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BackgroundIn many countries, HIV pre-exposure prophylaxis (PrEP) users are screened quarterly for STIs. We assessed the consequences of less frequent STI testing. We also assessed determinants of asymptomatic STI and potential for onward transmission.MethodsUsing data from the AMPrEP study, we assessed the proportion of syphilis, and genital, anal, and pharyngeal chlamydia and gonorrhoea diagnoses which would have been delayed with biannual versus quarterly screening. We assessed the potential for onward transmission by examining reported condomless anal sex (CAS) in periods after to-be-omitted visits when screening biannually. We assessed determinants of incident asymptomatic STIs using Poisson regression and calculated individual risk scores on the basis of the coefficients from this model.ResultsWe included 366 participants. Median follow-up was 47 months (IQR 43–50). 1,183STIs were diagnosed, of which 932(79%) asymptomatic. With biannual screening, 483 asymptomatic STIs (52%) diagnoses would have been delayed at 364 study visits. Of these visits, 129 (35%), 240 (66%) and 265 (73%) were followed by periods of CAS with steady, known casual or unknown casual partners, respectively. Older participants had a lower risk of asymptomatic STI (incidence rate ratio (IRR) 0.86/10-year increase, 95% CI 0.80 to 0.92), while CAS with known (IRR 1.36, 95% CI 1.10 to 1.68) and unknown (IRR 1.86, 95% CI 1.48 to 2.34) casual partners and chemsex (IRR 1.51, 95% CI 1.28 to 1.78) increased the risk. The individual risk scores had limited predictive value (sensitivity=0.70 (95% CI 0.66 to 0.74), specificity=0.50 (95% CI 0.48 to 0.51)).ConclusionReducing the STI screening frequency to biannually among PrEP users will likely result in delayed diagnoses, potentially driving onward transmission. Although determinants for asymptomatic STIs were identified, predictive power was low.

Physicians can prescribe medicines for different indications than the tested and authorised ones. Such 'off-label' uses expand therapeutic options but also create uncertainties. The COVID-19 pandemic triggered new off-label uses and, despite issues being reported in the literature, these have not resulted in substantial personal injury litigation in the EU. Against this backdrop, this article argues that civil liability plays, in fact, a limited role in off-label uses. In particular, civil liability may incentivise health actors to follow and react to the development of the evidence basis for off-label uses. However, it is ultimately unable to incentivise the conduct of additional research on off-label uses. This is problematic, as off-label research is key to protecting patients and is recommended by international medical ethics. The article concludes by critically discussing proposed mechanisms to incentivise off-label research. It argues that extending civil liability for unknown risks may have undesired effects on insurability and innovation, and most regulatory proposals seem ineffective. Building on the 2014 Italian reform of off-label uses, the article proposes the establishment of a fund financed by mandatory contributions from the industry, which should be used by pharmaceutical regulators to promote off-label research and develop guidelines for prescribers.

study of the impacts of drug-use, -misuse, and -abuse in Indonesia based on scoping study.

IntroductionStudies related to attitudes toward the use of prohibited substances in Turkish athletes are scarce. The World Anti-Doping Agency (WADA) has implemented anti-doping educational policies emphasizing doping-related education in studies conducted among Turkish wrestlers. However, it is still unclear the extent to which the wrestlers comply and adhere to these anti-doping policies. No research has previously examined the effect of anti-doping education on athletes' mindfulness and moral disengagement in doping (MDD). Therefore, the present study has a two-fold objective: first, to examine whether doping-related education (DRE) and the status of being a national athlete (NA) have an effect on athlete mindfulness and MDD. Second, to analyze the relationship between each sub-dimensions of athlete mindfulness: awareness (ASD), judgment (JSD), and refocus (RSD) with MDD.MethodsA total of 409 male wrestlers participated in this study. MANOVA analysis showed that NA and DRE alone have no effect on MDD but have a general effect on mindfulness.ResultsThe highest effect was on the ASD of being an NA (ηp2 = 0.173). When the interaction effect of NA*DRE was examined, significant difference in MDD (F = 8.218, p = 0.004), ASD (F = 8.476, p = 0.004), JSD (F = 5.844, p = 0.016), and RSD (F = 11.476, p = 0.001) were found. MDD has a weak negative relationship with ASD (r = −0.126) and RSD (r = −0.041) and a weak positive relationship with the JSD sub-dimension (r = 0.140). Those results suggest that being a NA and having received anti-doping education affect moral disengagement in doping and athletes' mindfulness.DiscussionAs a conclusion, it is recommended to increase awareness and anti-doping education among national-standard Turkish wrestlers to prevent them from engaging in doping behaviors.

