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Baddour LM, Weimer MB, Wurcel AG, McElhinney DB, Marks LR, Fanucchi LC, Esquer Garrigos Z, Pettersson GB, DeSimone DC. Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e187-e201. [PMID: 36043414 DOI: 10.1161/cir.0000000000001090] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The American Heart Association has sponsored both guidelines and scientific statements that address the diagnosis, management, and prevention of infective endocarditis. As a result of the unprecedented and increasing incidence of infective endocarditis cases among people who inject drugs, the American Heart Association sponsored this original scientific statement. It provides a more in-depth focus on the management of infective endocarditis among this unique population than what has been provided in prior American Heart Association infective endocarditis-related documents. METHODS A writing group was named and consisted of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery in October 2021. A literature search was conducted in Embase on November 19, 2021, and multiple terms were used, with 1345 English-language articles identified after removal of duplicates. CONCLUSIONS Management of infective endocarditis in people who inject drugs is complex and requires a unique approach in all aspects of care. Clinicians must appreciate that it requires involvement of a variety of specialists and that consultation by addiction-trained clinicians is as important as that of more traditional members of the endocarditis team to improve infective endocarditis outcomes. Preventive measures are critical in people who inject drugs and are cured of an initial bout of infective endocarditis because they remain at extremely high risk for subsequent bouts of infective endocarditis, regardless of whether injection drug use is continued.
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Saha R, Miller AP, Parriott A, Horvath H, Kahn JG, Malekinejad M. Viral blood-borne infections testing and linkage to care cascade among persons who experience homelessness in the United States: a systematic review and meta-analysis. BMC Public Health 2022; 22:1421. [PMID: 35883158 PMCID: PMC9327172 DOI: 10.1186/s12889-022-13786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Persons who experience homelessness remain at increased risk for three viral blood-borne infections: human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). We assessed the yield of testing and linkage to care programs targeting this population for these infections in the United States (US). METHODS We searched PubMed, Embase, Web of Science, and Cochrane Central for peer-reviewed articles through August 27, 2020. Additionally, we searched the grey literature. Two individuals independently reviewed all relevant studies to check for eligibility and extracted data for each step in the care cascade. We used random-effects model to generate weighted pooled proportions to assess yield at each step. Cumulative proportions were calculated as products of adjacent-step pooled proportions. We quantitatively synthesized data from the studies that focused on non-drug injecting individuals. RESULTS We identified 24 studies published between 1996-2019 conducted in 19 US states. Seventeen studies screened for HIV, 12 for HCV, and two screened for HBV. For HIV, 72% of approached were recruited, 64% had valid results, 4% tested positive, 2% were given results, and 1% were referred and attended follow-up. Of positives, 25% were referred to treatment and started care. For HCV, 69% of approached were recruited, 63% had valid results, 16% tested positive, 14% were given results, and 3% attended follow-up. Of positives, 30% were referred for treatment and 19% started care. The yield at each care cascade step differs widely by recruitment strategy (for example, for HIV: 71.6% recruited of reached under service-based with zero yield under healthcare facility-based and outreach). CONCLUSIONS A very large proportion of this population reached for HIV and HCV care were lost in the follow-up steps and never received treatment. Future programs should examine drop-out reasons and intervene to reduce health disparities in this population.
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Affiliation(s)
- Ria Saha
- Senior Public Health Intelligence Analyst, Medway Council, London, UK
| | - Amanda P Miller
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
| | - Andrea Parriott
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
- California Department of Public Health, Sacramento, CA, USA
| | - Hacsi Horvath
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - James G Kahn
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Mohsen Malekinejad
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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3
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Rossow I. Illicit drug use and oral health. Addiction 2021; 116:3235-3242. [PMID: 33247857 DOI: 10.1111/add.15360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022]
Abstract
People with drug use disorders (PWDUD) have elevated prevalence of oral diseases, in particular dental caries (tooth decay), periodontal (gum) disease and xerostomia (dry mouth). When left untreated, these oral health conditions may progress and lead to tooth ache, abscesses and tooth loss, and in turn, to poor chewing functioning and digestion, dental aesthetic problems and reduced wellbeing. Illicit drug use may, per se, cause xerostomia, which in turn increases vulnerability for dental caries. However, the other main drivers of oral diseases and their progression-poor oral hygiene, frequent sugar intake and infrequent dental visits-can mainly be ascribed to the irregular lifestyle, poor economy and mental health problems that often accompany illicit drug use. Establishment of good oral health habits is essential in the dental care for PWDUD. Dental treatment is often comprehensive and challenging; because the patients may have extensive treatment needs but also difficulties adhering to preventive measures and dental appointments. An integrated care approach for PWDUD would likely benefit both their oral and general health.
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Affiliation(s)
- Ingeborg Rossow
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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Jaffe K, Choi J, Hayashi K, Milloy MJ, Richardson L. A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1799-1806. [PMID: 33491849 PMCID: PMC8310531 DOI: 10.1111/hsc.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58-0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59-0.95) and cannabis (AOR = 0.78, 95% CI = 0.63-0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42-0.70) and street-based income generation (AOR = 0.75, 95% CI = 0.59-0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07-1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05-2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.
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Affiliation(s)
- Kaitlyn Jaffe
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Department of Sociology, University of British Columbia, Vancouver, BC Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, BC Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Department of Sociology, University of British Columbia, Vancouver, BC Canada
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5
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Freire MDCM, Lawder JADC, de Souza JB, de Matos MA. Satisfaction with oral health and associated factors among homeless people in Midwest Brazil. Oral Dis 2021; 28:2036-2042. [PMID: 34309141 DOI: 10.1111/odi.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Self-perceived oral health has been extensively investigated, but studies on homeless people are scarce, and there is currently no evidence from Latin America. OBJECTIVE To investigate the prevalence and factors associated with satisfaction with the oral health of homeless individuals in one Brazilian capital of the Midwest region. SUBJECT AND METHODS A cross-sectional study was carried out with 351 adult individuals attending a temporary public shelter who were interviewed about sociodemographic and psychosocial aspects, drugs use and oral health. The outcome was satisfaction with oral health (satisfied/dissatisfied). Pearson's chi-square test and Poisson regression with robust variance were used for statistical analysis. RESULTS The prevalence of dissatisfaction with oral health was 68.9% (95% CI = 63.9-73.6). After adjusting for covariates, dissatisfaction was more frequent among individuals who were married/in a stable relationship (PR = 1.18; 95% CI = 1.02-1.36), with felt need for treatment (PR = 2.27; 95% CI = 1.23-4.17) or complete prosthesis (PR = 1.35; 95% CI = 1.18-1.55), and those who used illicit drugs in the past six months (PR = 1.22; 95% CI = 1.06-1.39). CONCLUSION The prevalence of dissatisfaction with oral health in the homeless individuals studied was high and associated with their marital status, use of illicit drugs and self-reported need for dental treatment and complete prosthesis.
