Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: A mixed-methods study

Objective: The aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. Methods: This study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. Results: Analysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. Conclusion: This mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic? Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add? This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners? Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment

Aboriginal people with chronic HCV: The role of community health nurses for improving health-related quality of life

Introduction: There is a lack of knowledge about Health-Related Quality of Life (HRQL) of Aboriginal Australians with self-reported hepatitis C infection in Western Australia. This marginalised group of people is disproportionally affected by the hepatitis C virus (HCV) for which there is no preventative vaccine. This study provides data that help understand the long-term consequences of living with HCV infection within the Aboriginal community. It outlines opportunities for nursing interventions for hepatitis care that focus on supporting mental health and drug and alcohol issues within this population. Methods: We surveyed 123 Aboriginal people living with HCV in a community setting. Survey data included demographics, drug use history, length of time since diagnosis, changes in lifestyle since diagnosis, fatigue, social support, alcohol consumption, and physical and mental health measures. Results: Most participants reported amphetamine injecting frequently in the last six months and their duration of injecting drug ranged from 8 to more than 11 years. Additionally, half of the participants were classified as high-risk alcohol users. Overall 52% of participants were in poor physical and 60% of participants were in poor mental health. Discussion: This survey of Aboriginal people with self-reported hepatitis C infection indicates substantial problems of mental and physical comorbidities among this population. Conclusion: There is a need for the development of HCV community clinics in Aboriginal health care settings with trained Aboriginal community health nurses to reduce problematic alcohol consumption, assess liver health and subsequently provide HCV treatment in a culturally appropriate way

TALKING ABOUT TESTING: OPPORTUNITIES FOR PREVENTION IN BLOOD BORNE VIRUS TESTING AND VACCINATION WITH INJECTORS

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'Re-education' : the imperial pre-history and afterlives of a pedagogical conceit

In the aftermath of World War II, the terms ‘re-education’ and ‘rehabilitation’ were ubiquitous. Often employed almost interchangeably, these nouns named the aspirational outcomes sought by military government personnel, civilian administrators and relief workers—for entire national populations or particular encamped populations. In this article, Susan Carruthers traces the origins of these entangled efforts to ‘remake’ subject peoples, now primarily associated with the postwar occupations of Germany and Japan. She uncovers the hidden connections between re-education and democratization projects – typically projected as constructive and progressive – with Britain’s brutal suppression of colonial counterinsurgencies, as well as the afterlife of the concept in the United States’ Cold War era preoccupation with POW camps and brainwashing. By the 1960s and ‘70s, ‘re-education’ in the Western political lexicon denoted something pernicious practiced exclusively by cold war nemeses: in murderous camps in China, Vietnam, and Cambodia. Yet at the dawn of the twenty-first century, George W. Bush’s administration reanimated memories of the ‘good occupations’ that had transformed Axis foes into pacific and prosperous allies, hoping to persuade sceptics that ‘de-Baathification’ would be every bit as straightforward and successful as ‘de-Nazification’ had come to appear with hindsight. Re-education again provided a language of both obfuscation and legitimation

Sustainability of collaborative care management for depression in primary care settings with academic affiliations across New York State

Background In a large statewide initiative, New York State implemented collaborative care (CC) from 2012 to 2014 in 32 primary care settings where residents were trained and supported its sustainability through payment reforms implemented in 2015. Twenty-six clinics entered the sustainability phase and six opted out, providing an opportunity to examine factors predicting continued CC participation and fidelity. Methods We used descriptive statistics to assess implementation metrics in sustaining vs. opt-out clinics and trends in implementation fidelity 1 and 2 years into the sustainability phase among sustaining clinics. To characterize barriers and facilitators, we conducted 31 semi-structured interviews with psychiatrists, clinic administrators, primary care physicians, and depression care managers (24 at sustaining, 7 at opt-out clinics). Results At the end of the implementation phase, clinics opting to continue the program had significantly higher care manager full-time equivalents (FTEs) and achieved greater clinical improvement rates (46% vs. 7.5%, p = 0.004) than opt-out clinics. At 1 and 2 years into sustainability, the 26 sustaining clinics had steady rates of depression screening, staffing FTEs and treatment titration rates, significantly higher contacts/patient and improvement rates and fewer enrolled patients/FTE. During the sustainability phase, opt-out sites reported lower patient caseloads/FTE, psychiatry and care manager FTEs, and physician/psychiatrist CC involvement compared to sustaining clinics. Key barriers to sustainability noted by respondents included time/resources/personnel (71% of respondents from sustaining clinics vs. 86% from opt-out), patient engagement (67% vs. 43%), and staff/provider engagement (50% vs. 43%). Fewer respondents mentioned early implementation barriers such as leadership support, training, finance, and screening/referral logistics. Facilitators included engaging patients (e.g., warm handoffs) (79% vs. 86%) and staff/providers (71% vs. 100%), and hiring personnel (75% vs. 57%), particularly paraprofessionals for administrative tasks (67% vs. 0%). Conclusions Clinics that saw early clinical improvement and who invested in staffing FTEs were more likely to elect to enter the sustainability phase. Structural rules (e.g., payment reform) both encouraged participation in the sustainability phase and boosted long-term outcomes. While limited to settings with academic affiliations, these results demonstrate that patient and provider engagement and care manager resources are critical factors to ensuring sustainability

