PLOS ONE Medicine&Health

The changing role of substances: trends, characteristics of individuals and prior healthcare utilization among individuals with accidental substance-related toxicity deaths in Ontario Canada

by Shaleesa Ledlie, Alice Holton, Pamela Leece, Bisola Hamzat, Joanna Yang, Gillian Kolla, Nikki Bozinoff, Rob Boyd, Mike Franklyn, Ashley Smoke, Paul Newcombe, Tara Gomes

To investigate trends and the circumstances surrounding fatal substance-related toxicities directly attributed to alcohol, stimulants, benzodiazepines or opioids and combinations of substances in Ontario, Canada.

We conducted a population-based cross-sectional study of all accidental substance-related toxicity deaths in Ontario, Canada from January 1, 2018 to June 30, 2022. We reported monthly rates of substance-related toxicity deaths and investigated the combination of substances most commonly involved in deaths. Demographic characteristics, location of incident, and prior healthcare encounters for non-fatal toxicities and substance use disorders were examined.

Overall, 10,022 accidental substance-related toxicity deaths occurred, with the annual number of deaths nearly doubling between the first and last 12 months of the study period (N = 1,570–2,702). Opioids were directly involved in the majority of deaths (84.1%; N = 8,431), followed by stimulants (60.9%; N = 6,108), alcohol (13.4%; N = 1,346) and benzodiazepines (7.8%; N = 782). In total, 56.9% (N = 5,698) of deaths involved combinations of substances. Approximately one-fifth of individuals were treated in a hospital setting for a substance-related toxicity in the past year, with the majority being opioid-related (17.4%; N = 1,748). Finally, 60.9% (N = 6,098) of people had a substance use disorder diagnosis at time of death.

Our study shows not only the enormous loss of life from substance-related toxicities but also the growing importance of combinations of substances in these deaths. A large proportion of people had previously interacted within an hospital setting for prior substance-related toxicity events or related to a substance use disorder, representing important missed intervention points in providing appropriate care.

Journal of Clinical Nursing

A Cross‐Sectional Study of Risk Factors for Coronary Heart Disease in Secondary Prevention for Patients With the Disease in China

ABSTRACT

Aims

To explore risk factors for Coronary Heart Disease (CHD) in secondary prevention for patients with the disease in China.

Design

Cross-sectional study.

Methods

A two-stage sampling method was used (stratified sampling and systematic sampling). Patients who met WHO diagnostic criteria for CHD, had the capacity to give informed consent and volunteered to participate were recruited from five districts in Hengyang city, Hunan province, China. Six instruments were used: A general socio-demographic questionnaire, Coronary Heart Disease Self-Management Scale, International Physical Activity Questionnaires, Chinese Eight-Item Morisky Medication Adherence Scale, Zung's Self-Rating Anxiety Scale and Sexual Health Questionnaires. Participants completed the questionnaires in person or via telephone. Single-factor correlation analysis, Pearson correlation analysis and multiple linear regression analysis were carried out.

Results

A total of 373 patients were recruited with a mean age of 66.25 years (standard deviation = 9.98). The mean score was 57.00 (14.23) for self-management, 5.41 (1.82) for medication adherence, 53.61 (9.26) for anxiety, 8.66 (3.18) for sexual knowledge and 22.20 (9.68) for the need for sexual health education. The median was 1563.90 MET-min/day for total energy consumption of physical activity. Self-management, physical activity, medication adherence, anxiety and sexual health were significantly correlated with a range of demographic variables (age, gender, marital status, occupation, education levels, types of medical insurance, personal monthly income, living arrangements) and illness-related variables (illness duration, number of hospital admissions, type of therapy, number of other chronic diseases, cardiac function grading and BMI).

Conclusion

This research has showed the risk factors related to self-management skills, medication adherence, anxiety, physical activity, sexual knowledge and the need for sexual health education in secondary prevention for patients with CHD. Health professionals play an important role in helping patients reduce risk factors for CHD to minimise its reoccurrence and mortality.

Relevance to Clinical Practice

Both hospital-based and community-based health professionals, especially nurses, have an important role to play in developing and implementing health promotion interventions to help patients with CHD reduce risk factors for the disease and thus reduce mortality.

Patient or Public Contribution

No patient contribution. Community nursing staff contributed to the design of the general socio-demographic questionnaire for this study.

Reporting Method

The STROBE checklist was used to ensure comprehensive reporting (Appendix S1).