RESUMO
BACKGROUND: HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. METHODS: We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. RESULTS: Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. CONCLUSIONS: Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. TRIAL REGISTRATION: ClincalTrials.gov, Registration Number: NCT04804072 . Registered 18 February 2021.
Assuntos
Infecções por HIV , Transtornos Relacionados ao Uso de Opioides , Abuso de Substâncias por Via Intravenosa , Humanos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estados Unidos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Ciência da Implementação , Acessibilidade aos Serviços de Saúde/organização & administração , Características de Residência , Feminino , Masculino , Estigma Social , Prestação Integrada de Cuidados de Saúde/organização & administraçãoRESUMO
Providing appropriate healthcare to people in short-term police custody settings (i.e. watch-houses) is challenging due to the complexity of detainee health needs and the limitations of the custodial environment. However, little is known about how detainee healthcare is managed in Australia, including economic considerations. This study had two aims: (1) to understand police perspectives on the costs associated with the delivery of healthcare to watch-house detainees in Queensland, Australia and (2) to scope the applicability of the Prison Healthcare Expenditure Reporting Checklist (PHERC) tool for the Australian watch-house context. The study employed an exploratory qualitative descriptive approach. A purposive sample comprised 16 watch-house staff from six regions in Queensland, Australia, interviewed between April and November 2021. A key finding was that police viewed healthcare expenditure as a major, but largely unavoidable cost for Australian watch-houses. Participants reported that direct expenditure comprised mostly of in-house healthcare services (of which there were a variety of models), but also costs of medication and health-related consumables. Indirect costs included costs of escorting and guarding detainees requiring transfer to hospital for health assessment and treatment. Participants reported that the PHERC was not applicable to the Australian watch-house context. Future research should explore the cost-effectiveness of different watch-house healthcare delivery models and how best to measure this.
RESUMO
BACKGROUND: Public health research frequently relies on collaborations with community-based organizations, and these partnerships can be essential to the success of a project. However, while public health ethics and oversight policies have historically focused on ensuring that individual subjects are protected from unethical or unfair practices, there are few guidelines to protect the organizations which facilitate relationships with - and are frequently composed of - these same vulnerable populations. As universities, governments, and donors place a renewed emphasis on the need for community engaged research to address systematic drivers of health inequity, it is vital that the ways in which research is conducted does not uphold the same intersecting systems of gender, race, and class oppression which led to the very same health inequities of interest. METHODS: To understand how traditional notions of public health research ethics might be expanded to encompass partnerships with organizations as well as individuals, we conducted qualitative interviews with 39 staff members (executive directors and frontline) at community-based organizations that primarily serve people who use drugs, Black men who have sex with men, and sex workers across the United States from January 2016 - August 2017. We also conducted 11 in-depth interviews with professional academic researchers with experience partnering with CBOs that serve similar populations. Transcripts were analyzed thematically using emergent codes and a priori codes derived from the Belmont Report. RESULTS: The concepts of respect, beneficence, and justice are a starting point for collaboration with CBOs, but participants deepened them beyond traditional regulatory concepts to consider the ethics of relationships, care, and solidarity. These concepts could and should apply to the treatment of organizations that participate in research just as they apply to individual human subjects, although their implementation will differ when applied to CBOs vs individual human subjects. CONCLUSIONS: Academic-CBO partnerships are likely to be more successful for both academics and CBOs if academic researchers work to center individual-level relationship building that is mutually respectful and grounded in cultural humility. More support from academic institutions and ethical oversight entities can enable more ethically grounded relationships between academic researchers, academic institutions, and community based organizations.
Assuntos
Profissionais do Sexo , Minorias Sexuais e de Gênero , Ética em Pesquisa , Homossexualidade Masculina , Humanos , Masculino , Pesquisadores , Estados UnidosRESUMO
Objectives. To identify factors that influence when people who use drugs (PWUDs) call 911 for an overdose. Methods. We conducted 45 qualitative interviews and 180 surveys with PWUDs who had recently witnessed overdoses in Southern California from 2017 to 2019. We used conditional inference tree and random forest models to generate and validate a model to predict whether 911 would be called. Results. Our model had good in- (83%) and out-of-sample (84%) predictive accuracy. Three aspects of the social and policy environment influenced calling 911 for an overdose: the effectiveness of response strategies employed, the behavior of other bystanders, and whether the responder believes it is their responsibility to call. Conclusions. Even in the presence of policies that provide some protections, PWUDs are faced with difficult decisions about calling 911 and must weigh their own safety against that of an overdose victim. Potential interventions include strengthening training and safety planning for PWUDs, bolstering protections for PWUDs when they call 911, and separating law enforcement response from emergency medical response to overdoses.
