Prevention and management of problems related to alcohol abuse in Papua New Guinea through primary health care

This study is designed to answer three questions: 1) What is the situation in Papua New Guinea today with respect of the use and abuse of alcohol? 2) What are the existing programmes for the prevention and management of problems related to alcohol abuse in PNG? 3) Are the existing programmes of prevention and management integrated into the primary health care system or do they operate separately? The instrument for the study is a questionnaire which was adapted and modified from a World Health Organization sponsored workshop on prevention and management of alcohol and drug abuse problems in Africa held in September 1985 in Lagos. The questionnaires were administered to two groups of Papua New Guineans. The first group comprised community and religious leaders attending a workshop on alcohol education held in Lae in February 1988. The second group consisted of mental health nurses and general nurses working in the capitals of the nineteen provinces and the National Capital District of PNG. The questionnaires were administered to the second group personally or by post. The completed questionnaires were statistically analyzed and form the basis of this article. Legal drinking of alcohol for all mature Papua New Guineans started in 1962 when the law on prohibition was repealed. 'In the twenty years since drinking of alcoholic beverages by everyone of legal majority was allowed in Papua New Guinea, a rather clear-cut national style of alcohol use has developed. This style, if continued, points in a disturbing direction. It will lead to a number of serious problems that can be predicted with assurance because they have occurred in many other parts of the world where similar drinking styles exist.'     

A comparative study of alcohol-related problems among a group of university students and a group of clerks in the National Capital District, Papua New Guinea.

This article reports a comparative study of alcohol-related problems in two groups of Papua New Guinean youth. The first group consists of 25 undergraduate students of the University of Papua New Guinea. The second group consists of 25 staff members of the Post and Telecommunications Corporation (PTC). The research subjects in both groups were selected at random. The instrument used for the study is the Brief (10 item questions) Michigan Alcoholism Screening Test (MAST). Demographic data including age, sex, educational status, marital status and province of origin were also collected using a purpose designed questionnaire. The data collected were analyzed and compared between the two groups using chi-square statistical analysis. The findings and results point to the following conclusions: (a) Alcohol-related problems are more common among the clerks than among the students, but the differences are not statistically significant; (b) alcohol-related health problems (medical and neuropsychiatric complications) were not reported in the study sample; and (c) further surveys on larger samples using the Brief MAST were recommended for early detection of alcohol-related problems. The results could form a basis for future alcohol education programmes.     

Malaria in Papua New Guinea. Implications for the British Army

Malaria poses the greatest health threat to British soldiers engaged in jungle training in Papua New Guinea. This paper provides detailed epidemiological information gained following a visit to the Papua New Guinea Malaria Research Unit in January 1986.     

Polyresistant malaria in Gurkha soldiers returning from Papua New Guinea: treatment and prevention

Two company strength exercises to Papua New Guinea produced 21 malaria casualties of whom 16 had potentially fatal falciparum infections. The chemotherapy and prevention of polyresistant malaria from Papua New Guinea and the threat posed to the Hong Kong environment regarding malaria re-introduction are discussed.     

Malaria chemoprophylaxis with a proguanil-chloroquine-maloprim combination in Papua New Guinea

Proguanil 200mg daily and chloroquine base 300mg weekly along with maloprim 1 tablet weekly was used as malaria chemoprophylaxis for 140 Hong Kong based soliders on a seven-week jungle exercise in a holoendemic malarial area of Papua New Guinea. On return from exercise all personnel were treated with primaquine 7.5mg three times daily for a two week period. One solider developed P. falciparum on the exercise whilst taking chemoprophylaxis and four subsequently developed P. vivax malaria after cessation of chemoprophylaxis.     

Factors contributing to low participation in mammography screening in Papua New Guinea

AimThe aim of this paper is to describe the current state of mammography screening services in Papua New Guinea (PNG) and to document factors thought to contribute to low participation in the free mammography screening service at the Pacific International Hospital (PIH), Port Moresby.MethodWomen attending for mammography screening at PIH between August 2006 and July 2010 were invited to complete a survey investigating environmental, political, social, financial, cultural and health factors thought to be contributing to low participation in the mammography screening service.Ethics approval and permission to collect data was granted through the University of Papua New Guinea, School of Medicine and Health Sciences Research and Ethics Committee and by the Medical Director and Chief Operating Officer of PIH.ResultsThe reasons for low participation were found to be multifactorial; difficult environmental factors 42.86%; financial dependency factors 40.54%; cultural factors related to exposing the body 50.03%, social factors (sexual harassment) 77.6%, political factors 4.29% and health factors including poor health 54.54%.ConclusionThe study demonstrated that in this snapshot of PNG women, the low participation rate in the free mammography screening program at PIH was influenced by various interrelated factors inherent in both the PNG environment and culture, in particular lack of transport infrastructure, financial burden and sexual harassment. As low participation directly impacts upon the high breast cancer mortality in PNG women, a more comprehensive study of the women of PNG is required to validate this research.     

