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The first stage of the COVID pandemic in spring and early summer of 2020 was shaped by restrictions due to the so-called flattening-the-curve approach. Students globally were impacted when public and private colleges and universities were forced to either shut down temporarily or transition to remote learning. Studies from around the world found increased levels of stress, anxiety, depression, and suicidal ideation. Female students often reported being more affected than male students. Suicide rates, however, did not increase. The second stage, starting in late summer 2020, saw the highest case numbers but also a slow and mostly partial return to normal life enabled by vaccination efforts and policy decisions. The mental health of students in most countries recovered well, even when they had to go through repeated or continued lockdowns or restrictions. Although it cannot be predicted what portion of students will be affected by mental health issues in ten or twenty years, it is certain that there will be long-term mental health consequences for many. It is also uncertain which approach, "living with COVID" or "zero COVID," will show less impact on the mental health of students' long term.
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COVID-19 , Saúde Mental , SARS-CoV-2 , Estudantes , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudantes/psicologia , Feminino , Masculino , Universidades , Estresse Psicológico/psicologia , Estresse Psicológico/epidemiologia , Pandemias , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Depressão/psicologiaRESUMO
This study investigated the visual search behavior of equestrian dressage judges at different expertise levels during the assessment of Grand Prix horse-rider combinations. Twenty judges (11 foundational level, 9 advanced level) participated in the study, with their eye movements recorded using Tobii Fusion Eyetracker as they evaluated video recordings of dressage tests. Fixation metrics, namely Total Duration of Fixation (TDF), Average Duration of Fixation (ADF), and Total Number of Fixations (TNF), were analyzed across four Areas of Interest (AOIs): front, back, rider, and horse's feet. Statistical analysis utilized linear mixed-effects models. Results demonstrated that judges consistently focused more on the front of the horse, with additional differences in fixation duration and frequency based on judge experience and specific movements. Advanced judges focused more on the horses' feet, suggesting they draw meaning from specific areas indicative of performance quality. Conversely, foundational level judges focused more on the rider, reflecting different evaluative priorities at lower levels of the sport. These findings suggest that judges focus on a limited number of highly relevant areas, differing across movements and expertise levels. The study underscores the necessity of understanding both gaze behavior and subsequent interpretations of visual information to increase judging transparency, fairness, and equine welfare.
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The Financial Action Task Force (FATF) requires national governments to demonstrate an understanding of the distribution of money laundering risks across different sectors of the financial system. Such understanding is the foundation for effective control of money laundering under the risk-based approach called for by the FATF. We analyzed the National Risk Assessments (NRAs) of eight systemically important countries before 2020 to test whether these demonstrated that basic understanding. The eight show very different conceptualizations, analytic approaches, and products. None showed more than minimal competence at risk assessment. For example, most relied largely on expert opinion, solicited, however, in ways that violated the well-developed methodology for eliciting expert opinion. They consistently misinterpreted Suspicious Activity Reports, the most fine-grained quantitative data available on money laundering, and failed to provide risk assessments relevant for policymakers. Only one described the methodology employed. Although conducting strong money laundering risk assessments is challenging, given the difficulty of estimating the extent of laundering in any sector, existing practices can be improved. We offer some potential explanations for the failure of governments to take this task seriously. The lack of involvement of risk assessment professionals is an important contributing factor to the weaknesses of the current NRAs.
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The 2000-2001 and the 2022-2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland). The responses were not instantaneous, but rather evolved, sometimes over several years. This variety suggests that it can be hard to predict how drug markets will respond to disruptions, but two extreme views can be challenged. It would be naive to imagine that drug markets will not adapt to shocks, but also unduly nihilistic to presume that they will always just bounce back with no lasting effects. Substitution to another way of meeting demand is possible, but that does not always negate fully the benefits of disrupting the original market. Nonetheless, there is historical precedent for a European country's opioid market switching to synthetic opioids when heroin supplies were disrupted. Given how much that switch has increased overdose rates in Canada and the United States, that is a serious concern for Europe at present. A period of reduced opioid supply may be a particularly propitious time to expand treatment services (as Norway did in the early 2000s).
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Overdose de Drogas , Papaver , Humanos , Estados Unidos , Analgésicos Opioides , Heroína , Fentanila , Europa (Continente)/epidemiologiaRESUMO
Estimating stocks and flows is an innovative first step.
