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Allen, David. "Harm From Unadjusted Data?" Health Affairs 24, no. 4 (July 2005): 1181. http://dx.doi.org/10.1377/hlthaff.24.4.1181.
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Beynon, Caryl, David Bayliss, Jenny Mason, Kate Sweeney, Clare Perkins, and Clive Henn. "Alcohol-related harm to others in England: a cross-sectional analysis of national survey data." BMJ Open 9, no. 5 (May 2019): e021046. http://dx.doi.org/10.1136/bmjopen-2017-021046.
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ObjectivesTo estimate the prevalence, the frequency and the perpetrators of alcohol-related harm to others (AHTO) and identify factors associated with experiencing harm and aggressive harm.DesignCross-sectional survey.SettingEngland.ParticipantsAdults (general population) aged 16 and over.Outcome measuresPercentage of respondents who experienced harm. Socioeconomic and demographic factors associated with the outcomes. Outcomes were (1) experienced harm/did not experience harm and (2) experienced aggressive harm (physically threatened, physically hurt and forced/pressured into something sexual)/did not experience an aggressive harm (no aggressive harm plus no harm at all).ResultsData to support a response rate calculation were not collected; 96.3% of people surveyed completed the AHTO questions. The weighted sample was 4874; 20.1% (95% CI 18.9 to 21.4, N=980) reported experiencing harm in the previous 12 months and 4.6% (95% CI 4.0 to 5.4, N=225) reported experiencing an aggressive harm. Friends and strangers were the dominant perpetrators. Most harms (74.8%) occurred less than monthly. Factors associated with experiencing harm were: younger age (p<0.001), drinking harmfully/hazardously (p<0.001), white British (p<0.001 compared to other white groups and Asian groups and p=0.017 compared to black groups), having a disability (p<0.001), being educated (p<0.001 compared to no education) and living in private rented accommodation (p=0.004 compared with owned outright). Being in the family stage of life (defined as having children in the household) had significantly lower odds of harm (p=0.006 compared to being single), as did being retired (p<0.001 compared to being employed). Factors associated with experiencing an aggressive harm were similar.ConclusionsThis exploratory study, using data collected through the Alcohol Toolkit Survey, shows that AHTO affects 20.1% of the population of England. Even apparently minor harms, like being kept awake, can have a negative impact on health, while aggressive harms are clearly of concern. Using a standard methodology to measure harm across studies would be advantageous. Policies that focus on alcohol must take into consideration the impact of drinking on those other than the drinker.
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Curtis-Ham, Sophie, and Darren Walton. "The New Zealand Crime Harm Index: Quantifying Harm Using Sentencing Data." Policing: A Journal of Policy and Practice 12, no. 4 (August 23, 2017): 455–67. http://dx.doi.org/10.1093/police/pax050.
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Shepard, Benjamin. "Harm Reduction Outreach Services and Engagement of Chemically Dependent Homeless People Living with HIV/AIDS: An Analysis of Service Utilization Data to Evaluate Program Theory." Einstein Journal of Biology and Medicine 23, no. 1 (March 2, 2016): 26. http://dx.doi.org/10.23861/ejbm20072366.
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This study examines service utilization patterns among a socially vulnerable population of homeless people living with HIV/AIDS and who have a history of chemical dependence, as they are engaged through outreach services. CitiWide Harm Reduction collaborates with Montefiore Medical Center to connect homeless people with health care through harm reduction outreach and low threshold medical services. Analysis of two cohorts – individuals engaged through harm reduction outreach and individuals who “walk-in” to engage in services at CitiWide Harm Reduction’s drop-in center – assesses the program’s theory that outreach engagement is a mediating variable increasing service utilization. These results demonstrate that low-threshold harm reduction outreach, a brand of outreach designed to reduce barriers to services, does increase access to health care and related services for a socially vulnerable, traditionally “hard-to-reach,” population. Harm reduction outreach is a valuable intervention for increasing service utilization among this highly marginalized group.
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Frakt, Austin B., and Nicholas Bagley. "Protection or Harm? Suppressing Substance-Use Data." New England Journal of Medicine 372, no. 20 (May 14, 2015): 1879–81. http://dx.doi.org/10.1056/nejmp1501362.
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Rossow, Ingeborg, and Mats Ramstedt. "Challenges in Estimating Population Impacts of Alcohol's Harm to others." Nordic Studies on Alcohol and Drugs 33, no. 5-6 (December 2016): 503–13. http://dx.doi.org/10.1515/nsad-2016-0042.
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Background There is a renewed interest in alcohol's harm to others (AHTO), and survey studies in the general population are often used to estimate the extent of harm, to address the severity and variety of harms, and to identify the victims of such harm. While cross-sectional survey studies are attractive in several respects, they also entail several methodological challenges. Aim We discuss some of these issues, paying particular attention to the problems of causal attribution, transferability, survey data collection and range of harms. Conclusions We offer some suggestions for study design to enhance causal inferences from studies examining alcohol's harm to others.
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Hogan, Helen, Nora Cooke-O’Dowd, Kaushik Chattopadhyay, Jan van der Meulen, Christopher Sherlaw-Johnson, and Nick Black. "Observational study to determine the utility of hospital administrative data to support case finding of English patients at higher risk of severe healthcare-related harm." BMJ Open 9, no. 6 (June 2019): e025372. http://dx.doi.org/10.1136/bmjopen-2018-025372.
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ObjectivesTo identify ways of using routine hospital data to improve the efficiency of retrospective reviews of case records for identifying avoidable severe harmDesignDevelopment and testing of thresholds and criteria for two indirect indicators of healthcare-related harm (long length of stay (LOS) and emergency readmission) to determine the yield of specified harms coded in Hospital Episode Statistics (HES).SettingAcute National Health Service hospitals in England.ParticipantsHES for acute myocardial infarction (AMI), bowel cancer surgery and hip replacement admissions from 2014 to 2015.InterventionsCase-mix-adjusted linear regression models were used to determine expected LOS. Different thresholds were examined to determine the association with harm. Screening criteria for readmission included time to readmission, length of readmission and diagnoses in initial admission and readmission. The association with harm was examined for each criterion.ResultsThe proportions of AMI cases with a harm code increased from 14% among all cases to 47% if a threshold of three times the expected LOS was used. For hip replacement the respective increase was from 10% to 51%. However as the number of patients at these higher thresholds was small, the overall proportion of harm identified is relatively small (15%, 19%, 9% and 8% among AMI, urgent bowel surgery, elective bowel surgery and hip replacement cohorts, respectively). Selection of the time to readmission had an effect on the yield of harms but this varied with condition. At least 50% of surgical patients had a harm code if readmitted within 7 days compared with 21% of patients with AMI.ConclusionsOur approach would select a substantial number of patients for case record review. Many of these cases would contain no evidence of healthcare-related harm. In practice, Trusts may choose how many reviews it is feasible to do in advance and then select random samples of cases that satisfy the screening criteria.
