What colour are you? Smartphone addiction traffic lights and user profiles

PurposeThe key concern nowadays is smartphone addiction and user profiles. Following the risk and protective factors framework, the authors aim to characterize smartphone users according to two levels: (1) individual: referred to the use (i.e. boredom proneness, compulsive app downloading smartphone addiction) and (2) microsystem: referred to family and peers (i.e. family harmony and phubbing). Besides, the authors will derive useful managerial implications and strategies.Design/methodology/approachFirst, an extensive literature revision and in-depth interviews with experts were employed to identify the addiction-related variables at the individual and microsystem level. Second, information was collected from a sample of 275 Spanish smartphone users, and a K-means clustering algorithm was employed to classify smartphone users.FindingsThe proposed traffic lights schema identifies three users' profiles (red, yellow and green) regarding their smartphone addiction and considering individual and microsystem critical variables.Originality/valueThis study proposes a practical and pioneer traffic lights schema to classify smartphone users and facilitate each cluster's strategies development.

No Single Path: Review of Amy Sullivan's Opioid Reckoning

According to this framework, the pandemic is a two-part problem: one part virus, one part social resistance to the cure for the disease. [...]we hear that medical scientists have developed "gold standard" treatments for addiction, but that for reasons of bureaucratic lethargy, public skepticism, or sheer hopelessness among those suffering from addiction, the treatments are not adequately made available and sought out. The stories in the book are drawn from oral-history interviews that the author conducted with family members of people with addictions, doctors, community organizers, and treatment-center directors over a period of four years. Chapter Two reconstructs the life of a single man from the memories of his surviving family members, from the moment of his first exposure to opioids through fourteen separate rounds of addiction treatment and up to the moment of his fatal fentanyl overdose.

Accessibility and Financial Barriers in the Utilization of Alternative to Discipline Programs in the United States

Nurses are facing increased mental health issues, substance use, and even suicide since the novel coronavirus pandemicarrived in the United States. Nurses with substance use disorder (SUD) may enroll in alternative-to-discipline (ATD)programs to retain their license during initial treatment with the goal to return to practice, but this process is not withoutchallenges. For example, previous analyses have shown that the time surrounding disciplinary/regulatory process regardingsubstance use disorder (SUD) by either employers or licensure boards was a trigger for nurses who died by suicide. Internetsearches are a common approach to find information on health-related topics. This limited critical review sought toreplicate and evaluate a simple internet search that a nurse seeking information on their state ATD program may complete.Google searches for information on ATD programs were completed on the 50 continental states and Washington, DCbetween April and September 2022. States with ATD programs were evaluated for evidence-based components andbarriers to accessing program information. Publicly available ATD program information ranged from requirements forcontact information to obtain details to websites that outline the entire program, including associated costs. While ATDprograms offer a significant improvement over traditional disciplinary responses to nurse substance use, a significantbarrier is program cost, which can often exclude participation. In this article, we discuss the detailed results of our criticalreview and offer implications for practice that include opportunities for research and a national database to track ATDprogram components and target outcomes to support return to practice for nurses with SUDs © 2023, Online Journal of Issues in Nursing.All Rights Reserved.

Future perspectives of emerging novel drug targets and immunotherapies to control drug addiction.

Substance Use Disorder (SUD) is one of the major mental illnesses that is terrifically intensifying worldwide. It is becoming overwhelming due to limited options for treatment. The complexity of addiction disorders is the main impediment to understanding the pathophysiology of the illness. Hence, unveiling the complexity of the brain through basic research, identification of novel signaling pathways, the discovery of new drug targets, and advancement in cutting-edge technologies will help control this disorder. Additionally, there is a great hope of controlling the SUDs through immunotherapeutic measures like therapeutic antibodies and vaccines. Vaccines have played a cardinal role in eliminating many diseases like polio, measles, and smallpox. Further, vaccines have controlled many diseases like cholera, dengue, diphtheria, Haemophilus influenza type b (Hib), human papillomavirus, influenza, Japanese encephalitis, etc. Recently, COVID-19 was controlled in many countries by vaccination. Currently, continuous effort is done to develop vaccines against nicotine, cocaine, morphine, methamphetamine, and heroin. Antibody therapy against SUDs is another important area where serious attention is required. Antibodies have contributed substantially against many serious diseases like diphtheria, rabies, Crohn's disease, asthma, rheumatoid arthritis, and bladder cancer. Antibody therapy is gaining immense momentum due to its success rate in cancer treatment. Furthermore, enormous advancement has been made in antibody therapy due to the generation of high-efficiency humanized antibodies with a long half-life. The advantage of antibody therapy is its instant outcome. This article's main highlight is discussing the drug targets of SUDs and their associated mechanisms. Importantly, we have also discussed the scope of prophylactic measures to eliminate drug dependence.