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Affiliation(s)
| | | | - João Batista de Souza
- Postgraduate Program, Faculty of Dentistry, Federal University of Goiás, Goiania, Brazil
| | - Marcos André de Matos
- Postgraduate Program, Faculty of Nursing, Federal University of Goiás, Goiania, Brazil
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McLaughlin MF, Li R, Carrero ND, Bain PA, Chatterjee A. Opioid use disorder treatment for people experiencing homelessness: A scoping review. Drug Alcohol Depend 2021; 224:108717. [PMID: 33985863 PMCID: PMC9758007 DOI: 10.1016/j.drugalcdep.2021.108717] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The opioid-related overdose epidemic remains a persistent public health problem in the United States and has been accelerated by the 2019 coronavirus disease pandemic. Existing, evidence-based treatment options for opioid use disorder (OUD) are broadly underutilized, particularly by people experiencing homelessness (PEH). PEH are also more likely to misuse and overdose on opioids. To better understand current gaps and disparities in OUD treatment experienced by PEH and efforts to address them, we synthesized the literature reporting on the intersection of housing status and OUD treatment. METHODS We conducted a scoping review of the literature from the electronic databases MEDLINE, Embase, PsycINFO, and Web of Science Core Collection. We included studies describing treatment-related outcomes specific to PEH and articles assessing OUD treatment interventions tailored to this population. Relevant findings were compiled via thematic analysis and narratively synthesized. RESULTS 60 articles met our inclusion criteria, including 43 descriptive and 17 intervention-focused studies. These studies demonstrated that PEH experience more barriers to OUD treatment than their housed counterparts and access inpatient and detoxification treatment more commonly than pharmacotherapy. However, the reviewed literature indicated that PEH have similar outcomes once engaged in pharmacotherapy. Efficacious interventions for PEH were low-barrier and targeted, with housing interventions also demonstrating benefit. CONCLUSIONS PEH have diminished access to evidence-based OUD treatment, particularly medications, and require targeted approaches to improve engagement and retention. To mitigate the disproportionate opioid-related morbidity and mortality PEH experience, innovative, flexible, and interdisciplinary OUD treatment models are necessary, with housing support playing an important role.
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Affiliation(s)
- Matthew F. McLaughlin
- Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States,Corresponding author. Present address at: San Francisco Department of Public Health, 25 Van Ness Ave. Suite 500, San Francisco, CA, 94102, United States
| | - Rick Li
- Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States
| | | | - Paul A. Bain
- Countway Library, Harvard Medical School, 10 Shattuck St., Boston, MA, 02115, United States
| | - Avik Chatterjee
- Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA, 02118, United States,Boston University School of Medicine/Boston Medical Center, 72 E. Concord St., Boston, MA, 02118, United States
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Carlsen SEL, Isaksen K, Fadnes LT, Lygren OJS, Åstrøm AN. Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals' experiences. Subst Abuse Treat Prev Policy 2021; 16:44. [PMID: 34001202 PMCID: PMC8130131 DOI: 10.1186/s13011-021-00379-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). METHODS Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. RESULTS Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients' expectations and the services offered and perceived stigma. OMT patients' lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs' lack of knowledge and information of the OMT system and what they can offer patients. CONCLUSIONS OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased.
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Affiliation(s)
| | - Katja Isaksen
- Oral Health Centre of Expertise in Western Norway, PO Box 7900, 5020, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction medicine, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
- Institute of Global health, University of Bergen, PO Box 7804, 5020, Bergen, Norway
| | - Ole Jørgen Scheie Lygren
- Department of Addiction medicine, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
| | - Anne Nordrehaug Åstrøm
- Department of clinical dentistry, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
- Oral Health Centre of Expertise in Western Norway, PO Box 7900, 5020, Bergen, Norway.
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8
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Bahdila D, Aldosari M, Abdullah A, Nelson JL, Hegazi F, Badamia R, Alhazmi H, Chandel T, Odani S, Vardavas CI, Agaku IT. Cocaine, polysubstance abuse, and oral health outcomes, NHANES 2009 to 2014. J Periodontol 2020; 91:1039-1048. [PMID: 31919844 DOI: 10.1002/jper.19-0509] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/20/2019] [Accepted: 12/04/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cocaine is the second most abused illicit drug in the United States. To date, no study has examined the association between cocaine use and oral health with a nationally representative sample. Our study examined the association between cocaine use-singly and with other substances-and oral health outcomes, including periodontitis and untreated caries, among US adults. METHODS Data for 11,753 individuals, aged ≥30 years, who completed a periodontal examination, in the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Descriptive analyses and multivariable binary logistic regression analyses were conducted on weighted data. RESULTS Overall, 17% (20.5 million) of US adults aged ≥30 years had ever used cocaine, with higher likelihood seen among males, non-Hispanic whites, and those living in poverty. Current cocaine use prevalence was 2.6% (3.2 million). By number of co-used substances, the odds of having any periodontitis were higher among cocaine users who consumed ≥3 other substances (adjusted OR = 2.47; 95% CI = 1.15 to 5.30) when compared with solely cocaine users. By type of substance co-used, odds of having untreated caries were greater among those reporting cigarettes (adjusted OR = 1.94; 95% CI = 1.21 to 3.11) or methamphetamine (adjusted OR = 5.40; 95% CI = 1.92 to 15.14) usage. Odds of any periodontitis were higher among those reported ancillary cigarette use (adjusted OR = 2.84; 95% CI = 1.60 to 5.04) compared with cocaine-only users. CONCLUSIONS In addition to a positive association between periodontal disease, dental caries, and cocaine use, select co-usage elevated the risk of oral disease. Patients should be screened for and counseled regarding substance abuse to facilitate a successful quit.