Concentrations of drugs determined in blood samples collected from suspected drugged drivers in England and Wales

This communication reports the blood concentrations of alcohol and drugs from 376 cases of alleged driving under the influence of drugs analysed at the Forensic Science Service Chorley and London laboratories between February 2010 and March 2011. The samples were analysed for alcohol, amphetamine, benzodiazepines, cocaine, MDMA, opiates, γ-hydroxybutyrate (GHB), ketamine, methadone and methylmethcathinone (the 4-isomer of which is known as mephedrone). The results were interpreted with respect to the number and type of drugs of abuse detected and the concentrations measured. Alcohol was quantified in 113 cases (30%), and of these a level in excess of the prescribed UK limit for driving of 80 mg% was present in 90 cases. In 80 cases, only the concentration of alcohol was measured, the concentrations of both drugs and alcohol were measured in 33 cases. In the remaining 263 cases, only the concentrations of relevant drugs of abuse were measured. The most common drug of abuse quantified was cocaine which was detected in 92 cases, either as the active drug or as its major metabolite benzoylecgonine, followed by diazepam which was quantified in 76 cases. Concentrations of some new drugs, and drugs rarely reported in driving under the influence cases are also presented.     

Homicide mechanisms,weapon types and causes of death in the autopsy material of the Department of Forensic Medicine Medical University of Gdańsk Poland in the years 2010–2019

The study objective was the analysis of homicides based on reports of 107 medicolegal autopsies of victims, which were carried out in 2010–2019 at the Department of Forensic Medicine of the Medical University of Gdańsk, Poland. The study focused on the analysis of homicide mechanisms, on the weapon type, injuries characteristics, and both pathomechanisms and causes of death. Alcohol and illicit drugs abuse, which is a predisposing factor, was also assessed. In the analysed cohort, 70.1% were males and 29.9% females. The most frequently used weapon was a blunt instrument (accounting for 47.7% of homicides), while the least common was a firearm (accounting for 4.7% of homicides). There were significant differences in homicide mechanisms related to victims’ gender. In males, blunt or sharp instruments predominated, while in females violent suffocation and chop injuries were more frequent. Fatal head injuries and their consequences predominated in the pathomechanisms of death (32.7% of cases). It was shown that the highest blood alcohol concentration (BAC) was found in homicides due to violent strangulation and sharp instrument use, while the lowest BAC was found in gunshot victims. Toxicological tests were performed in 18 cases and in 7 cases showed positive results for illicit drugs. The analysis of various elements involved in homicide may contribute to a conceptual framework for preventive measures aiming at the reduction of homicides number.     

Positron emission tomography and single-photon emission computed tomography in substance abuse research

Many advances in the conceptualization of addiction as a disease of the brain have come from the application of imaging technologies directly in the human drug abuser. New knowledge has been driven by advances in radiotracer design and chemistry and positron emission tomography (PET) and single-photon emission computed tomography (SPECT) instrumentation and the integration of these scientific tools with the tools of biochemistry, pharmacology, and medicine. This topic cuts across the medical specialties of neurology, psychiatry, oncology, and cardiology because of the high medical, social, and economic toll that drugs of abuse, including the legal drugs, cigarettes and alcohol, take on society. This article highlights recent advances in the use of PET and SPECT imaging to measure the pharmacokinetic and pharmacodynamic effects of drugs of abuse on the human brain.     

A historical look at alcohol abuse trends in army and civilian populations, 1980-1995

OBJECTIVES: The purpose of this study was to compare civilian and Army alcohol-related hospitalization trends and to plot temporal changes in rates relative to alcohol-related legislation and social policies. METHOD: We compared population-based civilian and Army annual hospitalization rates for overall alcohol-related diagnoses and for alcohol-related diagnostic subgroups (1980-1995) and plotted them against civilian and military substance abuse regulations. Civilian data were adjusted to Army age, gender, and race. RESULTS: Although overall civilian and Army alcohol hospitalization rates were similar, alcohol subgroup rates varied. Simultaneous drug and alcohol abuse (polyabuse) rates were higher among civilians (16.6 per 10,000) than Army soldiers (5.1 per 10,000). Army rates for dependent alcohol-related disorders were higher and increased. Army nondependent alcohol disorders tracked with alcohol-related regulations as rates fell 69% between 1985 and 1995. CONCLUSION: Army and civilian alcohol abuse trends vary by abuse type. Without longitudinal, diagnosis-specific subgroup analyses, these trends would not have emerged. Army policies and screening may explain divergent nondependent alcohol abuse and lower polyabuse rates.     

