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Internal Medicine (Tokyo, Japan) Dec 1997Aspiration pneumonia is associated with decreases in both swallowing and cough reflexes and is the most common cause of death in the elderly. Basal ganglia strokes might... (Review)
Review
Aspiration pneumonia is associated with decreases in both swallowing and cough reflexes and is the most common cause of death in the elderly. Basal ganglia strokes might predispose these patients to develop pneumonia owing to reductions of both reflexes, resulting in frequent aspiration during sleep. An impairment of dopamine metabolism in the basal ganglia is observed in these patients and levodopa administration improves the impaired swallowing reflex. Both swallowing and cough reflexes are mediated by endogenous substance P (SP) released from vagal sensory nerves in the pharynx and upper airways. The addition of a low dose of capsaicin to liquid or food, which stimulates the release of SP, may help prevent aspiration pneumonia. Angiotensin-converting enzyme inhibitor decreases SP catabolism resulting in improvements in both reflexes. Oral care and the sitting position after meals may decrease aspiration pneumonia in the elderly.
Topics: Aged; Aging; Basal Ganglia; Cerebral Infarction; Cough; Deglutition; Humans; Pneumonia, Aspiration
PubMed: 9475237
DOI: 10.2169/internalmedicine.36.851 -
Women's Health (London, England) 2023Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals.
Patient and provider perspectives on barriers and facilitators to reproductive healthcare access for women experiencing homelessness with substance use disorders in San Francisco.
BACKGROUND
Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals.
OBJECTIVE
This study explored the reproductive aspirations of this population, as well as the barriers to accessing reproductive services from the perspectives of affected individuals, and the healthcare providers who serve them.
DESIGN
This mixed-methods study included surveys and interviews with women experiencing homelessness with substance use disorders and healthcare providers.
METHODS
We conducted surveys and semi-structured interviews with women recruited from opiate treatment programs and homeless encampments in San Francisco, California in 2018. We also conducted interviews and focus groups with healthcare providers in reproductive health and substance use treatment settings. Interviews were recorded, transcribed, and coded. Descriptive statistics of survey results were performed.
RESULTS
Twenty-eight women completed surveys, 96% of whom reported current substance use. Ten women participated in interviews. One-third (9/28) reported desiring pregnancy in the next year; over half (16/28) reported they would be somewhat or very happy to learn they were pregnant. A majority used no contraception at last intercourse (14/28). Twenty-six healthcare providers participated in interviews (n = 15) and focus groups (n = 2). Patients and providers identified similar barriers to care access, including discrimination, logistical and financial challenges, and delayed pregnancy awareness. While providers proposed solutions focused on overcoming logistical challenges, patients emphasized the importance of transforming the healthcare environment to treat patients affected by substance use and homelessness with dignity and respect.
CONCLUSION
Women experiencing homelessness with substance use disorders face intersecting and compounding barriers to accessing reproductive health services. For patients, the impact of stigma and bias on treatment experiences are particularly salient, in contrast to logistical barriers emphasized by providers. Improving access will require structural and individual-level solutions to address stigma and create person-centered, trauma-informed, and respectful care environments.
Topics: Pregnancy; Humans; Female; San Francisco; Health Services Accessibility; Ill-Housed Persons; Substance-Related Disorders; Focus Groups
PubMed: 36939096
DOI: 10.1177/17455057231152374 -
Journal of Substance Abuse Treatment Jan 2023This narrative describes my experience with substance use disorder. It includes a trip through the criminal legal system, recovery, higher education, and a career in...
This narrative describes my experience with substance use disorder. It includes a trip through the criminal legal system, recovery, higher education, and a career in research. I convey key points from a history of using substances and committing crimes and how these created barriers to collegiate and professional aspirations, despite long-term recovery. The substance use services research field has come to value lived experience such as mine, lowering barriers for people with substance use and criminal histories. I hope that my work, built upon this experience, not only helps improve services, but also clears the way for more people in recovery to pursue a career in research.
Topics: Humans; Prisons; Substance-Related Disorders; Criminals; Crime
PubMed: 36327616
DOI: 10.1016/j.jsat.2022.108922 -
Journal of Responsible Innovation 2018The Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative is focused on developing new tools and neurotechnologies to revolutionize our...
The Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative is focused on developing new tools and neurotechnologies to revolutionize our understanding of how the brain functions in health and disease, in large part to address the growing societal impact of neurological, mental health, and substance abuse disorders. Recent advances in neurotechnology are delivering unprecedented ways to interrogate and modulate brain function, and the BRAIN Initiative is focused on translation for human medical uses over the next decade. Since its inception, the NIH component of the BRAIN Initiative has utilized an iterative model of integrating ethics into the scientific trajectory of the Initiative, most recently with the creation of a Neuroethics Division of the NIH BRAIN Initiative Multi-Council Working Group. The Division serves as a resource of expertise, to help the BRAIN Initiative navigate issues involving ethics. Here we discuss the BRAIN Initiative, and its implications and aspirations for neuroethics. We also discuss new opportunities for collaboration and for integrating stakeholder voices.
PubMed: 30854409
DOI: 10.1080/23299460.2017.1319035 -
International Journal of Environmental... Jul 2022Nationwide, public libraries are experiencing an increase in "on-premise" opioid overdoses and other issues (e.g., suicide attempts) affecting unstably housed library...
Nationwide, public libraries are experiencing an increase in "on-premise" opioid overdoses and other issues (e.g., suicide attempts) affecting unstably housed library users. The public library presents a unique opportunity to access an otherwise hidden population. In partnership with the San Diego Central Library, researchers led focus groups, in-depth interviews, and surveys with 63 library patrons experiencing homelessness or housing instability ( = 49) and library staff ( = 14) (January-June 2019). Using a consensus organizing framework and mixed methods approach, the researchers conducted in-depth interviews exploring the library's strengths and opportunities for patrons experiencing homelessness, the barriers to meeting their aspirations, and whether having a social worker at the library or other policy changes in government or the library could help. Specifically, participants answered inquiries about the opportunities for the library to address substance use and human trafficking. In brief surveys, library patrons and staff provided views on the patrons' educational needs, library staff's training needs, and changes needed in government or library policies. Results revealed the desire of the library patrons (69%) and staff (93%) to have a library social worker who could link patrons to housing services, substance use harm reduction or treatment, and address food-insecure youth/families and human trafficking/sexual exploitation. Participants also valued peer advocates with lived homelessness experiences. Over 70% of the unstably housed patrons said they would like library patrons to participate in peer leadership training. Other significant themes were the need for crisis prevention and intervention, connecting patrons to resources and each other, and creating consistent assistance. Libraries urgently need more on-premise support to address patrons' pressing housing, health, and mental health needs.
Topics: Adolescent; Ill-Housed Persons; Housing; Humans; Social Problems; Social Workers; Substance-Related Disorders
PubMed: 35886311
DOI: 10.3390/ijerph19148449 -
Journal of Smooth Muscle Research =... 2020Oropharyngeal dysphagia (OD) is a common symptom in the older people, and may cause fatal complications such as aspiration pneumonia. However, there is no established... (Review)
Review
Oropharyngeal dysphagia (OD) is a common symptom in the older people, and may cause fatal complications such as aspiration pneumonia. However, there is no established treatment for OD. The relationship between the transient receptor potential vanilloid 1 (TRPV1) and substance P released by activated TRPV1 was recently demonstrated. Further, there are several reports showing that capsaicin, a specific agonist of TRPV1, can improve OD. Currently, the evaluation of swallowing is mainly performed by videofluoroscopic examination. However, there are no reports on the clinical application of ultrasonography using tissue Doppler imaging. In this review, we describe the pathophysiology and treatments for OD, introduce our novel US method to evaluate cervical esophageal motility, and then outline our clinical study examining the effects of capsaicin, a specific TRPV1 agonist, in older patients with OD.
Topics: Capsaicin; Deglutition Disorders; Gastrointestinal Motility; Humans; Substance P; TRPV Cation Channels; Ultrasonography, Doppler
PubMed: 32581185
DOI: 10.1540/jsmr.56.46 -
Stem Cell Research Oct 2019Adipose-derived Stem Cells (ASCs) present great potential for reconstructive procedures. Currently, isolation by enzyme digestion and culturing using xenogenic...
BACKGROUND
Adipose-derived Stem Cells (ASCs) present great potential for reconstructive procedures. Currently, isolation by enzyme digestion and culturing using xenogenic substances remain the gold standard, impairing clinical use.
