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Family relations are essential for the bereaved in terms of healing and adjusting to life, especially after experiencing a traumatic death. Although 500 000 people die in drug-related deaths each year, few works focus on family interactions and the help needs of those bereaved by such losses. In this qualitative study, we interviewed 14 parents who had lost their child through a drug-related death. Through a reflexive thematic analysis, we generated three themes: (I) considerable needs in the family become our responsibility, capturing how parents try to mend the disrupted family system and provide adequate care for those who struggle after death, (II) conversations that are important for family connections are obstructed, encompassing how family members sometimes seem afraid of grief emotions and try to protect each other by not talking, and (III) as parents, we can strengthen family connections, encapsulating how parents create space to talk and listen to each other in the family and navigate relational challenges in maintaining relationships. The findings are discussed through the Dual Process Model of Coping with Bereavement as well as family resilience theory. Based on the results, we propose that professional family-oriented help efforts for drug death-bereaved families in two main domains should be considered. The first includes those related to the family's need and ability to adapt roles and relationships to the new reality, and the second involves those connected to creating a space and environment for emotional sharing and joint meaning-making processes in the family. [ABSTRACT FROM AUTHOR]

Background and aims: The INTRO‐HCV randomized controlled trial conducted in Norway over 2017–2019 found that integrated treatment, compared with standard‐of‐care hospital treatment, for hepatitis C virus (HCV) with direct‐acting antivirals (DAAs) improved treatment outcomes among people who inject drugs (PWID). We evaluated cost‐effectiveness of the INTRO‐HCV intervention. Design: A Markov health state transition model of HCV disease progression and treatment with cost‐effectiveness analysis from the health‐provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality‐adjusted life‐years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia). Setting and participants: PWID attending community‐based drug treatment centers for people with opioid dependence in Norway. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70 000/QALY) willingness‐to‐pay threshold for Norway and lower (€20 000/QALY) threshold common among high‐income countries. Findings Integrated treatment resulted in an ICER of €13 300/QALY gained, with 99% and 71% probability of being cost‐effective against conventional and lower willingness‐to‐pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6 900/QALY gained, with 91% probability of being cost‐effective at the lower willingness‐to‐pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost‐saving, respectively. Sensitivity analyses suggest integrated treatment was cost‐effective at the lower willingness‐to‐pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost‐saving with 60%–90% price reductions. Conclusions: Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost‐effective compared with standard‐of‐care referral pathways in Norway and may be cost‐saving in settings with particular characteristics. [ABSTRACT FROM AUTHOR]

Background: Use of physical activity in the treatment and follow-up of people receiving opioid substitution therapy is an understudied area of research. Therefore, the objective of this systematic review was to synthesize the currently available research on the role of physical activity in opioid substitution therapy and proper adaptions for the group. Methods: A systematic search was performed on PsycINFO, EMBASE, MEDLINE, CINAHL, and Web of Science until September 2021 (PROSPERO-reg.no: CRD42020109873). The inclusion criteria were studies involving physical activity interventions for opioid substitution patients. Reference lists of relevant studies were screened to identify additional relevant studies. Data extracted were compiled into tables and descriptively presented. Results: The search yielded 2105 unique records. A total of 10 studies were included, whose methodological quality ranged from satisfactory to very good. Study quality was assessed using a 7-/8-point quality score. The agreement between the reviewers, assessed with Cohen's kappa, was 0.91. Overall, the results suggest that physical activity increases physical fitness of patients in opioid substitution therapy and decreases substance use. The minority of studies in this field are of high quality with sufficient power. Conclusions: The findings of this systematic review suggest beneficial effects of physical activity on physical fitness, substance use, and mental health for patients in opioid substitution therapy. Although the findings are quite consistent across studies, high-quality studies and sufficiently powered clinical trials are needed to confirm and validate the findings and to conclude on the degree of impact. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine how the Norwegian general adult population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown. We assessed quarantine, symptoms, social distancing, home office/school, work status, social contact and health-care contact through digital access and knowledge. Methods: A cross-sectional survey was performed of 29,535 adults (aged 18–99) in Norway after six weeks of non-pharmaceutical interventions in March/April 2020. Results: Most participants found the non-pharmaceutical interventions to be manageable, with 20% of all adults and 30% of those aged <30 regarding them as acceptable only to some or a limited degree. Sixteen per cent had been quarantined, 6% had experienced symptoms that could be linked to COVID-19 and 84% practiced social distancing. Eleven per cent reported changes in the use of health and social services. Three-quarters (75%) of those who had mental health or physiotherapy sessions at least monthly before the pandemic reported a reduction in their use of these services. A substantial reduction was also seen for home nursing, hospital services and dentists compared to usage before the non-pharmaceutical interventions. Immigrants were more likely to experience a reduction in follow-up from psychologists and physiotherapy. With regard to the use of general practitioners, the proportions reporting an increase and a reduction were relatively equal. Conclusions: The non-pharmaceutical interventions were perceived as manageable by the majority of the adult general population in Norway at the beginning of the COVID-19 pandemic. A substantial proportion of adults <30 years old experienced difficulties with social distancing, and those >70 years old lacked the digital tools and knowledge. Further, immigrant access to health services needs monitoring and future attention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Use of physical activity in the treatment and follow-up of people receiving opioid substitution therapy is an understudied area of research. Therefore, the objective of this systematic review was to synthesize the currently available research on the role of physical activity in opioid substitution therapy and proper adaptions for the group. METHODS: A systematic search was performed on PsycINFO, EMBASE, MEDLINE, CINAHL, and Web of Science until September 2021 (PROSPERO-reg.no: CRD42020109873). The inclusion criteria were studies involving physical activity interventions for opioid substitution patients. Reference lists of relevant studies were screened to identify additional relevant studies. Data extracted were compiled into tables and descriptively presented. RESULTS: The search yielded 2105 unique records. A total of 10 studies were included, whose methodological quality ranged from satisfactory to very good. Study quality was assessed using a 7-/8-point quality score. The agreement between the reviewers, assessed with Cohen's kappa, was 0.91. Overall, the results suggest that physical activity increases physical fitness of patients in opioid substitution therapy and decreases substance use. The minority of studies in this field are of high quality with sufficient power. CONCLUSIONS: The findings of this systematic review suggest beneficial effects of physical activity on physical fitness, substance use, and mental health for patients in opioid substitution therapy. Although the findings are quite consistent across studies, high-quality studies and sufficiently powered clinical trials are needed to confirm and validate the findings and to conclude on the degree of impact. [ABSTRACT FROM AUTHOR]

