Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment

Background  

Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been associated with poor Opioid Agonist Treatment (OAT) engagement, retention and response. Therefore, this study was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent women receiving OAT.     

Comparing opiate users in methadone treatment with untreated opiate users: results of a follow-up study with a Toronto opiate user cohort

Untreated opiate use is correlated with major social harms and costs in Canada. While methadone treatment has existed in Canada since the 1960s, there is little specific Canadian research on its effects. This paper reports on the one-year follow-up results of a Toronto cohort study of opiate users (N = 114) who were not in treatment at baseline. Sixty-nine people were recruited for re-interviewing. A number of these individuals (N = 29) had entered methadone treatment during the year between baseline and follow-up interviews. Comparisons with respect to social functioning, health status and health care utilization, drug use and related risks, and criminal justice system involvement were made between the follow-up subsample who remained untreated, and the subjects who entered methadone treatment. Differences were found with respect to illegal income generation, illicit opiate and other drug use, illicit drug market activities and emergency care and aspects of socio-economic integration, but no major effects on health and criminal justice status could be shown. Research and policy implications are discussed.     

Association of functional disability and treatment modalities with perceived effectiveness of treatment among adults with depression: a cross-sectional study

BackgroundApproximately 17.3 million US adults had at least one major depressive episode (MDE) in 2017. Of those, about two-thirds received mental health services from health professionals. Persons with disabilities (PWD) have higher risks of depression and may face more challenges in seeking treatment.ObjectiveExamined whether the presence of disabilities affected the perceived effectiveness of treatment for people with MDE who received outpatient mental health care.MethodsWe obtained MDE status, functional disability, modality of treatment (i.e., medication only, counseling only, medication plus counseling), self-reported effectiveness of treatment, and covariates from a nationally representative sample of US adults aged ≥18 years in the 2015–2019 National Survey on Drug Use and Health. We used multivariable logistic regression models with recommended survey weighting to examine associations between disability and perceived effectiveness of treatment.ResultsThe study population comprised 9992 respondents, representing 9.53 million US adults who had MDE and received outpatient mental health care in the past year. Overall, 58.9% had at least one functional limitation. A higher proportion of PWDs received medication plus counseling treatment compared to persons without disabilities (79.2% vs. 67.9%, P < .001). PWDs were significantly less likely to rate treatment as effective (OR = 0.77; 95% CI: 0.66–0.91). Odds ratios decreased as the number of limitations increased, and this association was moderated by treatment modality.ConclusionPWDs have poorer perceived outcomes of outpatient mental health care for depression, especially for treatment modalities involving counseling. These findings call for focused attention to depression treatment efforts for PWD that accommodate their needs.     

Somatic health among heroin addicts before and during opioid maintenance treatment: a retrospective cohort study

Background  

The long-term impact of opioid maintenance treatment (OMT) on morbidity and health care utilization among heroin addicts has been insufficiently studied. The objective of this study was to investigate whether health care utilization due to somatic disease decreased during OMT, and if so, whether the reduction included all kinds of diseases and whether a reduction was related to abstinence from drug use.     

Correlates to the variable effects of cannabis in young adults: a preliminary study

ABSTRACT: BACKGROUND: Cannabis use can frequently have adverse affects in those that use it and these can be amplified by various characteristics of an individual, from demographic and environmental variations to familial predisposition for mental illnesses. METHODS: The current study of 100 individuals, who were cannabis users during their adolescence and may still be users, was a survey of the self perceived effects of cannabis and their correlates. A reliable family member was also interviewed for determination of family history of various major mental illnesses and substance use. RESULTS: As many as 40% of cannabis users had paranoid feelings (suspiciousness) when using cannabis, although the most frequent effect was feeling relaxed (46%). Having a familial background for mental illnesses such as depression or schizophrenia did not determine the effects of cannabis nor its pattern of use, although the number of subjects with such a history was small. An age at which an individual began using cannabis did have an effect on how heavily it was used and the heavier the cannabis use, the more likely the individual was also to have had psychotic symptoms after use. There were no sex differences in effects of cannabis. These results are tempered by the reliance on self-report for many of the variables ascertained. CONCLUSION: Cannabis can frequently have negative effects in its users, which can be amplified by certain demographic and/or psychosocial factors. Thus, users with a specific profile may be at a higher risk of unpleasant effects from cannabis use and caution should be noted when cannabis is administered to young people for medicinal purposes.     

