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O'Brien K.K.,Royal College of Surgeons in Ireland | Schuttke A.,Trinity College Dublin | Alhakeem A.,Royal College of Surgeons in Ireland | Donnelly-Swift E.,Royal College of Surgeons in Ireland | And 5 more authors.
Drug and Alcohol Dependence | Year: 2015

Introduction: Drug misuse has been identified as a significant problem in homeless populations. This study examines aspects of physical and mental health, perceived quality of life and health service use among homeless illicit drug users and compares these to non-drug users. Methods: Participants were recruited through health clinics across Dublin. A questionnaire assessed participants' drug use, health and well-being, health behaviours and use of health services. Descriptive statistics are presented for the entire cohort and drug users separately. Logistic regression analysis was used to examine the relationship between drug use and (i) multimorbidity, (ii) anxiety and/or depression, (iii) perceived quality of life and (iv) use of health services. Results: Of 105 participants recruited, 35 (33%) were current drug users. Current and previous drug users were significantly more likely to have multimorbidity than those who had never taken drugs (OR 4.86, 95% CI 1.00-23.66). There was no significant difference between drug users and non-drug users in the prevalence of anxiety and/or depression. Drug users were five times more likely than non-drug users to have a low perceived quality of life (OR 5.2, 95% CI 1.7-16.0). Health service utilization was high, although some services were used less by drug users (e.g., dentist and psychiatric outpatient services) while others were used more often (e.g., phoneline services and day care centres). Conclusion: This study highlights the high levels of drug use in this population and the negative impact of drug use on health and perceived quality of life of a homeless population in Dublin. © 2015 Elsevier Ireland Ltd. Source


Foley P.,Memorial University of Newfoundland | Mather C.,Memorial University of Newfoundland | Mather C.,St. Johns University | Neis B.,SafetyNet
Marine Policy | Year: 2015

Critical analyses of neoliberalism[U+05F3]s influence on fisheries governance have documented how enclosure, quota leasing and renting, and commodification can precipitate negative social consequences for fishing communities. By contrast, this paper draws on the concept of embeddedness to argue that certain policies and social relations can regulate enclosure, quota renting, and commodification in ways that empower community-based groups to facilitate the anchoring of fishery resources and wealth in coastal communities. It does so through an analysis of northern shrimp fisheries in Newfoundland and Labrador, Canada, between the 1970s and the early 2000s. This case study illustrates how fisheries enclosure policies informed by geographically and morally defined principles of access and equity and limits on commodification can meaningfully embed fishery resources and benefits in rural and remote coastal regions that depend on small-scale fishing. Although the application of social principles continues to be marginalized in the context of neoliberal policy regimes that privilege individual economic efficiency over distributive concerns, this paper provides new insight into the conditions under which principles of ethical allocation and distribution of resources are able to persist through an era of neoliberalism. © 2014 The Authors. Source


Keogh C.,Royal College of Surgeons in Ireland | O'Brien K.K.,Royal College of Surgeons in Ireland | Hoban A.,Royal College of Surgeons in Ireland | O'Carroll A.,SafetyNet | Fahey T.,Royal College of Surgeons in Ireland
BMC Health Services Research | Year: 2015

Background: Homeless populations experience poorer physical and mental health, and more barriers to accessing adequate healthcare. This study investigates the health of this population, following the provision of a free to access primary care service for homeless people in Dublin (Safetynet). The health of this group will be compared to previous studies on homelessness conducted in Dublin prior to the establishment of this service (in 1997 and 2005). Methods: Participants were recruited through Safetynet clinics. A 133-item questionnaire was administered to determine participants' physical and mental well-being, use of health services and healthcare needs. Prescription data was extracted from participants' electronic health records. Results: A total of 105 participants were recruited. The majority were < 45 years of age (69%), male (75%), single (52%), Irish (74%) and had children (52%). Multimorbidity was common; with 5.3 ± 2.7 (mean ± SD) physical conditions reported per person. A large proportion of participants had at some point received a formal diagnosis of a mental health condition (70%; 73/105), including depression (50%; 52/105), addiction disorder (39%), anxiety (36%; 38/105), schizophrenia (13%; 14/105) and bipolar disorder (6%; 6/105). With regards to illicit drug use, 60% (63/105) of participants reported ever using drugs, while 33% (35/105) reported being active drug users. Based on AUDIT C criteria, 53% had an alcohol problem. Compared to previous studies, participants reported more positive ratings of health (70% vs. 57% in 1997 and 46% in 2005). The proportion of participants on one or more prescription medication was higher than in previous studies (81% vs. 32% in 1997 and 49% in 2005) and there was a decrease in attendance at outpatients departments (17% vs. 27% in 2005) and a trend towards a decrease in attendance at Accident and Emergency departments (A & E) (29% vs. 37% in 2005). Conclusions: This vulnerable population has many physical and mental health problems. Use of drugs, alcohol and smoking is common. Following the establishment of Safetynet, self-reported health was rated more positively, there was also a decrease in the use of A & E and outpatient services and an increase in prescription medicines. Source


Sucaldito N.L.,National Epidemiology Center | Tayag E.A.,Support Service Delivery Technical Cluster ational Epidemiology Center | Roces M.C.R.,SafetyNet | Robie B.D.,Non Communicable Disease Unit
International Journal of Public Health | Year: 2014

Objectives: The decentralization of the Philippines’ health sector in 1991 sought to improve the efficiency of local health resource allocation; however, local officials were unprepared for the increased responsibility. In 1999 the Philippines Department of Health, with assistance from the US Centers for Disease Control and Prevention (CDC), implemented the Philippines Field Management Training Program (FMTP) to provide local health officials with the managerial skills needed to perform their new, more responsible jobs. This paper addresses whether the FMTP has provided participants with useful managerial skills needed for their more responsible positions.Results: Between 2000 and 2010, 294 participants completed the FMTP and many were later promoted to more responsible positions. The participants also completed 204 applied management improvement projects resulting in documented improvements in service delivery, information systems, logistics, health insurance, policy and laboratory outcomes. Examples of their successes are included in this paper.Conclusions: The results provide compelling evidence that managers are using the skills learned to solve significant managerial problems.Methods: The method involved reviewing program outcomes, including results of applied management improvement projects the participants completed to solve managerial problems. © 2014, Swiss School of Public Health (outside the USA). Source


Foley P.,Memorial University of Newfoundland | Mather C.,Memorial University of Newfoundland | Neis B.,SafetyNet
Marine Policy | Year: 2015

Critical analyses of neoliberalism's influence on fisheries governance have documented how enclosure, quota leasing and renting, and commodification can precipitate negative social consequences for fishing communities. By contrast, this paper draws on the concept of embeddedness to argue that certain policies and social relations can regulate enclosure, quota renting, and commodification in ways that empower community-based groups to facilitate the anchoring of fishery resources and wealth in coastal communities. It does so through an analysis of northern shrimp fisheries in Newfoundland and Labrador, Canada, between the 1970s and the early 2000s. This case study illustrates how fisheries enclosure policies informed by geographically and morally defined principles of access and equity and limits on commodification can meaningfully embed fishery resources and benefits in rural and remote coastal regions that depend on small-scale fishing. Although the application of social principles continues to be marginalized in the context of neoliberal policy regimes that privilege individual economic efficiency over distributive concerns, this paper provides new insight into the conditions under which principles of ethical allocation and distribution of resources are able to persist through an era of neoliberalism. © 2014 The Authors. Source

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