Capturing Saddam Hussein: How the full story got away, and what conflict journalism can learn from it

The capture of Saddam Hussein in December 2003 was reported with a sense of triumph which must have greatly satisfied the United States forces occupying Iraq. This was the victory they had been looking for; the seminal moment which signalled that the invasion had been a success. But the reporting of that event was also a missed opportunity: an example of incomplete story telling. In this article, I use my personal experience of reporting on the event for the BBC as a starting point to examine what it, and the way it was covered, tell us about the omissions which are frequently a feature of conflict reporting. The article argues that the way in which reporters had to work in Iraq then meant that they did not convey all of the event’s wider implications, and suggests how that might be improved

A pragmatic group sequential placebo controlled randomised trial to determine the effectiveness of Glyceryl trinitrate for retained placenta (GOT-IT): a study protocol

A retained placenta is diagnosed when the placenta is not delivered following delivery of the baby. It is a major cause of postpartum haemorrhage and treated by the operative procedure of manual removal of placenta (MROP).The aim of this pragmatic, randomised, placebo-controlled, double-blind UK-wide trial, with an internal pilot and nested qualitative research to adjust strategies to refine delivery of the main trial, is to determine whether sublingual glyceryl trinitrate (GTN) is (or is not) clinically and cost-effective for (medical) management of retained placenta. The primary clinical outcome is need for MROP, defined as the placenta remaining undelivered 15 min poststudy treatment and/or being required within 15 min of treatment due to safety concerns. The primary safety outcome is measured blood loss between administration of treatment and transfer to the postnatal ward or other clinical area. The primary patient-sided outcome is satisfaction with treatment and a side effect profile. The primary economic outcome is net incremental costs (or cost savings) to the National Health Service of using GTN versus standard practice. Secondary outcomes are being measured over a range of clinical and economic domains. The primary outcomes will be analysed using linear models appropriate to the distribution of each outcome. Health service costs will be compared with multiple trial outcomes in a cost-consequence analysis of GTN versus standard practice.Ethical approval has been obtained from the North-East Newcastle and North Tyneside 2 Research Ethics Committee (13/NE/0339). Dissemination plans for the trial include the Health Technology Assessment Monograph, presentation at international scientific meetings and publication in high-impact, peer-reviewed journals.ISCRTN88609453; Pre-results

Special Issue: Inequality and Race in the Histories of Archaeology

This special issue gathers together a selection of short articles reflecting on the historical construction of inequality and race in the histories of archaeology. The articles also suggest ways in which the discipline might grapple with the—often obvious, sometimes subtle—consequences of that historical process. Solicited via an open call for papers in the summer of 2020 (one made with the aim of speedy publication), the breadth of the topics discussed in the articles reflect how inequality and race have become more prominent research themes within the histories of archaeology in the previous five-to-ten years. At the same time, the pieces show how research can—and should—be connected to attempts to promote social justice and an end to racial discrimination within archaeological practice, the archaeological profession, and the wider worlds with which the discipline interacts. Published at a time when a pandemic has not only swept the world, but also exposed such inequalities further, the special issue represents a positive intervention in what continues to be a contentious issue

Risk factors for borderline personality disorder in treatment seeking patients with a substance use disorder: An international multicenter study

Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs