Health and Social Care Workers Perceptions of Novel Psychoactive substances in Northern Ireland

Background: The EU Early Warning System currently monitors more than 450 new psychoactive substances (EMCDDA, 2015), far outweighing the total number of illicit drugs under international control (UNODC, 2013). Due to the recent emergence of NPS and rapidly changing nature of the market, evidence about the way in which the emerging drugs are managed in health and social care settings is limited. Methods: The study adopted a mixed methods design, utilising a cross sectional survey and follow up telephone interviews to capture data from staff working in drug and alcohol related services in statutory and voluntary sectors, across the five Health and Social Care (HSC) Trust areas in Northern Ireland. 196 staff participated in the survey and 13 took part in follow up telephone interviews. Results: Study respondents reported that addressing NPS related issues with service users was a key aspect of their daily role and function. Levels of injecting behaviours were also viewed as relatively high by the study participants. Almost all workers used harm reduction as their primary approach when working with service users and the majority of respondents called for additional practical training in relation to addressing drug interactions and intervening with NPS related issues.

Thiram in the environment: effect of humic substances and Cu(II) ions

Em Portugal, o tirame é um dos fungicidas mais utilizados, cujas vendas aumentaram significativamente nos últimos anos, sendo também um dos fungicidas mais utilizados em todo o mundo. No entanto, em comparação com outros pesticidas, existe falta de informação na literatura sobre o seu comportamento em sistemas ambientais, nomeadamente, no que diz respeito à sua degradação no solo ou em águas e produtos a que dá origem. Neste contexto, o objetivo deste trabalho foi estudar a influência das substâncias húmicas e iões cobre no comportamento e destino do tirame no meio ambiente. Foram realizados vários estudos para analisar o comportamento do tirame em solos com diferentes conteúdos de matéria orgânica e de iões cobre, e em águas naturais, estudando como as substâncias húmicas, os iões cobre e a luz solar podem afetar a sua degradação. Os estudos de adsorção-desadsorção do tirame nos solos revelaram que a matéria orgânica do solo e o conteúdo de cobre afetavam os processos de adsorção-desadsorção do tirame, influenciando a sua lixiviação e persistência no solo. De facto, verificou-se que o teor de cobre do solo tinha um efeito bastante marcante no processo de adsorçãodesadsorção do tirame. Verificou-se a ocorrência de reações entre o tirame e os iões cobre, cuja extensão durante os estudos de adsorção pode ser fortemente dependente do teor de cobre do solo e da concentração inicial de tirame em solução. Assim, a escolha do tempo de equilíbrio em estudos de adsorção e a determinação das isotérmicas de adsorção ao solo torna-se uma tarefa difícil. Além disso, os complexos formados com o cobre existente no solo são persistentes, não sendo facilmente lixiviados para as águas subterrâneas. Conclui-se que os iões cobre(II) podem contribuir para a imobilização do tirame no solo e o aumento da persistência dos seus resíduos ligados ao cobre. A partir de estudos de recuperação do tirame em águas naturais verificou-se a ocorrência de uma rápida degradação do tirame, devido provavelmente aos iões metálicos, nomeadamente, iões cobre. Verificou-se que dependendo da razão tirame:Cu podiam ocorrer dois processos: (i) complexação entre o tirame e o cobre, quando não há excesso de iões cobre, sendo o complexo formado mais persistente que o tirame; (ii) ou, quando há um grande excesso de iões cobre, a degradação do tirame e a estabilização dos produtos de degradação por complexação, podendo formar-se complexos que permanecem sem alteração em solução durante pelo menos dois meses. No geral, foi possível, pela primeira vez, identificar alguns dos complexos de cobre formados ao longo do tempo. Por fim, estudou-se a cinética de fotodegradação do tirame em solução aquosa sob a ação da luz solar e identificaram-se, pela primeira vez, três fotoprodutos. Verificou-se um aumento da velocidade de fotodegradação do tirame na presença de substâncias húmicas. Assim, podemos concluir que a matéria orgânica, os iões cobre(II) e a luz solar têm um efeito importante no comportamento do tirame no meio ambiente. Contudo, os iões cobre têm um efeito mais marcante na degradação e persistência dos produtos que são formados.

