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      Service Users’ Views and Experiences of Alcohol Relapse Prevention Treatment and Adherence: New Role for Pharmacists?

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          Abstract

          Aims

          To understand service users' views and experiences of alcohol relapse prevention medication, views of a telephone behavioural modification intervention delivered by pharmacists and the use of Contingency Management (CM) to support acamprosate adherence following assisted alcohol withdrawal.

          Methods

          Four focus groups were conducted within four alcohol treatment and recovery groups across England (UK), with service users with lived experience of alcohol dependence (26 participants). Semi-structured topic guide was used to explore participants' views and experiences of alcohol relapse prevention medication, a telephone behavioural modification medication intervention delivered by pharmacists, and the use of CM to support acamprosate adherence. These were audio-recorded, transcribed verbatim and thematically analysed inductively and deductively.

          Results

          Four themes were identified: concerns about support and availability of alcohol relapse prevention medication; lack of knowledge and understanding about acamprosate treatment; positive perceptions of acamprosate adherence telephone support from pharmacists; and negative perceptions of CM to support acamprosate adherence. There were misunderstandings about acamprosate's mode of action and strong negative beliefs about CM. However, most were positive about pharmacists' new role to support acamprosate adherence.

          Conclusion

          This study highlighted challenges service users face to commence alcohol relapse prevention medication. It appears service users could benefit from a pharmacist-led telephone intervention to improve understanding about acamprosate medication, particularly, if delivered in an engaging and motivating way.

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          Most cited references37

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

            Summary Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.
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              Reducing and meta-analysing estimates from distributed lag non-linear models

              Background The two-stage time series design represents a powerful analytical tool in environmental epidemiology. Recently, models for both stages have been extended with the development of distributed lag non-linear models (DLNMs), a methodology for investigating simultaneously non-linear and lagged relationships, and multivariate meta-analysis, a methodology to pool estimates of multi-parameter associations. However, the application of both methods in two-stage analyses is prevented by the high-dimensional definition of DLNMs. Methods In this contribution we propose a method to synthesize DLNMs to simpler summaries, expressed by a reduced set of parameters of one-dimensional functions, which are compatible with current multivariate meta-analytical techniques. The methodology and modelling framework are implemented in R through the packages dlnm and mvmeta. Results As an illustrative application, the method is adopted for the two-stage time series analysis of temperature-mortality associations using data from 10 regions in England and Wales. R code and data are available as supplementary online material. Discussion and Conclusions The methodology proposed here extends the use of DLNMs in two-stage analyses, obtaining meta-analytical estimates of easily interpretable summaries from complex non-linear and delayed associations. The approach relaxes the assumptions and avoids simplifications required by simpler modelling approaches.
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                Author and article information

                Contributors
                Journal
                Alcohol Alcohol
                Alcohol Alcohol
                alcalc
                Alcohol and Alcoholism (Oxford, Oxfordshire)
                Oxford University Press
                0735-0414
                1464-3502
                September 2022
                15 March 2022
                15 March 2022
                : 57
                : 5
                : 602-608
                Affiliations
                UCL Arts and Sciences Department , University College London, London, UK
                Pharmacy Department , University of Reading, Reading, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Institute for Clinical and Applied Health Research (ICAHR) , Faculty of Health Sciences, University of Hull, Hull, UK
                Institute for Mental Health , School of Psychology, University of Birmingham and Solihull Integrated Addiction Service, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Division of Psychiatry , Department of Brain Sciences, Imperial College London, London, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Institute for Clinical and Applied Health Research (ICAHR) , Faculty of Health Sciences, University of Hull, Hull, UK
                Faculty of Medicine , University of Southampton, Southampton, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                School of Cancer & Pharmaceutical Sciences , King's College London, London, UK
                UCL School of Pharmacy , University College London, London, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Addictions Department , National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Department of Clinical , Educational and Health Psychology, University College London, London, UK
                Author notes
                Corresponding author: Dr Ranjita Dhital, UCL Arts and Sciences Department, University College London, 33-35 Torrington Place, London, WC1E 7LA, UK. Email: r.dhital@ 123456ucl.ac.uk
                Author information
                https://orcid.org/0000-0002-4504-7318
                https://orcid.org/0000-0001-8020-4510
                https://orcid.org/0000-0002-1905-2025
                Article
                agac011
                10.1093/alcalc/agac011
                9465522
                35292814
                249eb3c0-1e23-4d6c-916c-20f7cac74056
                © The Author(s) 2022. Medical Council on Alcohol and Oxford University Press. All rights reserved.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 16 October 2021
                : 8 February 2022
                : 15 February 2022
                Page count
                Pages: 7
                Funding
                Funded by: National Institute for Health Research, DOI 10.13039/501100000272;
                Award ID: 13/86/03
                Funded by: National Health Service;
                Funded by: Department of Health and Social Care, DOI 10.13039/501100000276;
                Categories
                Article
                AcademicSubjects/MED00860

                Health & Social care
                Health & Social care

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