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Increasing capacity to provide buprenorphine, a treatment for opioid addiction, can help mitigate the opioid epidemic in the United States. This study models black-market pricing of buprenorphine to better understand supply and demand for opioid addiction treatment. A mixed effects linear model was used to quantify the effect of county-level racial composition, health insurance coverage, and drug characteristics on price variation. From November 2010 to June 2018, there were 2481 submissions for street buprenorphine transactions in the StreetRx dataset. The mean price was $3.95/mg (SD = $23.12/mg). Price decreased 3.05% each year and was highest in the summer and spring. Brand name buprenorphine was on average 11.18% more expensive than generic buprenorphine. Buprenorphine/naloxone combinations were on average 19.75% less expensive than pure buprenorphine. Purchases in bulk were on average 10.51% cheaper than purchases not in bulk. Street buprenorphine in film form was on average 14.34% more expensive than in pill/tablet form. Buprenorphine street price was 17.12% higher in spring and 22.26% higher in summer compared to fall. For every percentage point increase in percent white, buprenorphine sold for 0.88% higher price. For every percentage point increase in health insurance coverage, street buprenorphine sold for 0.02% lower price. Findings demonstrate that geographic, demographic, and socioeconomic factors shape the diversion of opioid addiction treatment to the black-market. Buprenorphine street pricing can help estimate public need, gaps in care and emerging public health priorities.

Some situations put Cuba at risk for drug use, such as an increase in tourism, relations with countries that have high rates of substance abuse, the geographic location in drug trafficking corridors, and the high prevalence of "opening doors" drugs. In this regard, the National Health System must be prepared to prevent the problem and care for those affected, so it is necessary to maintain updated information on risk factors and main products used by consumers. In the present literature review on the subject, it is sought to draw the attention of health workers to this point, data on the magnitude of the problem and elements of its background are offered, as well as drug classification, the risk factors associated with its use and the legal bases for its control in Cuba. [ABSTRACT FROM AUTHOR]

Several studies have reported on wide-spread contamination of U.S. paper currency with cocaine and to a lesser extent other illicit drugs. Canines are trained and employed to search for and alert to drugs. Canine alert to currency has been used as evidence that currency has been directly involved in illicit drug trafficking to justify currency seizure and forfeiture. This assertion, particularly when the only evidence is based upon canine alert, has been challenged in the courts considering that most currency in circulation is contaminated with cocaine. Comprehensive review of the scientific literature establishes that (i) 67-100% of circulated U.S. currency is contaminated with cocaine ranging from a few nanograms to over one milligram/bill (ii) various biological and environmental parameters impact canine alert to drugs. It is concluded that canine alert to U.S. currency is not sufficiently reliable to determine that currency was directly used in an illicit drug transaction.

BackgroundThe use of social media (SM) as a surveillance tool of global illicit drug use is limited. To address this limitation, a systematic review of literature focused on the ability of SM to better recognize illicit drug use trends was addressed.MethodsA search was conducted in databases: PubMed, CINAHL via Ebsco, PsychINFO via Ebsco, Medline via Ebsco, ERIC, Cochrane Library, Science Direct, ABI/INFORM Complete and Communication and Mass Media Complete. Included studies were original research published in peer-reviewed journals between January 2005 and June 2015 that primarily focused on collecting data from SM platforms to track trends in illicit drug use. Excluded were studies focused on purchasing prescription drugs from illicit online pharmacies.ResultsSelected studies used a range of SM tools/applications, including message boards, Twitter and blog/forums/platform discussions. Limitations included relevance, a lack of standardized surveillance systems and a lack of efficient algorithms to isolate relevant items.ConclusionIllicit drug use is a worldwide problem, and the rise of global social networking sites has led to the evolution of a readily accessible surveillance tool. Systematic approaches need to be developed to efficiently extract and analyze illicit drug content from social networks to supplement effective prevention programs.

Erdmann’s anion [1,6-diammino tetranitrocobaltate(III)] is useful in the isolation and crystallization of recently confiscated street drugs needing to be identified and catalogued. The protonated form of such drugs forms excellent crystals with that anion; moreover, Erdmann’s salts are considerably less expensive than the classically used AuCl4− anion to isolate them, while preparation of high-quality crystals is equally easy in both cases. We describe the preparation and structures of the K+CoH6N6O8− and NH4+CoH6N7O8−, salts of Erdmann’s. In addition, herein are described the preparations of this anion’s salts with cocaine (C17H28CoN7O12), with methamphetamine (C10H22CoN7O8), and with methylone (C22H34CoN8O14), whose preparation and stereochemistry had been characterized by the old AuCl4− salts methodology. For all species in this report, the space groups and cell constants were determined at 296 and 100 K, looking for possible thermally induced polymorphism—none was found. Since the structures were essentially identical at the two temperatures studied, we discuss only the 100 K results. Complete spheres of data accessible to a Bruker ApexII diffractometer with Cu–Kα radiation, λ = 1.54178 Å, were recorded and used in the refinements. Using the refined single crystal structural data for the street drugs, we computed their X-ray powder diffraction patterns, which are beneficial as quick identification standards in law enforcement work.

