Client Program Research Articles

Caregiver perceptions of usual care home programs for persons with acquired brain injury: a qualitative descriptive study

ObjectiveThe study explores caregiver perceptions of home programs for clients with acquired brain injury based on current clinical care after transition to the community.DesignA qualitative descriptive study.SettingWithin the community, post inpatient rehabilitation.ParticipantsA convenience sample of eight caregivers of clients with acquired brain injury from one clinical site. All participants spoke English, were between the ages of 18 and 85 years, had no neurodegenerative disorders, and self-identified as caregivers.ProceduresTwo nested semi-structured interviews were completed post-discharge from an inpatient rehabilitation facility. All interviews were audio recorded and transcribed. Qualitative data analysis was performed utilizing MAXQDA© software, consensus coding, and abstraction of themes.ResultsTwo themes with subsequent subthemes were identified: (1) Systems, Roles, and Responsibilities Influenced Caregivers' Perceptions of Home Program and Recovery Outlook and (2) Caregivers' Home Program Experience. The first theme addresses topics of caregiver roles and responsibilities, system supports and barriers, and their general outlook on recovery. Within the second theme, results provide a chronological description of home program training, use, and modification.ConclusionsA caregiver’s outlook on the care receiver’s recovery and home program implementation is influenced by the burden of responsibilities, and system-level supports and barriers. The home program experience of the caregivers was reported to involve limited but satisfactory training. Caregivers saw the value in home programs and advised others to engage in them. Future programs should encourage healthcare providers to provide explicit instruction to the caregiver about their intrinsic value to home program implementation and adherence.

RELINCHE: Automatically Checking Linearizability under Relaxed Memory Consistency

Concurrent libraries implement standard data structures, such as stacks and queues, in a thread-safe manner, typically providing an atomic interface to the data structure. They serve as building blocks for concurrent programs, and incorporate advanced synchronization mechanisms to achieve good performance. In this paper, we are concerned with the problem of verifying correctness of such libraries under weak memory consistency in a fully automated fashion. To this end, we develop a model checker, RELINCHE, that verifies atomicity and functional correctness of a concurrent library implementation in any client program that invokes the library methods up to some bounded number of times. Our tool establishes refinement between the concurrent library implementation and its atomic specification in a fully parallel client, which it then strengthens to capture all possible other more constrained clients of the library. RELINCHE scales sufficiently to verify correctness of standard concurrent library benchmarks for all client programs with up to 7--9 library method invocations, and finds minimal counterexamples with 4--7 method calls of non-trivial linearizability bugs due to weak memory consistency.

Exploring oral health challenges and integration strategies in opioid treatment programs: perspectives from clinicians and clients.

Background Despite the paramount importance of oral health, individuals undergoing treatment for opioid use disorder face unique challenges beyond traditional addiction care. This qualitative study explores the challenges Opioid Treatment Program (OTP) clients in Australia encounter when accessing oral health care, aiming to understand the underlying factors and identify effective strategies for integrating oral health into an OTP. Methods Semi-structured interviews were conducted with OTP clients, OTP clinicians and oral health clinicians using tested interview guides. Thematic analysis identified patterns and themes across participants' responses. Results Client behaviour and traits such as inadequate health prioritisation, crisis-driven care and lack of motivation, shaped by a complex social environment, contribute significantly to inconsistent care and neglected oral health. Addiction exacerbates oral health issues as clients prioritise drug use over oral care and financial constraints, resulting in poor oral hygiene and a higher prevalence of dental problems. Psychological barriers such as dental anxiety deter clients from seeking care, while access issues including administrative burdens and system barriers, lost phones and unstable living conditions hinder consistent management of oral health. Stakeholders recommend actionable steps to address OTP clients' challenges, including integrating holistic care, establishing collaborative support systems, improving awareness and education and enhancing accessibility and flexible scheduling. Conclusion This study established a framework for improving OTP clients' oral health through integrated, holistic strategies. By addressing gaps in existing research, it supports the development of public health policies integrating oral health care into OTPs, aiming to foster collaboration, improve access and advance client education for better health outcomes.

Appropriately Matching Transport Care Units to Patients in Interhospital Transport Care: Implementation Study.

