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Sample records for personal care substances

  1. Substance Use Among Persons with Homeless Experience in Primary Care

    PubMed Central

    Stringfellow, Erin J.; Kim, Theresa W.; Gordon, Adam J.; Pollio, David E.; Grucza, Richard A.; Austin, Erika L.; Johnson, N. Kay; Kertesz, Stefan G.

    2016-01-01

    Background Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There is less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. Methods We surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at 5 federally-funded programs in the U.S., administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). We used the ASSIST definitions of lower, moderate, and high risk to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Results Almost one-half of the sample (n = 601) had recently (within the past 3 months) used alcohol, and one-third had recently used an illicit drug. The most commonly used illicit drugs in the past 3 months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one-half (59%) of respondents had ASSIST-defined moderate or high risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Conclusions Less severe (moderate risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high risk use in this primary care, homeless-experienced sample. Our findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons. PMID:26914448

  2. Recovery-Promoting Care as Experienced by Persons with Severe Mental Illness and Substance Misuse

    ERIC Educational Resources Information Center

    Cruce, Gunilla; Ojehagen, Agneta; Nordstrom, Monica

    2012-01-01

    This paper explores recovery-promoting care as experienced by persons with concomitant severe mental illness and substance misuse. Sixteen in-depth interviews, based on an interview guide concerning their experiences of health, life situation and care, were held with eight participants in an outpatient treatment programme. The analysis aimed to…

  3. Recovery-Promoting Care as Experienced by Persons with Severe Mental Illness and Substance Misuse

    ERIC Educational Resources Information Center

    Cruce, Gunilla; Ojehagen, Agneta; Nordstrom, Monica

    2012-01-01

    This paper explores recovery-promoting care as experienced by persons with concomitant severe mental illness and substance misuse. Sixteen in-depth interviews, based on an interview guide concerning their experiences of health, life situation and care, were held with eight participants in an outpatient treatment programme. The analysis aimed to…

  4. Presence of selected priority and personal care substances in an onsite bathroom greywater treatment facility.

    PubMed

    Eriksson, E; Donner, E; Ledin, A

    2010-01-01

    In recent years, concerns about climate change and the inefficient use and ongoing pollution of water resources have increased the political motivation to encourage water recycling. This has led to the widespread introduction of water saving measures and to advances in the decentralised treatment and reuse of wastewater. In particular, the treatment and reuse of greywater has received attention, although important information such as greywater substance loadings is still only rarely available. With the implementation of the European Water Framework Directive the focus on controlling and phasing-out Priority/Priority Hazardous Substances (PS/PHS) is growing, and it is vital to know their sources and flows in order to generate sustainable emission control strategies. The main objective of this study was to quantify the concentrations and loads of PS/PHS and personal care substances in bathroom greywater, and to thereby assess the contribution of household activities to municipal wastewater loads for these substances. Nickel and mercury may be sourced substantially from household activities as it shown in the paper that bathroom greywater contributed a significant proportion of the overall load of these substances at the municipal wastewater treatment plant. Organic matter in the influent greywater was found to be principally associated with large particles (>8 µm), however it was the dissolved and small sized particles that were predominantly removed in the treatment.

  5. Person-Centered Care for Older Adults With Serious Mental Illness and Substance Misuse Within a Program of All-Inclusive Care for the Elderly.

    PubMed

    Cacchione, Pamela Z; Eible, Lisa; Gill, Le'Roi L; Huege, Steven F

    2016-05-01

    Providing person-centered care (PCC) to older adults with dual diagnosis, co-occurring serious mental illness (SMI), and substance misuse is complex and requires an interprofessional team. Older adults, who qualify for both Medicaid and Medicare (i.e., dual-eligibles) are overrepresented in the population of older adults with SMI and substance misuse. Programs of All-Inclusive Care for the Elderly (PACE) exist to support community living needs of nursing home-eligible older adults and are increasingly in a position to serve older adults with SMI and substance misuse issues. PACE programs provide integrated person-centered mental health care to address the serious medical, social, and emotional complications posed by having SMI and substance misuse disorders. The case study presented illustrates PCC provided to a dual-diagnosis PACE participant, illustrating the impact of recent and past trauma on current psychopathology and substance misuse. Finally, recommendations for addressing PCC of dual diagnosis within the PACE model are provided. [Journal of Gerontological Nursing, 42(5), 11-17.].

  6. Unhealthy substance-use behaviors as symptom-related self-care in persons with HIV/AIDS.

    PubMed

    Brion, John M; Rose, Carol Dawson; Nicholas, Patrice K; Sloane, Rick; Corless, Inge B; Lindgren, Teri G; Wantland, Dean J; Kemppainen, Jeanne K; Sefcik, Elizabeth F; Nokes, Kathleen M; Kirksey, Kenn M; Eller, Lucille; Hamilton, Mary Jane; Holzemer, William L; Portillo, Carmen J; Mendez, Marta Rivero; Robinson, Linda M; Moezzi, Shahnaz; Rosa, Maria; Human, Sarie; Maryland, Mary; Arudo, John; Ros, Ana Viamonte; Nicholas, Thomas P; Cuca, Yvette; Huang, Emily; Bain, Catherine; Tyer-Viola, Lynda; Zang, Sheryl M; Shannon, Maureen; Peters-Lewis, Angelleen; Willard, Suzanne

    2011-03-01

    Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.

  7. Quantification of pharmaceuticals, personal care products, and perfluoroalkyl substances in the marine sediments of Puget Sound, Washington, USA.

    PubMed

    Long, Edward R; Dutch, Margaret; Weakland, Sandra; Chandramouli, Bharat; Benskin, Jonathan P

    2013-08-01

    Concentrations of 119 pharmaceuticals and personal care products (PPCPs) and 13 perfluoroalkyl substances (PFASs) in marine sediments measured throughout Puget Sound (n = 10) and Bellingham Bay (n = 30), Washington, USA, are reported. These data are among the first measurements of PPCPs and PFASs in marine sediments from the Pacific Northwest and provide a comparison to previous measurements of these chemicals in influent, effluent, and biosolids from municipal wastewater treatment plants throughout the region. The concentrations of both PPCPs and PFASs in sediments from Puget Sound and Bellingham Bay ranged from very low to non-detectable for most compounds. Only 14 of the 119 PPCPs and 3 of 13 PFASs were quantifiable in sediments. Diphenhydramine (an antihistamine) was most frequently detected (87.5% of samples), with a maximum concentration of 4.81 ng/g dry weight and an estimated mean detected concentration of 1.68 ng/g. Triclocarban (an antibacterial) was detected in 35.0% of the samples, with a maximum concentration of 16.6 ng/g dry weight. Perfluoroalkyl substances were detected in 2.5% of analyses. Perfluorobutanoate, perfluorooctane sulfonate, and perfluorooctane sulfonamide were detected in 7, 5, and 1 sample(s) each, respectively, with the highest concentrations observed for perfluorooctane sulfonate (1.5 ng/g). Detected concentrations were often highest within the industrial harbor in Bellingham Bay and near the cities of Seattle and Bremerton. Environ Toxicol Chem 2013;32:1701-1710. © 2013 SETAC.

  8. Validation of an aggregate exposure model for substances in consumer products: a case study of diethyl phthalate in personal care products

    PubMed Central

    Delmaar, Christiaan; Bokkers, Bas; ter Burg, Wouter; Schuur, Gerlienke

    2015-01-01

    As personal care products (PCPs) are used in close contact with a person, they are a major source of consumer exposure to chemical substances contained in these products. The estimation of realistic consumer exposure to substances in PCPs is currently hampered by the lack of appropriate data and methods. To estimate aggregate exposure of consumers to substances contained in PCPs, a person-oriented consumer exposure model has been developed (the Probabilistic Aggregate Consumer Exposure Model, PACEM). The model simulates daily exposure in a population based on product use data collected from a survey among the Dutch population. The model is validated by comparing diethyl phthalate (DEP) dose estimates to dose estimates based on biomonitoring data. It was found that the model's estimates compared well with the estimates based on biomonitoring data. This suggests that the person-oriented PACEM model is a practical tool for assessing realistic aggregate exposures to substances in PCPs. In the future, PACEM will be extended with use pattern data on other product groups. This will allow for assessing aggregate exposure to substances in consumer products across different product groups. PMID:25352161

  9. European laws on compulsory commitment to care of persons suffering from substance use disorders or misuse problems- a comparative review from a human and civil rights perspective.

    PubMed

    Israelsson, Magnus; Nordlöf, Kerstin; Gerdner, Arne

    2015-08-28

    Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. The study raises questions concerning whether various European CCC laws in relation to substance use disorder or misuse problems

  10. Personality, Problem Solving, and Adolescent Substance Use

    ERIC Educational Resources Information Center

    Jaffee, William B.; D'Zurilla, Thomas J.

    2009-01-01

    The major aim of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. Although a number of studies have identified a relationship between personality and substance use, the precise mechanism by which this occurs is not clear. We hypothesized that problem-solving…

  11. Gender differences in substance abuse treatment and barriers to care among persons with substance use disorders with and without comorbid major depression.

    PubMed

    Chen, Lian-Yu; Strain, Eric C; Crum, Rosa M; Mojtabai, Ramin

    2013-01-01

    To compare substance use disorders (SUD) treatment patterns and barriers to such treatment among men and women with SUD with and without comorbid major depressive episodes (MDE) in a community sample. Using data from adult participants in the National Survey on Drug Use and Health 2005-2010, we investigated differences by sex in the association of MDE comorbidity with SUD on patterns of, perceived unmet need for, and the perceived barriers to SUD treatments. Compared with participants with SUD without MDE, both men and women with comorbid SUD and MDE were more likely to use SUD services or to report an unmet need for such treatment. Sex modified the association of comorbidity and treatment patterns: males with MDE comorbidity had a greater likelihood of emergency room visits and use of inpatient services than females. Barriers to substance treatment were remarkably similar for males and females in both the SUD without MDE group and with MDE group, with attitudinal factors being the most common barriers. Comorbidity with MDE seems to be an important predictor of service utilization and perceived need for SUD treatment in both men and women. The association of comorbidity with the use of some types of services, however, seems to vary according to sex. The findings have implications for the design of sex-specific SUD treatment programs.

  12. Zygotes, souls, substances, and persons.

    PubMed

    Bole, T J

    1990-12-01

    The thesis that the human zygote is essentially identical with the person into which it can develop is difficult to maintain, because the zygote can become several persons. In addition, the thesis depends upon ambiguities in the notions of human being, human individual, human body, and soul. A human being may be individual in the sense of either a biologically integrated unity or a psychologically integrated unity. A person is a psychologically integrated unity, because it must unify its experiences in morally imputable actions. To say that the zygote is a person requires one to assert that the zygote has the same principle of psychological integration, i.e., a rational soul, as one who can obviously manifest psychological integration. The assertion is incapable of being justified in empirical (e.g., non-religious) terms.

  13. Contingent reinforcement of personal goal activities for adolescents with substance use disorders during post-residential continuing care.

    PubMed

    Godley, Susan H; Godley, Mark D; Wright, Kelli L; Funk, Rodney R; Petry, Nancy M

    2008-01-01

    Contingency management (CM) is efficacious in improving outcomes of substance-abusing patients, but CM studies are relatively rare in adolescents. CM approaches can reinforce both abstinence and adherence to treatment-related goal areas. This paper describes 1,739 different activities in 10 goal areas (e.g., education, family/friends, and social/recreational) chosen by 86 adolescents who were participating in a multiple week CM study that reinforced both abstinence and adherence with goal-related activities. The mean activities selected was 20, and the mean completed was 13. Overall, 1,114 or 64% of chosen activities were completed. The clinical feasibility of activity incentive programs for adolescents is discussed.

  14. Re-offending in forensic patients released from secure care: the role of antisocial/borderline personality disorder co-morbidity, substance dependence and severe childhood conduct disorder.

    PubMed

    Howard, Rick; McCarthy, Lucy; Huband, Nick; Duggan, Conor

    2013-07-01

    Research suggests that a particular externalising phenotype, manifested in a developmental trajectory from severe childhood conduct disorder through early-onset substance abuse to adult antisocial/borderline personality disorder co-morbidity, may increase risk of antisocial behaviour in general and criminal recidivism in particular. This study aims to test the hypothesis that antisocial/borderline co-morbidity together with the triad of substance dependence, severe conduct disorder and borderline pathology would result in an increased risk of criminal recidivism. Fifty-three men who had been assessed and treated in a secure hospital unit were followed up after they had returned to the community. They were assessed for severity of the following: (i) antisocial personality disorder; (ii) borderline personality disorder; (iii) drug/alcohol dependence; and (iv) high Psychopathy Checklist Revised scores (factors 1 and 2). Patients with antisocial/borderline co-morbidity took significantly less time to re-offend compared with those without such co-morbidity. Both Psychopathy Checklist Revised factor 2 and the tripartite risk measure significantly predicted time to re-offence; the former largely accounted for the predictive accuracy of the latter. Risk of criminal recidivism can be adequately assessed without recourse to the pejorative term 'psychopath'. It is sufficient to assess the presence of the three elements of our risk measure: borderline and antisocial personality disorders in the context of drug/alcohol dependence and severe childhood conduct disorder. Practical implications of the study are as follows. (i) Sound assessment of personality, inclusive of a detailed history of childhood conduct disorder as well as adolescent and adult substance misuse, yields good enough information about risk of recidivism without recourse to the pejorative concept of 'psychopathy'. (ii) Given the high risk of alcohol-related violence in individuals with antisocial/borderline co

  15. Sampling in the Great Lakes for pharmaceuticals, personal care products, and endocrine-disrupting substances using the passive polar organic chemical integrative sampler.

    PubMed

    Li, Hongxia; Helm, Paul A; Metcalfe, Chris D

    2010-04-01

    The passive polar organic chemical integrative sampler in the pharmaceutical configuration (i.e., pharmaceutical-POCIS) was calibrated for sampling at water temperatures of 5, 15 and 25 degrees C to determine the influence of temperature on chemical-specific sampling rates (R(S)), thus providing more robust estimates of the time-weighted average concentrations of pharmaceuticals and personal care products (PPCPs) and endocrine-disrupting substances (EDS) in surface water. The effect of water temperature and flow on the R(S) of these analytes was evaluated in the laboratory with a static system. The loss of the test compounds from water by uptake into POCIS was linear over an 8-d period, and these experimental data yielded R(S) values in the range of 0.07 to 2.46 L/d across the temperature range for the 30 compounds tested. Water temperature and flow influenced POCIS uptake rates, but these effects were relatively small, which is consistent with the theory for uptake into POCIS samplers. Therefore, under a narrow range of water temperatures and flows, it may not be necessary to adjust the R(S) for POCIS. Except for acidic drugs and sulfonamide antibiotics, R(S) values were positively correlated with octanol-water partition coefficients (log K(OW)) of the test compounds. A linear relationship was also observed between R(S) and chromatographic retention times on a C18 reversed-phase column. These observations may provide a rapid method for estimating the R(S) of additional chemicals in the POCIS. The application of the R(S) to POCIS deployed for one month in Lake Ontario, Canada, during the summers of 2006 and 2008 yielded estimates of PPCP and EDS concentrations that are consistent with conventional concentration measurements of these compounds in Lake Ontario surface water. (c) 2009 SETAC.

  16. Borderline personality and substance use in women.

    PubMed

    Feske, Ulrike; Tarter, Ralph E; Kirisci, Levent; Pilkonis, Paul A

    2006-01-01

    The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD (including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD.

  17. Integrated Care for Pediatric Substance Abuse.

    PubMed

    Barclay, Rebecca P; Hilt, Robert J

    2016-10-01

    Integrated care is a way to improve the prevention, identification, and treatment of mental health difficulties, including substance abuse, in pediatric care. The pediatrician's access, expertise in typical development, focus on prevention, and alignment with patients and families can allow successful screening, early intervention, and referral to treatment. Successful integrated substance abuse care for youth is challenged by current reimbursement systems, information exchange, and provider role adjustment issues, but these are being addressed as comfort with this care form and resources to support its development grow.

  18. Balancing personalized medicine and personalized care.

    PubMed

    Cornetta, Kenneth; Brown, Candy Gunther

    2013-03-01

    The current description of personalized medicine by the National Institutes of Health is "the science of individualized prevention and therapy." Although physicians are beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act on personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. Because these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care.

  19. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the documented or potential hazards associated with trace exposure to these anthropogenic substances, many of which are highly bioactive and perpetually present in many aquatic locales. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized.Of the many facets involved in this complex issue, that of sources/origins and environmental occurrence is the better understood end of the larger spectrum. The potential for adverse ecological or human health effects (especially from long-term, combined exposure to multiple xenobiotics at low concentrations) is the

  20. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the documented or potential hazards associated with trace exposure to these anthropogenic substances, many of which are highly bioactive and perpetually present in many aquatic locales. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized.Of the many facets involved in this complex issue, that of sources/origins and environmental occurrence is the better understood end of the larger spectrum. The potential for adverse ecological or human health effects (especially from long-term, combined exposure to multiple xenobiotics at low concentrations) is the

  1. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the documented or potential hazards associated with trace exposure to these anthropogenic substances, many of which are highly bioactive and perpetually present in many aquatic locales. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized.Of the many facets involved in this complex issue, that of sources/origins and environmental occurrence is the better understood end of the larger spectrum. The potential for adverse ecological or human health effects (especially from long-term, combined exposure to multiple xenobiotics at low concentrations) is the l

  2. Substance Use by Persons with Recent Spinal Cord Injuries.

    ERIC Educational Resources Information Center

    Heinemann, Allen W.; And Others

    Substance use histories were obtained from 103 persons (16 to 63 years of age) with recent spinal cord injuries (SCI). Lifetime exposure to and current use of substances with abuse potential were substantially greater in this sample compared to a like-age national sample. Exposure to and recent use of substances with abuse potential was…

  3. Perspective: Balancing Personalized Medicine and Personalized Care

    PubMed Central

    Cornetta, Kenneth; Brown, Candy Gunther

    2013-01-01

    The current description of personalized medicine by the National Institutes of Health is “the science of individualized prevention and therapy.” Although physicians are just beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a true revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers an individual’s physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act upon personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. As these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care. PMID:23348082

  4. Interrelationships among Parental Family History of Substance Misuse, Delay Discounting, and Personal Substance Use

    PubMed Central

    VanderBroek, Lauren; Acker, John; Palmer, Abraham A.; de Wit, Harriet; MacKillop, James

    2015-01-01

    Rationale Despite consistent evidence of the familiality of substance misuse, the mechanisms by which family history (FH) increases the risk of addiction are not well understood. One behavioral trait that may mediate the risk for substance use and addiction is delay discounting (DD), which characterizes an individual’s preferences for smaller immediate rewards compared to larger future rewards. Objectives To examine the interrelationships among FH, DD, and diverse aspects of personal substance use, and test DD as a mediator of the relationship between FH and personal substance use. Methods The study used crowdsourcing to recruit a community sample of adults (N = 732). Family history was assessed using a brief assessment of perceived parental substance use problems, personal substance use was assessed using the Alcohol Use Disorders Identification Test and a measure of frequency of use, and delay discounting was assessed using a latent index of discounting preferences across six reward magnitudes. Results Steeper discounting was significantly associated with personal alcohol, tobacco, and marijuana use, and level of substance experimentation. Steeper DD was also associated with a denser parental FH of alcohol, tobacco, and overall substance misuse. Parental FH density was significantly associated with several aspects of personal substance use, and these relationships were partially mediated by DD. Conclusions The current study suggests that impulsivity, as measured by DD, is one proximal mechanism by which parental FH increases substance use later in life. The causal role of DD in this relationship will need to be established in future longitudinal studies. PMID:26395990

  5. The organization of substance abuse managed care.

    PubMed

    Sosin, M R; D'Aunno, T

    2001-01-01

    Managed care came to dominate the delivery of substance abuse services during the 1990s. This paper uses literature and new data to describe and analyze the set of arrangements it implies. The description suggests that substance abuse managed care typically is "carved out" of the general health care plan and treatment is coordinated by a behavioral health managed care company that manages treatment access, length, type, and intensity. This administrative agent is provided financial incentives to keep costs low and otherwise faces such mandates as to ensure timely access to treatment and to deliver reports. A typical agent has some interest in improving the quality of decision-making, but has few incentives for controlling the treatment technology. In contrast, agents tend to control treatment providers through relatively rigid rules that substitute outpatient for inpatient care, regulate the length and intensity of services, provide limited social services, mandate accreditation, allow limited clinician discretion, administer an entire "network" of providers as an only slightly differentiated mass, and rarely shape the details of the treatment process. These patterns are analyzed in terms of transaction cost economics and institutional and resource dependency theories. In general, it is argued that managed care reflects an interest in controlling costs but also in ensuring access within an environment where there is uncertainty accompanying competing demands, varying conceptions of the client, and controversies over the efficacy of specific treatment technologies.