Treatment programs to prevent perinatal and postnatal HIV‐1 transmission have become available in sub‐Saharan Africa, leading to an emerging population of HIV‐1 exposed uninfected (HEU) children. Exposure to HIV‐1 in utero and during breastfeeding may increase the risk of morbidity and mortality in HEU children. This study estimated the association of the severity of maternal HIV‐1 infection as assessed by CD4 count and viral load at baseline (7 d postpartum), with dmft count of their 5‐ to 7‐yr‐old HEU offspring. A follow‐up study was conducted of HIV‐1‐infected mother–HEU children pairs (n = 164) from the Ugandan site of the ANRS 12341‐PROMISE‐ PEP trial (ClinicalTrials.gov, number NCT00640263). HIV‐1‐infected mothers were interviewed and the HEU children were examined for caries using the World Health Organization's survey methods for field conditions and the dmft index. Directed acyclic graphs and negative binomial regression were used for analyses. The prevalence of 1 or more dmft was 48%. Negative binomial regression showed no association between the dmft count and maternal CD4 counts 7 d postpartum but a 10% lower dmft count with longer breastfeeding duration was found. Maternal CD4 count at birth was not associated with the dental caries experience in uninfected children born to women without severe immune suppression, while there appeared to be a protective effect of high viral load and breastfeeding duration. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest prevalence of overweight/obesity in Sub-Saharan Africa. Assessing the effect of modifiable factors such as early infant feeding on growth velocity and overweight/obesity is therefore important. This paper aimed to assess the effect of infant feeding in the transitional period (12 weeks) on 12-24 week growth velocity amongst HIV unexposed children using WHO growth velocity standards and on the age and sex adjusted body mass index (BMI) Z-score distribution at 2 years. Methods: Data were from 3 sites in South Africa participating in the PROMISE-EBF trial. We calculated growth velocity Z-scores using the WHO growth standards and assessed feeding practices using 24-hour and 7-day recall data. We used quantile regression to study the associations between 12 week infant feeding and 12-24 week weight velocity (WVZ) with BMI-for-age Z-score at 2 years. We included the internal sample quantiles (70th and 90th centiles) that approximated the reference cut-offs of+2 (corresponding to overweight) and +3 (corresponding to obesity) of the 2 year BMI-for-age Z-scores. Results: At the 2-year visit, 641 children were analysed (median age 22 months, IQR: 17-26 months). Thirty percent were overweight while 8.7% were obese. Children not breastfed at 12 weeks had higher 12-24 week mean WVZ and were more overweight and obese at 2 years. In the quantile regression, children not breastfed at 12 weeks had a 0.37 (95% 0 0.07, 0.66) increment in BMI-for-age Z-score at the 50th sample quantile compared to breast-fed children. This difference in BMI-for-age Z-score increased to 0.46 (95% CI 0.18, 0.74) at the 70th quantile and 0.68 (95% O 0.41, 0.94) at the 90th quantile . The 12-24 week WVZ had a uniform independent effect across the same quantiles. Conclusions: This study demonstrates that the first 6 months of life is a critical period in the development of childhood overweight and obesity. Interventions targeted at modifiable factors such as early infant feeding practices may reduce the risks of rapid weight gain and subsequent childhood overweight/obesity. [ABSTRACT FROM AUTHOR]