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Background: Stakeholder’s views on the role of recovery capital, including issues and barriers, that might address service provision for individuals with alcohol- and drug-related problems are impo...

This paper centers on a participatory qualitative study in which 22 pre-service special education teachers (i.e., undergraduate students) experienced, wrote about, and reflected upon their percepti...

Objective: Investigate the psychometric properties of the Severity of Dependence Scale (SDS) for codeine and its association with aberrant codeine related behaviors.Design: A voluntary and uncompensated cross-sectional online survey.Setting: Online population (≥18 years).Respondents: Two hundred and eighty-six respondents (66% women) who had used codeine containing medicines in the last 3 months and were living in the UK.Results: Of the respondents (mean age = 35.4 years, SD = 12.5), more than half were employed. Only 3.5% respondents reported no income. The majority of respondents (45.1%) primarily obtained prescription-only codeine from a consultation with a health professional, whilst 40.9% mainly purchased “over-the-counter” codeine containing medicines in a pharmacy without a medical prescription. Principal component analysis indicated a single factor solution accounting for 75% of the variance. Factor loadings ranged from 0.83 to 0.89. Cronbach's Alpha was high (α = 0.92). Several behaviors relating to codeine use were found to significantly predict probable codeine dependence. These included: daily codeine use in the last 3 months (OR = 66.89, 95% CI = 15.8–283.18); tolerance to codeine (OR = 32.14, 95% CI = 13.82–74.75); problems with role responsibility due to intoxication (OR = 9.89, 95% CI = 4.95–19.78); having sought advice on the internet to manage codeine use (OR = 9.56, 95% CI = 4.5–20.31); history of alcohol or drug treatment (OR = 3.73, 95% CI = 1.88–7.43).Conclusions: The SDS was acceptable and feasible to use to assess probable psychological codeine dependence in an online sample of people using codeine containing medicines. SDS scores were associated with behaviors known to be indicators of codeine dependence. Studies are needed in well-defined populations of people who use codeine to test the different aspects of psychometry of the scale compared against “gold standard” criterion [a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)].

The generation and source of ~230,000 km3 of total erupted volume of the predominately silicic (>90 %; Pankhurst et al., 2000) magmas which comprise the Jurassic Chon Aike Large Silicic Igneous Province (CASP) of Southern Patagonia is currently debated. In this study, we conducted a widespread sampling of multiple eruptive units, primarily ignimbrites and minor rhyolitic flows, along the Eastern Andean front (~47°S to 49°S), owning to the third and youngest eruptive episode of the CASP (El Quemado Complex; EQC). To determine the magmatic source and potential role of a significant crustal contribution proposed in the generation of these magmas, we analyzed the in-situ δ18O composition of both quartz and zircon by SIMS. We combined these data with LA-ICP-MS U/Pb analyses on single zircon crystals to characterize the potential for changing oxygen isotopic values through time and space within the EQC units along this ~230 km long transect.The northern-most units sampled have the lightest average δ18O (relative for the EQC) analyzed in zircon and quartz (7.7 and 10.4 ‰, respectively). Oxygen isotope values increase towards the South, with the highest δ 18O values previously reported in El Chaltén, reaching up to 10.1 ‰ for zircon and 12.5 ‰ for quartz (Seitz et al., 2018). Eruptive units from the same locality appear to be homogeneous in their oxygen isotopic composition.U/Pb zircon ages for the EQC range overall from ~148 to 155 Ma, though no obvious trend from North to South in zircon crystallization ages is noticeable. Multiple inherited zircon cores (at ~230, 460, 500, 1300 Ma) with Jurassic magmatic overgrowths were discovered. Isotopic compositions of these inherited magmatic cores are variable in their δ18O values throughout time. However, and more significantly, most of these inherited cores record high δ 18O values, with the highest value at 9.5 ‰ measured for a ~460 Ma core. These high values measured within inherited cores are found at all locations sampled for the EQC.The δ18O values of the EQC rocks are significantly higher than what would be expected for silicic magmas formed by simple closed-system fractionation from any mantle-derived melt (6­-7‰; Valley, 2003). Thus, our oxygen isotope data support significant input of crustal material - of either a sedimentary origin or from hydrothermally altered crust - to generate these ignimbrites and rhyolites with elevated δ18O values all along this transect.

