A public health response to the methamphetamine epidemic: the implementation of contingency management to treat methamphetamine dependence

BACKGROUND: In response to increases in methamphatemine-associated sexually transmitted diseases, the San Francisco Department of Public Health implemented a contingency management (CM) field program called the Positive Reinforcement Opportunity Project (PROP). METHODS: Methamphetamine-using men who have sex with men (MSM) in San Francisco qualified for PROP following expressed interest in the program, provision of an observed urine sample that tested positive for methamphetamine metabolites and self-report of recent methamphetamine use. For 12 weeks, PROP participants provided observed urine samples on Mondays, Wednesdays and Fridays and received vouchers of increasing value for each consecutive sample that tested negative to metabolites of methamphetamine. Vouchers were exchanged for goods and services that promoted a healthy lifestyle. No cash was provided. Primary outcomes included acceptability (number of enrollments/time), impact (clinical response to treatment and cost-effectiveness as cost per patient treated). RESULTS: Enrollment in PROP was brisk indicating its acceptability. During the first 10 months of operation, 143 men sought treatment and of these 77.6% were HIV-infected. Of those screened, 111 began CM treatment and averaged 15 (42%) methamphetamine-free urine samples out of a possible 36 samples during the 12-week treatment period; 60% completed 4 weeks of treatment; 48% 8 weeks and 30% 12 weeks. Across all participants, an average of $159 (SD =$165) in vouchers or 35.1% of the maximum possible ($453) was provided for these participants. The average cost per participant of the 143 treated was$800. CONCLUSION: Clinical responses to CM in PROP were similar to CM delivered in drug treatment programs, supporting the adaptability and effectiveness of CM to non-traditional drug treatment settings. Costs were reasonable and less than or comparable to other methamphetamine outpatient treatment programs. Further expansion of programs like PROP could address the increasing need for acceptable, feasible and cost-effective methamphetamine treatment in this group with exceptionally high rates of HIV-infection

COVID-19 vaccination for people with disabilities

Internationally, people with disabilities have been disproportionately impacted by COVID-19, accounting for nearly 60% of COVID-19 deaths in the UK and overall higher mortality rates based on social, clinical, and demographic factors. Ontario has prioritized people with disabilities across the three phases of its COVID-19 vaccination program, but there is a difference between availability and accessibility of vaccination. Ontario’s 34 public health units are responsible for leading the local distribution and administration of COVID-19 vaccines, and their public facing websites serve as entry points for information on the accessibility of vaccination. On average, these websites contain information about 5 of 18 key accessibility features, across three domains: accessible communication, physical accessibility, and accessible social and sensory environments. Ontario needs a multi-pronged strategy to reach all people with disabilities that includes improving information about communication accessibility, physical accessibility, and social and sensory environment accessibility throughout the COVID-19 vaccination journey. Ontario’s progress on vaccinating people with disabilities needs to also be measured through enhanced data monitoring efforts. </p

Safe Visiting is Essential for Nursing Home Residents During the COVID-19 Pandemic: An International Perspective

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Blanket and total bans of nursing home visitors were widespread at the beginning of the COVID-19 pandemic when governments and homes were unprepared to prevent and manage outbreaks. However, these visitor restrictions have been prolonged and often reinstated after having been lifted, despite increased home and health system readiness and mounting evidence of harms to residents. Further, in most nursing homes, visitor bans were introduced without discussion or consent from residents or their advocates, constituting a violation of the resident’s rights to have visitors

Predictors of Alcohol Abusers’ Inconsistent Self-Reports of Their Drinking and Life Events

Although considerable research supports the veridicality of alcohol abusers\u27 self-reports, all studies find that some proportion of self-reports are inaccurate. Recently, a few studies have examined variables predictive of inaccurate self-reports and found considerable intersubject variability. The present study examined predictors of alcohol abusers\u27 inconsistent reports of life events and drinking using test-retest reliability data from two questionnaires. Results indicated that inconsistent self-reports were associated with the type (i.e., objective versus subjective) and amount (i.e., more drinking involvement at the first interview was associated with greater discrepant reports at the second interview) of information to be recalled. It appears that the nature of the questions asked may be as much or more of a contributing factor to inaccurate self-reports as subject or setting factors, especially for individuals who report high levels of alcohol use, for whom special efforts may be necessary to gather valid self-report data