  6. The explanatory power of the substance view of persons.

    PubMed

    Beckwith, Francis J

    2004-01-01

    The purpose of this essay is to offer support for the substance view of persons, the philosophical anthropology defended by Patrick Lee in his essay. In order to accomplish this the author (1) presents a brief definition of the substance view; (2) argues that the substance view has more explanatory power in accounting for why we believe that human persons are intrinsically valuable even when they are not functioning as such (e.g., when on is temporarily comatose), why human persons remain identical to themselves over time, and why it follows from these points that the unborn are human persons; and (3) responds to two arguments that attempt to establish the claim that the early human being is not a unified substance until at least fourteen days after conception.

  7. Association between personality traits and substance use in Spanish adolescents.

    PubMed

    Gonzálvez, María T; Espada, José P; Guillon-Riquelme, Alejandro; Secades, Roberto; Orgilés, Mireia

    2016-03-02

    Substance use is considered one of the most frequent risk behaviors during adolescence. Personality factors are linked to consumption during adolescence. Although there are studies on personality and consumption among Spanish adolescents, some outcomes are contradictory, and more studies including larger samples and using validated measures are needed. The aim of this study is to analyze the relationship between different personality factors and substance use among Spanish adolescents. Participants were 1,455 students aged between 13-18 years. The adaptation of the 16PF-IPIP Personality Inventory was applied to assess Warmth, Stability, Gregariousness, Friendliness, Sensitivity, Trust, Openness to experience, Sociability, Perfectionism, and Calmness. Participants were asked about their different consumption substances during their lifetime. Results provide evidence for a relationship between personality factors and psychoactive substance use. There are different distributions of alcohol use regarding personality traits. Furthermore, personality factors have some influence on consumption of alcohol, cannabis, and cocaine.Trust and Calmness influence average alcohol, cannabis, and cocaine consumption, whereas Sociability had no statistically significant influence on any of the three substances. The results from this study are highly useful in the design of preventive programs, as they provide more evidence of the role of personality traits as a risk factor.

  8. Personality dimensions and substance use in individuals with mild to borderline intellectual disabilities.

    PubMed

    Poelen, Evelien A P; Schijven, Esmée P; Otten, Roy; Didden, Robert

    2017-04-01

    The aim of this study was to examine the role of the personality dimensions anxiety sensitivity, negative thinking, impulsivity and sensation seeking (as assessed by the revised version of the Substance Use Risk Profile Scale; SURPS) in substance use in individuals with mild to borderline intellectual disabilities (MBID). We tested the relationship between level of ID and SURPS personality dimensions and the relationship between SURPS personality dimensions and severity of alcohol and drug use. Participants were 118 persons (mean age 20.5 years) with a mean IQ of 71.1 admitted to care facilities for persons with MBID and severe behavioral problems. We found no significant relationship between level of ID and the four personality dimensions. In addition, findings showed that individuals with lower levels of anxiety sensitivity, higher levels of negative thinking, impulsivity and sensation seeking showed more severe alcohol use. Individuals with higher levels of negative thinking and sensation seeking had more severe drug use. The SURPS personality dimensions identify persons at increased risk for substance use disorders and might be useful in developing selective substance use interventions for individuals with MBID. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Personal Care in Learning Health Care Systems.

    PubMed

    Miller, Franklin G; Kim, Scott Y H

    2015-12-01

    The idea of a "learning health care system"--one that systematically integrates clinical research with medical care--has received considerable attention recently. Some commentators argue that under certain conditions pragmatic comparative effectiveness randomized trials can be conducted ethically within the context of a learning health care system without the informed consent of patients for research participation. In this article, we challenge this perspective and contend that conducting randomized trials of individual treatment options without consent is neither necessary nor desirable to promote and sustain learning health care systems. Our argument draws on the normative conception of personal care developed by Charles Fried in a landmark 1974 book on the ethics of randomized controlled trials.

  10. Impact of on-site, small and large scale wastewater treatment facilities on levels and fate of pharmaceuticals, personal care products, artificial sweeteners, pesticides, and perfluoroalkyl substances in recipient waters.

    PubMed

    Gago-Ferrero, Pablo; Gros, Meritxell; Ahrens, Lutz; Wiberg, Karin

    2017-12-01

    One of the main risks associated with effluents from both wastewater treatment plants (WWTPs) and on-site sewage treatment facilities (OSSFs) is the release of micropollutants (MPs) in receiving water bodies. However, the impact of MPs present in the effluents of OSSFs in the aquatic environment has not been studied so far. The current study evaluates the impact of the effluents of OSSFs and small-to-large scale WWTPs on natural waters. The discharge of 74 MPs was assessed including pharmaceuticals, personal care products, pesticides, artificial sweeteners and perfluoroalkyl substances (PFASs). The sampling was carried out within a Swedish catchment and included three sites that are exclusively affected by OSSFs and other sites that are mainly affected by WWTPs or a mixture of sources (7 sites, 28 samples). Results show that although OSSFs serve a much smaller total number of people, the MPs emitted from OSSFs reached the aquatic environment in significant quantities (concentrations of >150ngL(-1) of ∑MPs). The composition profiles for sites affected by WWTPs were similar and were dominated by sucralose (27% of the ∑MPs), caffeine (27% of the ∑MPs), lamotrigine (10% of the ∑MPs), desvenlafaxine (5% of the ∑MPs), and diclofenac (4% of the ∑MPs). In contrast, the sites affected by OSSFs showed high variability, exhibiting a different profile from those affected by WWTPs and also from each other, demonstrating that OSSFs are not homogeneous sources of MPs. Some specific compounds, such as diethyltoluamide (DEET) and caffeine, were proportionally much more important at sites affected by OSSFs than at sites affected by WWTPs (representing a much higher percentage of the ∑MPs in the OSSFs). In contrast, PFASs did not show high concentration variation among the different sampling sites and the composition profiles were relatively similar, indicating that these substances follow different routes of entry into the aquatic environment. Copyright © 2017

  11. Pharmaceuticals, hormones, personal-care products, and other organic wastewater contaminants in water resources: Recent research activities of the U.S. Geological Survey's toxic substances hydrology program

    USGS Publications Warehouse

    Focazio, Michael J.; Kolpin, Dana W.; Buxton, Herbert T.

    2003-01-01

    Recent decades have brought increasing concerns for potential contamination of water resources that could inadvertently result during production, use, and disposal of the numerous chemicals offering improvements in industry, agriculture, medical treatment, and even common household products. Increasing knowledge of the environmental occurrence or toxicological behavior of these contaminants from various studies in Europe, United States, and elsewhere has resulted in increased concern for potential adverse environmental and human health effects (Daughton and Ternes, 1999). Ecologists and public health experts often have incomplete understandings of the toxicological significance of many of these contaminants, particularly long-term, low-level exposure and when they occur in mixtures with other contaminants (Daughton and Ternes, 1999; Kümmerer, 2001). In addition, these ‘emerging contaminants’ are not typically monitored or assessed in ambient water resources. The need to understand the processes controlling the transport and fate of these contaminants in the environment, and the lack of knowledge of the significance of long-term exposures have increased the need to study environmental occurrence down to trace (nanogram per liter) levels. Furthermore, the possibility that mixtures of environmental contaminants may interact synergistically or antagonistically has increased the need to characterize the types of mixtures that are found in our waters. The U.S. Geological Survey’s Toxic Substances Hydrology Program (Toxics Program) is developing information and tools on emerging water-quality issues that will be used to design and improve water-quality monitoring and assessment programs of the USGS and others, and for proactive decision-making by industry, regulators, the research community, and the public (http://toxics.usgs.gov/regional/emc.html). This research on emerging water-quality issues includes a combination of laboratory work to develop new analytical

  12. New systems of care for substance use disorders: treatment, finance, and technology under health care reform.

    PubMed

    Pating, David R; Miller, Michael M; Goplerud, Eric; Martin, Judith; Ziedonis, Douglas M

    2012-06-01

    This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed “stigmatization” and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more “mainstream,” is to not comfortably feel that general slogans like “Treatment Works,” as promoted by Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and

  13. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    While the point-source emissions of pollutants from manufacturing waste streams have long been monitored and subject to controls, the environmental impact of the public's (i.e., the individual's) activities regarding the use of chemicals is more difficult to assess. Of particular question is the widespread release to sewage and surface/ground waters of pharmaceuticals and personal care products after their ingestion, external application, or disposal. Certain pharmaceutically active compounds (e.g., caffeine, nicotine, and aspirin) have been known for over 20 years to enter the environment by a variety of routes - primarily via treated and untreated sewage effluent. A larger picture, however, has emerged only more recently, where it is evident that numerous personal care products (such as fragrances and sunscreens) and drugs from a wide spectrum of therapeutic classes can occur in the environment and drinking water (albeit at very low concentrations), especially in natural waters receiving sewage. Nearly all ecological monitoring studies for pharmaceuticals and personal care products (informally referred to as

  14. Personality traits and illicit substances: the moderating role of poverty.

    PubMed

    Sutin, Angelina R; Evans, Michele K; Zonderman, Alan B

    2013-08-01

    Illicit substances increase risk of morbidity and mortality and have significant consequences for society. Personality traits are associated with drug use; we test whether these associations vary by socioeconomic status. Participants (N=412) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study completed the Revised NEO Personality Inventory and self-reported use of opiates and cocaine. 50% of participants were living below 125% of the federal poverty line. Mean-level personality differences across never, former, and current opiate/cocaine users were compared. Logistic regressions compared never versus current users and interactions between personality traits and poverty status tested whether these associations varied by socioeconomic status. High Neuroticism and low Agreeableness increased risk of drug use. The association between low Conscientiousness and drug use was moderated by poverty, such that low Conscientiousness was a stronger risk factor for illicit substance use among those with relatively higher SES. For every standard deviation decrease in Conscientiousness, there was a greater than 2-fold increase in risk of illicit substance use (OR=2.15, 95% CI=1.45-3.17). Conscientiousness was unrelated to drug use among participants living below 125% of the federal poverty line. Under favorable economic conditions, the tendency to be organized, disciplined, and deliberate is protective against drug use. These tendencies, however, matter less when financial resources are scarce. In contrast, those prone to emotional distress and antagonism are at greater risk for current drug use, regardless of their economic situation. Published by Elsevier Ireland Ltd.

  15. Recovery resources and psychiatric severity among persons with substance use disorders.

    PubMed

    Majer, John M; Payne, Jason C; Jason, Leonard A

    2015-05-01

    A comparative analysis of recovery resources (abstinence social support, abstinence self-efficacy) was conducted among two groups exiting inpatient treatment for substance use disorders: persons with psychiatric comorbid substance use disorders and persons with substance use disorders. Both groups reported comparable levels of abstinence social support, but this resource was not significantly related to substance use among persons with psychiatric comorbid substance use disorders. Although abstinence self-efficacy was significantly related to substance use, persons with psychiatric comorbid substance use disorders reported significantly lower levels of abstinence self-efficacy than persons with substance use disorders. Findings suggest that persons with psychiatric comorbid substance use disorders exit alcohol/drug treatment with lower levels of abstinence self-efficacy compared to their substance use disorder peers.

  16. Personality Traits and Vulnerability or Resilience to Substance Use Disorders

    PubMed Central

    Belcher, Annabelle M.; Volkow, Nora D.; Moeller, F. Gerard; Ferré, Sergi

    2014-01-01

    Clear evidence supports a genetic basis for Substance Use Disorders (SUD). Yet the search to identify individual gene contributions to SUD has been quite unsuccessful. Here we argue for the study of endophenotypes within the frame of individual differences, and identify three high-order personality traits that are tied to specific brain systems and genes, and that offer a tractable approach to studying SUD. These personality traits, and the genes that moderate them, interact dynamically with the environment and with the drugs themselves to ultimately determine an individual’s vulnerability or resilience to developing SUD. PMID:24612993

  17. Superabsorbents in Personal Care Industry

    NASA Astrophysics Data System (ADS)

    Li, Yong

    1997-10-01

    Water swellable hydrogels, often called Superabsorbent Polymers, are used as a major component in many absorbent products such as baby diapers. The superabsorbents used in personal care industry are typically lightly crosslinked sodium polyacrylate polymers. The current annual worldwide production of the material is close to one million metric tons. These hydrogels can absorb water more than 100 times of their own weight. The absorbed liquid is tightly held inside the superabsorbent materials even against pressure. The balance of many different properties will be discussed.

  18. Prenatal and postpartum care of women with substance use disorders.

    PubMed

    Gopman, Sarah

    2014-06-01

    The incidence of substance abuse in pregnancy is substantial and affects pregnancy health and outcomes. Multiple challenges exist in the identification of women with substance abuse disorders in pregnancy and the provision of care. A multidisciplinary approach has been shown to be most successful in providing comprehensive and effective care. This article outlines key aspects of prenatal and postpartum care, with a brief overview provided of intrapartum care. Issues covered include screening, opioid replacement therapy, comorbid medical and psychiatric conditions, environmental stressors, parenting preparation, pain management in labor and postpartum, breastfeeding guidance, prevention of relapse, and assistance with postpartum transition to primary care. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Person-centered dementia care: current perspectives

    PubMed Central

    Manthorpe, Jill; Samsi, Kritika

    2016-01-01

    Person-centered dementia care is widely accepted as a value-based commitment to supporting people with dementia and is a guiding principle in care services. Policy ambitions to put people at the center of their own care are being developed internationally. These may be seen as part of the evolution of person-centered care which has its origins in critical perspectives on practice and social responses to people with dementia. In England, one further development of person-centered care has been personalization – a government policy to extend individuals’ choice and control over their social care and, latterly, ways to meet their health care needs. This paper charts the evolution of the concept of person-centered care to the policy of personalization (which has international comparators) and summarizes emerging and conflicting evidence about the implications of personal budgets in England on older people with mental health problems such as dementia and their families. It focuses on the evidence base of personalization and on emerging lessons for practice, drawing from the implementation of personalization and the adoption of personal budgets by this group. While personalization may be one policy initiative, the values and practices of person-centered dementia care remain fundamental to practice and are inspiring new ideas related to rights and justice for people with dementia. PMID:27932869

  20. Person-centered dementia care: current perspectives.

    PubMed

    Manthorpe, Jill; Samsi, Kritika

    2016-01-01

    Person-centered dementia care is widely accepted as a value-based commitment to supporting people with dementia and is a guiding principle in care services. Policy ambitions to put people at the center of their own care are being developed internationally. These may be seen as part of the evolution of person-centered care which has its origins in critical perspectives on practice and social responses to people with dementia. In England, one further development of person-centered care has been personalization - a government policy to extend individuals' choice and control over their social care and, latterly, ways to meet their health care needs. This paper charts the evolution of the concept of person-centered care to the policy of personalization (which has international comparators) and summarizes emerging and conflicting evidence about the implications of personal budgets in England on older people with mental health problems such as dementia and their families. It focuses on the evidence base of personalization and on emerging lessons for practice, drawing from the implementation of personalization and the adoption of personal budgets by this group. While personalization may be one policy initiative, the values and practices of person-centered dementia care remain fundamental to practice and are inspiring new ideas related to rights and justice for people with dementia.

  1. Personality Traits and Illicit Substances: The Moderating Role of Poverty

    PubMed Central

    Sutin, Angelina R.; Evans, Michele K.; Zonderman, Alan B.

    2012-01-01

    Background Illicit substances increase risk of morbidity and mortality and have significant consequences for society. Personality traits are associated with drug use; we test whether these associations vary by socioeconomic status. Method Participants (N=412) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study completed the Revised NEO Personality Inventory and self-reported use of opiates and cocaine. 50% of participants were living below 125% of the federal poverty line. Mean-level personality differences across never, former, and current opiate/cocaine users were compared. Logistic regressions compared never versus current users and interactions between personality traits and poverty status tested whether these associations varied by socioeconomic status. Results High Neuroticism and low Agreeableness increased risk of drug use. The association between low Conscientiousness and drug use was moderated by poverty, such that low Conscientiousness was a stronger risk factor for illicit substance use among those with relatively higher SES: For every standard deviation decrease in Conscientiousness, there was a greater than 2-fold increase in risk of illicit substance use (OR=2.15, 95% CI=1.45–3.17). Conscientiousness was unrelated to drug use among participants living below 125% of the federal poverty line. Conclusions Under favorable economic conditions, the tendency to be organized, disciplined, and deliberate is protective against drug use. These tendencies, however, matter less when financial resources are scarce. In contrast, those prone to emotional distress and antagonism are at greater risk for current drug use, regardless of their economic situation. PMID:23265091

  2. [Dual diagnosis in psychoactive substance abusing or dependent persons].

    PubMed

    Błachut, Michał; Badura-Brzoza, Karina; Jarzab, Magdalena; Gorczyca, Piotr; Hese, Robert Teodor

    2013-01-01

    There has been noticed a systematic growth of using psychoactive substance (SP) in last years. The co-occurrence of mental and physical disorders related to substance abuse of treated patients is more often a serious problem to medical services. Dual diagnosis (DD) is a clinical term referring to co-morbidity or the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder. The aim of the study is to investigate the prevalence of dual diagnosis in patients with diagnosis of substance use disorder hospitalized in years 1994-2005, to assess the kind of co-morbid mental disorders and the course of treatment in three groups: patients with DD, with diagnosis of mental disorder without substance use and with diagnosis related to substance use. The retrospective study of 4 349 case records of patients hospitalized in the department of psychiatry in years 1994-2005. Out of this number two groups of patients were separated: persons abusing or dependent on SP (n = 825) and patients with dual diagnosis (n = 362). The control group (n = 200) was created among patients with mental disorders and without SP abuse. Socio-demographic factors, number and the length of hospitalizations, aggressive behaviours, suicide attempts, discharges from hospital on demand were analyzed. In the DD group there was an attempt to evaluate the relation between substance use disorders and co-occuring mental disorders performed. The frequency of DD among all patients hospitalized in the studied period of time was 8.3%, whereas among patients abusing SP was 30.5%. This study demonstrates that patients with the DD are statistically longer hospitalized, discharged from hospitals at their own request and more often need treatment in hospitals, statistically more often try to commit suicide and perform aggressive behavior. Mental disorders were substantially often secondary to substance related disorders in the DD group. There was proved that patients

  3. Substance use and abuse among older youth in foster care.

    PubMed

    Vaughn, Michael G; Ollie, Marcia T; McMillen, J Curtis; Scott, Lionel; Munson, Michelle

    2007-09-01

    The purpose of this study was to explore prevalence and predictors of current and lifetime substance use, substance abuse disorder, and polysubstance use among older youth in foster care. Interviews were conducted with 406 17-year old youth (90% of those eligible) in one state's foster care system between December 2001 and June 2003. Forty-five percent of foster care youth reported using alcohol or illicit drugs within the last six months; 49% had tried drugs sometime during their lifetime and 35% met criteria for a substance use disorder. Having a diagnosis of Conduct Disorder and/or living in an independent living situation significantly increased the likelihood of current and lifetime substance use and disorder. A diagnosis of Post Traumatic Stress Disorder also predicted increased likelihood of polysubstance use and substance abuse disorder. In conclusion, older youth in the foster care system report similar levels of lifetime alcohol and illicit substance use when compared to the general adolescent population. However, rates of substance use disorder are high. Particularly at risk for both high rates of use and disorder are youth in independent living situations and youth with a diagnosis of Conduct Disorder or Post Traumatic Stress Disorder.