Adolescent drug abuse: problem and prospectus

Available research indicates that adolescent alcohol and drug abuse is a multi-level phenomenon which seriously affects the functioning of the individual, his (her) interpersonal experiences, the school and society in terms of problem behaviour and other psychopathological and social dysfunctional correlates. Data of the prevalence and problems of abuse obtained by a survey of high school students indicate a high prevalence of alcohol and marijuana used combinationally and heavy users are likely to experience psychopathological consequences, including personal problems of identity diffusion, self-esteem, a motivational syndrome, and acute brain syndrome, interpersonal problems with peers and parents and problems with school participation and the law: adolescents who abuse alcohol and marijuana in combination at the same time are likely to have severe, chronic, and progressive psychopathological problems. Presented is an integrated prospectus for a comprehensive, integrated, longitudinal prevention and intervention program on the community level including components of a holistic information and education programme with a prevention focus; counselling through a student assistance programme of intervention, evaluation and treatment; and rehabilitation through alternative schools. Also included are recommendations for further study and a caution of the implications of drug research and programme for adolescents.     

Survey of factors related to criminal behavior in a sample of Iranian substance abusers

ObjectivesMany countries including Iran have a high rate of substance abuse. It is essential for public health and law enforcement strategies to know the causes and consequences of substance abuse and its relation to crimes.MethodsIn a prospective case–control study, covering a period of one year starting from March 21, 2010, 125 cases with criminal behavior and 125 cases with no history of criminal behavior were studied.ResultsEight percent of our studied population had a previous history of psychological disorder. Most of our cases were cigarette users (78.4%). Forty-two cases had a history of alcohol abuse (16.8%). Modern drugs were the most common type of drugs (56%) being used. Multivariate analysis using logistic regression revealed that criminal behavior was correlated with divorce (RR = 5.35; 95% CI = 1.59–16.01; P = 0.023), history of alcohol use (RR = 2.63; 95% CI = 1.11–6.22; P = 0.027), history of psychological disorder (RR = 4.97; 95% CI = 1.44–17.20; P = 0.011), Modern drug use (RR = 4.86; 95% CI = 2.01–11.76; P = 0.001) and starting drug abuse at an early age (RR = 0.94; 95% CI = 0.88–0.99; P = 0.03).ConclusionsRisk factors for criminal behavior among substance abusers include being divorced, history of alcohol abuse, history of psychological disorder, modern drug abuse and starting drug abuse at an early age.     

Active-duty and veteran alcoholics: differences in psychopathology presentation

The present study examines the differences in the presentation of psychopathology between active duty military and veteran patients enrolled in alcohol rehabilitation programs. The Millon Clinical Multiaxial Inventory was used to assess personality disorders, clinical syndromes, and substance abuse. Most veterans were seen as having avoidant and dependent personality disorders as well as a great deal of anxiety and depression. Forty-seven percent were above cutoff scores for alcohol abuse. Air Force patients were predominantly narcissistic and antisocial with much less distress. Only 9% were classified psychometrically as abusers. The results indicate that not only are veteran alcoholics more chronic but that active-duty alcohol abusers are underreporting abuse and care must be used in their assessment.     

Radiotherapy and oncology in Papua New Guinea--how it differs from Western practice

This article describes differences in professional oncology practice between Papua New Guinea and developed countries. The rugged terrain and tribalism have created the late persistence of a stone age culture with a low level of education and this in turn has caused the late presentation of tumours. Paradoxically the commonest cancers are those which are frequently cured in Western countries, yet the cure rates are low in PNG due to late presentation. Despite this very few metastasize--in contrast to cancers in developed countries. Difficulties in diagnosis are discussed. Differences in management arise due to lack of facilities such as electrons or iridium wires, but policy differences arise also due to the poor follow-up. Many patients cannot afford to return for follow-up and the government cannot assist. Many patients abscond and good pre-treatment counselling is essential. Chemotherapy is available but doses of the more marrow-toxic or expensive drugs are reduced in view of the poor support facilities. Problems of training staff and of Cancer Registration are discussed. Most of the above problems are non-medical and should gradually diminish with government determination to provide a Health Service to benefit the whole population.     

