Search

BACKGROUND AND AIMS: Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody. SETTING: This is an open-label, non-randomized trial conducted in correctional centres in New South Wales, Australia. Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm. INTERVENTION AND COMPARATOR: Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16. FINDINGS: Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P

Introduction and aims To assess the feasibility and acceptability of a take-home naloxone program for people with a history of opioid use released from prison in New South Wales, Australia. Design and methods Cross-sectional interviews with people with a history of opioid use who were recently released from prison (n = 105), and semi-structured interviews with key clinical and operational staff of Justice Health and Forensic Mental Health Network and Corrective Services NSW (n = 9). Results Among people with a history of opioid use who had recently left prison, there was very high awareness of the elevated risk of overdose following release from prison (95%) and the potential for naloxone to reverse an opioid overdose (97%). Participants considered that their personal risk of overdose was low, despite ongoing opioid use being common. Participants were largely supportive of take-home naloxone, but the majority (83%) stated that proactively obtaining naloxone would be a low priority for them following release. Key informants were supportive of introducing naloxone training and supply and identified barriers to implementation, including adequate resourcing, identifying the population for training, and developing an appropriate model of training and implementation. Discussion and conclusion There was widespread support for naloxone training in custody and distribution at release among people recently released from prison and key stakeholders in health-care provision and prisons administration. As proactively accessing naloxone is a low priority for patients, naloxone supply at release may be more effective than programs that refer releasees to local pharmacies, but developing a sustainable supply model requires consideration of several barriers.

Background: Opioid agonist treatment (OAT) is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings worldwide. Methods: This open-label trial compared depot buprenorphine, CAM2038 (weekly for 4 weeks then monthly) to oral methadone ( https://www.anzctr.org.au ACTRN12618000942257). Modelled treatment costs included a comparison group on sublingual buprenorphine-naloxone. Men and women, aged>18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder and a custodial sentence of at least six months were recruited from correctional centres in New South Wales, Australia. Findings: Between November 2018 and July 2019, 67 patients not in OAT treatment at recruitment commenced depot buprenorphine. Sixty-two patients already stable on oral methadone treatment were recruited to the comparison arm. Patients treated with depot buprenorphine commonly reported at least one adverse event related to study drug (63/67, 94%), typically mild and transient. No diversion of depot buprenorphine was identified. Retention in depot buprenorphine treatment was 92%. Self-reported use of non-prescribed opioids (primarily buprenorphine-naloxone) and injecting drug use decreased significantly among depot buprenorphine patients by 16 weeks (p

The neurobehavioural comorbidities associated with childhood epilepsy present significant physical challenges (i.e., excessive fatigue, memory impairment, headaches, visual impairments), emotional challenges (i.e., depression, anxiety), behavioural challenges (i.e., inattentiveness, distractibility, aggression), and social challenges (i.e., peer rejection, bullying, stigma) to children. Poor functioning within these domains can negatively affect academic success and school adjustment. As schools play a significant role in a child’s development, understanding how to support the social, psychological, and physical needs of these children is important. This article reviews literature examining the neurobehavioural comorbidities associated with childhood epilepsy and the barriers these conditions create to academic success and school adjustment. The article also provides recommendations based on the authors’ qualitative research about how best to support these children. Findings suggest that educating school communities about epilepsy and the challenges associated with it might promote inclusive school environments and mitigate negative school experiences. Findings also emphasize the need for an allied approach to the provision of support to ensure the needs of both students and faculty are met.

