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R Hartnoll

Publications and source records attributed to R Hartnoll.

16 recordsLinked to original sources
PubMed1999

A small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993.

STUDY OBJECTIVE: To determine the distribution of opioid use prevalence in small areas and its relation with socioeconomic indicators. DESIGN: Capture-recapture was applied using data from the Barcelona Drug Information System for 1993 (treatment demands, hospital emergency room visits, deaths from heroin acute adverse reaction and pre-trial prison admissions). To avoid dependence between sources, a log-linear regression model with interactions was fitted. For small neighbourhoods, where capture-recapture estimates were not obtainable, the Heroin Problem Index (HPI) was used to predict prevalence rates from a regression model. The correlation between estimated opioid use prevalence by neighbourhoods and their socioeconomic level was computed. MAIN RESULTS: The city's estimated prevalence was 12.9 opioid addicts per 1000 inhabitants aged 15 to 44 years (95% CI: 10.1, 17.2), which represents 9176 persons. The highest rate was found in the inner city neighbourhood. Comparing rates obtained for each neighbourhood with their unemployment rates, a high correlation coefficient was obtained (r = 0.80, p < 0.001). CONCLUSION: The main contribution of this study is that of combining capture-recapture with the HPI to produce small area prevalence estimates, which would not have been possible using only one method. Areas with higher socioeconomic status showed proportionally low addiction prevalences, but in depressed areas, prevalences varied widely.

Adolescent↗
PubMed1999

The EMCDDA/Pompidou Group treatment demand indicator protocol: a European core item set for treatment monitoring and reporting.

Over the last decades inside and outside of Europe, treatment-based data have been used in epidemiological research on drugs and drug abuse. They offer information on hidden populations and allow to follow socially stigmatised behaviour. As this type of research can be done on rather low budgets, there are long-term projects run in many countries. Experts from the national systems in several EU member states have been working together to develop a common standard on the basis of the Pompidou Group (PG) Definitive Protocol. The items and basic definitions of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)/PG Treatment Demand Indicator Protocol are described, which plays an important role in the process of harmonisation of data collection for the EMCDDA. Implementation strategies are described, and future steps are discussed.

Europe↗
PubMed1992

Research and the help-seeking process.

Recognition of changes in the nature and extent of problem drug taking in the early 1980s led to changes in service provision and to an increased interest in help-seeking. The advent of AIDS accelerated these changes. This paper introduces concepts from the wider field of help-seeking and compliance with preventive health measures. It reviews the major conclusions of studies of help-seeking by problem drug takers, and identifies areas for further research. These include the need to 'unpack' the concept of 'drug problems' and to differentiate dimensions of needs in different individuals and populations; to evaluate attempts to make services attractive and accessible and to contact out-of-treatment groups; to assess the role of 'significant others'; to understand the demands that changing service roles place on agency staff; and to give greater prominence to studies of the process of help-seeking in terms of drug users' perceptions of their drug use, of problems, of risks and of services within the wider context of their lifestyles.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The role of significant life events in discriminating help-seeking among illicit drug users.

This paper examines the role of significant life events in distinguishing two samples of illicit drug users: 120 help-seekers (the "agency group") and 120 not seeking help (the "non-agency group"). We examined 10 life areas clustered around the general categories of "substance use," "social functioning," and "emotional and interpersonal functioning." A range of objective and self-reported information was collected regarding each life area covering the 12 months prior to interview. Analysis revealed that the agency group experienced a greater number of negatively perceived drug-related life events than the non-agency group. These life events were also more likely to have occurred in recent months, prompting reported "concern" and "need for help" among the agency group. Additionally, length of use of current primary drug was seen to be a contributory variable in distinguishing between the groups.

Adult↗
PubMed1992

Help-seeking among illicit drug users: some differences between a treatment and nontreatment sample.

