Environmental Studies From Crisis To Cure PDF.epubl
Brynn Cropp
The sustainability of a fiber refers to the practices and policies that reduce environmental pollution and minimize the exploitation of people or natural resources in meeting lifestyle needs. Across the board, natural cellulosic and protein fibers are thought to be better for the environment and for human health, but in some cases manufactured fibers are thought to be more sustainable. Fabrics such as Lyocell, made from the cellulose of bamboo, are made in a closed loop production cycle in which 99% of the chemicals used to develop fabric fibers are recycled. The use of sustainable fibers will be key in minimizing the environmental impact of textile production.
In the two decades since the fast fashion business model became the norm for big name fashion brands, increased demand for large amounts of inexpensive clothing has resulted in environmental and social degradation along each step of the supply chain. The environmental and human health consequences of fast fashion have largely been missing from the scientific literature, research, and discussions surrounding environmental justice. The breadth and depth of social and environmental abuses in fast fashion warrants its classification as an issue of global environmental justice.
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so others may receive better help in the future.
In summary, phases one and two of the current COVID-19 pandemic represent a dangerous accumulation of risk factors for mental health problems in children and adolescents of enormous proportions: re-organization of family life, massive stress, fear of death of relatives, especially with relation to grandparents and great-grandparents, economic crisis with simultaneous loss of almost all support systems and opportunities for evasion in everyday life, limited access to health services as well as a lack of social stabilization and control from peer groups, teachers at school, and sport activities.
Climate change is contributing to humanitarian crises worldwide, with climate-related disasters driving increased levels of risks and vulnerability. The past eight years are on track to be the eight warmest on record and 2022 is estimated to be among the hottest. Of the 15 countries most vulnerable to the climate crisis, 12 had an internationally led humanitarian response. By the end of the century, deaths from extreme heat are projected to be comparable in magnitude to all cancers or all infectious diseases.
The Netherlands is well known for its early adoption of harm reduction (HR) programs at the height of its heroin crisis in the 1970s/1980s, including the implementation of the first needle and syringe program worldwide. In this manuscript, we describe how the Amsterdam Cohort Studies (ACS) among people who use drugs (PWUD) was conceived within the context of the Dutch HR approach, including the challenges scientists faced while establishing this cohort.This required striking a balance between public health and individual benefit, solving research dilemmas in the face of uncertainty, developing controversial innovative and cutting-edge interventions, which changed the prevention landscape for PWUD, and using longitudinal cohort data to provide unique insights. Studies from the ACS covering follow-up between 1985 and 2016 revealed that participation in both opioid agonist therapy and needle and syringe programs led to a major decrease in the risk of HIV and hepatitis B and C infection acquisition. ACS data have shown that the observed decrease in incidence also likely included shifts in drug markets and drug culture over time, selective mortality among those with the highest levels of risk behaviour, demographic changes of the PWUD population, and progression of the HIV and HCV epidemics. Moreover, HR programs in the Netherlands provided services beyond care for drug use, such as social support and welfare services, likely contributing to its success in curbing the HIV and viral hepatitis epidemics, increasing access and retention to HIV and HCV care and ultimately decreases in overdose mortality over time. Given the low coverage of HR programs in certain regions, it is unsurprising that continued HIV and HCV outbreaks occur and that transmission is ongoing in many countries worldwide. If we aim to reach the World Health Organization viral hepatitis and HIV elimination targets in 2030, as well as to improve the life of PWUD beyond infection risk, comprehensive HR programs need to be integrated as a part of prevention services, as in the Netherlands. We should use the evidence generated by longstanding cohorts, including the ACS, as a basis for which implementation and improved coverage of integrated HR services can be achieved for PWUD worldwide.
