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  1. Article ; Online: A disaster medicine course for Canadian medical students: first implementation of a large-scale mass-casualty simulation.

    Eastwood, Kyle W / Harris, Adam / Armstrong, John B P

    CJEM

    2023  Volume 25, Issue 12, Page(s) 949–952

    Abstract: Mass-casualty incidents have a significant global impact. Despite calls for improved disaster-preparedness training, most medical curriculums do not include formal disaster-medicine education. In 2021, the Medical Council of Canada introduced new ... ...

    Abstract Mass-casualty incidents have a significant global impact. Despite calls for improved disaster-preparedness training, most medical curriculums do not include formal disaster-medicine education. In 2021, the Medical Council of Canada introduced new disaster-medicine learning objectives. This article presents a mass-casualty-incident course for 3rd-year Canadian medical students. The course includes lectures, and a large-scale simulation of an explosion scene, field triage zone, and simulated emergency department (ED). The simulation incorporated "Dark-team-member" facilitators and 17 live actor and 8 mannequin patients with moulage. Pre-/post-event evaluation data was collected. One-hundred and twenty medical students participated in the course. Confidence in managing a real mass-casualty incident, on a scale from 1 to 10 (no-confidence to completely confident) significantly improved based on a Mann-Whitney U test, p < 0.05. Few formal medical student mass-casualty-incident courses exist. Combining "Dark-team-members" with live actors, imbedding clinician facilitators with medical students, and having a simulation with a continuous disaster scene to the ED are unique to this course. The methodology is presented for future replication.
    MeSH term(s) Humans ; Students, Medical ; Disaster Medicine/education ; Disaster Planning/methods ; Canada ; Triage/methods ; Mass Casualty Incidents
    Language English
    Publishing date 2023-11-10
    Publishing country England
    Document type Journal Article
    ISSN 1481-8043
    ISSN (online) 1481-8043
    DOI 10.1007/s43678-023-00601-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Loin pain haematuria syndrome 1967-2020: a review.

    Annear, Nicholas M P / Vanmassenhove, Jill / Lameire, Norbert / Phillips, Malcolm E / Eastwood, John B

    Clinical kidney journal

    2024  Volume 17, Issue 3, Page(s) sfae034

    Abstract: The purpose of this retrospective review is to question the validity of the condition 'loin pain haematuria syndrome' (LPHS). We highlight the possibility that most patients regarded as having LPHS have a psychiatric/psychological basis for their ... ...

    Abstract The purpose of this retrospective review is to question the validity of the condition 'loin pain haematuria syndrome' (LPHS). We highlight the possibility that most patients regarded as having LPHS have a psychiatric/psychological basis for their symptoms, particularly loin pain. Because of this, and because it recurs despite treatment, the review also questions the use of treatments that are invasive, expensive, and carry considerable morbidity.
    Language English
    Publishing date 2024-02-09
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfae034
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  3. Article ; Online: The development and internal validation of a multivariable model predicting 6-month mortality for people with opioid use disorder presenting to community drug services in England: a protocol.

    Roberts, Emmert / Strang, John / Horgan, Patrick / Eastwood, Brian

    Diagnostic and prognostic research

    2024  Volume 8, Issue 1, Page(s) 7

    Abstract: Background: People with opioid use disorder have substantially higher standardised mortality rates compared to the general population; however, lack of clear individual prognostic information presents challenges to prioritise or target interventions ... ...