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Borschmann, Rohan, Emma Thomas, Paul Moran, Megan Carroll, Ed Heffernan, Matthew J. Spittal, Georgina Sutherland, Rosa Alati, and Stuart A. Kinner. "Self-harm following release from prison: A prospective data linkage study." Australian & New Zealand Journal of Psychiatry 51, no. 3 (September 29, 2016): 250–59. http://dx.doi.org/10.1177/0004867416640090.
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Objective: Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison. Method: Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations. Results: During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]). Conclusion: Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.
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Treasure, Wilfrid. "First do no harm: data gathering and interpretation." British Journal of General Practice 62, no. 601 (August 2012): 430. http://dx.doi.org/10.3399/bjgp12x653679.
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Walji, M. F., A. Yansane, N. B. Hebballi, A. M. Ibarra-Noriega, K. K. Kookal, S. Tungare, K. Kent, et al. "Finding Dental Harm to Patients through Electronic Health Record–Based Triggers." JDR Clinical & Translational Research 5, no. 3 (December 10, 2019): 271–77. http://dx.doi.org/10.1177/2380084419892550.
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Background: Patients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs). Methods: We developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs. Results: Of the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room. Conclusion: By developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future. Knowledge Transfer Statement: A retrospective review of patients’ health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record–based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered.
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Seid, Abdu K., Ulrike Grittner, Thomas K. Greenfield, and Kim Bloomfield. "To Cause Harm and to be Harmed by Others: New Perspectives on Alcohol's Harms to Others." Substance Abuse: Research and Treatment 9s2 (January 2015): SART.S23506. http://dx.doi.org/10.4137/sart.s23506.
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Objective To examine how sociodemographic factors and alcohol consumption are related to a four-way typology of causing harm to others and/or being harmed by othersș and one's own drinking. Data and Methods Data from the 2011 Danish national survey ( n = 2,569) were analyzed with multinomial logistic regression. Results Younger age and heavy drinking were significant correlates of both causing harm and being harmed. Women and better educated respondents were more likely to report negative effects on relationship and family from another's drinking. Better educated respondents had higher risks for work, financial, or injury harms from another's drinking. Mean alcohol consumption and risky single occasion drinking were related to both causing harm and being harmed from one's own drinking. Conclusions Drinking variables were the strongest correlates of causing harm and being harmed. Efforts to reduce risky drinking may also help reduce exposures to collateral harm.
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Bibawy, Haidy, Anne Cossu, Kogan Sophia, and Richard M. Rosenfeld. "Harm and Adverse Events in Otolaryngology Journals." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P71—P72. http://dx.doi.org/10.1016/j.otohns.2008.05.230.
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Objective To identify the frequency and quality of harm and adverse events reporting in otolaryngology journals. Methods Four major otolaryngology journals from 2006 and 1996 were reviewed. Clinical research studies offering therapeutic recommendations were evaluated for frequency and quality of harm and adverse events reporting. Results Of 1835 total articles reviewed, 576 (31%) offered therapeutic recommendations. Only 65% provided any mention of harm or adverse events; 47% explicitly defined the events and 24% described methodology for collecting harm data. The median number of harms or adverse events reported was 3. Studies concluding a beneficial effect of therapy were more likely to not mention adverse events (odds ratio 2.99, p= 0.007), compared to studies concluding no benefit. Studies of surgical therapy were more likely to report harm or adverse events (odds ratio 1.46, p= 0.046) than medical therapy. Conclusions Harm and adverse events are under-reported and poorly described in otolaryngology journals, with about 1/3 of clinical research not mentioning adverse events at all. Most authors do not explicitly describe harm or adverse events (53%), or the methodology behind collecting adverse events data (76%). Under-reporting is more likely when a therapeutic effect is found to be beneficial.
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Lund, Ingunn Olea, and Anne Bukten. "Harm to Others from Substance Use and Abuse: The Underused Potential in Nationwide Registers." Substance Abuse: Research and Treatment 9s2 (January 2015): SART.S23545. http://dx.doi.org/10.4137/sart.s23545.
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This article considers the potential in using nationwide registers to study harm to others from substance use and abuse. The advantages of using registry data include the opportunity to include the data on the entire population nationwide and continuously updated longitudinal datasets; they allow for studying small subpopulations and have little missing data. Personal identification numbers and family numbers enable linkage of data from different registers. Such datasets can include extensive information on individual and family levels. In this article, we provide an introduction to nationwide registers and explain how they can be applied to investigate two types of third-party harms: harm to children and harm to partners/spouses from substance use and abuse in parents and partners/spouses. Finally, we discuss challenges, benefits, and ethical considerations regarding the use of such data.
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Moazed, Farzad, Lauren Chun, Michael A. Matthay, Carolyn S. Calfee, and Jeffrey Gotts. "Assessment of industry data on pulmonary and immunosuppressive effects of IQOS." Tobacco Control 27, Suppl 1 (August 29, 2018): s20—s25. http://dx.doi.org/10.1136/tobaccocontrol-2018-054296.
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IntroductionHeated tobacco products are being touted as novel reduced-harm tobacco products by tobacco companies. In the USA, Philip Morris International submitted a modified risk tobacco product (MRTP) application to the US Food and Drug Administration in 2016 in which it purports that its heated tobacco product, I-Quit-Ordinary-Smoking (IQOS), is associated with reduced harm compared with conventional cigarettes.MethodsWe reviewed Philip Morris International’s MRTP application to assess the pulmonary and immune toxicities associated with IQOS use in both animal and human studies.ResultsAmong rats exposed to IQOS, there was evidence of pulmonary inflammation and immunomodulation. In human users, there was no evidence of improvement in pulmonary inflammation or pulmonary function in cigarette smokers who were switched to IQOS.ConclusionIQOS is associated with significant pulmonary and immunomodulatory toxicities with no detectable differences between conventional cigarette smokers and those who were switched to IQOS in Philip Morris International’s studies. Philip Morris International also failed to consider how dual use and secondhand aerosol exposure may further impact, and likely increase, the harms associated with these products.
