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Associations between anabolic-androgenic steroid testing, healthcare access and undesirable effects among international consumers

2026-04-24T02:37:22Z

Title: Associations between anabolic-androgenic steroid testing, healthcare access and undesirable effects among international consumers Authors: Grobler, E.; Cheneal, P.; Bonenti, B.; Ferris, J.; Barratt, M. J.; Winstock, A.; Vigorous, S.; Domberelli, Amber; Spurling, G.; Piatkowski, T. Abstract: Abstract Background Anabolic–androgenic steroid (AAS) consumption is associated with significant physical and psychological health risks, often linked to unregulated supply chains and difficulty accessing informed healthcare. Therefore, this study examines how healthcare access difficulties and independently testing AAS purity and content relate to self-reported undesirable effects among AAS consumers. Methods Data from 854 respondents (95.6% male) reporting past-year AAS consumption in the 2024 Global Drug Survey were analysed. Respondents provided information on healthcare access, AAS testing behaviours, and undesirable physical (e.g., cardiovascular) and psychological (e.g., mood disturbances) effects. Chi-squared tests assessed differences across four groups defined by combinations of difficulty accessing healthcare and AAS testing. Results Respondents not testing their AAS and experiencing difficulty accessing healthcare (n = 196) reported significantly higher frequencies of several undesirable effects compared to the other three groups (n = 102–390). Significant differences were observed for decreased sexual function (χ² (3) = 10.19, p = .017, φc = 0.109), decreased fertility (χ² (3) = 11.54, p = .009, φc = 0.116), negative impacts on sexual organs (χ² (3) = 8.08, p = .044, φc = 0.097), anger/aggression (χ² (3) = 13.27, p = .004, φc = 0.125), depression/low mood (χ² (3) = 10.62, p = .014, φc = 0.112), and irritability (χ² (3) = 8.66, p = .034, φc = 0.101). Conclusion Difficulties accessing healthcare and not testing AAS are associated with higher reported AAS-related undesirable effects, though consumer-specific and contextual factors may be central. These findings highlight the need to address systemic and psychosocial barriers to reduce AAS-related harms.

Mixed- methods evaluation protocol for the Nurturing Connections Programme: a new Australian perinatal and infant mental health service

2026-01-30T04:06:29Z

Title: Mixed- methods evaluation protocol for the Nurturing Connections Programme: a new Australian perinatal and infant mental health service Authors: Cibralic, Sara; Fay- Stammbach, Tracey; Landry, Angeline; Meredith, Lee; Pretty, Danielle; Allan, Ashleigh; Olsen, Nicholas; Heath, Jacinta; Costa, Deborah; Eapen, Valsamma Abstract: ABSTRACT Introduction Forming secure attachment relationships provides children with the best possible start to life Children from families with high psychosocial vulnerability and complex mental health needs eg caregivers with lived experience of trauma experiencing mental illness or substance abuse current or past domestic violence and or current or a history of child protection issues are at the greatest risk of experiencing attachment disturbances Nurturing Connections is a new early intervention service launched by the New South Wales State Ministry of Health targeting both caregiver adversity and the caregiver- child attachment relationships in families with high psychosocial vulnerability and complex mental health needs This paper outlines the evaluation protocol of the Nurturing Connections Programme

Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit

2025-04-10T04:50:44Z

Title: Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit Authors: Daguman, E. I.; Taylor, A.; Flowers, M.; Lakeman, R.; Hutchinson, M. Abstract: Aim: An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression. Design: A single-centre retrospective study was undertaken. Method: Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices. Results: Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes. Conclusions: The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly. Relevance to clinical practice: Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses. Reporting method: This study followed the applicable STROBE guidelines. Patient or public involvement: Due to the study's retrospective nature, there was no service user or public involvement.

Development of a clinical pathway for screening and integrated care of eating disorders in a rural substance use treatment setting

2025-03-31T01:00:04Z

Title: Development of a clinical pathway for screening and integrated care of eating disorders in a rural substance use treatment setting Authors: Evans, J.; Horn, K.; Cowan, D.; Brunero, S. Abstract: Eating and substance use disorders frequently co-occur in clinical samples. This comorbidity presents a particular challenge due to increased medical complications, higher relapse rates, psychiatric comorbidity, and poorer overall outcomes for both disorders, and is associated with specific medical and psychiatric difficulties that contribute to complexity in diagnosis and treatment. However, patients with co-occurring substance use and eating disorders do not widely receive structured standardized assessment or treatment for eating disorders in substance use treatment settings. Focus groups were conducted to seek clinician's knowledge and perceptions of screening and care planning for eating disorder presentations in a rural substance use treatment setting. The study adheres to COREQ guidelines. To analyse the focus group data, the authors utilized thematic analysis and three major themes emerged as follows: beliefs about clients (stereotypical views, complexity of comorbidity, client expectations), understanding of self (lack of knowledge/skills, professional role), and organizational barriers and enablers. Whilst identifying a significant number of clinician and organizational barriers to providing screening and treatment of eating disorders in a substance use treatment setting, focus group discussions also highlighted a number of potential enablers. Most notably clinicians identified a willingness to provide screening and care planning if they were provided with education, a clinical pathway and access to screening tools. A consensus conferencing approach facilitated construction of a clinical pathway to enable the service to provide screening, assessment, and treatment planning for clients with comorbid eating disorder.