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The spread of illegally manufactured opioids, including fentanyl, has brought unprecedented levels of drug overdose deaths in North America. In some markets, illegally manufactured fentanyl (IMF) is essentially displacing heroin, not just being used to adulterate it. It is not possible at this time to provide an accurate point estimate of the amount of IMF consumed in the United States. Yet for various purposes (e.g. assessing changes in production levels and the appropriate role for various supply reduction efforts), it is important to have a sense of scale. This article provides guidance through two thought experiments that provide a hypothetical upper bound on U.S. consumption. The first considers a scenario in which IMF replaces heroin in all illegal opioid markets. The second starts with the number of individuals with an opioid use disorder and considers what total consumption would be if IMF was the only opioid they consumed. Both calculations suggest it is unlikely that the annual consumption of IMF in 2021 could have been more than single digit pure metric tons. For comparison, the most recent best estimates of the amount of cocaine and heroin consumed in the U.S. are 145 and 47 pure metric tons, respectively. The article also raises questions about the limitations of using traditional equianalgesic morphine equivalent dose conversions to estimate the total market consumption of IMF.
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Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Overdose de Drogas/epidemiologia , Fentanila , Heroína , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Objective: To assess how living arrangements influence lifestyle habits and behaviors that impact the health and academic achievement of students. Participants: 876 undergraduate students at a university in Florida. Methods: Students in all colleges were invited to participate in an anonymous survey. The survey was comprised of questions based on living arrangements, grade point average (GPA), anthropometric measures, as well as health behaviors. Data analysis was performed employing least squares regression and Wilcoxon and Kruskal-Wallis Rank Sums Test tests. Results: Different living arrangements were related to different health behaviors, but not one arrangement was associated with unhealthy or healthy habits only. Overall, there was no significant association between students' living arrangement, body-mass index (body mass index), and self-reported GPA. Conclusion: While university students' living arrangements are associated with differences in health behaviors and habits, these differences have no significant impact on students' average BMI or GPA.
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BACKGROUND: The illegal drug trade is often, and plausibly, asserted to be the largest illegal market, globally and in many individual countries. It is also claimed that a large share of its revenues is laundered, though there are no estimates of that volume. We provide rough estimates of that proportion and its primary determinants. METHODS AND DATA: This paper presents a model of a multi-tiered drug distribution network that is parameterized with data based on one typical, well-studied case, namely British Colombia's market for illegal opioids, supplemented by a corresponding economic interpretation of what determines the share of drug trade revenues that need to be laundered. Sensitivity with respect to key parameters is analyzed. FINDINGS: We suggest that less than half and perhaps no more than a quarter of revenues from established drug markets need laundering. Key parameters governing this proportion include the price mark-up across distribution levels, transaction volumes at each market level, and the capacity of market participants to spend cash on daily living expenses. CONCLUSION: This model permits estimation of the scale of money laundering associated with a particular drug market. It suggests that there are limits on money laundering controls as a way of reducing drug supply - although money laundering investigations may still be an effective way to identify and investigate high-level drug traffickers.
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Tráfico de Drogas , Lavanderia , Analgésicos Opioides , Crime , HumanosRESUMO
BACKGROUND AND AIMS: Several randomized controlled trials (RCTs) conclude that heroin-assisted-treatment (HAT) has a larger benefit-cost ratio than oral methadone because HAT more reliably and substantially reduces participants' criminal activity. This review: (1) summarizes results from RCTs concerning the comparative effectiveness of HAT for reducing criminal activity and (2) examines the role of different mechanisms for explaining changes in crime. DESIGN: Systematic search of five databases for RCTs evaluating comparative effectiveness of HAT on participant crime outcomes and potential mediators of crime. Narrative synthesis with tabular comparisons of outcomes extracted across RCTs. SETTING: Europe and Canada. PARTICIPANTS: Twenty studies, spanning 10 RCTs with 2427 participants, met inclusion criteria. INTERVENTIONS: HAT compared to other treatments for opioid use disorder, primarily oral methadone. MEASUREMENTS: The primary outcome was criminal activity. Mediator outcomes included illicit heroin use, drug expenditures, employment and earnings and social functioning. FINDINGS: All trials found significantly reduced criminal activity among HAT participants, and four found significantly larger reductions for HAT compared to control condition [median odds ratios (ORs) = 0.45]. Reductions in crime are concentrated in drug-related and property offenses (ORs range from 0.14 to 0.90 and from 0.12 to 1.89, respectively). Comparative efficacy of HAT for reducing illicit heroin use probably explains reductions in drug possession offenses, but does not show consistent correlation with drug dealing or property offenses. While three trials showed reductions in drug expenditures as possibly driving crime reductions, others did not report expenditures. There is little evidence that treatment effects on economic and social functioning outcomes explain within-trial changes in criminal activity. CONCLUSIONS: Existing literature suggests that heroin-assisted treatment reduces criminal activity, but trials varied in whether these effects exceeded those from oral methadone treatment. Inconsistency in outcome measures across trials complicates understanding drivers of heterogeneity. More detailed information on legal and illegal income, drug expenditures and social interactions could improve our understanding of the causal mechanisms underlying the effect of heroin-assisted-treatment on crime.