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Affiliation(s)
- Dania Bahdila
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muath Aldosari
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Abeer Abdullah
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jevae L Nelson
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Fahad Hegazi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Riddhi Badamia
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Hesham Alhazmi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Tejasvita Chandel
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Satomi Odani
- The National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Israel T Agaku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
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Differences in Utilization of Medical and Dental Services among Homeless People in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155304. [PMID: 32717950 PMCID: PMC7432539 DOI: 10.3390/ijerph17155304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: Homelessness contributes to both needs for care and barriers to access. This study aimed to explore the utilization of medical or dental services using Andersen's model for a vulnerable population of homeless in South Korea. (2) Methods: The data were applied from the first national survey for homeless people in South Korea, 2016. Totally 2032 persons participated in the interview survey. This study team requested the raw data through the public portal and analyzed them. (3) Results: The participants who were homeless for more than ten years, staying in small rooming house or shelter, non-employed, earning less than 500,000 won per month, and having a medical condition showed a significantly higher chance of using Medicaid. The use of outreach programs had a significant relationship with gender, duration of homelessness, and monthly income. Among dental patients, the homeless who did not consume alcohol, stayed in a shelter, and were employed had higher chances of using dental service. (4) Conclusions: Medicaid service was strongly related to enabling factors but outreach programs with predisposing factors. Dental service showed strong relationships with the enabling domain, but the pattern was opposite: the jobless had less chance to avail it. The policymakers need to consider these domains of service utilization to provide equitable access to healthcare services.
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Yazdanian M, Armoon B, Noroozi A, Mohammadi R, Bayat AH, Ahounbar E, Higgs P, Nasab HS, Bayani A, Hemmat M. Dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis. BMC Oral Health 2020; 20:44. [PMID: 32041585 PMCID: PMC7011515 DOI: 10.1186/s12903-020-1010-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of our study was to perform a systematic review of the literature and meta-analysis in order to investigate relationship between drug use and oral health. METHODS We searched for studies in English published before July 1, 2019 on PsycINFO, PubMed, SciELO, Scopus, and Web of Science. We assessed the relationship between drug use (methamphetamines, heroin; opiates; crack, cocaine and cannabis as dependent variables) and reported tooth loss, periodontal disease, or decayed, missing, and filled teeth index as an independent variable. The data were analyzed using Stata 12.0 software. RESULTS We initially identified 1836 potential articles (with 1100 duplicates) and screened the remaining 736 titles and abstracts, comprising 54 studies. In the next step, we evaluated the full-texts; 44 studies were excluded, accordingly. In total, we included 10 publications in the meta-analysis. Drug type was associated with periodontal disease (OR 1.44; 95% CI 0.8-2.6) and pooled estimates showed that type of drug used increased the odds of the number of decayed, missed and filled teeth (DMFT) (OR 4.11; 95% CI 2.07-8.15) respectively. CONCLUSIONS The analytical challenges of segregating the impact of individual drug types on oral health diseases mean that investigations on the direct relationship between oral health status and drug use are limited. Developing programs to improve potential confounding with various substances and addressing the dental health needs of people who use drugs is vital if we are to improve their overall quality of life.
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Affiliation(s)
- Mohsen Yazdanian
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Bahram Armoon
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Public Health,, Loresatn University of Medical Sciences, Khoram Abad, Iran
| | - Amir-Hosein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Elahe Ahounbar
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hormoz Sanaei Nasab
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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11
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Omerov P, Craftman ÅG, Mattsson E, Klarare A. Homeless persons' experiences of health- and social care: A systematic integrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1-11. [PMID: 31524327 DOI: 10.1111/hsc.12857] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 05/22/2023]
Abstract
Homelessness is associated with high risks of morbidity and premature death. Many interventions aimed to improve physical and mental health exist, but do not reach the population of persons experiencing homelessness. Despite the widely reported unmet healthcare needs, more information about the barriers and facilitators that affect access to care for persons experiencing homelessness is needed. A systematic integrative review was performed to explore experiences and needs of health- and social care for persons experiencing homelessness. The following databases were searched: AMED, ASSIA, Academic Search Complete, CINAHL, Cochrane library, Nursing and Allied Database, PsycInfo, PubMed, Scopus and Web of Science Core Collection. Twenty-two studies met the inclusion criteria of empirical studies with adult persons experiencing homelessness, English language, and published 2008-2018. Fifty percent of the studies were of qualitative and quantitative design, respectively. Most studies (73%) were conducted in the United States (n=11) and Canada (n=5). The analysis resulted in three themes Unmet basic human needs, Interpersonal dimensions of access to care, and Structural and organizational aspects to meet needs. The findings highlight that persons in homelessness often must prioritize provision for basic human needs, such as finding shelter and food, over getting health- and social care. Bureaucracy and rigid opening hours, as well as discrimination and stigma, hinder these persons' access to health- and social care.
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Affiliation(s)
- Pernilla Omerov
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Elisabet Mattsson
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Uppsala, Sweden
| | - Anna Klarare
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Uppsala, Sweden
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12
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Bowes C, Page G, Wassall R, Lloyd C. The need for further oral health research surrounding the provision of dental treatment for people with drug dependency. Br Dent J 2019; 227:58-60. [PMID: 31300786 DOI: 10.1038/s41415-019-0469-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this article is to highlight the need for further research in providing dental care for people with drug dependency. The association between people who misuse substances and dental disease is widely known occurrence, yet there have been few studies conducted in the UK surrounding this issue due to the nature of the cohort. Further to this, there are a multitude of barriers to accessing/seeking dental care that exist for those with drug dependency. Going forward, there is a need for the development of a new service model where dental care is part of a multidisciplinary team working towards treating people with drug dependency in a holistic way.