Assuntos
Overdose de Drogas/psicologia , Overdose de Drogas/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Antropologia Cultural , California , Árvores de Decisões , Feminino , Humanos , Entrevistas como Assunto , Masculino , Modelos Teóricos , Naloxona/administração & dosagem , Overdose de Opiáceos/epidemiologia , Overdose de Opiáceos/prevenção & controle , Pesquisa Qualitativa , Grupos Raciais , Fatores Sexuais , Fatores SocioeconômicosRESUMO
AIM: To evaluate prospectively a clinical pathway for investigation of haematuria that involves an initial screening using a urinary biomarker of bladder cancer (Cxbladder Triage™ (CxbT)) in combination with either a renal ultrasound or a computed tomography imaging. Only test-positive patients are referred for specialist assessment and flexible cystoscopy. METHODS: The clinical outcomes of 884 patients with haematuria who presented to their general practitioner were reviewed. Outcome measurements included the findings of laboratory tests, imaging, cystoscopies, specialist assessment and histology. RESULTS: Forty-eight transitional cell carcinomas (TCC) and three small cell carcinomas were diagnosed in the study cohort. The clinical pathway missed a solitary, small, low-risk TCC. When combined, imaging and CxbT had a sensitivity of 98.1% and a negative predictive value of 99.9% to detect a bladder cancer. Follow-up for a median of 21 months showed no further new cases of bladder cancer had occurred in the patient cohort. Review of all new bladder cancers diagnosed in the 15 months following the study showed that none had been missed by haematuria assessment using the clinical pathway. CONCLUSIONS: The combination of CxbT and imaging reliably identifies patients with haematuria who can be managed safely in primary care without the need for a secondary care referral and a flexible cystoscopy.
Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/urina , Procedimentos Clínicos , Hematúria/etiologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/urina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Carcinoma de Células de Transição/complicações , Cistite/complicações , Cistite/diagnóstico , Cistoscopia , Feminino , Hematúria/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Doenças Prostáticas/complicações , Doenças Prostáticas/diagnóstico , Encaminhamento e Consulta , Tomografia Computadorizada por Raios X , Ultrassonografia , Procedimentos Desnecessários , Neoplasias da Bexiga Urinária/complicações , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Adulto JovemRESUMO
The studyPowell J, Atherton H, Williams V, et al. Using online patient feedback to improve NHS services: the INQUIRE multimethod study. Health Serv Deliv Res 2019;7:38.This project was funded by the NIHR Health Services and Delivery Research programme (project number HS&DR 14/04/48).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000861/online-patient-feedback-is-mostly-positive-but-is-not-being-used-effectively.
Assuntos
Retroalimentação , Satisfação do Paciente , Medicina Estatal , Participação da Comunidade , Humanos , Medicina Estatal/normas , Reino UnidoRESUMO
The studyHewlett S, Almeida C, Ambler N, et al. Reducing arthritis fatigue impact: two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Ann Rheum Dis 2019;78:465-72.Hewlett S, Almeida C, Ambler N, et al. Group cognitive behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technol Assess 2019;23:57.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/112/01).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000860/group-cognitive-behavioural-courses-may-reduce-fatigue-from-rheumatoid-arthritis.
Assuntos
Artrite Reumatoide/complicações , Terapia Cognitivo-Comportamental/métodos , Fadiga/prevenção & controle , Fadiga/terapia , Psicoterapia de Grupo/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The studyPalmer R, Dimairo M, Cooper C, et al. Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. Lancet Neurol 2019;18:821-33.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/21/01) and the Tavistock Trust for Aphasia.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000864/after-a-stroke-computerised-speech-and-language-therapy-can-help-people-find-words.
Assuntos
Afasia , Acidente Vascular Cerebral , Atenção , Humanos , Terapia da Linguagem , FalaRESUMO
The studyDambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122This project was funded by the NIHR Health Technology Assessment Programme (project number 08/116/300) as well as the Wellcome Trust (grant number: G061895), the Epidemiology Unit programme (MC_UU_12015/4), and the National Health Service R&D support funding.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000841/weight-loss-after-type-2-diabetes-diagnosis-boosts-chance-of-remission.
Assuntos
Diabetes Mellitus Tipo 2 , Redução de Peso , Peso Corporal , Humanos , Estudos Prospectivos , Medicina EstatalRESUMO
The studyCooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019;394:1425-36.The study was funded by the NIHR Health Technology Assessment Programme (project number 12/35/23).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000837/keyhole-hysterectomy-is-effective-for-women-with-heavy-menstrual-bleeding.
Assuntos
Técnicas de Ablação Endometrial , Laparoscopia , Menorragia/cirurgia , Feminino , Humanos , Histerectomia , Avaliação da Tecnologia BiomédicaRESUMO
The studyCabral C, Horwood J, Symonds J, et al. Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach. BMC Fam Pract 2019;20:102.This project was funded by the NIHR School for Primary Care Research Programme (project number SPCR204).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000829/gps-assessment-not-parental-expectation-drives-antibiotic-prescribing.
