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Article: Early-onset smoking theory of compulsivity development: a neurocognitive model for the development of compulsive tobacco smoking.

Conti, Aldo Alberto / Baldacchino, Alexander Mario

2023 Volume 14, Page(s) 1209277

Abstract: According to the literature, individuals who start tobacco smoking during adolescence are at greater risk of developing severe tobacco addiction and heavier smoking behavior in comparison with individuals who uptake tobacco smoking during subsequent ... ...

Abstract	According to the literature, individuals who start tobacco smoking during adolescence are at greater risk of developing severe tobacco addiction and heavier smoking behavior in comparison with individuals who uptake tobacco smoking during subsequent developmental stages. As suggested by animal models, this may be related to the unique neuroadaptive and neurotoxic effects of nicotine on adolescents' fronto-striatal brain regions modulating cognitive control and impulsivity. Previous research has proposed that these neuroadaptive and neurotoxic effects may cause a heightened reward-oriented impulsive behavior that may foster smoking relapses during quit attempts. However, developments in the field of addiction neuroscience have proposed drug addiction to represent a type of compulsive behavior characterized by the persistent use of a particular drug despite evident adverse consequences. One brain region that has received increased attention in recent years and that has been proposed to play a central role in modulating such compulsive drug-seeking and using behavior is the insular cortex. Lesion studies have shown that structural damages in the insular cortex may disrupt smoking behavior, while neuroimaging studies reported lower gray matter volume in the anterior insular cortex of chronic smokers compared with non-smokers, in addition to correlations between gray matter volume in the anterior insular cortex and measures of compulsive cigarette smoking. Based on the findings of our recent study reporting on early-onset smokers (mean age at regular smoking initiation = 13.2 years) displaying lower gray matter and white matter volume in the anterior insular cortex compared to late-onset smokers (mean age at regular smoking initiation = 18.0 years), we propose that the anterior insular cortex may play a central role in mediating the association between smoking uptake during adolescence and smoking heaviness/tobacco addiction during adulthood.
Language	English
Publishing date	2023-07-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1209277
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Chronic tobacco smoking, impaired reward-based decision-making, and role of insular cortex: A comparison between early-onset smokers and late-onset smokers.

Conti, Aldo Alberto / Baldacchino, Alexander Mario

Frontiers in psychiatry

2022 Volume 13, Page(s) 939707

Abstract: Introduction: The literature suggests that tobacco smoking may have a neurotoxic effect on the developing adolescent brain. Particularly, it may impair the decision-making process of early-onset smokers (<16 years), by rendering them more prone to ... ...

Abstract	Introduction: The literature suggests that tobacco smoking may have a neurotoxic effect on the developing adolescent brain. Particularly, it may impair the decision-making process of early-onset smokers (<16 years), by rendering them more prone to impulsive and risky choices toward rewards, and therefore more prone to smoking relapses, in comparison to late-onset smokers (≥16 years). However, no study has ever investigated reward-based decision-making and structural brain differences between early-onset smokers and late-onset smokers. Methods: Computerized measures of reward-based decision-making [Cambridge Gambling Task (CGT); 5-trials adjusting delay discounting task (ADT-5)] were administered to 11 early-onset smokers (mean age at regular smoking initiation = 13.2 years), 17 late-onset smokers (mean age at regular smoking initiation = 18.0 years), and 24 non-smoker controls. Voxel-based morphometry (VBM) was utilized to investigate the gray matter (GM) and white matter (WM) volume differences in fronto-cortical and striatal brain regions between early-onset smokers, late-onset smokers, and non-smokers. Results: Early-onset smokers displayed a riskier decision-making behavior in comparison to non-smokers as assessed by the CGT ( Conclusion: Impairments in reward-based decision-making may not be affected by tobacco smoking initiation during early adolescence. Instead, lower GM and WM volume in the AI of early-onset smokers may underline a vulnerability to develop compulsive tobacco seeking and smoking behavior during adulthood.
Language	English
Publishing date	2022-08-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2022.939707
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Article ; Online: Rapid opioid overdose response system technologies.