The aim of this study was to identify the factors associated with the consumption of illicit drugs with stronger evidence in the personal, interpersonal, and contextual domains. For this reason, a review of reviews was carried out using international quality guidelines such as PRISMA and AMSTAR, searching in six databases and yielding 7782 articles in the initial search. In the end, 45 quantitative and qualitative reviews were included. Evidence of personal, interpersonal, and contextual factors was found that could be useful for the investigation of the most specific factors according to particular settings. Ecological approaches can be meaningful as integrative frameworks for this evidence. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of drug use before admission to juvenile detention centers (JDC) in Peru and determine individual, family and social influences on behavior.Methods: A cross-sectional analysis was performed using data from the 2016 National Population Census in Juvenile Detention Centers (NPCJDC). A total of 1960 Peruvian adolescent offenders were included. Generalized linear models of the Poisson family with a log link function were used to determine if characteristics before admission to a JDC were associated with drug use. These characteristics included employment, depression, neighborhood gang activity, having friends with a criminal record, a history of multiple admissions to a JDC, a history of running away from home, physical abuse during childhood and family history of drug use and incarceration.Results: More than half of young offenders reported using drugs before entering a JDC (59%) in Peru. The drug most frequently consumed was cannabis (86.6%), followed by cocaine and/or crack (11.6%), and inhalants and/or pills (1.8%). Smoking cigarettes [prevalence ratios (PR): 1.12, p = 0.003], using alcohol (PR: 1.22, p = 0.003), neighborhood gang activity (PR: 1.28, p < 0.001), having friends with a criminal record (PR: 1.62, p < 0.001), running away from home (PR: 1.20, p < 0.001) and a family history of incarceration (PR: 1.09, p = 0.010) were associated with drug use prior to admission to a JDC.Conclusion: Drug use before admission to a JDC was high among young offenders in Peru, with marijuana being the drug most frequently used. Having friends with a criminal record and neighborhood gang activity had the greatest association with drug use in young offenders. [ABSTRACT FROM AUTHOR]

Abstract Background The smoking of illicit drugs presents a serious social and economic burden in Canada. People who smoke drugs (PWSD) are at increased risk of contracting multiple infections through risky drug practices. Peer-led harm reduction activities, and the resulting social networks that form around them, can potentially minimize the dangers associated with the smoking illicit drugs. Goal The goals of this study were to pilot test the combined approaches of respondent driven sampling with community based participatory action research in these settings and compare the attributes and social networks of PWSD in two British Columbia cities with different harm reduction programs. Methods Using community-based participatory action research (CBPAR) and respondent-driven sampling (RDS), individuals with lived drug experiences were employed from communities in Abbotsford and Vancouver as peer researchers to interview ten contacts from their social networks. Contacts completed a questionnaire about their harm reduction behaviours and interactions. Results We found that PWSD residing in Abbotsford were more likely to report engaging in harm-promoting behaviours, such as sharing, reusing, or borrowing crack pipes. However, PWSD in the Downtown East side Community of Vancouver were more likely to report engaging in harm-reducing activities, such as being trained in naloxone use and CPR. We found no differences in network sizes between the two communities, despite the population differences and harm reduction programs Conclusion The high participation rates and interactions between researchers, and peer researchers enriched the study implementation and successfully informed our results. The fact that there were no differences in network size suggests that people have similar support in Vancouver as in Abbotsford, and that drug use practices differ mainly due to availability of harm reduction programming and resources.

BackgroundHistorically the success of mass spectrometry in the clinical laboratory has focused on drugs of abuse confirmations, newborn screening, and steroid analysis. Clinical applications of mass spectrometry continue to expand, and mass spectrometry is now being used in almost all areas of laboratory medicine.ContentA brief background of the evolution of mass spectrometry in the clinical laboratory is provided with a discussion of future applications. Prominent examples of mass spectrometry are covered to illustrate how it has improved the practice of medicine and enabled physicians to provide better patient care. With increasing economic pressures and decreasing laboratory test reimbursement, mass spectrometry testing has been shown to provide cost-effective solutions. In addition to pointing out the numerous benefits, the challenges of implementing mass spectrometry in the clinical laboratory are also covered.SummaryMass spectrometry continues to play a prominent role in the field of laboratory medicine. The advancement of this technology along with the development of new applications will only accelerate the incorporation of mass spectrometry into more areas of medicine.

Copyright of SMAD Revista Electronica Salud Mental, Alcohol y Drogas is the property of Universidade de Sao Paulo, Escola de Enfermagem de Ribeirao Preto and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The neural circuitry and molecules that control the rewarding properties of food and drugs of abuse appear to partially overlap in the mammalian brain. This has raised questions about the extent of the overlap and the precise role of specific circuit elements in reward and in other behaviors associated with feeding regulation and drug responses. The much simpler brain of invertebrates including the fruit fly Drosophila, offers an opportunity to make high-resolution maps of the circuits and molecules that govern behavior. Recent progress in Drosophila has revealed not only some common substrates for the actions of drugs of abuse and for the regulation of feeding, but also a remarkable level of conservation with vertebrates for key neuromodulatory transmitters. We speculate that Drosophila may serve as a model for distinguishing the neural mechanisms underlying normal and pathological motivational states that will be applicable to mammals.

