Primary care-based interventions for secondary prevention of opioid dependence in chronic non-cancer pain patients on pharmaceutical opioids: systematic review.

BACKGROUND: Globally almost one third of adults with chronic non-cancer pain (CNCP) are prescribed opioids. Prevention of opioid dependence among these patients is a public health priority. AIM: Synthesise the evidence on the effectiveness of primary care-based interventions for secondary prevention of opioid dependence in CNCP patients on pharmaceutical opioids. DESIGN & SETTING: Systematic review of randomised controlled trials (RCTs) and comparative non-randomised studies of interventions from high-income countries. METHOD: We searched five databases for studies on non-tapering secondary prevention interventions such as tools for predicting dependence, screening tools for early recognition of dependence, prescribing/medication monitoring, and specialist support. We examined multiple outcomes, including reduction in opioid dosage. Primary analyses were restricted to RCTs with data synthesised using an effect direction plot. Risk of bias was assessed using the Cochrane risk of bias (RoB2) tool. RESULTS: Of 7,102 identified reports, 18 studies were eligible (8 RCTs). Most used multiple interventions/components. Of the seven RCTs at low risk of bias or 'some concerns', five showed a positive intervention effect on at least one relevant outcome, four of which included a nurse care manager and/or other specialist support. The remaining two RCTs showed no positive effect of automated symptom monitoring and optimised analgesic management by a nurse care manager/physician pain specialist team, or of a mobile opioid management app. CONCLUSION: We identify a clear need for further adequately powered high quality studies. The conclusions that can be drawn on intervention effectiveness are limited by the sparsity and inconsistency of available data.

Nucleation increases the visual appeal of lager but does not alter overall likeability or drinking rate.

BACKGROUND: Glassware can be an effective vehicle to recruit customers, revive brands, build profits and increase alcohol consumption by capitalising on the immediacy of glassware to the point of consumption. The design of glassware can also contribute to harm reduction by slowing and reducing consumption. Nucleated bases have been added to lager glasses in recent years which allow carbon dioxide (CO2) to be more rapidly released and ascend through the solution. The aim of these studies was to investigate the effect of nucleated glasses on the likeability and drinking rate of lager in alcohol drinkers. METHODS: In Study 1, participants (n = 116) were asked to taste two glasses of lager (280 millilitres (ml) each) in separate 5-min taste tests and fill out a likeability questionnaire after each glass in a within-subjects design with one factor of glass (nucleated, non-nucleated). The primary outcome was the likeability of lager and the secondary outcome was volume consumption during taste tests. In Study 2, participants (n = 160) were asked to consume a pint of lager (568 ml) and fill out a likeability questionnaire in a between-subjects design with one factor of glass (nucleated, non-nucleated). The primary outcome was time taken to consume a pint of lager and secondary outcomes were the likeability of lager, mood and alcohol craving. RESULTS: There was no clear evidence that likeability of lager differed between nucleated and non-nucleated glasses in either study. In Study 1, a paired-samples t test found strong evidence that lager in nucleated glasses was more visually appealing (single item from likeability measure) than lager in non-nucleated glasses (mean difference (MD) = 10.2, 95% confidence interval (CI) 6.1, 14.2, p < 0.001). In Study 2, a linear regression found no clear evidence that lager was consumed at different rates from nucleated and non-nucleated glasses (nucleated: 16.9 min, non-nucleated: 16.3 min, MD: 0.6 min, 95% CI - 1.5, 2.7, p = 0.57). CONCLUSIONS: Nucleated lager glasses do not appear to alter the likeability or consumption (volume consumed in Study 1 or drinking rate in Study 2) of lager, although they do seem to increase the visual appeal and refreshment of lager. This may increase the number of drinking episodes by making the drinking experience more enjoyable which may lead to increased alcohol related harm.

Effect of glass shape on the pouring accuracy of liquid volume.

BACKGROUND: The shape of glassware may exacerbate or counteract biases in perceived volume, which may lead people to misjudge the pouring of alcoholic drinks. The aim of these studies was to investigate the effect of glass shape on the pouring accuracy of liquid volume. METHODS: In Study 1, using an online computerised task, participants (n = 211) were asked to pour liquid in glasses in a within-subjects design with factors of glass shape (straight, curved) and requested percentage fullness (10, 20, 25, 30, 40, 50, 60, 70, 75, 80, 90%). Curve estimations were carried out to determine if errors followed a linear or non-linear relationship. In Study 2, in a real world experimental study, participants (n = 96) were asked to pour water to the midpoint of pint glasses in a within-subjects design with one factor of glass shape (straight, curved, tulip, inverted). Differences between poured amounts were analysed using one-way repeated measures ANOVA. RESULTS: In Study 1, participants under-poured in curved glasses compared to straight glasses at all requested amounts. In Study 2, participants under-poured in curved (p < 0.001, dz = 1.51) and tulip (p < 0.001, dz = 0.59) glasses compared to straight glasses. Findings were inconclusive as to whether or not a difference was present between pourings in inverted and straight glasses. Participants displayed a tendency to under-pour in all glasses relative to requested amounts in both studies. CONCLUSIONS: The shape of glassware appears to influence the pouring accuracy of liquid. Pouring in tulip and curved glasses was more inaccurate compared to straight glasses, possibly due to the height of liquid within the glass and volume changing in a non-linear relationship.