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Colasante, Emanuela, Francesco Fabi, Carla Rossi, Gianpaolo S. Tomba, and Sabrina Molinaro. "Updated Indicators to Evaluate Harmful Drug Use, in Particular, Poly-Drug Use." Current Drug Research Reviews 11, no. 1 (February 26, 2019): 51–57. http://dx.doi.org/10.2174/1874473711666180924155231.
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Background: Drug use indicators that are capable of measuring the individual levels of harm following drug use, and in particular, poly-drug use, have previously been proposed, based on individual drug and frequency of use data and expert rankings of harms related to various substances. These indicators allow the estimation of risk profiles for selected groups of individuals and comparisons, both over time and between populations. Recent advances regarding the ranking of drug use harms allow a refinement of these indicators, separating the effects on self and others. Objective: To define updated indicators and compare their performance to previous ones on datasets related to the Italian ESPAD longitudinal data. Methods: Two new scores, based respectively on the Harm to self and Harm to others substance scores, are defined. These scores follow the same logic as the previous poly-drug score (PDS), but now using the new Harm to self and Harm to others scores as weights, both in the individual calculations and in the calculation of the two normalizing factors. Results: The new harm-to-self drug use indicator is shown to correlate strongly with the previous poly-drug use indicator; and the Harm to others indicator, is introduced and commented upon. Using further ESPAD survey information related to personal behaviour, it is shown that high values of poly-drug use indicators are linked to specific behaviours related to interest in school, relationship with parents and use of leisure time. These results are consistent with previous analyses based on surveys among high school students in Italy.
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Murray Boyle, Cailem, Matthew Browne, Matthew Rockloff, and Tracy Flenady. "Opportunity Costs or Not? Validating the Short Gambling Harm Screen against a Set of “Unimpeachable” Negative Impacts." Journal of Clinical Medicine 10, no. 3 (February 2, 2021): 549. http://dx.doi.org/10.3390/jcm10030549.
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Assessing the harmful consequences of gambling is an area of active investigation. One measure intended to capture gambling-related harm is the 10-item short gambling harm screen (SGHS). Although good psychometric properties have been reported, it has been suggested that the screen’s less severe probes may not represent genuinely harmful consequences, but rather may reflect rational opportunity costs. Consequently, it has been argued that the screen may lead to overestimation of the extent of gambling-related harm in the population. The current study sought to examine the psychometric performance of three less severe suspect items in the SGHS. Associations between each of these items and a specially constructed scale of relatively severe “unimpeachable” gambling harms were calculated from archival data from 5551 Australian and New Zealand gamblers. All three suspect items, both individually and upon aggregation, predicted greater endorsement of “unimpeachable” harms, and indicated the presence of gambling problems. Moreover, the SGHS as a whole is highly correlated with “unimpeachable” gambling harms. Including suspect items in the SGHS was found to improve predictions of low- and moderate-risk gambling status, but slightly decreased predictions of severe gambling problems. The results are inconsistent with the notion that SGHS harm probes capture either inconsequential consequences or opportunity costs. They confirm prior findings that harm symptomatology is unidimensional, and that the report of multiple more prevalent, but less severe, harms serves as an effective indicator of the spectrum of experienced harm.
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Clements, Caroline, Keith Hawton, Galit Geulayov, Keith Waters, Jennifer Ness, Muzamal Rehman, Ellen Townsend, Louis Appleby, and Nav Kapur. "Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England." British Journal of Psychiatry 215, no. 04 (May 30, 2019): 600–607. http://dx.doi.org/10.1192/bjp.2019.90.
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BackgroundIn England suicide rates are highest in midlife (defined as age 40–59). Despite a strong link with suicide there has been little focus on self-harm in this age group.AimTo describe characteristics and treatment needs of people in midlife who present to hospital following self-harm.MethodData from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000–2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models.ResultsA quarter of self-harm presentations were made by people in midlife (n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02–1.12, P < 0.01), and were positively correlated with national suicide incidence rates (r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00–1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide.ConclusionSelf-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide.Declaration of interestK.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.
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Moan, Inger Synnøve, Elisabet E. Storvoll, Erica Sundin, Ingunn Olea Lund, Kim Bloomfield, Ann Hope, Mats Ramstedt, Petri Huhtanen, and Sveinbjörn Kristjánsson. "Experienced Harm from Other People's Drinking: A Comparison of Northern European Countries." Substance Abuse: Research and Treatment 9s2 (January 2015): SART.S23504. http://dx.doi.org/10.4137/sart.s23504.
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Objective This study addresses how experienced harm from other people's drinking varies between six Northern European countries by comparing 1) the prevalence of experienced harm and 2) the correlates of harm. Method The data comprise 18ȓ69-year olds who participated in general population surveys in Denmark, Finland, Iceland, Norway, Sweden, and Scotland during the period 2008–2013. Comparative data were available on five types of harm: physical abuse, damage of clothes/belongings, verbal abuse, being afraid, and being kept awake at night. Results This study shows that harms from other's drinking are commonly experienced in all six countries. Being kept awake at night is the most common harm, while being physically harmed is the least common. The proportions that reported at least one of the five problems were highest in Finland and Iceland and lowest in Norway, but also relatively low in Sweden. Across countries, the level of harm was highest among young, single, urban residents, and for some countries among women and those who frequently drank to intoxication themselves. Conclusions The study revealed large differences in the prevalence of harm in countries with fairly similar drinking cultures. However, the correlates of such experiences were similar across countries. Possible explanations of the findings are discussed, including differences in study design.
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Castrén, Sari, Kalle Lind, Heli Hagfors, and Anne H. Salonen. "Gambling-Related Harms for Affected Others: A Finnish Population-Based Survey." International Journal of Environmental Research and Public Health 18, no. 18 (September 10, 2021): 9564. http://dx.doi.org/10.3390/ijerph18189564.
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Aims This study explores the prevalence of being a past-year affected other (AO) of a problem gambler by gender. The aims were to study the amount and type of gambling-related harms (GRHs) for subgroups of AOs and to distinguish GRH profiles for AO subgroups. Methods A total of 7186 adults aged 18 years and over participated in the Gambling Harms Survey evaluating year 2016. The data were analyzed using descriptive statistics and binary logistic regression. Results Of all respondents, 12.9% were defined as past-year AOs (women 13.7%; men 12.1%). The proportion of affected non-family members (ANFs) was 8.4%, and 5.6% were affected family members (AFMs). AFMs were usually women, and ANFs were usually men. Emotional, relationship, and financial harms were the most common types of harm. The odds of experiencing financial harm were highest for the 18- to 34-year-olds (OR 1.82) and for those whose partner/ex-partner had a gambling problem (OR 3.91). Having a parent/step-parent (OR 1.93) and child/stepchild (OR 3.64) increased the odds of experiencing emotional harm, whereas male gender (OR 0.50) and being an ANF (OR 0.58) decreased emotional harm. Relationship harm was evident for partners/ex-partners (OR 1.97–5.07). Conclusions GRH profiles for AO subgroups varied, which emphasizes the need for effective harm minimization strategies for those in need.