Representational Naturalization as a Process: How Do Representational Objects Become Social Reality?

Cet article examine les problemes sociaux en tant qu'objets représentationnels qui ont été construits â travers un processus complexe de définition collective d'une situation (Blumer, 1971). Les transformations sociales orientent les communications de la société vers les problemes sociaux en contribuant â la genese représentationnelle des objets sociaux, plus spécifiquement par l'objectivation. Nous soutenons que l'étude de l'objectivation permet de comprendre le processus par lequel la réalité sociale est construite, notamment par la naturalisation des representations sociales. Dans cet article, nous présentons notre approche théorique de la naturalisation représentationnelle, basée sur notre étude de la toxicomanie, du workaholisme et de COVID-19. Nous exposons d'abord le rôle de la naturalisation représentationnelle dans la construction de la réalité sociale. Nous expliquons ensuite les quatre phases de ce processus: 1) la reconnaissance;2) l'élimination des contradictions ;3) l'utilisation instrumentale;et 4) la validation par l'expérience. Ces avancées théoriques permettront d'étudier la genese représentationnelle comme une modalité de l'émergence du monde social.Alternate abstract:Acest articol examinează problemele sociale ca obiecte reprezentaţionale care au fost construite printr-un proces complex de definire colectivă a unei situaţii (Blumer, 1971). Transformările sociale orientează comunicările din societate către problemele sociale, contribuind la geneza reprezentaţională a obiectelor sociale, mai precis prin obiectivare. Susţinem că studiul obiectivării ne permite să înţelegem procesul prin care se construieşte realitatea socială, în special prin naturalizarea reprezentărilor sociale. În acest articol, prezentăm abordarea noastră teoretică a naturalizării reprezentaţionale, bazată pe studiul nostru privind dependenţa de droguri, dependenţa de muncă şi pandemia de COVID-19. În primul rând, stabilim rolul naturalizării reprezentaţionale în construcţia realităţii sociale. Apoi, explicăm cele patru faze ale acestui proces: 1) recunoaşterea;2) eliminarea contradicţiilor;3) utilizarea instrumentală;şi 4) validarea prin experienţă. Aceste progrese teoretice vor face posibilă studierea genezei reprezentaţionale ca o modalitate de emergenţă a lumii sociale.Alternate abstract:This article examines social problems as representational objects that have been constructed through a complex process of collectively defining a situation (Blumer, 1971). Social transformations orient the communications in society toward social problems by contributing to the representational genesis of social objects, more specifically through objectification. We argue that the study of objectification allows us to understand the process by which social reality is constructed, especially through the naturalization of social representations. In this article, we present our theoretical approach of representational naturalization, based on our study of drug addiction, workaholism and COVID-19. We first set out the role of representational naturalization in the construction of social reality. We then explain the four phases of this process : 1) recognition;2) elimination of contradictions ;3) instrumental use;and 4) validation by experience. These theoretical advances will make it possible to study representational genesis as a modality of the emergence of the social world.

