Le rôle des pairs chercheurs dans la recherche sur la consommation sexualisée de substances : avantages et défis.

CONTEXT: Sexual and gender diverse individuals (SGDI) report higher usage of methamphetamine in sexual contexts. They face difficulties making sense of their experiences and being heard in services. Peer researchers (individuals with lived experience) were involved in a participatory study on methamphetamine consumption. OBJECTIVES: 1) To describe the opportunities and challenges of involving peer researchers in all stages of the research process; 2) To discuss how this involvement could address the epistemic injustice experienced by SGDI who practice chemsex. METHODOLOGY: The peer-researcher participatory process was documented through a journal and meeting notes, which were analyzed through the framework of epistemic injustice. This notion refers to the mechanisms that prevent the knowledge of a person or group from being heard and considered legitimate. RESULTS: The contribution of peer researchers was highly valued and raised questions. Their in-depth knowledge facilitated data analysis and guided knowledge dissemination, promoting the transformation of current services. Their presence also helped to establish relationships of trust with the study population. DISCUSSION: This connection with the study population can create expectations for services that may require a significant level of involvement from researchers. The team’s commitment to improving services can generate a mistaken perception of a lack of objectivity.

Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal.

BACKGROUND: People experiencing homelessness are disproportionately affected by harms related to alcohol use. Indeed, their alcohol dependence is associated with numerous physical and mental health problems along with strikingly high rates of alcohol-related mortality. Recent research has extensively examined alcohol use patterns among people experiencing homelessness in an effort to develop interventions and treatments for this problem. However, only a few studies have incorporated the perspectives of the individuals under study about their drinking or examined the ways in which they manage the associated harms. To bridge this gap, we conducted a qualitative study exploring the relation between the drinking motives, risky drinking patterns and harm reduction practices of a group of people (n = 34) experiencing homelessness in Montreal, Canada. METHODS: The qualitative methods we used consisted of semi-structured interviews (n = 12) and focus groups (n = 2, with a total of 22 participants). The content of the collected data was then analyzed. RESULTS: Participants identified their various motives for alcohol use (coping with painful memories, dealing with harsh living conditions, socializing/seeking a sense of belonging, enjoying themselves/having fun); their risky drinking patterns (binge drinking, mixing alcohol with drugs, non-beverage alcohol drinking, failing to keep sufficient alcohol on hand to prevent acute withdrawal, drinking in public settings); their harm reduction practices (planning how much to drink, keeping a supply of alcohol to prevent acute withdrawal, hiding to drink, concealing alcohol, drinking alone, drinking/hanging out with others, drinking non-beverage alcohol, and taking benzodiazepines, cocaine or other stimulant drugs); and the rationales underpinning their alcohol use and harm reduction practices. CONCLUSION: Associating the drinking motives of a group of study participants with their risky drinking patterns and harm reduction practices shed light on their rationales for alcohol use, yielding insights that could be used to better tailor policies and interventions to their needs.

"A place to be safe, feel at home and get better": including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada.

BACKGROUND: The harmful use of alcohol is one of the leading health risk factors for people's health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada. METHODS: Community based participatory research approach and qualitative methods-including semi-structured interviews and focus groups-were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. RESULTS: Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants' alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal's wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. CONCLUSIONS: Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users' engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.

Enacting agency: movement, dementia, and interaction.

BACKGROUND: Arts-based programs can counter the dominant narrative of loss associated with dementia, in part through fostering expressions of agency. This study uses social science theories of interaction between structure and agency to examine how an arts-based movement program, entitled Mouvement de passage, supports agency among individuals with dementia. METHODS: Ethnographic methods were used to trace how participants enact agency within the structure of the movement program. The program's sessions were video recorded and iteratively analyzed. RESULTS: Participants expressed their agency in three ways: 1) transforming the exercise's structure according to individual interests and desires; 2) resisting the exercise's structure; and 3) improvising movements collectively. CONCLUSIONS: The movements of individuals with dementia were shaped by both program structure and individual/collective expressions of agency. The design of Mouvement de passage, based on open-ended structures and voluntary participation, provides a template for developing interventions that foster agency among these persons.

Interpersonal Physiological Synchrony for Detecting Moments of Connection in Persons With Dementia: A Pilot Study.