Fatty acid ethyl esters (FAEEs) as markers for alcohol in meconium: method validation and implementation of a screening program for prenatal drug exposure

Alcohol consumption during pregnancy is a widespread problem and can cause severe fetal damage. As the diagnosis of fetal alcohol syndrome is difficult, the implementation of a reliable marker for alcohol consumption during pregnancy into meconium drug screening programs would be invaluable. A previously published gas chromatography mass spectrometry method for the detection of fatty acid ethyl esters (FAEEs) as alcohol markers in meconium was optimized and newly validated for a sample size of 50 mg. This method was applied to 122 cases from a drug-using population. The meconium samples were also tested for common drugs of abuse. In 73 % of the cases, one or more drugs were found. Twenty percent of the samples tested positive for FAEEs at levels indicating significant alcohol exposure. Consequently, alcohol was found to be the third most frequently abused substance within the study group. This re-validated method provides an increase in testing sensitivity, is reliable and easily applicable as part of a drug screening program. It can be used as a non-invasive tool to detect high alcohol consumption in the last trimester of pregnancy. The introduction of FAEEs testing in meconium screening was found to be of particular use in a drug-using population.     

Prevalence, trends, and correlates of alcohol use, nonmedical drug use, and tobacco use among U.S. military personnel

This paper presents data on substance use by military personnel from a series of worldwide surveys conducted in 1985, 1982, and 1980 with primary emphasis on the 1985 survey. Estimates are based on responses from participants serving on active duty in the Army, Navy, Marine Corps, and Air Force. Results for 1985 indicate pervasive use of alcohol, substantial use of tobacco, and low nonmedical use of drugs among military personnel. Average daily consumption of alcohol declined significantly from 1.4 ounces in 1982 to 1.2 ounces in 1985, but the patterns of use remained relatively constant. Nonmedical drug use during the past 30 days declined significantly, from 27.0% in 1980, to 19.0% in 1982, to 8.9% in 1985. Cigarette smoking declined significantly from 51.4% in 1982 to 46.2% in 1985. Current alcohol and drug use is concentrated among younger, less educated, unmarried, and junior and mid-career enlisted personnel. Cigarette pack years are higher among males, whites, those with less than a high school education, and senior enlisted personnel. Results show progress in reducing drug use and smoking in the military, but little change in patterns of alcohol use. New initiatives and approaches by the military to further reduce substance abuse are discussed.     

Family co-operation programme description

Current parenting practices indicate a continuing trend towards less family interaction. Institutional attempts to intervene with parents often fail. The 'Family Co-operation Programme' provides a tangible method for families and schools to work together in preventing alcohol and drug abuse, by utilising the positive influence of the home and strengthening family relationships. The Board of Education for the State of Utah has tested and is currently implementing a unique, low-cost, alternative to impact on the home. Utilising a K-12 alcohol/drug abuse school-based curriculum, the child, based on his/her inclass training, becomes the resource for family co-operation activities. These include training in coping skills, decision-making, resistance to peer persuasion, increased self-esteem and alcohol/drug information. Grade level materials go home with the child, who returns a requested parent evaluation. Data for over one thousand families show the positive impact of the activities.     

Alcohol abuse disorders among U.S. service members with mild traumatic brain injury

Traumatic brain injury (TBI) has emerged as a preeminent injury in Iraq and Afghanistan. The relationship between TBI and post-injury alcohol use in military personnel has not been clearly defined. The aim of this study was to examine the prevalence of alcohol abuse disorders among combat-injured service members with mild TBI (MTBI). Male U.S. service members with combat injuries were identified from the Expeditionary Medical Encounter Database (n = 3,123). Diagnoses of alcohol abuse disorders were collected from the standard inpatient and ambulatory data records. Overall, a slightly higher proportion of service members with MTBI were diagnosed with an alcohol abuse disorder compared to those with other injury (6.1% vs. 4.9%). In a multivariate analysis, however, it was found that MTBI was not associated with higher levels of alcohol abuse (odds ratio, 1.24; 95% confidence interval, 0.90, 1.70). To better define the consequences of MTBI, future research should include other alcohol dependency measures along with comorbid mental health disorders.     

Comparative safety and efficacy of subcutaneous and intradermal administration of inactivated Japanese encephalitis vaccine during predeployment preparations in the Australian Defence Force

Japanese encephalitis is a viral disease emerging in areas of influence for the Australian Defence Force immediately north of the continent, including the Torres Strait border of Australia and Papua, New Guinea. Only the mouse brain-derived, inactivated, Nakayama strain vaccine is commercially available to the Australian Defence Force. This vaccine has a high cost and significant adverse event profile, requiring restricted duties after administration. To address these issues, intradermal vaccination (either single intradermal administration or two intradermal injections at two separate sites) was assessed, compared with the conventional subcutaneous vaccination method, in a randomized controlled trial among soldiers preparing for deployment. Dual intradermal vaccination (0.1 mL at two sites) was found to have a slightly more favorable adverse event profile while maintaining comparable serological efficacy and reduced cost. An expansion of the concept and a test of logistics were conducted by vaccinating a battalion formation during predeployment medical preparations. The method of vaccination was well accepted and retained comparable immunogenicity.