Drug use in pandemic times: reflections on mental health impacts

A new type of coronavirus, causing an infectious disease called COVID-19, with a high rate of transmissibility has spread around the world. The population was told to stay in their homes, in social isolation, so as not to act as vectors of virus transmission to more vulnerable individuals. The pandemic of the new coronavirus has brought social, economic, and psychological effects all over the world. Although these are necessary measures, the impacts of social isolation on the mental health of the population must be taken into consideration. This study aims to reflect on the effects of quarantine and the increase of addictive behaviors in this period of pandemic, bringing the implications of these for the mental and physical health of the population. This is a narrative review of articles, reports and book chapters published since the beginning of the pandemic, the main databases being Medline, Scielo and Scopus Elsevier. The findings point out that quarantine, has negatively impacted both the mental and physical health of the population, triggering psychological symptoms, such as anxiety, depression and addictive behavior, in addition, can arouse feelings such as sadness and anger, and may be punctual or extend after the end of isolation. However, there are strategies that, when adopted together, can minimize the psychological effects of isolation and make this moment less unhealthy. In this sense, this study highlights the importance of offering interdisciplinary treatments and effective public health strategies in public health systems, so that they can meet the needs of the population by providing comprehensive care and treatment, and by considering short, medium, and long-term actions to prevent addictive behaviors.

Factors associated with problematic substance use before and during the COVID-19 pandemic among a drug addiction recovery cohort: A prospective study in the Netherlands, Belgium, and UK.

BACKGROUND: The COVID-19 pandemic and measures have placed various burdens on societies and individuals. Emerging evidence suggests that people in drug addiction recovery were negatively affected. This study investigates whether risk and protective factors associated with return to problematic substance use differed between the periods before and during the pandemic for those in recovery. METHODS: A convenience sample of persons in drug addiction recovery for at least three months completed an assessment at baseline before the pandemic (T0, N = 367) and at two consecutive follow-ups 12 months apart (T1, N = 311; T2, N = 246). The final follow-up took place during the pandemic (2020-2021). We analyzed rates and predictors of problematic substance use in both periods, and whether relations between predictors and problematic use differed between the periods. RESULTS: Rates of problematic use did not differ significantly before and during the pandemic for those who were followed-up. However, the relationship between problematic use and commitment to sobriety differed between both periods (OR = 3.24, P = 0.010), as higher commitment was only associated with lower odds of problematic use during (OR = 0.27, P < 0.001), but not before, the pandemic (OR = 0.93, P = 0.762). In both periods, persons who were engaged in psychosocial support had lower odds of problematic use. CONCLUSIONS: The COVID-19 pandemic was not followed by significant return to problematic substance use in a cohort of people who were already in drug addiction recovery for some time before the pandemic. However, with restricted access to environmental resources, they may have been more dependent on internal motivations. Targeting personal recovery resources with interventions could therefore reduce the chances of return to problematic substance use during a pandemic.

Wastewater analysis and drug consumption: useful assessment tool.

Abstract: Drug use in Europe is now more than ever a multifaceted issue involving a broad and ever-changing range of substances. Alarmingly, recent European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reports show that roughly 83 million adults aged between 15 and 64 years in the European Union have used illicit substances at least once in their lifetime. Polydrug use is rife, and consumption patterns range from experimental/occasional, habitual use all the way to addiction. Traditional epidemiological methods delineating drug abuse specifics (i.e. number of users, age groups, specific characteristics and patterns of use) are questionnaire-based and therefore present the classic biases linked to the selected sample, thus risking an underesti-mation of the phenomenon. The Mario Negri IRCCS Pharmacological Research Institute has developed a new population screening method based on wastewater-based epidemiology (WBE) which makes it possible to detect drug metabolites in waste water and to estimate which and how many substances are consumed by the entire population belonging to the wastewater treatment plant being monitored. Such a technique has gained great interest at the national and international level, and may be especially valuable as a detection/monitoring tool at a time when novel psychoactive substances have come to trigger a major public health crisis, on account of their elusiveness and potential as substitutes/adulterants of traditional substances of abuse.