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Crime/prevenção & controle , Dependência de Heroína , Heroína , Heroína/uso terapêutico , Dependência de Heroína/tratamento farmacológico , Humanos , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Our study explored pre-nursing and graduating nursing students' experience with, knowledge of, and attitude toward complementary and alternative medicine (CAM). Both pre-nursing and nursing students reported positive attitudes toward CAM in general, indicated being interested in learning about CAM, and planned on making CAM practices part of their future careers.
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Atitude do Pessoal de Saúde , Terapias Complementares/normas , Estudantes de Enfermagem/psicologia , Adulto , Terapias Complementares/métodos , Terapias Complementares/psicologia , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosAssuntos
Dependência de Heroína , Preparações Farmacêuticas , Heroína , Humanos , Prevalência , Projetos de PesquisaRESUMO
OBJECTIVE: To explore the association between health behaviors and habits of university students and academic achievement. PARTICIPANTS: Six hundred fourteen undergraduate students at a state university in the United States. METHODS: Students were invited over a 2-year period to participate in an anonymous online survey that asked questions concerning a wide range of health behaviors and habits; participants were asked to report their current grade point average (GPA). Standard Least Squares Models were used to examine differences in self-reported GPA across the different health behaviors and habits, with individuals as replicates. RESULTS: The study found positive associations between breakfast consumption, physical activity, and strength training and self-reported GPA, and negative associations between the hours of sleep per night, hours worked per week, fast food and energy drinks consumption, and use of marijuana, alcohol and electronic vaping products. CONCLUSIONS: While there is an association for some of the studied health behaviors and habits with self-reported GPA, the effect sizes for these health behaviors were low. The significant effect of vaping on GPA as well as the increased use reported in this study indicates that the topic should be explored further. Furthermore, students should be educated on the potential positive and negative effects of health behavior choices to help them make better choices.
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OBJECTIVE: To explore the correlation between joint hypermobility and risk of musculoskeletal injuries in a university-aged population. DESIGN: Cross-sectional study using an anonymous survey. SETTING: Anatomy & Physiology lab. PARTICIPANTS: 816 undergraduate Anatomy & Physiology students at a university in the United States. MAIN OUTCOME MEASURES: Beighton score, self-reported musculoskeletal injuries. RESULTS: Athletically active study respondents reported more musculoskeletal injuries than respondents who indicated not being athletically active. Female respondents had lower rates of self-reported injuries than male respondents (55.4% vs. 65.5%; p = 0.0099; odds ratio: 1.53). The most commonly reported injury type for both women and men were quadriceps, groin and hamstring injuries. Neither male nor female respondents with generalized joint hypermobility (GJH) or localized joint hypermobility (LJH) reported higher rates of musculoskeletal injuries. CONCLUSIONS: Athletically active young adults are at greater risk for sustaining musculoskeletal injuries; however, there is no additional increase in injury risk for young people with GJH or LJH.
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Instabilidade Articular/epidemiologia , Músculo Esquelético/lesões , Doenças Musculoesqueléticas/epidemiologia , Adolescente , Atletas , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato , Estudantes , Inquéritos e Questionários , Estados Unidos , Universidades , Adulto JovemRESUMO
BACKGROUND: Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets. ANALYSIS: Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed. FINDINGS: Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more. IMPLICATIONS: GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.
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Cocaína , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Inquéritos Epidemiológicos , Heroína , Humanos , MasculinoRESUMO
For nearly a century heroin has dominated the illegal opioid trade. The global supply of heroin is estimated to generate tens of billions of dollars in revenues a year and its illegal use has long been the source of many societal harms. The arrival of inexpensive and mass-produced synthetic opioids, such as fentanyl, to parts of North America and Europe may signal the beginning of the end of heroin's dominance. Data from several places suggest that fentanyl and other synthetic opioids can quickly supplant heroin. Taking the extreme case, we calculate the estimated wholesale revenues of heroin currently and contrast that with fentanyl prospectively in the United States and in the rest of the world if fentanyl were to supplant heroin entirely. Heroin traffickers in the United States generate about $2.5 billion in revenues; the total import value of fentanyl, after replacing heroin, could be less than $100 million. For the rest of the world we project a reduction from $6.7 billion to less than $300 million. Retailer revenues on the other hand would probably rise because individuals may consume more frequently and with greater intensity due to fentanyl's shorter duration of action and so far there has been no indication of a notable reduction in retail prices. It is unlikely that heroin will entirely disappear, but very likely that globally heroin will account for a declining share of illegal opioids. Violence and corruption may decline but opioid related mortality and morbidity, as well as property crime, are likely to rise. Policy makers will face difficult challenges. Economics provides limited help in forecasting which opioid markets are likely to convert to synthetic opioids.