Natural substances and high pressure processing to preserve sea bass

Esta tese teve como objectivo estudar estratégias de conservação de pescado fresco, recorrendo ao uso de extractos e óleos essenciais de plantas e do processamento por alta pressão (HPP), usando filetes de robalo como um caso de estudo modelo. Relativamente aos extractos e óleos essenciais, avaliaram-se as suas propriedades antibacterianas e antioxidantes. Os extractos aquosos quente de poejo e de orégão e o óleo essencial de cravinho apresentaram a maior actividade antioxidante. Os óleos essenciais foram mais eficientes do que os extractos para inibir o crescimento das estirpes bacterianas testadas, tendo-se observado os menores valores de concentração mínima inibitória nos óleos essenciais de orégão, citronela, alho e orégão Espanhol. De seguida, estudou-se o efeito dos óleos essenciais de orégão Espanhol e de limão na conservação de filetes de robalo fresco tendo em conta critérios microbiológicos, químicos, físicos e sensoriais. A aplicação do óleo essencial de orégão Espanhol aumentou o tempo de vida útil dos filetes sob o ponto de vista bacteriano, mas não em termos sensoriais. A combinação dos óleos essenciais de orégão Espanhol e de limão melhorou o efeito antioxidante e reduziu a intensidade do odor e a sua eficácia em relação às Enterobacteriaceae, comparando com o tratamento com óleo essencial de orégão Espanhol per se. No sentido de reduzir o odor conferido pelos óleos essenciais realizou-se um estudo de conservação para avaliar o efeito de películas com óleos essenciais (citronela, alho e tomilho) em filetes de robalo, recorrendo a uma teste de desafio bacteriano. As películas sem óleos essenciais aumentaram o tempo de vida útil sob o ponto de vista bacteriano, mas este efeito não foi observado com a incorporação dos óleos essenciais nas películas. Em relação ao HPP, testaram-se diversas condições (nível de pressão, tempo de pressurização e taxa de pressurização) e avaliaram-se os efeitos na actividade enzimática, na qualidade global e na conservação de filetes de robalo fresco. Em geral, o aumento do nível de pressão e do tempo de pressurização diminuiu a actividade da fosfatase ácida e das enzimas proteolíticas, a carga bacteriana e a capacidade de retenção de água, enquanto que os filetes ficaram mais brancos. O HPP revelou potencial para o desenvolvimento de novos produtos: mais brancos, não translúcidos, mais firmes e com maior tempo de frescura e estabilidade microbiológica. Em conclusão, os óleos essenciais e o HPP têm potencial para conservar pescado fresco, devido aos seus efeitos na qualidade bacteriana. Ainda assim, mais esforços devem ser feitos no sentido de reduzir a transferência de odor dos óleos essenciais para o pescado e os efeitos do HPP no aspecto do pescado e na oxidação lipídica.