The availability of over-the-counter (OTC) medicines containing codeine has generated worldwide debate with increased focus on its safe use. Medicine agencies across the European Union (EU) have responded to the public health concern by placing restrictions and warnings on codeine medicines sold OTC in High Street and internet pharmacies. These restrictions include direct-to-consumer advertising; however, there are few published studies examining conditions of advertising across member states. A review of the conditions of advertising was conducted by accessing information pertaining to each medicine’s regulatory agency allowing the sale of codeine in the EU. Each agency was asked to respond to three topics: (1) level and type of restrictions placed on all forms of direct-to-consumer advertising of OTC medicines containing codeine; (2) labelling criteria on packaging including indication related to the risk of addiction and any other patient information specific to codeine; and (3) complaints received by the medicines agency related to direct consumer advertising of OTC medicines containing codeine. Data were collated and tabulated in Excel to demonstrate its position on OTC codeine advertising. In the EU, 12 countries allow the sale of OTC codeine, while 16 do not. Of the 12 countries permitting its sale OTC, 4 countries prohibited direct-to-consumer advertising of codeine. The majority of the countries permitting advertisements did not have any additional or special restrictions or warnings for codeine-containing products with the exception of the UK where advertising codeine was only permitted under certain restrictions including product endorsement and special warnings including its indication of use for a maximum of 3 days. There is wide disparity in advertising of OTC codeine in the EU. Safeguards for OTC codeine use are likely to continue to remain a priority in the interest of public safety.

• There is a wide variation in the sales of OTC medicines containing codeine across the European Union.

ObjectivesAttention-deficit hyperactivity disorder (ADHD) is a neuro-behavioural disorder characterised by early onset of persistent inattention–disorganisation and hyperactivity–impulsivity. Symptoms causing significant impairment in psychosocial function commence in childhood and heighten the risk for early substance experimentation and potential development of substance-use disorders (SUD). The research aimed to estimate the occurrence of adult attention-deficit hyperactivity disorder (ADHD) in new treatment cases of adults attending addiction treatment services.MethodsThe Adult ADHD Symptoms Rating Scale (ASRS) self-administered questionnaire was administered on entry and 2 weeks later for first admissions to inpatient and outpatient addiction treatment settings The ASRS is a validated and reliable 18-item self-report scale derived from the DSM-IV-TR diagnostic criteria for ADHD, comprising nine items on inattention and nine items on hyperactivity/impulsivity.ResultsA total of 47 new treatment cases took part in the study. The occurrence of ADHD among SUDs in this sample was 13% (n = 6). Four of the participants were being treated for Problem Poly Substance use, whereas two participants were being treated for Problem Drug use. None of the participants screening positive for ADHD were being treated for Problem Alcohol use. Of the positively screened cases, all were male, predominantly single and unemployed.ConclusionsThe ASRS screening instrument may be a useful tool to detect ADHD co-morbidity in SUD treatment-seeking cases. More research is needed to appropriately develop the SUD treatment pathways for adolescent and adult ADHD sufferers in Ireland.

Background: Misuse of codeine available on prescription and over-the-counter (OTC) has been highlighted as a potential problem in South Africa. Objective: To examine the perceptions of medical professionals regarding codeine use (prescribed and OTC), misuse, dependence and treatment options in South Africa. Method: Data for the study were obtained using a sample of medical professionals obtained through random and convenience sampling. A quantitative methodology was employed using a structured self-administered questionnaire with closed and open-ended items. Data analysis was conducted using SPSS version 21; 238 medical professionals involved in the prescribing of codeine completed the questionnaire. Results: Two-thirds of participants stated that they routinely reviewed patients prescribed codeine, and high levels of concern were expressed about the availability of OTC medicine containing codeine in pharmacies (84.9%) and on the internet (71.3%). There was agreement that medicines containing codeine should be regulated to a prescription-only medicine (85.3%). Only 22% of participants agreed that they had suitable screening methods to help with detection of codeine dependence. Eighty per cent indicated that they would welcome the opportunity for greater instruction on prescribing potentially addictive medicines. Conclusion: There appears to be a need to improve education on consumption and risks associated with codeine use. In addition, screening tools are needed to detect those with codeine dependence. Greater data sources are now needed to examine the sale of and consumption of codeine medicines in the interest of public health.

Letter to the editors: .....People who take codeine for valid reasons may require higher doses over time, and this can develop into dependence. Once dependent, people are likely to start doctor and pharmacy â?oshoppingâ? or stealing to consume high doses and avoid withdrawal. Tighter regulation and closer monitoring of over-the-counter sales may be part of the solution, but we also need to examine the service provision for patients with codeine dependence, as current treatment services may not be adequate or appropriate. Timely access to addiction treatment is necessary to tackle the consequences of codeine dependence.