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Ramstedt, Mats, Erica Sundin, Inger Synnøve Moan, Elisabet E. Storvoll, Ingunn Olea Lund, Kim Bloomfield, Ann Hope, Sveinbjörn Kristjánsson, and Christoffer Tigerstedt. "Harm Experienced from the Heavy Drinking of Family and Friends in the General Population: A Comparative Study of Six Northern European Countries." Substance Abuse: Research and Treatment 9s2 (January 2015): SART.S23746. http://dx.doi.org/10.4137/sart.s23746.
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Background Epidemiological research on alcohol-related harm has long given priority to studies on harm to the drinker. A limitation with this perspective is that it neglects the harm drinking causes to people around the drinker, and thus, it fails to give a full picture of alcohol-related harm in society. Aim The aim was to compare the prevalence and correlates of experiencing harm from the heavy drinking by family and friends across the Nordic countries and Scotland and to discuss whether potential differences match levels of drinking, prevalence of binge drinking, and alcohol-related mortality. Data and Method Data from recent national general population surveys with similar questions on experiences of harms from the drinking of family and friends were collected from Sweden, Finland, Denmark, Norway, Iceland, and Scotland. Results National estimates of the overall population prevalence of harm from the drinking of family and friends ranged from 14% to 28% across these countries, with the highest prevalence in Finland, Iceland, and Norway and lower estimates for Denmark, Sweden, and Scotland. Across all countries, the prevalence of harm from heavy drinking by family and friends was significantly higher among women and young respondents. Conclusion This study revealed large differences in the prevalence of harm across the study countries, as well as by gender and age, but the differences do not match the variation in population drinking and other indicators of harm. The implications of the findings for future research are discussed.
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Hulse, E. "Self-harm and poisoning data in rural Ugandan hospitals." Anaesthesia 72, no. 5 (April 12, 2017): 665. http://dx.doi.org/10.1111/anae.13882.
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Fischer, Jane Anne, Alexandra Marie Clavarino, and Jackob Moses Najman. "Drug, Sex and Age Differentials in the Use of Australian Publicly Funded Treatment Services." Substance Abuse: Research and Treatment 6 (January 2012): SART.S8561. http://dx.doi.org/10.4137/sart.s8561.
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Context Little is known about the proportion of the Australian population using alcohol or other drugs who may seek treatment. There is a need to have some additional estimates of population morbidity which reflect harms associated with use. Objective To determine Australian population rates of publicly funded community based specialised alcohol and other drug treatment and in-patient hospital care by those ‘at risk’, by drug type, sex and age. Design and setting The design is secondary data analysis of publicly available datasets. We use the latest available complete data on Australian general population incidence of alcohol, cannabis amphetamines and ecstasy use (2007 National Drug Strategy Household Survey) and nationally collected administrative data on publicly funded specialised alcohol and other drug treatment services (2006–2007 Alcohol and Other Drug Treatment Services National Minimum Dataset) and public hospitals (2006–2007 National Hospital Morbidity Minimum Dataset) to calculate rates of drug treatment and in-patient hospital care per 1000 Australians. ‘At risk’ for alcohol is defined as being at risk of short term harm, as defined by the National Health and Medical Research Council (2001). ‘At risk’ for illicit drugs is defined as those exposed to potential harm through at least weekly use of cannabis, amphetamines and ecstasy use. Results Risky alcohol consumption followed by recent cannabis use appears to lead to most harm. Greater harm seems to be experienced by males rather than females. Younger adults (15–19 years) and older adults (40+ years) seem also to experience the highest rates of harm. Conclusions It is possible to derive population estimates of harms associated with licit and illicit drugs use. Treatment rates vary across drug type, gender and age. Alcohol and cannabis are the substances whose use leads to the greatest demand for services. Ecstasy appears to generate few presentations for treatment. Publicly available data can be used to estimate harms associated with the use of particular substances. Such estimates are best interpreted in the light of other ways of estimating harms.
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Ozeran, Larry, Anthony Solomonides, and Richard Schreiber. "Privacy versus Convenience: A Historical Perspective, Analysis of Risks, and an Informatics Call to Action." Applied Clinical Informatics 12, no. 02 (March 2021): 274–84. http://dx.doi.org/10.1055/s-0041-1727197.
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Abstract Background The pace of technological change dwarfs the pace of social and policy change. This mismatch allows for individual harm from lack of recognition of changes in societal context. The value of privacy has not kept pace with changes in technology over time; individuals seem to discount how loss of privacy can lead to directed personal harm. Objective The authors examined individuals sharing personal data with mobile health applications (mHealth apps) and compared the current digital context to the historical context of harm. The authors make recommendations to informatics professionals to support consumers who wish to use mHealth apps in a manner that balances convenience with personal privacy to reduce the risk of harm. Methods A literature search focused by a historical perspective of risk of harm was performed throughout the development of this paper. Two case studies highlight questions a consumer might ask to assess the risk of harm posed by mobile health applications. Results A historical review provides the context for the collective human experience of harm. We then encapsulate current perceptions and views of privacy and list potential risks created by insufficient attention to privacy management. Discussion The results provide a historical context for individuals to view the risk of harm and shed light on potential emotional, reputational, economic, and physical harms that can result from naïve use of mHealth apps. We formulate implications for clinical informaticists. Conclusion Concepts of both harm and privacy have changed substantially over the past 20 years. Technology provides methods to invade privacy and cause harm unimaginable a few decades ago. Only recently have the consequences become clearer. The current regulatory framework is extremely limited. Given the risks of harm and limited awareness, we call upon informatics professionals to support more privacy education and protections and increase mHealth transparency about data usage.
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Clements, Caroline, Keith Hawton, Galit Geulayov, Keith Waters, Jennifer Ness, Muzamal Rehman, Ellen Townsend, Louis Appleby, and Nav Kapur. "Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England - ADDENDUM." British Journal of Psychiatry 216, no. 5 (November 27, 2019): 286. http://dx.doi.org/10.1192/bjp.2019.248.