METHODS
Abdominal lipo-aspirate and blood samples were obtained from healthy patients. A novel mechanical isolation method for ASCs was compared to (the standard) collagenase digestion. ASCs are examined by flowcytometry and multilineage differentiation assays. Cell cultures were performed without xenogenic or toxic substances, using autologous plasma extracted from peripheral blood. After eGFP-transfection, an in vivo differentiation assay was performed.
RESULTS
Mechanical isolation is more successful in isolating CD34/CD31/CD45/CD13/CD73/CD146 ASCs from lipo-aspirate than isolation via collagenase digestion (p <0 .05). ASCs display multilineage differentiation potential in vitro. Autologous plasma is a valid additive for ASCs culturing. eGFP-ASCs, retrieved after 3 months in vivo, differentiated in adipocytes and endothelial cells.
CONCLUSION
A practical method for human ASC isolation and culturing from abdominal lipo-aspirate, without the addition of xenogenic substances, is described. The mechanical protocol is more successful than the current gold standard protocol of enzyme digestion. These results are important in the translation of laboratory-based cell cultures to clinical reconstructive and aesthetic applications.
Topics: Adipose Tissue; Animals; Antigens, CD34; Cell Differentiation; Cell Separation; Cells, Cultured; Culture Media; Female; Humans; Mesenchymal Stem Cells; Mice; Mice, Nude
PubMed: 31421383
DOI: 10.1016/j.scr.2019.101532 -
Maternal and Child Health Journal Dec 2023Many cisgender women affected by homelessness and substance use desire pregnancy and parenthood. Provider discomfort with patient-centered counseling about reproductive...
Improving Reproductive Health Communication Between Providers and Women Affected by Homelessness and Substance Use in San Francisco: Results from a Community-Informed Workshop.
OBJECTIVES
Many cisgender women affected by homelessness and substance use desire pregnancy and parenthood. Provider discomfort with patient-centered counseling about reproductive choices and supporting reproductive decisions of these women poses barriers to reproductive healthcare access.
METHODS
We used participatory research methods to develop a half-day workshop for San Francisco-based medical and social service providers to improve reproductive counseling of women experiencing homelessness and/or who use substances. Guided by a stakeholder group comprising cisgender women with lived experience and providers, goals of the workshop included increasing provider empathy, advancing patient-centered reproductive health communication, and eliminating extraneous questions in care settings that perpetuate stigma. We used pre/post surveys to evaluate acceptability and effects of the workshop on participants' attitudes and confidence in providing reproductive health counseling. We repeated surveys one month post-event to investigate lasting effects.
RESULTS
Forty-two San Francisco-based medical and social service providers participated in the workshop. Compared to pre-test, post-test scores indicated reduced biases about: childbearing among unhoused women (p < 0.01), parenting intentions of pregnant women using substances (p = 0.03), and women not using contraception while using substances (p < 0.01). Participants also expressed increased confidence in how and when to discuss reproductive aspirations (p < 0.01) with clients. At one month, 90% of respondents reported the workshop was somewhat or very beneficial to their work, and 65% reported increased awareness of personal biases when working with this patient population.
CONCLUSIONS FOR PRACTICE
A half-day workshop increased provider empathy and improved provider confidence in reproductive health counseling of women affected by homelessness and substance use.
Topics: Humans; Female; Pregnancy; Health Communication; Reproductive Health; San Francisco; Ill-Housed Persons; Substance-Related Disorders
PubMed: 37204587
DOI: 10.1007/s10995-023-03671-y -
BMC Public Health May 2019Surveys of young people under-represent those in alternative education settings (AES), potentially disguising health inequalities. We present the first quantitative UK...
BACKGROUND
Surveys of young people under-represent those in alternative education settings (AES), potentially disguising health inequalities. We present the first quantitative UK evidence of health inequalities between AES and mainstream education school (MES) pupils, assessing whether observed inequalities are attributable to socioeconomic, familial, educational and peer factors.
METHODS
Cross-sectional, self-reported data on individual- and poly-substance use (PSU: combined tobacco, alcohol and cannabis use) and sexual risk-taking from 219 pupils in AES (mean age 15.9 years) were compared with data from 4024 pupils in MES (mean age 15.5 years). Data were collected from 2008 to 2009 as part of the quasi-experimental evaluation of Healthy Respect 2 (HR2).
