Enhancing Teacher Education and Community Learning Center Programs through Critical Participatory Action Research

This paper describes the impact of using Critical Participatory Action Research (CPAR) to enhance a campus-community partnership. The key stakeholders, who are also the participants, share how learning from the reflective journals, collaborative sessions, and interview data analysis transformed their practice. The collaborative partnership was designed to allow prospective teachers from a School of Education at a U.S. liberal arts college the opportunity to teach Diverse language learners (DLLs) who were attending a summer program at a nearby community learning center. The teacher educators responsible for teaching the prospective teachers, the director of the community learning center, and a student researcher joined the project as collaborative participant researchers. Together they analyzed the data collected from various participating groups which included their own work and reflections, as well as those of the prospective teachers and prevention specialists who were employed by the community learning center. The findings from this study revealed that all participants benefited from the campus-community partnership because it was built on trust, mutual respect, reciprocity, and the use of shared language among key stakeholders. This CPAR project provides specific ideas and steps implemented to develop a well-functioning and reflective partnership between a community learning center and a local college. Examples of the specific praxis involved in such partnerships are often absent from the literature

Clinical Outcomes of Benzodiazepine Prescribing for People Receiving Opioid Agonist Treatment: A Systematic Review of the Evidence:Pharmacy

Many countries are experiencing an increased use of unregulated benzodiazepines in combination with opioids and other drugs, which contributes to drug-related harm. This descriptive review identifies and synthesises the outcomes of studies co-prescribing benzodiazepines and opioids. A systematic review was undertaken in Medline, CINAHL, PsychInfo, Embase, and the Cochrane databases covering publications from 1 January 1991 to 18 November 2021. Inclusion criteria were peer reviewed, English language studies of adults prescribed opioid agonist treatment (OAT) and a concurrent benzodiazepine, and reporting outcome data. Of the 4370 titles screened, 18 papers were included. The main outcomes identified covered all-cause mortality (ACM) (n = 5); overdose death (n = 3); retention in treatment (n = 7); and hospitalisation/emergency department encounters (n = 2). Other outcomes included QTc interval, cognitive function, illicit drug use, and mental health. The prescription of benzodiazepines alongside OAT increased the ACM by 75–90%, while evidence on overdose death was less robust but indicative of increased risk (40–334%). There was an indicative positive effect on treatment retention, with increased retention in those prescribed a benzodiazepine with OAT compared to those not prescribed or taking non-prescribed benzodiazepines. In conclusion, methodologically robust epidemiological studies found increased ACM and overdose death but possibly improved retention. However confounders (e.g., psychiatric comorbidity) exist, so a trial is recommended

Clinical outcomes of benzodiazepine prescribing for people receiving opioid agonist treatment : a systematic review of the evidence

Funding: This study was funded by a Scottish Government Drug Deaths Taskforce Grant.Many countries are experiencing increased use of unregulated benzodiazepines in combination with opioids and other drugs, which contributes to drug-related harm. This descriptive review identifies and synthesises outcomes of studies of co-prescribing benzodiazepines and opiates. A systematic review was undertaken in Medline, CINAHL, PsychInfo, Embase, and the Cochrane database covering publications from 01/01/1991‒18/11/2021. Inclusion criteria were: peer reviewed, English language studies of adults prescribed opioid replacement treatment and a concurrent benzodiazepine, and reporting outcome data. Of 4370 titles screened, 18 papers were included. The main outcomes identified covered all-cause mortality (ACM) (n=5); Overdose death (n=3); Retention in treatment (n=7); Hospitalisation/emergency care (n=2). Other outcomes included QTc interval, cognitive function, illicit drug use and mental health. Prescription of benzodiazepines alongside ORT increases ACM by 75-90%, evidence on overdose death is less robust but indicative of increased risk (40-334%). There was an indicative positive effect on treatment retention with increased retention in those prescribed a benzodiazepine with ORT compared to those not prescribed or taking non-prescribed benzodiazepine. In conclusion there is a growing body of evidence from methodologically robust epidemiological studies. Such studies are subject to confounders e.g. psychiatric co-morbidity so an RCT is recommended.Peer reviewe

Association between benzodiazepine co-prescription and mortality in people on opioid replacement therapy:a population-based cohort study

Objective: To investigate the association between Opioid Replacement Therapy (ORT) and benzodiazepine co-prescription and all-cause mortality compared to the prescription of ORT alone.Design: Population based cohort studySetting: Scotland, UK.Participants: Participants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above.Main outcome measures: all-cause mortality, drug related deaths and non-drug related deaths. Secondary outcome: ORT continuous treatment duration.Analysis: Cox regression with time-varying covariates.Results: During follow up 5776 of 46899 participants died: 1398 while on co-prescription and 4378 while on Opioid Replacement Therapy only. The mortality per 100 person years was 3.11 during co-prescription and 2.34 on ORT only. The adjusted hazard ratio for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted hazard ratio for drug related death was 1.14 (95% CI 1.04 to 1.24) and the hazard for death not classified as drug-related was 1.19 (95% CI 1.09 to 1.30).Conclusion: Co-prescription of benzodiazepines in opioid replacement therapy increased risk of all cause mortality, although less than the international literature. Co-prescribing was also associated with longer retention in treatment. Risk from benzodiazepine co-prescription needs to be balanced against the risk from illicit benzodiazepines and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide clear clinical direction.<br/