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Chandler, Jennifer A., and Katherine Levitt. "Spatial Data Quality: The Duty to Warn Users of Risks Associated with Using Spatial Data." Alberta Law Review 49, no. 1 (July 1, 2011): 79. http://dx.doi.org/10.29173/alr127.
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This article discusses whether and when a private provider of spatial data may be liable to pay for damages resulting from physical injury that occurs due to reliance on erroneous spatial data. The existing case law supports the view that some courts will approach harm due to errors in spatial datasets that give rise to physical harm using principles applicable to defective products, while others regard these errors as negligent misrepresentation. This article analyzes the duty to warn and spatial data in two parts. First, it provides an overview of the general problem of spatial data quality and its growing importance in light of internet dissemination to the public. Second, it sketches out the basic rules in the three main subdivisions of Canadian product liability law (manufacturing defects, design defects, and failures to warn of risks associated with products) and applies them to the context of broadly disseminated spatial data.
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Steeg, S., R. Emsley, M. Carr, J. Cooper, and N. Kapur. "Routine hospital management of self-harm and risk of further self-harm: propensity score analysis using record-based cohort data." Psychological Medicine 48, no. 2 (June 22, 2017): 315–26. http://dx.doi.org/10.1017/s0033291717001702.
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BackgroundThe care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm.MethodObservational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months. Propensity score (PS) methods were used to address observed confounding. Missing data were imputed using multiple imputation.ResultsFollowing PS stratification, those who received a psychosocial assessment had a lower risk of repeat hospital attendance for self-harm than those who were not assessed [RR 0.87, 95% confidence interval (CI) 0.80–0.95]. The risk was reduced most among people less likely to be assessed. Following PS matching, we found no associations between risks of repeat self-harm and admission to a medical bed, referral to outpatient psychiatry or admission to a psychiatric bed. We did not find a relationship between psychosocial assessment and repeat self-harm in the 31 centre cohort.ConclusionsThis study shows the potential value of using novel statistical techniques in large mental health datasets to estimate treatment effects. We found that specialist psychosocial assessment may reduce the risk of repeat self-harm. This type of routine care should be provided for all individuals who present to hospital after self-harm, regardless of perceived risk.
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Gates, Allison, Patrina Caldwell, Sarah Curtis, Leonila Dans, Ricardo M. Fernandes, Lisa Hartling, Lauren E. Kelly, et al. "Reporting of data monitoring committees and adverse events in paediatric trials: a descriptive analysis." BMJ Paediatrics Open 3, no. 1 (March 2019): e000426. http://dx.doi.org/10.1136/bmjpo-2018-000426.
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ObjectivesFor 300 paediatric trials, we evaluated the reporting of: a data monitoring committee (DMC); interim analyses, stopping rules and early stopping; and adverse events and harm-related endpoints.MethodsFor this cross-sectional evaluation, we randomly selected 300 paediatric trials published in 2012 from the Cochrane Central Register of Controlled Trials. We collected data on the reporting of a DMC; interim analyses, stopping rules and early stopping; and adverse events and harm-related endpoints. We reported the findings descriptively and stratified by trial characteristics.ResultsEighty-five (28%) of the trials investigated drugs, and 18% (n=55/300) reported a DMC. The reporting of a DMC was more common among multicentre than single centre trials (n=41/132, 31% vs n=14/139, 10%, p<0.001) and industry-sponsored trials compared with those sponsored by other sources (n=16/50, 32% vs n=39/250, 16%, p=0.009). Trials that reported a DMC enrolled more participants than those that did not (median [range]): 224 (10–60480) vs 91 (10–9528) (p<0.001). Only 25% of these trials reported interim analyses, and 42% reported stopping rules. Less than half (n=143/300, 48%) of trials reported on adverse events, and 72% (n=215/300) reported on harm-related endpoints. Trials that reported a DMC compared with those that did not were more likely to report adverse events (n=43/55, 78% vs 100/245, 41%, p<0.001) and harm-related endpoints (n=52/55, 95% vs. 163/245, 67%, p<0.001). Only 32% of drug trials reported a DMC; 18% and 19% did not report on adverse events or harm-related endpoints, respectively.ConclusionsThe reporting of a DMC was infrequent, even among drug trials. Few trials reported stopping rules or interim analyses. Reporting of adverse events and harm-related endpoints was suboptimal.
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Yates, F. E. "IT Colum: A harm reduction programme for drug data users." Journal of Substance Misuse 2, no. 1 (January 1997): 3–4. http://dx.doi.org/10.3109/14659899709084608.
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Dolgin, Elie. "New data protection rules could harm research, science groups say." Nature Medicine 20, no. 3 (March 2014): 224. http://dx.doi.org/10.1038/nm0314-224b.
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Sandroni, Alvaro. "At Least Do No Harm: The Use of Scarce Data." American Economic Journal: Microeconomics 6, no. 1 (February 1, 2014): 1–4. http://dx.doi.org/10.1257/mic.6.1.1.
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When data is scarce, it is difficult to screen the opinions of informed and uninformed experts. In spite of this difficulty it is possible to deliver incentives for informed experts to honestly reveal their views, and for uninformed experts to do no harm to a principal in the sense that uninformed experts report the view the principal held originally (i.e., without the expert's report). This follows even if there is only a single data point to evaluate the expert's opinions and the expert's preferences over risk are unknown. (JEL D82, D86)
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Laslett, Anne-Marie, and Robin Room. "Using Registry Data to Better Understand Alcohol's Harm to Others." Journal of Studies on Alcohol and Drugs 82, no. 4 (July 2021): 457–59. http://dx.doi.org/10.15288/jsad.2021.82.457.
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Képeš, Erik, Pavel Pořízka, Jakub Klus, Pavlína Modlitbová, and Jozef Kaiser. "Influence of baseline subtraction on laser-induced breakdown spectroscopic data." Journal of Analytical Atomic Spectrometry 33, no. 12 (2018): 2107–15. http://dx.doi.org/10.1039/c8ja00209f.
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de Cates, Angharad N., Gennaro Catone, Paul Bebbington, and Matthew R. Broome. "Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data." International Journal of Social Psychiatry 65, no. 2 (February 18, 2019): 114–22. http://dx.doi.org/10.1177/0020764019827986.