Improved polymeric medical devices for active substances delivery

The work presented in this thesis was developed in collaboration with a Portuguese company, BeyonDevices, devoted to pharmaceutical packaging, medical technology and device industry. Specifically, the composition impact and surface modification of two polymeric medical devices from the company were studied: inhalers and vaginal applicators. The polyethylene-based vaginal applicator was modified using supercritical fluid technology to acquire self-cleaning properties and prevent the transport of bacteria and yeasts to vaginal flora. For that, in-situ polymerization of 2-substituted oxazolines was performed within the polyethylene matrix using supercritical carbon dioxide. The cationic ring-opening polymerization process was followed by end-capping with N,N-dimethyldodecylamine. Furthermore, for the same propose, the polyethylene matrix was impregnated with lavender oil in supercritical medium. The obtained materials were characterized physical and morphologically and the antimicrobial activity against bacteria and yeasts was accessed. Materials modified using 2-substituted oxazolines showed an effective killing ability for all the tested microorganisms, while the materials modified with lavender oil did not show antimicrobial activity. Only materials modified with oligo(2-ethyl-2-oxazoline) maintain the activity during the long term stability. Furthermore, the cytotoxicity of the materials was tested, confirming their biocompatibilty. Regarding the inhaler, its surface was modified in order to improve powder flowability and consequently, to reduce powder retention in the inhaler´s nozzle. New dry powder inhalers (DPIs), with different needle’s diameters, were evaluated in terms of internal resistance and uniformity of the emitted dose. It was observed that they present a mean resistance of 0.06 cmH2O0.5/(L/min) and the maximum emitted dose obtained was 68.9% for the inhaler with higher needle´s diameter (2 mm). Thus, this inhaler was used as a test and modified by the coating with a commonly-used force control agent, magnesium stearate, dried with supercritical carbon dioxide (scCO2) and the uniformity of delivered dose tests were repeated. The modified inhaler showed an increase in emitted dose from 68.9% to 71.3% for lactose and from 30.0% to 33.7% for Foradil.

First use of multiple substances: Identification of meaningful patterns

Context: Understanding the process through which adolescents and young adults are trying legal and illegal substances is a crucial point for the development of tailored prevention and treatment programs. However, patterns of substance first use can be very complex when multiple substances are considered, requiring reduction into a few meaningful number of categories. Data: We used data from a survey on adolescent and young adult health conducted in 2002 in Switzerland. Answers from 2212 subjects aged 19 and 20 were included. The first consumption ever of 10 substances (tobacco, cannabis, medicine to get high, sniff (volatile substances, and inhalants), ecstasy, GHB, LSD, cocaine, methadone, and heroin) was considered for a grand total of 516 different patterns. Methods: In a first step, automatic clustering was used to decrease the number of patterns to 50. Then, two groups of substance use experts, three social field workers, and three toxicologists and health professionals, were asked to reduce them into a maximum of 10 meaningful categories. Results: Classifications obtained through our methodology are of practical interest by revealing associations invisible to purely automatic algorithms. The article includes a detailed analysis of both final classifications, and a discussion on the advantages and limitations of our approach.

Hazardous substances in frequently used professional cleaning products.

A growing number of studies have identified cleaners as a group at risk for adverse health effects of the skin and the respiratory tract. Chemical substances present in cleaning products could be responsible for these effects. Currently, only limited information is available about irritant and health hazardous chemical substances found in cleaning products. We hypothesized that chemical substances present in cleaning products are known health hazardous substances that might be involved in adverse health effects of the skin and the respiratory tract. We performed a systematic review of cleaning products used in the Swiss cleaning sector. We surveyed Swiss professional cleaning companies (n = 1476) to identify the most used products (n = 105) for inclusion. Safety data sheets (SDSs) were reviewed and hazardous substances present in cleaning products were tabulated with current European and global harmonized system hazard labels. Professional cleaning products are mixtures of substances (arithmetic mean 3.5 +/- 2.8), and more than 132 different chemical substances were identified in 105 products. The main groups of chemicals were fragrances, glycol ethers, surfactants, solvents; and to a lesser extent, phosphates, salts, detergents, pH-stabilizers, acids, and bases. Up to 75% of products contained irritant (Xi), 64% harmful (Xn) and 28% corrosive (C) labeled substances. Hazards for eyes (59%) and skin (50%), and hazards by ingestion (60%) were the most reported. Cleaning products potentially give rise to simultaneous exposures to different chemical substances. As professional cleaners represent a large workforce, and cleaning products are widely used, it is a major public health issue to better understand these exposures. The list of substances provided in this study contains important information for future occupational exposure assessment studies.