Alcoholism – Epidemic of the Current Time after COVID-19 Pandemic (Letter to the Editor)

Introduction: Harmful consumption of alcohol has a serious impact on public health and is considered as one of the main risk factors for health damage and disease on a global level. Increased consumption of alcohol is dangerous at any age;however, a greater risk has been shown at younger age. For this reason, our research has been focused on the consumption of alcoholic beverages among adolescents. Objective: We investigated the attitudes of students in relation to alcohol consumption. Material and methodology: To obtain necessary information, we used existing available professional literature and a nonstandardized questionnaire. For the defined research goal, we included in the research group older elementary school students and high school students. 272 respondents took overall part in the research. To test the hypotheses, we used Pearson's chi- square test of independence, Student's t-test and one-factor analysis of variance (ANOVA test - non-parametric version). Results: The results showed significant differences in alcohol consumption between smokers and non-smokers of elementary school students and high school students. In the observed group, today's generation of young people and teenagers have almost equal experiences with alcohol, whereas boys have a slightly higher drinking frequency. We also confirmed the connection between the frequency of consumption of alcoholic beverages and smoking. Regarding prevention, girls perceive a higher prevention than boys, but the subjective rate of alcoholism prevention importance is not age related. Conclusion: Of all the negative phenomena of modern human society, alcoholism is the most dangerous, due to its massive distribution. Therefore, prevention at primary level is to be taken seriously, which emphasizes a controlled consumption of alcohol. Considering the unfavorable statistical indicators of the increased alcohol consumption, especially in case of women, it is necessary to create long-term selective preventive programs.

The Young were not Spared: What Death Certificates Reveal about Non-Covid Excess Deaths.

From April 2020 through at least the end of 2021, Americans died from non-Covid causes at an average annual rate of 97 000 in excess of previous trends. Hypertension and heart disease deaths combined were elevated 32 000. Diabetes or obesity, drug-induced causes, and alcohol-induced causes were each elevated 12 000 to 15 000 above previous (upward) trends. Drug deaths especially followed an alarming trend, only to significantly exceed it during the pandemic to reach 108 000 for calendar year 2021. Homicide and motor-vehicle fatalities combined were elevated almost 10 000. Various other causes combined to add 18 000. While Covid deaths overwhelmingly afflict senior citizens, absolute numbers of non-Covid excess deaths are similar for each of the 18 to 44, 45 to 64, and over-65 age groups, with essentially no aggregate excess deaths of children. Mortality from all causes during the pandemic was elevated 26% for working-age adults (18-64), as compared to 18% for the elderly. Other data on drug addictions, non-fatal shootings, weight gain, and cancer screenings point to a historic, yet largely unacknowledged, health emergency.

Ultrasound combined with glial cell line-derived neurotrophic factor-loaded microbubbles for the targeted treatment of drug addiction.

Drug addiction is a serious problem globally, recently exacerbated by the COVID-19 pandemic. Glial cell-derived neurotrophic factor (GDNF) is considered a potentially effective strategy for the treatment of addiction. Previous animal experiments have proven that GDNF has a good therapeutic effect on drug addiction, but its clinical application is limited due to its poor blood-brain barrier (BBB) permeability. Low-frequency focused ultrasound, combined with microbubbles, is a non-invasive and reversible technique for locally-targeted BBB opening. In the present study, magnetic resonance imaging-guided low-frequency focused ultrasound, combined with GDNF microbubbles, was used to target BBB opening in the ventral tegmental area (VTA) region. The effects of GDNF on morphine-induced conditioned place preference (CPP) and acute withdrawal symptoms in rats after a partially opened BBB were evaluated by behavioral observation. Western blot was used to detect changes in tyrosine hydroxylase (TH) expression levels in the VTA region after different treatments, and high performance liquid chromatography was used to detect the changes in monoamine neurotransmitter content. The results showed that ultrasound combined with GDNF microbubbles targeted and opened the BBB in the VTA region, and significantly increased GDNF content, destroyed morphine-induced CPP, and reduced the withdrawal symptoms of morphine addiction in rats. Furthermore, the up-regulation of TH expression and the increase of norepinephrine and dopamine content induced by morphine were significantly reversed, and the increase of 5-hydroxytryptamine content was partially reversed. Therefore, ultrasound combined with GDNF microbubbles to target and open the BBB can effectively increase the content of central GDNF, thus playing a therapeutic role in morphine addiction. Our study provides a new approach to locally open the BBB and target delivery of neurotrophic factors, such as GDNF, to treat brain diseases like addiction.

