, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Renae Fomiatti
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jermaine D. Jones
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
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6
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Duncan T, Dwyer R, Savic M, Pennay A, MacLean S. 'Super googs on a Zoom, are you kidding me?': The pleasures and constraints of digitally-mediated alcohol and other drug consumption. Drug Alcohol Rev 2021; 41:1293-1303. [PMID: 34875140 DOI: 10.1111/dar.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/17/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The COVID-19 pandemic and associated social restrictions have profoundly shaped the routines, practices and space-times of alcohol and other drug (AOD) consumption. As a part of these transformations, video conferencing services (e.g. Zoom, Whereby) have emerged as popular mediums for socialising and AOD consumption. In this article, we adopt a more-than-human theoretical framework to explore how these online contexts re-shape experiences of AOD consumption. METHODS Data were gathered using a case-study approach, guided by principles of digital ethnography. We 'staged' the online gatherings of three established friendship clusters of adults in Melbourne, Australia, and drew on a discussion guide to elicit accounts of past online AOD encounters during the COVID-19 pandemic. Our thematic analysis was sensitised to the dynamic composition of these encounters and the kinds of relations, practices and affects they enabled and constrained. RESULTS Composed via video conferencing services, AOD consumption afforded distinct pleasures, including enhanced sociality, excitement and momentary reprieves from isolation. Importantly, these effects were not uniform or stable. Participants also navigated various constraints of online AOD consumption while establishing for themselves what substances and associated practices 'fit' within these novel encounters. DISCUSSION AND CONCLUSIONS Our study conveys the importance of digitally-mediated AOD consumption as a site of socialising and pleasure. In so doing, it demonstrates the ways in which AOD consumption was drawn on in the everyday negotiation of health and wellbeing under lockdown conditions. We call for research and policy approaches that are sensitive to the affirmative potentials of digitally=mediated AOD encounters.
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Affiliation(s)
- Tristan Duncan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Sarah MacLean
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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7
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Caluzzi G, Pennay A, Laslett AM, Callinan S, Room R, Dwyer R. Beyond 'drinking occasions': Examining complex changes in drinking practices during COVID-19. Drug Alcohol Rev 2021; 41:1267-1274. [PMID: 34601754 PMCID: PMC8653297 DOI: 10.1111/dar.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022]
Abstract
Introduction ‘Drinking occasions’ are commonly used to capture quantities of alcohol consumed. Yet this standardised terminology brings with it numerous assumptions and epistemological limitations. We suggest that social changes brought on by COVID‐19 restrictions have influenced routines, patterns of time use and drinking practices, highlighting the need to re‐examine how we conceptualise drinking and ‘drinking occasions’ in alcohol research. Methods This analysis draws on data gathered from 59 qualitative interviews conducted during the second half of 2020 with Australian drinkers aged 18 and over. The interviews explored how COVID‐19 restrictions impacted daily practices and alcohol consumption patterns. Findings Participants spoke about their work, study and social routines changing, which influenced the times, timing and contexts of their drinking practices. We separated these shifts into four overarching themes: shifting of structures shaping drinking; the permeability of drinking boundaries; the extension of drinking occasions; and new contexts for drinking. Discussion and Conclusion COVID‐19 restrictions have led to shifts in the temporal boundaries and contexts that would otherwise shape people's drinking, meaning drinking practices may be less bound by structures, norms, settings and rituals. The drinking occasions concept, although a simple tool for measuring how much people drink, has not been able to capture these complex developments. This is a timely consideration given that COVID‐19 may have enduring effects on people's lifestyles, work and drinking practices. It may be useful to examine drinking as practice, rather than just an occasion, in order to better contextualise epidemiological studies going forward.
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Affiliation(s)
- Gabriel Caluzzi
- Centre for Alcohol Policy Research, Trobe University, Melbourne, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, Trobe University, Melbourne, Australia
| | - Anne-Marie Laslett
- Centre for Alcohol Policy Research, Trobe University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, Trobe University, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, Trobe University, Melbourne, Australia.,Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, Trobe University, Melbourne, Australia
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8
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Abstract
Quetiapine, an atypical antipsychotic, is widely used to treat delirium in intensive care units (ICUs). Studies demonstrate its efficacy and favorable safety profile. We report a case of an elderly patient who developed clinical and biochemical evidence of neuroleptic malignant syndrome (NMS) 5 days after quetiapine was commenced. Signs of NMS resolved after discontinuation of quetiapine and administration of dantrolene. Quetiapine-induced NMS has occurred with long-term use in the elderly in the outpatient setting. However, NMS has not previously been reported after treatment of ICU delirium. NMS is an important complication to consider before prescribing quetiapine in the ICU.
