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Rathod SD, Annand PJ, Hosseini P, Guise A, Platt L. Epidemiological features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis. BJPsych Open 2024; 10:e93. [PMID: 38686447 PMCID: PMC11060085 DOI: 10.1192/bjo.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In England in 2021, an estimated 274 000 people were homeless on a given night. It has long been recognised that physical and mental health of people who are homeless is poorer than for people who are housed. There are few peer-reviewed studies to inform health and social care for depression or anxiety among homeless adults in this setting. AIMS To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe distribution of symptoms across sociodemographic, social vulnerability and health-related characteristics. METHOD We completed structured questionnaires with 311 adults who were homeless and who had difficulty accessing healthcare in London, UK, between August and December 2021. We measured anxiety and depression symptoms using the 4-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of the sociodemographic, social vulnerability and health-related characteristics, and tested for associations using the Kruskal-Wallis test. RESULTS The median PHQ-4 score was 8 out of 12, and 40.2% had scores suggesting high clinical need. Although PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with: young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and frequency of marijuana use. The most common (60%) barrier to accessing healthcare related to transportation. CONCLUSIONS Adults who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support consideration of population-level, multisectoral intervention.
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Affiliation(s)
- Sujit D. Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - P. J. Annand
- Department of Sociology, University of Surrey, UK
| | - Paniz Hosseini
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Guise
- Department of Population Health Sciences, King's College London, UK
| | - Lucy Platt
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Rasmussen AN, Guise A, Overgaard C. The role of social support in the experience of life with ischemic heart disease for socially disadvantaged patients: A qualitative study. Chronic Illn 2023; 19:354-367. [PMID: 34870487 DOI: 10.1177/17423953211065005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Ischemic heart disease (IHD) displays wide social inequalities that are often explained with reference to lifestyle factors. However, research indicates that social support may also play an important role in social inequality in IHD. This study aims to explore the role of social support in the experience of life with IHD for socially disadvantaged patients. METHODS The study was conducted as a critical hermeneutic qualitative study in Denmark between October 2018 and August 2019. Data consist of in-depth qualitative interviews with 30 socially disadvantaged patients with IHD. RESULTS The findings showed a notable difference between the participants who were engaged in close and supportive social relationships and those who were not. Life with IHD for those who lacked supportive relationships tended to be marked by feelings of chaos, powerlessness and meaninglessness. Contrarily, those who were engaged in supportive relationships received help to navigate their life with illness, reconcile with what had happened to them, feel empowered, and gain a sense of meaning in their life.Discussion: Social support from close social relationships appears to be crucial for socially disadvantaged ischemic heart patients, and should be encouraged and facilitated in healthcare and interventions targeting this patient group.
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Affiliation(s)
- Amanda Nikolajew Rasmussen
- Department of Health Science and Technology, 1004Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark
| | - Andrew Guise
- Population Health Sciences, 4616King's College London, Great Maze Pond, London SE1 1UL, UK
| | - Charlotte Overgaard
- Department of Health Science and Technology, 1004Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark
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Annand PJ, Platt L, Rathod SD, Hosseini P, Guise A. 'Progression capitals': How homeless health peer advocacy impacts peer advocates. Soc Sci Med 2022; 298:114770. [PMID: 35240541 PMCID: PMC9005785 DOI: 10.1016/j.socscimed.2022.114770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/08/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
This article presents analysis from a qualitative evaluation of a homeless health peer advocacy (HHPA) service in London, United Kingdom. Whilst evidence is growing for the impact of peer programming on clients, understanding of the impact on peers themselves is limited in the context of homelessness. Research here is vital for supporting sustainable and effective programmes. Analysis of interview data with 14 current and former peer advocates, 2 members of staff and 3 external stakeholders suggests peer advocacy and its organizational setting can generate social, human, cultural and physical resources to help peer advocates fulfil their own life goals. We explore these with reference to ‘recovery capital’, reframed as ‘progression capitals’ to reflect its relevance for pursuits unrelated to clinical understandings of recovery. Progression capitals can be defined as resources to pursue individually determined goals relating to self-fulfilment. We find engagement with, and benefits from, a peer advocacy service is most feasible among individuals already possessing some ‘progression capital’. We discuss the value of progression capitals for peers alongside the implications of the role being unsalaried within a neoliberal political economy, and comment on the value that the progression capitals framework offers for the development and assessment of peer interventions more broadly. HHPA can support advocates to ‘recover’ from health issues and fulfil self-defined life goals. Reframing ‘recovery capital’ as ‘progression capitals’ better captures HHPA's impact on peers. Progression capitals are resources to pursue self-determined goals relating to fulfilment. Organizations should maximize the progression capitals such programmes can enable for peers. Progression capitals offer a framework for developing/assessing peer programmes across sectors.