In interfacility transport care, a critical challenge exists in accurately matching ambulance response levels to patients' needs, often hindered by limited access to essential patient data at the time of transport requests. Existing systems cannot integrate patient data from sending hospitals' electronic health records (EHRs) into the transfer request process, primarily due to privacy concerns, interoperability challenges, and the sensitive nature of EHR data. We introduce a distributed digital health platform, Interfacility Transport Care (ITC)-InfoChain, designed to solve this problem without compromising EHR security or data privacy. This study aimed to detail the implementation of ITC-InfoChain, a secure, blockchain-based platform designed to enhance real-time data sharing without compromising data privacy or EHR security. The ITC-InfoChain platform prototype was implemented on Amazon Web Services cloud infrastructure, using Hyperledger Fabric as a permissioned blockchain. Key elements included participant registration, identity management, and patient data collection isolated from the sending hospital's EHR system. The client program submits encrypted patient data to a distributed ledger, accessible to the receiving facility's critical care unit at the time of transport request and emergency medical services (EMS) teams during transport through the PatienTrack web app. Performance was evaluated through key performance indicators such as data transaction times and scalability across transaction loads. The ITC-InfoChain demonstrated strong performance and scalability. Data transaction times averaged 3.1 seconds for smaller volumes (1-20 transactions) and 6.4 seconds for 100 transactions. Optimized configurations improved processing times to 1.8-1.9 seconds for 400 transactions. These results confirm the platform's capacity to handle high transaction volumes, supporting timely, real-time data access for decision-making during transport requests and patient transfers. The ITC-InfoChain platform addresses the challenge of matching appropriate transport units to patient needs by ensuring data privacy, integrity, and real-time data sharing, enhancing the coordination of patient care. The platform's success suggests potential for regional pilots and broader adoption in secure health care systems. Stakeholder resistance due to blockchain unfamiliarity and data privacy concerns remains. Funding has been sought to support a pilot program to address these challenges through targeted education and engagement.

Religious Effect-Based Education Model in Pesantren on Handling Drug Cases

The handling of drug cases has developed with the presence of Islamic boarding schools that specifically focus their educational orientation on handling this case. The involvement of Islamic boarding schools in handling drug offenders indicates the development of a rehabilitation process that has only been played by the National Narcotics Agency. This study will reveal the religious effect-based education model in handling drug cases in Ar-Rahman Palembang and Suryalaya Tasikmalaya Islamic boarding schools with an empirical qualitative descriptive approach. Data collection uses in-depth interviews, observation, and documentation which are then analyzed using Spradley's inductive model technique which begins with compiling research questions, then determining research propositions, research analysis units, data linkage logic with propositions, criteria for interpreting findings, and finally presenting research results. The research findings show three essential things. First, overcoming drug offenders is carried out through five stages, namely client acceptance, program orientation, primary program, re-entry program, and complete program. Second, client healing is carried out with therapist techniques with religious methods, Focus Group Discussions, narcotic animus, as well as medical and psychological. Third, the implications are oriented towards three main aspects: behavioral and mental changes, awareness to stop consuming drugs, and the emergence of obedience in worship. In line with that, this study has limitations because it only uses descriptive analysis of limited data. Therefore, further studies with more comprehensive data coverage are expected.

Culture and Patient-Provider Trust Among People with HIV: Psychometric Properties of the HCR Trust Scale-Revised in Haitian Creole and Spanish.

Patient-provider trust is associated with optimal HIV care engagement and ART adherence. However, cross-cultural examination of trust in providers in this diverse population is limited. The current study examines data from 1272 Miami-Dade County Ryan White Program clients. Study objectives were to explore the psychometric properties of the HCR Trust Scale-Revised translated inHaitian Creole and Spanishand to evaluate similarities and differences in responses to the HCR Trust Scale-Revised across Non-Hispanic Black, Haitian, and Hispanic participants and the English, Haitian Creole, and Spanishtranslations of the scale. Results indicated that the HCR Trust Scale-Revised has a single structure with good reliability for all groups except Haitian participants, for which response patterns were characterized by low variance and high endorsement of alternative response options. We draw on previous literature examining patient-provider experiences to discuss the importance of considering culture in the measurement of patient-provider trust.

