People Who Research Articles

Risk of Neuropsychiatric Symptoms Among People Who Develop Cognitive Impairment With and Without a History of Post-traumatic Stress Disorder.

We aimed to prospectively assess the change in neuropsychiatric symptoms among people who develop cognitive impairment and have a history of post-traumatic stress disorder (PTSD). We analyzed longitudinal data from the National Alzheimer's Coordinating Center Unified Data Set (March 2015 to December 2021). Analyses included individuals who were cognitively normal and who had nonmissing assessment of PTSD at the initial visit and had at least 1 follow-up visit with cognitive impairment. We compared the difference in the mean neuropsychiatric symptom score at the first Unified Data Set visit versus the first visit with a Clinical Dementia Rating of 0.5 between those with and without a history of PTSD. The mean neuropsychiatric symptom score change did not differ between those with and without a history of PTSD (1.06 vs. 0.77, respectively; P =0.79). The null results found in this study warrant future research. Several methodological limitations might explain these results.

The Impact of Addictions Management Following Cardiac Surgery on People Who Inject Drugs and Have Infective Endocarditis

BackgroundManaging reinfection in patients who inject drugs and have undergone cardiac surgery could reduce mortality. A significant gap exists in the management of addiction in this population and it is rarely addressed during index hospitalization for surgical intervention. This study sought to determine if management of addiction changed rates of readmission for reinfection. MethodsThis study was a retrospective chart review and analysis. Patients who underwent cardiac surgery for infective endocarditis due to injection drug use underwent a full chart review to determine if they received management of their addiction (addictions medicine consultation, social work consultation, medication- and/or opioid-assisted treatment, and community follow-up) following their surgical intervention. ResultsA total of 41 patients were identified who met the inclusion criteria. For addictions management, 43.2% of patients received an addictions medicine consultation, 67.6% received a social work consultation, 40.5% received medication- and/or opioid-assisted treatment, and 56.8% received community follow-up. Overall mortality of these patients was 21.6%, and 56.8% of patients were readmitted with reinfection. Multivariate logistic regression showed that patients who received intervention were 1.6 times more likely to be readmitted with reinfection (odds ratio 1.65, 95% confidence interval 0.29-9.41, P = 0.5736). Female patients had a significantly higher odds of reinfection, when adjusted for gender (odds ratio 9.95, 95% confidence interval 1.42-69.72, P = 0.021). ConclusionsWe demonstrated a nonstandardized approach to consultation and varying approaches to management of addiction. Patients who received intervention for addiction were more likely to be readmitted for reinfection, but this difference was not significant. Future efforts can include promotion of formalized addictions consultation services for high-risk patients.

Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study.

Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.

“Giving the People Who Use the Service a Voice”: Student Experiences of University Disability Services

Disabled students are systematically disadvantaged compared to their non-disabled peers and Disability Services can provide important access to accommodations and support. Such services are not, however, without issues. The present study investigates student experiences with University Disability Services in order to identify shared barriers to inclusion and recommendations for practice. Individual semi-structured online interviews were conducted with twelve female students. Each student discussed their engagement with Disability Services as an undergraduate or postgraduate student, and each student disclosed a long-term, nonvisible condition. A thematic analysis was used to identify three themes. These were (1) Identity and Legitimacy (Identification as Disabled, Perceived Legitimacy, The Importance of Evidence), (2) Knowledge and Understanding (Knowledge of Specific Conditions, Knowledge of Disability Services, Disability Services Staff Knowledge and Understanding, Peer Knowledge and Understanding), and (3) Independence and Support (Desire for Autonomy, The Importance of Self-Advocacy, Additional Support). The findings highlight shared barriers to support experienced by students with different diagnoses who engage with University Disability Services. A range of recommendations are provided to improve Disability Services provision (e.g., universities are advised to review the language used to advertise Disability Services).

Study on the Critical Attitude of College Students' Self-Awareness and Social Status to the People Who Are not in School

The purpose of this study is to explore the relationship between the self-awareness of college students and the critical attitude of social status to the people who are not in school. Through questionnaire survey and in-depth interviews with a large number of college students, combined with relevant literature review, this study deeply analyzes this complex and important social psychological phenomenon from the perspective of psychology and sociology. The results show that there is a certain correlation between the self-awareness level of college students and their critical attitude towards the people who are not in school. Students with high self-awareness tend to show a certain sense of superiority, which leads to a certain critical concept of the people who are not in school. This phenomenon may be related to the successful experience of college students in academic and social fields, which may lead to psychological prejudice against others. This study not only provides a new perspective for deeply understanding the social psychological phenomenon of college students, but also provides the basis for empirical research to promote social harmony and the healthy development of interpersonal relationships. Future research should further explore the formation mechanism of critical attitude in order to formulate more effective intervention measures.

