185 research outputs found
sj-png-4-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-png-4-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
sj-png-6-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-png-6-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
sj-png-3-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-png-3-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
sj-docx-1-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-docx-1-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
sj-png-7-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-png-7-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
sj-png-5-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-png-5-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
sj-png-2-whe-10.1177_17455057221123998 – Supplemental material for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis
No full textSupplemental material, sj-png-2-whe-10.1177_17455057221123998 for Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis by Sébastien Poix, Nuha Ibrahim, Stacey Scriver, Srinivas Raghavendra, Nata Duvvury and Khalifa Elmusharaf in Women’s Health</p
The lived experience of \u27opioid use disorder\u27 in Ireland in the 21st century
No full textThis thesis focuses on three critical phases in the life journey of a person with an
opioid use disorder (OUD) ; Initial, random intermittent opioid use, termed
‘Recreational Sporadic Use’, transitioning to increased persistent opioid use,
labelled ‘Intensified Sustained Use’, culminating in complete impulsivity and full
opioid dependence, coined, ‘Loss of Control’. The crucial role of the neurobiology
of dependence, explored in depth in this thesis, underpins these key phases in
developing and sustaining an opioid dependence. Building on this framework the
thesis unravels the effect of Adverse Childhood Experiences on the likelihood of
experimenting with opioids and subsequently cultivating a dependence. It then
recounts the effect of both dual diagnosis and concurrent benzodiazepine abuse on
sustaining and intensifying one’s dependence until an individual eventually
surrenders to the inevitable destructive effects of an opioid dependence and loses
all voluntary control over their usage. The thesis then delves further into the lives
of individuals with OUD by illuminating both positive and negative factors in
their life journeys, which influence the remitting, relapsing nature of their illness.
Invariably, given the neurobiological factors nourishing drug dependence the
negative factors triumph, and relapse to drug use prevails. In unravelling the
complexities of the neurobiology of dependence, this thesis, highlights that
undoubtedly the best approach to help, support and where possible treat
individuals with an OUD is under the umbrella term of harm reduction. A special
focus is placed on the harm reductive properties of methadone as a therapeutic
agent in combatting OUD, with a particular emphasis on the need to educate all
members of society on its therapeutic benefits. Undoubtedly, the most harrowing
outcome for all in this often-thwarted journey is fatal overdose (OD),
unfortunately the outcome for which far too many individuals succumb.
Therefore, the most pivotal of harm reduction strategies to ebb the flow of death
in OUD, ‘Take Home Naloxone Programmes’ (THNPs) are examined in the latter
half of this thesis, with particular scrutiny given to Ireland’s THNP. As this thesis
highlights, in Ireland, we have made much progress in our approach to addressing
the opioid crisis but, as always, there is much room for improvement and
advances.
Aims
The predominant aim of this thesis echoes a key strategic purpose of Ireland’s
latest drug strategy, ‘Reducing harm, supporting recovery: a health-led response
to drug and alcohol use in Ireland 2017- 2025’, which is to reduce the morbidity
and mortality associated with OUD. Two studies are undertaken to achieve this
purpose. Study 1 aims to give clients of the Mid-West of Ireland’s Programme for
Methadone Maintenance Treatment (MMT) a voice, to document their lived
experience of opioid dependence before, during and after their ‘three-phase
journey’ through OUD. It aims to co-develop with clients a tailored care plan to
enhance their chance of successfully engaging with the MMTP. Study 2 aims to gain an overall appreciation of Ireland’s national THNP to optimise its
functioning. A second objective of this study is to improve the likelihood of a
patient attending hospital post administration of naloxone in the community, a
step that is associated with overall better survival rates.
Methods
This thesis employs a mixed method research design. Study 1 is a qualitative study;
Study 2 employs a quantitative method.
Results
Study 1 reveals an enriching insight into the personal experience of each
individual client’s journey. Their journeys, though each unique, had common
chronological sub-themes which are recounted in depth. Subsequent data analysis
identifies common life experiences, which influence their journey both negatively
and positively. Final data analysis identifies clients’ individual suggestions for
improving their journey. The results of Study 2 reveal inadequacies in the current
reporting mechanism currently in place on the use of naloxone in the community
setting in Ireland. Descriptive analysis then looks at the characteristics pertaining
to overdose patients themselves and subsequently the characteristics of the
overdose scene are documented. Thereafter, using a logistical regression model,
statistical results on the variables that influence a patient’s hospital attendance are
presented.
