OBJECTIVE: Widespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset. We sought to understand patterns of drug use initiation and/or re-initiation among people with a history of injection drug use (IVDU).
METHODS: Data were obtained from three harmonized prospective cohort studies of PWUD in Vancouver. Participants with a lifetime history of IVDU who responded to a survey between June 2021 and May 2022 were included. The primary outcome variable was a composite of substance use initiation and re-initiation over the study period, labelled as drug (re)-initiation. A multivariable generalized linear mixed-effects model was used to examine factors associated with self-reported (re)-initiation of substance use over the past six months.
RESULTS: Among 1061 participants, the median age was 47 years at baseline and 589 (55.5%) identified as men. In total, 183 (17.2%) participants reported initiating and/or re-initiating a drug, with 44 (4.1%) reporting new drug initiation and 148 (14.0%) reporting drug re-initiation (9 participants responded \'yes\' to both). Overall, unregulated stimulants (e.g., crystal methamphetamine and cocaine) were the most common drug class (re-)initiated (n = 101; 55.2%), followed by opioids (n = 74; 40.4%) and psychedelics (n = 36; 19.7%). In the multivariable analysis, (re-)initiation of drug use was independently associated with recent IVDU (adjusted odds ratio [AOR] 2.62, 95% confidence interval [CI] 1.02, 6.76), incarceration (AOR 3.36, CI 1.12, 10.14) and inability to access addiction treatment (AOR 4.91, 95% CI 1.22, 19.75).
CONCLUSIONS: In an era impacted by the intersecting effects of the COVID-19 pandemic and the overdose crisis, nearly one in five PWUD with a history of IVDU began using a new drug and/or re-started use of a previous drug. Those who reported drug (re-)initiation exhibited riskier substance use behaviours and reported difficulty accessing treatment services. Our findings underscore the need to provide additional resources to support this high-risk population.

BACKGROUND: The Cheyenne River Sioux Tribe (CRST) is affected by high nicotine use and disease burden. Understanding nicotine exposure is important to recognize what groups may be at higher risk for negative health outcomes, including COVID-19.
OBJECTIVE: To compare self-reported health outcomes and nicotine use between exclusive electronic cigarette (e-cig) users, users of combustible cigarettes, dual e-cig/cigarette users, and nonusers among adult residents on the CRST.
METHODS: The CRST \"COVID-19 - Wayakta He study\" (\"Are you on guard against COVID-19?\") recruited 562 participants on the reservation who filled out a 97-item survey. Regression models were used to analyze nicotine exposure, demographic characteristics, and health outcomes.
RESULTS: Prevalence of nicotine use among participants was 53%. Reported median puffs per day was 15 for e-cig, 100 for cigarette, and 20 for dual users (p < 0.001). The odds of having COVID-19 were lower for nicotine users compared to nonusers (p < 0.001). The odds of hypertension (p = 0.04) and high cholesterol (p = 0.03) were lower for nicotine users compared to nonusers. The proportional odds were higher for nicotine users for longer COVID-19 recovery time (p = 0.046) and lower for more severe COVID-19 infection (p = 0.001).
CONCLUSIONS: This study provides critical data on self-reported COVID-19, chronic disease outcomes, and exposure to commercial nicotine products. Results from this unique Tribal community-driven study with a large sample size (N = 562 participants from 289 households) will help understand the role that environmental exposures played on increased COVID-19 mortality, help target public health interventions, and inform Tribal public health policies on emergency preparedness and exposure analyses.

暂无摘要。

Little is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation, and whether its use is suitable for referral to HIV care pathways. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and its implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted the flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.
A qualitative analysis of voluntary assisted partner notificationLittle is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.

The ageing of Western societies is leading to a marked increase in mortality. Death and old age are now intertwined. This situation should be of particular concern to palliative care. But in reality, palliative care remains too inaccessible to the oldest sections of the population. Why this paradox? After reviewing the clinical and organisational reasons that are often given, we invite you to take a more global look, one that is both sociological and ethical.