Interpersonal physiological synchrony has been successfully used to characterize social interactions and social processes during a variety of interpersonal interactions. There are a handful of measures of interpersonal physiological synchrony, but those that exist have only been validated on able-bodied adults. Here, we present a novel information-theory based measure of interpersonal physiological synchrony-normalized Symbolic Transfer Entropy (NSTE)-and compare its performance with a popular physiological synchrony measure-physiological concordance and single session index (SSI). Using wearable sensors, we measured the electrodermal activity (EDA) of five individuals with dementia and six able-bodied individuals as they participated in a movement activity that aimed to foster connection in persons with dementia. We calculated time-resolved NSTE and SSI measures for case studies of three dyads and compared them against moments of observed interpersonal connection in video recordings of the activity. Our findings suggest that NSTE-based measures of interpersonal physiological synchrony may provide additional advantages over SSI, including resolving moments of ambiguous SSI and providing information about the direction of information flow between participants. This study also investigated the feasibility of using interpersonal synchrony to gain insight into moments of connection experienced by individuals with dementia and further encourages exploration of these measures in other populations with reduced communicative abilities.

"When I hear my language, I travel back in time and I feel at home": Intersections of culture with social inclusion and exclusion of persons with dementia and their caregivers.

Individuals with dementia and their carers often experience a rupture of relationships that co-occurs with declining functional and cognitive abilities, leading to their increased social exclusion in both intimate relationships and community settings. While initiatives have been developed to support meaningful interaction and participation in society, they have broadly ignored the significance of how cultural factors influence experiences of inclusion/exclusion of these individuals. An ethnographic study was conducted by an interdisciplinary research team between April 2018 and January 2019 to explore the intersections of culture and social inclusion/exclusion in a culturally diverse group of persons with dementia, caregivers and staff members of a non-profit organization located in a multicultural neighborhood of a bilingual Canadian city. The participants' culture was inextricably linked to their experiences in three overarching themes of social inclusion/exclusion: transformation of the person with dementia and the caregiver; participation in social networks and meaningful relations; and styles of care provision in health and social services. Cultural mandates that prescribe practices of intergenerational care shape the way certain caregivers perceive their role and mitigated experiences of exclusion. Culturally specific notions and views associated with dementia prevalent in certain communities increased experiences of inclusion or exclusion. Engagement with the cultural elements of individuals with dementia was shown to be an effective and underexplored tool for fostering inclusion. The results of this study highlight the value of the ethnographic methods for incorporating the perspective of persons with dementia in research.

Mouvement de passage: Creating connections through movement among persons with dementia.

One of the challenging consequences of dementia is the change in relationships that can co-occur with the progression of this condition. Despite this well-documented change, few arts-based interventions target the relational dimension of dementia. This study aims to explore the effects of one arts-based relational intervention: a movement program designed to foster connections within a group of persons with dementia. We used ethnographic methods-including participant observations and informal interviews-to understand the relational effects of this program conducted by two dancers and a musician. The movement sessions were video recorded, and participant movement trajectories were analyzed for different ways in which they created connections. We identified two types of connections-nonreciprocal and reciprocal-and four subtypes of connections-connection to exercise/music, connection to participant, interpersonal connection, and group connection-that participants engaged in during the movement program. Despite most participants not remembering the previous movement sessions, they experienced increasing numbers of connections over the course of the program, particularly reciprocal interpersonal connections. Participants explored new forms of moving and creatively transformed the movement structures proposed by the dancers. The results demonstrate the effectiveness of this program in augmenting connections and fostering exploration and creativity in individuals with dementia, providing a template for further developments of interventions targeting the relational dimensions of dementia. This study also highlights the potential of combining ethnographic methods and video analysis to include the perspectives of persons with dementia in research.

"You're Part of Us and We're Happy to Have You Here": Practices of Social Inclusion for Persons with Dementia.

Objectives: Practices of social inclusion are important for maintaining the relationships of persons with dementia and are associated with positive clinical outcomes. The objective of this study was to explore the in-action practices of social inclusion in the activity center of a community-based organization.Methods: This study applies an ethnographic approach - including participant observation, informal and semi-structured interviews - with persons with dementia (n = 31) and organization staff members (n = 9) to explore the in-action practices of social inclusion.Results: Seven in-action practices of inclusion were identified: ensuring time for individual relationships, building schedules centered around flexibility, empowering decision-making, normalizing dementia-related behaviors, involving family members, soliciting and integrating persons with dementia's feedback, and supporting persons with dementia to practice social inclusion.Conclusions: Care providers of individuals with dementia can effectively facilitate active connections with them by continually soliciting and incorporating their feedback, and by supporting persons with dementia to practice inclusion and care for others.Clinical Implications: Community-based organizations can be effective at supporting the active connection of individuals with dementia with others and should be promoted for individuals with mild to moderate dementia.