Qualitative work with students who use prescription medicines for academic purposes is limited. Thus, a more nuanced understanding of tertiary students’ experiences is urgently needed. Our study – which draws on five semi-structured interviews with New Zealand university students, complemented with information from local newspapers, blog entries and discussion forums – reveals students’ motivations and perceived effects, their risk perceptions and provides insights into the circumstances enabling the engagement with prescription medicines for academic purposes. Students were influenced by peers and social norms; and ideas about identity, morality and fairness also played a role for engaging with cognitive enhancers. Students used high levels of stress and workload to justify their use but took individual responsibility for their practices. By taking responsibility in this way, rather than considering it as a product of their environment, they buy into the neoliberal university discourse. Unexpectedly, some participants were already receiving medically justified psychopharmacological treatment but extended and supplemented this with nonmedical use. Others considered their use as being for academic emergencies, and that their low level of use helped manage risks. Overall, students viewed pharmacological cognitive enhancement for improving academic performance as cautious, safe, and morally acceptable. We argue in this paper that a local understanding of students’ motivations, justifications and perceptions of pharmacological cognitive enhancement is required, to tailor policies and support systems better to their needs and behaviours.

Objective: Transcranial direct current stimulation (tDCS) and mindfulness practices have been proposed as a potential approach to improve executive functions (EFs) and reduce craving in persons with substance use disorders. Based on the neural mechanisms of action of each of these interventions, the combination of both non-pharmacological interventions might have additive effects. In the current study, the effects of tDCS combined with mindfulness-based substance abuse treatment (MBSAT) to improve EFs and reduce craving were investigated in early abstinent methamphetamine abuse. Methods: Eighty (youths aged between 18 and 21) early-abstinent methamphetamine users were randomly assigned to the research groups (tDCS group [n = 20], mindfulness group [n = 20], combined mindfulness-tDCS group [n = 20], and sham group [n = 20]). Active tDCS (1.5 mA,20 min, 12 sessions) or sham tDCS was appliedover the left dorsolateral prefrontal cortex and the MBSAT protocol was used over twelve 50-min sessions. Results: Both in the post-test phase (immediately after the intervention) and follow-up phase (one month after the intervention), performance in most EFs tasks significantly improved in the combination group which received real tDCS ＋ MBSAT, as compared to baseline values and sham stimulation group. Similarly, a significant reduction in craving was observed after intervention inall treatment groups, but not the sham stimulation group. Interestingly, the increase in EFs and the reduction in craving post versus pre tDCS ＋ MBSAT intervention were correlated. Conclusion: Findings from the current study provide initial support for the clinical effectiveness of combination tDCS ＋ MBSAT, possibly influencing cognitive/affective processes.