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Affiliation(s)
- C Nestor
- From the Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Dublin, Ireland
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9
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Cook M, Dwyer R, Kuntsche S, Callinan S, Pennay A. ‘I’m not managing it; it’s managing me’: a qualitative investigation of Australian parents’ and carers’ alcohol consumption during the COVID-19 pandemic. Drugs: Education, Prevention and Policy 2021. [DOI: 10.1080/09687637.2021.1950125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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10
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Wilkinson C, Dwyer R, Mugavin J, Jackson S. Barriers to addressing alcohol-related harm through planning and licensing systems: A case study from Victoria, Australia. Drug Alcohol Rev 2020; 39:781-784. [PMID: 33222295 DOI: 10.1111/dar.13061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Claire Wilkinson
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Janette Mugavin
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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11
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Wright CJC, Livingston M, Dwyer R, Callinan S. Second, third, fourth COVID-19 waves and the 'pancession': We need studies that account for the complexities of how the pandemic is affecting alcohol consumption in Australia. Drug Alcohol Rev 2020; 40:179-182. [PMID: 33045122 PMCID: PMC7675730 DOI: 10.1111/dar.13188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Michael Livingston
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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12
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Kamal N, Jeerakathil T, Stang J, Liu M, Rogers E, Smith EE, Demchuk AM, Siddiqui M, Mann B, Bestard J, Lang E, Shand E, Benard M, Collins L, Martin K, Hartley C, Reiber M, Valaire S, Mrklas KJ, Hill MD, Allen D, Anderson B, Angelstand J, Anokye E, Antymniuk C, Arsenault N, Ashman B, Baker K, Bakker J, Balenga D, Berg M, Berry LA, Betzner M, Black L, Blain D, Boutilier T, Brady J, Lynn Brewster S, Brown P, Buchynski K, Bugbee E, Bullard M, Burke D, Burnett C, Butcher K, Cackett P, Canham H, Chiovetti A, Chivers L, Cobb C, Cote M, Coutts S, Currie D, Eric Daniels J, Desouza N, Diebert M, Dixon T, Dotchin J, Duckett S, Dustow V, Dwyer R, Dymond M, Edmond C, Eesa M, Elias N, Elliott T, Empson S, Falls L, Forder M, Foreman R, Forsythe D, Fortier T, Fowler L, Franklin S, Garland J, Garon C, Gerl D, Ghauri I, Gough S, Mark KG, Mary-Lou Halabi G, Halldorson S, Harsch J, Hatcher C, Hebner K, Hemsley R, Holloway D, Holman D, Holsworth S, Holton S, Hull G, Hyciek B, Ibach R, Imoukhuede O, Jeal B, Jill D, Johnson M, Jones O, Kabaroff A, Kalashyan H, Kay F, Kaytor P, Keppy T, King P, Kiszszak S, Klick R, Koshurba E, Kruhlak R, Lacasse J, Lane M, Laughs T, Laut-Barss L, Lavalee P, Leclair T, Linden P, Linderman T, Livingstone J, Lodder M, Lundgard K, Lyle E, Mackenzie K, Malarczuk A, Malfair D, Malone J, Manosalva Alzate H, McCann K, McCarthy S, McKenzie M, McRobert L, Meroniuk D, Millar R, Miller R, Mir B, Montpetit J, Morissette J, Morrison L, Murray-Galbraith F, Mydeen F, Namagiri L, Neidig N, Neil G, Newcommon N, Newell C, Nichol C, Norris C, Norton D, Noseworthy S, O’Hara L, O’Neail S, Orr W, Panes E, Panes T, Paradis J, Parry T, Peacock D, Peebles T, Petersen S, Phelps I, Pooley R, Potvin N, Pryor R, Ramsahoye M, Rashead M, Reedyk K, Reynolds D, Rideout S, Rimmer K, Salih E, San Agustin P, Sandbeck D, Sattar S, Sauter N, Schmidt K, Seib E, Selzler J, Sevcik B, Sharman D, Shuaib A, Smith D, Snider B, Snider J, Stander J, Stephenson C, Stewart C, Stoyberg C, Suranyi Y, Tablin M, Taralson C, Throndson J, Traverse K, van der Nest D, Van Mulligan T, Van Vuuren C, Vanderlinde E, Vilneff R, Volk G, Wall K, Wang DJ(T, Warharft D, Watson J, Weir L, Weiss D, Welch D, Winder T, Winsor W, Woudstra D, Youn D, Young L, Zerna C. Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population. Stroke 2020; 51:2339-2346. [DOI: 10.1161/strokeaha.120.029734] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes.
Methods:
A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback.
Results:
Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51–93) to 39.0 minutes (interquartile range, 27–58) for patients treated per guideline (
P
<0.0001). The percentage of patients discharged home from acute care increased from 45.6% to 59.5% (
P
<0.0001); the median 90-day home time increased from 43.3 days (interquartile range, 27.3–55.8) to 53.6 days (interquartile range, 36.8–64.6) (
P
=0.0015); and the in-hospital mortality decreased from 14.5% to 10.5% (
P
=0.0990).
Conclusions:
The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta.
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Affiliation(s)
- Noreen Kamal
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada (N.K.)
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
| | - Thomas Jeerakathil
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (T.J., M.S.)
| | - Jillian Stang
- Data Analytics, Alberta Health Services, Canada (J.S., M.L.)
| | - Mingfu Liu
- Data Analytics, Alberta Health Services, Canada (J.S., M.L.)
| | - Edwin Rogers
- Strategic Management Branch, Government of Saskatchewan, Regina, Canada (E.R.)
| | - Eric E. Smith
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
- Department of Community Health Sciences (E.E.S., K.J.M., M.D.H.), University of Calgary, Alberta, Canada
| | - Andrew M. Demchuk
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
- Department of Radiology (A.M.D., M.D.H.), University of Calgary, Alberta, Canada
| | - Muzaffar Siddiqui
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (T.J., M.S.)
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada (M.S.)
| | - Balraj Mann
- Cardiovascular Health and Stroke, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada (B.M., S.V.)
| | | | - Eddy Lang
- Department of Emergency Medicine (E.L.), University of Calgary, Alberta, Canada
| | - Elaine Shand
- Red Deer Regional Hospital Centre, Alberta, Canada (J.B., E.S.)
| | | | - Lisa Collins
- North Zone, Alberta Health Services, Cold Lake, Canada (L.C.)
| | - Kevin Martin
- Chinook Regional Hospital, Lethbridge, Alberta, Canada (K.M., C.H.)
| | - Corinna Hartley
- Chinook Regional Hospital, Lethbridge, Alberta, Canada (K.M., C.H.)
| | - Marnie Reiber
- Lloydminster Hospital, Lloydminster, Alberta/Saskatchewan, Canada (M.R.)
| | - Shelley Valaire
- Cardiovascular Health and Stroke, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada (B.M., S.V.)
| | - Kelly J. Mrklas
- Department of Community Health Sciences (E.E.S., K.J.M., M.D.H.), University of Calgary, Alberta, Canada
- System Innovation and Programs, Strategic Clinical Networks, Alberta Health Services, Calgary, Canada (K.J.M.)
| | - Michael D. Hill
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
- Department of Community Health Sciences (E.E.S., K.J.M., M.D.H.), University of Calgary, Alberta, Canada
- Department of Radiology (A.M.D., M.D.H.), University of Calgary, Alberta, Canada
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Fomiatti R, Farrugia A, Fraser S, Dwyer R, Neale J, Strang J. Addiction stigma and the production of impediments to take-home naloxone uptake. Health (London) 2020; 26:139-161. [PMID: 32529843 DOI: 10.1177/1363459320925863] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Opioid overdose deaths are a major health issue in Australia and around the world. Programmes to provide opioid consumers with 'take-home' naloxone to reverse overdose exist internationally, but uptake by mainstream health services and consumers remains inconsistent. Researchers have identified a range of important educational, training and logistical impediments to take-home naloxone uptake and distribution, yet they have focused less on the social dynamics that can enhance or limit access, such as stigma. In this article, we also explore impediments to uptake, drawing on qualitative interview data gathered for an Australian research project on take-home naloxone. Mobilising a performative approach to stigma, we argue that overdose and prevention are shaped by the social dynamics of stigma and, as such, responsibility for dealing with overdose, as with take-home naloxone, should also be considered social (i.e. shared among peers, the public, communities and governments). Our interview data illuminate the various ways in which addiction stigma limits the possibilities and capacities of take-home naloxone and overdose prevention. First, we focus on how stigma may impede professional information provision about take-home naloxone by limiting the extent to which it is presented as a matter of interest for all opioid consumers, not just those who consume opioids illicitly. Second, we explore how stigma may limit the scale-up and expansion of programmes and access points. From here, we focus on how stigma co-constitutes the politics of overdose and prevention, rendering take-home naloxone ill-suited to many social settings of overdose. In closing, we point out that stigma is not just a post hoc impediment to access to and use of take-home naloxone but is central to opioid overdose production itself, and to effective prevention. While take-home naloxone is an excellent life-saving initiative, uncritically valorising it may divert attention from broader goals, such as the de-stigmatisation of drug consumption through decriminalisation, and other ambitious attempts to reduce overdose.
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Affiliation(s)
- Renae Fomiatti
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia
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14
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Liu J, Gan Y, Jiang H, Li L, Dwyer R, Lu K, Yan S, Sampson O, Xu H, Wang C, Zhu Y, Chang Y, Yang Y, Yang T, Chen Y, Song F, Lu Z. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occup Environ Med 2019; 76:927-937. [PMID: 31611310 DOI: 10.1136/oemed-2019-105849] [Citation(s) in RCA: 289] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/09/2019] [Accepted: 09/22/2019] [Indexed: 11/04/2022]
Abstract
We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I 2 statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.
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Affiliation(s)
- Jianxin Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Liqing Li
- Department of Management Science and Engineering, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, China
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kai Lu
- Office of Student Affairs, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijiao Yan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Opoku Sampson
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbin Xu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Chang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yudi Yang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Yang
- Department of Nutrition, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yawen Chen
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Lai Joyce Chun K, Olsen A, Taing MW, Clavarino A, Hollingworth S, Dwyer R, Middleton M, Nielsen S. How prepared are pharmacists to provide over-the-counter naloxone? The role of previous education and new training opportunities. Res Social Adm Pharm 2019; 15:1014-1020. [DOI: 10.1016/j.sapharm.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 02/05/2023]
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16
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Olsen A, Lawton B, Dwyer R, Taing MW, Chun KLJ, Hollingworth S, Nielsen S. Why aren't Australian pharmacists supplying naloxone? Findings from a qualitative study. Int J Drug Policy 2019; 69:46-52. [PMID: 31078908 DOI: 10.1016/j.drugpo.2019.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioid overdose is a significant public health issue among people who use pharmaceutical opioids and/or heroin. One response to reducing overdose deaths is to expand public access to naloxone. The Australian Therapeutic Goods Administration down-scheduled naloxone from prescription only (S4) to pharmacist only over-the-counter (OTC, schedule 3) in February 2016. There is little research examining pharmacists' perspectives or experiences of this change. METHODS Thirty-seven semi-structured interviews with Australian community pharmacists were conducted in 2016-2017 to investigate pharmacists' attitudes to and experiences of OTC naloxone. Transcripts were thematically analysed, guided by a broad interest in facilitators and barriers to OTC supply. RESULTS Around half of the pharmacists were aware of the down-scheduling and only two had provided OTC naloxone. Core barriers to pharmacist provision of OTC naloxone included limited understanding of opioid overdose, confusion about the role and responsibilities of pharmacists in providing OTC naloxone, concerns about business, stigma related to people who inject drugs (PWID) and system-level challenges. CONCLUSION Pharmacy provision of OTC naloxone offers an important opportunity to reduce overdose mortality. Our study suggests this opportunity is yet to be realised and highlights several individual- and structural-level impediments hindering the expansion of public access to naloxone via community pharmacies. There is a need to develop strategies to improve pharmacists' knowledge of OTC naloxone and opioid overdose as well as to address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. These need to be addressed at the individual level (training) as well as the system level (information, regulation and supply).
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Affiliation(s)
- Anna Olsen
- National Centre for Epidemiology and Population Health, Australian National University, Acton ACT, 0200, Australia.
| | - Belinda Lawton
- Crawford School of Public Policy, Australian National University, Acton ACT, 0200, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, LaTrobe University, Bundoora Vic, 3086, Australia
| | - Meng-Wong Taing
- School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia; Centre for Optimising Pharmacy Practice-based Excellence in Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Ka Lai Joyce Chun
- School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia
| | - Samantha Hollingworth
- School of Pharmacy, University of Queensland, Brisbane St Lucia, Queensland, 4072, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick New South Wales, 2031, Australia; Monash Addiction Research Centre, Monash University, Frankston, Victoria, 31699, Australia
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Abstract
'Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.