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Background: Impulsivity may be an important risk factor in terms of future self-harm. However, the extent of this, whether it may relate to self-harm that is new in onset and/or repetition of self-harm, and the detail of any interaction with mood instability (MI) and childhood sexual abuse (CSA) requires detailed examination. Aims: We used the 2000 Adult Psychiatry Morbidity Survey and an 18-month follow-up data to test hypotheses relating to the role of impulsivity, CSA and MI in the inception and persistence of self-harm. Methods: We assessed associations of impulsivity with (1) suicidal self-harm (SSH) and (2) non-SSH (NSSH) at baseline and follow-up, controlling for confounders including MI. Finally, we tested whether impulsivity mediated the relationship between CSA and self-harm. Results: A total of 8,580 respondents were assessed at baseline and 2,406 at follow-up as planned. Impulsivity significantly predicted emergence of new NSSH at 18-month follow-up even after adjustment for MI and other confounders. Impulsivity did not significantly predict repetition of NSSH, or repetition or new inception of SSH, even before inclusion of MI in the model. However, the absolute numbers involved were small. Cross-sectionally, impulsivity was a stronger mediator of the link between CSA and SSH (13.1%) than that between CSA and NSSH (4.8%). Conclusion: Impulsivity may increase the risk of future development of NSSH independently of MI, which is clinically important for risk assessment. The involvement of impulsivity in the repetition of self-harm generally appears less certain. However, impulsivity may have a role in SSH in the context of previous CSA.
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Feusner, Jamie D., Reza Mohideen, Stephen Smith, Ilyas Patanam, Anil Vaitla, Christopher Lam, Michelle Massi, and Alex Leow. "Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics Study." Journal of Medical Internet Research 23, no. 6 (June 21, 2021): e25482. http://dx.doi.org/10.2196/25482.
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Background Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers’ previous conceptualizations of OCD. Objective In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings. Methods We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words. Results We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster. Conclusions The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research.
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Freisthler, Bridget, Jennifer Price Wolf, Ashleigh I. Hodge, and Yiwen Cao. "Alcohol Use and Harm to Children by Parents and Other Adults." Child Maltreatment 25, no. 3 (October 8, 2019): 277–88. http://dx.doi.org/10.1177/1077559519878514.
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This study used mixed methods to examine parent-reported harm to children (lack of supervision or physical harm) due to alcohol use by themselves or someone else as well as parent beliefs about alcohol, parenting, and harms to children. We conducted a cross-sectional general population survey of 1,599 parents who were primary caregivers to a child aged 10 or younger and follow-up interviews with 23 parents who responded “yes” to one of the questions about alcohol use causing harm their child. Survey data were analyzed using multilevel logistic models. Compared to abstainers, parents who drank at least once a year were less likely to report that someone else’s drinking caused a lack of supervision or physical harm to their child. Higher continued volumes of drinking were related to fewer reports of not watching a child closely enough. Social companionship support (having people to go out with) was related to greater odds that a parent’s drinking would cause physical harm to his or her child(ren). In the qualitative analysis, four relevant themes emerged: perceived effects of alcohol use, tangible support and child supervision, immediate and distal harm, and turning points in drinking behaviors.
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Cloninger, C. Robert, Thomas R. Przybeck, and Dragan M. Svrakic. "The Tridimensional Personality Questionnaire: U.S. Normative Data." Psychological Reports 69, no. 3 (December 1991): 1047–57. http://dx.doi.org/10.2466/pr0.1991.69.3.1047.
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The Tridimensional Personality Questionnaire is a self-report personality inventory measuring three major personality dimensions: Novelty Seeking, Harm Avoidance, and Reward Dependence. Normative data, based on a U.S. national probability sample of 1,019 adults, are presented and the psychometric properties of the questionnaire are discussed.
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Zakiullah, Nida, Sadia Saleem, Sameea Sadiq, Nadia Sani, Munira Shahpurwala, Afroz Shamim, Atif Yousuf, Murad M. Khan, and Parvez Nayani. "Deliberate Self-Harm." Crisis 29, no. 1 (January 2008): 32–37. http://dx.doi.org/10.1027/0227-5910.29.1.32.
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Abstract. Introduction: Previous deliberate self-harm (DSH) is the strongest predictor of suicide. Although several studies exist in other countries, characteristics of DSH have not been well-studied in Pakistan. Aims: To identify characteristics of deliberate self-harm in a hospital population, building on previous work carried out on this subject at this center. Methods: 284 cases admitted to the Aga Khan University Hospital, Karachi, between January 1997 and August 2003 were studied by analyzing medical records. Information was collected regarding demographics, family history, personal history, suicidal ideation, current stressors, the act of DSH and its management. Results: The most common age group was 21-25 years of age. The majority were females (60.3%). 95.1% of patients used self-poisoning as a method of deliberate self-harm. 47.3% used benzodiazepines for self-poisoning. Precipitating factors included conflict with family, marital problems, chronic illnesses, and unemployment. Comorbid psychiatric disorders were present in 76.4% patients. Discussion: Despite the difference in socio-cultural background of our patients, many of our results were found to be consistent with Western data. Our findings suggest that problem-solving therapy, stress management and improved mental health care may be effective interventions in preventing DSH. Prescription of medications should be regulated. Further studies are suggested at the community level.
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Penn, Rebecca Ann, Carol Strike, and Sabin Mukkath. "Building recovery capital through peer harm reduction work." Drugs and Alcohol Today 16, no. 1 (March 7, 2016): 84–94. http://dx.doi.org/10.1108/dat-08-2015-0039.
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Purpose – Peer harm reduction programmes engage service users in service delivery and may help peers to develop employment skills, better health, greater stability, and new goals. Thus far, peer work has not been discussed as an intervention to promote recovery. The purpose of this paper is to provide findings related to two research questions: first,do low-threshold employment programmes have the potential to contribute to positive recovery capital, and if so, how? Second, how are such programmes designed and what challenges do they face in supporting the recovery process? Design/methodology/approach – Using a community-based research approach, data were collected at a Toronto, Canada community health centre using in-depth interviews with peer workers (n=5), staff (n=5), and programme clients (n=4) and two focus groups with peer workers (n=12). A thematic analysis was undertaken to describe the programme model and to explore the mechanisms by which participation contributes to the development of recovery capital. Findings – The design of the Regent Park Community Health Centre peer work model demonstrates how opportunities for participation in community activities may spark cumulative growth in positive recovery capital within the community of PUDs. However, the recovery contagion of peer work may lose momentum with insufficient opportunities for new and experienced peer workers. Originality/value – Using the concept of recovery capital, the authors demonstrate how low-threshold employment interventions have the potential to contribute to the development of positive recovery capital.
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Owens, Christabel, Lorraine Hansford, Siobhan Sharkey, and Tamsin Ford. "Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data." British Journal of Psychiatry 208, no. 3 (March 2016): 286–91. http://dx.doi.org/10.1192/bjp.bp.113.141242.