Στόχος της παρούσας εργασίας είναι, μέσω της ανάλυσης βιογραφιών ζωής εξαρτημένων ατόμων, να διερευνηθεί η σχέση ανάμεσα στα τραυματικά γεγονότα ζωής και τα συναισθήματα που τα συνοδεύουν με την έναρξη της χρήσης ουσιών και την πρόωρη εγκατάλειψη του σχολείου. Η ανάλυση βιογραφιών ζωής ατόμων που εισάγονται σε προγράμματα απεξάρτησης του ΚΕΘΕΑ αξιοποιείται προκειμένου να διερευνηθούν οι ερμηνείες και το νόημα που τα ίδια αποδίδουν στις εμπειρίες τους αλλά και να γίνει κατανοητός ο τρόπος κατασκευής ιστοριών ζωής από τη σκοπιά του παρόντος. Μέσα από την ανάλυση δέκα βιογραφιών ζωής τις οποίες καλούνται να συγγράψουν όλα τα άτομα που συμμετέχουν σε θεραπευτική κοινότητα απεξάρτησης, αναζητά την ερμηνεία που τα ίδια τα άτομα δίνουν για τη σχέση ανάμεσα στα τραυματικά γεγονότα ζωής και στην έναρξη της χρήσης ουσιών, τη σχολική αποτυχία και την πρόωρη διακοπή του σχολείου. Με τη μέθοδο της ανάλυσης περιεχομένου προκύπτει ότι σε κάθε αναπτυξιακή φάση αναδύονται συγκεκριμένοι παράγοντες που συνδυάζονται με την πρόωρη εγκατάλειψη του σχολείου και την έναρξη της χρήσης ουσιών και που αφορούν κυρίως δυσμενείς εμπειρίες ζωής κατά την παιδική ηλικία. Η εργασία προτείνει την εφαρμογή προγραμμάτων διά βίου μάθησης και μη τυπικής εκπαίδευσης στο σύνολο της σχολικής κοινότητας για την πρόληψη της σχολικής διαρροής και της χρήσης ουσιών., The aim of the current study is to understand the pathways to drug use and early school dropout in relation to adverse childhood experiences. The study focuses in exploring the meaning that participants themselves give to their experiences through the analysis of their biographies. The current study focuses on the analysis of the biographies that therapeutic community members in a Greek drug-free treatment organization, KETHEA, write upon their entrance in the treatment setting. The study wishes to understand how participants perceive their childhood experiences and especially adverse childhood experiences, in relation to their initiation to drug use and school dropout. Biographies were written by members themselves in a private and quite space and researchers requested access through KETHEA paying particular attention to the issues of confidentiality and ethics. Through the analysis, it was revealed that school dropout and initiation to drug use coincide and are both related with several adverse childhood experiences. These include, neglect and abuse, even sexual abuse by a family member, dysfunctional familial relationships, and several learning and behavioural problems at school. Biographies are analysed per developmental age, that include pre-school years, childhood, early adolescence, middle adolescence, and late adolescence. The study concludes that by middle and late adolescence many behavioural patterns linked to adverse early childhood experiences already develop. The analysis reveals that already in preschool years children experience loneliness, because of neglect and the loss of a loved one. In school years, abuse is often perceived as ‘normal’ given that children do not have positive life experiences of what is like to grow in a caring environment and problems in relation to school attendance and acceptance already surface. In early adolescence, the realization comes that family and life conditions are adverse and many feel rejected from the school environment. In middle adolescence drug and alcohol use are already initiated and school dropout seems a plausible option. In late adolescence drug use is present and other phenomena such as early engagement with sexual behaviour and victimization of others make their appearance. Therefore, the study suggests the significance of the development of early prevention and intervention programmes much earlier than high school.

We examine the typologies of workplaces for sex workers in Dnipro, Ukraine as part of the larger Dynamics Study, which explores the influence of conflict on sex work. We conducted a cross-sectional survey with 560 women from September 2017 to October 2018. The results of our study demonstrate a diverse sex work environment with heterogeneity across workplace typologies in terms of remuneration, workload, and safety. Women working in higher prestige typologies earned a higher hourly wage, however client volume also varied which resulted in comparable monthly earnings from sex work across almost all workplace types. While sex workers in Dnipro earn a higher monthly wage than the city mean, they also report experiencing high rates of violence and a lack of personal safety at work. Sex workers in all workplaces, with the exception of those working in art clubs, experienced physical and sexual violence perpetrated by law enforcement officers and sex partners. By understanding more about sex work workplaces, programmes may be better tailored to meet the needs of sex workers and respond to changing work environments due to ongoing conflict and COVID-19 pandemic.