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Affiliation(s)
- Charlotte Bowes
- Newcastle University, Restorative Dentistry, Dental Hospital, Newcastle, UK.
| | - Geoff Page
- University of York, Department of Social Policy and Social Work, York, UK
| | - Rebecca Wassall
- Newcastle University, School of Dental Sciences, Newcastle, UK
| | - Charlie Lloyd
- University of York, Social Policy and Criminal Justice, Director of Graduate School, York, UK
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13
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Freitas DJ, Kaplan LM, Tieu L, Ponath C, Guzman D, Kushel M. Oral health and access to dental care among older homeless adults: results from the HOPE HOME study. J Public Health Dent 2019; 79:3-9. [PMID: 30295922 PMCID: PMC6420347 DOI: 10.1111/jphd.12288] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/01/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the prevalence of and factors associated with oral health measures in a sample of older homeless adults in Oakland, CA. METHODS We conducted a cross-sectional analysis of data from a population-based study of 350 homeless adults aged ≥50 in which trained researchers conducted structured interviews using validated questions regarding sociodemographics, health-related behaviors, healthcare utilization, and health status. We assessed self-reported tooth loss, oral pain, and unmet need for dental care. We used multivariable logistic regression to examine factors associated with missing half or more teeth. RESULTS Over half 201/350 (57.4 percent) of participants were missing at least half of their teeth. Half 191/350 (54.6 percent) reported oral pain in the past 6 months; 101/350 (28.9 percent) reported that oral pain prevented them from eating and 73/350 (20.9 percent) reported that pain prevented sleeping. Almost half, 141/350 (40.3 percent), had not seen a dentist in over 5 years, and over half 190/350 (54.3 percent) reported being unable to obtain needed dental care. In multivariate models, increased age (AOR = 1.09, 95 percent CI 1.04-1.14), moderate-to-high risk alcohol use (AOR = 2.17, CI = 1.23-3.84), moderate-to-high risk cocaine use (AOR = 1.72, CI = 1.03-2.88), and ever smoking (AOR = 2.87, CI = 1.59-5.18) were associated with an increased odds of having lost half or more teeth. CONCLUSIONS Tooth loss and oral pain are highly prevalent in older homeless adults. Increasing age, alcohol, drug, and tobacco use are associated with tooth loss.
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Affiliation(s)
- Daniel J Freitas
- Department of Family & Community Medicine, University of California, San Francisco
| | - Lauren M. Kaplan
- Division of General Internal Medicine at Zuckerberg General Hospital and Trauma Center; University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center; University of California, San Francisco
| | - Lina Tieu
- Division of General Internal Medicine at Zuckerberg General Hospital and Trauma Center; University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center; University of California, San Francisco
| | - Claudia Ponath
- Division of General Internal Medicine at Zuckerberg General Hospital and Trauma Center; University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center; University of California, San Francisco
| | - David Guzman
- Division of General Internal Medicine at Zuckerberg General Hospital and Trauma Center; University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center; University of California, San Francisco
| | - Margot Kushel
- Division of General Internal Medicine at Zuckerberg General Hospital and Trauma Center; University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center; University of California, San Francisco
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Ranin J, Salemovic D, Brmbolic B, Marinkovic J, Boricic I, Pesic PI, Zerjav S, Stanojevic M, Jevtovic D. Comparison of Demographic, Epidemiological, Immunological, and Clinical Characteristics of Patients with HIV Mono-infection Versus Patients Co-infected with HCV or/and HBV: A Serbian Cohort Study. Curr HIV Res 2019; 16:222-230. [PMID: 30014804 DOI: 10.2174/1570162x16666180717115614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The study aimed to correlate the status of hepatitis C (HCV) and hepatitis B virus (HBV) co-infection in patients with human immunodeficiency virus (HIV) infection with clinical and demographic data prior to starting highly active antiretroviral therapy (HAART) and assess the impact of HCV and HBV co-infection on the natural history of HIV infection. PATIENTS AND METHODS The study involved a total of 836 treatment-naive patients with available serological status for HBV and HCV at the point of therapy initiation. Patients were stratified into four groups: HIV mono-infection, HIV/HCV, HIV/HBV, and HIV/HCV/HBV co-infection. Demographic, epidemiological, immunological and clinical characteristics were analyzed in order to assess the possible impact of HCV and HBV co-infection on HIV - related immunodeficiency and progression to AIDS. RESULTS The prevalence of HCV and HBV co-infection in our cohort was 25.7% and 6.3%, respectively. Triple HIV/HCV/HBV infection was recorded in 1.7% of the patients. In comparison with those co-infected with HCV, patients with HIV mono-infection had lower levels of serum liver enzymes activity and higher CD4 cell counts, and were less likely to have CD4 cell counts below100 cells/µL and clinical AIDS, with OR 0.556 and 0.561, respectively. No difference in the development of advanced immunodeficiency and/or AIDS was recorded between patients with HIV monoinfection and those co-infected with HBV, or both HCV/HBV. CONCLUSION HIV/HCV co-infection was found to be more prevalent than HIV/HBV co-infection in a Serbian cohort. Co-infection with HCV was related to more profound immunodeficiency prior to therapy initiation, reflecting a possible unfavorable impact of HCV on the natural history of HIV infection.
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Affiliation(s)
- J Ranin
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Salemovic
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Brmbolic
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Marinkovic
- University of Belgrade Faculty of Medicine, Institute for Medical Statistics, Belgrade, Serbia
| | - I Boricic
- University of Belgrade Faculty of Medicine, Institute for Pathohystology, Belgrade, Serbia
| | - Pavlovic I Pesic
- Virology Laboratory, Microbiology Department, Clinical Center Serbia, Belgrade, Serbia
| | - S Zerjav
- Virology Laboratory, Microbiology Department, Clinical Center Serbia, Belgrade, Serbia
| | - M Stanojevic
- University of Belgrade Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia
| | - D Jevtovic
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
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Bonny-Noach H, Ronel N. Everyday Substance Insecurity Among Homeless Injection Drug Users in Israel’s Largest Open Drug Scene. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618791261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited attention has been given to Homeless Injection Drug Users (HIDUs) perceived need for illegal substances. This study assessed self-perceived illegal drug need in HIDUs based on their experiences. Observations and in-depth qualitative interviews were conducted with 11 HIDUs and with four treatment professionals. The findings revealed three findings concerning the unique experiences and perceptions of HIDUs: (a) Everyday Substance Need caused fear and anxiety, (b) Substance Need was experienced as more urgent than basic survival needs, and (c) HIDU participants attributed misunderstanding and denial of Substance Need to the authorities. It was found that HIDUs suffer from “Substance Insecurity,” which may be defined as the uncertain availability of quality substances (or their substitutes) and uncertain ability to acquire substances/substitutes and safe injection equipment in socially acceptable (or not) ways. Increased awareness of Substance Insecurity for HIDUs as a Substance Security First (SSF) model should be adopted.