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Affiliation(s)
- P J Annand
- King's College London, United Kingdom; University of Surrey, United Kingdom.
| | - Lucy Platt
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Sujit D Rathod
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Paniz Hosseini
- London School of Hygiene and Tropical Medicine, United Kingdom
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Ejaz H, McGrath H, Wong BLH, Guise A, Vercauteren T, Shapey J. Artificial intelligence and medical education: A global mixed-methods study of medical students’ perspectives. Digit Health 2022; 8:20552076221089099. [PMID: 35521511 PMCID: PMC9067043 DOI: 10.1177/20552076221089099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Medical students, as clinicians and healthcare leaders of the future, are key stakeholders in the clinical roll-out of artificial intelligence-driven technologies. The authors aim to provide the first report on the state of artificial intelligence in medical education globally by exploring the perspectives of medical students. Methods The authors carried out a mixed-methods study of focus groups and surveys with 128 medical students from 48 countries. The study explored knowledge around artificial intelligence as well as what students wished to learn about artificial intelligence and how they wished to learn this. A combined qualitative and quantitative analysis was used. Results Support for incorporating teaching on artificial intelligence into core curricula was ubiquitous across the globe, but few students had received teaching on artificial intelligence. Students showed knowledge on the applications of artificial intelligence in clinical medicine as well as on artificial intelligence ethics. They were interested in learning about clinical applications, algorithm development, coding and algorithm appraisal. Hackathon-style projects and multidisciplinary education involving computer science students were suggested for incorporation into the curriculum. Conclusions Medical students from all countries should be provided teaching on artificial intelligence as part of their curriculum to develop skills and knowledge around artificial intelligence to ensure a patient-centred digital future in medicine. This teaching should focus on the applications of artificial intelligence in clinical medicine. Students should also be given the opportunity to be involved in algorithm development. Students in low- and middle-income countries require the foundational technology as well as robust teaching on artificial intelligence to ensure that they can drive innovation in their healthcare settings.
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Affiliation(s)
- Hamza Ejaz
- Norwich Medical School, University of East Anglia, UK
- Psychological and Behavioural Sciences, London School of Economics, UK
| | - Hari McGrath
- GKT School of Medical Education, King’s College London, UK
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian LH Wong
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Secretariat, the Lancet and Financial Times Commission on Governing Health Futures 2030, Global Health Centre, The Graduate Institute, 1211 Geneva, Switzerland
- Steering Committee, Digital Health Section, European Public Health Association (EUPHA), Utrecht, Netherlands
| | - Andrew Guise
- School of Population Health and Environmental Sciences, King’s College London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
- Department of Neurosurgery, King’s College Hospital, London, UK
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Platt L, Rathod SD, Cinardo P, Guise A, Hosseini P, Annand PJ, Surey J, Burrows M. Prevention of COVID-19 among populations experiencing multiple social exclusions. J Epidemiol Community Health 2021; 76:107-108. [PMID: 34728498 DOI: 10.1136/jech-2021-216889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/23/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sujit D Rathod
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paola Cinardo
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Guise
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Paniz Hosseini
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - P J Annand
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Julian Surey
- Institute of Global Health, University College London, London, UK.,Find and Treat, UCL NHS Trust, London, UK
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6
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Rathod SD, Guise A, Annand PJ, Hosseini P, Williamson E, Miners A, Bowgett K, Burrows M, Aldridge RW, Luchenski S, Menezes D, Story A, Hayward A, Platt L. Peer advocacy and access to healthcare for people who are homeless in London, UK: a mixed method impact, economic and process evaluation protocol. BMJ Open 2021; 11:e050717. [PMID: 34140346 PMCID: PMC8212404 DOI: 10.1136/bmjopen-2021-050717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates-that is, trained volunteers with lived experience-to support people who are homeless to access healthcare. METHODS AND ANALYSIS We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation. ETHICS AND DISSEMINATION Ethics approval for all study designs has been granted by the National Health Service London-Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine's Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.