Background: Very little is known about the long-term neuropsychological outcomes of infants who were treated with pyrimethamine and sulfadiazine for congenital Toxoplasma infection. This study investigated the neurocognitive functioning and behavior of a cohort of treated infants exposed to Toxoplasma gondii in the 1994-1995 outbreak in Victoria, British Columbia. Methods: Ten infants from the original cohort, treated with pyrimethamine and sulfadiazine starting during first year of life and continuing for 12 months, were evaluated at 7 to 8.5 years of age. Neuropsychological evaluations focused on the cognitive, academic, adaptive, and behavioral functioning of these children. Results: The cohort demonstrated generally average neurocognitive abilities and academic achievement. According to parental ratings, the children’s executive functions, behavior and adaptive functioning did not differ significantly from the normative population. However, subtle difficulties were seen on more demanding sustained attention and impulse control tasks. Conclusions: These results suggest favorable outcomes in infants who were treated for one year with pyrimethamine and sulfadiazine. Nonetheless, congenital toxoplasmosis might contribute to some difficulties with higher-order cognitive abilities or tasks demanding greater self-monitoring. These difficulties could become more pronounced as higher demands for these abilities and brain areas come online during late childhood and adolescence. These findings highlight the importance of effective treatment and longitudinal follow-up of children with congenital toxoplasmosis.

Epilepsy affects between 0.3 and 0.6% of Canadian children aged 18 years and younger, and is one of the most frequently diagnosed neurological disorders among children in Canada as well as Europe. As such, it is likely that teachers will experience having a child with epilepsy in the classroom. Understanding how best to support children with epilepsy can contribute to their positive adaptation and quality of life. This article, written by Jillian Roberts and Cheryl Whiting-MacKinnon of the University of Victoria, British Columbia, reviews literature examining the social, emotional, physical and academic effects of epilepsy on children's lives, and explores the implications of these effects for their quality of life and school experiences.

Epilepsy is one of the most frequently diagnosed neurological disorders among children. Epilepsy is continuously linked with academic underachievement and social challenges. Despite the implications that these difficulties have for a child's educational success, little is known of how children with epilepsy experience school. Understanding how to best support and accommodate these children can contribute to their positive adaptation and quality of life. The purpose of this phenomenological study by Jillian Roberts and Cheryl Whiting of the University of Victoria, British Columbia, Canada, is to understand the school experiences of children with epilepsy. Data was gathered through open-ended, semi-structured interviews. The caregivers' narratives were transcribed and analysed to elicit the essential experiences of school children with epilepsy. Five categories were elicited from the families' narratives: (1) health-related issues, (2) family coping, (3) academic experience, (4) social belonging, and (5) awareness. This information will be particularly useful for teachers and allied professionals serving the needs of children with epilepsy – as well as those with other chronic health conditions.

Recent advances in the treatment of HIV/AIDS have led to medical improvements for persons living with the virus. As a result, many now think of HIV infection as a chronic rather than a terminal illness. Along with this shift comes the understanding that individuals now live with treatments that require long-term adherence to regimens that are often complex, time consuming, and not without deleterious side effects. The greater life expectancy, nature of new treatments and their dependence on regimented adherence has recently led to the investigation of psychosocial variables loosely categorized as quality of life (QOL). Although there has been relatively little research on the topic in relation to new HIV therapies, what is known is that QOL - with all of its complications and dimensions - appears to play an essential role in HIV and HIV treatment. Moreover, QOL would seem to be a most worthwhile component to further investigations of improved therapies and betterment for the lives of infected individuals. The following literature review discusses these issues, highlights key research findings, and provides directions for further research. Recent developments in the management of HIV/AIDS have brought about dramatic alterations in the lives of persons infected by the virus. The introduction of more effective treatments, especially highly active antiretroviral therapy regimens (HAART) have not only resulted in lower viral loads, but also made significant impacts on morbidity and mortality (Altice & Friedland, 1998; Faber & McDaniel, 1999; Holzemer, Henry, Portillo, & Miramontes, 2000; Jeffe, Meredith, Mundy, & Fraser, 1998; Singh et al., 1999). In fact, as Singh et al. state, "The remarkable success of the newer antiretroviral therapeutic regimens, with their ability to achieve durable suppression of HIV replication, have transformed HIV infection into a chronic manageable disease" (p. 824). Antiretroviral medications are documented in the prolonging survival of individuals infected with HIV and, hence, in the status change of the disorder to one requiring long-term management and continued ongoing treatment (Bright, 1999;Jeffe et al., 1998). This is noteworthy in that ongoing treatment is the often daunting and complex nature of the regimens that are part of HAART (Altice & Friedland, 1998; Bright, 1999; Holzemer et al., 1999). Further, these complicated and time-consuming treatments require rigorous adherence, with a medication cut-off point typically stipulated at 80% of doses taken for an adherence/ nonadherence distinction (Rabkin & Chesney, 1999; Williams, 1999). Conscientious maintenance is necessary in order to achieve full treatment effect and avoid increased viral loads, and the possibility of viral mutation and resistance (Holzemer et al., 1999; Holzemer et al., 2000; Mostashiri, Riley, Selwyn, & Altice, 1998; Singh et al., 1999). The transition of HIV infection to a chronic disorder involving relatively complex treatments dependent on diligent patient adherence raises the need to consider how these treatments affect psychological integrity and the quality of life (QOL) of infected individuals. QOL includes dimensions of well-being spanning the physical, mental, and social, and including a diversity of aspects from direct symptomology and daily functioning to work performance and emotional status (Anderson, Hollenberg, & Williams, 1999; Cramer, 1999; Keith & Schalock, 1992, 1994). Medical diagnoses and treatments have implications that extend beyond the disease or infirmity, however; as Cramer notes, such matters are "often not brought to the attention of the physician" (p. S52). However, in the context of HIV/AIDS, QOL concerns are particularly relevant because they have been directly correlated with adherence to treatment regimens (Anderson et al., 1999; Holzemer et al., 1999; Holzemer et al., 2000; Mostashiri et al., 1998; Pequegnat & Stover, 1999; Singh et al. …