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Affiliation(s)
- Adrian Farrugia
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia
| | - Renae Fomiatti
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Dietze
- Behaviours and Health Risks Programs, Burnet Institute, Melbourne, Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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18
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Olsen A, Dwyer R, Lenton S. Take-home naloxone in Australia and beyond. Drug Alcohol Rev 2018; 37:437-439. [PMID: 29744978 DOI: 10.1111/dar.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Olsen
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
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19
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Dwyer R, Olsen A, Fowlie C, Gough C, van Beek I, Jauncey M, Lintzeris N, Oh G, Dicka J, Fry CL, Hayllar J, Lenton S. An overview of take-home naloxone programs in Australia. Drug Alcohol Rev 2018; 37:440-449. [PMID: 29744980 DOI: 10.1111/dar.12812] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/06/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Take-home naloxone (THN) programs commenced in Australia in 2012 in the Australian Capital Territory and programs now operate in five Australian jurisdictions. The purpose of this paper is to record the progress of THN programs in Australia, to provide a resource for others wanting to start THN projects, and provide a tool for policy makers and others considering expansion of THN programs in this country and elsewhere. DESIGN AND METHODS Key stakeholders with principal responsibility for identified THN programs operating in Australia provided descriptions of program development, implementation and characteristics. Short summaries of known THN programs from each jurisdiction are provided along with a table detailing program characteristics and outcomes. RESULTS Data collected across current Australian THN programs suggest that to date over 2500 Australians at risk of overdose have been trained and provided naloxone. Evaluation data from four programs recorded 146 overdose reversals involving naloxone that was given by THN participants. DISCUSSION AND CONCLUSIONS Peer drug user groups currently play a central role in the development, delivery and scale-up of THN in Australia. Health professionals who work with people who use illicit opioids are increasingly taking part as alcohol and other drug-related health agencies have recognised the opportunity for THN provision through interactions with their clients. Australia has made rapid progress in removing regulatory barriers to naloxone since the initiation of the first THN program in 2012. However, logistical and economic barriers remain and further work is needed to expand access to this life-saving medication.
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Affiliation(s)
- Robyn Dwyer
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Centre for Cultural Diversity and Wellbeing, Victoria University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Anna Olsen
- Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Carrie Fowlie
- Alcohol, Tobacco and Other Drug Association ACT, Canberra, Australia
| | - Chris Gough
- Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australia
| | | | | | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, NSW Health, Sydney, Australia
| | - Grace Oh
- Alcohol and Other Drug and Prevention Services - WA Mental Health Commission, Perth, Australia
| | - Jane Dicka
- Harm Reduction Victoria, Melbourne, Australia
| | - Craig L Fry
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Jeremy Hayllar
- Metro North Hospital and Health Service Alcohol and Drug Service, Queensland Health, Brisbane, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Melbourne, Australia
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20
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Fraser S, Farrugia A, Dwyer R. Grievable lives? Death by opioid overdose in Australian newspaper coverage. International Journal of Drug Policy 2018; 59:28-35. [DOI: 10.1016/j.drugpo.2018.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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21
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MacLean S, Savic M, Pennay A, Dwyer R, Stanesby O, Wilkinson C. Middle-aged same-sex attracted women and the social practice of drinking. Critical Public Health 2018. [DOI: 10.1080/09581596.2018.1495828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
- Department of Community and Clinical Allied Health, La Trobe University, Bundoora, Australia
| | - Michael Savic
- Eastern Health Clinical School, Monash University, Box Hill, Australia
- Turning Point, Eastern Health, Richmond, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Oliver Stanesby
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - Claire Wilkinson
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
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Dwyer R, Gabbe B, Tran TD, Smith K, Lowthian JA. Patterns of emergency ambulance use, 2009-13: a comparison of older people living in Residential Aged Care Facilities and the Community. Age Ageing 2018; 47:615-619. [PMID: 29688243 DOI: 10.1093/ageing/afy056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE to examine demand for emergency ambulances by older people. DESIGN retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. SETTING Victoria, Australia. PARTICIPANTS people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. MAIN OUTCOME MEASURES rates of emergency ambulance attendance. RESULTS older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. CONCLUSION these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate individual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.
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Affiliation(s)
- R Dwyer
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - B Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - T D Tran
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - K Smith
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
- Ambulance Victoria, 375 Manningham Road, Doncaster, Melbourne, Victoria, Australia
| | - J A Lowthian
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Level 1, 347 Burwood Highway Forest Hill, Melbourne, Victoria, Australia
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23
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Dietze PM, Draper B, Olsen A, Chronister KJ, van Beek I, Lintzeris N, Dwyer R, Nelson M, Lenton S. Does training people to administer take-home naloxone increase their knowledge? Evidence from Australian programs. Drug Alcohol Rev 2018; 37:472-479. [DOI: 10.1111/dar.12680] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/10/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Paul M. Dietze
- Behaviours and Health Risks Program; Burnet Institute; Melbourne Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Bridget Draper
- Behaviours and Health Risks Program; Burnet Institute; Melbourne Australia
| | - Anna Olsen
- Research School of Population Health; Australian National University; Canberra Australia
| | - Karen J. Chronister
- South Eastern Sydney Local Health District; Sydney Australia
- Kirby Institute, UNSW Sydney; Sydney Australia
| | - Ingrid van Beek
- South Eastern Sydney Local Health District; Sydney Australia
- Kirby Institute, UNSW Sydney; Sydney Australia
| | - Nicholas Lintzeris
- South Eastern Sydney Local Health District; Sydney Australia
- Division Addiction Medicine; University of Sydney; Sydney Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts; National Drug Research Institute, Curtin University; Melbourne Australia
- Centre for Cultural Diversity and Wellbeing; Victoria University; Melbourne Australia
- Centre for Alcohol Policy Research; Curtin University; Melbourne Australia
| | - Marina Nelson
- National Drug Research Institute; Curtin University; Perth Australia
| | - Simon Lenton
- National Drug Research Institute; Curtin University; Perth Australia
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Affiliation(s)
- Adrian Farrugia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Fraser
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Robyn Dwyer
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
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25
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Dwyer R, Fraser S. Engendering drug problems: Materialising gender in the DUDIT and other screening and diagnostic ‘apparatuses’. International Journal of Drug Policy 2017. [DOI: 10.1016/j.drugpo.2017.05.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.