    Abstract Background: People with opioid use disorder have substantially higher standardised mortality rates compared to the general population; however, lack of clear individual prognostic information presents challenges to prioritise or target interventions within drug treatment services. Previous prognostic models have been developed to estimate the risk of developing opioid use disorder and opioid-related overdose in people routinely prescribed opioids but, to our knowledge, none have been developed to estimate mortality risk in people accessing drug services with opioid use disorder. Initial presentation to drug services is a pragmatic time to evaluate mortality risk given the contemporaneous routine collection of prognostic indicators and as a decision point for appropriate service prioritisation and targeted intervention delivery. This study aims to develop and internally validate a model to estimate 6-month mortality risk for people with opioid use disorder from prognostic indicators recorded at initial assessment in drug services in England.
    Methods: An English national dataset containing records from individuals presenting to drug services between 1 April 2013 and 1 April 2023 (n > 800,000) (the National Drug Treatment Monitoring System (NDTMS)) linked to their lifetime hospitalisation and death records (Hospital Episode Statistics-Office of National Statistics (HES-ONS)). Twelve candidate prognostic indicator variables were identified based on literature review of demographic and clinical features associated with increased mortality for people in treatment for opioid use disorder. Variables will be extracted at initial presentation to drug services with mortality measured at 6 months. Two multivariable Cox regression models will be developed one for 6-month all-cause mortality and one for 6-month drug-related mortality using backward elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of both models will be reported using Harrel's c and d-statistics. Calibration curves and slopes will be presented comparing expected and observed event rates.
    Discussion: The models developed and internally validated in this study aim to improve clinical assessment of mortality risk for people with opioid use disorder presenting to drug services in England. External validation in different populations will be required to develop the model into a tool to assist future clinical decision-making.
    Language English
    Publishing date 2024-04-16
    Publishing country England
    Document type Journal Article
    ISSN 2397-7523
    ISSN (online) 2397-7523
    DOI 10.1186/s41512-024-00170-8
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  4. Article ; Online: In memoriam: Jacob Plange-Rhule, MB, ChB, PhD, FGCP, FWACP, FRCP (1957-2020).

    Adu, Dwomoa / Eastwood, John B

    Kidney international

    2020  Volume 98, Issue 4, Page(s) 802–803

    Language English
    Publishing date 2020-09-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2020.07.018
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  5. Article ; Online: Acute impact of self-guided mental imagery on craving in cocaine use disorder: a mixed-methods analysis of a randomized controlled trial.

    Lowry, Natalie / Marsden, John / Clydesdale, Bethany / Eastwood, Brian / Havelka, Eva Maria / Goetz, Camille

    Addiction (Abingdon, England)

    2021  Volume 116, Issue 9, Page(s) 2418–2430

    Abstract: ... effects of reduced craving after the imagery task (b = -29.2, 95% confidence interval (CI) = -45.3 to -13 ... 1, P-value < 0.001) and increased craving for the future-negative task (b = 14.2, 95% CI = 0.1-28.4 ... P-value 0.049). There was a future-negative task by post-imagery craving interaction (b = 28.1, 95 ...