Background: There is a need to develop specific care route for vulnerable people with hepatitis C virus. Objective: At a nurse-led clinic, we aimed to: (1) report the prevalence of patients initiating an hepatitis C treatment who (a) achieved sustained virologic response and (b) were adherent to their treatment; and (2) explore factors associated with adherence and sustained virologic response. Design: A clinical record-based prospective cohort study. Setting: A community-based nurse-led clinic coordinating outreach services for people with hepatitis C virus in Québec City, Québec, Canada. Population: All patients initiating an hepatitis C treatment at the nurse-led clinic from January 1, 2012 to December 31, 2017 (end of data collection). Methods: Patients were followed from the day they initiated their hepatitis C treatment, up to 24 weeks after the end of the treatment. Sustained virologic response was achieved if hepatitis C virus ribonucleic acid (RNA) was undetectable or below the lower limit of quantification at week 12 or later. Patients who reported hepatitis C treatment completion without missing any doses were considered adherent. Factors associated with adherence and sustained virologic response were identified using adjusted prevalence ratios. Results: A total of 171 patients infected with hepatitis C virus (women: n = 51, 30%; criminal record: n = 102, 60%; substance addiction: n = 99, 58%) initiated an hepatitis C treatment at the nurse-led clinic. Overall, 126/171 (74%) patients were adherent. Patients using illicit drugs were less likely to be adherent (adjusted prevalence ratio 0.77, 95% confidence interval 0.67–0.89). Among 156/171 (91%) patients with an hepatitis C virus RNA test post-treatment, 96% (n = 149) achieved sustained virologic response. Patients who were less likely to achieve sustained virologic response were those who were non-adherent (adjusted prevalence ratio 0.81, 95% confidence interval 0.68–0.98) or who had a criminal record (adjusted prevalence ratio 0.87, 95% confidence interval 0.79–0.97). Conclusions: A nurse-led clinic could fill an important gap in hepatitis C health services targeted at vulnerable people in a community setting, to drive adherence and achievement of sustained virologic response.

The consumption of illicit drugs is a matter of social relevance and public health. Ecological models enrich the explanation of variations in the consumption of illicit substances, by facilitating the inclusion of individual factors and the context in which people develop. This rapid review aims to identify the concepts of ecological models used in research on drug use, what are the levels of determination expected and what factors associated with the consumption of drugs of a personal, family and social nature. A dozen denominations were identified for the ecological models, from of 22 manuscripts included in the final phase of the review, as well as levels of personal, family and social context determination. Ecological models are outlined as flexible, dynamic conceptual structures with the potential to sustain comprehensive public policies with better results. [ABSTRACT FROM AUTHOR]

Copyright of Adicciones is the property of Sociedad Cientifica Espanola de Estudios sobre el Alcohol and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Urine drug screen (UDS) immunoassays are a quick and inexpensive method for determining the presence of drugs of abuse. Many cross-reactivities exist with other analytes, potentially causing a false-positive result in an initial drug screen. Knowledge of these potential interferents is important in determining a course of action for patient care. We present an inclusive review of analytes causing false-positive interferences with drugs-of-abuse UDS immunoassays, which covers the literature from the year 2000 to present. English language articles were searched via the SciFinder platform with the strings 'false positive [drug] urine' yielding 173 articles. These articles were then carefully analyzed and condensed to 62 that included data on causes of false-positive results. The discussion is separated into six sections by drug class with a corresponding table of cross-reacting compounds for quick reference. False-positive results were described for amphetamines, opiates, benzodiazepines, cannabinoids, tricyclic antidepressants, phencyclidine, lysergic acid diethylamide and barbiturates. These false-positive results support the generally accepted practice that immunoassay positive results are considered presumptive until confirmed by a second independent chemical technique.

BackgroundUse of synthetic cathinones (SC) and cannabimimetics (i.e., "THC homologues" [TH]) is associated with adverse health effects. We investigated the epidemiology of synthetic drug use among a cohort of injection drug users (IDUs) in San Diego, California.MethodsWe used logistic regression analysis to identify correlates of SC and TH use among 485 IDUs enrolled from June 2012 to September 2013.ResultsSeven percent of participants reported ever using SC and 30% reported ever using TH. In multivariate logistic regression, age and recent hospitalization were significantly associated with odds of SC use (Adjusted Odds Ratio [AOR] 0.93, 95% Confidence Interval [C.I.] 0.90, 0.97; and AOR 2.34 95% C.I. 1.00, 5.49, respectively) and TH use (AOR 0.96, 95% C.I. 0.94, 0.98; and AOR 2.62, 95% C.I. 1.47, 4.68, respectively). Use of methamphetamine (AOR 9.35, 95% C.I. 1.20, 72.79) and club drugs in the past six months (AOR 3.38, 95% C.I. 1.17, 9.76) were significantly associated with SC use. Being on probation/parole (AOR 2.42, 95% C.I. 1.44, 4.07), initiating injection drug use with stimulants (AOR 1.89 95% C.I. 1.13, 3.16), and past six-month marijuana (AOR 9.22, 95% C.I. 4.49, 18.96) and prescription drug use (AOR 1.98, 95% C.I. 1.20, 3.27) were significantly associated with TH use.ConclusionsA considerable proportion of IDU use synthetic drugs and may experience harms associated with their use. Findings have implications for criminal justice system management. Prevention efforts should emphasize the risks associated with rapidly changing synthetic formulations, and the potential harms associated with polydrug use.

BackgroundWe examined Mexican migrants' perceived barriers to entering substance abuse treatment and potential differences by gender.MethodsThis study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment.ResultsSignificant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City.ConclusionsDrug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227.