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Affiliation(s)
- Steve Matthews
- Plunkett Centre for Ethics, Centre for Moral Philosophy and Applied Ethics, Australian Catholic University (ACU), Institute for Religion and Critical Inquiry (IRCI), 7 Ice Street, Darlinghurst, Sydney, NSW 2010 Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts (SSAC) Research Program, National Drug Research Institute (Melbourne Office), Faculty of Health Sciences, Curtin University, Bentley, Australia
- Centre for Cultural Diversity and Wellbeing, College of Arts, Victoria University, Melbourne, Australia
| | - Anke Snoek
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
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Dwyer R, Fraser S, Dietze P. Benefits and barriers to expanding the availability of take-home naloxone in Australia: A qualitative interview study with service providers. Drugs: Education, Prevention and Policy 2016. [DOI: 10.3109/09687637.2016.1150964] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Persons, substances, bodies, consumption: an ever widening process of “addicting” is underway in Western societies. In this article, we turn our attention to the production of addiction on the microblogging social media platform, Twitter, as an important emerging site in which the addicting of contemporary societies is also occurring. Our analysis explores two questions. First, we investigate the ways in which addiction is enacted via Twitter. How is addiction being made on Twitter? Second, we ask how the technology of Twitter itself is shaping meaning: how do the technological “affordances” of Twitter help constitute the kinds of addiction being materialized? While we find a multiplicity of meanings in the 140-character messages, we also find a pattern: a tendency toward extremes—addiction riven between pain and pleasure. In addition, we find significant areas of commonality between approaches and notable silences around alternatives to common understandings of addiction. We argue that the constraints on communication imposed by Twitter technology afford a “shorthand” of addiction that is both revealing and productive. Illuminated is the importance of addiction as a piece of cultural shorthand that draws on and simultaneously reproduces simplistic, reductive addiction objects. In concluding, we consider what these realities of addiction being enacted through Twitter can tell us about contemporary conditions of possibility for drug use in society and for individual subjectivities and experiences.
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Affiliation(s)
- Robyn Dwyer
- Social Studies of Addiction Concepts Research Program, National Drug Research Institute (Melbourne Office), Faculty of Health Sciences, Curtin University, Australia
| | - Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, National Drug Research Institute (Melbourne Office), Faculty of Health Sciences, Curtin University, Australia
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29
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Dwyer R, Fraser S. Addiction screening and diagnostic tools: ‘Refuting’ and ‘unmasking’ claims to legitimacy. International Journal of Drug Policy 2015; 26:1189-97. [DOI: 10.1016/j.drugpo.2015.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
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Higgs P, Dwyer R, Cogger S, Hellard M, Maher L. Behavioural research to inform understanding of hepatitis C resistance. Lancet Infect Dis 2015; 15:1260-1. [PMID: 26531033 DOI: 10.1016/s1473-3099(15)00352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/23/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Peter Higgs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Fitzroy, VIC 3065, Australia.
| | - Robyn Dwyer
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Fitzroy, VIC 3065, Australia
| | | | | | - Lisa Maher
- Kirby Institute, University of New South Wales Australia, Kensington, NSW, Australia
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Dwyer R, Power R, Denham G, Dietze P. Public injecting and public amenity in an inner-city suburb of Melbourne, Australia. Journal of Substance Use 2014. [DOI: 10.3109/14659891.2014.987834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dwyer R, Bruckard WJ, Rea S, Holmes RJ. Bioflotation and bioflocculation review: microorganisms relevant for mineral beneficiation. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1743285512y.0000000005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dwyer R, Collins DR. Atrial fibrillation: the faulty cement mixer. Ir Med J 2013; 106:261-262. [PMID: 24416845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- R Dwyer
- Age-related Health Care/ Stroke Service, AMNCH, Tallaght, Dublin
| | - D R Collins
- Age-related Health Care/ Stroke Service, AMNCH, Tallaght, Dublin
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Dwyer R, Moore D. Enacting multiple methamphetamines: the ontological politics of public discourse and consumer accounts of a drug and its effects. Int J Drug Policy 2013; 24:203-11. [PMID: 23540297 DOI: 10.1016/j.drugpo.2013.03.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/27/2013] [Accepted: 03/03/2013] [Indexed: 11/26/2022]
Abstract
Over the last decade in Australia, methamphetamine has come to be seen as a significant issue for drug research, policy and practice. Concerns have been expressed over its potency, the increasing prevalence of its use and its potential for producing greater levels, and more severe forms, of harm compared to amphetamine or other drugs. In this article, we critically examine some of the ways in which methamphetamine and its effects are produced and reproduced within and through Australian public discourse, focusing in particular on the associations made between methamphetamine and psychosis. We show how public discourse enacts methamphetamine as an anterior, stable, singular and definite object routinely linked to the severe psychological 'harm' of psychosis. We contrast the enactment of methamphetamine within public discourse with how methamphetamine is enacted by consumers of the drug. In their accounts, consumers perform different methamphetamine objects and offer different interpretations of the relationships of these objects to psychological problems and of the ontological nature (i.e. relating to what is real, what is, what exists) of these problems. In examining public discourse and consumer accounts, we challenge conventional ontological understandings of methamphetamine as anterior, singular, stable and definite, and of its psychological effects as indicative of pathology. In line with recent critical social research on drugs, we draw on social studies of science and technology that focus on the performativity of scientific knowledge and material practices. We suggest that recognising the ontological contingency, and therefore the multiplicity, of methamphetamine offers a critical counterpoint to conventional research, policy and practice accounts of methamphetamine and its psychological effects.