Recent advances in HIV/AIDS treatments are extending the life expectancy of many infected children, allowing them to survive well into their school age years. However the mixing of pædiatric HIV/AIDS and school systems has not been an easy one. This article discusses the primary ethical dilemmas involved when children with HIV/AIDS attend school: a) the right to admittance and b) the right to privacy. A review of the American and Canadian ethical and legal findings surrounding these two contentious issues is offered.

As a result of recent advances in HIVIAIDS treatments, the near future will bring a significantly increased number of children either infected with - or affected by - HIV/AIDS into public schools in Canada. In order to help the psychologist and other professionals involved in the education of children, we have interpreted the Canadian Psychological Association (CPA) Guidelines for Non-Discriminatory Practice in this context. As with the Canadian Code of Ethics for Psychologists (CPA, 1991) the general principles of the Guidelines for Non-Discriminatory Practice include: I. Respect for the Dignity of Persons, II. Responsible Caring, III. Integrity in Relationships, and IV Responsibility to Society. In addition, we have included practical vignettes in the hope of stimulating continued dialogue.

The last few years has shown great advances in HIV/AIDS treatments. As a result, many HIV/AIDS infected children are living longer and attending school. Educational and psychological professionals will need to understand all of the factors influencing the developmental trajectory of HIV/AIDS infection in children to be able to accommodate their overall needs. With this aim in mind, the present article reviews pertinent American and Canadian research regarding the neurological and psychosocial implications of pædiatric HIV/AIDS. Suggestions regarding directions for future research in these areas is also offered.