Motivations for and perspectives of medication diversion among clients of a safer opioid supply program in Toronto, Canada

BackgroundSafer opioid supply programs in Canada have come under intense scrutiny related to the perceived risk of diversion of safer opioid supply medications. We sought to explore the experiences and perspectives of safer opioid supply medication diversion with clients of a safer opioid supply program in Toronto, Canada. MethodsFrom December 2022 to August 2023, we conducted in-depth, semi-structured interviews with 25 adult clients of a safer opioid supply program in Toronto, Canada. We analyzed the data using deductive and inductive approaches via thematic analysis. ResultsOur analysis identified five themes regarding clients’ perceptions and experiences with safer opioid supply diversion: (i) Compassionate sharing with others to address withdrawal symptoms; (ii) Selling or sharing due to unmet medication or survival needs of program clients; (iii) High demand for safer alternatives to those that are available in unregulated drug markets; (iv) Price of safer opioid supply medications in the unregulated drug markets as a diversion deterrent; and (v) Coerced diversion through harassment or violence. ConclusionsThese findings document experiences of medication diversion and the multifaceted and complex interplay of various individual and contextual factors that motivate safer opioid supply clients to engage in it. Future policy and safer opioid supply practice should address root causes of diversion, particularly barriers to service access and the diverse medication needs of clients.

Analysis of Robert K. Merton's Adaptation Typology in the Implementation of Social Reintegration Program of Correctional Client

This study investigates the social reintegration programs for correctional clients at Sintang Correctional Center in Indonesia, utilizing Robert K. Merton's adaptation typology to analyze the pathways of ex-prisoners during their reintegration process. Emphasizing the rights of prisoners as outlined in Indonesian law, the research highlights the significance of effective community guidance in mitigating recidivism and facilitating successful adaptation. Through qualitative method toward 20 correctional clients, the study identifies the challenges faced by ex-prisoners, including economic hardship and societal stigma, which impede their reintegration efforts. The educational backgrounds of respondents reveal a concerning lack of higher education, further limiting employment opportunities. The community guidance program, structured in three stages those are early, advance, and final stage which aims to enhance the quality of life for these individuals. However, findings indicate that a majority remain engaged in case work rather than group activities, suggesting areas for program improvement. By applying Merton's typology, the study categorizes clients' adaptation experiences into Conformity, Retreatism, and Innovation, illustrating the diverse strategies employed by ex-prisoners in navigating their reintegration. The findings underscore the necessity for comprehensive community support systems that address the multifaceted challenges faced by correctional clients, ultimately aiming to reduce recidivism and promote successful societal reintegration. Future recommendations include enhancing educational and vocational training opportunities and fostering community acceptance to improve reintegration outcomes.

The usefulness of a rehabilitation programme for people with stress-related disorders - A case from a rehabilitation center in Estonia.

Background Rehabilitation programs help to improve people’s lives and reduce turnover rates in organisations. The current analysis revealed that dissatisfaction occurred among practitioners, doctors’ overlapping services, and fragmented plans. No comprehensive assessment and rehabilitation program currently exists for stress-related disorders in Estonia indicating an urgent need to conduct research and development programs for clients to reduce stress (Bugarski, Z, et al., 2016). This study research aimed to determine the usefulness of rehabilitation programs for individuals people with stress-related disorders. Method A qualitative approach was used. Methodology The sample included 10 individuals recruited from various rehabilitation centers in Estonia. Convenience sampling was used to select participants for this research. Open- and closed-ended questions were formulated using the 12 questions enclosed in this research. All transcribed interviews were formatted using the code. Extract codes within participant interviews were compared to identify similarities, differences, and closeness, and therefore formulated categories. Results The findings revealed that rehabilitation programs contribute to quality services, self-motivation, daily activities plan, self-control, recovery, attention and concentration, and coping skills, whereas traditional treatment can reduce symptoms but not change people’s lives. Conclusion This study suggests that rehabilitation programs are useful for individuals with stress disorders in the context of the Estonian healthcare system. The rehabilitation program is a useful intervention method revealed in the context of Estonia’s healthcare system, as it improves quality services, increases coping skills, self-control, and cognitive skills, and enhances recovery.

Assessing Doula Preparedness for Supporting Clients in a Hospital-Based Volunteer Doula Program.