Introduction. Internationally, there have been several studies carried out in order to demonstrate the relationship between a high level of Sensation Seeking and illegal drug abuse. However, few studies in Colombia replicate those results. The objective is to examine the difference of Sensation Seeking personality trait and its subscales in the behaviour of drug abuse on two Colombian samples, consumers and non-consumers, measured through the Sensation Seeking Scale-V (Zuckerman & Kulhman, 1980). Methodology. 341 adult subjects, from both genders, composed the sample, half of them were consumers of illegal drugs and half of them non-consumers, assessed through Sensation Seeking Scale Version V. Results. There is a significant difference between consumers and non-consumers within the general scale and three subscales of the trait (Thrill and Adventure Seeking, Experience Seeking and Disinhibition). Discussion. Differences between the scores of consumers and non-consumers sample regarding the general trait and subtraits show the relevance of personality factors regarding substance abuse, independently than social and learning factors are influential as well. Conclusions. There is a link between Sensation Seeking and substance abuse showing the importance of the level of the trait in the multivariate phenomenon of substance dependence.

BackgroundThis study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine.MethodsA total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China.ResultsMethamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine.ConclusionsThere is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context.

Background: The smoking of illicit drugs presents a serious social and economic burden in Canada. People who smoke drugs (PWSD) are at increased risk of contracting multiple infections through risky drug practices. Peer-led harm reduction activities, and the resulting social networks that form around them, can potentially minimize the dangers associated with the smoking illicit drugs. Goal: The goals of this study were to pilot test the combined approaches of respondent driven sampling with community based participatory action research in these settings and compare the attributes and social networks of PWSD in two British Columbia cities with different harm reduction programs. Methods: Using community-based participatory action research (CBPAR) and respondent-driven sampling (RDS), individuals with lived drug experiences were employed from communities in Abbotsford and Vancouver as peer researchers to interview ten contacts from their social networks. Contacts completed a questionnaire about their harm reduction behaviours and interactions. Results: We found that PWSD residing in Abbotsford were more likely to report engaging in harm-promoting behaviours, such as sharing, reusing, or borrowing crack pipes. However, PWSD in the Downtown East side Community of Vancouver were more likely to report engaging in harm-reducing activities, such as being trained in naloxone use and CPR. We found no differences in network sizes between the two communities, despite the population differences and harm reduction programs Conclusion: The high participation rates and interactions between researchers, and peer researchers enriched the study implementation and successfully informed our results. The fact that there were no differences in network size suggests that people have similar support in Vancouver as in Abbotsford, and that drug use practices differ mainly due to availability of harm reduction programming and resources. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Serratia marcescens infections have historic association with injection drug use. The present report is about a 53-year-old man with a history of intravenous (IV) drug use who presented with acute loss of vision due to endophthalmitis associated with disseminated S. marcescens infection. Case Report: A 53-year-old man with a history of active illicit IV drug use presented with a chief complaint of loss of vision in his left eye for 5 days. He also reported having a fever, chills, and shortness of breath. While in the Emergency Department, he became hypotensive and hypoxic. He needed to be intubated and was started on vasopressor support. An ophthalmological examination was suspicious for endophthalmitis. The patient underwent a vitreous tap with injection of intravitreal antibiotics on the day of admission. An echocardiogram showed severe tricuspid endocarditis requiring valve replacement. He also was found to have a left lung/pleural abscess, which was surgically drained. Later, a left eye vitrectomy was performed and the intravitreal antibiotics were repeated; the treatment was unsuccessful and enucleation eventually was required. In addition, the patient had gastric bleeding and underwent esophagogastroduodenoscopy, which showed ischemic stomach ulcers suggestive of septic emboli. Cultures of the patient's blood, tricuspid valve, lung abscess, and vitreous fluid revealed S. marcescens. He was treated long term with a 2-drug antibiotic regimen and discharged in stable condition. Conclusions: We have presented a rare case of acute loss of vision due to endophthalmitis in a patient with a history of IV drug use, which was associated with disseminated infection with the Gram-negative saprophyte S. marcescens. [ABSTRACT FROM AUTHOR]

Copyright of SMAD Revista Electronica Salud Mental, Alcohol y Drogas is the property of Universidade de Sao Paulo, Escola de Enfermagem de Ribeirao Preto and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The prevalence of street drug abuse is difficult to establish in women because of stigma associated with the practice. The main objective of this study was to analyze possible differences between men and women in a sample of patients attended for emergencies due to acute poisonings. The secondary aim was to identify variables associated with severe poisonings defined arbitrarily as requiring intensive care for more than 12 hours after hospital admission., Material and Methods: Retrospective study in 2 hospital EDs. We included patients over the age of 18 years attended for street drug poisonings between July 1, 2020, and July 31, 2023. Epidemiologic, clinical, and laboratory variables were analyzed., Results: A total of 1032 patients were studied; 191 (18.5%) were women. The mean (SD) age was 35 years, and the prevalences of acute mental illness and HIV infection were high at 32.2% and 35.7%, respectively. Drug use was recreational in most cases (90.9%). Cocaine, alcohol, and methamphetamines were the substances most often used. Multivariate analysis showed that the factors associated with the seriousness of poisoning were age, with an odds ratio (OR) of 1.03 (95% CI, 1.01-1.05; P = .003); HIV (OR, 2.10; 95% CI, 1.29-3.41; P = .003); use of benzodiazepines (OR, 3.48; 95% CI, 2.14-5.66; P .0001); and suicidal ideations (OR, 1.82; 95% CI, 1.25-3.79; P = .004)., Conclusion: Differences in poisoning characteristics in women were found, probably related to the younger ages of men in the sample and their higher frequency of alcohol consumption. Public health policies and campaigns to prevent drug abuse should take gender differences into consideration in order to adapt messages to the target populations.