  4. Substance Use and Abuse among Older Youth in Foster Care

    PubMed Central

    Vaughn, Michael G.; Ollie, Marcia T.; McMillen, J. Curtis; Scott, Lionel; Munson, Michelle

    2007-01-01

    The purpose of this study was to explore prevalence and predictors of current and lifetime substance use, substance abuse disorder, and polysubstance use among older youth in foster care. Interviews were conducted with 406 17-year old youth (90% of those eligible) in one state’s foster care system between December 2001 and June 2003. Forty-five percent of foster care youth reported using alcohol or illicit drugs within the last six months; 49% had tried drugs sometime during their lifetime and 35% met criteria for a substance use disorder. Having a diagnosis of Conduct Disorder and/or living in an independent living situation significantly increased the likelihood of current and lifetime substance use and disorder. A diagnosis of Post Traumatic Stress Disorder also predicted increased likelihood of polysubstance use and substance abuse disorder. In conclusion, older youth in the foster care system report similar levels of lifetime alcohol and illicit substance use when compared to the general adolescent population. However, rates of substance use disorder are high. Particularly at risk for both high rates of use and disorder are youth in independent living situations and youth with a diagnosis of Conduct Disorder or Post Traumatic Stress Disorder. PMID:17239547

  5. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environment. PPCPS, in contrast to other types of pollutants, owe their origins in the environment directly to their worldwide, universal, frequent, highly dispersed, and individually small but cumulative usage by multitudes of individuals - as opposed to the larger, highly delineated, and more controllable industrial manufacturing/usage of most high- volume synthetic chemicals. Many PPCPs (as well as their metabolites and transformation products) can enter the environment following ingestion or application by the user or administration to domestic animals. Disposal of unused/expired PPCPs in landfills and in domestic sewage is another route to the environment. The aquatic environment serves as the major, ultimate receptacle for these chemicals, for which little is known with respect to actual or potential adverse effects. Domestic sewage treatment plants are not specifically engineered to remove PPCPS, and the efficiencies with which they are removed vary from nearly complete to ineffective. While PPCPs in the environment (or domestic drinking water) are not regulated, and even though their concentrations are extremely low (ng/L-ug/L), the consequences of exposure over multiple generations to

  6. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPs) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environment. PPCPs, in contrast to other types of pollutants, owe their origins in the environment directly to their worldwide, universal, frequent, highly dispersed, and individually small but cumulative usage by multitudes of individuals ? as opposed to the larger, highly delineated, and more controllable industrial manufacturing/usage of most high-volume synthetic chemicals.Many PPCPs can enter the environment following ingestion or application by the user or administration to domestic animals. Disposal of unused/expired PPCPs in landfills and in domestic sewage is another route to the environment. The aquatic environment serves as the major, ultimate receptacle for these chemicals, for which little is known with respect to actual or potential adverse effects. Domestic sewage treatment plants are not specifically engineered to remove PPCPs, and the efficiencies with which they are removed vary from nearly complete to ineffective. While PPCPs in the environment (or domestic drinking water) are not regulated, and even though their concentrations are extremely low (ng/L- g/L), the consequences of exposure over multiple generations to multiple compounds having different as well as similar modes

  7. Randomized Controlled Trial of Personalized Motivational Interventions in Substance Using Patients With Facial Injuries

    PubMed Central

    Shetty, Vivek; Murphy, Debra A.; Zigler, Corwin; Yamashita, Dennis-Duke R.; Belin, Thomas R.

    2011-01-01

    Purpose The proximate use of illicit drugs or alcohol (substance use) is the most common precipitator of facial injuries among socioeconomically disadvantaged populations. Reducing these risky behaviors could minimize adverse health sequelae and potential reinjury. The objective of our study was to test whether a culturally competent, personalized motivational intervention incorporated into surgical care could significantly reduce existing substance use behaviors in facial injury patients. Patients and Methods Substance-using subjects (n = 218) presenting with facial injuries to a level 1 trauma center were randomly assigned to either a personalized motivational intervention (PMI) condition or a health-information (HI) control condition. After a brief assessment of the individual’s substance use severity and willingness to change these behaviors, both groups attended 2 counseling sessions with a trained interventionist. The PMI subjects (n = 118) received individualized, motivational interventions, whereas the HI subjects (n = 100) received only general health information. Both groups were reassessed at 6 and 12 months postinjury, and changes in substance-use patterns were measured to assess the effects of intervention. Results The PMI and HI groups were closely matched on their sociodemographic and substance use characteristics. Subjects in the PMI group showed statistically significant declines in drug use at both the 6- and 12-month assessments. The intervention’s effect on lowering illicit drug use was greatest at the 6-month assessment but had weakened by the 1-year follow-up. The efficacy of the PMI was moderated by an individual’s initial drug use severity; individuals with greater drug use dependency at baseline were seen to have larger intervention effects, as did individuals who were most aware of their drug problem and willing to change their substance use behaviors. Unlike illicit drug use, changes in alcohol use did not differ significantly

  8. Personality pathology and substance abuse in eating disorders: a longitudinal study.

    PubMed

    Thompson-Brenner, Heather; Eddy, Kamryn T; Franko, Debra L; Dorer, David; Vashchenko, Maryna; Herzog, David B

    2008-04-01

    Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes. This study investigates longitudinal associations between personality and substance use. Personality pathology and substance use were assessed in 213 individuals with anorexia nervosa and bulimia nervosa at baseline; substance use was assessed at regular follow-up intervals over a 9-year period. Of the five personality factors identified, the obsessional-sensitive and high-functioning types were negatively associated with substance abuse at baseline, while the behaviorally dysregulated type was positively associated with substance abuse at baseline. Longitudinal associations were observed, suggesting that obsessional-sensitive personality type was protective against the development of substance abuse. Longitudinal associations between the other personality types and substance abuse were nonsignificant after baseline substance abuse history was included as a covariate in the model. Substance use demonstrates cross-sectional associations with personality style, but substance abuse history appears to be the most important predictor of future substance abuse in women with eating disorders. Copyright 2007 by Wiley Periodicals, Inc.

  9. 21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons...

  10. 21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons...

  11. 21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons...

  12. 21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons...

  13. 21 CFR 1305.04 - Persons entitled to order Schedule I and II controlled substances.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... to order Schedule I and II controlled substances. (a) Only persons who are registered with DEA under... are registered with DEA under section 1008 of the Act (21 U.S.C. 958) to export these substances may obtain and use DEA Form 222 (order forms) or issue electronic orders for these substances. Persons...

  14. Negotiating case decisions in substance abuse managed care.

    PubMed

    Sosin, Michael R

    2002-09-01

    In substance abuse managed care, the number of treatment sessions that a provider can deliver is constrained by the policies and procedures of the specialized managed care organizations (MCOs) that typically administer the substance abuse portions of healthcare plans. Managed care organizations commonly are alleged to control treatment providers through rules, but they also might rely on a particular patterned authorization of discretion, whereby they determine when and how frequently to respond to providers' appeals of rule-based decisions. The current paper uses data from a national random sample of managed care contracts between MCOs and substance abuse providers to test the hypotheses that (1) managed care organizations' "logics" about the types of provider discretion to allow affect the rate to which they concede to appeals, and (2) the rate of conceding to appeals, in turn, affects the providers' duration of substance abuse treatment. Results from generalized linear estimation models support the hypotheses and suggest that many MCOs pattern discretion to balance strict rules with concern about the quality or cost of care. The results more generally suggest that MCOs use discretion in planned ways, and thus that the patterns of control are more complex and sophisticated than commonly described in the literatures on managed care, transaction cost economics, or other perspectives.

  15. Conduct Disorder and Antisocial Personality Disorder in Persons With Severe Psychiatric and Substance Use Disorders

    PubMed Central

    Mueser, Kim T.; Crocker, Anne G.; Frisman, Linda B.; Drake, Robert E.; Covell, Nancy H.; Essock, Susan M.

    2006-01-01

    Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders. PMID:16574783

  16. Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders.

    PubMed

    Mueser, Kim T; Crocker, Anne G; Frisman, Linda B; Drake, Robert E; Covell, Nancy H; Essock, Susan M

    2006-10-01

    Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.

  17. Reframing Person-Centered Nursing Care for Persons With Dementia

    PubMed Central

    Penrod, Janice; Yu, Fang; Kolanowski, Ann; Fick, Donna M.; Loeb, Susan J.; Hupcey, Judith E.

    2010-01-01

    Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia. PMID:17378465

  18. Genetic variation in personality traits explains genetic overlap between borderline personality features and substance use disorders.

    PubMed

    Few, Lauren R; Grant, Julia D; Trull, Timothy J; Statham, Dixie J; Martin, Nicholas G; Lynskey, Michael T; Agrawal, Arpana

    2014-12-01

    To examine the genetic overlap between borderline personality features (BPF) and substance use disorders (SUDs) and the extent to which variation in personality traits contributes to this covariance. Genetic structural equation modelling was used to partition the variance in and covariance between personality traits, BPF and SUDs into additive genetic, shared and individual-specific environmental factors. All participants were registered with the Australian Twin Registry. A total of 3127 Australian adult twins participated in the study. Diagnoses of DSM-IV alcohol and cannabis abuse/dependence (AAD; CAD) and nicotine dependence (ND) were derived via computer-assisted telephone interview. BPF and five-factor model personality traits were derived via self-report questionnaires. Personality traits, BPF and substance use disorders were partially influenced by genetic factors with heritability estimates ranging from 0.38 (neuroticism; 95% confidence interval: 0.30-0.45) to 0.78 (CAD; 95% confidence interval: 0.67-0.86). Genetic and individual-specific environmental correlations between BPF and SUDs ranged from 0.33 to 0.56 (95% CI = 0.19-0.74) and 0.19-0.32 (95% CI = 0.06-0.43), respectively. Overall, there was substantial support for genetic influences that were specific to AAD, ND and CAD (30.76-68.60%). Finally, genetic variation in personality traits was responsible for 11.46% (extraversion for CAD) to 59.30% (neuroticism for AAD) of the correlation between BPF and SUDs. Both genetic and individual-specific environmental factors contribute to comorbidity between borderline personality features and substance use disorders. A substantial proportion of this comorbidity can be attributed to variation in normal personality traits, particularly neuroticism. © 2014 Society for the Study of Addiction.

  19. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In contrast to other types of pollutants, PPCPs owe their origins in the environment directly to their worldwide, universal, frequent, highly dispersed, and individually small but aggregate/cumulative usage and disposal by multitudes of individuals. An overview of this multi-faceted issue can be found at a U.S. EPA web site (http://www.epa.gov/nerlesdl/chemistry/pharma/index.htm), which also provides a reprint of a review article published in Environmental Health Perspectives. PPCPs can enter the environment following their ingestion or application by the user or administration to domestic animals. Disposal of unused/expired PPCPS in landfills and to domestic sewage are additional routes to the environment. Domestic sewage treatment plants are not specifically engineered to remove PPCPS; the efficiencies with which they are removed from sewage vary from nearly complete to ineffective. The aquatic environment serves as the major, ultimate receptacle for most PPCPS. Little is known with respect to actual or even potential adverse effects on non-target species; human exposure via drinking water is poorly defined. While PPCPs in the environment (or domestic drinking water) are not regulated

  20. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    Modern sanitary practices result in large volumes of human waste, as well as domestic and industrial sewage, being collected and treated at common collection points, wastewater treatment plants (WWTP). In recognition of the growing use of sewage sludges as a fertilizers and as soilamendments, and the scarcity of current data regarding the chemical constituents in sewage sludges, the United States National Research Council (NRC) in 2002 produced a report on sewage sludges. Among the NRC's recommendations was the need for investigating the occurrence of pharmaceuticals and personal care products (PPCPs) in sewage sludges. PPCPsare a diverse array of non-regulated contaminants that had not been studied in previous sewage sludges surveys but which are likely to be present. The focus of this paper will be to review the current analytical methodologies available for investigating whether pharmaceuticals are present in WWTP-produced sewage sludges, to summarize current regulatory practices regarding sewage sludges, and to report on the presence of pharmaceuticals in sewage sludges. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subta

  1. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In contrast to other types of pollutants, PPCPs owe their origins in the environment directly to their worldwide, universal, frequent, highly dispersed, and individually small but aggregate/cumulative usage and disposal by multitudes of individuals. An overview of this multi-faceted issue can be found at a U.S. EPA web site (http://www.epa.gov/nerlesdl/chemistry/pharma/index.htm), which also provides a reprint of an Environmental Health Perspectives review article. PPCPs can enter the environment via excreta or wash water following their ingestion or application by the user or administration to domestic animals. Direct disposal of unused/expired PPCPs in landfills and domestic sewage is an additional route to the environment. Domestic sewage treatment plants are not specifically engineered to remove PPCPS; removal efficiencies vary from nearly complete to ineffective. The aquatic and groundwater environments serve as the major, ultimate receptacles for most PPCPS. Little is known with respect to actual or even potential adverse effects on non-target species; human exposure via drinking water is poorly defined. While PPCPs in the environment (or drinking water) are not regulated, and even t

  2. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In contrast to other types of pollutants, PPCPs owe their origins in the environment directly to their worldwide, universal, frequent, highly dispersed, and individually small but aggregate/cumulative usage and disposal by multitudes of individuals. An overview of this multi-faceted issue can be found at a U.S. EPA web site (http://www.epa.gov/nerlesdl/chemistry/pharma/index.htm), which also provides a reprint of a review article published in Environmental Health Perspectives as well as many other resources including several chapters from a new American Chemical Society book. PPCPs can enter the environment following their ingestion or application by the user or administration to domestic animals. Disposal of unused/expired PPCPs in landfills and to domestic sewage are additional routes to the environment. Domestic sewage treatment plants are not specifically engineered to remove PPCPS; the efficiencies with which they are removed from sewage vary from nearly complete to ineffective. The aquatic environment serves as the major, ultimate receptacle for most PPCPS. Little is known with respect to actual or even potential adverse effects on non-target species; human exposure via drinking wate

  3. Substance abuse intervention for health care workers: a preliminary report.

    PubMed

    Lapham, S C; Chang, I; Gregory, C

    2000-05-01

    The Workplace Managed Care Cooperative Agreement project targets 3,300 health care professionals in hospital, specialty clinic, and primary care settings located in metropolitan New Mexico communities. This project will evaluate whether enhancements to existing substance abuse prevention/early intervention programs can prevent the onset of risky drinking, reduce prevalence of risky drinking, better identify employees who abuse alcohol and drugs, and improve employee wellness. This article describes one such enhancement (Project WISE [Workplace Initiative in Substance Education]), implemented at Lovelace Health Systems. Project WISE includes relatively low-cost elements such as substance abuse awareness training, information on how to reduce drinking, and brief motivational counseling. Evaluation will consist of baseline comparisons of the intervention and comparison sites, a process evaluation, a qualitative analysis using focus groups, and an outcome evaluation using health and work records. Methodological challenges, solutions, and implications for researchers undertaking similar projects are presented.

  4. Personality disorder and pathways to inpatient psychiatric care.

    PubMed

    Hayward, Marianne; Moran, Paul

    2007-06-01

    The impact of personality disorder on pathways into psychiatric care is unknown. To examine associations between personality disorder status, length of pathway into inpatient psychiatric care, and involvement of the criminal justice service in the pathway into care. The Structured Clinical Interview for DSM-IV personality disorders (SCID-II) and a modified WHO Pathways Encounter Form were administered to a sample of 153 consecutive inpatients admitted to acute wards in one inner London borough over a 4-month period. Diagnosis, socio-demographic variables, social support and substance misuse were also ascertained. The presence of personality disorder was not associated with significant differences in the number of carers, time spent along the pathway, or probability of criminal justice system involvement. However, all three personality disorder clusters were significantly associated with increased use of Accident and Emergency (A & E) services. Given the high levels of contact with A & E services, casualty staff should receive improved training in the assessment and management of patients with personality disorders. Improved detection of personality disorder within A & E departments could lead to earlier diversion to mental health services and a consequential improvement in the planning of subsequent treatment.

  5. Personality, temperament, and character dimensions and the DSM-IV personality disorders in substance abusers.

    PubMed

    Ball, S A; Tennen, H; Poling, J C; Kranzler, H R; Rounsaville, B J

    1997-11-01

    The authors evaluated the relationship between P. T. Costa and R. R. McCrae's (1992) NEO 5-factor model, C. R. Cloninger's (1993) 7-factor Temperament and Character Inventory (TCI), and the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., personality disorders in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. NEO Neuroticism was associated with many disorders, and different patterns for Agreeableness, Conscientiousness, and Extraversion emerged for the different disorders. Several TCI scales were associated with different personality disorders, although not as strongly as the NEO dimensions. Results did not support most predictions made for the TCI. Normal personality dimensions contributed significantly to the prediction of personality disorder severity above and beyond substance abuse and depression symptoms.

  6. Personality and Substance Use in Midlife: Conscientiousness as a Moderator and the Effects of Trait Change

    PubMed Central

    Turiano, Nicholas A.; Whiteman, Shawn D.; Hampson, Sarah E.; Roberts, Brent W.; Mroczek, Daniel K.

    2012-01-01

    Personality traits predict substance use in adolescence, but less is known about prospective substance use in middle age and beyond. Moreover, there is growing interest in how personality change and the multiplicative effects among personality traits relate to substance use. Participants included approximately 4,000 adults aged 25–74 who participated in two waves of the Midlife in the U.S. (MIDUS) study. Higher levels of neuroticism, extraversion, openness, and lower levels of conscientiousness and agreeableness predicted longitudinal substance use. Increases in neuroticism and openness predicted increased substance use while increases in conscientiousness and agreeableness predicted decreased substance use. Higher levels of conscientiousness moderated two of the other trait main effects. Personality, trait change, and interactions among traits reliably forecasted 10-year substance-use behaviors. PMID:22773867

  7. Personality and Substance Use in Midlife: Conscientiousness as a Moderator and the Effects of Trait Change.

    PubMed

    Turiano, Nicholas A; Whiteman, Shawn D; Hampson, Sarah E; Roberts, Brent W; Mroczek, Daniel K

    2012-06-01

    Personality traits predict substance use in adolescence, but less is known about prospective substance use in middle age and beyond. Moreover, there is growing interest in how personality change and the multiplicative effects among personality traits relate to substance use. Participants included approximately 4,000 adults aged 25-74 who participated in two waves of the Midlife in the U.S. (MIDUS) study. Higher levels of neuroticism, extraversion, openness, and lower levels of conscientiousness and agreeableness predicted longitudinal substance use. Increases in neuroticism and openness predicted increased substance use while increases in conscientiousness and agreeableness predicted decreased substance use. Higher levels of conscientiousness moderated two of the other trait main effects. Personality, trait change, and interactions among traits reliably forecasted 10-year substance-use behaviors.

  8. Genetic variation in personality traits explains genetic overlap between borderline personality features and substance use disorders

    PubMed Central

    Few, Lauren R.; Grant, Julia D; Trull, Timothy J.; Statham, Dixie J.; Martin, Nicholas G.; Lynskey, Michael T.; Agrawal, Arpana

    2014-01-01

    Aims To examine the genetic overlap between borderline personality features (BPF) and substance use disorders (SUDs) and the extent to which variation in personality traits contributes to this covariance. Design Genetic structural equation modelling was used to partition the variance in and covariance between personality traits, BPF, and SUDs into additive genetic, shared, and individual-specific environmental factors. Setting All participants were registered with the Australian Twin Registry. Participants A total of 3,127 Australian adult twins participated in the study. Measurements Diagnoses of DSM-IV alcohol and cannabis abuse/dependence (AAD; CAD), and nicotine dependence (ND) were derived via computer-assisted telephone interview. BPF and five-factor model personality traits were derived via self-report questionnaires. Findings Genetic factors were responsible for 49% (95%CI: 42%–55%) of the variance in BPF, 38–42% (95%CI range: 32%–49%) for personality traits and 47% (95%CI: 17%–77%), 54% (95%CI: 43%–64%), and 78% (67%–86%) for ND, AAD and CAD, respectively. Genetic and individual-specific environmental correlations between BPF and SUDs ranged from .33–.56 (95%CI range: .19–.74) and .19–.32 (95%CI range: .06–.43), respectively. Overall, there was substantial support for genetic influences that were specific to AAD, ND and CAD (31%–69%). Finally, genetic variation in personality traits was responsible for 11% (Extraversion for CAD) to 59% (Neuroticism for AAD) of the correlation between BPF and SUDs. Conclusions Both genetic and individual-specific environmental factors contribute to comorbidity between borderline personality features and substance use disorders. A substantial proportion of this comorbidity can be attributed to variation in normal personality traits, particularly Neuroticism. PMID:25041562

  9. Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

    ERIC Educational Resources Information Center

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

    2011-01-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

  10. Adolescent substance abuse treatment: Organizational change and quality of care

    PubMed Central

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine; Henderson, Stuart

    2013-01-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives. PMID:23750096

  11. Adolescent substance abuse treatment: Organizational change and quality of care.

    PubMed

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine; Henderson, Stuart

    2011-04-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives.

  12. Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

    ERIC Educational Resources Information Center

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

    2011-01-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

  13. A Care Coordination Program for Substance-Exposed Newborns

    ERIC Educational Resources Information Center

    Twomey, Jean E.; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M.

    2011-01-01

    The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by…

  14. A Care Coordination Program for Substance-Exposed Newborns

    ERIC Educational Resources Information Center

    Twomey, Jean E.; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M.