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BackgroundPresentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood.AimsTo examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter.MethodSecondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16–25 with experience of self-harm.ResultsParticipants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received ‘treatment as usual’, i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle.ConclusionsThe clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.
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Polling, C., Ioannis Bakolis, Matthew Hotopf, and Stephani L. Hatch. "Differences in hospital admissions practices following self-harm and their influence on population-level comparisons of self-harm rates in South London: an observational study." BMJ Open 9, no. 10 (October 2019): e032906. http://dx.doi.org/10.1136/bmjopen-2019-032906.
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ObjectivesTo compare the proportions of emergency department (ED) attendances following self-harm that result in admission between hospitals, examine whether differences are explained by severity of harm and examine the impact on spatial variation in self-harm rates of using ED attendance data versus admissions data.SettingA dataset of ED attendances and admissions with self-harm to four hospitals in South East London, 2009–2016 was created using linked electronic patient record data and administrative Hospital Episode Statistics.DesignProportions admitted following ED attendance and length of stay were compared. Variation and spatial patterning of age and sex standardised, spatially smoothed, self-harm rates by small area using attendance and admission data were compared and the association with distance travelled to hospital tested.ResultsThere were 20 750 ED attendances with self-harm, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30 to 2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours (54% of all admissions at highest admitting hospital vs 35% at lowest). A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm. This was not altered when distance travelled to hospital was adjusted for.ConclusionsHospitals vary substantially in likelihood of admission after ED presentation with self-harm and this is likely due to the differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data could exacerbate existing health inequalities in inner-city areas where these data may underestimate rates relative to other areas.
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Rossow, Ingeborg. "How Well Do Survey Studies Capture Alcohol's Harm to Others?" Substance Abuse: Research and Treatment 9s2 (January 2015): SART.S23503. http://dx.doi.org/10.4137/sart.s23503.
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Empirical studies assessing alcohol's harm to others very often rely on population survey data. This study addresses some of the problems and challenges in using survey data for this purpose. Such problems include the limited capacity of population surveys in identifying infrequent harm and long-term consequences of drinking. Moreover, the drinker may report the alcohol-related harm or the person being harmed may report the damage. However, irrespective of who reports the harm, causal attribution to drinking is problematic. Challenges for future population surveys to address alcohol's harm to others include the need for improved models and understanding of complex mechanisms to guide empirical studies within the broad range of harm. Study designs other than cross-sectional surveys, such as longitudinal study designs and combinations of population surveys and other data sources, are likely to overcome some of the identified problems in current population surveys of alcohol's harm to others.
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Wright-Hughes, Alexandra, Elizabeth Graham, David Cottrell, and Amanda Farrin. "Routine hospital data – is it good enough for trials? An example using England’s Hospital Episode Statistics in the SHIFT trial of Family Therapy vs. Treatment as Usual in adolescents following self-harm." Clinical Trials 15, no. 2 (March 2, 2018): 197–206. http://dx.doi.org/10.1177/1740774517751381.
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Background: Use of routine data sources within clinical research is increasing and is endorsed by the National Institute for Health Research to increase trial efficiencies; however there is limited evidence for its use in clinical trials, especially in relation to self-harm. One source of routine data, Hospital Episode Statistics, is collated and distributed by NHS Digital and contains details of admissions, outpatient, and Accident and Emergency attendances provided periodically by English National Health Service hospitals. We explored the reliability and accuracy of Hospital Episode Statistics, compared to data collected directly from hospital records, to assess whether it would provide complete, accurate, and reliable means of acquiring hospital attendances for self-harm – the primary outcome for the SHIFT (Self-Harm Intervention: Family Therapy) trial evaluating Family Therapy for adolescents following self-harm. Methods: Participant identifiers were linked to Hospital Episode Statistics Accident and Emergency, and Admissions data, and episodes combined to describe participants’ complete hospital attendance. Attendance data were initially compared to data previously gathered by trial researchers from pre-identified hospitals. Final comparison was conducted of subsequent attendances collected through Hospital Episode Statistics and researcher follow-up. Consideration was given to linkage rates; number and proportion of attendances retrieved; reliability of Accident and Emergency, and Admissions data; percentage of self-harm episodes recorded and coded appropriately; and percentage of required data items retrieved. Results: Participants were first linked to Hospital Episode Statistics with an acceptable match rate of 95%, identifying a total of 341 complete hospital attendances, compared to 139 reported by the researchers at the time. More than double the proportion of Hospital Episode Statistics Accident and Emergency episodes could not be classified in relation to self-harm (75%) compared to 34.9% of admitted episodes, and of overall attendances, 18% were classified as self-harm related and 20% not related, while ambiguity or insufficient information meant 62% were unclassified. Of 39 self-harm-related attendances reported by the researchers, Hospital Episode Statistics identified 24 (62%) as self-harm related while 15 (38%) were unclassified. Based on final data received, 1490 complete hospital attendances were identified and comparison to researcher follow-up found Hospital Episode Statistics underestimated the number of self-harm attendances by 37.2% (95% confidence interval 32.6%–41.9%). Conclusion: Advantages of routine data collection via NHS Digital included the acquisition of more comprehensive and timely trial outcome data, identifying more than double the number of hospital attendances than researchers. Disadvantages included ambiguity in the classification of self-harm relatedness. Our resulting primary outcome data collection strategy used routine data to identify hospital attendances supplemented by targeted researcher data collection for attendances requiring further self-harm classification.
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Wright-Hughes, Alexandra, Rebecca Walwyn, Judy M. Wright, Amanda Farrin, Peter Fonagy, Dennis Ougrin, Daniel Stahl, and David Cottrell. "Reducing Self-harm in Adolescents. An individual participant data meta-analysis (RISA-IPD): systematic review protocol." BMJ Open 11, no. 5 (May 2021): e049255. http://dx.doi.org/10.1136/bmjopen-2021-049255.