The purpose of this evaluation was to assess doulas' sense of preparedness after completing birth doula training. The extent to which doulas feel prepared to serve clients after training is unknown. This program evaluation took place within a hospital-based volunteer doula program in the southeastern United States. The analysis focused on comparing the self-reported preparedness of volunteer doulas trained through the Partners in Birth Training program, a doula training created by the doula program, with preparedness of volunteer doulas trained by nationally recognized training programs. A survey assessed doulas' preparedness to provide physical, emotional, and informational support. Of the 100 doulas active in the program at the time of survey administration, 48 had completed the Partners in Birth Training program, 26 (54%) of whom completed the survey. Of the 32 doulas who entered the doula program following training with national organizations, 19 (59%) completed the survey. The remaining 20 doulas in the program completed a third training option and were excluded from this evaluation. In comparing doulas' overall sense of preparedness between the 2 groups, results were similar, with the median response for both groups being mostly prepared (4 on a Likert scale from 1 to 5). Results suggest that localized doula training offered by hospital-based doula programs may be as effective at preparing doulas to serve in such programs as Other training organizations. Systematic evaluations can help researchers and doulas identify topics and pedagogical approaches to training that increase preparedness.

What do you want to eat? Cuisine and nutrition intervention preferences among people using a large food pantry in Texas

ObjectiveNutrition interventions delivered through food pantries could reduce health disparities for people experiencing food insecurity. We identified clients’ preferences for cuisines, nutrition interventions, and outcomes and whether preferences differ for subpopulations. MethodsCross-sectional study at a large pantry in Dallas, Texas (N = 200). Survey collected from February-May 2023 on demographics, cuisine preferences, nutrition intervention preferences, and outcomes clients hope to achieve when changing lifestyle (weight loss, feeling comfortable in clothes, feeling good about diet, wellbeing). A subsample (N = 130) had height and weight measured. We tested whether food security and BMI (categorical) were associated with intervention or outcome preferences using IBM SPSS Statistics (Version 29) to conduct analysis of variance. ResultsTop-rated cuisines were Mexican, Chinese, Italian. Participants reported a desire for interventions implemented through the pantry reflected by high Nutrition Intervention Index scores. The highest rated intervention was bringing more healthy food into the pantry and lowest rated was restricting unhealthy donations.Overall wellbeing was the most important outcome and weight loss the least important.Neither food security nor BMI were associated with desire for interventions. All outcomes were rated in a similar pattern, though people with obesity and overweight rated weight loss as more important than people with normal weight. ConclusionsMost participants demonstrated a strong desire for healthier, ethnically diverse options, and nutrition interventions delivered through the pantry. Our findings explore cuisines and outcomes preferred by people that use food pantries which can guide researchers, clinicians, and non-profit organizations in planning and promotion of nutrition programs for pantry clients.

Autonomy and Respect in Pregnancy Care for LGBTQIA+ Families: Evaluation of a Home Visiting Program.

The purpose of this program evaluation was to gather information on proportions of LGBTQIA+ individuals and families, their needs, and care experiences in a county health department's home visiting programs for perinatal clients and to make recommendations for improving culturally competent care for LGBTQIA+ individuals and families. In this engaged scholarship partnership, home visiting nurses administered a questionnaire to perinatal clients including demographic information on sexual orientation and gender identity. Differences between LBGTQIA+ identifying individuals' perception of the perinatal care received and those of heterosexual, cisgender individuals were assessed. On the basis of these data, 10% of the 52 respondents identified as LGBTQIA+ and 4% identified with a gender other than "woman." Clients who identified as straight had similar mean scores to those who listed an LGBTQIA+ sexual orientation. Clients who chose a gender identity other than "woman" had scores that fell within the 50th to 75th percentile of the overall mean. Qualitative interviews with 2 respondents provided additional in-depth information on their experiences. Overall, clients served by these perinatal programs reported similar diversity in terms of gender identity and sexual orientation as compared with national averages. This project provided evidence of the diversity among the clientele served by this agency and the importance of expanding the focus on inclusionary language and practices.

Nurse-Led Evidence-Based Diabetes Prevention Study: An Innovative Risk Reduction Program for Clients With Substance Use Disorders.