Mortality and failure among tuberculosis patients who did not complete treatment in Vietnam: a cohort study

Background  

Tuberculosis treatment failure and death rates are low in the Western Pacific Region, including Vietnam. However, failure or death may also occur among patients who did not complete treatment, i.e. reported as default or transfer-out. We aimed to assess the proportion failures and deaths among new smear-positive pulmonary tuberculosis patients with reported default or transfer-out.     

Smoking status and quality of life: a longitudinal study among adults with disabilities

BACKGROUND: Current research suggests that people with disabilities are more likely to use tobacco, less likely to quit, and less likely to be screened for tobacco use. However, little is known about the impact of changes in smoking status on the health-related quality of life (HRQL) of people with disabilities. OBJECTIVE: The primary objective of this paper is to examine the association between changes in HRQL and smoking status over time among people with disabilities. METHODS: The study data were derived from the Massachusetts Survey of Secondary Conditions, a longitudinal survey of adults with disabilities; Phase I was conducted in 1996-1998, Phase II in 1998-1999, and Phase III in 1999-2000. The main outcome measure was HRQL as measured by the Medical Outcomes Study Short Form-36 (SF-36). Analysis was primarily done in 2003. RESULTS: Current smokers and those who began smoking during follow-up had significantly poorer HRQL compared with nonsmokers with disabilities. Longitudinal analysis suggests that controlling for age, gender, race/ethnicity, education, and activities of daily living, changes in HRQL scores over time were associated with changes in smoking status. Compared to smokers, those who quit smoking during follow-up experienced a significant improvement in mean SF-36 scores over time for the dimensions of mental health, energy and vitality, and general health. CONCLUSIONS: Findings from this study highlight a strong need to inform public health programs, people with disabilities and healthcare providers about the association between tobacco cessation and improved health-related quality of life among people with disabilities.     

Long-term mortality among older adults with burn injury: a population-based study in Australia

Objective

To assess if burn injury in older adults is associated with changes in long-term all-cause mortality and to estimate the increased risk of death attributable to burn injury.

Methods

We conducted a population-based matched longitudinal study – based on administrative data from Western Australia’s hospital morbidity data system and death register. A cohort of 6014 individuals who were aged at least 45 years when hospitalized for a first burn injury in 1980–2012 was identified. A non-injury comparison cohort, randomly selected from Western Australia’s electoral roll (n = 25 759), was matched to the patients. We used Kaplan–Meier plots and Cox proportional hazards regression to analyse the data and generated mortality rate ratios and attributable risk percentages.

Findings

For those hospitalized with burns, 180 (3%) died in hospital and 2498 (42%) died after discharge. Individuals with burn injury had a 1.4-fold greater mortality rate than those with no injury (95% confidence interval, CI: 1.3–1.5). In this cohort, the long-term mortality attributable to burn injury was 29%. Mortality risk was increased by both severe and minor burns, with adjusted mortality rate ratios of 1.3 (95% CI: 1.1–1.9) and 2.1 (95% CI: 1.9–2.3), respectively.

Conclusion

Burn injury is associated with increased long-term mortality. In our study population, sole reliance on data on in-hospital deaths would lead to an underestimate of the true mortality burden associated with burn injury.     

Antibody response to hepatitis B vaccine is independently associated with hepatitis B breakthrough infection among adults: Results from a three-year follow-up study in China

Hepatitis B breakthrough infection (HBBI) and its risk factors are rarely reported among adults in China. In 2009–2010 in three townships of China, hepatitis B vaccine (HepB) administration and anti-HBs detection after HepB were conducted among the residents aged 18–59 years. HBsAg, anti-HBs and anti-HBc were detected for these vaccinees in 2013. A total of 252 out of 4701 vaccinees turned to be positive for anti-HBc in 2013, but nobody was positive for HBsAg. The HBBI rate was 5.36% (95% CI 4.73, 6.04). The highest rate was found in age-group of 18–29 years (7.33%, 95% CI: 5.31, 9.82). The rate was significantly different by the residential townships (P < 0.001) and by the antibody response to HepB (P = 0.003). Multivariate analysis showed that anti-HBs response to HepB was the independent risk factor of HBBI. The study documents the association between hyporesponse to HepB and HBBI among adults. It also suggests more attention should be given to new HBV infection among young adults.     