Assuntos
Antibacterianos , Infecções Respiratórias , Criança , Humanos , Motivação , Pais , Atenção Primária à SaúdeRESUMO
The studyChappell LC, Brocklehurst P, Green ME, et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019;394:1181-90.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/25/03).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000838/mothers-benefit-from-a-planned-earlier-delivery-for-late-pre-eclampsia.
Assuntos
Pré-Eclâmpsia , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Mães , Gravidez , Avaliação da Tecnologia Biomédica , Conduta ExpectanteRESUMO
The studyEveritt H, Landau G, Little P. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2019;23:1-154.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/69/02).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000784/irritable-bowel-syndrome-helped-by-telephone-or-internet-cbt.
Assuntos
Síndrome do Intestino Irritável , Humanos , Internet , Fonoterapia , Avaliação da Tecnologia Biomédica , TelefoneRESUMO
PURPOSE: Novel approaches must address the underlying factors sustaining the tuberculosis (TB) epidemic in the United States, specifically what maintains new Mycobacterium tuberculosis (Mtb) transmission. METHODS: Culture-confirmed TB cases reported to the Michigan Department of Health and Human Services (2004-2012) were analyzed for time-restricted genotypic and/or geospatial clustering. Cases with both types of clustering were used as a proxy for recent, local transmission. Modified, multivariate Poisson regression models were fit to estimate this prevalence in relation to various individual- and neighborhood-level demographic and socio-economic variables. RESULTS: Those individuals that were spatially clustered were 1.7 times as likely to also be time-restricted genotypically clustered. The prevalence of recent, local transmission was higher among U.S.-born cases, males, and non-Hispanic blacks. Moreover, people living in neighborhoods in the highest poverty quartile had 13.8 times the prevalence of recent, local transmission compared with those in the lowest poverty neighborhoods. CONCLUSIONS: Our results suggest geographic areas with high concentration of TB cases are likely driven by ongoing transmission, rather than enclaves of individuals who have reactivated a case of latent TB. Furthermore, efforts to continue reducing Mtb transmission in the United States, and other low-incidence settings, must better identify community-level sources of risk, manifested through the complex social interactions among people and their environments.
Assuntos
Disparidades nos Níveis de Saúde , Mycobacterium tuberculosis/genética , Características de Residência , Tuberculose/epidemiologia , Tuberculose/transmissão , Análise por Conglomerados , Feminino , Genótipo , Mapeamento Geográfico , Humanos , Incidência , Masculino , Michigan/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Vigilância da População , Prevalência , Fatores de Risco , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/microbiologiaRESUMO
The studyLyttle MD, Rainford NEA, Gamble C, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet 2019;393:2125-34.This trial was funded by the NIHR Health Technology Assessment Programme (project number 12/127/134).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000790/levetiracetam-vs-phenytoin-in-stopping-childrens-prolonged-epileptic-seizures.
Assuntos
Epilepsia , Estado Epiléptico , Criança , Humanos , Levetiracetam , Fenitoína , ConvulsõesRESUMO
The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000803/cardiac-rehabilitation-for-heart-failure-can-improve-quality-of-life-and-fitness.
Assuntos
Reabilitação Cardíaca , Insuficiência Cardíaca , Exercício Físico , Terapia por Exercício , Humanos , Qualidade de VidaRESUMO
The studyTaylor S, Mallett S, Beare S et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019;4:529-37.This project was funded by the NIHR Health Technology Assessment Programme (project number 10/68/01).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000797/identifying-metastatic-disease-in-colorectal-cancer-with-whole-body-mri.
Assuntos
Neoplasias Colorretais , Segunda Neoplasia Primária , Humanos , Imageamento por Ressonância Magnética , Estudos Prospectivos , Avaliação da Tecnologia BiomédicaRESUMO
The studyHajek P, Phillips-Waller A, Przulj D, et al. A randomised trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med 2019;380:629-37.This trial was funded by the NIHR Health Technology Assessment Programme (12/167/135) and by Cancer Research UK.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000757/e-cigarettes-helped-more-smokers-quit-than-nicotine-replacement-therapy.
Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Nicotina/uso terapêutico , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Análise Custo-Benefício , Humanos , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Resultado do TratamentoAssuntos
Pesquisa Biomédica , Disseminação de Informação/métodos , Publicações Periódicas como Assunto , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Ensaios Clínicos como Assunto , Humanos , Cooperação Internacional , Qualidade da Assistência à Saúde , Apoio à Pesquisa como Assunto , Reino UnidoRESUMO
The studyBeard D, Davies L, Cook J, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 2019;394:746-56.The study was funded by the NIHR Health Technology Assessment Programme (project number 08/14/08).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000824/partial-knee-replacement-could-be-first-choice-in-some-patients.