Clients with substance use disorders (SUDs) have a substantial risk of developing Type 2 diabetes mellitus (T2DM). The connection between SUD and DM stems from rapid cell damage, pancreatic beta-cell dysfunction, and glucose dysregulation due to increased oxidative stress and decreased antioxidant activity. This study aims to reduce the risk of T2DM among individuals undergoing SUD recovery treatments. This nurse-led diabetes prevention program, a 1-year-long, peer-based intervention, was implemented among clients at a federally funded, stand-alone drug addictions treatment center based on evidence that lifestyle modifications in dietary control, physical activity, and health behaviors can halt or delay the progression of Type 2 diabetes. Four trained peer educators delivered diabetes prevention interventions to a sample of individuals in drug addiction treatment in Nigeria. The nurse program leader provided weekly mentoring and guidance to the peer educators and collected, reviewed, and analyzed study participants' logs of weights and self-reported lifestyle modifications. There were significant differences in participants' behaviors pre- and post-lifestyle interventions, except in dairy product intakes as well as cigarette and cannabis use. This diabetes prevention program is innovative and effective with this at-risk population. Interventions were delivered with minor financial resources. SUD treatment must address physical and psychological health and consider the heightened risks of chronic illness in this population. Preventing somatic diseases, such as T2DM, is vital to long-term health and well-being.

An innovative approach to developing practice informed evidence in the absence of RCTs for a Family-led peer to peer support program

ObjectiveTo illustrate how whole-population linked data can be used to understand a system perspective of client complexity, and build robust evidence of Family by Family program impact. MethodsFamily by Family program (the program) participant data were linked into the Better Evidence Better Outcomes Linked Data (BEBOLD) Platform. BEBOLD is a whole-of-population linked de-identified administrative data platform for all South Australian children born 1991 onwards (n~500,000), as well as their parents including data spanning health, education, and social services. We descriptively analysed parental child protection history, emergency department presentations, hospitalisations, homelessness and justice system contact in the 24 months prior to and post program commencement. We emulate a trial using the ‘target trial’ causal inference framework to evaluate the program effect on a range of child outcomes using targeted maximum likelihood with a set of over 20 confounders. Results There were 361 families and 841 children in the program included in analysis. Selected results follow: Prior to the program, 35.8% of children were in a family where at least one parent had their own child protection history and 8% had a parent who experienced out-of-home care. Nearly 40% of children had at least one parent with a mental health related emergency department and/or hospitalisation, while 22% of children were in a family with specialist homelessness service contact. Program impact results will be presented at the conference. ConclusionThis research-practice partnership illustrates how bringing together program and linked-administrative data generates new evidence about client complexity and program impact.

Routine Testing for Chlamydia trachomatis and Neisseria gonorrhoeae Infections within an HIV Pre-Exposure Prophylaxis Program in Hanoi, Vietnam: Implications for Low- and Middle-Income Countries.

Data on Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections within HIV pre-exposure prophylaxis (PrEP) programs in low- and middle-income countries (LMICs) are limited. Our study reports the prevalence, anatomical distribution, and correlates of NG and CT infections within an HIV PrEP program in Hanoi, Vietnam. From January-December 2022, HIV PrEP program clients who were male at birth, ≥16 years old, reported ≥1 male sex partner in the prior 12 months, were enrolled. A questionnaire collected sociodemographics, sexual behaviors, and clinical data. CT/NG testing was performed on self-collected urine, rectal, and pharyngeal specimens. Multivariate logistic regression was used to identify factors associated with CT and NG infections. There were 529 participants enrolled, the median age was 25.1 years. The overall prevalence of CT or NG was 28.9% (153/529). The prevalence of NG was 14.3% and highest for pharyngeal infections (11.7%), while for CT, the prevalence was 20.4% and highest for rectal infections (14.0%). Symptoms in the prior week were reported by 45.8% (70/153) of those with CT or NG infections. Condomless anal sex (aOR= 1.98; 95% CI: 1.27, 3.08) and sexualized drug use in the prior 6 months (aOR= 1.68; 95% CI: 1.07, 2.65) were associated with CT/NG infections. Our study found a high prevalence of NG and CT infections, including pharyngeal and rectal infections, within an HIV PrEP program in Hanoi, Vietnam. The findings underscore the need for further research on CT/NG prevention and the development of evidence-based guidelines for CT/NG screening in HIV PrEP programs in LMIC settings.