男男性行为人群队列失访情况及影响因素分析

目的 了解男男性行为人群(MSM)队列研究中失访人群特征及失访率水平,分析造成失访可能的影响因素.方法 于2009年6-10月在8个城市开展基线调查,收集人口学、性行为特征等信息,并进行HIV、单纯疱疹病毒和梅毒检测.在基线调查基础上建立MSM队列后的第6个月和第12个月对队列进行两次随访,记录所有队列成员的失访情况.通过单因素分析和二分类logistic回归分析,了解各因素对失访的影响.结果 在基线调查基础上建立3196人的MSM研究队列.在1年随访期间内,共有894人(28.0％)失访,2302人(72.1％)至少参加-次随访.单因素和多因素分析结果显示,研究对象年龄、在本地居住时间≤1年、无业、最近1年未接受HIV检测、个人性取向为双性或异性恋、最近6个月发生异性性行为是队列失访的危险因素.结论 年龄、在当地居住时间、性取向和HIV检测史等因素与MSM队列失访有关,故在开展MSM队列研究时,应考虑这些因素.     

Changes in glycemic control from 1996 to 2006 among adults with type 2 diabetes: a longitudinal cohort study

Background  

Our objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort.     

HIV risks among women who are married to men who have sex with men in India: a qualitative investigation

In countries such as India, men who have same-sex partnerships may marry women due to cultural pressures regardless of their sexual desires and preferences. The wives of such men may be at risk for HIV but limited existing research addresses this issue. This qualitative study used in-depth interviews to investigate HIV-related risk among married men who have sex with men (n = 34) and women who were aware of their husband’s same-sex behaviour (n = 13) from six research sites in five states and a Union Territory in India: Delhi (Delhi), Visakhapatnam (Andhra Pradesh), Hyderabad (Telangana), Bengaluru (Karnataka), Chennai and Madurai (Tamil Nadu). Thematic analysis revealed that wives of men who have sex with men were at risk for HIV from their husbands’ sexual practices, which are often hidden to avoid the potential consequences of stigmatisation, as well as from gender-based inequities that make husbands the primary decision-makers about sex and condom use, even when wives are aware of their husband’s same-sex behaviour. Innovative interventions are needed to address HIV-related risk in couples where wives remain unaware of their husband’s same-sex behaviour, and for wives who are aware but remain within these marriages.     

男男性行为人群艾滋病病毒新发感染风险的队列研究

目的 了解与分析影响MSM人群HIV新发感染的危险因素。方法 通过MSM队列研究,随访调查目标人群在随访期间HIV相关行为暴露情况,进而通过广义估计方程,分析该人群HIV新发感染影响因素。结果 2013－2015年对4 305名HIV阴性MSM进行了随访观察。网络交友的MSM发生被动插入性肛交的比例和肛交坚持使用安全套的比例高于会所酒吧和浴池交友的MSM。随访研究期间HIV平均阳转密度为4.3/100人年,被动接受肛交性行为者发生HIV新发感染的风险是主动插入方的2.20倍（95%CI：1.49～3.24）;使用助性剂（aRR＝1.55, 95%CI：1.10～2.17）、不能坚持使用安全套（aRR＝2.24,95%CI：1.62～3.08）和梅毒感染（aRR＝2.95,95%CI：2.00～4.35）是HIV新发感染的主要危险因素;而控制了其他因素后,3种交友方式与HIV新发感染的关联不再有统计学意义。结论 MSM人群中造成HIV流行的因素较为复杂,亟需多角度开展研究,为制定有针对性的防治措施提供依据。     

Factors associated with maintenance of regular condom use among single heterosexual adults: a longitudinal study

OBJECTIVE: The aims of this study were to describe behavioural and psychosocial characteristics of single heterosexuals towards regular condom use, and to identify factors associated with the maintenance of this behaviour over time. METHOD: A cohort of 179 single heterosexual adults (83 men and 96 women, mean age: 32 years) was followed over a period of 2 years. The data were collected, by phone interviews, at baseline and 1 and 2 years later. The phone numbers were generated using a random digit strategy. RESULTS: The following changes were observed: over time fewer people were sexually active, but those who were, reported more often having had more than one sexual partner. No significant change was observed regarding condom use. The psychosocial variables remained stable during the study period. To have a favourable intention was the main factor associated with maintenance of condom use. Having had a STD, personal normative beliefs and positive attitude were also associated with regular condom use. DISCUSSION: Promotion strategies should highlight the importance of acting as a responsible person, reinforce the advantages of using condoms, and select strategies that favour the implementation of intention of using condoms.