‘I Can Tell You It’s a Bit of a Gamble’: A Qualitative Analysis of How People Who Engage in Gaming and Gambling Understand a Link Between These Two Behaviours

This article explores the attention given to potential motives and determinants of the transition process from video games to gambling. Forty individual interviews were conducted among active video game players (n = 20), and people diagnosed with a gambling disorder who had the experience of playing video games (n = 20). A qualitative thematic analysis was employed to explore the collected empirical data. The range of factors considered responsible for the transition from playing video games to gambling included experiencing similar emotional states, the presence of gambling in video games, advertising of gambling companies in video games, loot boxes. The awareness of factors associated with the development of gambling disorders among video game players has an important role in informing prevention policies in the rapidly changing video gaming and gambling market. Decision-makers should introduce effective regulation of the use of gambling components in video games to protect gamers against the gambling-related harm.

Nicotine Delivery and Changes in Withdrawal and Craving During Acute Electronic Cigarette, Heated Tobacco Product, and Cigarette Use Among a Sample of Black and White People Who Smoke.

E-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers. Twenty-two nicotine-deprived people who smoke (black [n = 12] and white [n = 10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal. UBC delivered significantly greater levels of nicotine compared to the e-cigarette (p < .001) and HTP (p < .01) during both the standardized and ad libitum sessions. HTP delivered more nicotine than the e-cigarette during the standardized puffing session (p = .047) but not the ad libitum session. Only craving during the standardized puffing session and not the ad libitum session showed significant differences across products (p < .001) such that UBC resulted in the greatest reduction followed by HTP and e-cigarette. Despite greater nicotine delivery from the UBC compared to e-cigarette and HTP, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. Use of participant's UBCs (UBC) resulted in greater nicotine delivery compared to both the e-cigarette and HTP. Despite this relative difference in nicotine delivery, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. These findings suggest that in this sample of black and white people who smoke, HTPs and e-cigarettes provided significant relief from negative symptoms that maintain smoking.

“I Don’t Go Overboard”: Perceptions of Overdose Risk and Risk Reduction Strategies among People Who Use Drugs in Rhode Island

Background : North America experiencing an unprecedented overdose epidemic, with data estimating almost 110,000 overdose deaths occurring in 2022 in the United States (US). To address fatal overdoses in the US, community organizations and local health departments in some jurisdictions have expanded community distribution of naloxone, and increased overdose prevention education, and other harm reduction supplies and services (e.g., fentanyl test strips, drug checking programs) to reduce harm for people who use drugs (PWUD). Objectives : Understanding how PWUD manage overdose risk within the context of these expanded services is important for ensuring public health services are meeting their needs. Semi-structured qualitative interviews were conducted with 25 PWUD who were accessing harm reduction services in Rhode Island. Data were imported into NVivo where they were coded and analyzed thematically. Results : Our findings demonstrate the complexity of managing overdose risk in the context of a fentanyl drug supply. While most participants were concerned about overdosing, they sought to manage overdose risk through their own harm reduction practices (e.g., testing their drugs, going slow) and drug purchasing dynamics, even when using alone. Conclusions : Study findings point to the need to implement and scale-up community-level interventions to better support PWUD within the context of the current US overdose crisis.

Injection Behaviors and Use of Syringe Service Programs over Time among People Who Inject Drugs in Baltimore, Maryland

Introduction: People who inject drugs (PWID) are at increased risk for infectious disease transmission, including hepatitis C and HIV. Understanding trends in injection risk behaviors and syringe service program (SSP) use over time can help improve infectious disease prevention and other harm reduction services. Methods: Using National HIV Behavioral Surveillance System data from Baltimore, Maryland, we examined changes in receptive sharing of (1) syringes, (2) injection equipment, (3) syringes to divide drugs; and (4) receipt of syringes from SSPs among PWID from 2009 to 2018 (n = 518 in 2009, n = 638 in 2012, n = 586 in 2015, and n = 575 in 2018) using unadjusted and adjusted logistic models calculated across time for the total sample. Results: The conditional probability of receptive sharing of syringes and receipt of syringes from SSPs remained relatively stable, while receptive sharing of injection equipment and receptive sharing of syringes to divide drugs dropped substantially after 2009. White race and daily injection frequency were positively associated with sharing syringes and injection equipment and negatively associated with SSP use over time. In 2015, there was a notable shift such that women were twice as likely as men to receive syringes from SSPs and less likely than men to report the use of shared syringes or equipment. Conclusion: Findings indicate overall steady or decreasing trends in injection risk and steady trends in SSP usage over time, with some notable improvements among women and indications of shifting drug market patterns. Injection-related risk behaviors remain high among White PWID and may require targeted outreach and interventions.