BackgroundStudies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as thegateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking. This study replicates a cornerstone study revealing a positive association between both adolescent e-cigarette use and subsequent tobacco use; and tobacco and subsequent e-cigarette use in the Netherlands and Flanders.DesignThe longitudinal design included baseline (n=2839) and 6-month (n=1276) and 12-month (n=1025) follow-up surveys among a school-based cohort (mean age: 13.62). Ten high schools were recruited as a convenience sample. The analyses involved (1) associations of baseline e-cigarette use and subsequent tobacco smoking among never smokers; (2) associations of e-cigarette use frequency at baseline and tobacco smoking frequency at follow-up; and (3) the association of baseline tobacco smoking and subsequent e-cigarette use among non-users of e-cigarettes.FindingsConsistent with prior findings, baseline e-cigarette use was associated with higher odds of tobacco smoking at 6-month (OR=1.89; 95% CI 1.05 to 3.37) and 12-month (OR=5.63; 95% CI 3.04 to 10.42) follow-ups. More frequent use of e-cigarettes at baseline was associated with more frequent smoking at follow-ups. Baseline tobacco smoking was associated with subsequent e-cigarette use (OR=3.10; 95% CI 1.58 to 6.06 at both follow-ups).ConclusionOur study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.

Unhealthy behaviors such as use of alcohol and drug usually begin during adolescence. Izmir is on transit route for illicit substance due to geographical situation. Children and adolescents are the most important threatened group in terms of alcohol and substance abuse. In this study, it was aimed to investigate alcohol and substance use profile of children and adolescents in Izmir/Turkey with the toxicological analysis results obtained from Addiction Toxicology Laboratory. Urine and blood samples of 4524 cases at and under the age of 18 years coming from various departments to the laboratory in 2015-2016 were analyzed by enzymatic immunoassay. Information and analysis results of the cases were obtained by retrospective analysis of the hospital system. 83,3% of the cases were male and the mean age was 16,69 +/- 1,63. Alcohol and/or substance use was determined in 13,2% of the cases. Among the cases with positive results of analysis, cannabis (33%) was mostly detected and was followed by amphetamine type stimulants (ATS, 15%), polysubstance use (15%) and alcohol (13%). While cannabis, polysubstance use and ATS were the most common in male, ethyl alcohol, ATS and benzodiazepine were mostly detected in female. There was a significant increase in the substance use rate in 2016 compared to the previous year. A substance use profile was obtained through drug testing in adolescents who are in the risk group for substance use. In this context, our data will be indicative for the development of new and more effective preventive strategies targeting children and adolescents.

IntroductionEvent-driven pre-exposure prophylaxis (edPrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective for preventing HIV acquisition in men who have sex with men (MSM) and is preferred over daily PrEP by some MSM. However, it is largely unknown how well MSM adhere to edPrEP. We then aimed to assess PrEP protection during CAS among MSM using edPrEP and participating in the Amsterdam PrEP demonstration project (AMPrEP).MethodsWe analysed data from participants enrolled in AMPrEP who were taking edPrEP. We measured adherence through (1) a mobile application in which sexual behaviour and PrEP-use were recorded daily, (2) three-monthly self-completed questionnaires and (3) dried blood spot (DBS) samples collected around six, twelve and twenty-four months after PrEP initiation. We assessed the proportion of days with condomless anal sex (CAS) acts that were protected by PrEP, per partner type (i.e. steady partners, known casual partners, unknown casual partners), and the proportion of three-month periods during which PrEP was correctly used. Intracellular TFV-diphosphate (TFV-DP) concentrations were determined from DBS. Good adherence was defined as at least one tablet before and one tablet within 48 hours after a CAS act.ResultsBetween 11 September 2015 and 6 October 2019, 182 of 376 MSM (48.4%) used edPrEP for at least one three-month period. Of the 8224 CAS days that were reported in the app during edPrEP-use, we observed good protection for most CAS days involving steady partners (n = 1625/2455, 66.9%), known casual partners (n = 3216/3472, 92.6%) and unknown casual partners (n = 2074/2297, 90.3%). Men reported consistently correct PrEP-use in 851 (81.4%) of the 1046 three-month periods of edPrEP-use. The median TFV-DP concentration was 591 fmol/sample (interquartile range = 270 to 896).ConclusionsAdherence to edPrEP was high as determined from the online app and questionnaire. DBS measurements were consistent with two to three tablets per week on average.