Participatory action research initiatives engage research participants as co-investigators and provide them with an avenue to explore their own experiences. It is not always easy, however, to determine how to involve participants in meaningful ways. Funding limitations and rigid methodological procedures pose barriers for creative approaches to inquiry. Nonetheless, the HIV program at the Hospital for Sick Children in collaboration with the University of Victoria, has taken an important step towards involving participants in a meaningful way - through the dissemination of research results. The present article describes the procedure used to share the role of researcher/author. INTRODUCTION Researchers are beginning to understand that the more they involve participants in the process of research, the more powerful and meaningful are the outcomes. This is especially true in the ever-changing field of HIV research where the experiences of affected individuals are so closely interconnected with care and treatment. The more that affected families contribute to the process of creating knowledge, the greater the overall contribution. Involvement in research initiatives provides many families with a way to increase their sense of empowerment and, hence, their overall quality of life (Roberts & Cairns, 1999). Participatory action research methodologies have much to offer research in the areas of health. Funding and traditional methodological limitations often create barriers to involving participants in meaningful ways. Creative approaches to inquiry need to be used to avoid these barriers. This article describes how the HIV team at the Hospital for Sick Children - in collaboration with the University of Victoria - took an important step towards significantly engaging participants in the process of research. Namely, selected participants, acting as co-authors, were engaged in the process of disseminating the results of a national, multisite research project. CONTEXT In 1997, the HIV team at the Hospital for Sick Children in Toronto published a study (Salter Goldie, DeMatteo, King, & Wells, 1997) focusing on the psychosocial issues for families in Canada living with HIV/AIDS. Parents were greatly concerned with how to disclose their own HIV status to their children, as well as how to tell a child of his or her own HIV infection. Disclosure had the potential for creating conflict among family members and between families and professionals. The HIV team examined these concerns with a national, multisite research project focusing exclusively on the complex issues surrounding disclosure (DeMatteo et al., 1999). Families who participated in this study expressed an interest in creating a disclosure handbook that could help families share with each other their disclosure experiences. The HIV team agreed that the creation of a disclosure handbook could both meet this need as well as serve as a way to significantly involve families in the research process. PROCEDURE The first step in this project was to strengthen community partnerships as a way of overcoming inherent barriers. The HIV team used an already established, multisite, national research network to recruit participants from the initial study (DeMatteo et al., 1999). Eleven families from across the country (representing 25% of families who participated in the first study) were asked to continue in this follow-up based on their situation (i.e., we considered it inappropriate to invite gravely ill families) and their ability and willingness to attend research meetings. A co-investigator participated at each site and their involvement was crucial to the success of the project. In addition to helping organize travel plans locally, they contributed to discussions, willingly and conscientiously took notes, remained tuned into the needs of "their" families, and quietly solved problems. Perhaps most importantly, all families who attended knew someone who was a member of the research team. …

The purpose of this article is to explore the effects of radiofrequency ablation (RFA), an investigational treatment for breast cancer, on the quality of life of elderly women. For this descriptive phenomenological study, the authors interviewed 12 White women (aged 60-81 years) 4 months to 1 year after treatment and analyzed these interviews for common themes. They asked questions regarding the lived experience of RFA treatment and its effects on quality of life. Analyses focused on the effects of deciding to have the RFA treatment and the treatment itself. They found quality of life improved because the women felt empowered by (a) their decision to have the procedure, (b) knowing that the procedure might kill the tumor, (c) and feeling that they were contributing to cancer research. The level of support received from the medical team, family and friends, and other cancer survivors also improved participant quality of life.

Background/Purpose: The current project is a preliminary qualitative exploration of changes in quality of life of patients who have undergone the Nuss Procedure. The current study explores quality of life after surgical repair from the perspectives of both the patients and the parent(s) of the younger participants. Methods: This research constitutes the first segment in a mixed-method longitudinal design. The author conducted semistructured interviews based on the Keith and Schalock's quality of life model. Five youth who have undergone the Nuss Procedure and the parent(s) of the 4 younger participants were included in the study for a total of 10 participants. Textual analysis has been carried out using Atlas.ti, a qualitative data analysis program that facilitates such activities as selecting, coding, and comparing textual segments. Results: Results based on these preliminary data indicate that the patients interviewed had significant improvement in overall quality of life, which they attributed to the surgery. Specific examples of patients' expressions of improved self-confidence and renewed interest in physical activity are given. Conclusions: The Nuss Procedure is a minimally invasive surgical option for correcting pectus excavatum deformities that may make important contributions to patients' self-perceptions and quality of life. The participants in the current study expressed satisfaction with both the physical results of the surgery and with how it improved their overall quality of life. The authors recommend further prospective longitudinal research that assesses pre- and postsurgery psychosocial status and the maintenance of perceived quality of life changes. J Pediatr Surg 38:779-783. © 2003 Elsevier Inc. All rights reserved.