Suchergebnisse

Purpose: Medical respite provides postacute care to people experiencing homelessness upon hospital discharge if they are too sick to recover on the streets or in a traditional shelter. The current study examined the feasibility of conducting a study to test the effectiveness of a medical respite intervention for older people experiencing homelessness. Methods: Fifteen patient and 11 provider participants were interviewed between July and November 2018. Results: Participants' considerations for how to design a program of research included (1) desired qualities of researchers; (2) preferences for study design; (3) mechanisms for participant recruitment and retention; (4) what, where, and how to collect data; and (5) barriers and motivations to participation. Conclusions: Findings from this study build on an emerging research base on how to appropriately engage vulnerable patient groups, including older people experiencing homelessness, in trauma-informed research by including peer researchers on research teams to serve as advisors throughout the research process.

<i>Aims:</i> This study investigated a possible association between violence and the use of drugs, particularly methamphetamine and alcohol. <i>Methods:</i> Cross-sectional, baseline data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. Subjects were asked whether they had suffered or perpetrated violence in the 6 months prior to the interview. <i>Results:</i> In total, 478 youth were enrolled, with a median age of 22 years (interquartile range = 20.0–23.9); 230 (48%) reported having been victims of violence, while 165 (34.5%) reported having perpetrated violence. Daily methamphetamine use was not associated with either outcome. In a multivariate analysis, daily alcohol consumption was significantly associated with being a victim (adjusted odds ratio = 2.10) and a perpetrator (adjusted odds ratio = 2.02) of violence. A history of abuse, failing a grade, and dealing drugs were also independently associated with violence, while having a regular partner was protective. <i>Conclusion:</i> Contrary to popular media reports that methamphetamine causes violence, we found no association. The association of alcohol with violence, though, has implications for screening and intervention programs.

Although there have been repeated calls for the establishment of safe injection facilities (SIFs) in Vancouver since the early 1990s, questions remain concerning the feasibility of SIFs due to the high prevalence of injection cocaine and the concomitant problems cocaine use presents. Therefore, we determined the prevalence of willingness to attend SIFs among cocaine injectors in Vancouver and explored the factors associated with this willingness, using data from the Vancouver Injection Drug Users Study. After considering the results derived from this analysis, additional qualitative methods were employed to explore further willingness to use SIFs, barriers and facilitators of SIF utilization, and methods of maximizing use among selected subpopulations of cocaine injectors. The results suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF if one were available. However, in order to better accommodate cocaine injectors, several modifications could be made to conventional SIF service design and delivery. The vast majority of these modifications relate to ensuring effective responses to cocaine toxicity. Given the acceptability of SIFs among cocaine injectors, it appears that an SIF pilot could result in significant and immediate benefits in terms of public health and community safety.

Background: Although the survival benefits of antiretroviral therapy (ART) for the treatment of HIV infection are well established, the clinical management of HIV disease continues to present major challenges. There are particular concerns regarding access to appropriate HIV treatment among HIV-infected injection drug users (IDU). Methods In a prospective cohort study of HIV-infected IDU in Vancouver, Canada, we examined initial ART regimens vis-à-vis the provincial government's therapeutic guidelines at the time ART was initiated. Briefly, there have been four sets of guidelines: Era 1 (1992 to November 1995; double-drug (dual NRTIs) ART for patients with a CD4 cell count of 350 or less); Era 2 (December 1995 to May 1996; double-drug therapy for patients with a CD4+ cell count of 500 or less); Era 3 (June 1996 to June 1997; triple-drug therapy (dual NRTIs with a PI or NNRTI) for patients who had a plasma viral load of > 100,000 HIV-1 RNA copies/mL; dual therapy with two NRTIs for those with a plasma viral load of 5,000 to 100,000 HIV-1 RNA copies/mL); Era 4 (since July 1997; universal use of triple drug therapy as first-line treatment). Results Between May 1996 and May 2003, 431 HIV-infected individuals were enrolled into the cohort. By May 31, 2003, 291 (67.5%) individuals had initiated ART. We noted instances of inappropriate antiretroviral prescription in each guideline era, with 9 (53%) in Era 1, 3 (12%) in Era 2, 22 (28%) in Era 3, and 23 (15%) in Era 4. Of the 57 subjects who received an inappropriate ART regimen initially, 14 never received the appropriate therapy; among the remaining 43, the median time to the initiation of a guideline-appropriate ART regimen was 12 months (inter-quartile range 5 – 20). Conclusion The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple-therapy era. As therapeutic guidelines continue to evolve, it is critical that mechanisms be put in place to ensure prescription of ART combinations for IDU that are consistent with current expert recommendations. ; Medicine, Department of ; Medicine, Faculty of ; Non UBC ; Reviewed ; Faculty

This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leading to high levels of housing stability, decreasing levels of housing stability over time, and low levels of housing stability over time. The presence of resources rather than risk factors differentiated the trajectories of participants who achieved housing stability from those who had low levels of housing stability. Participants who had better housing stability were more likely to live in subsidized housing. Findings highlight the need for programs and policies directed at addressing the housing affordability problem through income support strategies and the creation of affordable housing.