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IntroductionUp to 10% of adolescents report self-harm in the previous year. Non-fatal repetition is common (18% in 1 year), death from any cause shows a fourfold and suicide a 10-fold excess. Despite the scale of the problem, there is insufficient evidence for effective interventions for self-harm. Those who self-harm do so for a variety of different reasons. Different treatments may be more effective for subgroups of adolescents; however, little is known about which subgroups are appropriate for further study. This protocol outlines a systematic review and individual participant data meta-analysis (IPD-MA) to identify subgroups of adolescents for which therapeutic interventions for self-harm show some evidence of benefit.Methods and analysisA systematic literature search was conducted in August 2019 (including Cochrane Library, Embase, trial registers and other databases). An update search is planned. Study selection will identify randomised controlled trials examining interventions to reduce self-harm in adolescents who have self-harmed and presented to services. Identified research teams will be invited to contribute data and form a collaborative group. Two-stage IPD-MA will be used to evaluate effectiveness of different therapeutic interventions compared with any active or non-active control on repetition of self-harm, general psychopathology, depression, suicidal ideation, quality of life and death. Subgroup analyses will identify adolescent subgroups in whom different therapeutic interventions may be more effective. Meta-regression will explore moderating study and intervention effects. Sensitivity analyses will incorporate aggregate data from studies lacking IPD and test the robustness of results to methods for handling missing data, within-study clustering, non-adherence and study quality.Ethics and disseminationEthical approval is provided by the University of Leeds, Faculty of Medicine and Health Ethics Committee (18-098). Outcomes will inform research recommendations and will be disseminated internationally through the collaborative group, a service user advisory group, open-access peer-reviewed publication and conference presentations.PROSPERO registration numberCRD42019152119.
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Room, Robin, Anne-Marie Laslett, and Heng Jiang. "Conceptual and Methodological Issues in Studying Alcohol's Harm to Others1." Nordic Studies on Alcohol and Drugs 33, no. 5-6 (December 2016): 455–78. http://dx.doi.org/10.1515/nsad-2016-0038.
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While there is a longer history of concern about alcohol's harm to others, researchers' interest has intensified in the last few years. The background of variation in concern over time in different societies is outlined. Three main traditions of research have emerged: population survey studies of such harm from the perspective of the ‘other’; analysis of register or case-record data which includes information on the involvement of another's drinking in the case; and qualitative studies of interactions and experiences involved in particular harms from others' drinking. In the course of the new spate of studies, many conceptual and methodological issues have arisen, some of which are considered in the paper. The diverse types of harms which have been studied are discussed. The social and personal nature of many of the harms means they do not ft easily into a disability or costing model, raising questions about how they might best be counted and aggregated. Harm from others' drinking is inherently interactional, and subject to varying definitions of what counts as harm. The attribution to drinking, in the usual situation of conditional causation, is also subject to variation, with moral politics potentially coming into play. For measurement and comparison, account needs to be taken of cultural and individual variations in perceptions and thresholds of what counts as a harm, and attribution to alcohol. The view from the windows of a population survey and of a response agency case register are often starkly different, and research is needed, as an input and spur to policy initiatives, on what influences this difference and whether and how the views might be reconciled.
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Stockwell, Tim, Cecilia Benoit, Kiffer Card, and Adam Sherk. "Problematic substance use or problematic substance use policies?" Health Promotion and Chronic Disease Prevention in Canada 40, no. 5/6 (June 2020): 135–42. http://dx.doi.org/10.24095/hpcdp.40.5/6.01.
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This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.
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Obeidat, Nour A., Mai Al-Hadid, Asma A. Hatoqai, Rawan A. Shihab, and Feras I. Hawari. "Reclaiming the value of pictorial health warning labels in Jordan." Tobacco Control 27, no. 5 (August 28, 2017): 589–91. http://dx.doi.org/10.1136/tobaccocontrol-2017-053679.
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BackgroundIn Jordan, four non-graphic pictorial health warning labels (PHWLs) concerning a limited selection of tobacco-caused harms have been used since 2011; however, research suggests that they may be ineffective.ObjectivesTo explore Jordanian smokers’ reactions to novel PHWLs featuring various health themes and/or graphic and symbolic imagery and to discuss existing PHWLs in light of the novel PHWLs.MethodsWe conducted 14 focus groups (FGs) with smokers who assessed 12 novel PHWLs and commented on four existing PHWLs. Data were analysed using an inductive approach.ResultsSix themes emerged from the FG discussions: understanding the overall meaning of PHWLs, the impact of graphic images, magnitude and controllability of harm, personal or vicarious experiences, the futility of quitting and fatalism. PHWLs depicting graphic respiratory and oral tobacco-caused harms resonated with most smokers. Smokers also sought direct, harm-specific taglines when trying to understand the overall PHWL. Some smokers viewed the PHWLs as exaggerated, and while the majority acknowledged that smoking was harmful, they felt that PHWLs would not accomplish their goal of inducing quitting.ConclusionsOur findings support the use of graphic imagery to communicate tobacco-caused harms (particularly respiratory ones) and the use of specific taglines explaining the mechanism of harm depicted.
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Vandenbroucke, J. P. "Balancing benefits and harms in health care: Observational data on harm should complement systematic reviews of benefit." BMJ 327, no. 7417 (September 27, 2003): 750—a—750. http://dx.doi.org/10.1136/bmj.327.7417.750-a.
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Jefferson, T. "Balancing benefits and harms in health care: Observational data on harm are already included in systematic reviews." BMJ 327, no. 7417 (September 27, 2003): 750—b—750. http://dx.doi.org/10.1136/bmj.327.7417.750-b.
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Crawford, Mike J., Olivia Thomas, Nusrat Khan, and Elena Kulinskaya. "Psychosocial interventions following self-harm." British Journal of Psychiatry 190, no. 1 (January 2007): 11–17. http://dx.doi.org/10.1192/bjp.bp.106.025437.
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BackgroundWith almost a million people dying by suicide worldwide each year, reducing the rate of suicidal behaviour is a priority in many countries.AimsTo examine whether additional psychosocial interventions following an episode of self-harm reduce the likelihood of subsequent suicide.MethodWe conducted a systematic review and meta-analysis of data from randomised controlled trials of interventions for people following self-harm. Likelihood of suicide was compared by calculating the pooled root difference in suicide rate with 95% confidence intervals.ResultsWe obtained suicide data from 18 studies with a total population of 3918. Eighteen suicides occurred among people offered active treatment and 19 among those offered standard care (pooled root difference in suicide rate 0.0, 95% CI – 0.03 to 0.03). The overall rate of suicide among people participating in trials was similar to that reported in observational studies of people who self-harm.ConclusionsResults of this meta-analysis do not provide evidence that additional psychosocial interventions following self-harm have a marked effect on the likelihood of subsequent suicide.
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Graham, John W., Melinda M. Roberts, James W. Tatterson, and Sara E. Johnston. "Data Quality in Evaluation of an Alcohol-Related Harm Prevention Program." Evaluation Review 26, no. 2 (April 2002): 147–89. http://dx.doi.org/10.1177/0193841x02026002002.
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