    2011-01-01

    The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by…

  15. A personalized care plan in chronic care: implementation and evaluation

    PubMed Central

    Engels, Jeanny; Rebel, Marjolein; Boshuizen, Doortje

    2012-01-01

    Purpose Implementation and evaluation of a personalized care plan for approximately 350 people with (an increased risk of) cardiovascular disease in ten general practices in the Netherlands. Context The ‘Healthy Vessels’ (‘Vitale Vaten’) care standard of 2009 describes the optimum care for people with (an increased risk of) cardiovascular disease and is based on the Chronic Care Model. New: working with a personalized care plan, with detailed attention for the promotion of self-management and shared decision-making (SDM). This requires patients to adopt a more active attitude, with a more coaching role from care providers. Vilans has developed the personalized care plan for cardiovascular disease (the booklet ‘Zorgplan Vitale Vaten’) and the personalized care plan for diabetes and for COPD in 2011. In 2011 Vilans also started with the development of a general care plan for patients with multi morbidity diseases. Data sources Patients: quantitative survey with a written questionnaire sent to approximately 75 patients. Baseline and end points for 40 patients, plus in-depth interviews with eight patients. Care providers Quantitative survey with a written questionnaire sent to 45 care providers. Baseline and end points for 22 care providers, plus in-depth interviews with 10 care providers. Case description The personalized care plan is produced by a shared decision-making process and consists of: A prioritised list of the patient’s SMART objectives A personalized plan for achieving those objectives Agreements concerning what the patient will do himself/herself and the support or advice needed Agreements concerning contact to review the progress (how and when) The patient or the care provider notes the plan in the patient’s booklet (the ‘Zorgplan Vitale Vaten’=‘Healthy Vessels Care Plan’). This booklet also contains information about the risk factors for cardiovascular disease, the importance of the patient adopting an active role, measurement

  16. Official conceptualizations of person-centered care: which person counts?

    PubMed

    O'Dwyer, Ciara

    2013-08-01

    Numerous studies have indicated that a "psycho-social" person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a "consumer-based" rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the "Fourth Age". This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Under the influence: informing oral health care providers about substance abuse.

    PubMed

    Riemer, Lynn; Holmes, Ronald

    2014-06-01

    Treating the drug addicted dental patient is different than treating the non-addicted patient due to differences related to the emotional/behavioral/personality issues of the addict, the addict's often poor general health and poor nutrition, ongoing problems of oral hygiene and the effects of drugs on the oral mucosa, gingiva and dentition Oral health care providers need to be aware of the emerging trends in substance abuse, able to recognize patient's addicted to drugs and to be knowledgeable about the effects of substance abuse to provide the most efficacious treatment to avoid the consequences of contraindicated dental procedures and therapy. This article defines the scope of the problem of drug abuse and provides an overview of commonly abused substances and their effects on health and oral health. A review of the literature combined with the authors' extensive experience in the substance abuse field explains parameters of oral health care treatment of the drug addicted individual for patient and provider safety. The drug culture has evolved and the drug user is different. Oral health care providers need to realize that any patient may be an addict in order to identify them, provide appropriate oral care and direct them, if they desire, toward appropriate treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. The Administrative Control System of Substance Abuse Managed Care

    PubMed Central

    Sosin, Michael R

    2005-01-01

    Objective This article searches for the dimensions of the administrative structures in outpatient substance abuse managed care that control the behavior of agency providers. It also ascertains how these dimensions, and several financial mechanisms, affect key aspects of the providers services: the average number of sessions of care that are delivered, the rate of completion of care, and the (estimated) rate at which clients control their substance use. Data Sources The data were collected in 1999 for this investigation. Study Design These data come from a nationally representative, cross-sectional sample of individual contracts between outpatient drug treatment providers and the Behavioral Health Managed Care Organizations (BHMCOs) that are empowered to regulate the delivery of services. Provider responses are analyzed here. Data Collection Methods Factor analyses at a contract level examine the structural dimensions of the control system. Multivariate analyses at the same level rely on generalized linear models to predict the dependent variables by the structural dimensions and financial mechanisms. Findings The factor analyses suggest that there are six multiple variable structural dimensions. The multivariate analyses suggest that the dimension that mandates follow-up of discharged clients tends to relate to more sessions of care and perhaps a higher rate of service completion. Most other dimensions are found to relate to fewer sessions of care, lower rates of service completion, or lower rates of control of substance abuse. No structural dimension relates to all dependent variables. Financial mechanisms evince varying relations to the sessions of care. They rarely relate to the other dependent variables. Conclusion The results generally suggest that providers, payers, or policymakers might affect service provision by selecting BHMCOs that stress particular structural dimensions and financial mechanisms. However, managed care contracts most heavily rely on

  19. Personal theories of substance use among middle-aged and older adults with bipolar disorder.

    PubMed

    Canham, Sarah L; Mahmood, Atiya; Stalman, Marissa N; King, David; O'Rourke, Norm

    2017-03-08

    Most persons with bipolar disorder (BD) misuse alcohol and/or illicit drugs at some point, yet research specific to older adults with BD is nascent. The current study sought an in-depth understanding of the experiences and meanings of substance use in a sample of adults who self-reported substance misuse. Semi-structured interviews were conducted and thematically analyzed to understand the personal theories of substance use by 12 adults (9 women and 3 men; M = 49 years old) who self-reported diagnoses of BD and regular alcohol or illicit drug use. Findings provide an in-depth picture of the theories middle-aged and older adults with BD have developed to explain their substance use. Participants' theories suggest multiple reasons for substance use, including self-medication; increased confidence with substance use; rejection of prescribed medications; easy access to alcohol; early social exposure/use as facilitator; and living in a culture of substance use. Findings suggest multiple theories for the comorbid link between BD and substance use, primarily that persons with BD use drugs and/or alcohol to relieve stress or manage symptoms. It is clinically relevant to incorporate personal reasons for actively and regularly using substances as part of personalized substance treatment and BD symptom management.

  20. Improving person-centred care in dementia.

    PubMed

    Armstrong, Dorothy; Byrne, Grainne

    Failings in dementia care in acute hospitals have been reported to the Scottish Public Services Ombudsman and other scrutiny bodies in Scotland and the UK. This article sets out key knowledge and resources to help nurses provide compassionate and person-centred care.

  1. Relational Care for Perinatal Substance Use: A Systematic Review.

    PubMed

    Kramlich, Debra; Kronk, Rebecca

    2015-01-01

    The purpose of this systematic review of the literature is to highlight published studies of perinatal substance use disorder that address relational aspects of various care delivery models to identify opportunities for future studies in this area. Quantitative, qualitative, and mixed-methods studies that included relational variables, such as healthcare provider engagement with pregnant women and facilitation of maternal-infant bonding, were identified using PubMed, Scopus, and EBSCO databases. Key words included neonatal abstinence syndrome, drug, opioid, substance, dependence, and pregnancy. Six studies included in this review identified statistically and/or clinically significant positive maternal and neonatal outcomes thought to be linked to engagement in antenatal care and development of caring relationships with healthcare providers. Comprehensive, integrated multidisciplinary services for pregnant women with substance use disorder aimed at harm reduction are showing positive results. Evidence exists that pregnant women's engagement with comprehensive services facilitated by caring relationships with healthcare providers may improve perinatal outcomes. Gaps in the literature remain; studies have yet to identify the relative contribution of multiple risk factors to adverse outcomes as well as program components most likely to improve outcomes.

  2. A Study of personality profile and criminal behavior in substance abusers

    PubMed Central

    Aggarwal, Atul; Vaish, Supriya; Sharma, D. K.; Sushil, C. S.; Usman, Nashat; Sudarsanan, S.

    2015-01-01

    Aim: The aim of the present study was to study the personality characteristics and criminal behavior in the substance abusers. The role of various sociodemographic variables in substance abusers, which affected their criminal behavior was also studied. Moreover, in the present study, the personality profile of substance users and nonusers was compared using psychoticism, extraversion, and neuroticism (PEN) inventory. Materials and Methods: A total of 50 consecutive subjects diagnosed as per International Classification of Diseases-10 criteria for substance abuse, fulfilling the inclusive and exclusive criteria were taken. A well-matched control was also assessed to compare the studied subject using a well-designed semi-structured proforma and PEN inventory. Results: Most of the substance abusers were Hindus, married, belonged to 21–30 age group and urban domicile, and were presently unemployed, educated up to middle class, and belonged to lower socioeconomic status. Family history of substance use was significant in the subjects, and the chief substance of use was opioids. Scores for psychoticism and neuroticism, as well as the criminal behavior was significantly higher in studied subjects. Conclusion: Thus, conclusions drawn were that personality characteristics of the substance abusers differed significantly from the control group and second, the number of variables including occupational status, socioeconomic status, family history of substance use, and type of substance of abuse significantly correlated with the criminal behavior in the substance abusers. Identifying these variables can be the first step in the intervention in substance abusers in order to reduce their future criminal behavior. PMID:26257481

  3. Dialectical Behavior Therapy for Substance Abusers Adapted for Persons Living with HIV/AIDS with Substance Use Diagnoses and Borderline Personality Disorder

    ERIC Educational Resources Information Center

    Wagner, Elizabeth E.; Miller, Alec L.; Greene, Lori I.; Winiarski, Mark G.

    2004-01-01

    The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad…

  4. Do Substance Use Risk Personality Dimensions Predict the Onset of Substance Use in Early Adolescence? A Variable- and Person-Centered Approach

    ERIC Educational Resources Information Center

    Malmberg, Monique; Kleinjan, Marloes; Vermulst, Ad A.; Overbeek, Geertjan; Monshouwer, Karin; Lammers, Jeroen; Engels, Rutger C. M. E.

    2012-01-01

    Various studies found personality to be related to substance use, but little attention is paid to the role of personality risk dimensions with regard to an early onset of alcohol, tobacco, and marijuana use. Therefore, the current study used a variable-centered approach to examine whether anxiety sensitivity, hopelessness, sensation seeking, and…

  5. Dialectical Behavior Therapy for Substance Abusers Adapted for Persons Living with HIV/AIDS with Substance Use Diagnoses and Borderline Personality Disorder

    ERIC Educational Resources Information Center

    Wagner, Elizabeth E.; Miller, Alec L.; Greene, Lori I.; Winiarski, Mark G.

    2004-01-01

    The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad…

  6. Do Substance Use Risk Personality Dimensions Predict the Onset of Substance Use in Early Adolescence? A Variable- and Person-Centered Approach

    ERIC Educational Resources Information Center

    Malmberg, Monique; Kleinjan, Marloes; Vermulst, Ad A.; Overbeek, Geertjan; Monshouwer, Karin; Lammers, Jeroen; Engels, Rutger C. M. E.

    2012-01-01

    Various studies found personality to be related to substance use, but little attention is paid to the role of personality risk dimensions with regard to an early onset of alcohol, tobacco, and marijuana use. Therefore, the current study used a variable-centered approach to examine whether anxiety sensitivity, hopelessness, sensation seeking, and…

  7. Stress, Substance Use and Sexual Risk Behaviors among Primary Care Patients in Cape Town, South Africa

    PubMed Central

    Avalos, Lyndsay Ammon; Mertens, Jennifer R.; Ward, Catherine L.; Flisher, Alan J.; Bresick, Graham F.; Weisner, Constance M.

    2009-01-01

    We assessed the relationship between stress, substance use and sexual risk behaviors in a primary care population in Cape Town, South Africa. A random sample of participants (and over-sampled 18–24 year olds) from 14 of the 49 clinics in Cape Town's public health sector using stratified random sampling (N=2,618), was selected. We evaluated current hazardous drug and alcohol use and three domains of stressors (Personal Threats, Lacking Basic Needs, and Interpersonal Problems). Several personal threat stressors and an interpersonal problem stressor were related to sexual risk behaviors. With stressors included in the model, hazardous alcohol use, but not hazardous drug use, was related to higher rates of sexual risk behaviors. Our findings suggest a positive screening for hazardous alcohol use should alert providers about possible sexual risk behaviors and vice versa. Additionally, it is important to address a broad scope of social problems and incorporate stress and substance use in HIV prevention campaigns. PMID:19205865

  8. Mental disorder, substance misuse and violent behaviour: the Swedish experience of caring for the triply troubled.

    PubMed

    Lindqvist, Per

    2007-01-01

    Professional standards in psychiatry, especially concerning the care of people with the combined clinical presentation of psychiatric symptoms, substance misuse and violent behaviour - the 'triply troubled', have been subject to much criticism in Sweden. To present the current Swedish situation concerning treatment and care of 'the triply troubled' and to discuss future development. Analysis of official government documents and contemporary literature as a basis for a personal assessment of the current state of the art. Due to the work of a government task force, the National Psychiatric Services Commission, considerable improvements have been seen for treating substance-abusing mentally disordered people who are not aggressively or criminally inclined. This is less true for 'the triply troubled'. The 'triply troubled' should be given higher priority in mental health services and there is a salient need for more extensive professional training, service improvement, method development and overarching coordination and planning for these people. Copyright (c) 2007 John Wiley & Sons, Ltd.

  9. Training Doctors for Person-Centered Care.

    PubMed

    English, Jeannine

    2016-03-01

    Person-centered care, in which an individual patient's goals and preferences are treated as paramount, should be the standard throughout the nation. Achieving this ideal will require a change in the culture of health care, and medical schools can play a vital role in helping achieve it. Lack of communication, uncoordinated services, and dealings with sometimes-aloof clinicians and staff all can increase stress and undermine a person's sense of well-being. In a person-centered system, such experiences would be much less common. The cultural shift starts with the idea of "engaging the consumer" rather than "treating the patient." Such engagement requires honoring individuality. The doctor may have a certain way of doing things. But people vary enormously in their values and priorities. They have different goals, different thresholds of pain, different anxieties, different needs for support, different backgrounds, and different resources to draw on. Individuals should feel empowered, aware of their choices, and connected to their health care providers through meaningful communication and understanding. They deserve to feel that their personal dignity and their wishes are a top priority. They should be made to feel that they, along with their caregivers, are members of the care team. This change will benefit not only patients and families but doctors as well. Doctors will benefit from more insight into the individuals they serve, their interactions with consumers and caregivers will be more positive, and the quality of care will improve.

  10. Self-preserving personal care products.

    PubMed

    Narayanan, M; Sekar, P; Pasupathi, M; Mukhopadhyay, T

    2017-06-01

    As questions on the safety of some popular preservatives are on the rise, there is a growing interest in developing 'self-preserving' personal care products. Use of multifunctional ingredients/actives with antimicrobial properties has been explored as replacements for conventional preservatives. This study explores the use of combinations of multifunctional actives (MFA) and other cosmetic ingredients in various personal care formulations, to deliver microbiologically safe self-preserving products. Products studied in this study include face wash, gel-based leave-on skin care product and face mask. Minimum inhibitory concentration (MIC) of several cosmetic ingredients was determined to identify multifunctional actives with antimicrobial activity. Personal care formulations made with multifunctional actives and other cosmetic ingredients were studied for preservative efficacy by challenging the product with six multiple cycles of microbial challenge. Formulations with combinations of multifunctional actives with antioxidant (AO) and chelators (CHL) were found to work synergistically and were highly efficacious in controlling multiple microbial challenges as observed in the preservative efficacy test (PET) studies. The effective combinations were able to withstand up to six multiple microbial challenges without product degradation. The preservative efficacy profile was similar to control formula containing preservatives. Self-preserving personal care/cosmetic products can be developed which are as efficacious as preserved products by a prudent selection of multifunctional actives, antioxidants and chelators as a part of the formulation. © 2016 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  11. PHARMACEUTICAL AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    There is no abstract available for this product. If further information is requested, please refer to the bibliographic citation and contact the person listed under Contact field. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subtask 1: To integrate state-of-the-art technologies (polar organic chemical integrative samplers, advanced solid-phase extraction methodologies with liquid chromatography/electrospray/mass spectrometry) and apply them to studying the sources and fate of a select list of PPCPs. Application and improvement of analytical methodologies that can detect non-volatile, polar, water-soluble pharmaceuticals in source waters at levels that could be environmentally significant (at concentrations less than parts per billion, ppb). IAG with USGS ends in FY05. APM 20 due in FY05.Subtask 2: Coordination of interagency research and public outreach activities for PPCPs. Participate on NSTC Health and Environment subcommittee working group on PPCPs. Web site maintenance and expansion, invited technical presentations, invited articles for peer-reviewed journals, interviews for media, responding to public inquiries. S

  12. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    There is no abstract for this product. If further information is requested, please refer to the bibliographic citation and contact the person listed under Contact field. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subtask 1: To integrate state-of-the-art technologies (polar organic chemical integrative samplers, advanced solid-phase extraction methodologies with liquid chromatography/electrospray/mass spectrometry) and apply them to studying the sources and fate of a select list of PPCPs. Application and improvement of analytical methodologies that can detect non-volatile, polar, water-soluble pharmaceuticals in source waters at levels that could be environmentally significant (at concentrations less than parts per billion, ppb). IAG with USGS ends in FY05. APM 20 due in FY05.Subtask 2: Coordination of interagency research and public outreach activities for PPCPs. Participate on NSTC Health and Environment subcommittee working group on PPCPs. Web site maintenance and expansion, invited technical presentations, invited articles for peer-reviewed journals, interviews for media, responding to public inquiries. Subtask 3: T

  13. PHARMACEUTICAL AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    There is no abstract available for this product. If further information is requested, please refer to the bibliographic citation and contact the person listed under Contact field. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subtask 1: To integrate state-of-the-art technologies (polar organic chemical integrative samplers, advanced solid-phase extraction methodologies with liquid chromatography/electrospray/mass spectrometry) and apply them to studying the sources and fate of a select list of PPCPs. Application and improvement of analytical methodologies that can detect non-volatile, polar, water-soluble pharmaceuticals in source waters at levels that could be environmentally significant (at concentrations less than parts per billion, ppb). IAG with USGS ends in FY05. APM 20 due in FY05.Subtask 2: Coordination of interagency research and public outreach activities for PPCPs. Participate on NSTC Health and Environment subcommittee working group on PPCPs. Web site maintenance and expansion, invited technical presentations, invited articles for peer-reviewed journals, interviews for media, responding to public inquiries. S

  14. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    There is no abstract available for this product. If further information is requested, please refer to the bibliographic citation and contact the person listed under Contact field. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subtask 1: To integrate state-of-the-art technologies (polar organic chemical integrative samplers, advanced solid-phase extraction methodologies with liquid chromatography/electrospray/mass spectrometry) and apply them to studying the sources and fate of a select list of PPCPs. Application and improvement of analytical methodologies that can detect non-volatile, polar, water-soluble pharmaceuticals in source waters at levels that could be environmentally significant (at concentrations less than parts per billion, ppb). IAG with USGS ends in FY05. APM 20 due in FY05.Subtask 2: Coordination of interagency research and public outreach activities for PPCPs. Participate on NSTC Health and Environment subcommittee working group on PPCPs. Web site maintenance and expansion, invited technical presentations, invited articles for peer-reviewed journals, interviews for media, responding to public inquiries. S

  15. Personalized Care in Uterine Cancer

    PubMed Central

    Iglesias, David A.; Bodurka, Diane C.

    2016-01-01

    Endometrial cancer typically presents at an early stage when surgery alone, with or without radiotherapy, is often curative. However, in women who present with advanced disease or who develop disease recurrence, long-term prognosis is poor. While surgical cytoreduction remains the mainstay of initial therapy, over the last several decades, the roles of cytotoxic chemotherapy, radiotherapy, and hormonal therapy have been evaluated in both the adjuvant and recurrent setting in an attempt to improve long-term survival while also minimizing associated toxicities. Unfortunately, response rates remain poor and survival is limited in these settings. More recently, with the introduction of personalized cancer treatment, several biologic agents have been developed that target specific pathways critical to tumor initiation and growth. Molecular studies have found that many endometrial cancers are driven by some of these tumorigenic pathways, which has led to early clinical studies evaluating the role of these targeted agents in patients with advanced or recurrent endometrial cancer. This review describes existing treatment options for patients with early and advanced endometrioid endometrial cancer, as well as for patients with uterine serous cancers. Furthermore, this review examines the growing body of literature involving targeted biologic agents as treatment for patients with advanced or recurrent endometrial cancer. PMID:23271352

  16. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

    EPA Pesticide Factsheets

    There is no abstract available for this product. If further information is requested, please refer to the bibliographic citation and contact the person listed under Contact field. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subtask 1: To integrate state-of-the-art technologies (polar organic chemical integrative samplers, advanced solid-phase extraction methodologies with liquid chromatography/electrospray/mass spectrometry) and apply them to studying the sources and fate of a select list of PPCPs. Application and improvement of analytical methodologies that can detect non-volatile, polar, water-soluble pharmaceuticals in source waters at levels that could be environmentally significant (at concentrations less than parts per billion, ppb). IAG with USGS ends in FY05. APM 20 due in FY05.Subtask 2: Coordination of interagency research and public outreach activities for PPCPs. Participate on NSTC Health and Environment subcommittee working group on PPCPs. Web site maintenance and expansion, invited technical presentations, invited articles for peer-reviewed journals, interviews for media, responding to public inquiries. S

  17. Culturally competent substance abuse treatment with transgender persons.

    PubMed

    Nuttbrock, Larry A

    2012-01-01

    Transgender individuals are misunderstood and inadequately treated in many conventional substance abuse treatment programs. This article reviews current concepts regarding the definition and diversity of transgenderism and summarizes the existing literature on the prevalence and correlates of substance use in transgendered populations. Examples of culturally competent and gender-sensitive treatment in specialized settings are cited, with a call to extend these initiatives throughout the gamut of service venues that engage transgender individuals. Cultural competence combined with gender sensitivity should improve the effectiveness of substance abuse treatment for transgender individuals and will contribute to the goal of providing effective services in an increasingly diverse society.

