Diabetes

This chapter provides a comprehensive overview of diabetes care and management. It starts with a classification and diagnosis of diabetes, followed by sections on expert management of both Type 1 and Type 2 diabetes. Living with diabetes is then explored, from sports and exercise, travel, alcohol and recreational drug use, and special considerations such as Ramadan. Hospital inpatient management and diabetes-related emergencies are covered in detail. Diabetes and pregnancy, and paediatric and transition diabetes both have sections explaining common and rare presentations. Finally there are sections on discrete diabetic conditions, such as diabetic eye disease, nephropathy and chronic kidney disease, neuropathy, the diabetic foot, and macrovascular disease.

Sex, Drugs, and Genes: Illuminating the Moral Condemnation of Recreational Drugs

Over the past decade, evolutionary psychologists have proposed that many moral stances function to promote self-interests. At the same time, behavioral geneticists have demonstrated that many moral stances have genetic bases. We integrated these perspectives by examining how moral condemnation of recreational drug use relates to sexual strategy (i.e., being more vs. less open to sex outside of a committed relationship) in a sample of Finnish twins and siblings ( N = 8,118). Twin modeling suggested that genetic factors accounted for 53%, 46%, and 41% of the variance in drug condemnation, sociosexuality, and sexual-disgust sensitivity, respectively. Further, approximately 75% of the phenotypic covariance between drug condemnation and sexual strategy was accounted for by genes, and there was substantial overlap in the genetic effects underlying both drug condemnation and sexual strategy ( rg = .41). Results are consistent with the proposal that some moral sentiments are calibrated to promote strategic sexual interests, which arise partially via genetic factors.

Health-Related Quality Of Life And Its Determinants Among Recreational Drug Users In A Rural Area In Cameroon: A Cross-Sectional Study

Background This study was aimed to evaluate the health-related quality of life (HRQoL) and its drivers among recreational drug users, compared to non-users using WHOQOL-BREF. Methods A total of 246 recreational drug users and 141 non-recreational drug users were recruited using consecutive sampling of adults in the community. Socio-demographic data, data related to recreational drug use and HRQoL were collected. Data were compared using t-test, analysis of variance and chi-square test. Determinants of HRQoL were obtained using multivariate regression models. Results The mean overall quality of life (OQOL) score was significantly higher for non-recreational drug users compared to users (75.89 ± 22.64 vs 61.08 ± 23.94, respectively, p < 0.001), non-users as well had significantly higher mean scores across all four domains of WHOQOL-BREF. After multivariable adjustment, use of recreational drugs negatively affected the psychological domain (β=-4.17, 95% CI -8.22 to -0,13) and the environmental domain (β=-4.47, 95% CI -8.48 to -0.45). Years of recreational drug use affected the social relationship domain (β=-0.55, 95% CI -0.88 to -0.22), OQOL (β=-0.57, 95% CI -0.94 to -0.19), and general health satisfaction (β=-0.71, 95% CI -1.08 to -0.35). Number of recreational drugs used contributed to poorer physical health (β=-1.45, 95% CI -2.57 to -0.33), psychological domain (β=-2.04, 95% CI -3.18 to -0.91), social relationship domain (β=-1.87, 95% CI -3.39 to -0.35) as well as overall quality of life (β=-2.13, 95% CI -3.89 to -0.37). Besides recreational drugs, monthly income also affected physical health (β = 5.17, 95% CI 2.96 to 7.38), psychological domain (β = 3.34, 95% CI 1.10 to 5.58), environmental domain (β = 2.64, 95% CI 0.42 to 4.85) and also the OQOL (β = 4.16, 95% CI 0.70 to 7.62). Conclusions Our findings suggest that, recreational drugs significantly negatively affect the health-related quality of life of its users. People who use multiple recreational drugs and longer years of recreational drug use had a more widespread effect across the health domains. Higher monthly income could improve the HRQoL of recreational drug users.

Does the Presence of On-Site Medical Services at Outdoor Music Festivals Affect Attendees’ Planned Alcohol and Recreational Drug Use?

Background: Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees’ perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs. Method: A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees’ planned substance use. Results: A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees’ planned use of alcohol and recreational drugs. Conclusions: This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees’ perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.

Transient musical hallucinations in a young adult male associated with alcohol withdrawal

AimsWe present the case of a 25-year-old male who presented to A&E with isolated musical hallucinations, in the absence of audiological or neurological disease.BackgroundMusical hallucinations (MH) are a form of complex auditory hallucinations whereby an individual experiences an instrumental and/or vocal melody in the absence of auditory stimuli.ResultThe patient had a history of recreational drug use and a family history of psychosis. Hallucinations, which were preceded by discontinuation of alcohol and re-initiation of citalopram for depression, resolved spontaneously after three days.ConclusionAetiological factors are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning musical hallucinations remains elusive, the case illustrates the potential role of alcohol withdrawal, serotonin toxicity, recreational drug use and genetic vulnerability.