法学最新文献

Chemsex is defined as the use of psychoactive substances - most commonly methamphetamine, synthetic cathinones, and Gamma-hydroxybutyrate/Gamma butyrolactone (GHB/GBL) - to enhance sexual activity primarily among gay, bisexual, and other men who have sex with men (GBM). It is associated with higher rates of sexually transmitted infections, HIV, and mental health conditions. However, despite substantial public health concerns regarding rising overdose deaths, the relationship between chemsex and overdose remains poorly studied. In this perspective, we synthesize the current evidence, identify critical knowledge gaps regarding the association between chemsex and overdose risk among GBM, and outline harm reduction and behavioral interventions. Assessing chemsex-related overdose deaths among GBM is challenging due to the limited documentation of sexual practices and sexual orientation in medical or legal records. Stigma further reduces disclosure, and chemsex involvement is rarely identifiable posthumously. Chemsex frequency and perceptions of harm also obscure problematic use. Effective pharmacologic treatments for stimulant dependence remain limited. In contrast, contingency management (CM) has been proven effective in reducing stimulant use, yet remains underutilized. Integrated harm reduction approaches are essential to mitigate the potential risks of chemsex. Key interventions include HIV testing, needle exchange, sexual health screenings, psychosocial interventions, and vaccinations. There is an urgent need for targeted research, improved data collection, and tailored harm reduction strategies to better understand and reduce overdose risk within chemsex contexts. Addressing these gaps is essential for reducing preventable deaths and improving health outcomes in this population.

Adolescent family violence (AFV) has become a topic of increasing attention, yet our understanding of how to assess the risk of future family violence among this cohort is limited. This systematic review aimed to determine what risk assessment tools have been validated for use with AFV and investigate their predictive validity. It also sought to determine whether the literature adhered to the Risk Assessment Guidelines for the Evaluation of Efficacy statement (i.e., RAGEE guidelines). Out of 11,663 studies identified, seven met inclusion criteria and validated six instruments, including the Structured Assessment of Violence Risk in Youth (SAVRY), Youth Level of Service/Case Management Inventory (YLS/CMI), Victoria Police Screening Assessment for Family Violence Risk (VP-SAFvR), Static Assessment of Family Violence Recidivism (SAFVR), Dynamic Risk Assessment for Family Violence (DYRA), and the Integrated Safety Response (ISR). The discriminant ability of the Psychopathy Checklist: Youth Version (PCL-YV) was also considered in one study. Three key findings arose from this review. First, there are very few validated risk assessment tools for AFV behaviours, and variability in predictive and discriminant validity amongst those few that have been validated (with Area Under the Curve values ranging from .54 to .67). Second, there is a reasonably positive adherence to RAGEE guidelines. Third, there appears to be a high risk of bias among studies which validated risk assessment tools for use with AFV. The findings underscore the need for validated risk assessment tools tailored specifically for use with AFV, particularly for clinicians and professionals working in the family violence field.

A dementia-friendly community (DFC) is a place where people living with dementia (PLWD) and family carers' rights are supported and communities value their input. Many developed countries have social policies to address the discrimination and stigma faced by PLWD and to support their interest in continuing to live in their homes and communities. This exploratory, micro-ethnographic case study research examined micro-processes in two committees established to build DFCs in Australia. Data were derived from participant observation, field notes, and 16 interviews with DFC committee members. Findings highlight two key learnings. First, active engagement requires meeting the rights of PLWD to have a voice, be heard, and hold power in committees. Second, recognizing how positioning PLWD as consumers or leaders affects participation and inclusion. From our analyses and insights gained, we propose how a dialogical community development approach could improve local initiatives through interpersonal relationships and actions as well as explicit reflection and discussion of how professionals can facilitate or constrain inclusive and participatory practices among PLWD.

Background: Alcohol Use Disorder (AUD) is a leading contributor to global morbidity and mortality, disproportionately affecting people experiencing homelessness. Managed Alcohol Programs (MAPs) represent a harm reduction-based strategy for individuals with severe AUD and homelessness, providing controlled amounts of alcohol alongside comprehensive health and social supports. While evidence of MAP benefits continues to grow, important questions remain about how best to integrate social and medical care, and how to tailor services to align with participants' goals, values, and broader social and structural contexts.

Main body: This commentary explores the operational strategies and clinical practices of the Ottawa Inner City Health (OICH) MAP, which has been running since 2001. We describe how the program is embedded within supportive housing and leverages an interdisciplinary team-including peer workers and an Indigenous healer-to deliver person-centered care. Key components include structured alcohol delivery tailored to individual needs, meal provision, social supports including life skills training, medication administration and comprehensive physical and mental health services. Clinical care is tailored to participants' day-to-day circumstances, challenges, and goals in managing their AUD, with particular attention to hygiene and nutrition, proactive screening for health decline, and timely management of common health complications. The program operates through strong partnerships with community organizations, pharmacies and subspecialists, to enable integrated, coordinated care. Collaborative and trauma-informed approaches reduce reliance on emergency care and foster a sense of dignity, stability, and community.

Conclusion: MAPs have evolved from experimental interventions into internationally recognized harm reduction models. The OICH MAP demonstrates how the integration of housing, healthcare, and social supports can address the complex needs of individuals experiencing homelessness and severe AUD. However, challenges remain in scaling these models, refining screening protocols, and developing evidence-based policy frameworks. This commentary offers practical insights to inform the effective operation of MAPs and calls for continued research and dialogue to ensure they remain adaptable, sustainable, and aligned with the realities of the populations they serve.

Empirical discourses surrounding bisexuality often focus on challenges and disparities. This analysis identifies counternarratives of coping and survival among 21 midlife and older bisexual individuals. Findings are presented in three found poems followed by interpretations within participants' life experiences. Each poem depicts an "act" of life, separating narratives into three stages of meaning-making. Act I: The Struggle captures early-to midlife experiences fraught with confusion, isolation, mental health challenges, and interpersonal conflict. In Act II: Coping and Survival Looks Like…participants reflect on strengths, skills, and relationships they used to confront significant challenges. Act III: Healing Bisexual Futures presents reflections on what bisexuality means to participants in later life and how they envision their futures. This streamlined version of complex and messy life histories represents an agentive story-telling process in which participants seek meaning and cohesion in narrating their lives. Creative methodologies are well-suited to capturing this narrative nuance and poignance.