    Abstract Mental imagery manipulations are used to treat several psychological disorders, but their utility in treating cocaine use disorder (CUD) is unknown. Using prompted re-experiences and simulations with contrasting valence, we assessed the acute impact of a deliberate mental imagery task on cocaine craving.
    Design: A quantitative-qualitative 'mixed-methods' analysis of data collected for a randomized controlled trial that was stopped prematurely.
    Setting: UK National Health Service addictions treatment clinic and outpatient clinical research facility (laboratory).
    Participants: Adults with CUD. The original target sample was 120. All participants enrolled at the point the original trial was stopped were included (38 enrolled, 31 completed study).
    Interventions: Personalized (3-minute) cue-exposure (handling cocaine paraphernalia and watching video of drug preparation), immediately followed by a single 5-minute, audio-recorded, self-guided and verbally described imagery task with random assignment to one of four conditions: two mental imagery memory re-experiences (positive image before initiation to cocaine use or a negative image of a 'worst time' adverse cocaine use episode) or two future simulations (positive theme of recovery from CUD or negative theme of worsened CUD).
    Measurements: Task transcripts were rated for imagery detail using five dimensions using a six-point scale of imagery detail (ID) (total score = 0-25) and thematically coded. The outcome measure was cocaine craving using the Craving Experiences Questionnaire-strengths version (CEQ-S11; score = 0-110) reported at baseline, arrival at the laboratory, and immediately after the cue-exposure and mental imagery tasks.
    Findings: A mixed-effects, longitudinal, restricted linear regression, with the past-positive imagery condition as referent, showed main effects of reduced craving after the imagery task (b = -29.2, 95% confidence interval (CI) = -45.3 to -13.1, P-value < 0.001) and increased craving for the future-negative task (b = 14.2, 95% CI = 0.1-28.4, P-value 0.049). There was a future-negative task by post-imagery craving interaction (b = 28.1, 95% CI = 0.1-56.1, P-value 0.049). A theory-driven, deductive/inductive qualitative analysis of the transcripts revealed six major themes: sensory characteristics, CUD vicious cycle, self-care, emotions and appraisals, social role and CUD recovery. Positively themed simulations included interpersonal connections and rewarding activity; negative images included personal adversity, with appraisals of self-criticism and hopelessness. Transcripts with more imagery detail were not associated with significantly greater reductions in craving in the positive or negative imagery task (r = -0.32, 95% CI = -0.69 to 0.13 and r = 0.06, 95% CI = -0.58 to 0.53, respectively).
    Conclusion: In people with cocaine use disorder, after cue-exposure, a self-guided imagery task with positive themes reduced craving, whereas mental imagery simulating worsened cocaine use disorder did not appear to.
    MeSH term(s) Adult ; Cocaine ; Cocaine-Related Disorders/therapy ; Craving ; Humans ; Imagery, Psychotherapy ; State Medicine
    Chemical Substances Cocaine (I5Y540LHVR)
    Language English
    Publishing date 2021-01-28
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1141051-6
    ISSN 1360-0443 ; 0965-2140
    ISSN (online) 1360-0443
    ISSN 0965-2140
    DOI 10.1111/add.15405
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  6. Article ; Online: Superiority and cost-effectiveness of Individual Placement and Support versus standard employment support for people with alcohol and drug dependence: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial.

    Marsden, John / Anders, Paul / Shaw, Claire / Amasiatu, Chioma / Collate, Winnie / Eastwood, Brian / Horgan, Patrick / Khetani, Meetal / Knight, Jonathan / Knight, Sandy / Melaugh, Alexandra / Clark, Helen / Stannard, Jez

    EClinicalMedicine

    2024  Volume 68, Page(s) 102400

    Abstract: Background: Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown ... ...