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Goode J, Hoang H, Crocombe L. Homeless adults' access to dental services and strategies to improve their oral health: a systematic literature review. Aust J Prim Health 2018; 24:PY17178. [PMID: 29983138 DOI: 10.1071/py17178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 11/23/2022]
Abstract
Homeless people have poor oral health and high treatment needs, yet tend to make problem-based dental visits. This review aimed to determine how and where homeless adults receive oral health care, the barriers that prevent homeless adults accessing dental care and find strategies to promote oral health to homeless adults. The databases MEDLINE via OvidSP, PubMed, CINAHL and Scopus were searched using the keywords: homeless, roofless, houseless, rough sleeper, couch surfer, shelter, hostel, dental and oral health. The inclusion criteria were: participants over the age of 17 years, studies written in English, based in developed countries and published after 2003. Selected articles were assessed using the Mixed Methods Appraisal Tool and data extracted were thematically analysed. Twenty-two studies met the inclusion criteria. Five main themes were found: how homeless people accessed dental care; factors affecting the uptake of care; strategies used to improve access to care; the effect of non-dental staff on dental care; and challenges with providing care to homeless people. Dental care for homeless adults was affected by numerous factors. Improving their access to dental services requires collaboration between support service providers, dental care to be near homeless populations and flexibility by dental services.
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17
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Baggio S, Dupuis M, Richard JB, Beck F. Addictive behaviors and healthcare renunciation for economic reasons in a French population-based sample. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:1-7. [PMID: 28818639 DOI: 10.1016/j.drugpo.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/22/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare renunciation for economic reasons is a major health concern, but it has been scarcely investigated among drug users, even if drug users constitute a vulnerable population in need of medical care. This study investigated associations of healthcare renunciation for economic reasons and addictive behaviors (alcohol, tobacco, cannabis, illicit drug use, and gambling) in a population-based sample of adults living in France, a country with universal health coverage. METHODS Data were collected using the 2014 Health Barometer, a French cross-sectional survey conducted among a random representative sample of the general population aged 18-64 (n=12,852). Measures included healthcare renunciation, substance use (alcohol, tobacco, cannabis, and other illicit drugs) and gambling. Experimental/recreational and heavy/chronic use were assessed. Logistic regressions were used to test the relationship between healthcare renunciation and addictive behaviors, controlling for relevant covariates. RESULTS A total of 25% of the participants had renounced care at least once in the previous twelve months. Most variables of drug use were significantly associated with increased healthcare renunciation. This was the case for heavy/hazardous use and experimental/recreational use. Regular gambling was not associated with healthcare renunciation, but disordered gambling was. CONCLUSION This study showed that addictive behaviors, including substance use and gambling, were part of the burden of vulnerability of people who forgo care. Therefore, drug use and gambling patterns should be a focus in the development of policies to reduce health inequalities, not only for heavy and chronic drug users.
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Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Switzerland; Division of Correctional Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Marc Dupuis
- Institute of Psychology, University of Lausanne, Switzerland.
| | | | - François Beck
- Observatoire Français des Drogues et des Toxicomanies (OFDT), The French Monitoring Center for Drugs and Drug Addiction, France; ERES, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMRS, 1136 Paris, France.
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18
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Dahlman D, Kral AH, Wenger L, Hakansson A, Novak SP. Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:29. [PMID: 28558841 PMCID: PMC5450090 DOI: 10.1186/s13011-017-0112-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022]
Abstract
Background People who inject drugs (PWID) often have poor health and lack access to health care. The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU). We describe the prevalence and features of self-reported physical pain and its association with NMPOU. Methods PWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013. Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs. Results Almost half of the sample reported pain, based on self-reported measures in the 24 h before their interview. The most common pain locations were to their back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21–3.80), and past 24 h pain interference with general activity (AOR 1.82 [95% CI 1.04–3.21]), walking ability (AOR 2.52 [95% CI 1.37–4.63]), physical ability (AOR 2.01 [95% CI 1.16–3.45]), sleep (AOR 1.98 [95% CI 1.13–3.48]) and enjoyment of life (AOR 1.79 [95% CI 1.02–3.15]). Conclusion Both pain and NMPOU are common among PWID, and highly correlated in this study. These findings suggest that greater efforts are needed to direct preventive health and services toward this population.
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Affiliation(s)
- Disa Dahlman
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Lund, Sweden. .,Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4, SE-205 02, Malmo, Sweden.
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, USA
| | - Lynn Wenger
- Behavioral and Urban Health Program, RTI International, San Francisco, USA
| | - Anders Hakansson
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Lund, Sweden.,Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4, SE-205 02, Malmo, Sweden
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Shetty V, Harrell L, Murphy DA, Vitero S, Gutierrez A, Belin TR, Dye BA, Spolsky VW. Dental disease patterns in methamphetamine users: Findings in a large urban sample. J Am Dent Assoc 2015; 146:875-85. [PMID: 26610832 PMCID: PMC5364727 DOI: 10.1016/j.adaj.2015.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface. METHODS Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease. RESULTS On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance. CONCLUSIONS MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive. PRACTICAL IMPLICATIONS The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.
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Affiliation(s)
- Vivek Shetty
- School of Dentistry, University of California, Los Angeles, Los Angeles, 90095-1668, USA
| | - Lauren Harrell
- School of Dentistry, University of California, Los Angeles, Los Angeles, 90095-1668, USA
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, 90095-1563, USA
| | - Debra A. Murphy
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, 90095-1563
| | | | - Alexis Gutierrez
- School of Dentistry, University of California, Los Angeles, Los Angeles, 90095-1668, USA
| | - Thomas R. Belin
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, 90095-1563, USA
| | - Bruce A. Dye
- National Institute of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA
| | - Vladimir W. Spolsky
- School of Dentistry, University of California, Los Angeles, Los Angeles, 90095-1668, USA
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Health, perceived quality of life and health services use among homeless illicit drug users. Drug Alcohol Depend 2015; 154:139-45. [PMID: 26188997 DOI: 10.1016/j.drugalcdep.2015.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/11/2015] [Accepted: 06/17/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Drug misuse has been identified as a significant problem in homeless populations. This study examines aspects of physical and mental health, perceived quality of life and health service use among homeless illicit drug users and compares these to non-drug users. METHODS Participants were recruited through health clinics across Dublin. A questionnaire assessed participants' drug use, health and well-being, health behaviours and use of health services. Descriptive statistics are presented for the entire cohort and drug users separately. Logistic regression analysis was used to examine the relationship between drug use and (i) multimorbidity, (ii) anxiety and/or depression, (iii) perceived quality of life and (iv) use of health services. RESULTS Of 105 participants recruited, 35 (33%) were current drug users. Current and previous drug users were significantly more likely to have multimorbidity than those who had never taken drugs (OR 4.86, 95% CI 1.00-23.66). There was no significant difference between drug users and non-drug users in the prevalence of anxiety and/or depression. Drug users were five times more likely than non-drug users to have a low perceived quality of life (OR 5.2, 95% CI 1.7-16.0). Health service utilization was high, although some services were used less by drug users (e.g., dentist and psychiatric outpatient services) while others were used more often (e.g., phoneline services and day care centres). CONCLUSION This study highlights the high levels of drug use in this population and the negative impact of drug use on health and perceived quality of life of a homeless population in Dublin.