  18. Perspectives on personalized cancer care

    PubMed Central

    Dancik, Garrett M.; Theodorescu, Dan

    2017-01-01

    Summary Sir William Osler has been quoted as saying “If it were not for the great variability among individuals, medicine might as well be a science and not an art”. Molecular profiles, be they host or those providing insight into the genomic changes that define a cancerous cell, together possess the predictive ability required for the various aspects of individualized care: risk assessment, patient prognosis, and prediction of therapeutic responses. Such profiles, obtained by RNA, DNA and protein microarrays, SNP arrays, methylation screens, and high throughput or targeted gene sequencing can provide patient- and tumor-specific information that details the biological complexity of a particular cancer and can be exploited to understand its clinical implications and glean therapeutic insights. This knowledge is also being combined with host factors to begin formulating an understanding at the system level of how the tumor interacts with the host and how this relationship can be exploited therapeutically or for biomarker development. Here we discuss these advances and how they may relate to urologic oncology. PMID:22489325

  19. Unhealthy Substance Use Behaviors as Symptom-Related Self-Care in HIV/AIDS

    PubMed Central

    Brion, John M.; Rose, Carol Dawson; Nicholas, Patrice K.; Sloane, Rick; Voss, Joachim G.; Corless, Inge B.; Lindgren, Teri G.; Wantland, Dean J.; Kemppainen, Jeanne K.; Sefcik, Elizabeth F.; Nokes, Kathleen M.; Kirksey, Kenn M.; Eller, Lucille Sanzero; Hamilton, Mary Jane; Holzemer, William L.; Portillo, Carmen J.; Mendez, Marta Rivero; Robinson, Linda M.; Moezzi, Shanaz; Rosa, Maria; Human, Sarie; Maryland, Mary; Arudo, John; Ros, Ana Viamonte; Nicholas, Thomas P.; Cuca, Yvette; Huang, Emily; Bain, Catherine; Tyer-Viola, Lynda; Zang, Sheryl M.; Shannon, Maureen; Peters-Lewis, Angelleen

    2014-01-01

    The prevalence of symptoms in HIV disease can be associated with HIV disease itself, comorbid illness, and/or antiretroviral therapy. Unhealthy substance use behaviors, particularly substance-use behaviors including heavy alcohol intake, marijuana use, other illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage disease-related symptoms. This study is a secondary data analysis of baseline data from a larger randomized-controlled trial of an HIV/AIDS Symptom Management Manual. In the present study, the prevalence and characteristics of unhealthy substance use behaviors in relation to HIV/AIDS symptoms are examined. Subjects were recruited from a variety of settings which provide HIV/AIDS care and treatment. The mean age of the sample (n=775) was 42.8 years (SD=9.6) and nearly thirty-nine percent (38.5%) of the sample was female. The racial demographics of the sample were: 28% African American, 28% Hispanic, 21% White/Caucasian, 16% African from Kenya or South Africa, 1% Asian, and 5% self-described as “Other.” The mean number of years living with HIV was reported to be 9.1 years (SD=6.6).Specific self-reported unhealthy substance-use behaviors were use of marijuana (n= 111; 14.3%), cigarette smoking (n=355; 45.8%), heavy alcohol use (n= 66; 8.5%), and illicit drugs (n= 98; 12.6%). A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance use behaviors including amphetamine and injection drug use in addition to heavy alcohol use, cigarette smoking, and marijuana use. Implications for clinical practice include assessment of self-care behaviors, screening for substance abuse, and education of persons related to self-management across the trajectory of HIV disease. PMID:21352430

  20. Tridimensional personality of adolescents with internet addiction and substance use experience.

    PubMed

    Ko, Chih-Hung; Yen, Ju-Yu; Chen, Cheng-Chung; Chen, Sue-Huei; Wu, Kuanyi; Yen, Cheng-Fang

    2006-12-01

    This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group). In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use. Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores. Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.

  1. Development of a Personalized Bidirectional Text Messaging Tool for HIV Adherence Assessment and Intervention among Substance Abusers

    PubMed Central

    Ingersoll, Karen; Dillingham, Rebecca; Reynolds, George; Hettema, Jennifer; Freeman, Jason; Hosseinbor, Sharzad; Winstead-Derlega, Chris

    2013-01-01

    We describe the development of a two-way text messaging intervention tool for substance users who are non-adherent with HIV medications, and examine message flow data for feasibility and acceptability. The assessment and intervention tool, TxText, is fully automated, sending participants mood, substance use, and medication adherence queries by text message. Participants respond, the tool recognizes the category of response, and sends the personalized intervention message that participants designed in return. In 10 months, the tool sent 16,547 messages (half initial, half follow-up) to 31 participants assigned to the TxText condition, who sent 6711 messages in response to the initial messages. Response rates to substance use (n=2370), medication (n=2918) and mood (n=4639) queries were 67%, 69%, and 64%, respectively. Responses indicating medication adherence, abstinence from substances, and good moods were more common than negative responses. The TxText tool can send messages daily over a 3 month period, receive responses, and decode them to deliver personalized affirming or intervention messages. While we await the outcomes of a pilot randomized trial, the process analysis shows that TxText is acceptable and feasible for substance abusers with HIV, and may serve as a complement to HIV medical care. PMID:24029625

  2. Development of a personalized bidirectional text messaging tool for HIV adherence assessment and intervention among substance abusers.

    PubMed

    Ingersoll, Karen; Dillingham, Rebecca; Reynolds, George; Hettema, Jennifer; Freeman, Jason; Hosseinbor, Sharzad; Winstead-Derlega, Chris

    2014-01-01

    We describe the development of a two-way text messaging intervention tool for substance users who are non-adherent with HIV medications, and examine message flow data for feasibility and acceptability. The assessment and intervention tool, TxText, is fully automated, sending participants mood, substance use, and medication adherence queries by text message. Participants respond, the tool recognizes the category of response, and sends the personalized intervention message that participants designed in return. In 10months, the tool sent 16,547 messages (half initial, half follow-up) to 31 participants assigned to the TxText condition, who sent 6711 messages in response to the initial messages. Response rates to substance use (n=2370), medication (n=2918) and mood (n=4639) queries were 67, 69, and 64%, respectively. Responses indicating medication adherence, abstinence from substances, and good moods were more common than negative responses. The TxText tool can send messages daily over a 3month period, receive responses, and decode them to deliver personalized affirming or intervention messages. While we await the outcomes of a pilot randomized trial, the process analysis shows that TxText is acceptable and feasible for substance abusers with HIV, and may serve as a complement to HIV medical care.

  3. The Correlation between Emotional Intelligence and Instable Personality in Substance Abusers.

    PubMed

    Haj Hosseini, Fatemeh; Mehdizadeh Zare Anari, Ali

    2011-01-01

    Substance dependence has recently turned into one of the most important social problems. Clinical findings have shown personality traits, social relations, attitudes and values, along with emotional intelligence factors such as emotions, feelings, emotions management, challenging with problems, problem solving, tolerating psychological pressure, impulse control, self esteem and interpersonal relations, to affect substance dependence. Consequently, understanding the meaning and developing tools for assessment of emotional intelligence are significantly vital in human psychological health. This study aimed to investigate the relation between emotional intelligence and instable personality in substance abusers. The present correlational study selected 80 male addicts through available sampling. The subjects referred to the Therapeutic Community Center and Kimia, Yas, and Aban Clinics in Yazd, Iran. Their emotional intelligence and personality were evaluated by BarOn questionnaire and Eysenck personality questionnaire (EPQ) for adults, respectively. Pearson's correlation coefficient was used to assess the correlations between different factors. There was a negative significant correlation (P = 0.050) between emotional intelligence and instable personality in substance abusers. Problem solving and optimism (P = 0.001), interpersonal relation (P = 0.010), self esteem (P = 0.013), and realities (P = 0.017) had significant effects on instable personality. Based on our findings, emotional intelligence was significantly correlated with instable personality in substance abusers. However, using more accurate tools in order to assess all aspects of personality can give better results.

  4. Tobacco-related mortality among persons with mental health and substance abuse problems.

    PubMed

    Bandiera, Frank C; Anteneh, Berhanu; Le, Thao; Delucchi, Kevin; Guydish, Joseph

    2015-01-01

    The rate of cigarette smoking is greater among persons with mental health and/or substance abuse problems. There are few population-based datasets with which to study tobacco mortality in these vulnerable groups. The Oregon Health Authority identified persons who received publicly-funded mental health or substance abuse services from January 1996 through December 2005. These cases were then matched to Oregon Vital Statistics records for all deaths (N= 148,761) in the period 1999-2005. The rate of tobacco-related death rates was higher among persons with substance abuse problems only (53.6%) and those with both substance abuse and mental health problems (46.8%), as compared to the general population (30.7%). The rate of tobacco-related deaths among persons with mental health problems (30%) was similar to that in the general population. Persons receiving substance abuse treatment alone, or receiving both substance abuse and mental health treatment, were more likely to die and more likely to die prematurely of tobacco-related causes as compared to the general population. Persons receiving mental health services alone were not more likely to die of tobacco-related causes, but tobacco-related deaths occurred earlier in this population.

  5. Co-occurrence of addictive behaviours: personality factors related to substance use, gambling and computer gaming.

    PubMed

    Walther, Birte; Morgenstern, Matthis; Hanewinkel, Reiner

    2012-01-01

    To investigate co-occurrence and shared personality characteristics of problematic computer gaming, problematic gambling and substance use. Cross-sectional survey data were collected from 2,553 German students aged 12-25 years. Self-report measures of substance use (alcohol, tobacco and cannabis), problematic gambling (South Oaks Gambling Screen - Revised for Adolescents, SOGS-RA), problematic computer gaming (Video Game Dependency Scale, KFN-CSAS-II), and of twelve different personality characteristics were obtained. Analyses revealed positive correlations between tobacco, alcohol and cannabis use and a smaller positive correlation between problematic gambling and problematic computer gaming. Problematic computer gaming co-occurred only with cannabis use, whereas problematic gambling was associated with all three types of substance use. Multivariate multilevel analyses showed differential patterns of personality characteristics. High impulsivity was the only personality characteristic associated with all five addictive behaviours. Depression and extraversion were specific to substance users. Four personality characteristics were specifically associated with problematic computer gaming: irritability/aggression, social anxiety, ADHD, and low self-esteem. Problematic gamblers seem to be more similar to substance users than problematic computer gamers. From a personality perspective, results correspond to the inclusion of gambling in the same DSM-V category as substance use and question a one-to-one proceeding for computer gaming. Copyright © 2012 S. Karger AG, Basel.

  6. Personality Disorders, Narcotics, and Stimulants; Relationship in Iranian Male Substance Dependents Population

    PubMed Central

    Noorbakhsh, Simasadat; Zeinodini, Zahra; Khanjani, Zeynab; Poorsharifi, Hamid; Rajezi Esfahani, Sepideh

    2015-01-01

    Background: Individuals with certain personality disorders, especially the antisocial and borderline personality disorders, are more prone to substance use disorders. Objectives: Regarding the importance of substance use disorders, this study aimed to explore the association between personality disorders and types of used drugs (narcotics and stimulants) in Iranian male substance users. Patients and Methods: The current study was a correlation study. We evaluated 285 male substance users and excluded 25 according to exclusion criteria. A total of 130 narcotic users and 130 stimulant users were recruited randomly in several phases from January 2013 to October 2013. All participants were referred to Substance Dependency Treatment Clinics in Tehran, Iran. Data collection process was accomplished by means of clinical interview based on DSM-V criteria for substance use disorders, Iranian version of addiction severity index (ASI), and Millon clinical multi-axial inventory-III (MCMI-III). Data were analyzed by SPSS 21 using Pearson correlation coefficient and regression, the. Results: There was a significant correlation between stimulant use and histrionic personality disorder (P < 0.001) and antisocial and narcissistic personality disorders (P < 0.05). In addition, correlation between avoidant, histrionic, and narcissistic personality disorders (P < 0.05) and depressed, antisocial, and borderline personality disorders (P < 0.001) with narcotics consumption were significant. In clusters, there was a significant correlation between cluster B personality disorders, and narcotic and stimulants consumption (P < 0.001). In addition, this association was explored between cluster C personality disorder and narcotics (P < 0.001). Conclusions: The results of this study in terms of personality disorders and types of used drugs were in accordance with the previous studies results. It is necessary to design appropriate treatment plans for medical treatment of those with personality

  7. Personality Disorders, Narcotics, and Stimulants; Relationship in Iranian Male Substance Dependents Population.

    PubMed

    Noorbakhsh, Simasadat; Zeinodini, Zahra; Khanjani, Zeynab; Poorsharifi, Hamid; Rajezi Esfahani, Sepideh

    2015-06-01

    Individuals with certain personality disorders, especially the antisocial and borderline personality disorders, are more prone to substance use disorders. Regarding the importance of substance use disorders, this study aimed to explore the association between personality disorders and types of used drugs (narcotics and stimulants) in Iranian male substance users. The current study was a correlation study. We evaluated 285 male substance users and excluded 25 according to exclusion criteria. A total of 130 narcotic users and 130 stimulant users were recruited randomly in several phases from January 2013 to October 2013. All participants were referred to Substance Dependency Treatment Clinics in Tehran, Iran. Data collection process was accomplished by means of clinical interview based on DSM-V criteria for substance use disorders, Iranian version of addiction severity index (ASI), and Millon clinical multi-axial inventory-III (MCMI-III). Data were analyzed by SPSS 21 using Pearson correlation coefficient and regression, the. There was a significant correlation between stimulant use and histrionic personality disorder (P < 0.001) and antisocial and narcissistic personality disorders (P < 0.05). In addition, correlation between avoidant, histrionic, and narcissistic personality disorders (P < 0.05) and depressed, antisocial, and borderline personality disorders (P < 0.001) with narcotics consumption were significant. In clusters, there was a significant correlation between cluster B personality disorders, and narcotic and stimulants consumption (P < 0.001). In addition, this association was explored between cluster C personality disorder and narcotics (P < 0.001). The results of this study in terms of personality disorders and types of used drugs were in accordance with the previous studies results. It is necessary to design appropriate treatment plans for medical treatment of those with personality disorders.

  8. Personality psychopathology, drug use and psychological symptoms in adolescents with substance use disorders and community controls

    PubMed Central

    Forns, Maria; Goti, Javier; Castro-Fornieles, Josefina

    2015-01-01

    Substance use is a risk behavior that tends to increase during adolescence, a time when part of the personality is still in development. Traditionally, personality psychopathology has been measured in terms of categories, although dimensional models have demonstrated better consistency. This study aimed to analyze differences in personality profiles between adolescents with substance use disorders (SUD n = 74) and matched community controls (MCC n = 74) using the Personality Psychopathology Five (PSY-5) dimensional model. Additionally, we compared age at first drug use, level of drug use and internalizing and externalizing symptoms between the groups. In this study, the PSY-5 model has proved to be useful for differentiating specific personality disturbances in adolescents with SUD and community adolescents. The Disconstraint scale was particularly useful for discriminating adolescents with substance use problems and the Delinquent Attitudes facet offered the best differentiation. PMID:26082873

  9. Integrated EAP/Managed Behavioral Health Plan Utilization by Persons with Substance Use Disorders

    PubMed Central

    Levy Merrick, Elizabeth S.; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Greenfield, Shelly F.; McCann, Bernard

    2011-01-01

    New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral healthcare organization's integrated EAP/managed behavioral health care product (N=1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. PMID:21185684

  10. Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders.

    PubMed

    Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard

    2011-04-01

    New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes.

  11. Cleanser, Detergent, Personal Care Product Pretreatment Evaluation

    NASA Technical Reports Server (NTRS)

    Adam, Niklas

    2010-01-01

    The purpose of the Cleanser, Detergent, Personal Care Product, and Pretreatment Evaluation & Selection task is to identify the optimal combination of personal hygiene products, crew activities, and pretreatment strategies to provide the crew with sustainable life support practices and a comfortable habitat. Minimal energy, mass, and crew time inputs are desired to recycle wastewater during long duration missions. This document will provide a brief background on the work this past year supporting the ELS Distillation Comparison Test, issues regarding use of the hygiene products originally chosen for the test, methods and results used to select alternative products, and lessons learned from testing.

  12. Using the tidal model of mental health recovery to plan primary health care for women in residential substance abuse recovery.

    PubMed

    Young, Brenda B

    2010-09-01

    Women currently are 30% of the substance abuse recovery population in North America and have gender specific treatment needs as they enter the difficult work of recovery. Important among women's specific needs as they enter recovery is the need for a focus on primary health care. Few models designed to guide the provision of health care for this population are available in the literature. The Tidal Model of Mental Health Recovery and Reclamation is based on the concept of nursing as "caring with" persons in the experience of distress. Given the emphasis in this model on developing a partnership between caregiver and client, it is especially appropriate for women in recovery for substance abuse. The Tidal Model, integrated with the United States Substance Abuse and Mental Health Services' CSAT model for comprehensive alcohol and other drug (AOD) abuse treatment, is used to guide planning for delivery of primary health care in a residential women's substance abuse recovery center in the Midwest. This article describes the Tidal Model, and identifies how the model can improve the delivery of primary care to women in residential substance abuse treatment. Strategies for implementation of the model are proposed. Evaluation and outcome criteria are identified.

  13. Personalized Health Care and Business Success

    PubMed Central

    Ozbolt, Judy G.

    1999-01-01

    Perrow's models of organizational technologies provide a framework for analyzing clinical work processes and identifying the management structures and informatics tools to support each model. From this perspective, health care is a mixed model in which knowledge workers require flexible management and a variety of informatics tools. A Venn diagram representing the content of clinical decisions shows that uncertainties in the components of clinical decisions largely determine which type of clinical work process is in play at a given moment. By reducing uncertainties in clinical decisions, informatics tools can support the appropriate implementation of knowledge and free clinicians to use their creativity where patients require new or unique interventions. Outside health care, information technologies have made possible breakthrough strategies for business success that would otherwise have been impossible. Can health informatics work similar magic and help health care agencies fulfill their social mission while establishing sound business practices? One way to do this would be through personalized health care. Extensive data collected from patients could be aggregated and analyzed to support better decisions for the care of individual patients as well as provide projections of the need for health services for strategic and tactical planning. By making excellent care for each patient possible, reducing the “inventory” of little-needed services, and targeting resources to population needs, informatics can offer a route to the “promised land” of adequate resources and high-quality care. PMID:10495097

  14. Does comorbid substance use disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance dependence.

    PubMed

    Lee, Han-Joo; Bagge, Courtney L; Schumacher, Julie A; Coffey, Scott F

    2010-10-01

    There is compelling evidence that comorbid borderline personality disorder (BPD) negatively impact the clinical courses and outcomes of substance use disorders (SUD). Conversely, there is little evidence that concurrent SUD exacerbates the clinical characteristics of BPD. Thus, this study sought to examine whether the presence of current substance dependence among BPD patients would be associated with stronger BPD-relevant personality traits and behavioral characteristics. Female BPD patients without (BOR; n = 37) or with current substance dependence (BSUD; n = 19), and female non-BPD/SUD controls (CON; n = 48) were compared with respect to impulsivity, affective lability, affective intensity, externalizing behaviors, and self-harming/suicidal tendencies, taking into consideration their comorbid mood disorders, anxiety disorders, and antisocial personality disorder. Results indicated that both BOR and BSUD groups scored higher than CON in most of the measures, but BOR and BSUD failed to reveal significant group differences especially when the influence of comorbid psychopathology was removed. The overall pattern of findings remained identical even when comparing BPD patients with versus without the diagnosis of lifetime substance dependence. Our results do not support the notion that BPD individuals with SUD display more severe BPD features than individuals with BPD alone.