Introduction: Ecstasy (MDMA) is a popular recreational drug, but its illegal production and trade in the Netherlands have developed into a serious public order and ecological problem which endanger and question the harm reduction approach of the Dutch ecstasy policy.Methods: The market characteristics, adverse health effects, risk profile, and link to criminal activity of ecstasy were reviewed.Results: Ecstasy is often used in combination with other substances (i.e. polydrug use). Compared to several other illicit drugs and alcohol, ecstasy has a very low abuse and dependence liability and, as yet, there is little evidence of long-term harm. A potential health risk associated with ecstasy is acute hyperthermia, however this occurs at an unknown incidence rate and seems to be more prevalent when ecstasy is consumed in combination with heavy exercise at high ambient temperatures or when used in combination with other substances, including alcohol. Organized crime related to the production and trafficking of ecstasy in the Netherlands is a growing problem.Conclusions: This review provides a science-based summary that can be used to assist the public and political debate surrounding future Dutch ecstasy policy to reduce ecstasy-related organized crime while maintaining the principle of harm reduction.

Raising a minimum legal drinking age (MLDA) has generated interest and debate in research and politics, but opposition persists. Up to now, the presentation of impacts focussed on effectiveness (i.e., intended impact); to our knowledge, no literature syntheses focussed on both intended and unintended impacts. A systematic scoping review was conducted in which a search strategy was developed iteratively and literature was obtained from experts in alcohol research and scientific and grey databases. Ninety-one studies were extracted and analysed using formative thematic content analysis. Intended impacts were reported in 119 units of information from the studies (68% positive), forming four paths: implementation, primary and (two) on secondary societal harm and violence. Unintended developments were reported in 43 units of information (30% positive), forming five themes. Only eight studies reported on implementation. Furthermore, a division between primary and secondary paths and the use of a bridging variable (drinking patterns in analyses or methodology) was discovered. These results provide an insight into how well legislation works and can be used to discover or implement new means of curbing underage drinking and alcohol-related violence and harm. They also offer valuable starting points for future research and underline the importance of considering unintended developments.

Objectives Anticholinergic burden defined by the Anticholinergic Risk Scale (ARS) has been associated with cognitive and functional decline. Associations with health-related quality of life (HRQoL) have been scarcely studied. The aim of this study was to examine the association between anticholinergic burden and HRQoL among older people living in long-term care. Further, we investigated whether there is an interaction between ARS score and HRQoL in certain underlying conditions. Design and participants Cross-sectional study in 2017. Participants were older people residing in long-term care facilities (N=2474) in Helsinki. Measurements Data on anticholinergic burden was assessed by ARS score, nutritional status by Mini Nutritional Assessment, and HRQoL by the 15D instrument. Results Of the participants, 54% regularly used ARS-defined drugs, and 22% had ARS scores ≥2. Higher ARS scores were associated with better cognition, functioning, nutritional status and higher HRQoL. When viewing participants separately according to a diagnosis of dementia, nutritional status or level of dependency, HRQoL was lower among those having dementia, worse nutritional status, or being dependent on another person’s help (adjusted for age, sex, comorbidities). Significant differences within the groups according to ARS score were no longer observed. However, interactions between ARS score and dementia and dependency emerged. Conclusion In primary analysis there was an association between ARS score and HRQoL. However, this relationship disappeared after stratification by dementia, nutritional status and dependency. The reasons behind the interaction concerning dementia or dependency remain unclear and warrant further studies.

Identity development has been linked to substance use, however, the directionality of this relationship remains unclear. We examined the longitudinal associations of educational and relational identity with substance use across three annual waves in 360 Dutch adolescents (Mean age = 13.7 years). Using the identity dimensions of commitment, exploration, and reconsideration as indicators, we found three latent profiles clusters: achievement, diffusion, and moratorium. With latent profile transition analysis, we examined substance use as a predictor of profile transition. Using classification probabilities to determine participants’ clusters at each time point, we distinguished three identity transition groups (stable, progressive, and regressive). These groups were used to examine the effects of identity transition group membership on substance use with ANCOVAs. No longitudinal associations were found in either direction, but we found significant cross-sectional correlations between identity and substance use. Therefore, our findings do not support a directional process linking identity and substance use. Instead, these associations suggest a spectrum/continuity or common cause model.