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Affiliation(s)
- Robyn Dwyer
- National Drug Research Institute, Melbourne Office, Curtin University, 54-62 Gertrude St., Fitzroy, VIC 3065, Australia
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Hegarty M, O'Neill W, Colreavy F, Dwyer R, Cunningham P, Hanlon M. Potential organ donor audit in Ireland. Ir Med J 2010; 103:294-296. [PMID: 21560498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
As increasing demand for organs is a challenge for transplant services worldwide it is essential to audit the process of organ donation. To address this, a national audit of potential organ donors was undertaken across hospitals with Intensive Care Units (N = 36). Questionnaires were returned on all patients (n = 2073) who died in these units from 1/9/07-31/8/08; 200 (10%) of these patients were considered for Brain Stem Testing (BST), 158 patients (79%) were diagnosed Brain Stem Dead (BSD) and 138 patients (87%) became potential donors. Consent for donation was given by 92 (69%) next of kin and 90 potential donors (65%) became organ donors. There was no evidence of a large number of potential organ donors being missed. Recommendations included completion of BSTs on all appropriate patients, development of support on BST, referral of all BSD patients to the Organ Procurement Service; enhanced co-ordination within hospitals and sustained information/education campaigns.
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Affiliation(s)
- M Hegarty
- Department of Public Health, HSE Dublin Mid-Leinster, Tullamore, Co Offaly.
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Murray G, Nicholas CL, Kleiman J, Dwyer R, Carrington MJ, Allen NB, Trinder J. Nature's clocks and human mood: the circadian system modulates reward motivation. ACTA ACUST UNITED AC 2009; 9:705-16. [PMID: 19803592 DOI: 10.1037/a0017080] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Existing literature on reward motivation pays scant attention to the fact that reward potential of the environment varies dramatically with the light/dark cycle. Evolution, by contrast, treats this fact very seriously: In all species, the circadian system is adapted to optimize the daily rhythm of environmental engagement. We used 3 standard protocols to demonstrate that human reward motivation, as measured in the dynamics of positive affect (PA), is modulated endogenously by the circadian clock. Under naturalistic conditions, 13.0% of PA variance was explained by a 24-hr sinusoid. In a constant routine protocol, 25.0% of PA variance was explained by the unmasked circadian rhythm in core body temperature (CBT). A forced desynchrony study showed PA to align with CBT in exhibiting circadian periodicity independent of a 28-hr sleep/wake cycle. It is concluded that the circadian system modulates reward activation, and implications for models of normal and abnormal mood are discussed.
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Affiliation(s)
- Greg Murray
- Psychological Science and Statistics, Swinburne University of Technology, Hawthorn, Victoria, Australia.
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Hartmann M, Dwyer R, Kerin M. Analysis of Primary Breast Tumour Stromal Cells and Their Potential Role in Disease Progression. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
It has emerged in recent years that interaction between breast cancer stromal and epithelial cells supports tumour progression through promotion of epithelial cell growth, migration and invasion. Although this is thought to be mediated through both secretion of paracrine factors and cell-cell contact, the precise mechanisms are poorly understood. The aim of this study was to further characterise stromal cells derived from primary breast tumours and potentially elucidate mechanisms through which they exert their action.Following written informed consent, specimens of human breast cancer were harvested from patients undergoing surgery. Cells were isolated from tumour (n=19) and tumour-associated normal (TAN, n=9) regions of breast tissue. Breast tissue obtained from reduction mammoplasty served as normal controls. Following tissue dissociation and digestion, stromal cells were isolated by differential centrifugation. Following culture of stromal cells, RNA was extracted, reverse transcribed and relative quantitative PCR performed using primers targeting Fibroblast Activation Protein (FAP), Transforming Growth Factor β (TGFβ), Transforming Growth Factor β Receptor II (TGFβRII), Matrix Metalloproteinase 3 (MMP3), and Vascular Endothelial Growth Factor A (VEGF A).There was a trend towards increased expression of VEGF A, TGFβRII and MMP3 in tumour compared to normal stromal cells, while the level of TGFβ expression was equivalent in all samples examined. There was a significant positive correlation between expression of the proangiogenic factor VEGF A and TGFβRII (Pearson correlation coefficient r=0.317, p<0.05). There was also a significant positive correlation between expression of FAP and TGFβRII (r=0.404, p<0.05).Tumour stromal cells have the potential to stimulate angiogenesis through secretion of paracrine factors such as VEGF. This proangiogenic factor is a known target of the TGFb signalling pathway. The elevated level of TGFβRII observed in this study may support TGFβ mediated upregulation of VEGF and thus promote tumour angiogenesis. Further characterisation of stromal cells and their impact on epithelial cell genotype and phenotype is critical to identify targets to inhibit initiation of the metastatic cascade.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4163.