    Abstract Background: Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown effectiveness for people with alcohol and drug dependence. The Individual Placement and Support-Alcohol and Drug (IPS-AD) is the first superiority trial to evaluate effectiveness and cost-effectiveness.
    Methods: IPS-AD was a pragmatic, parallel-group, multi-centre, randomised, controlled, phase 3 trial of standard employment support (treatment-as-usual [TAU]) versus IPS. IPS was offered as a single episode for up to 13 months. The study was done at seven community treatment centres for alcohol and drug dependence in England. Study participants were adults (18-65 years), who had been enrolled for at least 14 days in treatment for alcohol use disorder (AUD), opioid use disorder (OUD), or another drug use disorder (DUD; mostly cannabis and stimulants); were unemployed or economically inactive for at least six months; and wished to attain employment in the open competitive labour market. After random allocation to study interventions, the primary outcome was employment during 18-months of follow-up, analysed by mixed-effects logistic regression, using multiple imputation for the management of missing outcome data. There were two cost-effectiveness outcomes: a health outcome expressed as a quality adjusted life year (QALY) using £30,000 and £70,000 willingness-to-pay [WTP] thresholds; and additional days of employment, with a WTP threshold of £200 per day worked. The study was registered with ISRCTN (ISRCTN24159790) and is completed.
    Findings: Between 8 May 2018 and 30 September 2019, 2781 potentially eligible patients were identified. 812 were excluded before screening, and 1720 participants were randomly allocated to TAU or IPS. In error, nine participants were randomised to study interventions on two occasions-so data for their first randomisation was analysed (modified intention-to-treat). A further 24 participants withdrew consent for all data to be used (full-analysis set therefore 1687 participants [70.1% male; mean age 40.8 years]; TAU, n = 844; IPS, n = 843 [AUD, n = 610; OUD, n = 837; DUD, n = 240]). Standard employment support was received by 559 [66.2%] of 844 participants in the TAU group. IPS was received by 804 [95.37%] of 843 participants in the IPS group. IPS was associated with an increase in attainment of employment compared with TAU (adjusted odds ratio [OR] 1.29; 95% CI 1.02-1.64; p-value 0.036). IPS was effective for the AUD and DUD groups (OR 1.48; 95% CI 1.14-1.92; p-value 0.004; OR 1.45, 95% CI 1.03-2.04, p-value 0.031, respectively), but not the OUD group. IPS returned an incremental QALY outcome gain of 0.01 (range 0.003-0.02) per participant with no evidence of cost-effectiveness at either WTP threshold-but QALY gains were cost-effective for the AUD and DUD groups at the £70,000 WTP threshold (probability 0.52 and 0.97, respectively). IPS was cost-effective for additional days of employment (probability 0.61), with effectiveness relating to the AUD group only (probability >0.99). Serious Adverse Events were reported by 39 participants (13 [1.5%] of 844 participants in the TAU group and 23 [2.7%] of 43 participants in the IPS group). There was a total of 25 deaths (1.5%; 9 in the TAU group and 16 in the IPS group)-none judged related to study interventions.
    Interpretation: In this first superiority randomised controlled trial of IPS in alcohol and drug dependence, IPS helped more people attain employment in the open competitive labour market than standard employment support. IPS was cost-effective for a QALY health outcome (£70,000 WTP threshold) for the AUD and DUD groups, and for additional days of employment for the AUD group (£200 per day worked WTP threshold).
    Funding: UK government Work and Health Unit.
    Language English
    Publishing date 2024-01-18
    Publishing country England
    Document type Journal Article
    ISSN 2589-5370
    ISSN (online) 2589-5370
    DOI 10.1016/j.eclinm.2023.102400
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  7. Article ; Online: 'Joining the Dots: Linking Prenatal Drug Exposure to Childhood and Adolescence' - research protocol of a population cohort study.

    Lawler, Kate / Dronavalli, Mithilesh / Page, Andrew / Lee, Evelyn / Uebel, Hannah / Bajuk, Barbara / Burns, Lucinda / Dickson, Michelle / Green, Charles / Dicair, Lauren / Eastwood, John / Oei, Ju Lee

    BMJ paediatrics open

    2024  Volume 8, Issue 1

    Abstract: Introduction: Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The : Methods and analysis: Information from routinely ...

    Abstract Introduction: Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The
    Methods and analysis: Information from routinely collected administrative databases was linked for all births registered in New South Wales (NSW), Australia between 1 July 2001 and 31 December 2020 (n=1 834 550). Outcomes for seven mutually exclusive groups of children with varying prenatal exposure to maternal substances of addiction, including smoking, alcohol, prescription/illicit drugs and neonatal abstinence syndrome will be assessed. Key exposure measures include maternal drug use type, maternal social demographics or social determinants of health, and maternal physical and mental health comorbidities. Key outcome measures will include child mortality, academic standardised testing results, rehospitalisation and maternal survival. Data analysis will be conducted using Stata V.18.0.
    Ethics and dissemination: Approvals were obtained from the NSW Population and Health Services Research Ethics Committee (29 June 2020; 2019/ETH12716) and the Australian Capital Territory Health Human Research Ethics Committee (11 October 2021; 2021-1231, 2021-1232, 2021-1233); and the Aboriginal Health and Medical Research Council (5 July 2022; 1824/21), and all Australian educational sectors: Board of Studies (government schools), Australian Independent Schools and Catholic Education Commission (D2014/120797). Data were released to researchers in September 2022. Results will be presented in peer-reviewed academic journals and at international conferences. Collaborative efforts from similar datasets in other countries are welcome.
    MeSH term(s) Adolescent ; Child ; Female ; Humans ; Pregnancy ; Australia/epidemiology ; Australian Aboriginal and Torres Strait Islander Peoples ; Cohort Studies ; Health Services, Indigenous ; New South Wales/epidemiology ; Prenatal Exposure Delayed Effects/epidemiology ; Data Collection
    Language English
    Publishing date 2024-04-11
    Publishing country England
    Document type Journal Article
    ISSN 2399-9772
    ISSN (online) 2399-9772
    DOI 10.1136/bmjpo-2024-002557
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  8. Article ; Online: The hospital admission profile of people presenting to specialist addiction services with problematic use of alcohol or opioids: A national retrospective cohort study in England.