Ireland currently has the highest birthrate of the 27 European Union countries which has led to an increase in demand for maternity services. In the Irish Republic, most maternity units have traditionally followed the medical-led model of care, which, as a result, has limited women’s choice for maternity care. Although various different midwifery-led schemes are available, concerns exist regarding the knowledge and accessibility of these schemes.The aim of this descriptive, exploratory survey was to explore and determine the views of “low-risk” pregnant women (n= 394) regarding their antenatal care and services. A purposive homogeneous sample comprised the first phase of a mixed methods study and data were analyzed using Predictive Analytics Software. The findings identified a lack of awareness and understanding of the concept of a low-risk pregnancy. Consequently, women identified an overall lack of information and an inability to access available options for their care.

OBJECTIVE: Misuse of codeine-containing medicines in combination with new psychoactive substances (NPS) is inadequately described. This study characterises codeine consumption amongst NPS users and non-NPS users to provide warning of health issues. METHODS: Online survey conducted between July 2015 and March 2016. RESULTS:: Out of 340 respondents, residing in a country in Europe and using codeine recently, 63.8% were female. Mean age: 34.9 years (SD = 12.4). Substance use included NPS (18.5%) and illicit controlled drugs (55.9%). Factors relating to codeine use found to significantly predict NPS use were consuming codeine extracted from combination tablets (OR = 16.79, 95% CI [8.67, 32.51]), obtaining codeine from friends, family, and acquaintances (OR = 3.98, 95% CI [1.82, 8.7]), use of illicit controlled drugs (OR = 34.99, 95% CI [8.39, 145.94]) and use of codeine to experience euphoria (OR = 6.41, 95% CI [3.42, 12.04]). CONCLUSIONS: Amongst NPS users, codeine is less likely to be used daily but more likely to be used for recreational purposes. Smaller populations engaging in high-risk use exist who take multiple drugs in high doses. Combinations of misused codeine and NPS highlight the need for policy to respond to a more complex drug situation.

Background Codeine misuse and dependence poses a clinical and public health challenge. However, little is known about dependence and treatment needs in the UK and Ireland. Aim To characterise codeine use, dependence, and help-seeking behaviour. Design An online cross-sectional survey advertised on Facebook, Twitter, health and drug websites and e-mail circulars. Methods The survey collected data on demographics and codeine use amongst adults from the UK and Ireland. The Severity of Dependence Scale measured the level of codeine dependence. Results The sample of 316 respondents had a mean age of 35.3 years (SD = 12.3) and 67% were women. Of the 316 respondents, 54 scored â?¥5 on the Severity of Dependence Scale indicating codeine dependence (17.1%). Our study found that codeine dependence is a problem with both prescribed and 'over-the-counter' codeine. Codeine dependence was associated with daily use of codeine, faking or exaggerating symptoms to get a prescription for codeine and 'pharmacy shopping' (P < 0.01). A higher number of respondents had sought advice on the Internet (12%) rather than from their general medical practitioner (GP) (5.4%). Less than 1% of respondents had sought advice from a pharmacist. Conclusions Codeine dependent users were more likely to seek help on the Internet to control their use of codeine than from a GP, which may indicate a potential for greater specialised addiction treatment demand through increased identification and referrals in primary care.

Schools are an important setting for the implementation of health education–prevention initiatives. Teachers are valuable partners in the delivery of health and social material, including that relating to alcohol and drugs. However, school-based substance education–prevention often exists in competition with academic agendas. The research aimed to investigate teacher's perspectives in Ireland on their role and that of the school in the delivery of school-based alcohol and cannabis education–prevention. Irish school-based drug education–prevention is currently provided within the remit of the Social Personal Health Education (SPHE) module, which is a compulsory element of the curriculum within secondary schools. Thirteen second-level schools partook in the research. A teacher questionnaire collected information around teacher's experiences of student alcohol and cannabis use, attitudes toward teacher and school prevention roles, and levels of school satisfaction (n = 131). The results indicated that teacher's experiences of effects of student alcohol and cannabis use in school were rare. Over half of teachers had never partaken in education–prevention activities, with those delivering SPHE teachers more likely to partake and report a positive attitude toward school-based alcohol and cannabis education–prevention. Teacher levels of satisfaction with their school were positively correlated with attitude toward the teacher and school's role in alcohol and cannabis education–prevention. High awareness of school drug and alcohol policies was recorded, along with the need for training, support, and information for all teachers. The findings underscore the need for ‘whole school’ integrated approaches involving a shared organization-wide approach to student substance education–prevention.