ABSTRACT Objectives: to analyze characteristics of homeless people and factors associated with living on the streets. Methods: a census-type sectional survey carried out between 2015 and 2018, in the municipality of Maringá-Paraná. A total of 701 homeless answered a structured questionnaire with sociodemographic data, living conditions, and drug use. We used Pearson’s correlation test for the association analysis of the variables at a 95% confidence level. Results: men (90.7%) the average age of 37.7 years had been homeless for an average of 5.39 years. Most had little education (54.2%), and homelessness was due to drug use (47.2%) and family disagreements (38.9%). Conclusions: drug use and family disagreements were the main reasons for homelessness. Time on the street, gender, and drugs were associated with a negative correlation to be homeless; and age, mean daily income, the number of daily meals, having been in prison, and having an income source were associated with positive correlation.

Objective: to assess risk related to drug use in men admitted to a psychiatric hospital and to identify associations with sociodemographic, socioeconomic variables, and risk conditions. Method: a cross-sectional study with the application of a screening test in 209 participants hospitalized for mental and behavioral disorders due to the use of psychoactive substances. Statistical analysis was performed using descriptive statistics and adjustment of a binary logistic regression model for moderate or high risk of drug use. The odds ratio measured the strength of association. Results: high use in life was observed, with alcohol and tobacco experimentation in adolescence. A high prevalence of related risk was observed for alcohol, tobacco, smoked and inhaled cocaine, and marijuana. Moderate and elevated risks were found for tobacco (22.5% and 62.5%, respectively), alcohol (13.5% and 73%), marijuana (16% and 32.5%), smoked cocaine (3% and 41%) and inhaled cocaine (9% and 19.5%). Conclusion: the results showed high use in life, with an age of early experimentation. Tobacco and alcohol are the main drugs used by hospitalized men.

ABSTRACT Objectives: to evaluate the impact of training on brief interventions for use of substances on the attitudes; and, face validity and internal consistency of Brazilian versions of the Drug and Drug Problems Perceptions Questionnaire (DDPPQ-br) and the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) for use among teachers. Methods: methodological (N=122) and quasi-experimental study (n=27). A sociodemographic questionnaire, the DDPPQ-br and the SAAPPQ were applied before and three months after the training. For analysis, were applied the Mann-Whitney and Wilcoxon tests. Results: the DDPQ-br and SAAPPQ were considered valid by experts. The training improved teachers’ attitudes towards accountability on the approach to substance use at schools and on the readiness to perform this role. In relation to drugs, it increased the perception of support. Conclusions: teachers’ training can improve their attitudes and strengthen the school in the function of preventing substance-related harm.

While street drugs appear unlikely to alter the metabolism of antiretroviral (ARV) medications, several ARVs may induce or inhibit metabolism of various street drugs. However, research on these interactions is limited. Case reports have documented life-threatening overdoses of ecstasy and gamma-hydroxybutyrate after starting ritonavir, an ARV that inhibits several metabolic enzymes. For opioid addiction, methadone or buprenorphine are the treatments of choice. Because a number of ARVs decrease or increase methadone levels, patients should be monitored for methadone withdrawal or toxicity when they start or stop ARVs. Most ARVs do not cause buprenorphine withdrawal or toxicity, even if they alter buprenorphine levels, with rare exceptions to date including atazanavir/ritonavir associated with significant increases in buprenorphine and adverse events related to sedation and mental status changes in some cases. There are newer medications yet to be studied with methadone or buprenorphine. Further, there are many frequently used medications in treatment of complications of HIV disease that have not been studied. There is need for continuing research to define these drug interactions and their clinical significance.

Abstract Objective To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. Materials and methods A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. Results Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). Conclusions In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime.

Objective: To analyze the correlation between self-esteem and risk for drug use among adolescents in 8th and 9th years of elementary school in the municipal network of city in the interior of Minas Gerais. Methods: Cross-sectional, descriptive correlational study with a quantitative approach, with the participation of 347 students of both genders in the 8th and 9th years of the municipal education network in a city in the interior of Minas Gerais. For data collection, the Drug Use Screening Inventory) and the Rosenberg Self-Esteem Scale were used. The dependent variables are all of the ordinal type, and correlation tests of the Nonparametric type are performed. Results: The majority of the participants were girls (62.82%), from the age group of 14 years (38.62%) and socioeconomic class B2 (39.49%). It was found that in absolute density all areas of the DUSI, except the substance use area, were directly influenced by the adolescents' negative self-esteem, with the greatest correlation with psychiatric disorders; in relative density, only the family system was related to negative self-esteem. Conclusion: the risk of problems related to substance use does not depend on a positive or negative self-esteem, but negative self-esteem can influence the development of psychiatric disorders and family relationships. [ABSTRACT FROM AUTHOR]