Tay Wee Teck, Joseph / Oteo, Alberto / Baldacchino, Alexander

Current opinion in psychiatry

2023 Volume 36, Issue 4, Page(s) 308–315

Abstract: Purpose of review: Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid ...

Abstract	Purpose of review: Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. Recent findings: Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. Summary: This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.
MeSH term(s)	Humans ; Opiate Overdose ; Artificial Intelligence ; Naloxone/therapeutic use ; Drug Overdose/epidemiology ; Analgesics, Opioid/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/drug therapy
Chemical Substances	Naloxone (36B82AMQ7N) ; Analgesics, Opioid ; Narcotic Antagonists
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	645162-7
ISSN	1473-6578 ; 0951-7367
ISSN (online)	1473-6578
ISSN	0951-7367
DOI	10.1097/YCO.0000000000000870
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Article ; Online: Overdose Alert and Response Technologies: State-of-the-art Review.

Oteo, Alberto / Daneshvar, Hadi / Baldacchino, Alexander / Matheson, Catriona

Journal of medical Internet research

2023 Volume 25, Page(s) e40389

Abstract: Background: Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer ... ...

Abstract	Background: Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses. Objective: Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated. Methods: We conducted a "state-of-the-art review." A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject. Results: Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48% (11/23) of the papers and 67% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30%), efficacy or effectiveness (5/23, 22%), device use and decision-making (3/23, 13%), and description of devices (6/23, 26%). Conclusions: There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them.
MeSH term(s)	Humans ; United States ; Drug Overdose ; Naloxone/therapeutic use ; Analgesics, Opioid/therapeutic use ; Telemedicine ; Technology
Chemical Substances	Naloxone (36B82AMQ7N) ; Analgesics, Opioid
Language	English
Publishing date	2023-02-15
Publishing country	Canada
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/40389
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Substance abuse by anaesthesiologists, shouldn't we do more?

Forget, Patrice / Baldacchino, Alexander

European journal of anaesthesiology

2021 Volume 38, Issue 7, Page(s) 682–683

MeSH term(s)	Anesthesiologists ; Delivery of Health Care ; Health Personnel ; Humans ; Substance-Related Disorders/diagnosis ; Substance-Related Disorders/epidemiology ; Suicide
Language	English
Publishing date	2021-02-05
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0000000000001466
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1955: Show issues

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Article: Neuroanatomical Correlates of Impulsive Choices and Risky Decision Making in Young Chronic Tobacco Smokers: A Voxel-Based Morphometry Study.

Conti, Aldo Alberto / Baldacchino, Alexander Mario

Frontiers in psychiatry

2021 Volume 12, Page(s) 708925

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2021-08-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2021.708925
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Article ; Online: Why Do Different Forms of Knowledge Matter in Evidence-Based Drug Policy?

Tay Wee Teck, Joseph Brian / Baldacchino, Alexander

American journal of public health

2022 Volume 112, Issue S2, Page(s) S140–S142

MeSH term(s)	Evidence-Based Medicine ; Humans ; Knowledge ; Policy
Language	English
Publishing date	2022-03-19
Publishing country	United States
Document type	Editorial
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2022.306818
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Article ; Online: The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework.

Dumbrell, Josh / Daneshvar, Hadi / Oteo, Alberto / Baldacchino, Alexander / Matheson, Catriona

Harm reduction journal

2023 Volume 20, Issue 1, Page(s) 40

Abstract: Background: Opioids were implicated in approximately 88,000 fatal overdoses (OD) globally. However, in principle all opioid OD are reversible with the timely administration of naloxone hydrochloride. Despite the widespread availability of naloxone among ...