Heatwaves pose a serious threat and are projected to amplify with changing climate and social demographics. A comprehensive understanding of heatwave exposure to the communities is imperative for the development of effective strategies and mitigation plans. This study explores spatiotemporal characterization of heatwaves across the historically vulnerable communities in Mississippi, United States. We derive multiple heatwave metrics including frequency, duration, and magnitude based on temperature data for urban-specific daytime, nighttime, and day-night combined conditions. Our analysis depicts a rising heatwave trend across all counties, with the most extreme shifts observed in prolonged day-night events lacking overnight relief. We integrate physical heatwave hazards with a socioeconomic vulnerability index to develop an integrated urban heatwave risk index. Integrated metric identifies the counties in northwest Mississippi as heat-prone areas, exhibiting an urgent need to prioritize heat resilience and adaptive strategies in these regions. The compounding urban heatwave and vulnerability risks in these communities highlights an environmental justice imperative to implement equitable policies that protect disadvantaged populations. Although this study is focused on Mississippi, our framework is scalable and can be employed to urban regions globally. This study provides a solid foundation for developing timely heatwave preparedness and mitigation to avert preventable heat-related tragedies as extremes intensify with climate change.

Major power outages have risen over the last two decades, largely due to more extreme weather conditions. However, there is a lack of knowledge on the distribution of power outages and its relationship to social vulnerability and co-occurring hazards. We examined the associations between localized outages and social vulnerability factors (demographic characteristics), controlling for environmental factors (weather), in Washington State between 2018-2021. We additionally analyzed the validity of PowerOutage.us data compared to federal datasets. The population included 27 counties served by 14 electric utilities. We developed a continuous measure of daily outage burden using PowerOutage.us data and operationalized social vulnerability using four factors: poverty level, unemployment, disability, and limited English proficiency. We applied zero-altered lognormal generalized additive mixed-effects models to characterize the relationship between social vulnerability and daily power outage burden, controlling for daily minimum temperature, maximum wind speed, and precipitation, from 2018 to 2021 in Washington State. We found that social vulnerability factors have non-linear relationships with outages. Wind and precipitation are consistent drivers of outage occurrence and duration. There are seasonal effects that vary by county-utility area. Both PowerOutage.us and federal datasets have missing and inaccurate outage data. This is the first study evaluating differential exposure to localized outages as related to social vulnerability that has accounted for weather and temporal correlation. There is a lack of transparency into power outage distribution for those most vulnerable to climate impacts, despite known contributions by electric utilities to climate change. For effective public health surveillance of power outages and transparency, outage data should be made available at finer spatial resolution and temporal scales and/or utilities should be required to report differential exposure to power outages for socially vulnerable populations.

Through a quality improvement project, we developed an initiative that leveraged patient- and community-level data to address health disparities and social vulnerability among patients receiving outpatient dialysis, including both incenter and home modalities. Using the Area Deprivation Index, we identified patients living in areas with the highest levels of deprivation and developed targeted interventions to help address adverse social determinants of health to improve patient health outcomes. Our quality improvement project demonstrates the potential of data-driven ap - proaches to identify and address health disparities in outpatient dialysis, and highlights the importance of addressing social determinants of health in improving patient outcomes.

暂无摘要。

Population-based payment in Medicare Advantage (MA) can foster innovation in care delivery by giving risk-bearing providers flexibility and strong incentives to enhance care and engage patients. This may particularly benefit historically underserved groups for whom payments often exceed costs. In this study, using data from Humana MA plans, we examined \"senior-focused\" primary care organizations that are supported predominantly by population-based payments in contracts with MA plans. We explored whether such organizations supported by such payment are associated with better care and improved equity compared with other primary care organizations receiving other forms of payment in MA. Analyses of data from 462,872 MA beneficiaries in 2021 showed that senior-focused primary care organizations served more Black and dually eligible beneficiaries than other primary care organizations serving MA beneficiaries, and regression-adjusted analysis showed that senior-focused primary care patients received 17 percent more primary care visits. Differences were largest among Black and dual-eligible beneficiaries. These findings suggest that risk-bearing organizations in MA are responding to current payment dynamics and providing enhanced care and access to patients, particularly historically underserved populations.