Conclusion
The thesis concludes with recommendations for improvement in the management
of OUD. It proposes how knowledge of ACEs should influence the MMTPs in
Ireland and internationally, to adopt a more ‘trauma informed’ ethos.
Subsequently, recommendations centre on dually diagnosed individuals, with a
specific focus on addressing benzodiazepine misuse. Next, the theme of
therapeutics is explored, listing specific proposals on how to both promote
education and reduce stigma in relation to methadone, as a treatment option in
OUD. Finally, the thesis focuses on recommendations with regard to THNPs.
Initial suggestions focus on improving the Irish THNP and subsequently general
recommendations applicable to THNPs internationally are addressed
Addressing the harms related to youth substance use: treatment of individuals and population focused legislative responses
No full textSubstance use, and substance use disorders (SUD), are major contributors to global burden of disease among youth. They constitute an important risk factor for other disorders, including mental disorders. This thesis seeks to examine methods to reduce the harm associated with youth substance use, looking at the impact of treatment on the individual adolescent with a SUD and at legislative measures operating at the population level. While treatment models for SUD have become more liberal and harm reduction orientated in recent decades, legislation remains conservative and prohibitionist. The archetypal harm reduction treatment is opiate substitution treatment (OST) used with heroin dependence. The evidence base for OST in adolescents is sparse. Outcome of OST was examined. It emerged that OST delivers early reductions in heroin use, which continue to improve significantly from month three to month twelve of treatment. Evidence of improved psychological wellbeing is also demonstrated by adolescents on OST. In order to explore the impact of conservative legislative measures on harm related to substance use, a quasi-experimental approach was undertaken to explore changes which occurred in Ireland before, during and after the arrival of a vast network of head shops selling new psychoactive substances (NPS). Evidence is presented indicating that the expansion of head shops coincided with increased NPS addiction episodes among both adolescents and young adults. There was also evidence of increased drug related psychiatric admissions. All of these harms began to diminish within months of the closure of the head shops. Overall, these findings lend support to the position of providing tolerant and responsive treatment which does not demand abstinence for the small subset of youth who develop a SUD, while simultaneously maintaining an intolerant and conservative approach to prevention of substance use at the wider population level
The preparedness of medical students from the Middle East for the modern curriculum: a cross-sectional study
No full text[EN] Aim
This study aims to examine whether there were any differences in self-directed learning readiness
(SDLR) between students who entered medicine with a local Bahraini schools certificate and those
students who entered with an international schools certificate.
Results
We analysed how self-management, desire for learning, self-control and total SDLR scores varied in
relation to the student’s previous exit award: ‘A’ levels (or equivalent) or Bahrain Secondary School
(BSS) certificate. BSS certificate students had a significantly lower mean standardised desire for
learning score (63.5) compared to those ‘A’ levels or equivalent (73.6; p=0.003). BSS certificate
students also had a significantly lower mean total self-directed learning readiness score (192.3)
compared to those with the ‘A’ levels and equivalent (214.5; p=0.015). When we controlled for all the
other factors, secondary school award certificate was the only independent predictor of self-control
(standardised beta 0.4; p=0.02) and SDLR (standardised beta 0.36; p=0.043).
Conclusion
Self-directed learning is a key skill in the modern curriculum. Students who exit with a local Middle
Eastern secondary school certificate are finding it difficult to prepare themselves for independent
learning in medical school. This poses a challenge for institutions bringing a more active-learning type
of curriculum to the Middle East.Rashid-Doubell, F.; Doubell, T.; O'sullivan, R.; Elmusharaf, K. (2015). The preparedness of medical students from the Middle East for the modern curriculum: a cross-sectional study. En 1ST INTERNATIONAL CONFERENCE ON HIGHER EDUCATION ADVANCES (HEAD' 15). Editorial Universitat Politècnica de València. 258-266. https://doi.org/10.4995/HEAd15.2015.299OCS25826
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