  15. 21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... person registered or authorized to conduct chemical analysis or research with controlled substances may... chemical analysis, instructional activities, or research with the substances with either a DEA Form 222 or..., instructional activities, or research. (e) A person registered as a compounder of narcotic substances for use...

  16. 21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... II controlled substances, whether on a DEA Form 222 or an electronic order, may be filled only by a person registered with DEA as a manufacturer or distributor of controlled substances listed in Schedule I... DEA to dispense the substances, or to export the substances, if he/she is discontinuing business or...

  17. 21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... II controlled substances, whether on a DEA Form 222 or an electronic order, may be filled only by a person registered with DEA as a manufacturer or distributor of controlled substances listed in Schedule I... DEA to dispense the substances, or to export the substances, if he/she is discontinuing business or...

  18. 21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... II controlled substances, whether on a DEA Form 222 or an electronic order, may be filled only by a person registered with DEA as a manufacturer or distributor of controlled substances listed in Schedule I... DEA to dispense the substances, or to export the substances, if he/she is discontinuing business or...

  19. 21 CFR 1305.06 - Persons entitled to fill orders for Schedule I and II controlled substances.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... II controlled substances, whether on a DEA Form 222 or an electronic order, may be filled only by a person registered with DEA as a manufacturer or distributor of controlled substances listed in Schedule I... DEA to dispense the substances, or to export the substances, if he/she is discontinuing business or...

  20. Changes in personal networks of women in residential and outpatient substance abuse treatment.

    PubMed

    Min, Meeyoung O; Tracy, Elizabeth M; Kim, Hyunsoo; Park, Hyunyong; Jun, Minkyoung; Brown, Suzanne; McCarty, Christopher; Laudet, Alexandre

    2013-10-01

    Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Are inmates’ subjective sleep problems associated with borderline personality, psychopathy, and antisocial personality independent of depression and substance dependence?

    PubMed Central

    Harty, Laura; Duckworth, Rebecca; Thompson, Aaron; Stuewig, Jeffrey; Tangney, June P.

    2009-01-01

    Previous research investigating the relationship between Borderline Personality Disorder (BPD) and sleep problems, independent of depression, has been conducted on small atypical samples with mixed results. This study extends the literature by utilizing a much larger sample and by statistically controlling for depression and substance dependence. Subjective reports of sleep problems were obtained from 513 jail inmates (70% male) incarcerated on felony charges. Symptoms of BPD were significantly associated with sleep problems even when controlling for depression. Thus, sleep problems associated with BPD cannot be attributed simply to co-morbid symptoms of depression and substance dependence was ruled out as proximal causes for this relationship. Symptoms of depression, but not Antisocial Personality features, were related to sleep problems independent of substance dependence. Treatment of individuals with BPD may be more effective if sleep problems are explicitly addressed in the treatment plan. PMID:20198127

  2. Electronic health records: essential tools in integrating substance abuse treatment with primary care

    PubMed Central

    Tai, Betty; Wu, Li-Tzy; Clark, H Westley

    2012-01-01

    While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted. PMID:24474861

  3. Electronic health records: essential tools in integrating substance abuse treatment with primary care.

    PubMed

    Tai, Betty; Wu, Li-Tzy; Clark, H Westley

    2012-01-01

    While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.

  4. In-Home Continuing Care Services for Substance-Affected Families: The Bridges Program.

    ERIC Educational Resources Information Center

    Gruber, Kenneth J.; Fleetwood, Thomas W.; Herring, Michael W.

    2001-01-01

    Presents a preliminary view of a continuing care substance abuse recovery services program designed to assist the substance-affected family. The program focuses on helping substance abusers and their families achieve relapse prevention by addressing functioning in four domains: individual actions and cognitions; individual recovery actions; family…

  5. In-Home Continuing Care Services for Substance-Affected Families: The Bridges Program.

    ERIC Educational Resources Information Center

    Gruber, Kenneth J.; Fleetwood, Thomas W.; Herring, Michael W.

    2001-01-01

    Presents a preliminary view of a continuing care substance abuse recovery services program designed to assist the substance-affected family. The program focuses on helping substance abusers and their families achieve relapse prevention by addressing functioning in four domains: individual actions and cognitions; individual recovery actions; family…

  6. Personalizing health care: feasibility and future implications

    PubMed Central

    2013-01-01

    Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients. PMID:23941275

  7. Association of housing first implementation and key outcomes among homeless persons with problematic substance use.

    PubMed

    Davidson, Clare; Neighbors, Charles; Hall, Gerod; Hogue, Aaron; Cho, Richard; Kutner, Bryan; Morgenstern, Jon

    2014-11-01

    Housing First is a supportive housing model for persons with histories of chronic homelessness that emphasizes client-centered services, provides immediate housing, and does not require treatment for mental illness or substance abuse as a condition of participation. Previous studies of Housing First have found reduced governmental costs and improved personal well-being among participants. However, variations in real-world program implementation require better understanding of the relationship between implementation and outcomes. This study investigated the effects of Housing First implementation on housing and substance use outcomes. Study participants were 358 individuals with histories of chronic homelessness and problematic substance use. Clients were housed in nine scatter-site Housing First programs in New York City. Program fidelity was judged across a set of core Housing First components. Client interviews at baseline and 12 months were used to assess substance use. Clients in programs with greater fidelity to consumer participation components of Housing First were more likely to be retained in housing and were less likely to report using stimulants or opiates at follow-up. Consistently implemented Housing First principles related to consumer participation were associated with superior housing and substance use outcomes among chronically homeless individuals with a history of substance use problems. The study findings suggest that program implementation is central to understanding the potential of Housing First to help clients achieve positive housing and substance use outcomes.

  8. The accessibility of substance abuse treatment facilities in the United States for persons with disabilities.

    PubMed

    West, Steven L

    2007-07-01

    This study assessed the accessibility of a nationally representative sample of substance abuse treatment facilities in the United States for persons with disabilities (PWDs). A stratified random sample of 159 substance abuse treatment facilities in 40 states completed a survey regarding physical accessibility and the provision of services that could enhance the ability to serve individuals with disabilities. Most responding facilities self-reported a variety of barriers to physical accessibility, as well as the lack of services and physical accommodations for persons with sensory limitations. Such widespread inaccessibility may be a factor that promotes the low representation of PWDs in the treatment population.

  9. [Substance use, affective problems and personality traits: test of two association models].

    PubMed

    Chakroun, N; Doron, J; Swendsen, J

    2004-01-01

    The International Consortium of Psychiatric Epidemiology has confirmed the high comorbidity in community-drawn samples between substance use disorders and anxiety or depression. In the same way, associations between substance use and specific personality traits (such as novelty seeking, harm avoidance or antisocial personality) have also been extensively documented. Self-medication and social deviance are among the most commonly evoked explanatory models for these forms of comorbidity, and are based on findings that affective disorders and specific personality traits often precede the onset of substance use disorders. The self-medication model postulates that an individual chooses a specific substance according to its psychopharmacologic action on the given psychological state of the person. By contrast, the social deviance model posits that this form of comorbidity is due to the fact that persons consuming certain substances may have affective or personality characteristics that are more severe or more deviant than non-consumers (or than consumers of socially well-accepted substances). In this way, the individual does not use a particular substance to assuage pre-existing disorders but, due to a more deviant personality, is less influenced by social norms and may more easily turn to using illicit substances or to polyconsumption. However, a major limitation of the current scientific literature concerning tests of these models is that previous investigations have been based in overwhelming majority on clinical populations. The examination only of clinical samples renders difficult the identification of causal (or primary) risk factors for the emergence of substance use disorders from the potential consequences of substance use itself. The goal of the current study was therefore to simultaneously compare both models of association using a non clinical population of substance users. In addition to selecting subjects based on use (rather than abuse or dependence

  10. Longitudinal associations between depression and problematic substance use in the Youth Partners in Care study.

    PubMed

    McKowen, James W; Tompson, Martha C; Brown, Timothy A; Asarnow, Joan R

    2013-01-01

    Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using latent growth modeling, we examined the (a) longitudinal association between depressive symptoms and problematic substance use, (b) impact of depressive symptoms on problematic substance use, (c) impact of problematic substance use on depressive symptoms, and (d) role of co-occurring symptoms on depression and problematic substance use. Participants were part of the Youth Partners in Care study, an effectiveness trial evaluating a quality improvement intervention for youth depression through primary care. This ethnically diverse sample included youths aged 13 to 21 years screening positive for depression from 5 health care organizations. Participants were followed 4 times over an 18-month period and assessed for both depressive symptoms and problematic substance use. Both depressive symptoms and problematic substance use declined over time. Higher baseline depressive symptoms predicted a slower decline in problematic substance use, but baseline problematic substance use did not predict changes in depressive symptoms. These prospective associations remained robust controlling for co-occurring symptoms. Results support prior large-scale depression studies indicating depression burden negatively impacts substance use outcome and extends these findings to real-world practice settings. Findings underscore the importance of addressing depression severity in youth with concurrent substance use problems, even in the context of comorbid symptoms of anxiety, delinquency, and aggression.

  11. Medicaid Managed Care, Substance Abuse Treatment and People with Disabilities: Review of the Literature

    ERIC Educational Resources Information Center

    Bachman, Sara S.; Drainoni, Mari-Lynn; Tobias, Carol

    2004-01-01

    Most states enroll individuals with disabilities who receive Supplemental Security Income (SSI) in Medicaid managed care plans. The impact of managed care on these individuals, especially those with substance abuse disorders, is not well understood. A review of the literature related to substance abuse, disability, and Medicaid managed care…

  12. Substance Abuse among Health-Care Professionals in Rutherford and Surrounding Counties.

    ERIC Educational Resources Information Center

    Edwards, Sherri Reid; Heritage, Jeannette G.

    Drug abuse is a serious problem in today's work force. It is found in every occupation, from the entry-level employee to the chief executive officer. Among health care professionals alcohol is the number-one substance abused, prescription drugs are second, and cocaine is third. Substance abuse among health-care professionals in Rutherford,…

  13. Prevention of adolescent substance abuse through the development of personal and social competence.

    PubMed

    Botvin, G J

    1983-01-01

    The initiation of substance use typically begins during adolescence and appears to be the result of the complex interplay of social, personality, cognitive, attitudinal, behavioral, and developmental factors. Traditional smoking, alcohol, and drug education programs have attempted to increase students' knowledge of the risks associated with using these substances in the hope that this would deter use. Other programs have attempted to enrich the personal and social development of students through what has been referred to as "affective" education. Unfortunately, the inescapable conclusion to be drawn from the substance abuse prevention literature is that few of these programs have demonstrated any degree of success in terms of the actual prevention of substance use/abuse. Traditional educational approaches to substance abuse prevention appear to be inadequate because they are based on faulty assumptions and are too narrow in their focus. The "affective" education approaches, on the other hand, appear to have placed too little emphasis on the acquisition of the kind of skills that are likely to increase general personal competence and enable students to cope with the various interpersonal and intrapersonal pressures to begin using tobacco, alcohol, or drugs. From the perspective of social learning theory (Bandura 1977) and problem behavior theory (Jessor and Jessor 1977), substance use is conceptualized as a socially learned, purposive, and functional behavior which is the result of the interplay of social (environmental) and personal factors. One potentially effective approach to substance abuse prevention might involve enhancing general personal competence and teaching adolescents the kind of problem-specific skills and knowledge which will increase their ability to resist the various forms of pro-substance-use social pressure. Brief reviews of the social skills training literature and the literature related to techniques for coping with anxiety not only provide

  14. Psychiatric Severity and HIV-Risk Sexual Behaviors among Persons with Substance Use Disorders

    PubMed Central

    Majer, John M.; Komer, Anne C.; Jason, and Leonard A.

    2014-01-01

    Objective The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use) and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity), to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. Methods Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110, 110/266), while 27.8% reported using cocaine (n = 74, 74/266) and 12.8% reported using alcohol (n = 34, 34/266). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. Results Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not

  15. Psychiatric severity and HIV-risk sexual behaviors among persons with substance use disorders.

    PubMed

    Majer, John M; Komer, Anne C; Jason, Leonard A

    2015-01-01

    The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well-established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use), and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity) to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110), while 27.8% reported using cocaine (n = 74) and 12.8% reported using alcohol (n = 34). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not frequency of unprotected behavior), such that those higher

  16. Proteomic contributions to personalized cancer care.

    PubMed

    Koomen, John M; Haura, Eric B; Bepler, Gerold; Sutphen, Rebecca; Remily-Wood, Elizabeth R; Benson, Kaaron; Hussein, Mohamad; Hazlehurst, Lori A; Yeatman, Timothy J; Hildreth, Lynne T; Sellers, Thomas A; Jacobsen, Paul B; Fenstermacher, David A; Dalton, William S

    2008-10-01

    Cancer impacts each patient and family differently. Our current understanding of the disease is primarily limited to clinical hallmarks of cancer, but many specific molecular mechanisms remain elusive. Genetic markers can be used to determine predisposition to tumor development, but molecularly targeted treatment strategies that improve patient prognosis are not widely available for most cancers. Individualized care plans, also described as personalized medicine, still must be developed by understanding and implementing basic science research into clinical treatment. Proteomics holds great promise in contributing to the prevention and cure of cancer because it provides unique tools for discovery of biomarkers and therapeutic targets. As such, proteomics can help translate basic science discoveries into the clinical practice of personalized medicine. Here we describe how biological mass spectrometry and proteome analysis interact with other major patient care and research initiatives and present vignettes illustrating efforts in discovery of diagnostic biomarkers for ovarian cancer, development of treatment strategies in lung cancer, and monitoring prognosis and relapse in multiple myeloma patients.

  17. Proteomic Contributions to Personalized Cancer Care*

    PubMed Central

    Koomen, John M.; Haura, Eric B.; Bepler, Gerold; Sutphen, Rebecca; Remily-Wood, Elizabeth R.; Benson, Kaaron; Hussein, Mohamad; Hazlehurst, Lori A.; Yeatman, Timothy J.; Hildreth, Lynne T.; Sellers, Thomas A.; Jacobsen, Paul B.; Fenstermacher, David A.; Dalton, William S.

    2008-01-01

    Cancer impacts each patient and family differently. Our current understanding of the disease is primarily limited to clinical hallmarks of cancer, but many specific molecular mechanisms remain elusive. Genetic markers can be used to determine predisposition to tumor development, but molecularly targeted treatment strategies that improve patient prognosis are not widely available for most cancers. Individualized care plans, also described as personalized medicine, still must be developed by understanding and implementing basic science research into clinical treatment. Proteomics holds great promise in contributing to the prevention and cure of cancer because it provides unique tools for discovery of biomarkers and therapeutic targets. As such, proteomics can help translate basic science discoveries into the clinical practice of personalized medicine. Here we describe how biological mass spectrometry and proteome analysis interact with other major patient care and research initiatives and present vignettes illustrating efforts in discovery of diagnostic biomarkers for ovarian cancer, development of treatment strategies in lung cancer, and monitoring prognosis and relapse in multiple myeloma patients. PMID:18664563

  18. Mate similarity for substance dependence and antisocial personality disorder symptoms among parents of patients and controls.

    PubMed

    Sakai, J T; Stallings, M C; Mikulich-Gilbertson, S K; Corley, R P; Young, S E; Hopfer, C J; Crowley, T J

    2004-08-16

    Substance dependence (SD) and antisocial personality disorder (ASPD) are highly comorbid and aggregate in families. Mating assortment may be an important process contributing to this familial aggregation. Symptom counts of substance dependence, antisocial personality disorder, and retrospectively assessed conduct disorder (CD) will be correlated significantly among parents of youth in treatment for substance use and conduct problems and, separately, among parents of community controls. We examined SD, ASPD, and CD among 151 pairs of parents of adolescents in treatment for substance use and conduct problems, and in 206 pairs of parents of control subjects. For average dependence symptoms (ADS) (the sum of across-drug substance dependence symptoms divided by the number of substance categories meeting minimum threshold use) mother-father correlations were 0.40 for patients and 0.28 for controls. Mother--father correlations for ASPD symptom count were 0.33 for patients and 0.26 for controls and for CD symptom count were 0.31 for patients (all P < 0.01) and 0.10 for controls (P = 0.14). Spousal correlations for ADS and ASPD, suggest substantial non-random mating. Results support gender differences in homogamy for SD. Behavior genetic studies of these disorders need to account for assortment to avoid biases in estimates of genetic and environmental effects.

  19. Personal networks of women in residential and outpatient substance abuse treatment.

    PubMed

    Kim, HyunSoo; Tracy, Elizabeth; Brown, Suzanne; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung; McCarty, Chris

    This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse.

  20. Validation of vocational assessment tool for persons with substance use disorders

    PubMed Central

    Sethuraman, Lakshmanan; Subodh, B. N.; Murthy, Pratima

    2016-01-01

    Background: Work-related problems are a serious concern among persons with substance use but due to lack of a standardized tool to measure it; these problems are neither systematically assessed nor appropriately addressed. Most existing measures of work performance cater to the needs of the workplace rather than focusing on the workers' perception of the difficulties at work. Aim: To develop a standardized instrument to measure work-related problems in persons with substance use disorders. Methods: Qualitative data obtained from interviews with substance users were used to develop a scale. The refined list of the scale was circulated among an expert panel for content validation. The modified scale was administered to 150 cases, and 50 cases completed the scale twice at the interval of 2 weeks for test–retest reliability. Results: Items with a test–retest reliability kappa coefficient of 0.4 or greater were retained and subjected to factor analysis. The final 45-item scale has a five-factor structure. The value of Cronbach's alpha of the final version of the scale was 0.91. Conclusions: This self-report questionnaire, which can be completed in 10 min, may help us in making a baseline assessment of the work-related impairment among persons with substance use and the impact of substance use on work. PMID:28163409

  1. Personal networks of women in residential and outpatient substance abuse treatment

    PubMed Central

    Kim, HyunSoo; Tracy, Elizabeth; Brown, Suzanne; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung; McCarty, Chris

    2015-01-01

    This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse. PMID:27011762

  2. Risk of Pain Medication Misuse After Spinal Cord Injury: The Role of Substance Use, Personality, and Depression.

    PubMed

    Clark, Jillian M R; Cao, Yue; Krause, James S

    2017-02-01

    Our purpose was to identify risk of pain medication misuse (PMM) among participants with spinal cord injury (SCI) by examining associations with multiple sets of risk factors including demographic and injury characteristics, pain experiences, frequency of pain medication use, substance use, personality, and depressive symptoms. Risk of PMM was defined by a cutoff score ≥30 measured using the Pain Medication Questionnaire (PMQ) and examined in 1,619 adults with traumatic SCI of at least 1 year duration who reported at least 1 painful condition and use of prescription pain medication using a cross-sectional design. Results indicated 17.6% of participants had scores of ≥30 on the PMQ. After controlling for demographic, injury, and pain characteristics, logistic regression analysis showed that being a current smoker, recently using cannabis (behavioral factors), and multiple psychological factors were associated with risk of PMM, as indicated by scores on the PMQ. These included elevated depressive symptomatology and exhibiting impulsive or anxious personality traits. Because risk of PMM is indicated in individuals with SCI, prescribers should assess and monitor multiple risk factors for PMM including substance use behaviors and psychological indicators. This article identifies behavioral substance use and psychological factors associated with risk of PMM, measured using the PMQ, among those with SCI. Identification of these related variables will help health care professionals better prescribe and monitor pain medication use and/or misuse among individuals with SCI. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  3. [Personalized nursing care and perceived quality of care in hospitals].

    PubMed

    García Juárez, M A Del Rosario; López Alonso, Sergio R; Orozco Cózar, M A José; Caro Quesada, Raimundo; Ramos Osquet, Gádor; Márquez Borrego, M A José; Cano Antelo, M A Dolores; Serrano Pedrero, Carmen

    2011-01-01

    To determine whether there is an association between the Primary Nursing Model and perceived quality of care. An observational, descriptive, cross-sectional study in four hospital wards with Primary Nursing organization. Over a 12-month period, all the patients discharged from each ward were included in this study. The degree of development of Primary Nursing was measured by using the Personalization of Nursing Care Index and the perceived quality of care was measured with the LOPSS-12. Bivariate statistical analysis was carried out through ANOVA and Student's t-tests. Multivariate linear regression analysis was then applied to correlated variables (p < 0.05). 817 patients were included, 447 from two medical wards and 370 from two surgical wards. After a preliminary data analysis performed 6 months after the start of the study, four items were removed from the LOPSS-12 and each of the remaining items were analyzed separately. Scores for both patient satisfaction and the introduction of the Primary Nursing Model were higher in the surgical wards. Bivariate and multivariate regression analyses showed a statistically significant (p < 0.05) association between implantation of the model and all except one of the items included in the questionnaire. The introduction of the Primary Nursing Model in hospital wards allows the presence of a primary nurse for each patient and consequently improves the nurse-patient relationship, increasing perceived quality of care among patients. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  4. Enhancing Readiness-to-Change Substance Abuse in Persons with Schizophrenia

    PubMed Central

    Carey, Kate B.; Purnine, Daniel M.; Maisto, Stephen A.; Carey, Michael P.

