The Meaning of Drug Use among Homeless Young People:A longitudinal pathways analysis

A strong link between drug use and homelessness has long since been documented in the international literature. However, much of the research has concentrated on the direction of the relationship between drug use and homelessness, seeking to establish drug use as a cause or consequence of homelessness, with far less attention to the intersection of drug and homeless ‘careers’. This paper examines the drug and homeless pathways of young people who are participants in a qualitative longitudinal study of homeless youth in Dublin, Ireland. The findings highlight downward drug transitions as associated with exiting homelessness and continued or escalated consumption as associated with remaining homeless. Analyses of the meanings young people attach to drug use over time reveal the importance of housing as an enabler to engaging with treatment and as assisting the process of becoming and remaining drug free. Young people who remained homeless did not accept their situations, as ‘acculturation’ accounts would suggest; rather, they aspired to changing their situations. However, they also face strong barriers to accessing housing which in turn hamper their efforts to address the matter of their drug use. The implications for how the homeless/drug use ‘nexus’ is conceptualised and understood, as well as implications for policy, are discussed.

Test-retest variability in structural and functional parameters of glaucoma damage in the glaucoma imaging longitudinal study.

PURPOSE:

To determine the test-retest variability in perimetric, optic disc, and macular thickness parameters in a cohort of treated patients with established glaucoma.

PATIENTS AND METHODS:

In this cohort study, the authors analyzed the imaging studies and visual field tests at the baseline and 6-month visits of 162 eyes of 162 participant in the Glaucoma Imaging Longitudinal Study (GILS). They assessed the difference, expressed as the standard error of measurement, of Humphrey field analyzer II (HFA) Swedish Interactive Threshold Algorithm fast, Heidelberg retinal tomograph (HRT) II, and retinal thickness analyzer (RTA) parameters between the two visits and assumed that this difference was due to measurement variability, not pathologic change. A statistically significant change was defined as twice the standard error of measurement.

RESULTS:

In this cohort of treated glaucoma patients, it was found that statistically significant changes were 3.2 dB for mean deviation (MD), 2.2 for pattern standard deviation (PSD), 0.12 for cup shape measure, 0.26 mm for rim area, and 32.8 microm and 31.8 microm for superior and inferior macular thickness, respectively. On the basis of these values, it was estimated that the number of potential progression events detectable in this cohort by the parameters of MD, PSD, cup shape measure, rim area, superior macular thickness, and inferior macular thickness was 7.5, 6.0, 2.3, 5.7, 3.1, and 3.4, respectively.

CONCLUSIONS:

The variability of the measurements of MD, PSD, and rim area, relative to the range of possible values, is less than the variability of cup shape measure or macular thickness measurements. Therefore, the former measurements may be more useful global measurements for assessing progressive glaucoma damage.

Impaired orthostatic blood pressure recovery and cognitive performance at two-year follow up in older adults: The Irish Longitudinal Study on Ageing

Background: Prospective investigations of the association between impaired orthostatic blood pressure (BP) regulation and cognitive decline in older adults are limited, and findings to-date have been mixed. The aim of this study was to determine whether impaired recovery of orthostatic BP was associated with change in cognitive function over a 2-year period, in a population based sample of community dwelling older adults. 

Methods: Data from the first two waves of the Irish Longitudinal Study on Ageing were analysed. Orthostatic BP was measured during a lying to standing orthostatic stress protocol at wave 1 using beat-to-beat digital plethysmography, and impaired recovery of BP at 40 s post stand was investigated. Cognitive function was assessed at wave 1 and wave 2 (2 years later) using the Mini-Mental State Exam (MMSE), verbal fluency and word recall tasks. 

Results: After adjustment for measured, potential confounders, and multiple imputation for missing data, the change in the number of errors between waves on the MMSE was 10 % higher [IRR (95 % CI) = 1.10 (0.96, 1.26)] in those with impaired recovery at 40 s. However, this was not statistically significant (p = 0.17). Impaired BP recovery was not associated with change in performance on any of the other cognitive measures. 

Conclusions: There was no clear evidence for an association between impaired recovery of orthostatic BP and change in cognition over a 2-year period in this nationally representative cohort of older adults. Longer follow-up and more detailed cognitive testing would be advantageous to further investigate the relationship between orthostatic BP and cognitive decline.

Mismatches and matches in address information from the Census and the BSO: A longitudinal perspective 2001-2011

Accurate address information from health service providers is fundamental for the effective delivery of health care and population monitoring and screening. While it is currently used in the production of key statistics such as internal migration estimates, it will become even more important over time with the 2021 Census of UK constituent countries integrating administrative data to enhance the quality of statistical outputs. Therefore, it is beneficial to improve understanding of the accuracy of address information held by health service providers and factors that influence this. This paper builds upon previous research on the social geography of address mismatch between census and health service records in Northern Ireland. It is based on the Northern Ireland Longitudinal Study; this is a large data linkage study including about 28 per cent of the Northern Ireland population, which is matched between the census (2001, 2011) and Health Card Registration System maintained by the Health and Social Care Business Service Organisation (BSO). This research compares address information from the Spring 2011 BSO download (Unique Property Reference Number, Super Output Area) with comparable geographic information from the 2011 Census. Multivariate and multilevel analyses are used to assess the individual and ecological determinants of match/mismatch between geographical information in both data sources to determine if the characteristics of the associated people and places are the same as the position observed in 2001. It is important to understand if the same people are being inaccurately geographically referenced in both Census years or if the situation is more variable.