A number of both medical and nonmedical disciplines have expressed concern regarding the large numbers of individuals that fail to present to services, despite experiencing problems similar to those of active help-seekers. Such a concern is most pertinent in the field of substance misuse, particularly in terms of the role of injecting drug users in the spread of HIV and AIDS. This study looked at two samples of problem drug takers in London: 120 seeking help (the "agency group") and 120 not seeking help (the "non-agency group"). A number of factors were examined to distinguish the two groups, including sociodemographic profiles, drug histories, and self-reported "concern" and "need for help" in a wide variety of life areas. Data analysis highlighted the significance of "concern" and "need for help" in specified life areas.

Adaptation, Psychological↗
PubMed1991

Epidemiological approaches to drug misuse in Britain.

Most surveys in Britain are carried out at local level, though some indicators are monitored at national level. An example of a successful multi-source and multiple method model used in local studies is described. The importance of integrating both quantitative and qualitative approaches is stressed. The emphasis is on the value of local research, and of comparative studies between localities (e.g., cities). National surveys offer a useful baseline against which to set local studies. They are also used to inform broad policies, though it is argued that they are often misused and that their contribution at national policy level is overrated. Most service delivery and prevention activities occur at local level. It is here that research can be interpreted in the local context, thus giving richer and more relevant insights. It is important that a range of methods and sources are used, since any one approach is partial and can easily lead to bias. The strengths and weaknesses of different methods are discussed.

Epidemiologic Methods↗
PubMed1989

A multi-city study of drug misuse in Europe.

This paper presents a report of the results of a comparative epidemiological study of indicators of drug misuse in seven European cities. The study was carried out between 1982 and 1986 under the auspices of the Pompidou Group of the Council of Europe. The members of the expert group summarize the drug situation in the seven cities and critically examine a range of indicators that are sometimes assumed to reflect trends in the prevalence of drug misuse. They conclude that a valuable assessment of drug misuse problems can be provided by drawing together data from several indicators. It is essential that these agency-based data are complemented by surveys and other studies of drug misuse in the populations concerned. The members of the expert group suggest that a single organizational unit is needed to integrate and analyse data and epidemiological studies and discuss different models of how this can be achieved. Improvement in the consistency and quality of the data is essential if policies are to be based on a sound understanding of trends in drug misuse.

Europe↗
PubMedDate not supplied

A framework for evaluating activities to reduce the demand for drugs in Europe.

This paper describes a provisional framework that could be used to help compare and evaluate activities concerned with reducing the demand for illicit drugs in the European Community. It provides a background to European concern in this field, and comments on some methodological problems that arise regarding evaluation. The overall goal of demand reduction may be attempted through a diverse range of activities--treatment and rehabilitation, reduction of secondary harm arising from drug use, primary prevention, and suppression of drug availability and use--each of which may involve different interventions at different levels of generality and with different subsidiary objectives. Thus it is essential that data for evaluation are collected in terms of a framework where demand reduction activities and their objectives are clearly specified, together with criteria for success or failure, appropriate measures for those criteria and suitable methods to obtain those measures. The paper provides some examples of how this framework could be applied to evaluating attempts to reduce demand for drug through treating addicts, and comments on the use of global measures (indicators) of trends in the demand for drugs. A possible administrative structure for comparing drug demand activities in different countries through a European network on health data is suggested.

Europe↗
PubMedDate not supplied

[Prevalence of human immunodeficiency virus and risk behaviours among opioid users seen in an emergency room].