Background:There is increasing commitment to improve health of working populations in order to reduce the amount of claims for sickness and disability benefits.The aim of this paper was to examine sickness absence trends in the Republic of Ireland as reported by medical certification on the claiming of illness benefit over a seven year period, namely 2008 to 2014. Methods:Data were extracted by the Statistical unit of the Department of Social Protection from their central database to include all claims for illness and occupational injury benefit between 2008 and 2014 and presented to the researcher. This data was recoded using broad codes contained in the ICD-10 and combined into a database where summative values were produced under each classification in order to evaluate the average rate of claims per 1000 person employed per year. Results:A total of 67,021 illness benefit claims were made in 2014 compared to 73,609 in 2008. When the total workforce was considered this represented a total reduction from 34.2 claims per 1000 person employed (2008) to 30 claims per 1000 employed (2014). Mental and behavioural disorders (FF00-F99) had the highest rate of illness benefit claims resulting in 8.8 claims per 1000 persons employed in 2008 to 8.2 claims per 1000 persons employed in 2014. Disease of the musculoskeletal system and connective tissue (M00-M99) had the second highest rate of claims overall. The most likely reason given under the ICD-code M00-M99 was back/neck/rib and disc problems which accounted for 62.7% of all claims in the 7 year period. The main reason for occupational injury claims were for injury, poisoning and certain other consequences of external cause (S00-T98) followed by diseases of the musculoskeletal and connective tissue (M00-M99). Conclusion:Results of this study should be taken into account for future planning of primary healthcare in the Republic of Ireland and for training of GPs in practice.

Objectives To explore prescribing practitioners' perspectives on prescribed codeine use, their ability to identify dependence and their options for treatment in the UK.Design Cross-sectional design using a questionnaire containing closed-ended and open-ended items.Setting A nationally representative sample of prescribing professionals working in the UK.Participants 300 prescribing professionals working in primary care and pain settings.Results Participants stated that they regularly reviewed patients prescribed codeine, understood the risks of dependence and recognised the potential for codeine to be used recreationally. Over half the participants felt patients were unaware of the adverse health consequences of high doses of combination codeine medicines. One-quarter of participants experienced patient resentment when asking about medicines containing codeine. Just under 40% of participants agreed that it was difficult to identify problematic use of codeine without being informed by the patient and did not feel confident in identification of codeine dependence. Less than 45% of all participants agreed that codeine dependence could be managed effectively in general practice. Slow or gradual withdrawal was the most popular suggested treatment in managing dependence. Education and counselling was also emphasised in managing codeine-dependent patients in primary care.Conclusions Communication with patients should involve assessment of patient understanding of their medication, including the risk of dependence. There is a need to develop extra supports for professionals including patient screening tools for identifying codeine dependence. The support structure for managing codeine-dependent patients in primary care requires further examination.

Aims: The aim of the study was to examine prescribing professional's perceptions on prescribed and OTC medicines, containing codeine in the Republic of Ireland. A secondary aim was to examine perceptions on codeine dependence, screening and treatment.\ud Methods: A cross sectional study of a nationally representative group of prescribing professionals was conducted using a questionnaire containing a number of open and closed ended items. Data were analysed using SPSS version 21 and content analysis techniques.\ud Results: 398 medical professionals participated in the study giving a response rate of 18%. 77% of respondents agreed to routinely review patient prescribed codeine. 59% of respondents routinely asked patients about their use of OTC medicines and 50% documented use of OTC codeine in their patients' medical notes. 93% indicated concern about the potential to purchase codeine from multiple sources. 88% implied that patients did not fully understand the risks of taking OTC medicine containing codeine. Only 21% of respondents were confident in identifying codeine dependence without being informed by the patient and 11.4% agreed to having suitable screening methods in practice. 76% indicated that they would like more instruction on prescribing addictive medicines.\ud Conclusion: Policy should examine the need for greater public health awareness on codeine use and should examine the role of OTC and internet sales in the development of dependence. Further consideration should be given to training and support for those who prescribe addictive medicines in practice.

Objective: To develop the Irish-English version of the Profiling Elements of Prosody in Speech-Communication (PEPS-C) assessment, identify the normal prosodic performance of typically developing children aged 5–11 years on the PEPS-C assessment, and identify significant age-related changes between different age groups. Method: Thirty typically developing children between the ages of 5;9 and 11;1 years completed the PEPS-C assessment, which involved both receptive and expressive tasks. Results: Significant differences were found between the youngest group’s prosodic performance and the two older groups. The 5- to 6-year-old age group performed less well than the 10- to 11-year-old age group (p < 0.05). The 10- to 11-year-old age group performed above chance level on all prosodic tasks. Conclusion: While 5- and 6-year-old children have acquired some functional prosodic skills, there are further developments between the ages of 5;9 and 9;5, with some aspects of prosody continuing to develop up to 11 years.