Introduction: Ecstasy (MDMA) is a popular recreational drug, but its illegal production and trade in the Netherlands have developed into a serious public order and ecological problem which endanger and question the harm reduction approach of the Dutch ecstasy policy.Methods: The market characteristics, adverse health effects, risk profile, and link to criminal activity of ecstasy were reviewed.Results: Ecstasy is often used in combination with other substances (i.e. polydrug use). Compared to several other illicit drugs and alcohol, ecstasy has a very low abuse and dependence liability and, as yet, there is little evidence of long-term harm. A potential health risk associated with ecstasy is acute hyperthermia, however this occurs at an unknown incidence rate and seems to be more prevalent when ecstasy is consumed in combination with heavy exercise at high ambient temperatures or when used in combination with other substances, including alcohol. Organized crime related to the production and trafficking of ecstasy in the Netherlands is a growing problem.Conclusions: This review provides a science-based summary that can be used to assist the public and political debate surrounding future Dutch ecstasy policy to reduce ecstasy-related organized crime while maintaining the principle of harm reduction.

Objectives Chemsex-using illicit drugs during sex-is prevalent among men who have sex with men (MSM) and associated with sexual and mental health harms. Sexually transmitted disease (STD) clinics are a frequently visited and trusted health care facility for MSM. This study assessed the frequency and extent to which chemsex is addressed by Dutch STD nurses. Methods Of the 24 Dutch public STD clinics, an online questionnaire was distributed in 20 STD clinics (83%) in 2019; the questionnaire was sent to 191 STD nurses, of whom 108 (57%) completed the questionnaire. The main outcome was addressing chemsex during regular MSM consultations, measured on a 5-point Likert scale (never-always). Items measuring knowledge, attitude, self-efficacy, and the social norm were also measured on a 5-point Likert scale (totally disagree-totally agree). Results Of the 108 participating STD nurses, 77 (71%) addressed chemsex regularly or always during MSM consultations. In general, STD nurses indicated to have sufficient knowledge about chemsex (mean [SD], 3.6 [0.5]) and a positive attitude toward addressing chemsex (mean [SD], 4.3 [0.5]). A need for training on chemsex was reported by 82 (76%) STD nurses, especially in signaling problematic chemsex (56/82; 68%). Three STD clinics (15%) had a protocol on addressing chemsex, and 3 STD clinics (15%) had referral pathways to addiction care. Conclusion Sexually transmitted disease nurses from Dutch STD clinics regularly addressed chemsex during MSM consultations. Our results show relevance of educating STD nurses on signaling problematic chemsex and arranging referral pathways to addiction care to optimize chemsex related health care.

Adolescent hookah pipe use is increasing at a rapid rate, thus posing a major public health concern globally. The hookah pipe is a gateway substance to other substances that may be more harmful. Yet, at present, little is known about why adolescents are so drawn to this mechanism. It is this gap that this study attempted to fill. This study, therefore, aimed to review the determinants of adolescent hookah pipe use. An electronic search of 12 databases identified studies investigating determinants of adolescent hookah pipe use. Twenty-five studies sampling a total of 88,988 adolescents who use the hookah pipe were included. This study found that adolescent hookah pipe use is determined by an interplay of family factors, peer/friends factors, individual factors, school factors, the actual hookah pipe mechanism, advertisements, and awareness of hookah pipe lounges or bars. Prevention and early intervention strategies aimed at reducing adolescent hookah pipe use is needed.

ObjectivesContinuing high STI positivity among men who have sex with men (MSM) attending centres for sexual health (CSH) indicates that high-risk behaviour is ongoing. The objective of this study was to gain a better insight into risk behaviours among MSM attending CSH and to explore STI and HIV positivity by subgroups.MethodsWe used national data routinely collected during CSH consultations for this study. From September to December 2017, questions on group sex, substance use and sex with HIV-positive partners were asked at each CSH consultation. We analysed latent classes of client-related factors and sexual risk behaviour among MSM attending CSH in this period. We examined STI positivity and prevalence ratios by latent classes.ResultsA total of six classes were identified in order of increasing risk: ‘overall low-risk behaviour’ (n=2974; 22.0%), ‘Western origin and multiple sex partners’ (MSP) (n=4182; 30.9%), ‘Non-Western origin and MSP’ (n=2496; 18.5%), ‘living with HIV’ (n=827; 6.1%), ‘group sex and HIV-positive partners’ (n=1798; 13.3%) and ‘group sex and chemsex’ (n=1239; 9.2%). The any STI positivity ranged from 14.0% in the overall low-risk behaviour class to 35.5% in the group sex and chemsex class. HIV positivity did not differ significantly between classes. The Western origin and MSP class was largest and accounted for the majority of STI and HIV infections.ConclusionsAlthough STI positivity increased with increased risky behaviours, considerable STI positivity was found in all six latent classes. Comparable HIV positivity between classes indicates risk reduction strategies among subgroups engaged in risky behaviours. The differences in risk behaviour and STI positivity require preventive strategies tailored to each subgroup.

Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in the quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health-care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.

Antimicrobial usage in both human and veterinary medicine is considered one of the main drivers of antimicrobial resistance; its reduction poses a serious challenge. To analyse the associations between usage and resistance, data from monitoring systems and classification of all antimicrobial substances are crucial. In this analysis, we investigated longitudinal data collected between 2013 and 2020 within the Veterinary Consumption of Antibiotics project from pig farms in Germany, including all antimicrobial classes, but focusing on critically important antimicrobials: third- and fourth-generation cephalosporins, fluoroquinolones, macrolides, and polymyxins. Analysing the treatment frequency, we found that a reduction in antimicrobial use in all types of pig production has occurred over time, accompanied by a rising percentage of farms without any usage. The lists of the World Health Organisation, World Organisation for Animal Health, and European Medicine Agency classify different antimicrobial substances as critically important. The vast differences between the respective weighted treatment frequencies allocated to the antimicrobials of main interest reflect the huge impact of the three categorisation systems. We concluded that, with the aim of creating national treatment guidelines supporting veterinarians to make treatment decisions, the list of the European Medicine Agency is the most suitable.

Background: The secular decline in labor market participation and the concurrent increase in opioid use in many developed countries have sparked a policy debate on the possible connection between these two trends. We examined whether the use of prescription opioids was connected to labor market outcomes relating to participation, employment and unemployment among the Finnish population. Methods: The working-age population (aged 19–64 years) living in Finland during the period 1995–2016 was used in the analyses (consisting of 67 903 701 person-year observations). Lagged values of prescription opioid use per capita were used as the exposure. Instrumental variables (IV) estimation method was used to identify causal effects, where opioid use per capita for the elderly (65–95-year-old) was used as an instrument for the opioid use per capita for the working-age population of the same gender, education and region. Results: Increased opioid use led to worse labor market outcomes in the long run, with the effect size of 16 % and 20 %, compared to the standard deviation of the employment and participation rates. On the contrary, in the short run, increased opioid use had positive employment effects. Conclusions: Policymakers should take the contradictory short- and long-term effects into account while considering regulation and monitoring of opioid use. Regulating and monitoring long-term prescription opioids is crucial for reducing their negative labor market consequences. publishedVersion

Simple Summary The antibiotic colistin has been used for Gram-negative bacterial infections in veterinary medicine since the 1950s, with resistance rates remaining low. However, due to the discovery of resistance via transmissible plasmids in 2015, the use of colistin for animals became a subject of discussion, and actions taken resulted in a pan-European reduction of colistin sales for animal use of 76.5% between 2011 and 2020. Nevertheless, few studies evaluated real-world field data on the use patterns of veterinary use of colistin in different countries and species in Europe. A survey among 662 veterinary practitioners revealed that the majority did not use or ceased colistin use (51.9%), 33.4% had decreased their use, 10.4% stabilised their use, and 2.7% increased use. The most important indications for use of colistin were gastrointestinal diseases followed by septicaemia. Governmental/industry restrictions regarding colistin use were reported by 16% of the responding veterinarians, and of them, the most common was "use only after susceptibility testing" (57%). Polymyxin E (colistin) is a medically important active substance both in human and veterinary medicine. Colistin has been used in veterinary medicine since the 1950s. Due to the discovery of the plasmid-borne mcr gene in 2015 and the simultaneously increased importance in human medicine as a last-resort antibiotic, the use of colistin for animals was scrutinised. Though veterinary colistin sales dropped by 76.5% between 2011 to 2020, few studies evaluated real-world data on the use patterns of colistin in different European countries and sectors. A survey among veterinarians revealed that 51.9% did not use or ceased colistin, 33.4% decreased their use, 10.4% stabilised their use, and 2.7% increased use. The most important indications for colistin use were gastrointestinal diseases in pigs followed by septicaemia in poultry. A total of 106 (16.0%) responding veterinarians reported governmental/industry restrictions regarding colistin use, most commonly mentioning "use only after susceptibility testing" (57%). In brief, colistin was perceived as an essential last-resort antibiotic in veterinary medicine for E. coli infections in pigs and poultry, where there is no alternative legal, safe, and efficacious antimicrobial available. To further reduce the need for colistin, synergistic preventive measures, including improved biosecurity, husbandry, and vaccinations, must be employed.