Demographic shift related to change to online delivery of smoking cessation courses in response to COVID-19 at a university hospital in the Republic of Ireland

BackgroundIn September 2020, in-person smoking cessation courses, running for many years at St Vincent’s University Hospital, were converted to online delivery due to COVID-19. The courses, which normally were held in person in the early evening, were directed at patients and members of the hospital catchment area community. The difficulties in forming supportive networks online and lack of carbon monoxide monitoring for motivation when developing an ‘ex-smoker’ identity were initial concerns with the move online. The aim of this study was to compare in-person and online participation, satisfaction and quit rates.MethodsThe six-week programme was slightly adjusted for online use. Pre-course meetings, with individuals or in small groups, were organised to meet participants and sort technical issues.Registration and follow-up data were analysed from January 2015 – February 2020 (in-person group 6-week course;272 participants) and March 2020 – November 2021 (online group 6-week course;62 participants). Data was also available for 107 in-person and 23 online participants who completed evaluation forms.ResultsOnline participants were more significantly more likely to be female (73.6% vs 58.9%;p=0.022) and have a mean age approximately 4 years younger (46.8 vs 50.9;p=0.011). Online participants were also significantly more likely to use pharmacotherapy (74.6% vs 47.8%;p<0.001). The online and in-person groups had similar attendance, with an average of 3.56 and 3.8 sessions attended respectively. The online groups had non-significantly higher quit rates at the end of course, at 1 month, and 3 months than their onsite counterparts (47.9 vs 45%;40.3 vs 35%;22.8% vs 22.5%;ns). ‘Useful’ ratings were similar – 98% (in-person) and 96% (online).DiscussionThe move online was successful, with similar engagement and ratings and a maintenance of quit rates. However, the demographic shift is notable;technology requirements may have deterred older smokers. When we return fully to normal in-person service delivery, this is a COVID-related change we will continue as part of a hybrid model of smoking cessation courses, as online courses should continue to suit some future participants.

A national audit of smoking cessation services in adult specialist cancer care hospitals in Ireland

BackgroundDespite the progress made in smoking reduction in Ireland, smoking remains a challenge, particularly in cancer patients where post-diagnosis smoking has detrimental impacts on treatment and survival. This audit was of existing hospital smoking cessation services (SCS) for all patients (including cancer) at the eight specialist adult cancer hospitals (tertiary referral university hospitals) and one specialist radiotherapy hospital.MethodsAn audit was conducted online, completed by smoking cessation (SC)/health promotion officers at each hospital in 2021, with questions based on literature review and the (first) consultative National Clinical Stop Smoking Guideline (published 2022).ResultsOne hospital did not participate due to unavailability of relevant staff. SCS were provided at 7 of 9 (77.8%) hospitals, predominantly to inpatients on admission or during hospital stay (5;55.5%) but also at lower rate at discharge (3;33.3%) and in outpatients (4;44.4%). SCS were provided in the main by medical, nursing and hospital SC officers (6;66.6%);just 44.4%% noted alignment with community SC (for ongoing support). SCS provided included brief intervention and or ongoing support (6;66.6%), intensive support (4;44.4%), follow up phone support (2;22.2%). SCS were delivered mainly (pre-COVID) as individual face-to-face (5;55.5%) but phone (4;44.4%), online (3;33.3%) and group work (1;11.1%%) were also utilised. Nicotine Replacement Therapy was the first-choice in 2021 which almost all provided (7;77.8%), with fewer offering varenicline (5;55.5%) or bupropion (2;22.2%). SCS was promoted on the hospital website in 55.5% despite hospital campuses being smoke-free, however, SC information was provided in appointment letters. Most hospitals (6;66.6%) provide/promote SC training;and 4 (44.4%) have staff trained to deliver intensive stop-smoking advice.Six (66.6%) of 9 hospitals provided SCS to cancer patients attending outpatient clinics, day units, inpatients or other departments (e.g., radiology, emergency). However, many hospitals noted low referral rates for cancer patients. While 6 hospitals recorded data on overall SCS uptake, one recorded it specifically for cancer patients. Cancer patients who smoke are automatically referred to SCS (at diagnosis/when starting systemic anti-cancer therapy/radiotherapy) and routinely prescribed SC medications at one hospital. Few oncology staff had received SC intervention training.ConclusionA hospital visit/admission provides a cue to action for smokers and is an important opportunity for brief intervention by healthcare professionals to promote SC. This first National Clinical Guideline should assist necessary strengthening of hospital SCS and promote smoking cessation support, particularly among cancer patients.

Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program.

BACKGROUND: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. OBJECTIVE: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. METHODS: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant's physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. RESULTS: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. CONCLUSIONS: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality.

Changes in the Care Activity in Addiction Centers with Dual Pathology Patients during the COVID-19 Pandemic.

BACKGROUND: Health care provision during the COVID-19 pandemic and confinement has led to significant changes in the activity of addiction centers. These changes in healthcare activity may have had a greater impact on patients with dual pathology. The aim of this study is to compare the treatment indicators of patients with dual pathology in addiction centers during the pre-confinement, confinement, and post-confinement periods. METHODS: A retrospective observational study was conducted for the period between 1 February 2019 and 30 June 2021. A total of 2785 patients treated in specialized addiction services were divided into three periods according to their time of admission: pre-confinement, confinement, and post-confinement. RESULTS: During the pre-pandemic period, the addiction centers attended to an average of 121.3 (SD = 23.58) patients, decreasing to 53 patients during confinement (SD = 19.47), and 80.69 during the post-confinement period (SD = 15.33). The number of appointments scheduled monthly for each patient decreased during the confinement period, although this number increased after confinement. There was a reduction in the number of toxicological tests carried out both during and after confinement (except for alcohol). CONCLUSIONS: The results show a reduction in the number of patients seen and the care activity delivered to dual diagnosis patients. These results, which were caused by the COVID-preventive measures, may affect the progress and recovery of dual patients. A greater investment is needed to bring the care activity up to the standards of the years prior to confinement.

Nitrous Oxide/Whippits-Induced Thoracic Spinal Cord Myelopathy and Cognitive Decline With Normal Serum Vitamin B12.

Abuse of nitrous oxide leads to irreversible neurologic deficits. Nitrous oxide is commonly abused through the inhalation of whipped cream canisters. These whipped cream chargers, also known as "whippits," are widely available in the United States and their sale is unregulated. There is an increasing prevalence of whippet abuse, and many are unaware of the catastrophic effects. The mechanism of injury is mediated through severe depletion of vitamin B12. Here, we report a case of nitrous oxide abuse leading to thoracic cord myelopathy. The patient has been inhaling approximately 80-100 nitrous oxide canisters daily for three months total. A magnetic resonance imaging (MRI) of the spinal cord illustrates the lesion within the thoracic cord. Further diagnostic workup with serum vitamin B12 levels was normal. However, elevated levels of methylmalonic acid (MMA) were seen. Despite supplementation of vitamin B12, the patient's neurologic deficits persisted, and he was referred to a rehabilitation center. The abuse of whippets is a serious public health threat and warrants greater regulation of their sale. MMA and holotranscobalamin (holoTC) are improved biomarkers for diagnosing vitamin B12 deficiency.

E-Cigarette Flavors, Devices, and Brand Preferences Among Youths in Canada, England, and the United States: The Value and Challenges of Comparing International Survey Data