Toxic substances in blood: an analysis of current recommendations under a Bayesian (decision) approach

This article extends existing discussion in literature on probabilistic inference and decision making with respect to continuous hypotheses that are prevalent in forensic toxicology. As a main aim, this research investigates the properties of a widely followed approach for quantifying the level of toxic substances in blood samples, and to compare this procedure with a Bayesian probabilistic approach. As an example, attention is confined to the presence of toxic substances, such as THC, in blood from car drivers. In this context, the interpretation of results from laboratory analyses needs to take into account legal requirements for establishing the 'presence' of target substances in blood. In a first part, the performance of the proposed Bayesian model for the estimation of an unknown parameter (here, the amount of a toxic substance) is illustrated and compared with the currently used method. The model is then used in a second part to approach-in a rational way-the decision component of the problem, that is judicial questions of the kind 'Is the quantity of THC measured in the blood over the legal threshold of 1.5 μg/l?'. This is pointed out through a practical example.

Le burnout de l'élève : validation du School Burnout Inventory, identification de facteurs de risque et de protection et exploration des liens avec la consomation de substances

Syndrome de stress scolaire chronique, le bumout de l'élève ou bumout scolaire suscite un intérêt grandissant mais ses déterminants sont encore peu connus. De plus, ce phénomène est rarement étudié chez les adolescents francophones et aucune recherche n'a encore été menée en Suisse. Par conséquent, au travers de ce travail de thèse, nous proposons d'étendre la recherche sur le bumout scolaire aux adolescents de Suisse francophone et d'apporter des précisions sur ses facteurs de risque ou de protection. Pour ce faire, nous avons mené deux recherches empiriques impliquant 861 adolescents âgés de 14 à 18 ans et scolarisés en Suisse francophone. Ces adolescents ont répondu à une série d'échelles évaluant notamment le burnout scolaire, le stress scolaire, le soutien social, la consommation de substances et le parcours scolaire. Les résultats montrent tout d'abord que l'inventaire de Burnout Scolaire, version française du School Burnout lnventory, est un outil fiable et valide. Ensuite, il apparaît que le burnout scolaire touche jusqu'à 24% des adolescents de Suisse francophone et que ce dernier se caractérise par une perte d'intérêt pour l'école, une grande remise en question du sens du travail scolaire ainsi qu'un sentiment élevé d'insuffisance à l'école. Il apparaît également que le stress scolaire lié au succès et à l'avenir scolaire augmente le risque de bumout alors que le soutien des parents et des enseignants le diminue. Par ailleurs, nous mettons en évidence que l'effet du soutien social sur le burnout scolaire est médiatisé par le stress scolaire, ce qui souligne d'autant plus le rôle protecteur du soutien social. Nos résultats montrent également que les niveaux de bumout scolaire varient en fonction, d'une part de certaines caractéristiques du contexte scolaire et d'autre part en fonction de la sévérité de la consommation de substances des adolescents. Enfin, les connaissances accumulées dans ce travail et leur mise en perspective dans un modèle d'intervention précoce permettent d'insister sur le rôle de l'école et des professionnels de l'école dans la prévention du burnout scolaire. -- Syndrome of chronic school stress, pupil 's bumout or school bumout is of growing interest. However, little is known about its determinants. Moreover, this phenomenon is rarely studied in French speaking adolescents and no research has yet been conducted in Switzerland. Therefore, through this thesis, we propose to extend the research on school bumout to Swiss French speaking adolescents and to clarify its risk and protective factors. To achieve this, we conducted two empirical research involving 861 adolescents aged 14 to 18 and enrolled in the French part of Switzerland. These adolescents were asked to answer a questionnaire about school bumout, academic stress, social support, substance use and schooling. Results first show, that the French version of the School Bumout Inventory is a reliable and valid tool. lt then appears that school bumout affects up to 24% of adolescents in the French speaking part of Switzerland and that this phenomenon is characterized by a loss of interest in school, a great challenge to the sense of school work and a high sense of insufissance school. lt also appears that stress related to school success and academic future increases the risk of bumout while parents and teachers support decreases it. Moreover, we highlight that the effect of social support on school bumout is mediated by school stress, which further underscores the protective role of social support. Our results also show that school bumout levels vary depending on characteristics of the school context and on the severity of substance use of adolecents. Finally, the knowledge accumulated in this work and putting it onto perspective within early intervention model enable to insist on the role of school and school professionals in the prevention of school bumout