A Qualitative Exploration of People Who Have Left Housing First and Returned to Homelessness

This article offers a thick, rich, multidimensional, and situational look into a Housing First (HF) program in Charlotte, North Carolina, called HousingWorks. This study focuses on individuals who have experienced chronic homelessness and who exited permanent supportive housing (PSH) programs that employ a HF model and return to homelessness. In January 2022, there were 582,500 people experiencing homelessness in the United States (The U.S Department of Housing and Urban Development [HUD], 2023). One-third of these individuals had patterns of chronic homelessness, which has doubled since 2016 (HUD, 2023). Additionally, one-third of unsheltered individuals are at a high risk of being unsheltered again. To address issues of chronic homelessness, emphasis has been placed on increasing supportive housing, which combines permanent affordable housing with supportive services (permanent supportive housing), commonly called a housing first, or the rapid rehousing approach. Participants exited HousingWorks for multiple individual and programmatic reasons. All exits in this study were tied to relationships individuals had with friends, family (of choice and biological), romantic partners, case managers, and neighbors. Consumers, providers, and former residents describe their experiences and offer insights for improving housing retention in PSH programs. Implications for implementation and housing first fidelity criteria are also discussed.

Everything but the Kitchen Sink: An Analysis of Bacterial and Chemical Contaminants Found in Syringe Residue From People Who Inject Drugs.

People who inject drugs (PWID) are at high risk of severe wounds, invasive infections, and overdoses. To date, there are few data on the bacterial and chemical contaminants PWID are exposed to when using illicitly manufactured fentanyls and stimulants. Previously used injection drug use equipment was recovered in St Louis, Missouri, by harm reduction organizations over a 12-month period. Syringe residue was analyzed for bacterial contaminants by routine culturing followed by whole genome sequencing of single bacterial isolates. Chemical adulterants in syringe residue were identified by liquid chromatography-mass spectrometry. Bacteria were cultured from 58.75% of 160 syringes analyzed. Polymicrobial growth was common and was observed in 23.75% of samples. Bacillus cereus was the most common pathogen present and was observed in 20.6% of syringe residues, followed closely by Staphylococcus aureus at 18.8%. One hundred syringes underwent mass spectrometry, which demonstrated that chemical adulterants were common and included caffeine, diphenhydramine, lidocaine, quinine, and xylazine. Analysis of syringe residue from discarded drug use equipment demonstrates both chemical and biological contaminants, including medically important pathogens and adulterants.

HIV and Hepatitis C Among People Who Inject Drugs in Memphis, Tennessee: an Intersectional Risk Environment Analysis of the Social Determinants of Health

HIV and Hepatitis C Among People Who Inject Drugs in Memphis, Tennessee: an Intersectional Risk Environment Analysis of the Social Determinants of Health

Binge Drug Injection in a Cohort of People Who Inject Drugs in Montreal: Characterizing the Substances and Social Contexts Involved

AbstractWe describe binge drug injection in a longitudinal cohort study of people who inject drugs (PWID) in Montreal, Canada (eligibility: age ≥ 18, past-6-month injection drug use; follow-up: 3-monthly interviews). Bingeing was defined as injecting large quantities of drugs over a limited period, until participants ran out or were unable to continue, in the past 3 months. We recorded substances and circumstances typically involved in binge episodes. Eight hundred five participants (82% male, median age 41) provided 8158 observations (2011–2020). Thirty-six per cent reported bingeing throughout follow-up. Binges involved a diverse range of substances and social contexts. Cocaine was involved in a majority of recent binges (73% of visits). Injection of multiple drug classes (24% of visits) and use of non-injection drugs (63% of visits) were common, as were opioid injection (42%) and injecting alone (41%). Binge drug use may thus be an important yet overlooked trigger of overdose and other harms among PWID. This understudied high-risk behavior warrants further research and public health attention.

Quality of Life Health Outcomes Among People Who Lived in a Nursing Home Prior to and During the COVID-19 Pandemic.