Abstract	Background: Opioids were implicated in approximately 88,000 fatal overdoses (OD) globally. However, in principle all opioid OD are reversible with the timely administration of naloxone hydrochloride. Despite the widespread availability of naloxone among people who use opioids (PWUO), many who suffer fatal OD use alone, without others present to administer the reversal agent. Recognising this key aspect of the challenge calls for innovations, a number of technological approaches have emerged which aim to connect OD victims with naloxone. However, the acceptability of OD response technologies to PWUO is of key concern. Methods: Drawing on the Technology People Organisations Macroenvironment (TPOM) framework, this study sought to integrate acceptability-related findings in this space with primary research data from PWUO, affected family members and service providers to understand the factors involved in harm reduction technology acceptability. A qualitative study using a focus group methodology was conducted. The participant groups were people with lived experience of problem opioid use, affected family members and service providers. Data analysis followed a multi-stage approach to thematic analysis and utilised both inductive and deductive methods. Results: Thirty individuals participated in one of six focus groups between November 2021 and September 2022. The analysis generated six major themes, three of which are reported in this article-selected for their close relevance to PWUO and their importance to developers of digital technologies for this group. 'Trust-in technologies, systems and people' was a major theme and was closely linked to data security, privacy and confidentiality. 'Balancing harm reduction, safety and ambivalence' reflects the delicate balance technological solutions must achieve to be acceptable to PWUO. Lastly, 'readiness-a double bind' encapsulates the perception shared across participant groups, that those at the highest risk, may be the least able to engage with interventions. Conclusion: Effective digital strategies to prevent fatal OD must be sensitive to the complex relationships between technological, social/human, organisational and wider macroenvironmental factors which can enable or impede intervention delivery. Trust, readiness and performance are central to technology acceptability for PWUO. An augmented TPOM was developed (the TPOM-ODART).
MeSH term(s)	Humans ; Analgesics, Opioid/therapeutic use ; Naloxone/therapeutic use ; Opioid-Related Disorders/drug therapy ; Drug Overdose/prevention & control ; Drug Overdose/drug therapy ; Technology ; Narcotic Antagonists/therapeutic use
Chemical Substances	Analgesics, Opioid ; Naloxone (36B82AMQ7N) ; Narcotic Antagonists
Language	English
Publishing date	2023-03-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-023-00763-4
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Article ; Online: The Boy With the Jellyfish Tattoo and Facial Swelling.

Tortell, Alexandra / Baldacchino, Reuben Vella / Grech, Jamie Alexander

Wilderness & environmental medicine

2021 Volume 32, Issue 4, Page(s) 545–547

MeSH term(s)	Animals ; Cnidaria ; Humans ; Male ; Scyphozoa ; Tattooing
Language	English
Publishing date	2021-09-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1238909-2
ISSN	1545-1534 ; 1080-6032
ISSN (online)	1545-1534
ISSN	1080-6032
DOI	10.1016/j.wem.2021.07.004
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Article: Implementing buprenorphine prolonged-release injection using a health at the margins approach for transactional sex-workers.

Gittins, Rosalind / Teck, Joseph Tay Wee / Knowles, Rebecca / Clarke, Nicole / Baldacchino, Alexander

Frontiers in psychiatry

2023 Volume 14, Page(s) 1224376

Abstract: Background: Access to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers ... ...

Abstract	Background: Access to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers frequently cycled in and out of treatment for OUD such that they never reached a level of engagement that permitted opportunities to meet their healthcare or housing needs. Barriers to accessing care provision include an itinerant lifestyle, difficulties with travel at unpredictable hours, impacting upon adherence to medication regimens including daily supervised consumption. Objectives: To use a co-produced, "health at the margins" approach, to reach the sex-working population in Leeds, and support informed choices about the potential to receive buprenorphine prolonged-release injection (BPRI) as a treatment option for OUD. Methods: BPRI was introduced using a theory of change model and improvements in sex-worker care delivery was reviewed. Strategies included buprenorphine micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based and trauma-informed approach. Results: Benefits of BPRI included removal of the need for daily pharmacy visits, reducing the risk of diversion, improved medication adherence, stability and engagement with treatment and supportive services. Conclusion: BPRI may offer an additional option for pharmacological interventions for people with OUD where there may be increased barriers to accessing treatment for example due to sex-working. Strategies for effective BPRI include micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based approach.
Language	English
Publishing date	2023-07-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1224376
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