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Cardiovascular disease among people with drug use disorders. Int J Public Health 2015; 60:659-68. [PMID: 26104131 DOI: 10.1007/s00038-015-0698-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/06/2015] [Accepted: 05/27/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To present the prevalence and incidence of cardiovascular disease (CVD) in a national cohort of patients seeking treatment for drug use disorders (DUD). METHODS This is a longitudinal record linkage study of consecutive DUD treatment admissions between 2000 and 2006 from Denmark. RESULTS Of 17,642 patients seeking treatment for DUD, 828 individuals (4.53%) had a history of CVD at treatment entry. Among the remaining patients, 16,820 were traced and 1535 new incident cases of CVD were observed during a mean follow-up time of 7.5 years. The incidence of CVD was associated with intravenous drug use [subhazard ratio (SHR) = 1.41, p < 0.001], not responding to injection question (SHR = 1.23, p = 0.005), older age (SHR = 1.04 per year, p = 0.000), use of prescription methadone (SHR = 1.32, p < 0.001), use of benzodiazepines (SHR = 1.21, p = 0.005), and being referred to methadone treatment (SHR = 1.15, p = 0.022). The use of amphetamines was negatively associated with the risk of CVD within this cohort (SHR = 0.75, p = 0.001). CONCLUSIONS Patients injecting drugs using prescribed methadone were at elevated risk for cardiovascular disease and should be monitored for CVD. Opioid medications should be evaluated in terms of their cardiovascular sequelae.
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O'Rourke A, Ruiz MS, Allen ST. Client-identified needs and agency-provided services at a harm reduction community based organization in the District of Columbia. Harm Reduct J 2015; 12:17. [PMID: 26037624 PMCID: PMC4455049 DOI: 10.1186/s12954-015-0051-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Harm reduction case management relies on client-identified goals to drive the provision of care in order to “meet clients where they are at”. This research measured the level of agreement between client-identified needs and agency-provided services at a community based organization (CBO) in Washington DC by examining: (1) the services clients most often identified, (2) the services most often given to clients by the CBO, and (3) the level of alignment between client-identified needs and services provided. Methods Case file reviews were completed for 151 clients who received case management services at the CBO between January 2010 and February 2011. Client-identified needs and agency-provided services were extracted from case files and divided into 9 matching need and service categories: pharmaceutical assistance (e.g., prescription renewal), medical or dental care, housing, mental health services, substance use services, support services (e.g., support group meetings), legal assistance, and employment/job training. Client-identified needs and services provided were analyzed using McNemar’s Chi-square to assess for significant differences in discordant pairs. Results Clients were mostly Black (90.7 %), heterosexual (63.6 %), HIV positive (93.4 %), and over 40 years old at the time of intake (76.2 %). On average, clients identified 2.44 needs and received 3.29 services. The most common client-identified needs were housing (63.7 %), support services (34.3 %), and medical/dental care (29.5 %). The most common agency-provided services were housing (58.2 %), support services (51.4 %), and medical/dental care (45.2 %). In 6 of the 9 service categories, there were statistically significant (p < .01) differences between those who received services not asked for and those who did not receive asked for services in the categories of pharmaceutical assistance, medical/dental care, substance abuse services, support services, legal assistance, and food access. In each of these matched service categories, the percentage of clients who received services not asked for was significantly higher than those who did not. Conclusion This research shows that, while there is general alignment between the services that clients most often want and the services most often provided, there are still instances where services are requested but are not being provided.
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Affiliation(s)
- Allison O'Rourke
- Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave, Suite 300, Washington, DC, 20052, USA.
| | - Monica S Ruiz
- Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave, Suite 300, Washington, DC, 20052, USA.
| | - Sean T Allen
- Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave, Suite 300, Washington, DC, 20052, USA.
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Truong A, Higgs P, Cogger S, Jamieson L, Burns L, Dietze P. Oral health-related quality of life among an Australian sample of people who inject drugs. J Public Health Dent 2015; 75:218-24. [PMID: 25753928 DOI: 10.1111/jphd.12092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/26/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES People who inject drugs (PWID) have poor oral health. However, their oral health-related quality of life (OHRQoL) is unknown. Our study was designed to measure the OHRQoL of PWID. METHODS The Oral Health Impact Profile-14 (OHIP-14) was administered to 794 PWID recruited in Australian capital cities as part of the 2013 Illicit Drug Reporting System (IDRS). Three OHIP-14 summary indicators were examined: "Prevalence" (proportion reporting ≥1 item at least "fairly often"), "severity" (mean total OHIP-14 score), and "extent" (number of impacts reported at least "fairly often"). Associations between "prevalence" and "extent" and variables drawn from the health, drug use, and social domains were investigated. RESULTS All OHIP-14 summary indicators among IDRS participants were significantly higher than in the general Australian population. In multivariate analysis, the "prevalence" indicator was significantly and positively associated with female gender [adjusted odds ratio (AOR) = 1.75, 95% CI 1.27-2.38], those born in Australia (AOR = 2, 95% CI 1.25-3.23), not completing Year 10 compared with those who had completed Year 12 or a higher qualification (AOR = 1.59, 95% CI 1.03-2.44), and methadone treatment (AOR = 1.61, 95% CI 1.14-2.29). The "extent" indicator was significantly and positively associated with female gender [adjusted incidence rate ratio (AIRR) = 1.56, 95% CI 1.19-2.08], unemployment (AIRR = 1.59, 95% CI 1.01-2.44), and having an injecting career of 10-20 years (AIRR = 1.76, 95% CI 1.03-3.01). CONCLUSIONS PWID have poorer OHRQoL than the Australian general population. Poor OHRQoL was particularly common in female PWID and those with longer injecting careers. Interventions to improve the oral health of PWID may improve their OHRQoL.