Syringe services program staff and participant perspectives on changing drug consumption behaviors in response to xylazine adulteration

BackgroundXylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence.MethodsFrom June–July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes.ResultsFrom interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a “tranquilizer-like substance” that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers’ experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation.ConclusionsXylazine’s emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Examining HIV pre-exposure prophylaxis (PrEP) acceptability among rural people who inject drugs: predictors of PrEP interest among syringe service program clients

ABSTRACT Rural communities in the US have increasing HIV burden tied to injection drug use, yet engagement in pre-exposure prophylaxis (PrEP) care has been low among people who inject drugs (PWID). Syringe service programs (SSPs) are widely implemented in Kentucky’s Appalachian region, presenting an important opportunity to scale PrEP services. This paper examines PrEP awareness, interest and preferences among PWID attending community-based SSPs in Appalachia. Eighty participants were enrolled from two SSP locations. Eligibility included: ≥ 18 years old, current injection drug use and SSP use, and an indication for PrEP as defined by CDC guidelines. Participants completed a structured baseline interview. Predictors of PrEP awareness, interest and formulation preferences were examined. 38.8% reported baseline awareness of PrEP, 50% expressed high interest in PrEP, and 48.1%reported a preference for injectable PrEP. Significant bivariate predictors of PrEP interest included: current worry about health, higher perceived HIV risk, higher community HIV stigma, and higher enacted substance use stigma in the past year; in the adjusted model, enacted substance use stigma remained significant. Findings demonstrate substantial interest in PrEP among rural PWID. Intrapersonal and social determinant factors were associated with PrEP interest, which suggests the importance of multi-level intervention targets to increase PrEP uptake.

Protective or potentially harmful? Altering drug consumption behaviors in response to xylazine adulteration.

Xylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence. From June-July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes. From interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a "tranquilizer-like substance" that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers' experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation. Xylazine's emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Oral health status and oral health-related quality of life: a cross-sectional study of clients in an Australian opioid treatment program.

Background Individuals with opioid dependence often experience poor oral health, including dental decay, periodontal disease and mucosal infection, frequently exacerbated by factors such as smoking, alcohol consumption, inadequate oral hygiene and low utilisation of oral health services. This study aimed to assess oral health status and oral health-related quality of life (OHRQoL) among opioid-dependent individuals and explore their potential associations. Methods Participants enrolled in an opioid treatment program (OTP) at three Australian urban clinics were assessed using the validated Oral Health Assessment Tool (OHAT) and Oral Health Impact Profile (OHIP-14). Results The average age of the 75 participants was 44.7years, with 45% receiving opioid treatment for over 5years. Dental decay and inadequate oral hygiene were prevalent. Mean OHAT and OHIP-14 scores were 6.93 and 20.95 respectively, indicating moderate oral health severity and poor OHRQoL. Physical pain and psychological discomfort significantly impacted participants' quality of life, with the effects being particularly pronounced for those aged 30 and above. An exploratory analysis revealed a strong correlation between OHAT and OHIP-14 severity scores, with a one-point increase in OHAT associated with 1.85times higher odds of a lower OHRQoL (odds ratio=1.85, 95% confidence interval: 1.38-2.49, P = Conclusions These findings underscore the multifaceted impact of oral health on the well-being of OTP clients. Routine dental check-ups, education on oral hygiene practices and timely treatment for oral health problems are crucial recommendations based on this study. Such measures hold the potential to enhance the quality of life for individuals attending OTPs.

Reflections on the Collaborative Story Analysis Method to Understand Qualitative Perspectives of Indigenous Syringe Services Program Clients

Many scholars have cautioned that the use of Western research methods is problematic in studies with Indigenous communities given colonialist histories that have exploited Indigenous populations. One solution has been to utilize a Community-Based Participatory Research (CBPR) approach to enhance equity in research partnerships. Employing a CBPR approach, however, does not necessitate the inclusion of Indigenous Research Methods, an additional step that can further benefit studies with their explicit alignment with Indigenous worldviews and values. In a CBPR project aiming to understand Indigenous harm reduction clients' perspectives of barriers and facilitators to opioid use disorder treatment, our research group assembled a multidisciplinary qualitative data analysis team that included diverse tribal community members and academics. Sparse literature was available to guide the use of Indigenous Research Methods for the qualitative data analysis phase of the research. To address this gap, the aims of this process paper are: (1) to describe the implementation of the Collaborative Story Analysis method, and (2) in the Indigenous tradition of honoring and sharing stories, describe our analysis team's experiences and perceptions of implementing this Indigenous Research Method. Through a series of process discussions, the analysis team found that applying the Collaborative Story Analysis method: (1) honored relationships and story, (2) strengthened the depth of analysis, and (3) exhibited tensions when working in a dominant Western culture. Through sharing our team's experiences, the aspiration is that others can use these insights in their own consideration and implementation of an Indigenous Research Method for qualitative data analysis.