Introduction: clandestine abortions increase maternal morbi-mortality in sub-Saharan Africa and are closely linked to restrictive legislation and low contraceptive prevalence. In Brazzaville street drugs are commonly used to induce abortion. The purpose of this study is to determine street drug prevalence and socio-demographic characteristics of these patients. Methods: we conducted a longitudinal study of 67 patients with induced abortion complications admitted to the Talangaï Hospital from July to December 2018. (i) Sociodemographic (ii) and obstetrical (iii) characteristics as well as abortion features (procedure, Manganguiste involvement, abortion rank and cost) were collected and analyzed using EPI info 7 software. We compared the means using student's test, proportions with CHI-2, p value was set to < 0.05. Results: the average age of patients was 25 years ± 6.6; 59.7% of them were attending college, 53.8% had no income-generating activity, 38.8% lived alone and in 15% of cases biological father had denied paternity. Street drugs had been used in 74.5% of cases, mean abortion cost was 3500 CFA (US$7) and 29500CFA (US$59) when it had been performed by health-care professionals. High school respondents were more likely (73.69%) to know at least contraceptive methods (p<0.05). Greater numbers of singles (p=0.000) and of those who knew a contraceptive method (p=0.003) expressed the intention to use contraception. Conclusion: combatting the use of street drugs and securing the right to safe voluntary abortion are necessary to limit complications due to clandestine abortions. [ABSTRACT FROM AUTHOR]

Urine has been a biological matrix of choice for drug screening, but recent advances in technology and the introduction of commercial oral fluid assays have effectively established oral fluid as a viable alternative matrix. This systematic review aimed to evaluate the sensitivity of oral fluid in detecting some illicit drugs compared to urine, and to compare the initial and final detection times of these drugs in both fluids. The electronic search in MEDLINE, Cochrane Library, Scopus, and Web of Science was carried out covering studies published from January 2003 and June 2019, in order to find all valid studies that detected drugs in oral fluid and urine in the same patient. Studies about illicit drugs, such as tetrahydrocannabinol, cocaine, amphetamines and illicit opioids, with fluids collection at the same day, controlled drug administration during the study, reported administration interval and time of collection were favored. Out of 2598 studies identified by electronic search, 7 studies were selected for qualitative analysis. Five were clinical trials and 2 were crossover trials. In total, 74 patients aged 20–52 years underwent a diagnostic examination (4 studies with tetrahydrocannabinol, 1 with methamphetamine, and 2 with cocaine) after drug administration. Illicit drug detection in oral fluid is similar to urine but oral fluid has a strong potential for the immediate detection of recent marijuana use compared to urine. In relation to cocaine and methamphetamine, the largest drugs detection window is obtained through urine analysis. Oral fluids cannot replace urine for most of the purposes of drug testing. [ABSTRACT FROM AUTHOR]

Copyright of SMAD Revista Electronica Salud Mental, Alcohol y Drogas is the property of Universidade de Sao Paulo, Escola de Enfermagem de Ribeirao Preto and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It is common to find marijuana users with alterations in motivation, in clinical practice. Several studies have found evidence about a possible amotivational syndrome in marijuana users, both from the analysis of behavior and from the neurological examination. However, the existence of such a syndrome associated with the use of marijuana has not been firmly established, among other reasons, due to the concurrence of factors such as depression and the use of other drugs that may lead to inadequate generalization of the situation of some consumers of the substance and due to methodological difficulties in research aimed at establishing whether or not there is a decrease in the general motivation associated with the use of marijuana. Likewise, the decrease in motivation could be the result of the disorder by substances rather than by the consumption of marijuana. Due to the growing use of marijuana in the world, the study of its consequences is of the greatest importance, for the design of better treatments for people with substance use disorders. The aim of this study was to obtain evidence about the existence or not of deficiencies in the motivation of marijuana users. In addition, we sought to establish which are the characteristic behaviors that show this possible reduction of motivation. A battery of questions was constructed from a systematic literature review in PubMed, Lilacs, MedLine, Cochrane library, Embase, Science Direct and Bibliomed, using as terms "amotivational syndrome", "amotivation cannabis", "amotivation marijuana", "comorbidity cannabis", "comorbidity marijuaba", "mental disorders and cannabis", "cannabis and mental consequences", "amotivation and drug use". Likewise, an expert consultation was done about behaviors that were indicative of a reduction in the motivation of marijuana users. From the review and consultation of experts, a set of 70 possible behaviors expressed in questions about probable deficiencies in motivation was extracted. These questions, along with other instruments selected to exclude from the analysis participants with depression, prefrontal symptoms, alcohol use disorders, apathy and affective flattening, which could confuse the results, were presented to a sample of 1455 participants. The Rasch model was applied to establish whether it was possible to identify a measurable and consistent dimension that corresponded to a deficiency in motivation, and to discern which behaviors would be most characteristic of a possible motivational deficiency in habitual marijuana users. In addition, an exploratory factor analysis was carried out to identify possible groupings of the characteristic symptoms of a reduction in motivation. Our Results and conclusions show that it was estimated that 54.9% of the participants would have a serious disorder due to the use of marijuana; 54.0% presented symptoms of affective flattening, and 60.9% would be marijuana users with high levels of tetrahydrocannabinol (THC). The average number of cigarettes consumed per month would be 44.5. Using the Rasch model it was established that, with the constructed set of questions, it was possible to identify a dimension or factor coinciding with a motivational deficiency. Using the exploratory factor analysis, it was found that the characteristic behaviors could be grouped into four possible subdimensions: emotional apathy; social withdrawal; neglect of personal image and motor slowdown. [ABSTRACT FROM AUTHOR]