Codeine, a weak opiate, requires increased pharmacovigilance relating to availability, heterogeneous nature of misuse, dependence and associated harm. A scoping review of literature on codeine was conducted using Arksey & O’Malley’s framework (1). Databases searched included PubMed, EBSCO Host, Science Direct, EMBASE, PsycINFO, Cochrane library and Medline from 1994 to 2014. Follow-up search strategies involved hand searching and searching of pharmaceutical, health, medical and drug related websites. Initial zscreening identified 3,105 articles with 475 meeting the inclusion criteria. Eight broad categories organised the literature, data charting and qualitative synthesis. This paper presents implications for practice and makes recommendations to address these issues. Themes identified relate to raising public and practitioner awareness, risk management, dispensing practices and monitoring and surveillance of codeine. Evidence to inform law enforcement, drug surveillance, public health initiatives, harm reduction approaches, pharmacy, clinical and treatment practices is warranted.

BACKGROUND Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties. AIMS To explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland. METHODS A qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used. RESULTS Three major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification. CONCLUSIONS GPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.

The complexity of a fitness for work consultation is well documented. General practitioners (GPs) find that such consultations often create conflict and they feel ill-prepared for the task.We aimed to examine the consultation process in the fitness for work consultation and to report on the response of GPs to two hypothetical consultations of work related sickness absence, one of a psychological and one of a physical nature.Three areas of the consultation were examined; social/family circumstances, workplace history and information required assessing the severity of the condition. We used a randomized design using an online questionnaire completed by 62 GPs located in the Republic of Ireland. Analysis was conducted in NVivo 8 qualitative software using thematic and content analysis techniques.GPs may be expected to collect and consider information relating to social, domestic, financial, lifestyle and workplace factors, including workload, job satisfaction, job strain, work ethic, inter staff relationships and employee support mechanisms. The mode of presentation may trigger specific information seeking in the consultation.GPs may evaluate fitness for work in a variety of ways depending on medical and non-medical factors. Further research should further examine the factors that may influence the GPs decision to prescribe sickness leave.

Sickness certification is a common task undertaken by General Practitioners (GPs) in most developed countries. Research suggests that they find this task complex and difficult. Primary health care structures and sickness certification practices differ across Europe and little research explores GPs certifying practices in the Republic of Ireland.The aim of the study was to explore GPs' views on sickness certification, the strategies used to issue sickness certificates to patients and scope for improvement in the current system.A qualitative thematic approach used one to one in-depth interviews with 14 individual GPs, across 11 primary health care practices in Ireland. Analysis of the data was conducted using NVivo 8 qualitative software.GPs can find their role as certifier problematic, and a source of conflict during the consultation process with patients. GPs were concerned with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances. Sickness certification was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments.This study highlights the various complexities and challenges that GPs face when dealing with patients requiring sickness certification. Issues in assessment of fitness for work and problems within the social welfare structure were recurrent themes. The study highlights the opportunities to improve the system and how these might be achieved. Further research is now warranted in Ireland.

Processing of Computed radiography image plates involves a time delay between the image acquisition and processing. This delay can vary from 1 to 30 minutes depending on the clinical situation. This study aims to examine the effects latent image fade upon the low contrast resolution of computed radiography images over time and establish whether kVp has an influence on image fade. Three observers assessed the images. Image quality figures were calculated as a measure of contrast detail resolution. Significant reductions in low contrast resolution were seen to occur as the delay between exposure and processing increased. The image quality decreased by 2.8% at 5mins; 6% at 10mins and 8.8% at 20mins. Deterioration then continued at a steady rate until the plateau of 20.7% was reached at 3 hours finally at 15hrs the deterioration was 40.49% compared to the reference image. The rate of this deterioration increased with kVp. At 20mins for 75kVp the low contrast resolution had decreased by 8.8%; at 80kVp it was 9.6%; 10.15% at 85kVp and at 95kVp 16.8%. A substantial decrease in low contrast resolution of CR images result from long delays between exposure time and processing, this is exacerbated by higher kVps. Radiographers will lose at least 8.8% in low contrast resolution of an image with a processing delay of 20 minutes.

Misuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over-the-counter (OTC) and prescribed codeine. A qualitative design comprising six focus groups (n = 45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine-containing products and the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer–pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine and difficulties in relationships between pharmacists and prescribers. A number of recommendations were put forward as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and potential ways to deal with misuse and dependence.