BACKGROUND: The prevalence of doping in competitive sport, and the methods for assessing prevalence, remain poorly understood. This reduces the ability of researchers, governments, and sporting organizations to determine the extent of doping behavior and the impacts of anti-doping strategies. OBJECTIVES: The primary aim of this subject-wide systematic review was to collate and synthesize evidence on doping prevalence from published scientific papers. Secondary aims involved reviewing the reporting accuracy and data quality as evidence for doping behavior to (1) develop quality and bias assessment criteria to facilitate future systematic reviews; and (2) establish recommendations for reporting future research on doping behavior in competitive sports to facilitate better meta-analyses of doping behavior. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. Articles were included if they contained information on doping prevalence of any kind in competitive sport, regardless of the methodology and without time limit. Through an iterative process, we simultaneously developed a set of assessment criteria; and used these to assess the studies for data quality on doping prevalence, potential bias and reporting. RESULTS: One-hundred and five studies, published between 1975 and 2019,were included. Doping prevalence rates in competitive sport ranged from 0 to 73% for doping behavior with most falling under 5%. To determine prevalence, 89 studies used self-reported survey data (SRP) and 17 used sample analysis data (SAP) to produce evidence for doping prevalence (one study used both SRP and SAP). In total, studies reporting athletes totaled 102,515 participants, (72.8% men and 27.2% women). Studies surveyed athletes in 35 countries with 26 involving athletes in the United States, while 12 studies examined an international population. Studies also surveyed athletes from most international sport federations and major professional sports and examined international, national, and sub-elite level athletes, including youth, masters, amateur, club, and university level athletes. However, inconsistencies in data reporting prevented meta-analysis for sport, gender, region, or competition level. Qualitative syntheses were possible and provided for study type, gender, and geographical region. The quality assessment of prevalence evidence in the studies identified 20 as "High", 60 as "Moderate", and 25 as "Low." Of the 89 studies using SRP, 17 rated as "High", 52 rated as "Moderate", and 20 rated as "Low." Of the 17 studies using SAP, 3 rated as "High", 9 rated as "Moderate", and 5 rated as "Low." Examining ratings by year suggests that both the quality and quantity of the evidence for doping prevalence in published studies are increasing. CONCLUSIONS: Current knowledge about doping prevalence in competitive sport relies upon weak and disparate evidence. To address this, we offer a comprehensive set of assessment criteria for studies examining doping behavior data as evidence for doping prevalence. To facilitate future evidence syntheses and meta-analyses, we also put forward "best practice" recommendations and reporting guidelines that will improve evidence quality. ispartof: SPORTS MEDICINE vol:51 issue:9 pages:1909-1934 ispartof: location:New Zealand status: published

Adolescent hookah pipe use is increasing at a rapid rate, thus posing a major public health concern globally. The hookah pipe is a gateway substance to other substances that may be more harmful. Yet, at present, little is known about why adolescents are so drawn to this mechanism. It is this gap that this study attempted to fill. This study, therefore, aimed to review the determinants of adolescent hookah pipe use. An electronic search of 12 databases identified studies investigating determinants of adolescent hookah pipe use. Twenty-five studies sampling a total of 88,988 adolescents who use the hookah pipe were included. This study found that adolescent hookah pipe use is determined by an interplay of family factors, peer/friends factors, individual factors, school factors, the actual hookah pipe mechanism, advertisements, and awareness of hookah pipe lounges or bars. Prevention and early intervention strategies aimed at reducing adolescent hookah pipe use is needed.