    Roberts, Emmert / Hotopf, Matthew / Strang, John / Marsden, John / White, Martin / Eastwood, Brian / Drummond, Colin

    The Lancet regional health. Europe

    2021  Volume 3, Page(s) 100036

    Abstract: Background: Over the past decade in England the rate of alcohol and opioid-related hospitalisation has increased alongside a simultaneous reduction in people accessing specialist addiction treatment. We aimed to determine the hospitalisation patterns of ...

    Abstract Background: Over the past decade in England the rate of alcohol and opioid-related hospitalisation has increased alongside a simultaneous reduction in people accessing specialist addiction treatment. We aimed to determine the hospitalisation patterns of people presenting to addiction treatment with problematic use of alcohol or opioids, and estimate how individual sociodemographic characteristics and hospital admission diagnoses are associated with the rate of hospitalisation, death and successful completion of addiction treatment.
    Methods: A national record linkage between Hospital Episode Statistics (HES) and the National Drug Treatment Monitoring System (NDTMS) captured lifetime hospital admission profiles of people presenting to addiction services in England in 2018/19. Latent class analysis assigned individuals to clusters based on the ICD-10 diagnosis coded as primary reason for admission. Negative binomial, and multilevel logistic regression models determined if outcomes differed due to sociodemographic characteristics or assigned diagnostic clusters.
    Findings: Inpatient data were available for 64,840 alcohol patients, and 107,296 opioid patients. The most common reasons for admission were alcohol withdrawal (
    Interpretation: This is the first study to interrogate national hospitalisation patterns within people presenting to addiction services with problematic use of alcohol or opioids. Having identified high-risk, high-cost individuals with increased hospital usage, and increased odds of death, future work should focus on targeting appropriate interventions, to improve their health outcomes and prevent unnecessary hospital readmission.
    Funding: The work was funded by the Medical Research Council (MRC).
    Language English
    Publishing date 2021-05-05
    Publishing country England
    Document type Journal Article
    ISSN 2666-7762
    ISSN (online) 2666-7762
    DOI 10.1016/j.lanepe.2021.100036
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  9. Article: Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression.

    Eastwood, John G / Kemp, Lynn A / Jalaludin, Bin B

    SpringerPlus

    2016  Volume 5, Issue 1, Page(s) 1081

    Abstract: Background: We have recently described a protocol for a study that aims to build a theory of neighbourhood context and postnatal depression. That protocol proposed a critical realist Explanatory Theory Building Method comprising of an: (1) emergent ... ...