The Netherlands is well known for its early adoption of harm reduction (HR) programs at the height of its heroin crisis. Both early implementation and broad access to these programs for people who use drugs (PWUD) have been linked to limited transmission of HIV and hepatitis B and C infections in Amsterdam [1]. These findings were based on data from the Amsterdam Cohort Studies (ACS), which had been established in 1985, with follow-up now spanning over three decades, and closed in 2016 [2]. In the ACS, drug use was defined as the use of hard drugs, including heroin, cocaine, amphetamines and methadone. Its contributions included evidence for the impact of HR programs on the risk of blood-borne viral infections, drug use behaviour, all-cause and cause-specific mortality, and HIV and hepatitis C virus (HCV) treatment uptake and adherence. Meanwhile, the ACS has also conducted various multidisciplinary studies, which have increased our understanding of HIV and HCV pathogenesis, viral dynamics and their impact on the immune system [3, 4]. Despite these major contributions, the scientists establishing and leading this cohort were faced with persistent challenges.
Decreased risk behaviour and HR programs likely contributed to a decline in IDU and HIV, HCV and HBV incidence over time [1, 25,26,27]. However, other factors, such as changes in drug markets, outward migration, demographic shifts within the PWID population and selective HIV-mortality in the 1990s, played an additional role [18, 22]. Several epidemiological and mathematical modelling studies from the ACS have attempted to disentangle the effects of HR and other factors influencing declines in infection incidence and risk behaviour and are summarized below.
Heroin, methadone and injecting use patterns are not only highly variable between cohort participants, but also within participants [25]. An ACS study indicated that there were five distinct longitudinal patterns describing injecting trajectories between 1985 and 2005 among PWID [37]. Three of these trajectories displayed stable injecting risk behaviour over time and two displayed a downward trend: a group who decreased injecting early during follow-up (13% of all participants) and another group who showed a gradual decrease over follow-up time (12%). Interestingly, IDU patterns in the ACS were similar to those observed in the USA, suggesting that these injecting trajectories can exist irrespective of cultural differences [37]. Another ACS study reported that among PWUD with a history of addiction to heroin, cocaine and/or amphetamines, abstinence to these drugs and methadone for at least four months was observed in 27% at 20 years from initiating regular drug use [38]. It should be noted, however, that individuals who cease injecting drugs may be more likely to be lost to follow-up, thereby leading to an underestimation of drug cessation in the cohort. While the ACS studies suggested that adequate methadone dosages had a positive impact on drug use cessation, long-term cessation was uncommon, thus consistent with the concept of addiction as a chronic disease.
Several reviews of the available evidence on the effect of HR programs and infection risk have been conducted and have found that most studies did not adequately adjust their results for time-varying confounding or the effect of biased selection into HR programs participation (i.e. people engaging in risk behaviours were more likely to participate in HR programs) [18, 22]. As such, definitive conclusions regarding the effect of HR cannot be drawn from previous epidemiological nor mathematical studies. Moreover, as HR programs were implemented before the initiation of the ACS cohort, ACS researchers were unable to compare infection incidence prior to the availability of these interventions. Using data from the ACS between 1985 and 2014, we recently assessed the effect of combined HR program participation on HIV, HCV and HBV infection risk using causal inference methods, which can account for these previously mentioned biases [45]. We showed that the optimal combination of NSP and OAT led to a decrease in risk of 85% for HCV, 44% for HIV and 71% for HBV among PWID participating in the ACS compared to no or partial participation. Using standard statistical methods would have led to attenuated estimates of these protective effects [25].
While problematic heroin use is currently no longer a major public health concern in the Netherlands, the number of prescription opioid users nearly doubled between 2008 and 2017 as well as the number of opioid-related hospital admissions and individuals treated for opioid use disorder [58]. The localized HIV/HCV epidemics among PWUD in the USA were preceded by increased opioid prescriptions. Therefore, vigilance is needed to prevent a similar opioid crisis in the Netherlands as in the USA, although such an event is highly unpredictable. Nevertheless, the lessons drawn from studies among PWUD from the past should remind us to consider the hurdles for future prevention, in particular the difficulty in completely discontinuing opioid use once regular use becomes established. Moreover, as the number of HR services decreases in the Netherlands, the expertise to deal with opiate addiction decreases as well. Therefore, there is always the question as to whether we will be ready to quickly scale up and respond to a potential new opioid crisis in the Netherlands.
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