A matter of time: grappling with everyday ethical tensions at the confluence between policy and practice in a psychiatric unit.

OBJECTIVE: To provide insights on emergent ethical tensions experienced by mental health practitioners during system re-organisation, which is sufficiently grounded in empirical data at the local level to inform policy on recovery at institutional and provincial levels. METHOD: Ethnographic methods using narrative and critical phenomenological resources over 24 months. FINDINGS: Everyday ethical tensions emerged at the confluence of different experiences of time, for example, how a context of increasing pressure to decrease patients' length of stay at the hospital (service-defined time) challenged efforts to listen to and advocate for what mattered to patients (personal time) and maintain the integrity of interventions (clinical time). In this context, practitioners drew on clinical language and that of personal recovery to strategically 'push back', 'play with' or 'take back' time. DISCUSSION: Examining everyday practices through ethnographic methods can illuminate the everyday ethical tensions that arise when mental health professionals and psychiatrists grapple with, often competing, goods. Critical phenomenological resources can help expand the structural considerations in empirical ethics, excavate underground practices and raise questions about the conceptual categories undergirding normative ethics. Experiencing-with practitioners in clinical contexts as they encounter and creatively resolve ethical tensions also propose a normative ethics of possibility, to help bridge the gap between empirical and normative ethics. CONCLUSION: Focus on the relationship between policy, temporal practices and ethics suggests a reconfiguration of time and re-imagination of ethics in institutional settings in ways that can ultimately benefit patients and professionals alike.

Wearable Technology for Detecting Significant Moments in Individuals with Dementia.

The detection of significant moments can support the care of individuals with dementia by making visible what is most meaningful to them and maintaining a sense of interpersonal connection. We present a novel intelligent assistive technology (IAT) for the detection of significant moments based on patterns of physiological signal changes in individuals with dementia and their caregivers. The parameters of the IAT are tailored to each individual's idiosyncratic physiological response patterns through an iterative process of incorporating subjective feedback on videos extracted from candidate significant moments identified through the IAT algorithm. The IAT was tested on three dyads (individual with dementia and their primary caregiver) during an eight-week movement program. Upon completion of the program, the IAT identified distinct, personal characteristics of physiological responsiveness in each participant. Tailored algorithms could detect moments of significance experienced by either member of the dyad with an agreement with subjective reports of 70%. These moments were constituted by both physical and emotional significances (e.g., experiences of pain or anxiety) and interpersonal significance (e.g., moments of heighted connection). We provide a freely available MATLAB toolbox with the IAT software in hopes that the assistive technology community can benefit from and contribute to these tools for understanding the subjective experiences of individuals with dementia.

Tranquilizer misuse among active cocaine users: Predictors of initiation.

INTRODUCTION AND AIMS: Tranquilizer use is associated with negative health outcomes among people who use drugs. This paper aims to estimate the incidence rate (initiation) and identify predictors of tranquilizer misuse (TM) among cocaine users. DESIGN AND METHODS: A prospective cohort study was conducted in Montreal, Canada. Interviewer-administered questionnaires were carried out at 3-month intervals. Initiation was defined as misusing a tranquilizer for the first time during follow-up. 'Lasting-initiation', defined as reporting TM at the next visit following first use, was also examined. Cox proportional hazard regression analyses were carried out to assess predictors of initiation to TM. RESULTS: Among the 245 participants who were eligible for the initiation analyses, 123 started TM during follow-up for an incidence rate of 40.49 per 100 person-years (95% confidence interval, CI: 33.80-48.15). Of the 123 initiates, 35.7% were still using at the interview following initiation for an incidence rate of 14.70 per 100 person-years (95% CI: 10.82-19.56). Multivariate models showed that independent predictors of initiation and 'lasting initiation' were identical as having had a criminal activity as the main source of income, having been recently in treatment for a substance use disorder (SUD) and reporting non-medical use of prescription opioids. DISCUSSION AND CONCLUSIONS: The incidence rate of TM initiation was high among a sample of cocaine users. Initiation was predicted by a problematic drug use pattern involving polydrug use, involvement in the street economy and having been in treatment for a SUD. These findings have implications for prevention and harm reduction strategies.

"I love having benzos after my coke shot": The use of psychotropic medication among cocaine users in downtown Montreal.

BACKGROUND: Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal. METHOD: Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner. RESULTS: Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) "downers" from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of "trip" (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine). CONCLUSION: PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients' substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.