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Affiliation(s)
- M. Hartmann
- 1National University of Ireland Galway, Ireland
| | - R. Dwyer
- 1National University of Ireland Galway, Ireland
| | - M. Kerin
- 1National University of Ireland Galway, Ireland
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Newman J, Dwyer R, St-Pierre P, Richards S, Clark M, Rattigan S. Reply from J. Newman, R. Dwyer, P. St-Pierre, S. Richards, M. Clark and S. Rattigan. J Physiol 2009. [DOI: 10.1113/jphysiol.2009.181370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Sweeney R, Conroy AB, Dwyer R, Aitken CK. The economic burden to the public health system of treating non-viral injecting-related injury and disease in Australia (a cost of illness analysis). Aust N Z J Public Health 2009; 33:352-7. [DOI: 10.1111/j.1753-6405.2009.00407.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Salmon AM, Dwyer R, Jauncey M, van Beek I, Topp L, Maher L. Injecting-related injury and disease among clients of a supervised injecting facility. Drug Alcohol Depend 2009; 101:132-6. [PMID: 19167171 DOI: 10.1016/j.drugalcdep.2008.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The process of drug injection may give rise to vascular and soft tissue injuries and infections. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. Supervised injecting facilities (SIFs) seek to address such issues associated with public injecting drug use. AIMS Estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications. DESIGN, SETTING, PARTICIPANTS Self-report data from 9552 injecting drug users (IDUs) registering to use the Sydney Medically Supervised Injecting Centre (MSIC). FINDINGS Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs; 26% (n=2469) reported ever experiencing IRP and 10% (n=972) reported IRID. Prevalence of IRP included difficulties finding a vein (18%), prominent scarring or bruising (14%) and swelling of hands or feet (7%). Prevalence of IRID included abscesses or skin infection (6%), thrombosis (4%), septicaemia (2%) and endocarditis (1%). Females, those who mainly injected drugs other than heroin, and those who reported a history of drug treatment, drug overdose, and/or sex work, were more likely to report lifetime IRID. Frequency and duration of injecting, recent public injecting, and sharing of needles and/or syringes were also independently associated with IRID. CONCLUSIONS IRPs and IRIDs were common. Findings support the imperative for education and prevention activities to reduce the severity and burden of these preventable injecting outcomes. Through provision of hygienic environments and advice on venous access, safer injecting techniques and wound care, SIFs have the potential to address a number of risk factors for IRID.
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Affiliation(s)
- Allison M Salmon
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, New South Wales, Australia.
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Dwyer R, Topp L, Maher L, Power R, Hellard M, Walsh N, Jauncey M, Conroy A, Lewis J, Aitken C. Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users. Drug Alcohol Depend 2009; 100:9-16. [PMID: 19013725 DOI: 10.1016/j.drugalcdep.2008.08.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 08/25/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalences and correlates of non-viral injecting-related injuries and diseases (IRIDs) in Australian injecting drug users (IDUs) remain unknown. METHODS A cross-sectional survey of IDUs was conducted in six sites across Australia's eastern states to investigate IRID experience among Australian IDU. Correlates of IRIDs were explored using logistic and negative binomial regression analyses. RESULTS 393 IDUs were recruited. Lifetime experience of non-serious IRIDs was common (e.g., 'dirty hit' 68%); potentially serious and serious IRIDs were less commonly experienced (e.g., abscess 16%; gangrene <1%). Factors independently associated with potentially serious or serious IRIDs in the previous 12 months were: injecting in sites other than arms (Adjusted Odds Ratio 3.0, 95% confidence interval 1.7-5.4), injecting non-powder drug forms (5.0, 2.2-11.2), unstable accommodation (2.0, 1.1-3.5), being aged 25 years or older (4.3, 1.7-10.6) and not always washing hands before injection (9.3, 2.1-41.8). Factors independently associated with multiple IRIDs in the preceding 12 months were using three or more injecting sites (Adjusted Incidence Rate Ratio 1.5, 95% CI 1.1-2.0), injecting in sites other than arms (1.7, 1.3-2.2), using non-powder drug forms (1.9, 1.4-2.5), injecting daily or more often (1.7, 1.3-2.2), current pharmacotherapy experience (1.5, 1.1-1.9), and not always washing hands before injecting (1.9, 1.2-2.9). DISCUSSION Some IRIDs are widespread among Australian IDUs. Observed associations, particularly the protective effect of handwashing, have useful public health implications.
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Affiliation(s)
- R Dwyer
- Centre for Epidemiology and Population Health Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne 3001, Australia
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Abstract
AIMS To examine the effects of a series of injecting drug users' (IDU) characteristics and drug use behaviours upon the self-reported oral health of a sample of IDU. DESIGN Cross-sectional survey. SETTING Melbourne, Australia. PARTICIPANTS A total of 285 IDU recruited through needle and syringe programmes, snowballing and outreach across six sites. MEASUREMENTS Structured survey that collected information on current drug use patterns, self-reported blood-borne virus status and general health factors, including open-ended questions on past-year dental health problems. FINDINGS Sixty-eight per cent of the sample reported dental problems that were commonly severe and caused dental pain. Despite these reported problems, almost half the sample had not visited the dentist in the 12 months prior to the survey. Participants who were older, and reported homelessness, not eating every day and more common injection of amphetamines rather than heroin in the previous month, were more likely to report having a past-year dental problem. CONCLUSIONS Dental problems in IDUs are common but few receive treatment. Further, those using amphetamines, with poor housing, hygiene and poor nutrition, are most at risk. Programmes designed to improve the oral health of IDU need to be developed and implemented in a manner amenable to the varying social circumstances of this marginalized group in the community.
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Abstract
OBJECTIVE To report on the response rate achieved in a survey of medical practitioners and discuss the reasons for it. METHOD An on-line (internet-based) survey of all 609 registered pharmacotherapy prescribers in Victoria and Queensland; invitations to participate were sent by mail in late April 2007, and one reminder letter in late May 2007. RESULTS Six hundred and nine invitation letters were mailed, nine were returned to sender, and 52 questionnaires completed, making the overall response rate 52/600 = 8.7%. The response rate in Queensland was 13.2% (16/121), and in Victoria 7.5% (36/479). CONCLUSIONS Despite utilising sound techniques, our response rate was much lower than those achieved in recent Australian paper-based surveys of medical practitioners. It is possible that the issue being addressed (injecting-related injuries and diseases) was not of high priority for many invitees, leading to reduced response. IMPLICATIONS On-line surveys are not yet an effective method of collecting data from Australian medical practitioners; researchers should continue to use paper questionnaires for maximum response.
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Affiliation(s)
- Campbell Aitken
- Centre for Epidemiology and Population Health Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.