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Affiliation(s)
- Sujit D Rathod
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Guise
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - P J Annand
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Paniz Hosseini
- Department of Public Health, Environments and Society, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Williamson
- Department of Public Health, Environments and Society, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Alec Miners
- Department of Public Health, Environments and Society, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robert W Aldridge
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Serena Luchenski
- UCL Farr Institute of Health Informatics Research, University College London, London, UK
| | - Dee Menezes
- UCL Farr Institute of Health Informatics Research, University College London, London, UK
| | - Alistair Story
- Find & Treat, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew Hayward
- Infection and Population Health, University College London, London, UK
| | - Lucy Platt
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Kusin S, Khouri R, Dietrich P, Dropkin B, Joice G, Ward E, Baumgarten A, Kansal J, Guise A, Morey A. 055 Minimally Invasive vs. Degloving Plication for Correction of Congenital Penile Curvature. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meyers SA, Rafful C, Jain S, Sun X, Skaathun B, Guise A, Gonzalez-Zuñiga P, Strathdee SA, Werb D, Mittal ML. The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico. Subst Abuse Treat Prev Policy 2020; 15:78. [PMID: 33046125 PMCID: PMC7552370 DOI: 10.1186/s13011-020-00322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the U.S. and Canada, people who inject drugs' (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID's experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use. METHODS PReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision. RESULTS At PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants' recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment. CONCLUSION Tijuana's abstinence-based drug treatment and recovery services were viewed as unable to meet participants' recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Claudia Rafful
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- Addison House, Guy's Hospital, King's College London, Strand, London, WC2R 2LS, UK
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
- Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P, 22540, Tijuana, Baja California, Mexico.
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Dietrich P, Roadman D, Kiani K, Machen G, Smith-Harrison L, Guise A. 345 Penile Plication is an Effective Treatment Option for Congenital Penile Curvature. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Jipp J, Guise A. 253 Descriptive Outcomes of Patients Undergoing UroLift for Extended Indications. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mittal ML, Guise A, Rafful C, Gonzalez-Zuñiga P, Davidson P, Vashishtha D, Strathdee SA, Werb D. "Another Person Was Going to Do It": The Provision of Injection Drug Use Initiation Assistance in a High-Risk U.S.-Mexico Border Region. Subst Use Misuse 2019; 54:2338-2350. [PMID: 31389282 PMCID: PMC6883155 DOI: 10.1080/10826084.2019.1648514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Persons who inject drugs (PWID) play a key role in assisting others' initiation into injection drug use (IDU). We aimed to explore the pathways and socio-structural contexts for this phenomenon in Tijuana, Mexico, a border setting marked by a large PWID population with limited access to health and social services. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER) is a multi-cohort study assessing socio-structural factors associated with PWID assisting others into initiating IDU. Semi-structured qualitative interviews in Tijuana included participants ≥18 years old, who reported IDU within the month prior to cohort enrollment and ever initiating others into IDU. Purposive sampling ensured a range of drug use experiences and behaviors related to injection initiation assistance. Thematic analysis was used to develop recurring and significant data categories. Results: Twenty-one participants were interviewed (8 women, 13 men). Broadly, participants considered public injection to increase curiosity about IDU. Many considered transitioning into IDU as inevitable. Emergent themes included providing assistance to mitigate overdose risk and to protect initiates from being taken advantage of by others. Participants described reluctance in engaging in this process. For some, access to resources (e.g., shared drugs or a monetary fee) was a motivator to initiate others. Conclusion: In Tijuana, public injection and a lack of harm reduction services are perceived to fuel the incidence of IDU initiation and to incentivize PWID to assist in injection initiation. IDU prevention efforts should address structural factors driving PWID participation in IDU initiation while including PWID in their development and implementation.