First-generation e-cigarettes were visually more like traditional tobacco cigarettes but lacked choice in flavors, whereas newer versions have evolved, looking less like their predecessors and gaining flavor alternatives. Equally, however, choice of flavors plays an important role in potentially supporting adults who use e-cigarettes as a smoking cessation aid.4 It has therefore been a challenge for policymakers in different jurisdictions to balance actions that reduce pathways of harm for young people's health and actions that minimize disruption of smoking cessation efforts among adults, a choice often made within a limited supply of evidence. [...]comparing findings from different countries can present challenges given the international divergence in e-cigarette use, which likely reflects differences in the regulatory landscape over the past decade.7 For example, Hammond et al. highlighted that, unlike in the United States and Canada, cartridge and pod e-cigarettes remain less prevalent than refillable tank devices among youth and adult vapers in the United Kingdom. Since 2016, there has been a plateauing of e-cigarette use in the United Kingdom, in contrast to the large growth seen in the United States during this period.8 European Union legislation such as the Tobacco Products Directive likely delayed the entry of products such asJUUL into UK markets as a result of the restrictions on e-liquids with a nicotine strength of more than 20 milligrams per milliliter. [...]our later research showed that the proliferation of e-cigarette use in the United Kingdom likely contributed to hardening attitudes toward smoking amongyoung people.10 In contrast to the United States, the majority of users of nicotine-based vaping products in the United Kingdom are adults.11 After implementation of the Tobacco Products Directive, e-cigarette flavor remained an important reason for e-cigarette experimentation among young people in the United Kingdom.3 Attraction to flavors continues to be a strong reason in more recent Englandbased surveys.11 Efforts to address vaping flavor enticement among young people may thus take different forms moving forward, with North America highlighting the role of nicotine-based products and England focusing more attention on the role of non-nicotine products.

Experimental Forum 2: Two Years After the 2020 Food and Drug Administration Guidance on E-Cigarette Flavors

Putatively, flavorings afford adult cigarette smokers options to switch to vaping.1 But the flavorings are also perceived to be attractive to people who have never smoked cigarettes, with particular concern about nicotine initiation by underage youths.2 In particular, the flavor and type of device on which nicotine use is initiated may influence later nicotine dependence in young adults.3 In the United States, three broad classes of vaping device are common: (1) single-unit disposable devices roughly equivalent to a pack of cigarettes;(2) homemade devices with, for example, customizable nicotine liquid tanks, batteries, and mouthpieces;and (3) devices with a rechargeable battery and replaceable cartridges containing nicotine liquid. Creating complicated relationships, and further limiting possible benefits to smoking cessation in the public health audience's eyes, Altria (formerly Philip Morris) purchased a major stake in JUUL in 2018. In addition to stay-at-home mandates, fear of contracting the respiratory illness was noted to increase motivation to quit cigarette smoking.8 Interestingly, e-cigarette users also reported greater quit attempts (41 %) than did cigarette smokers (26%) because of COVID-19 fears.9 In addition, various state and local prohibitions against public vaping and fluctuations in product cost have also occurred. Because of changes in sampling necessitated by the COVID-19 pandemic, data quality in large population-based surveys remains an area of active investigation, including potential discontinuities that could limit comparisons overtime. [...]we note that one or two time points since the Guidance was released may not portend sustained changes in behavior.

Pause, pivot and proceed: a before-after study to examine the impact of the COVID-19 pandemic on a community-based peer-recovery program for substance use disorder. (Special Issue: COVID-19 and health inequities: insights from communication research and practice.)

Background: During the COVID-19 pandemic, most peer recovery programs had to end face-to-face services and move to an online and or phone-based format. It is not clear what impact if any, this may have had on individual referrals, contact and services rendered. The goal of this study was to explore the impact of the COVID-19 pandemic on a community-based peer-recovery program.

The rate of smoking and drug addiction among patients with COVID-19 specially based on sex genetic factor

The aim of this study was to determine the extent of tobacco and drug addiction to opium, methamphetamine and heroin in hospitalized patients due to COVID-19. In this cross-sectional descriptive study, the rate of smoking and drug addiction among COVID-19 patients admitted to Shahid Sadoughi hospital in Yazd was investigated. A total of 500 patients were studied and patient information such as smoking and drug use history, dosage, type of substance, length of hospital stay and severity of the disease were extracted in this paper. Then the data were entered into SPSS software and analyzed. No significant relationship was found between patients sex (Main genetic factor) and smoking with disease severity. Also, no significant relationship was found between smoking and length of hospital stay. Also, there was no significant difference between the severity of clinical symptoms in drug users and other subjects. In this study, the prevalence of smoking among COVID-19 patients was about 6.6 %. © 2021 Health Biotechnology And Biopharma. All Rights Reserved.