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Affiliation(s)
- Arthur Truong
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter Higgs
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.,National Drug Research Institute, Curtin University, Fitzroy, VIC, Australia
| | - Shelley Cogger
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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Al-Tayyib AA, Thiede H, Burt RD, Koester S. Unmet Health Care Needs and Hepatitis C Infection Among Persons Who Inject Drugs in Denver and Seattle, 2009. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 16:330-40. [DOI: 10.1007/s11121-014-0500-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Salem BE, Nyamathi A, Brecht L, Phillips LR, Mentes J, Sarkisian C, Stein JA. Constructing and identifying predictors of frailty among homeless adults—a latent variable structural equations model approach. Arch Gerontol Geriatr 2014; 58:248-56. [PMID: 24505611 PMCID: PMC4005873 DOI: 10.1016/j.archger.2013.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Homeless urbanites are a heterogeneous population with unique health and social service needs. The study examined situational, behavioral, health-related and resource indicators in terms of their direct impact on frailty, hypothesized as a latent variable. Using structural equation modeling (SEM), a model was tested with 150 homeless men and women, ages 40–73, from three homeless day center drop-in sites on Skid Row and one residential drug treatment (RDT) facility that works with homeless parolees and probationers. In bivariate analyses with the latent construct frailty, months homeless (p < 0.01), female gender (p < 0.05), education (p < 0.05), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), health care utilization (p < 0.01), and falls (p < 0.001) were significantly associated with frailty. In the final path model, significant predictors of frailty included educational attainment (p < 0.01), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), and falls (p < 0.01). These findings will serve as a foundation for future nurse-led, community-based initiatives that focus on key predictors of frailty among the homeless and the development of interventions.
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Affiliation(s)
- Benissa E. Salem
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Adeline Nyamathi
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Lynn Brecht
- UCLA School of Nursing, Address: 700 Tiverton Avenue Los Angeles,
CA 90095
| | - Linda R Phillips
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Janet Mentes
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Catherine Sarkisian
- Geriatric Research Education Clinical Center (GRECC), Address:
11301 Wilshire Blvd. Los Angeles, CA 90073
| | - Judith A. Stein
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
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The oral health of heroin drug users: case study in Bosnia and Herzegovina. BMC Public Health 2013; 13:1202. [PMID: 24355082 PMCID: PMC3878313 DOI: 10.1186/1471-2458-13-1202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injection drug use is a major public health problem. Oral health problems and the appearance of dental disease among injection drug users (IDUs) are caused by their lifestyle. The aim of the present study was to examine the relations between socioeconomic factors, drug use, and oral hygiene habits on the oral health of heroin drug users. METHODS A cross-sectional survey on oral health was carried out as part of UNICEF's research on the biological and behaviours survey among injection drug users in Sarajevo, Banja Luka and Zenica in Bosnia and Herzegovina. A sample of 519 IDUs participated in the survey. Respondent Driven Sampling (RDS) was used to obtain the sample. The data were obtained through face-to-face interviews using a structured questionnaire related to socio-demographic characteristics, duration of drug injection, frequency of drug injection in the last month and oral health. RESULTS Older participants (OR = 1.06; 95% CI = 1.02 -1.10), part-time employment (OR = 3.57; 95% CI = 1.02 - 12.20) and unemployment (OR = 3.23; 95% CI = 1.23 - 8.33) in comparison to full-time employment as the referent category, and longer duration of drug injection (OR = 1.06; 95% CI = 1.003 - 1.12) were predictors of bad oral health. A higher level of education (OR = 0.56; 95% CI = 0.39 - 0.79), more frequent tooth brushing (OR = 0.59; 95% CI = 0.49 - 0.71), and regular dental checkups (OR = 3.30; 95% CI = 1.42 - 7.67) were predictors of good oral health. CONCLUSIONS Socioeconomic characteristics of IDUs as well as their lifestyles may contribute to oral health problems. Heroin drug users have specific dental needs, and programmes to improve their oral health should be an integral part of strategies to prevent addictions including treatments and harm reduction programmes.
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Simons D, Pearson N, Movasaghi Z. Developing dental services for homeless people in East London. Br Dent J 2013; 213:E11. [PMID: 23059693 DOI: 10.1038/sj.bdj.2012.891] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to describe the dental services delivered by the Community Dental Service (CDS) of Tower Hamlets (TH) and City and Hackney (CH) for adult homeless people in 2009-2011, to assess if the service met its planned objectives and to report the outcomes of the dental care provided. METHOD TH and CH CDS provided a nine tier dental service for homeless people during April 2009 to September 2011, in which the dedicated mobile dental service (MDS) and the dedicated dental clinic (DDS) provided 3,102 dental appointments for homeless people. Data collection from a random sample (n = 350) of record cards of adult patients who were homeless and offered oral care from these services was conducted, in collaboration with an analysis of appointment books, service delivery rotas and day sheets. Patients' oral findings, treatments, challenges as well as feedback received from the service users were recorded and evaluated against the planned objectives. RESULTS One thousand two hundred and twelve (39.1%) of these appointments went to the 350 patients whose record cards were examined as part of this audit. One of the record cards randomly selected had incomplete date and was excluded from the results, so data was presented on the 349 complete record cards. The age range of these patients was 18-74 years, with a mean age of 38.46 years ± 9.1 standard deviation (SD) with 80% of the patients (n = 281) under 50 years of age. Forty percent of these patients presented in pain with a further 5% complaining of swelling and infection, 99% of people required treatment and only nine people had no decay, three of whom were edentulous. Two hundred and thirteen (61%) patients completed their treatments, which took between 1 to 18 appointments, but only 97 (27.8%) patients did so without any failed or cancelled appointments. Of the 128 (36.7%) patients who were lost after the first appointment, only 15 (11.7%) did not receive any treatment; most had been treated for pain with temporary fillings, extractions, permanent fillings and management of swelling. Sixty-seven band 1, 16 band 1.2 (emergency only), 148 band 2 and 52 band 3 courses of treatment were submitted. CONCLUSION This study showed a significant need for services providing oral healthcare for this population and highlighted that flexibly delivered dental services, embedded in local health and social networks, seemed to promote uptake in these clients who normally find it extremely difficult to find dental care services elsewhere.