The purpose of the current study was to compare quality of life health outcomes during the year prior to and first year of the coronavirus disease 2019 (COVID-19) pandemic among people who lived in a nursing home. This study used quarterly cross-sectional data from Minimum Data Sets between March 2019 and March 2021 among 96 people who resided in a nursing home. Health outcomes were cognitive function, transfer ability, depression, rejecting care, falls, urinary tract infections, physical conflict, and verbal conflict. Data were analyzed using Stuart-Maxwell test to compare differences in health outcomes in the year prior to and first year of the COVID-19 pandemic. There were statistically significant differences between the two time periods for the worsening of health outcomes related to transfer ability, rejecting care, physical conflict, and verbal conflict. Understanding the influence of the COVID-19 pandemic on health outcomes among people who live in nursing homes is critical for improving individual health and health system preparedness. [Journal of Gerontological Nursing, 49(12), 41-48.].

61 Preliminary Outcomes of Staphylococcus aureus (SA) and Group A Streptococcus (GAS) blood stream infections (BSI) in People Who Inject Drugs (PWID’s) and non PWID; a 12 month prospective pilot cohort study

61 Preliminary Outcomes of Staphylococcus aureus (SA) and Group A Streptococcus (GAS) blood stream infections (BSI) in People Who Inject Drugs (PWID’s) and non PWID; a 12 month prospective pilot cohort study

Web Exclusive. Annals On Call - Suspected Bronchiectasis in People Who Smoke.

Web Exclusive. Annals On Call - Suspected Bronchiectasis in People Who Smoke.

Music Therapy in Shelters for People Who Are Unhoused: A Scoping Review

Abstract A scoping review of publications pertaining to music therapy interventions with people who are unhoused and living in shelters was implemented to determine if the available evidence supports professional advocacy and program development with this underserved population at the present time. Searches using EBSCOHost, PsycINFO, ProQuest, and search engines for music therapy journals resulted in 294 publications. Specification of inclusion criteria (population-context-concept) resulted in 13 articles for review to determine the types of evidence, key characteristics of participants and interventions, and gaps and limitations in the literature. An overview of therapists’ descriptions of their sessions’ goals, interventions, and recommendations, combined with information from shelter staff and former participants, provides practical information for interventions and future research. However, the diversity within the small collection of articles prevents generalizations and provides only a glance at possibilities, not a foundation, for professional advocacy and program development.

Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections.

Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections.

Executive Summary: State-of-the-Art Review: Frame Shift-Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections.

Executive Summary: State-of-the-Art Review: Frame Shift-Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections.

1856. Barriers to Improving Outcomes among People Experiencing Homelessness and People Who Inject Drugs Hospitalized for Complicated Infections

Abstract Background People experiencing homelessness (PEH) and people who inject drugs (PWID) experience health disparities and worse outcomes. Challenges include suboptimal medication use, loss to follow-up, and non-compliance due to social determinant of health (SDOH) barriers, including lack of stable housing and transportation, limited financial resources, substance use, and addiction. Methods This quality improvement project aimed to address SDOH barriers among hospitalized PEH and/or PWID requiring ≥ 2 weeks of antibiotics to improve antibiotic compliance and outcomes in Detroit from 6/2022-4/2023. Interventions included antibiotic education, addiction medicine and pharmacy discharge medication cost inquiry consults when indicated, ensuring oral antibiotics were in hand at discharge, strengthening discharge planning between inpatient and ambulatory case managers (ACM), and referrals to community-based organizations to address SDOH needs. Results 34 patients were included (8 PEH, 11 PWID, 15 both); 3 who died in the hospital were excluded. Multiple individual and structural barriers and challenges to improving adherence and outcomes were identified (Table 1). Loss to follow-up was a significant challenge among this cohort, primarily due to patients self-discharging (29%) and being unreachable (52%). 10 (37%) patients were offered SDOH services (Table 2). Patients also had significant behavioral health/substance use disorder needs and utilized healthcare at a very high rate, with 29% having an ED revisit and 44% being readmitted within 30 days after discharge. Several structural and SDOH barriers existed, including limited staff capacity and limited placement options after discharge, resulting in suboptimal treatment delivery. Conclusion Addressing SDOH barriers for PEH and PWID is challenging but vital to improving outcomes. Qualitative research should be conducted to understand these barriers. Having an interdisciplinary team comprising of infectious diseases, pharmacy, addiction medicine, case management and population health is critical to address patient needs holistically. Strengthening internal processes and building additional community-based partnerships will be essential to better meet patient needs after discharge. Disclosures Michael Veve, PharmD, MPH, National Institutes of Health: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support