Effect of glass markings on drinking rate in social alcohol drinkers.

Background: The main aim of these studies was to explore the influence of volume information on glassware on the time taken to consume an alcoholic beverage. Methods: In Study 1, male and female social alcohol consumers ( n = 159) were randomised to drink 12 fl oz of either low or standard strength lager, from either a curved glass marked with yellow tape at the midpoint or an unmarked curved glass, in a between-subjects design. In Study 2, male and female social alcohol consumers ( n = 160) were randomised to drink 12 fl oz of standard strength lager from either a curved glass marked with », ½ and ¾ volume points or an unmarked curved glass, in a between-subjects design. The primary outcome measure for both studies was total drinking time of an alcoholic beverage. Results: In Study 1, after removing outliers, total drinking time was slower from the glass with midpoint volume marking [mean drinking times (min): 9.98 (marked) vs. 9.55 (unmarked), mean difference = 0.42, 95% CI: -0.90, 1.44]. In Study 2, after removing outliers, total drinking time was slower from the glass with multiple volume marks [mean drinking times: 10.34 (marked) vs. 9.11 (unmarked), mean difference = 1.24, 95% CI: -0.11, 2.59]. However, in both studies confidence intervals were wide and also consistent with faster consumption from marked glasses. Conclusion: Consumption of an alcoholic beverage may be slower when served in glasses with volume information. Replication in larger studies is warranted.

Association of Alcohol Consumption with Perception of Attractiveness in a Naturalistic Environment.

AIMS: To investigate the relationship between objectively-assessed alcohol consumption and perception of attractiveness in naturalistic drinking environments, and to determine the feasibility and acceptability of conducting a large-scale study in these environments. METHODS: Observational study conducted simultaneously across three public houses in Bristol, UK. Participants were required to rate the attractiveness of male and female face stimuli and landscape stimuli administered via an Android tablet computer application, after which their expired breath alcohol concentration (BrAC) was measured. RESULTS: Linear regression revealed no clear evidence for relationships between alcohol consumption and either overall perception of attractiveness for stimuli, for faces specifically, or for opposite-sex faces. The naturalistic research methodology was feasible, with high levels of participant engagement and enjoyment. CONCLUSIONS: We found no evidence for a relationship between alcohol consumption and perception of attractiveness in our large-scale naturalistic study. Our study is important given the large sample size, the successful translation of an experimental, laboratory-based paradigm to a naturalistic drinking environment and the high level of public engagement with the study. Future studies should use similarly ecologically-valid methodologies to further explore the conditions under which this effect may be observed and identify the mechanisms underlying any relationships.

The effect of glass shape on alcohol consumption in a naturalistic setting: a feasibility study.

BACKGROUND: Alcohol-related harms are a major public health concern, and population-level interventions are needed to reduce excessive alcohol consumption. Glass shape is an easily modifiable target for public health intervention. Laboratory findings show beer is consumed slower from a straight glass compared to a curved glass, but these findings have not been replicated in a naturalistic setting. The purpose of this study is to investigate the feasibility of conducting a randomised controlled trial investigating the effect of glass shape on alcohol consumption in public houses. METHODS: Straight and curved half-pint and pint glasses were delivered to three public houses over two weekends. Glass type was counterbalanced over the two weekends and between the public houses. Monetary takings were recorded as an indirect measure of consumption. RESULTS: Replacing stocks of glassware in public houses was feasible and can be enacted in a short space of time. One landlord found the study too disruptive, possibly due to a laborious exchange of glassware and complaints about the new glassware from some customers. One public house's dishwasher could not accommodate the supplied curved full-pint glasses. Obtaining monetary takings from public house staff was a feasible and efficient way of measuring consumption, although reporting absolute amounts may be commercially sensitive. Monetary takings were reduced by 24 % (95 % confidence interval 77 % reduction to 29 % increase) when straight glasses were used compared to curved glasses. CONCLUSIONS: This study shows that it is feasible to carry out a trial investigating glass shape in a naturalistic environment, although a number of challenges were encountered. Brewery owners and landlords are willing to engage with public health research in settings where alcohol is consumed, such as public houses. Good communication with stakeholders was vital to acquire good data, and highlighting the potential commercial benefits of participating was vital to the study's success. A full scale evaluation of the effects of glass shape on alcohol consumption could inform local and national policy.