Spore forming bacteria infections and people who inject drugs: Implications for harm reduction.

BACKGROUND: There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. METHODS: The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. RESULTS: 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p < 0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p < 0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p < 0.001) or discussed the postcard (aOR = 6.707, CI 2.744 16.252, p < 0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR = 3.304 CI 1.425 7.660, p < 0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events. CONCLUSION: More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

Association between harm reduction intervention uptake and skin and soft tissue infections among people who inject drugs.

BACKGROUND: Bacterial skin and soft tissue infections (SSTIs) are a health issue for people who inject drugs (PWID). There is a lack of evidence on the associations between harm reduction (HR) uptake and SSTIs. This paper examines the associations between the uptake of injecting equipment (IE) and opiate substitution treatment (OST) on SSTIs among PWID, and the injecting behaviours associated with having had an SSTI. This is the first large-scale, national study to examine the association between IE uptake and SSTIs. METHODS: A cross-sectional, voluntary and anonymous survey was undertaken with PWID recruited from pharmacies/agencies providing IE across mainland Scotland during 2013-2014. Participants were asked: if they had an SSTI within the past year; about their uptake of HR within the past 6 months (including needle/syringes (N/S), paraphernalia and OST); and about their frequency of injecting, sharing of IE and re-use of own N/S. Data from 1876 PWID who had reported injecting within the past 6 months were analysed. FINDINGS: In multivariate logistic regression, those with high combined IE-OST uptake (adjusted odds ratio [AOR] 0.614, 95% CI 0.458-0.823, p=0.001) and medium combined IE-OST uptake (AOR 0.725, 95% CI 0.546-0.962, p=0.026) had lower odds of having had an SSTI compared to those with low combined IE-OST uptake. CONCLUSIONS: IE and OST uptake may reduce the level of SSTIs among PWID, suggesting increasing combined uptake may be beneficial. Nevertheless, a sizeable proportion of PWID with high HR uptake experienced SSTIs, suggesting the importance of other interventions.

Mapping the recovery stories of drinkers and drug users in Glasgow: quality of life and its associations with measures of recovery capital.

INTRODUCTION AND AIMS: The study investigates what 'recovery' means for those who describe themselves as in alcohol or drug recovery. DESIGN AND METHODS: The project used multiple methods-snowballing, recruitment through recovery groups and advertisements in local press-to recruit 205 people (107 in alcohol and 98 in heroin recovery) who reported a lifetime dependence on alcohol and/or heroin; had not used their primary substance in the last year and perceived themselves to be either recovered or in recovery. They were interviewed by researchers using a structured questionnaire reported in the current paper and a semi-structured interview reported elsewhere. RESULTS: The average time dependent for heroin users was 10.8 years and for drinkers 15.7years, but onset and desistance were earlier for heroin. Longer time since last use of alcohol or heroin was associated with better quality of life. Greater engagement in meaningful activities was associated with better functioning, and was associated with quality of life, followed by number of peers in recovery in the social network. Heroin users in abstinent recovery generally reported better functioning than those in maintained recovery. DISCUSSION AND CONCLUSIONS: Recovery experiences vary widely, but better functioning is typically reported after longer periods and is associated with supportive peer groups and more engagement in meaningful activities, and supports models promoting the development of peer networks immersed in local communities.

Practical aspects of oronasopharyngeal suction in children.

Undergoing oronasopharyngeal suction is an unpleasant experience, but the intervention may prevent the deterioration of children who cannot clear their secretions. A successful procedure requires a practitioner with appropriate knowledge, dexterity and communication skills. Thorough training should be provided and a careful risk-benefit assessment is important before suction is performed.

Nasogastric tube feeding--which syringe size produces lower pressure and is safest to use?

BACKGROUND: For this research, we worked on the hypothesis that larger syringe sizes would not generate greater pressures (negative or positive) than smaller ones. This contradicts current practice and theory, which states that larger syringes produce lower pressures and are safer. AIM: To establish the most appropriate syringe size in a laboratory experiment. METHOD: We attached a manometer to a syringe with and without nasogastric tubes and measured negative pressures generated when aspirating, and positive pressures generated when injecting fluids. RESULTS: The findings suggest that smaller syringes generate lower pressures; further research is needed to confirm this. CONCLUSION: If we are correct there is a patient safetyissue, which must be addressed urgently. Also, smaller syringes may lead to significant cost savings.