Association between benzodiazepine coprescription and mortality in people on opioid replacement therapy:a population-based cohort study

Objective To investigate the association between opioid replacement therapy (ORT) and benzodiazepine (BZD) coprescription and all-cause mortality compared with the prescription of ORT alone.Design Population-based cohort study.Setting Scotland, UK.Participants Participants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above.Main outcome measures All-cause mortality, drug-related deaths and non-drug related deaths.Secondary outcome ORT continuous treatment duration.Analysis Cox regression with time-varying covariates.Results During follow-up, 5776 of 46 899 participants died: 1398 while on coprescription and 4378 while on ORT only. The mortality per 100 person years was 3.11 during coprescription and 2.34 on ORT only. The adjusted HR for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted HR for drug-related death was 1.14 (95% CI, 1.04 to 1.24) and the hazard for death not classified as drug-related was 1.19 (95% CI, 1.09 to 1.30).Conclusion Coprescription of BZDs in ORT was associated with an increased risk of all-cause mortality, although with a small effect size than the international literature. Coprescribing was also associated with longer retention in treatment. Risk from BZD coprescription needs to be balanced against the risk from illicit BZDs and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide a clear clinical direction.Trial registration number NCT04622995.</p

Association between benzodiazepine coprescription and mortality in people on opioid replacement therapy: a population-based cohort study

Objective To investigate the association between opioid replacement therapy (ORT) and benzodiazepine (BZD) coprescription and all-cause mortality compared with the prescription of ORT alone. Design Population-based cohort study. Setting Scotland, UK. Participants Participants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above. Main outcome measures All-cause mortality, drug-related deaths and non-drug related deaths. Secondary outcome ORT continuous treatment duration. Analysis Cox regression with time-varying covariates. Results During follow-up, 5776 of 46 899 participants died: 1398 while on coprescription and 4378 while on ORT only. The mortality per 100 person years was 3.11 during coprescription and 2.34 on ORT only. The adjusted HR for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted HR for drug-related death was 1.14 (95% CI, 1.04 to 1.24) and the hazard for death not classified as drug-related was 1.19 (95% CI, 1.09 to 1.30). Conclusion Coprescription of BZDs in ORT was associated with an increased risk of all-cause mortality, although with a small effect size than the international literature. Coprescribing was also associated with longer retention in treatment. Risk from BZD coprescription needs to be balanced against the risk from illicit BZDs and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide a clear clinical direction. Trial registration number NCT0462299

Examining trends in the incidence of HIV infection among people with a history of drug use to inform an outbreak investigation and response: a retrospective cohort study

Background: In the context of an outbreak of HIV among people who inject drugs in Glasgow, Scotland, identified in 2015, our objectives were to: (1) develop epidemiological methods to estimate HIV incidence using data linkage, and (2) examine temporal changes in HIV incidence to inform public health responses. Methods: This was a retrospective cohort study involving data linkage of laboratory HIV testing data to identify individuals with a history of drug use. Person-years (PY) and Poisson regression were used to estimate incidence by time period (pre-outbreak: 2000–2010 and 2011–2013; early outbreak: 2014–2016; ongoing outbreak: 2017–2019). Results: Among 13 484 individuals tested for HIV, 144 incident HIV infections were observed from 2000 to 2019. Incidence rates increased from pre-outbreak periods (1.00/1000 PY (95% confidence interval, CI: 0.60–1.65) in 2000–2010 and 1.70/1000 PY (95% CI: 1.14–2.54) in 2011–2013) to 3.02/1000 PY (95% CI: 2.36–3.86) early outbreak (2014–2016) and 2.35 (95% CI 1.74–3.18) during the ongoing outbreak period (2017–2019). Compared with the pre-outbreak period (2000–2010), the incidence rates were significantly elevated during both the early outbreak (2014–16) (adjusted incidence rate ratio (aIRR) = 2.87, 95% CI: 1.62–5.09, p &lt; 0.001) and the ongoing outbreak periods (2017–19) (aIRR = 2.12, 95% CI: 1.16–3.90, p = 0.015). Conclusions: Public health responses helped to curb the rising incidence of HIV infection among people with a history of drug use in Glasgow, but further efforts are needed to reduce it to levels observed prior to the outbreak. Data linkage of routine diagnostic test data to assess and monitor incidence of HIV infection provided enhanced surveillance, which is important to inform outbreak investigations and guide national strategies on elimination of HIV transmission.</p