    2008-01-01

    This article describes a four-session intervention designed for persons with co-occurring substance abuse and schizophrenia-spectrum disorders, to be administered as an add-on module to supplement ongoing mental health treatment in an outpatient setting. The intervention targets those dually diagnosed individuals with low readiness-to-change as indicated by current use, and/or low level of engagement in treatment for substance abuse. The intervention is designed to increase problem recognition, to enhance motivation to change maladaptive patterns of substance use, and to facilitate engagement in substance abuse. To achieve these goals, we have adopted constructs from the Transtheoretical Model of Change and utilize principles of motivational and harm reduction interventions, and tailored them to the target population. PMID:11428245

  5. Examining the Role of Personality, Peers, and the Transition to College on Substance Use

    ERIC Educational Resources Information Center

    Bailey, Ursula Louise

    2011-01-01

    It is well established that there is an increase in substance use among college students. In the literature, this increase in use has been attributed to different personality factors, such as sensation seeking. However, what has not received sufficient attention is the possibility that the new peer groups, afforded by the transition to college,…

  6. Linking "Big" Personality Traits to Anxiety, Depressive, and Substance Use Disorders: A Meta-Analysis

    ERIC Educational Resources Information Center

    Kotov, Roman; Gamez, Wakiza; Schmidt, Frank; Watson, David

    2010-01-01

    We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66…

  7. Examining the Role of Personality, Peers, and the Transition to College on Substance Use

    ERIC Educational Resources Information Center

    Bailey, Ursula Louise

    2011-01-01

    It is well established that there is an increase in substance use among college students. In the literature, this increase in use has been attributed to different personality factors, such as sensation seeking. However, what has not received sufficient attention is the possibility that the new peer groups, afforded by the transition to college,…

  8. Linking "Big" Personality Traits to Anxiety, Depressive, and Substance Use Disorders: A Meta-Analysis

    ERIC Educational Resources Information Center

    Kotov, Roman; Gamez, Wakiza; Schmidt, Frank; Watson, David

    2010-01-01

    We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66…

  9. Adolescent Substance Use Groups: Antecedent and Concurrent Personality Differences in a Longitudinal Study

    PubMed Central

    Oliva, Elizabeth M.; Keyes, Margaret; Iacono, William G.; McGue, Matt

    2011-01-01

    OBJECTIVE This study attempted to extend Shedler and Block’s (1990) influential study which found that adolescent drug experimenters had the healthiest personality functioning compared to abstainers and frequent users. METHOD Using a prospective design, we examined the relationship between antecedent and concurrent personality and age-18 substance use in a community sample of 1,298 twins (96% Caucasian, 49% male). Personality measures at ages 11 and 18 assessed positive emotionality (agentic and communal), negative emotionality, and constraint. Substance use groups—abstainers, experimenters, and problem users—were created at age 18. RESULTS Age-18 substance use groups differed in age-11 and age-18 constraint such that problem users were lower than experimenters who were lower than abstainers. Age-18 substance use groups did not differ in age-18 positive emotionality. However, abstainers were significantly lower than experimenters in communal positive emotionality while female abstainers scored higher in agentic positive emotionality than female experimenters who scored higher than female problem users. Experimenters were significantly lower in negative emotionality than problem users. CONCLUSIONS Our findings are inconsistent with the notion that experimenters had the healthiest personality functioning and instead suggest different strengths and weaknesses for each group. Future studies should examine agentic and communal positive emotionality separately. PMID:22091739

  10. Aggression, impulsivity, and psychopathic traits in combined antisocial personality disorder and substance use disorder.

    PubMed

    Alcorn, Joseph L; Gowin, Joshua L; Green, Charles E; Swann, Alan C; Moeller, F Gerard; Lane, Scott D

    2013-01-01

    Aggression, impulsivity, and psychopathic traits are prominent in both antisocial personality disorder (ASPD) and substance use disorders (SUD), but have rarely been examined collectively. The authors' results show that all three variables were elevated in adults with comorbid ASPD/SUD, relative to SUD-only and control subjects.

  11. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

  12. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

  13. Attitude to substance abuse: do personality and socio-demographic factors matter?

    PubMed

    Rahimian Boogar, Isaac; Tabatabaee, Sayed Mosa; Tosi, Jalileh

    2014-09-01

    Substance abuse is a serious global problem that is affected by multiple psychosocial and socio-demographic factors. This study aimed to investigate the leading factors in positive attitude and tendency toward substance abuse in terms of personality, socio-economic, and socio-demographic factors. In a cross-sectional study, 200 college students (105 females and 95 males) residing in Damghan University dormitory in northeast of Iran were recruited by random sampling from March to July 2013. The participants were instructed and asked to complete the NEO FIVE-factor Inventory, the attitude to substance abuse scale, and the demographic questionnaire. Then data were analyzed by stepwise multiple regression employing PASW 18. Being male sex and neuroticism had a significant positive role in predicting positive attitude toward substance abuse in university students. In addition, agreeableness, conscientiousness, openness, and socio-economic status had a significant negative role in predicting tendency toward substance abuse (P < 0.001). Extraversion had no significant role in prediction of positive attitude to substance abuse (P > 0.05). Lower agreeableness, decreased conscientiousness, higher neuroticism, diminished openness, low socio-economic status, and male sex might make university students more inclined to substance abuse. Thus, it is reasonable to show the importance of these factors in tailored prevention programs.

  14. Microbiological risk assessment for personal care products.

    PubMed

    Stewart, S E; Parker, M D; Amézquita, A; Pitt, T L

    2016-12-01

    Regulatory decisions regarding microbiological safety of cosmetics and personal care products are primarily hazard-based, where the presence of a potential pathogen determines decision-making. This contrasts with the Food industry where it is a commonplace to use a risk-based approach for ensuring microbiological safety. A risk-based approach allows consideration of the degree of exposure to assess unacceptable health risks. As there can be a number of advantages in using a risk-based approach to safety, this study explores the Codex Alimentarius (Codex) four-step Microbiological Risk Assessment (MRA) framework frequently used in the Food industry and examines how it can be applied to the safety assessment of personal care products. The hazard identification and hazard characterization steps (one and two) of the Codex MRA framework consider the main microorganisms of concern. These are addressed by reviewing the current industry guidelines for objectionable organisms and analysing reports of contaminated products notified by government agencies over a recent 5-year period, together with examples of reported outbreaks. Data related to estimation of exposure (step three) are discussed, and examples of possible calculations and references are included. The fourth step, performed by the risk assessor (risk characterization), is specific to each assessment and brings together the information from the first three steps to assess the risk. Although there are very few documented uses of the MRA approach for personal care products, this study illustrates that it is a practicable and sound approach for producing products that are safe by design. It can be helpful in the context of designing products and processes going to market and with setting of microbiological specifications. Additionally, it can be applied reactively to facilitate decision-making when contaminated products are released on to the marketplace. Currently, the knowledge available may only allow a

  15. Distinguishing General and Specific Personality Disorder Features and Implications for Substance Dependence Comorbidity

    PubMed Central

    Jahng, Seungmin; Trull, Timothy J.; Wood, Phillip K.; Tragesser, Sarah L.; Tomko, Rachel; Grant, Julia D.; Bucholz, Kathleen K.; Sher, Kenneth J.

    2014-01-01

    Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities. PMID:21604829

  16. Child maltreatment and foster care: unpacking the effects of prenatal and postnatal parental substance use.

    PubMed

    Smith, Dana K; Johnson, Amber B; Pears, Katherine C; Fisher, Philip A; DeGarmo, David S

    2007-05-01

    Parental substance use is a well-documented risk for children. However, little is known about specific effects of prenatal and postnatal substance use on child maltreatment and foster care placement transitions. In this study, the authors unpacked unique effects of (a) prenatal and postnatal parental alcohol and drug use and (b) maternal and paternal substance use as predictors of child maltreatment and foster care placement transitions in a sample of 117 maltreated foster care children. Models were tested with structural equation path modeling. Results indicated that prenatal maternal alcohol use predicted child maltreatment and that combined prenatal maternal alcohol and drug use predicted foster care placement transitions. Prenatal maternal alcohol and drug use also predicted postnatal paternal alcohol and drug use, which in turn predicted foster care placement transitions. Findings highlight the potential integrative role that maternal and paternal substance use has on the risk for child maltreatment and foster care placement transitions.

  17. Medical Education About the Care of Addicted Incarcerated Persons: A National Survey of Residency Programs.

    PubMed

    Kraus, Mark L.; Isaacson, J. Harry; Kahn, Ruth; Mundt, Marlon P.; Manwell, Linda Baier

    2001-06-01

    In June 1998, there were 1.8 million inmates in correctional facilities for adults; 1.2 million in state and federal prisons and 600,000 in municipal/county jails (668 persons per 100,000 U.S. population). Rates of TB, AIDS, mental illness, and substance abuse are 2-13 times higher in persons living in jails and prisons. This study was designed to assess the level of training offered to residents in seven medical specialties in the care of addicted incarcerated persons. The study design involved two stages. The first entailed a mailed survey to 1,831 residency directors in family medicine, internal medicine, osteopathic medicine, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. The second stage was a telephone interview, about substance use disorders, of faculty listed by the residency directors as teaching residents. The mailed survey was completed by 1,205 residency directors (66%). The 769 faculty from those identified programs, who participated in the telephone interview, reported that only 14% of their residency programs offered lectures or conferences on the care of incarcerated persons, yet 44% of the programs had residents caring for incarcerated persons with substance abuse problems, in a clinical setting. Only 22% offered clinical experiences for residents in a correctional facility.We recognize that our survey of correctional health and substance abuse training is limited, but as such, a greater number of respondents to our survey do not teach residents addiction medicine topics pertaining to prevention, evaluation, intervention, and management of the addicted criminal offender/patient in a correctional setting or give adequate clinical exposure to this special population. The data suggests a need to develop and implement educational programs on medical care for this high-risk and expanding population.

  18. Is conventional wisdom wrong? Coverage for substance abuse treatment under Medicaid managed care.

    PubMed

    Maglione, Margaret; Ridgely, M Susan

    2006-06-01

    Conventional wisdom suggests that coverage for substance abuse treatment under Medicaid is generally poor, and that access to care may be reduced when control over behavioral health services is given to private health plans, such as those under Medicaid managed care. To examine this premise, this study reports on a cross-sectional comparative survey of state Medicaid managed care programs conducted in the year 2000. Although not all states provided substance abuse benefits under their Medicaid programs, our findings suggest that a majority of states used managed care arrangements to provide substance abuse treatment, with most providing an array of covered services. Most Medicaid behavioral health plans were fully capitated. The number of comprehensive health plans providing substance abuse services was slightly higher than the number of behavioral health carveouts. About half of the waiver programs that covered substance abuse treatment covered methadone maintenance, but waiver programs employing comprehensive health plans were more likely to provide coverage for methadone maintenance.

  19. Innovation in the personal care industry.

    PubMed

    Knaggs, Helen

    2010-09-01

    When considering opportunities to develop novel, eye-catching and consumer-relevant personal care (PC) products, it is important to understand and reflect on how science has changed over the last two decades and how this has generated a new body of data from which to draw ideas and technologies. This article outlines some advances in scientific technologies and new ways of thinking in science, which lead to new insights into skin biology. How these innovations may impact and be leveraged into the development of new products in PC is also discussed. For example, fundamental discoveries in skin biology and the advancement of scientific methodologies are enabling step changes in technology in PC. Two examples of areas where we have seen much advancement are discussed. This article is based on and summarizes a presentation given at the HBA in Sep 2009 as part of a session entitled "Emerging Technologies and New Opportunities in Antiaging in PC." © 2010 Wiley Periodicals, Inc.

  20. Personal qualities necessary to care for people with dementia.

    PubMed

    Pulsford, David; Duxbury, Joy; Carter, Bernie

    2016-05-11

    Carers of people with dementia should embrace the philosophy of person-centred care and understand that social and psychological aspects of care are as important as physical care. This article discusses a three-component model that identifies the personal qualities that carers should ideally possess to deliver person-centred care to people with dementia. These qualities are empathy with the person, person-centred attitudes and a compassionate approach. The intention is that these will induce a state of cognitive security in people with dementia and enhance their sense of wellbeing. The article defines each of the personal qualities and details their component parts. It explores why person-centred care can often be difficult to achieve in practice, as well as the role of education in its promotion.

  1. Telephone-based continuing care counseling in substance abuse treatment: economic analysis of a randomized trial

    PubMed Central

    Daley, Marilyn C.; Neuman, Matthew J.; Blaakman, Aaron P.; McKay, James R.

    2016-01-01

    Purpose To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse. Methods Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes. Results The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1,684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p<0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (−$1,400 per abstinent year). TEL also proved favorable under a benefit-cost perspective. Conclusions TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered. PMID:26718395

  2. The Relationship between Personality and Self-Reported Substance Use: Exploring the Implications for High School and College Educational Programs.

    ERIC Educational Resources Information Center

    Austin, Megan; Brosh, Joanne; Dous, Julie; Iannella, Gina; Outten, Rebecca; Rowles, Peggy; Chambliss, Catherine

    This study explored the personality correlates of substance use by administering a questionnaire consisting of the Mini Markers Scale and items assessing substance abuse to 108 high school students and 155 college students. The Mini Markers Scale is a 40 item self-report inventory that measures basic dimensions of personality, including…

  3. Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders

    PubMed Central

    Savage, Seddon R.; Kirsh, Kenneth L.; Passik, Steven D.

    2008-01-01

    Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat. A knowledge of pain and its interrelationships with addiction enhances the addiction specialist’s efficacy with many patients, both in the substance abuse setting and in collaboration with pain specialists. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment. PMID:18497713

  4. A Tool for Assessing a Community's Capacity for Substance Abuse Care.

    PubMed

    Green, Brandn; Lyerla, Rob; Stroup, Donna F; Azofeifa, Alejandro; High, Patrick M

    2016-09-22

    Evidence-based programs for prevention and intervention in substance abuse are increasing. Community needs assessments and health rankings provide descriptions of local behavioral health needs but do not provide public health practitioners and policy makers with guidelines on the number of programs, health care practitioners, or interventions needed in the local substance abuse care system. This article presents a new framework for measuring and assessing the substance abuse care system in a community. The assessment can inform resource allocation across the continuum of care to more equitably and efficiently distribute interventions and care. We conducted 2 literature reviews and synthesized our findings to create a community assessment methodology and needs calculator, CAST (calculating for an adequate system tool). We reviewed 212 articles to produce an inventory of community and social correlates of behavioral health, components of a substance abuse care system, and numerical values for guidelines for estimating community needs. CAST produces community-specific assessments of the capacity of the components of a community substance abuse care system. CAST generates recommendations by the application of social and community determinants of health as risk coefficients to each estimate of component need. CAST can assist public health practitioners in evaluation and improvement of the capacity of community-based, substance abuse care systems. By using recommendations for component needs across the continuum of care, community leaders can use CAST to prioritize resource allocation more effectively and efficiently.

  5. A Tool for Assessing a Community’s Capacity for Substance Abuse Care

    PubMed Central

    Lyerla, Rob; Stroup, Donna F.; Azofeifa, Alejandro; High, Patrick M.

    2016-01-01

    Evidence-based programs for prevention and intervention in substance abuse are increasing. Community needs assessments and health rankings provide descriptions of local behavioral health needs but do not provide public health practitioners and policy makers with guidelines on the number of programs, health care practitioners, or interventions needed in the local substance abuse care system. This article presents a new framework for measuring and assessing the substance abuse care system in a community. The assessment can inform resource allocation across the continuum of care to more equitably and efficiently distribute interventions and care. We conducted 2 literature reviews and synthesized our findings to create a community assessment methodology and needs calculator, CAST (calculating for an adequate system tool). We reviewed 212 articles to produce an inventory of community and social correlates of behavioral health, components of a substance abuse care system, and numerical values for guidelines for estimating community needs. CAST produces community-specific assessments of the capacity of the components of a community substance abuse care system. CAST generates recommendations by the application of social and community determinants of health as risk coefficients to each estimate of component need. CAST can assist public health practitioners in evaluation and improvement of the capacity of community-based, substance abuse care systems. By using recommendations for component needs across the continuum of care, community leaders can use CAST to prioritize resource allocation more effectively and efficiently. PMID:27657505

  6. Underlying personality differences between alcohol/substance-use disorder patients with and without an affective disorder.

    PubMed

    Janowsky, D S; Hong, L; Morter, S; Howe, L

    1999-01-01

    The Myers-Briggs Type Indicator (MBTI), a popular personality test, was used to profile the personalities of in-patient alcoholics/substance-use disorder patients who had, and those who did not have, a concurrent affective disorder diagnosis. The MBTI divides individuals into eight categories: Extroverts and Introverts, Sensors and Intuitives, Thinkers and Feelers, and Judgers and Perceivers. Alcohol/substance-use disorder patients with no affective disorder differed from a normative population only in being significantly more often Sensing and significantly less often Intuitive single-factor types. The Extroverted/Sensing/ Feeling/Judging four-factor type was also significantly over-represented in this group, compared to a normative population. In contrast, mood-disordered alcohol/substance-use disorder patients were significantly more often Introverted, Sensing, Feeling, and Perceiving and significantly less often Extroverted, Intuitive, Thinking, and Judging single-factor types. They were also significantly more often Introverted/Sensing/ Feeling/Perceiving and Introverted/Intuitive/Feeling/Perceiving four-factor types. 'Pure' alcohol/ substance-use disorder patients differed from alcohol/substance-use disorder patients with a mood disorder in that they were significantly more often Extroverted and Thinking and significantly less often Introverted and Feeling single-factor types; and significantly less often were an Introverted/Sensing/ Feeling/Perceiving four-factor type. The above results may have psychogenetic, diagnostic, and psychotherapeutic implications.

  7. Craving and substance use among patients with alcohol, tobacco, cannabis or heroin addiction: a comparison of substance- and person-specific cues.

    PubMed

    Fatseas, Melina; Serre, Fuschia; Alexandre, Jean-Marc; Debrabant, Romain; Auriacombe, Marc; Swendsen, Joel

    2015-06-01

    It is well established that craving increases following exposure to substance-related 'cues', but the role of life-styles or substance use habits that are unique to each person remains poorly understood. This study examines the association of substance-specific and personal cues with craving and substance use in daily life. Ecological momentary assessment was used during a 2-week period. Data were collected in a French out-patient addiction treatment centre. A total of 132 out-patients beginning treatment for alcohol, tobacco, cannabis or opiate addiction were included. Using mobile technologies, participants were questioned four times per day relative to craving, substance use and exposure to either substance-specific cues (e.g. seeing a syringe) or personal cues unique to that individual (e.g. seeing the specific person with whom the substance is used). Craving intensity was associated with the number of concurrently assessed substance-specific cues (t = 4.418, P < 0.001) and person-specific cues (t = 4.006, P < 0.001) when analysed jointly within the same model. However, only person-specific cues were associated with increases in craving over subsequent hours of the day (t = 2.598, P < 0.05). Craving intensity, in turn, predicted increases in later substance use (t = 4.076, P < 0.001). Causal mediation analyses demonstrated that the association of cues with later substance use was mediated by craving intensity (mediated effect = 0.007, 95% confidence interval = 0.004-0.011). Unique person-specific cues appear to have a robust effect on craving addictive substances, and the duration of this association may persist longer than for more general substance-specific cues. Mobile technologies provide new opportunities for understanding these person-specific risk factors and for providing individually tailored interventions. © 2015 Society for the Study of Addiction.

  8. Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse.