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Affiliation(s)
- D Simons
- Barts and The London Community Heath Services Division Dental Services, Dental Admin, 3rd Floor, B Block St Leonards Primary Care Centre, Nuttall Street, London, N1 5LZ, UK.
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SHEKARCHIZADEH H, KHAMI MR, MOHEBBI SZ, EKHTIARI H, VIRTANEN JI. Oral Health of Drug Abusers: A Review of Health Effects and Care. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:929-40. [PMID: 26060654 PMCID: PMC4453891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/10/2013] [Indexed: 11/24/2022]
Abstract
Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug abuse: patients' need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment protocols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating addicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barriers, oral health care at various levels including education, prevention, and treatment should be integrated into general care services for addicts.
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Affiliation(s)
- Hajar SHEKARCHIZADEH
- 1. Research Center for Caries Prevention, Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,2. Dept. of Oral Public Health, University of Helsinki, Helsinki, Finland
| | - Mohammad R. KHAMI
- 2. Dept. of Oral Public Health, University of Helsinki, Helsinki, Finland,3. Dental Research Center, Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,* Corresponding Author:
| | - Simin Z. MOHEBBI
- 1. Research Center for Caries Prevention, Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,2. Dept. of Oral Public Health, University of Helsinki, Helsinki, Finland
| | - Hamed EKHTIARI
- 4. Translational Neuroscience Program, Institute for Cognitive Science Studies, Iran,5. Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Jorma I. VIRTANEN
- 6. Dept. of Community Dentistry, University of Oulu, Oulu, Finland,7. Dept. of Public Health, University of Helsinki, Helsinki, Finland
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Murphy RD, Gorbach PM, Weiss RE, Hucks-Ortiz C, Shoptaw SJ. Seroadaptation in a sample of very poor Los Angeles area men who have sex with men. AIDS Behav 2013; 17:1862-72. [PMID: 22644067 DOI: 10.1007/s10461-012-0213-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.
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Wallace BB, MacEntee MI, Harrison R, Hole R, Mitton C. Community dental clinics: providers' perspectives. Community Dent Oral Epidemiol 2012; 41:193-203. [DOI: 10.1111/cdoe.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 09/06/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Bruce B. Wallace
- Faculty of Dentistry; University of British Columbia; Vancouver; BC; Canada
| | | | - Rosamund Harrison
- Faculty of Dentistry; University of British Columbia; Vancouver; BC; Canada
| | - Rachelle Hole
- School of Social Work; University of British Columbia - Okanagan; Kelowna, BC; Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation; Vancouver Coastal Health; Research Institute School of Population and Public Health; University of British Columbia; Vancouver; BC; Canada
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Dental disease prevalence among methamphetamine and heroin users in an urban setting. J Am Dent Assoc 2012; 143:992-1001. [DOI: 10.14219/jada.archive.2012.0326] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rungsiyanont S, Vacharotayangul P, Lam-Ubol A, Ananworanich J, Phanuphak P, Phanuphak N. Perceived dental needs and attitudes toward dental treatments in HIV-infected Thais. AIDS Care 2012; 24:1584-90. [PMID: 22428899 DOI: 10.1080/09540121.2012.663884] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite the advancement in highly active antiretroviral therapy and improved health status of HIV-infected individuals, dental problems are still affecting their life and well-beings. We aimed to establish the prevalence of oral and dental complaints among HIV-infected patients, the prevalence of delayed access to dental service, and factors related with delayed access to dental service. A cross-sectional study using self-report questionnaire completed by the HIV-positive subjects was conducted at the largest HIV research clinic in Thailand during 2009-2010. Of all 299 subjects (28.6% males, 71% females, and 0.4% sex change from male to female: ages ranged from 22 to 59 years [mean 36.7±5.53)]), 84.3% reported of having past or present illnesses or problems related to the dental or oral conditions. The most reported problems were dental hypersensitivity (93.3%), bleeding from the gum (92.1%), and having dental caries (65.9%). Two-hundred and forty-two subjects (80.9%) would not disclose their HIV status when seeing a dentist. The most cited reasons of such behavior were their personal right whether to reveal or not, and being afraid of not receiving dental treatment from the dentists or staffs (51.7 and 40.9%, respectively). It is important to note that HIV-subjects admitted to having fear of being discriminated by the dental staffs even if they trusted their dentists as having high morality. In conclusion, our HIV-subjects had good basic knowledge of oral health with regard to HIV infection, experienced common dental problems, and wished to have accesses to HIV-dental specialist services, if possible.
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Affiliation(s)
- Sorasun Rungsiyanont
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Wattana, Bangkok, Thailand.
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Hunter C, Strike C, Barnaby L, Busch A, Marshall C, Shepherd S, Hopkins S. Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play? Harm Reduct J 2012; 9:9. [PMID: 22339847 PMCID: PMC3306827 DOI: 10.1186/1477-7517-9-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crystal methamphetamine smoking is associated with many negative health consequences, including the potential for transmission of hepatitis. We examined whether or not a kit for crystal methamphetamine smoking might have some potential to reduce the negative health effects of crystal methamphetamine smoking. METHODS Five focus groups were conducted with crystal methamphetamine smokers recruited by community health agencies and youth shelters in Toronto, Canada. Target groups included homeless/street-involved youth, sex workers, men who have sex with men, and youth in the party scene. Participants (n = 32) were asked questions about motivations for crystal methamphetamine use, the process of smoking, health problems experienced, sharing behaviour, risky sexual practices, and the ideal contents of a harm reduction kit. RESULTS Pipe sharing was widespread among participants and was deemed integral to the social experience of smoking crystal methamphetamine. Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lips, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug. Demand for harm reduction kits was mixed. CONCLUSIONS Changing pipe sharing behaviours may be difficult because many participants considered sharing to be integral to the social experience of smoking crystal methamphetamine. Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities (e.g., homeless/street-involved youth) is worth pursuing.
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Affiliation(s)
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto; Centre for Addiction and Mental Health, Toronto, Canada
| | - Lorraine Barnaby
- Shout Clinic, Central Toronto Community Health Centres, Toronto, Canada
| | - Adam Busch
- AIDS Committee of Toronto, Toronto, Canada
| | - Chantel Marshall
- The Works - Needle Exchange, Toronto Public Health, Toronto, Canada
| | - Susan Shepherd
- Toronto Drug Strategy Secretariat, Toronto Public Health, Toronto, Canada
| | - Shaun Hopkins
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
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