The ESPAD Study: implications for prevention

The European Schools Project on Alcohol and other Drugs (ESPAD) was concerned with the substance use, beliefs, attitudes and risk factors among over 50,000 16-year-olds in 26 European countries. Based on this data, the present paper focuses on critical issues in prevention and uses a country-level analysis with focus on the extent that contextual and cultural factors interact with factors influencing the use of alcohol and other drugs. The results indicate that: (i) an emphasis on risks and dangers may be a poor prevention strategy since many young people do not believe the widely accepted dangers of certain forms of substance use (e.g. cigarette smoking); (ii) misperception of norms in relation to substance use, that is, the belief that use of alcohol and other drugs is more common than it actually is, emerged in most countries with the exception of Nordic countries; (iii) the correlation between perceived access to substances and actual use depended on the substance involved; correlations were strongest for cannabis but low for alcohol; (iv) the measure of problem behaviour was used in the ESPAD study (truancy from school), is correlated with substance use in a way that is opposite to that predicted in problem behaviour theory; and (v) there were no indications that the potential restraining factors that were examined in this study (involvement in athletics and leisure) acted in a way that prevented people from experimenting with drugs. The results of this analysis suggests that far from our having identified a core set of universal influences that act to determine substance use, the importance of cultural and contextual factors have been underestimated as has the importance of the specific substance involved.     

METOCLOPRAMIDE AND PERPHENAZINE IN THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING: Double-blind Comparison

Metoclopramide 10 mg and perphenazine 5 mg were compared ina double-blind trial on 188 women undergoing planned gynaecologicallaparotomies. Metoclopramide or perphenazine was given intramuscularlyat the end of the operation, and the patients were observedfor 6 hours in the recovery ward. The metoclopramide-treatedgroup had significantly less nausea, retching and vomiting thanthe perphenazine-treated group. The difference was significantat the 0.5 per cent level when comparing the "nausea-score"of the two groups by a Wilcoxon-Mann-Whitney test, at the 2.5per cent level when comparing the incidence of retching andvomiting in the two groups by a ² test. The awakening time wasslightly longer in the metoclopramide-treated group than inthe perphenazine-treated group. There was no significant effecton blood pressure or pulse rate in either group. A significantlylower incidence of pethidine injections was noted in the metoclopramide-treatedgroup than in the perphenazine-treated group. This has no effecton the conclusion that metoclopramide 10 mg is more effectivein preventing postoperative nausea and vomiting than perphenazine5 mg.     

Effect of Patients' Expectations on Recovery from Acute Tonsillitis

To investigate whether the personal attention paid to a patientcan affect his or her subjective recovery from acute tonsillitis,a controlled study was performed on 100 patients consultinga doctor for this disease. At the consultation a randomly assignedexperimental group (n=50) was given more detailed informationabout the diagnosis, treatment and prognosis and also a moreextensive physical examination than a control group (n=50).At a follow-up interview two days later significantly more ofthe experimental group felt that their symptoms had improved(P<0.005) than the control group, significantly more feltthat the treatment had helped them (P<0.005) and significantlymore felt they had received sufficient information about theirillness and treatment (P<0.001). A deliberate attempt tomaximize the expectation effect was thus shown to influencethe clinical course of acute tonsillitis, recorded as the degreeof subjective improvement.     

URODYNAMIC FACTORS INFLUENCE THE DURATION OF ESCHERICHIA COLI BACTERIURIA IN DELIBERATELY COLONIZED CASES

Purpose

We evaluated the influence of urodynamic factors on the establishment of bacteriuria, after deliberate intravesical inoculation with Escherichia coli.

Materials and Methods

Nine women and 7 men with recurrent symptomatic urinary tract infections underwent intravesical injection of E. coli 83972. This strain had documented ability to persist in the urinary tract and it lacks expressed virulence factors associated with urinary tract infection.

Results

Successful long-term colonization (5 months to 3 years) was achieved in 6 of 12 patients with neurogenic bladder disorder, including normal or high bladder capacity, normal or low detrusor pressure and residual urine. Short-term bacteriuria (13 days) occurred in 1 but long-term bacteriuria was not established in the 4 patients with normal lower urinary tract function. Occasionally urine samples from the colonized patients contained other bacterial strains, which cleared spontaneously except for a Klebsiella strain that became established in 2 and subsequently eliminated E. coli 83972.

Conclusions

E. coli 83972 bacteriuria could only be established in a subset of patients with defective bladder voiding, suggesting that urodynamic defects permit a nonvirulent strain to establish in the urinary tract, but that additional host factors determine if bacteriuria will persist.