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Affiliation(s)
- Maria L Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Division of Health and Social Care Research, King's College, London, UK
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Peter Davidson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Devesh Vashishtha
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
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Stengel CM, Mane F, Guise A, Pouye M, Sigrist M, Rhodes T. "They accept me, because I was one of them": formative qualitative research supporting the feasibility of peer-led outreach for people who use drugs in Dakar, Senegal. Harm Reduct J 2018; 15:9. [PMID: 29486774 PMCID: PMC5830063 DOI: 10.1186/s12954-018-0214-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/18/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Peer outreach harm reduction initiatives are being developed with and for people who use drugs in Dakar, Senegal. This is in response to growing injecting drug use across the West Africa region and linked emerging epidemics of HIV and hepatitis C. We undertook formative qualitative research to explore the feasibility and potential of peer outreach in this context and in particular how outreach could be linked to fostering community-level processes of change. METHODS We undertook a total of 44 semi-structured qualitative interviews. Thirty-four interviews were with people who used drugs (comprised of 25 participants who had injected at least once in their life) and included 11 peer educators who delivered "awareness-raising" harm reduction activities. We also interviewed 10 service providers involved in the planning and monitoring of peer outreach initiatives. We used thematic analysis to identify key characteristics of how peer-led outreach is being delivered, beneficiary need, and the nature of the social networks in which the awareness-raising activities operate. RESULTS Through interviews with peer educators, people who use drugs, and service providers, four main overlapping themes are identified as follows: peer educators as a bridge to responsibilization through awareness-raising activities, awareness-raising activities as an enactment of recovery, awareness raising through social network diffusion, and the contexts and constraints of peer outreach engagement through awareness-raising activities. CONCLUSIONS The study results suggest that peer education is on a trajectory to develop into a central role for harm reduction interventions in Dakar, Senegal. This research shows how peer education is bound in processes of responsibilization and self-change, which link to varying possibilities for risk reduction or recovery. For peer education to achieve a range of significant goals, broader structural and system changes should be implemented in the region. We caution that without such changes, awareness-raising activities and the role of peer educators may instead become part of state- and agency-sponsored processes of seeking to responsibilize individuals for health and harm reduction.
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Affiliation(s)
- Camille May Stengel
- University of Greenwich, Old Royal Naval College, Park Row, London, SE10 9LS, UK.
| | - Famara Mane
- Alliance Nationale des Communautés pour la Santé, Cité Keur Gorgui Villa 41, 10297, Dakar, Senegal
| | - Andrew Guise
- Addison House, Guy's Hospital, King's College London, London, SE1 9RT, UK
| | - Magath Pouye
- Alliance Nationale des Communautés pour la Santé, Cité Keur Gorgui Villa 41, 10297, Dakar, Senegal
| | - Monika Sigrist
- International HIV/AIDS Alliance, Preece House, 91-101 Davigdor Rd, Brighton, BN3 1RE, UK
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Piotrowski J, Jipp J, Radtke A, Smith-Harrison L, Tobin C, Sanger J, Guise A. 191 Adult Acquired Buried Penis: Experience and Outcomes after Surgical Correction at a Single Institution. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sundaram CP, Martin GL, Guise A, Bernie J, Bargman V, Milgrom M, Shalhav A, Govani M, Goggins W. Complications after a 5-year experience with laparoscopic donor nephrectomy: the Indiana University Experience. Surg Endosc 2007; 21:724-8. [PMID: 17334861 DOI: 10.1007/s00464-006-9176-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 09/25/2006] [Accepted: 11/20/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy (LDN) is becoming the standard of care for living donor nephrectomy. However, questions have been raised about the safety of LDN for the donor and about the potentially increased rates for ureteral complications experienced by the recipient. In this report, the authors review their 5-year experience with 253 living laparoscopic donor nephrectomies. METHODS A retrospective chart review was performed for 253 laparoscopic live donors. Graft function and survival were compared using recipient postoperative creatinine values up to 12 months. RESULTS The overall rate of complications in the investigated series was 10.3%. There were seven intraoperative complications (2.8%), three of which required open conversion. There were 19 postoperative complications (7.5%), three of which required reexploration for bleeding. The majority of complications were minor including 62% grade 1, 8% grade 2, 31% grade 3, and no grade 4 or 5 complications. There were no intraoperative complications in the right-sided donor group. There was a 5% complication rate for patients with a body mass index (BMI) exceeding 25. The findings showed that 11.2% of the recipients had slow graft function, and 4.4% had delayed graft function. Less than 1% of the recipients experienced ureteral stricture requiring permanent stent placement or reoperation. Overall, there was a 2% graft loss rate. CONCLUSIONS The findings show a low rate of intraoperative and postoperative complications, most of which were minor complications. There was an increase in operative time and hospital stay in the right-sided group, but no increase in complication rate. There was no significant difference in outcome or complication rate for the overweight patients.
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Affiliation(s)
- C P Sundaram
- Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202-5289, USA.
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