INTRODUCTION: As prevalence of HIV-1 among drug users in Spain is high and it is difficult to contact them because of their hidden behaviors, emergency rooms are one of the health facilities where they can be located. A cross-sectional interview study was planned. The aims of the study were to estimate prevalence of HIV-1 and to describe risk behaviors. METHODS: The sample included all patients that in spring 1992 were detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. Drug users who did not know their HIV status or were negative for more than six months were asked to provide a urine sample to test HIV serology. A descriptive analysis with simple stratification was carried out. Row and adjusted odds ratio were used to analyse association between different variables and HIV status. Logistic regression was used to examine variables associated with HIV infection and risk behaviors (injecting drug use, sharing needles, and no use of condom). RESULTS: Three hundred and eighty three opiate users were interviewed. It was possible to know HIV status of 94% of the subjects. Of them, 61% were positive (219). The best adjusted logistic model to predict associated variables with HIV included being female, primary school level, sickness absence, to attend because of organic pathology, and more years of parenteral use. Seventy five percent of the sample injected drugs during the past 30 days, and among them 30% shared syringes. The variables associated with a higher probability of having injected heroin or cocaine in the last 30 days were to have completed at least primary education, to be unemployed or reliant on illegal activities, not to be in drug treatment, and a larger number of drugs used in the last 30 days. A higher probability of sharing syringes was associated with a lower educational level, not to be in drug treatment, to live alone and a higher number of drugs used during last 30 days. Twenty one percent of the subjects who were sexually active always or nearly always used condom with regular partners and 56% with casual partners. Women were more likely to use condom than men with casual partners. Subjects who shared syringes during last 30 days were nearly three times more likely not to use condom with casual partners. CONCLUSIONS: Although a high prevalence of HIV-1 was estimated among opioid users seen in an emergency room, it is not higher than estimates for intravenous drug users recruited from treatment centres, prison or needles exchange programs. A high frequency of risk behavior was also observed indicating a need to develop specific prevention programs for drug users.

Adolescent↗
PubMedDate not supplied

[The characteristics of opiate users seen in an emergency service].

INTRODUCTION: Despite of the fact that it was reported for years that emergency rooms are the first health services where drug users attend, there are very few direct studies of this population. In most emergency room studies, the information was obtained from data available in the clinical records, and in very few drug users were interviewed. With the aim of having a deeper knowledge of opiate users who attend the emergency room it was planned to carry out a cross-sectional study interviewing them. The aims of this paper are to describe demographic characteristics, patterns of drug use and to know whether they contact first to an emergency room or to a treatment centre. METHODS: The sample included all patients detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. A descriptive bivariate analysis with simple stratification was carried out. RESULTS: Of the subjects referred by the doctor 383 opiate users were interviewed and 76 were not interviewed. The male/female ratio for the 383 interviewed opiates users was 2. Women were younger than men (25.8 vs 28.3, p (3/4) 0.001). Heroin or cocaine ever injected was reported by 93% and 76% reported injecting in the last 30 days. The mean age at the first use of heroin was higher for those who started use during 1989 or after (21.6) than those who started before 1989 (17.9) (p (3/4) 0.0001). Patients attending the emergency room for organic pathology were older (28.5) than those who attended for withdrawal (26.2) and those who attended for overdose (27.3) (p (3/4) 0.05). Thirty eight percent reported to attend first an emergency room for a drug related problem since they started drug use, and 47% to contact first with a treatment centre for drug dependence. CONCLUSION: Drug users interviewed seem to be more heavy users than those who started drug treatment in the public centres of Barcelona in 1992. Also, the hypothesis that emergency rooms are for this population the first contact point with health services is not supported by this study.

Adult↗
PubMedDate not supplied

Drug information systems, early warning, and new drug trends: can drug monitoring systems become more sensitive to emerging trends in drug consumption?

Drug Information Systems (DIS) are called upon to provide an early warning of emerging trends in drug use. However, little theoretical attention is directed toward exploring conceptual issues in this area. In this paper a typology of existing DIS is offered. Among the features that distinguish DIS are their structure (human network or organization systems) and the range of information sources used. Indicators of drug use can be placed on a continuum of sensitivity ranging from leading edge indicators to lagged indicators. Sensitivity implies volatility as sensitive indicators also react to fluctuations that do not become trends. DIS conventionally are largely reliant upon lagged indicators. What is required are DIS that combine a critical information processing function with the ongoing systematic collection of data from a range of data sources.

Data Collection↗