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Wright E, Brew B, Arayawichanont A, Robertson K, Samintharapanya K, Kongsaengdao S, Lim M, Vonthanak S, Lal L, Sarim C, Huffam S, Li P, Imran D, Lewis J, Lun WH, Kamarulzaman A, Tau G, Ali ST, Kishore K, Bain MP, Dwyer R, McCormack G, Hellard M, Cherry C, McArthur J, Wesselingh S. Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region. Neurology 2008; 71:50-6. [DOI: 10.1212/01.wnl.0000316390.17248.65] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dwyer R. Privileging pleasure: temazepam injection in a heroin marketplace. Int J Drug Policy 2007; 19:367-74. [PMID: 17997090 DOI: 10.1016/j.drugpo.2007.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 08/30/2007] [Accepted: 09/12/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pleasure and its pursuit provide the key explanatory frame in this ethnographic analysis of temazepam injection among a set of drug injectors who enthusiastically embrace high-risk practices. The foregrounding of pleasure challenges key assumptions of harm reduction: namely, the 'rational' subject and the privileging of health as a universal good. In this paper I problematise the concepts of pleasure and conventional understandings of rationality. Interrogating these concepts through the actions and accounts of temazepam injectors, I argue that the model of the subject implicit in harm reduction does not sufficiently account for their everyday social practices. METHODS The paper draws on ethnographic research among heroin user/sellers of Vietnamese ethnicity in a local Australian heroin marketplace. RESULTS Temazepam was used in combination with heroin to enhance the experience of intoxication. Intense intoxication was desired for the pleasurable bodily sensations and emotional feelings it produced. The transgressive and dangerous nature of the practice added to its pleasure. Injection of temazepam capsules was also one of the practices constituting as well as expressing central social and cultural processes of heroin use in this particular social field. CONCLUSION Despite embodied awareness of the harms associated with temazepam injection, these people were prepared to sacrifice 'health' for the pleasures they perceived to be afforded by injecting the gel capsules. My ethnographic analysis suggests that if harm reduction is to respond to high-risk practices such as these, then attention needs to be paid to the pleasures people derive from their practices, and to the social and cultural values these constitute and express.
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Affiliation(s)
- Robyn Dwyer
- National Drug Research Institute, Curtin University of Technology, Perth, Australia.
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Potter-Beirne S, Dwyer R, Kerin M. 2019 POSTER The role of primary stromal cell-derived chemokines in the breast tumour microenvironment. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Larney V, Dwyer R. Hyponatraemic convulsions and fatal head injury secondary to desmopressin treatment for enuresis. Eur J Anaesthesiol 2006; 23:895-7. [PMID: 16953948 DOI: 10.1017/s0265021506241371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2006] [Indexed: 11/07/2022]
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Dwyer R, Ortqvist A, Aufwerber E, Henriques Normark B, Marrie TJ, Mufson MA, Torres A, Woodhead MA, Alenius M, Kalin M. Addition of a macrolide to a ß-lactam in bacteremic pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis 2006; 25:518-21. [PMID: 16896822 DOI: 10.1007/s10096-006-0183-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the study presented here, data collected prospectively from 340 adult patients hospitalised in five countries with bacteremic pneumococcal CAP and treated with a ss-lactam +/- a macrolide were analysed retrospectively to evaluate the efficacy of this antimicrobial combination. Univariate and multivariate analyses revealed no significant effect on case fatality rate when a macrolide/ss-lactam regimen was used as initial therapy. Results were not affected by severity of illness, or by excluding patients who died within 2 days of admission. Identified predictors of death in a multivariate regression model were age >65 years (OR=2.6), two or more lung lobes affected (OR=2.2), and severity of disease as estimated using the acute physiology score (APS)>8.
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Affiliation(s)
- R Dwyer
- Department of Medicine, Infectious Disease Unit, Karolinska University Hospital, 14186 Stockholm, Sweden.
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Rohan D, Dwyer R, Costello J, Phelan D. Audit of Mobile Intensive Care Ambulance Service. Ir Med J 2006; 99:76-8. [PMID: 16700258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The transfer of critically ill patients between hospitals carries significant risk. The Mobile Intensive Care Ambulance Service (MICAS) in Ireland was established in 1996 to provide a ground transfer service between hospitals for critically ill patients. The aim of this audit was to determine if a centralised retrieval system for interhospital transport of critically ill patients in Ireland by MICAS is safe and efficient. 484 critically ill patients transported by MICAS between April 1996 and December 2004 were studied retrospectively. There were no patient deaths during transfer. 47% of transfers were between hospitals in the greater Dublin area. 45% were from regional centres to Dublin. 93% of patients required airway intervention before transfer (intubation or tracheostomy) and 32% needed inotropic support during transfer. The MICAS data confirm the demand for interhospital transport of critically ill patients and suggest that transfer using a centralised retrieval system is safe.
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Affiliation(s)
- D Rohan
- Department of Anesthesia and Intensive Care Medicine, Beaumont Hospital, Dublin 9, Ireland
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Lane A, Baggot M, Power M, Dwyer R. Benchmarking outcome in ICU. Ir Med J 2005; 98:213-5. [PMID: 16185019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
There are as yet few well developed systems for comparing the quality of care in Irish hospitals with other hospitals either nationally or internationally. The best known are the perinatal mortality rates of the Dublin maternity hospitals. Other examples include mortality rates after cardiac surgery and survival rates after cancer surgery. We describe a comparison of outcomes in an Irish ICU with internationally validated mortality rates for a given severity of illness. The method of stratifying for severity of illness is by use of the APACHE II scoring system. In 2003 the standardised mortality ratio for Beaumont Hospital ICU was 0.87 with a mean APACHE II admission score of 17.5 which compares favourably with similar data produced from UK units.
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Affiliation(s)
- A Lane
- Department of Anaesthesia and Intensive Care, Beaumont Hospital, Dublin 9.
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