RESULTS
AES pupils reported higher levels of substance use, including tobacco use, weekly drunkenness, using cannabis at least once a week and engaging in PSU at least once a week. AES pupils also reported higher levels of sexual health risk behaviours than their MES counterparts, including: earlier sexual activity; less protection against sexually transmitted infections (STIs); and having 3+ lifetime sexual partners. In multivariate analyses, inequalities in sexual risk-taking were fully explained after adjusting for higher deprivation, lower parental monitoring, lower parent-child connectedness, school disengagement and heightened intentions towards early parenthood among AES vs MES pupils. However, an increased risk (OR = 1.73, 95% CI 1.15, 2.60) of weekly PSU was found for AES vs MES pupils after adjusting for these factors and the influence of peer behaviours.
CONCLUSION
AES pupils are more likely to engage in health risk behaviours, including PSU and sexual risk-taking, compared with MES pupils. AES pupils are a vulnerable group who may not be easily targeted by conventional population-level public health programmes. Health promotion interventions need to be tailored and contextualised for AES pupils, in particular for sexual health and PSU. These could be included within interventions designed to promote broader outcomes such as mental wellbeing, educational engagement, raise future aspirations and promote resilience.
Topics: Adolescent; Adolescent Behavior; Alcoholic Intoxication; Cross-Sectional Studies; Female; Health Promotion; Health Risk Behaviors; Humans; Male; Multivariate Analysis; Schools; Sexual Behavior; Sexual Partners; Socioeconomic Factors; Substance-Related Disorders; Teaching
PubMed: 31088403
DOI: 10.1186/s12889-019-6892-0 -
Reproductive Biology and Endocrinology... Nov 2003The onset of clinical assisted reproduction, a quarter of a century ago, required the isolation of motile spermatozoa. As the indication of assisted reproduction shifted... (Review)
Review
The onset of clinical assisted reproduction, a quarter of a century ago, required the isolation of motile spermatozoa. As the indication of assisted reproduction shifted from mere gynaecological indications to andrological indications during the years, this urged andrological research to understand the physiology of male germ cell better and develop more sophisticated techniques to separate functional spermatozoa from those that are immotile, have poor morphology or are not capable to fertilize oocytes. Initially, starting from simple washing of spermatozoa, separation techniques, based on different principles like migration, filtration or density gradient centrifugation evolved. The most simple and cheapest is the conventional swim-up procedure. A more sophisticated and most gentle migration method is migration-sedimentation. However, its yield is relatively small and the technique is therefore normally only limited to ejaculates with a high number of motile spermatozoa. Recently, however, the method was also successfully used to isolate spermatozoa for intracytoplasmic sperm injection (ICSI). Sperm separation methods that yield a higher number of motile spermatozoa are glass wool filtration or density gradient centrifugation with different media. Since Percoll as a density medium was removed from the market in 1996 for clinical use in the human because of its risk of contamination with endotoxins, other media like IxaPrep, Nycodenz, SilSelect, PureSperm or Isolate were developed in order to replace Percoll. Today, an array of different methods is available and the selection depends on the quality of the ejaculates, which also includes production of reactive oxygen species (ROS) by spermatozoa and leukocytes. Ejaculates with ROS production should not be separated by means of conventional swim-up, as this can severely damage the spermatozoa. In order to protect the male germ cells from the influence of ROS and to stimulate their motility to increase the yield, a number of substances can be added to the ejaculate or the separation medium. Caffeine, pentoxifylline and 2-deoxyadenosine are substances that were used to stimulate motility. Recent approaches to stimulate spermatozoa include bicarbonate, metal chelators or platelet-activating factor (PAF). While the use of PAF already resulted in pregnancies in intrauterine insemination, the suitability of the other substances for the clinical use still needs to be tested. Finally, the isolation of functional spermatozoa from highly viscous ejaculates is a special challenge and can be performed enzymatically to liquefy the ejaculate. The older method, by which the ejaculate is forcefully aspirated through a narrow-gauge needle, should be abandoned as it can severely damage spermatozoa, thus resulting in immotile sperm.
Topics: Cell Separation; Humans; Infertility, Male; Male; Reproductive Techniques, Assisted; Sperm Motility; Spermatozoa
PubMed: 14617368
DOI: 10.1186/1477-7827-1-108