Objective: to assess risk related to drug use in men admitted to a psychiatric hospital and to identify associations with sociodemographic, socioeconomic variables, and risk conditions. Method: a cross-sectional study with the application of a screening test in 209 participants hospitalized for mental and behavioral disorders due to the use of psychoactive substances. Statistical analysis was performed using descriptive statistics and adjustment of a binary logistic regression model for moderate or high risk of drug use. The odds ratio measured the strength of association. Results: high use in life was observed, with alcohol and tobacco experimentation in adolescence. A high prevalence of related risk was observed for alcohol, tobacco, smoked and inhaled cocaine, and marijuana. Moderate and elevated risks were found for tobacco (22.5% and 62.5%, respectively), alcohol (13.5% and 73%), marijuana (16% and 32.5%), smoked cocaine (3% and 41%) and inhaled cocaine (9% and 19.5%). Conclusion: the results showed high use in life, with an age of early experimentation. Tobacco and alcohol are the main drugs used by hospitalized men. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe drug consumption and the co-occurrence use of more than one illegal drug as well as associated factors in freshmen at a public university in Southern Brazil. METHODS: Cross-sectional study with census of students entering undergraduate courses in 2017. A total of 1,788 university students answered questions about illicit drug use. For analysis, ordinal logistic regression was used. RESULTS: Marijuana was the most consumed drug (lifetime: 42.1%; 30-day use: 22.7%), followed by hallucinogens (lifetime: 13.1%, 30-day use: 2.8%). Rates for lifetime use of 0, 1 and 2 or more drugs were 56.2%, 23.3% and 20.4%, respectively, and were associated with men (OR = 2.2; 95%CI:1.4-3.5), being at least 23 years old (OR = 2.7; 95%CI: 1.4-5.1), under 18 years old first experimentation with drugs (OR = 2.3; 95%CI: 1.3-3.9) and living with friends (OR = 2.0; 95%CI: 1.2-3.4). Rates for 30-day use of 0, 1 and 2 or more drugs were 76.8%; 18.1% and 5.1%, respectively, and were associated with being single, separated or widowed (OR = 3.2; 95%CI: 1.4-7.0), lower socioeconomic classes (OR = 0.3; 95%CI: 0.1-1.1; p = 0.001), under 18 years old first experimentation with drugs (OR = 1.8; 95%CI: 1.1-2.9) and living with friends (OR = 1.8 95%CI: 1.2-2.8). CONCLUSION: Results indicate that students are at greater risk of illicit drug-related health problems. Thus, a better understanding of this consumption should be pursued, as well as the development of a prevention plan. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Toxicología is the property of Asociacion Espanola de Toxicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective Investigate the use of psychoactive substances at least once in life among students at the beginning and end of their courses and determine the associated factors. Methods A cross-sectional study conducted with a representative sample of 398 students in public university. The students answered a questionnaire validated for the evaluation of drug use and socio-demographic data. Poisson regression analysis was performed. Results A total of 56.3% and 13.3% of the students had used both legal and ilegal drugs. The following variables remained significantly associated with legal drug use in the final model: male sex (PR=1.48; 95%CI: 1.25-1.76), older age group (PR=1.23; 95%CI: 1.03-1.47), not living with parents (PR=1.20; 95%CI: 1.01-1.41), not having a religion (PR=1.37; 95%CI: 1.16-1.62) and taking a course in the health field (PR=1.33; 95%CI: 1.08-1.64). The following variables were significantly associated with ilegal drug use: male sex (PR=2.33; 95%CI: 1.35-4.02), older age group (PR=2.27; 95%CI: 1.28-4.02), higher monthly income (PR=1.73; 95%CI: 1.05-2.85) and not having a religion (PR=1.70; 95%CI: 1.02-2.84). Conclusion Legal and ilegal drug use at least once in life was associated with social factors, sex, age, income, religion, living situation and type of higher education course.

Abstract Given the current opioid crisis around the world, harm reduction agencies are seeking to help people who use drugs to do so more safely. Many harm reduction agencies are exploring techniques to test illicit drugs to identify and, where possible, quantify their constituents allowing their users to make informed decisions. While these technologies have been used for years in Europe (Nightlife Empowerment & Well-being Implementation Project, Drug Checking Service: Good Practice Standards; Trans European Drugs Information (TEDI) Workgroup, Factsheet on Drug Checking in Europe, 2011; European Monitoring Centre for Drugs and Drug Addiction, An Inventory of On-site Pill-Testing Interventions in the EU: Fact Files, 2001), they are only now starting to be utilized in this context in North America. The goal of this paper is to describe the most common methods for testing illicit substances and then, based on this broad, encompassing review, recommend the most appropriate methods for testing at point of care. Based on our review, the best methods for point-of-care drug testing are handheld infrared spectroscopy, Raman spectroscopy, and ion mobility spectrometry; mass spectrometry is the current gold standard in forensic drug analysis. It would be prudent for agencies or clinics that can obtain the funding to contact the companies who produce these devices to discuss possible usage in a harm reduction setting. Lower tech options, such as spot/color tests and immunoassays, are limited in their use but affordable and easy to use.

Abstract Background The exact nature of treatment and management recommendations made, and received, for mood and anxiety disorders in a community population is unclear. In addition, there is limited evidence on the impact of recommendations on actual receipt of treatment or implementation of management strategies. We aim to describe the frequency with which specific recommendations were made and implemented; and thus assess the size of any gap between the recommendation and implementation of treatments and management strategies. Methods We used the Survey ‘Living with a Chronic Condition in Canada - Mood and Anxiety Disorders (SLCDC-MA), a unique crossectional survey of a large (N = 3358) and representative sample of Canadians with a diagnosed mood or anxiety disorder, which was conducted by Statistics Canada. The survey collected information on recommendations for medication, counselling, exercise, reduction of alcohol consumption, smoking cessation and reduction of street drug use. We also estimate the frequency that recommendations are made and followed, as well the impact of the prior on the latter. We consulted people with lived experience of the disorders to help interpret our results. Results The results generally showed that most people would receive recommendations, almost all for antidepressant medications (94.6%), with lower proportions for the other treatment and management strategies (e.g. 62.1 and 66% for counselling and exercise). Most recommendations were implemented and had an impact on behaviour. The exception to this was smoking reduction/cessation, which was often not recommended or followed through. Other than with medication, at least 20% of the population, for each recommendation, would not have their recommendation implemented. A substantive group also exists who access treatments, and employ various management strategies, without a recommendation. Conclusions The results indicate that there is a gap between recommendations made and the implementation of treatments. However, its size varies substantially across treatments.

Objective. To analyze the care strategies of the adolescent crack user under treatment. Methods. Study of qualitative approach of descriptive type. The participants were 20 professionals from the Centro de Atenção Psicossocial Álcool e Drogas (Center for Psychosocial Care Alcohol and Drugs) and 10 professionals from the Centro de Atenção Psicossocial Infanto-juvenil (Center for Child Psychosocial Care) in a municipality in the interior of Rio Grande do Sul (Brazil). Data collection occurred through semi-structured interviews and the data were submitted to Thematic Analysis. Results. It was identified the development of strategies in four scopes: attractive activities in specialized services, the building of bonds between the team and the adolescent, the inclusion of family in the care and the intersectoral work. Conclusion. Care strategies, directed to and that address the needs of adolescents, contribute to better adherence to treatment and social reintegration. How to cite this article: Ribeiro JP, Gomes GC, Mota MS, Ortiz E, Eslabão AD. Strategies of care for adolescent users of crack undergoing treatment. Invest. Educ. Enferm. 2019; 37(3):e12.

Objective. This research sought to analyze the predictive effect of personal (personality traits), social (social support and social stigma) and community factors (characteristic of the neighborhood and exposure to consumption) on the transition of drug use in young adults. Methods. Case and control study. The cases were 70 individuals from 18 to 34 years of age who had already transitioned into illicit drug use and the controls were 210 legal drug usuers (tobacco or alcohol) in the same age range who had not had the transition. A data file was applied along with seven instruments that measured the transition and consumption variables. Results. Marihuana was the illicit drug of highest transition. It was shown that greater personality traits of neuroticism, extraversion, and openness to the experience meant higher probability of drug use transition; while greater personality traits of agreeableness and conscience meant lower probability for the transition. The characteristics of the neighborhood environment and exposure to the opportunity of consumption increase the probability of the drug use transition. Social support and social stigma influenced negatively upon the drug use transition. Conclusion. Personality traits, neighborhood characteristics, exposure to drug use, social support, and the social stigma of drug use are factors that intervene in the transition from legal to illicit drug use How to cite this article: Ozuna MS, Candia JS, Alonso MM, López KS, Guzmán FR. Factors in the Transition from Legal to Illicit Drug Use in Young Adults from Northern Mexico. Invest. Educ. Enferm. 2019; 37(3):e11.

Background: Mass media campaigns can be used to communicate public health messages at the population level. Although previous research has shown that they can influence health behaviours in some contexts, there have been few attempts to synthesise evidence across multiple health behaviours. Objectives: To (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps. Design: The study comprised (1) a systematic review of reviews, (2) a review of primary studies examining alcohol mass media campaigns, (3) a review of cost-effectiveness evidence and (4) a review of recent primary studies of mass media campaigns conducted in the UK. A logic model was developed to inform the reviews. Public engagement activities were conducted with policy, practitioner and academic stakeholders and with young people. Results: The amount and strength of evidence varies across the six topics, and there was little evidence regarding diet campaigns. There was moderate evidence that mass media campaigns can reduce sedentary behaviour and influence sexual health-related behaviours and treatment-seeking behaviours (e.g. use of smoking quitlines and sexual health services). The impact on tobacco use and physical activity was mixed, there was limited evidence of impact on alcohol use and there was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics, and to influence intentions regarding physical activity and smoking. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media. Limitations: Statistical synthesis was not possible owing to considerable heterogeneity across reviews and studies. The focus on review-level evidence limited our ability to examine intervention characteristics in detail. Conclusions: Overall, the evidence is mixed but suggests that (1) campaigns can reduce sedentary behaviour, improve sexual health and contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective. Future work: Future work could fill evidence gaps regarding diet mass media campaigns and new-media campaigns, examine cost-effectiveness in areas other than tobacco and explore the specific contribution of mass media campaigns to multicomponent interventions and how local, regional and national campaigns can work together. Study registration: This study is registered as PROSPERO CRD42015029205 and PROSPERO CRD42017054999. Funding: The National Institute for Health Research Public Health Research programme.