    Abstract Background: We have recently described a protocol for a study that aims to build a theory of neighbourhood context and postnatal depression. That protocol proposed a critical realist Explanatory Theory Building Method comprising of an: (1) emergent phase, (2) construction phase, and (3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design was described. The protocol also described in detail the Theory Construction Phase which will be presented here.
    Methods: The Theory Construction Phase will include: (1) defining stratified levels; (2) analytic resolution; (3) abductive reasoning; (4) comparative analysis (triangulation); (5) retroduction; (6) postulate and proposition development; (7) comparison and assessment of theories; and (8) conceptual frameworks and model development.
    Theory construction: The stratified levels of analysis in this study were predominantly social and psychological. The abductive analysis used the theoretical frames of: Stress Process; Social Isolation; Social Exclusion; Social Services; Social Capital, Acculturation Theory and Global-economic level mechanisms. Realist propositions are presented for each analysis of triangulated data. Inference to best explanation is used to assess and compare theories. A conceptual framework of maternal depression, stress and context is presented that includes examples of mechanisms at psychological, social, cultural and global-economic levels. Stress was identified as a necessary mechanism that has the tendency to cause several outcomes including depression, anxiety, and health harming behaviours. The conceptual framework subsequently included conditional mechanisms identified through the retroduction including the stressors of isolation and expectations and buffers of social support and trust.
    Conclusion: The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions.
    Language English
    Publishing date 2016-07-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2661116-8
    ISSN 2193-1801
    ISSN 2193-1801
    DOI 10.1186/s40064-016-2729-9
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  10. Article ; Online: Change in alcohol and other drug use during five years of continuous opioid substitution treatment.

    Eastwood, Brian / Strang, John / Marsden, John

    Drug and alcohol dependence

    2018  Volume 194, Page(s) 438–446

    Abstract: Background: English national prospective, observational cohort study of patients continuously enrolled for five years in opioid substitution treatment (OST) with oral methadone and sublingual buprenorphine. This is a secondary outcome analysis of change ...

    Abstract Background: English national prospective, observational cohort study of patients continuously enrolled for five years in opioid substitution treatment (OST) with oral methadone and sublingual buprenorphine. This is a secondary outcome analysis of change in use of alcohol and other drug use (AOD) following identification of heroin use trajectories during OST.
    Methods: All adults admitted to community OST in 2008/09 and enrolled to 2013/14 (n = 7717). Data from 11 sequential, six-monthly clinical reviews were used to identify heroin and AOD use trajectories by multi-level Latent Class Growth Analysis. OST outcome in the sixth and seventh year was 'successful completion and no re-presentation' (SCNR) to structured treatment and was assessed using multi-level logistic regression.
    Results: With 'rapid decreasing' heroin use trajectory as referent, 'continued high-level' heroin use predicted 'continued high-level' crack cocaine use (relative risk ratio [RRR] 58.7; 95% confidence interval [CI] 34.2-100.5),'continued high-level' alcohol use (RRR 1.2; 95% CI 1.0-1.5), 'increasing' unspecified drug use (RRR 1.7; 95% CI 1.4-2.1) and less 'high and increasing' cannabis use (RRR 0.5; 95% CI 0.4-0.6). 'Increasing' crack use was negatively associated with SCNR outcome for the 'decreasing then increasing' and 'gradual decreasing' heroin use groups (adjusted odds ratio [AOR] 0.5; 95% CI 0.3-0.9 and AOR 0.2; 95% CI 0.1-0.7, respectively).
    Conclusions: Continued high-level heroin use non-response during long-term OST is associated with high-level crack cocaine and alcohol use, increasing unspecified drug use, but less high and increasing cannabis use. Increasing use of crack cocaine is negatively associated with the likelihood that long-term OST is completed successfully.
    MeSH term(s) Adult ; Aged ; Alcohol Drinking/epidemiology ; Buprenorphine/therapeutic use ; Cohort Studies ; Female ; Hospitalization ; Humans ; Male ; Marijuana Use/epidemiology ; Methadone/therapeutic use ; Middle Aged ; Opiate Substitution Treatment ; Prevalence ; Prospective Studies ; Substance-Related Disorders/drug therapy ; Substance-Related Disorders/psychology ; Young Adult
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z)
    Language English
    Publishing date 2018-11-26
    Publishing country Ireland
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 519918-9
    ISSN 1879-0046 ; 0376-8716
    ISSN (online) 1879-0046
    ISSN 0376-8716
    DOI 10.1016/j.drugalcdep.2018.11.008
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