    PubMed

    Dimaggio, Giancarlo; D'Urzo, Maddalena; Pasinetti, Manuela; Salvatore, Giampaolo; Lysaker, Paul H; Catania, Dario; Popolo, Raffaele

    2015-02-01

    Many patients with substance abuse problems present with co-occurrent cluster C personality disorders. Focusing on both disorders disrupts the maintenance mechanisms and the vicious cycle between the 2 conditions; however, treatment teams often neglect this issue. In this work, we describe the features of metacognitive interpersonal therapy as applied to a man with avoidant and depressive personality disorders and heroin, cocaine, and alcohol abuse. Psychotherapy proceeded through the following steps: (a) conducting drug therapy to deal with symptoms of abstinence from heroin; (b) forming a therapeutic bond to overcome the patient's severe emotional withdrawal; (c) fostering basic metacognitive capacities such as awareness of emotions and their triggers; (d) sharing formulations of maladaptive interpersonal schemas and descriptions of the associated states of mind; (e) conveying an understanding of the link between interpersonal events (recent ones and traumatic memories) and substance abuse; (f) facilitating the acquisition of critical distance from maladaptive schemas; and (g) promoting the use of adaptive coping skills instead of resorting to substance abuse. Implications for generalizing these procedures to the treatment of other patients with co-occurrent personality disorders and substance abuse are described.

  9. Diagnosing antisocial personality disorder among substance abusers: the scid versus the MCMI-II.

    PubMed

    Messina, N; Wish, E; Hoffman, J; Nemes, S

    2001-11-01

    There is much controversy among social scientists and clinicians over the proper measurement of antisocial personality disorder (ASPD). The degree to which various diagnostic measures differ in their assessment of ASPD among substance abusers is not known. This study assessed the degree of agreement between a semistructured clinical interview and a self-report inventory on a diagnosis of ASPD among substance abusers. The Structured Clinical Interview for DSM-III-R (SCID-II), a clinically generated instrument, and the Millon Clinical Multiaxial Inventory (MCMI-II), a self-report inventory, were administered to 275 clients randomly assigned to two therapeutic communities (TCs). Based on the limited existing literature, it was hypothesized that there would be minimal agreement between the diagnosis of ASPD by the two scales. This hypothesis was supported. The kappa statistic indicated low agreement between the scales (kappa = 0.27), with the MCMI-II diagnosing ASPD more often than the SCID-II. The low agreement on a diagnosis of ASPD may be due to the different types of information collected by the two scales. The SCID-II emphasizes observable behavioral criteria, while the MCMI-II emphasizes pathological personality traits. The focus of the MCMI-II on pathological personality traits may more accurately diagnose ASPD in substance-abusing populations in which the majority of the clients have extensive criminal histories. Definite conclusions regarding the proper measurement of ASPD in substance-abusing samples is difficult without additional empirical evidence.

  10. Substance Abuse Treatment for Persons with HIV/AIDS. Treatment Improvement Protocol (TIP) Series 37.

    ERIC Educational Resources Information Center

    CDM Group, Inc.

    The role of substance abuse in the transmission of HIV and AIDS is clear, and the current trend in the pandemic shows that a disproportionate number of minorities in inner cities are affected or are at risk for contracting HIV. The recommendations and guidelines in this TIP support the creation of a comprehensive, integrated system of care for…

  11. Offenders with mental health problems and problematic substance use: affective psychopathic personality traits as potential barriers to participation in substance abuse interventions.

    PubMed

    Durbeej, Natalie; Palmstierna, Tom; Berman, Anne H; Kristiansson, Marianne; Gumpert, Clara Hellner

    2014-01-01

    Substance abuse is related to re-offending, and treatment of substance abuse may reduce criminal recidivism. Offender characteristics including problem severity, violence risk and psychopathic personality traits may be positively or negatively associated with participation in substance abuse treatment. We explored the relationships between such characteristics and participation in substance abuse interventions among Swedish offenders with mental health problems and problematic substance use. Our analyses revealed that problem severity regarding drugs, employment, and family/social situations predicted intervention participation, and that affective psychopathic personality traits were negatively associated with such participation. Thus, affective psychopathic personality traits could be considered as potential barriers to participation in substance abuse interventions. Among offenders with mental health problems and problematic substance use, such personality traits should be taken into account in order to optimize treatment participation and treatment outcome. Approaches used in cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) could be applicable for these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. OI Issues: Dental Care for Persons with OI

    MedlinePlus

    ... Issues: Dental Care for Persons with OI Introduction Osteogenesis imperfecta (OI) is always associated with bone fragility. In ... require special care. Oral cavity problems related to osteogenesis imperfecta may include the following: A skeletal Class III ...

  13. A systematic review of interventions for co-occurring substance use and borderline personality disorders.

    PubMed

    Lee, Nicole K; Cameron, Jacqui; Jenner, Linda

    2015-11-01

    The aim of this study was to undertake a systematic review on effective treatment options for co-occurring substance use and borderline personality disorders to examine effective treatments for this group. A systematic review using a narrative analysis approach was undertaken as there were too few studies within each intervention type to undertake a meta-analysis. The inclusion criteria comprised of English language studies (between 1999 and 2014) and a sample of >70% borderline personality disorder, with measurable outcomes for substance use and borderline personality disorder. All abstracts were screened (n = 376) resulting in 49 studies assessed for eligibility, with 10 studies, examining three different treatment types, included in the final review. There were four studies that examined dialectical behaviour therapy (DBT), three studies that examined dynamic deconstructive psychotherapy (DDP) and three studies that examined dual-focused schema therapy (DFST). Both DBT and DDP demonstrated reductions in substance use, suicidal/self-harm behaviours and improved treatment retention. DBT also improved global and social functioning. DFST reduced substance use and both DFST and DPP improved treatment utilisation, but no other significant positive changes were noted. Overall, there were a small number of studies with small sample sizes, so further research is required. However, in the absence of a strong evidence base, there is a critical need to respond to this group with co-occurring borderline personality disorder and substance use. Both DBT and DPP showed some benefit in reducing symptoms, with DBT the preferred option given its superior evidence base with women in particular. © 2015 Australasian Professional Society on Alcohol and other Drugs.

  14. Substance Abuse Treatment in Persons with HIV/AIDS: Challenges in Managing Triple Diagnosis

    PubMed Central

    Durvasula, Ramani; Miller, Theodore R.

    2014-01-01

    This paper provides a review of the current literature addressing substance abuse treatment in persons living with HIV/AIDS. Clinical management of HIV must account for the “triple diagnosis” of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990's, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention. PMID:24274175

  15. Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act

    PubMed Central

    Ghitza, Udi E.; Tai, Betty

    2014-01-01

    Undertreated or untreated substance use disorders (SUD) remain a pervasive, medically-harmful public health problem in the United States, particularly in medically underserved and low-income populations lacking access to appropriate treatment. The need for greater access to SUD treatment was expressed as policy in the Final Rule on standards related to essential health benefits, required to be covered through the 2010 Affordable Care Act (ACA) health insurance exchanges. SUD treatment services have been included as an essential health benefit, in a manner that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Consequently, with the ACA, a vast expansion of SUD-care services in primary care is looming. This commentary discusses challenges and opportunities under the ACA for equipping health care professionals with appropriate workforce training, infrastructure, and resources to support and guide science-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for SUD in primary care. PMID:24583486

  16. The impact of personality on person-centred care: a study of care staff in Swedish nursing homes.

    PubMed

    Elfstrand Corlin, Tinna; Kajonius, Petri J; Kazemi, Ali

    2017-06-01

    In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care. © 2016 John Wiley & Sons Ltd.

  17. Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

    PubMed Central

    Nicholas, Patrice K.; Willard, Suzanne; Thompson, Clinton; Dawson-Rose, Carol; Corless, Inge B.; Wantland, Dean J.; Sefcik, Elizabeth F.; Nokes, Kathleen M.; Kirksey, Kenn M.; Holzemer, William L.; Portillo, Carmen J.; Rivero Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Maryland, Mary; Arudo, John; Eller, Lucille Sanzero; Stanton, Mark A.; Voss, Joachim G.; Moezzi, Shahnaz

    2014-01-01

    Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care. PMID:24800065

  18. Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS.

    PubMed

    Nicholas, Patrice K; Willard, Suzanne; Thompson, Clinton; Dawson-Rose, Carol; Corless, Inge B; Wantland, Dean J; Sefcik, Elizabeth F; Nokes, Kathleen M; Kirksey, Kenn M; Hamilton, Mary Jane; Holzemer, William L; Portillo, Carmen J; Rivero Mendez, Marta; Robinson, Linda M; Rosa, Maria; Human, Sarie P; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Eller, Lucille Sanzero; Stanton, Mark A; Driscoll, Marykate; Voss, Joachim G; Moezzi, Shahnaz

    2014-01-01

    Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.

  19. Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study

    PubMed Central

    Gwadz, Marya; de Guzman, Rebecca; Freeman, Robert; Kutnick, Alexandra; Silverman, Elizabeth; Leonard, Noelle R.; Ritchie, Amanda Spring; Muñoz-Plaza, Corinne; Salomon, Nadim; Wolfe, Hannah; Hilliard, Christopher; Cleland, Charles M.; Honig, Sylvie

    2016-01-01

    Drug use is associated with low uptake of HIV antiretroviral therapy (ART), an under-studied step in the HIV care continuum, and insufficient engagement in HIV primary care. However, the specific underlying mechanisms by which drug use impedes these HIV health outcomes are poorly understood. The present qualitative study addresses this gap in the literature, focusing on African-American/Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued ART and who also were generally poorly engaged in health care. Participants (N = 37) were purposively sampled from a larger study for maximum variation on HIV indices. They engaged in 1–2 h audio-recorded in-depth semi-structured interviews on HIV histories guided by a multilevel social-cognitive theory. Transcripts were analyzed using a systematic content analysis approach. Consistent with the existing literature, heavy substance use, but not casual or social use, impeded ART uptake, mainly by undermining confidence in medication management abilities and triggering depression. The confluence of African-American/Black or Hispanic race/ethnicity, poverty, and drug use was associated with high levels of perceived stigma and inferior treatment in health-care settings compared to their peers. Furthermore, providers were described as frequently assuming participants were selling their medications to buy drugs, which strained provider–patient relationships. High levels of medical distrust, common in this population, created fears of ART and of negative interactions between street drugs and ART, but participants could not easily discuss this concern with health-care providers. Barriers to ART initiation and HIV care were embedded in other structural- and social-level challenges, which disproportionately affect low-income African-American/Black and Hispanic PLWH (e.g., homelessness, violence). Yet, HIV management was cyclical. In collaboration with trusted providers and ancillary staff

  20. Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study.

    PubMed

    Gwadz, Marya; de Guzman, Rebecca; Freeman, Robert; Kutnick, Alexandra; Silverman, Elizabeth; Leonard, Noelle R; Ritchie, Amanda Spring; Muñoz-Plaza, Corinne; Salomon, Nadim; Wolfe, Hannah; Hilliard, Christopher; Cleland, Charles M; Honig, Sylvie

    2016-01-01

    Drug use is associated with low uptake of HIV antiretroviral therapy (ART), an under-studied step in the HIV care continuum, and insufficient engagement in HIV primary care. However, the specific underlying mechanisms by which drug use impedes these HIV health outcomes are poorly understood. The present qualitative study addresses this gap in the literature, focusing on African-American/Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued ART and who also were generally poorly engaged in health care. Participants (N = 37) were purposively sampled from a larger study for maximum variation on HIV indices. They engaged in 1-2 h audio-recorded in-depth semi-structured interviews on HIV histories guided by a multilevel social-cognitive theory. Transcripts were analyzed using a systematic content analysis approach. Consistent with the existing literature, heavy substance use, but not casual or social use, impeded ART uptake, mainly by undermining confidence in medication management abilities and triggering depression. The confluence of African-American/Black or Hispanic race/ethnicity, poverty, and drug use was associated with high levels of perceived stigma and inferior treatment in health-care settings compared to their peers. Furthermore, providers were described as frequently assuming participants were selling their medications to buy drugs, which strained provider-patient relationships. High levels of medical distrust, common in this population, created fears of ART and of negative interactions between street drugs and ART, but participants could not easily discuss this concern with health-care providers. Barriers to ART initiation and HIV care were embedded in other structural- and social-level challenges, which disproportionately affect low-income African-American/Black and Hispanic PLWH (e.g., homelessness, violence). Yet, HIV management was cyclical. In collaboration with trusted providers and ancillary staff

  1. Comorbid depression, antisocial personality, and substance dependence: Relationship with delay discounting.

    PubMed

    Moody, Lara; Franck, Christopher; Bickel, Warren K

    2016-03-01

    Within the field of addiction, as many as four-fifths of individuals in treatment for substance use disorder have co-existing lifetime psychopathology and as high as two-thirds have current psychopathology. Among substance-dependent individuals, excessive delay discounting is pervasive. Despite evidence of excessive discounting across substance use disorders, few studies have investigated the impact of co-occurring psychopathologies and SUD on delay discounting. We compared delay discounting in currently abstaining substance users with (a) SUD (n=166), (b) SUD and managed major depressive disorder (MDD; n=44), (c) SUD and antisocial personality disorder (APD; n=35), (d) SUD and managed MDD and APD (n=22) and (e) no SUD or co-occurring psychopathology (n=60). All groups with SUD discounted future delayed rewards significantly more than healthy controls (p<0.001 in each case, d=0.686, 0.835, 1.098 and 1.650, respective to groups a-d above). Individuals with both APD and SUD and individuals with MDD, APD, and SUD discounted future rewards significantly more than substance users without comorbid psychopathology (p=0.029, d=0.412 and p<0.001, d=0.964, respectively). Overall, individuals with multiple psychopathologies in addition to substance use have exacerbated deficits in discounting of the future, above and beyond that observed in substance use alone. Increased discounting in combined substance and psychopathology profiles suggest a greater chance of treatment failure and therefore may necessitate individualized treatment using adjunctive interventions to achieve better treatment outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Substance use and violent behavior in women with antisocial personality disorder.

    PubMed

    Lewis, Catherine F

    2011-01-01

    The purpose of this study was to examine the relationship between substance abuse and dependence and violent behavior in a sample of incarcerated women with antisocial personality disorder (ASPD). Among male populations, substance dependence is associated with aggression and criminal behavior. Individuals with ASPD have more severe substance dependence, including higher symptom counts, earlier age of onset, and more frequent co-morbidity. Incarcerated women have a high prevalence of ASPD and substance dependence, but there has been little detailed work regarding addiction severity. Similarly, work on association of substance abuse and dependence with specific violent behaviors has been limited. This study examined a group of 41 mid-sentence female felons with a diagnosis of ASPD to determine associations with substance abuse and dependence. Data were gathered through administration of the Semi-Structured Assessment of the Genetics of Alcoholism II (SSAGA II). Substance dependence was highly prevalent (i.e., alcohol dependence, 56.1%; opiate dependence, 48.8%; cocaine dependence, 61.0%). While specific diagnoses were not associated with violent behavior and offending, symptom severity (i.e., age of onset, symptom count, co-morbidity) was associated with violent behavior in women dependent on opiates, alcohol, and cocaine. Arrest for an assault 1 was associated with alcohol dependence and opiate dependence. These data suggest that measurement of symptom severity and co-morbidity is important in assessing violent behavior in incarcerated women with ASPD. These findings are potentially important in examining non-incarcerated, substance-dependent women. Copyright © 2011 John Wiley & Sons, Ltd.

  3. Guidance on maintaining personal hygiene in nail care.

    PubMed

    Malkin, Bridget; Berridge, Pat

    Nail care is important in the maintenance of personal hygiene and is an essential aspect of patient care. Confusion about who should perform nail care for patients has resulted in poor practice and cycles of non-activity. This article provides guidance for nurses on performing routine nail care.

  4. Personal support networks, social capital, and risk of relapse among individuals treated for substance use issues.

    PubMed

    Panebianco, Daria; Gallupe, Owen; Carrington, Peter J; Colozzi, Ivo

    2016-01-01

    The success of treatment for substance use issues varies with personal and social factors, including the composition and structure of the individual's personal support network. This paper describes the personal support networks and social capital of a sample of Italian adults after long-term residential therapeutic treatment for substance use issues, and analyses network correlates of post-treatment substance use (relapse). Using a social network analysis approach, data were obtained from structured interviews (90-120 min long) with 80 former clients of a large non-governmental therapeutic treatment agency in Italy providing voluntary residential treatments and rehabilitation services for substance use issues. Participants had concluded the program at least six months prior. Data were collected on socio-demographic variables, addiction history, current drug use status (drug-free or relapsed), and the composition and structure of personal support networks. Factors related to risk of relapse were assessed using bivariate and multivariate logistic regression models. A main goal of this study was to identify differences between the support network profiles of drug free and relapsed participants. Drug free participants had larger, less dense, more heterogeneous and reciprocal support networks, and more brokerage social capital than relapsed participants. Additionally, a lower risk of relapse was associated with higher socio-economic status, being married/cohabiting, and having network members with higher socio-economic status, who have greater occupational heterogeneity, and reciprocate support. Post-treatment relapse was found to be negatively associated with the socioeconomic status and occupational heterogeneity of ego's support network, reciprocity in the ties between ego and network members, and a support network in which the members are relatively loosely connected with one another (i.e., ego possesses "brokerage social capital"). These findings suggest the

  5. Person-centred care: an overview of reviews.

    PubMed

    Sharma, Tanvi; Bamford, Megan; Dodman, Denise

    2015-01-01

    Existing evidence suggests that a person-centred approach can improve coordination and access to health care and services. This overview sought to: (1) identify and define components of person-centred care; (2) explore nursing and health-care provider behaviours that are person-centred; and (3) identify systems level supports required to enable person-centred care. An overview of reviews was conducted to locate synthesized literature published between June 2005 and April 2014. Two independent reviewers screened, extracted data and quality appraised the sources. Results were synthesized narratively. A total of 46 articles were deemed relevant to this overview. This paper synthesizes the results of 43 of the 46 articles. A universal definition of person-centred care was not found, however; common components, associated health-care provider behaviours and the organizational supports required for person-centred care are discussed. Key findings from this review outline that health-care providers and organizations need to promote person-centred care by engaging persons in partnerships, shared decision-making, and meaningful participation in health system improvement.

  6. POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS: PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

  7. POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS: PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

  8. POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS: PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPs) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

  9. POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS: PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPs) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

  10. Economic Evaluation of Continuing Care Interventions in the Treatment of Substance Abuse: Recommendations for Future Research

    ERIC Educational Resources Information Center

    Popovici, Ioana; French, Michael T.; McKay, James R.

    2008-01-01

    The chronic and relapsing nature of substance abuse points to the need for continuing care after a primary phase of treatment. This article reviews the economic studies of continuing care, discusses research gaps, highlights some of the challenges of conducting rigorous economic evaluations of continuing care, and offers research guidelines and…

  11. Addressing the critical health problem of adolescent substance use through health care, research, and public policy.

    PubMed

    Feinstein, Emily C; Richter, Linda; Foster, Susan E

    2012-05-01

    The use of addictive substances-tobacco, alcohol, and other drugs-during adolescence interferes with brain development and increases the risk of serious health and mental health conditions, including addiction. Yet, adolescents live in a culture in which family, social, community, and media influences regularly bombard them with pro-substance use messages, creating an environment in which substance use is considered an expected behavior, rather than a considerable health risk. To prevent the significant harm that falls to teens and young adults because of substance use, The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) undertook a study to explore how adolescent brain development relates to the risk of substance use and addiction; the cultural influences that create an environment in which substance use is considered normative behavior; individual factors that make some teens more disposed to substance use and addiction; and evidence-based prevention and treatment strategies for addressing this problem. The recently published report Adolescent Substance Use: America's #1 Public Health Problem concludes that risky substance use is a major public health problem that can be ameliorated through evidence-based public health measures, including education about the disease and its risk factors, screenings, and clinical interventions, and that addiction can be treated and managed effectively within routine health care practice and specialty care. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  12. Initiation of Substance Use by Adolescents after One Year in Residential Youth Care

    ERIC Educational Resources Information Center

    Monshouwer, Karin; Kepper, Annelies; van den Eijnden, Regina; Koning, Ina; Vollebergh, Wilma

    2015-01-01

    Background: Several studies have shown that substance use levels among adolescents living in residential youth care are high. However, it is not clear to what extent adolescents initiate (heavy) substance during their stay and to what extent these rates are higher than would be expected based on their risk profile. Objective: The aim of the…

  13. Care at the Crossroads: Navigating the HIV, HCV, and Substance Abuse Syndemic

    PubMed Central

    Reece, Rebecca; Dugdale, Caitlin; Touzard-Romo, Francine; Noska, Amanda; Flanigan, Timothy; Rich, Josiah D.

    2014-01-01

    For patients with both HIV/HCV coinfection and substance addiction, multidisciplinary teams can facilitate coordination of care and improve clinical outcomes. Such teams should include HIV/HCV treatment providers, mental health specialists, case managers, social workers, and substance abuse counselors. PMID:25520548

  14. Preliminary Support for Multidimensional Treatment Foster Care in Reducing Substance Use in Delinquent Boys

    ERIC Educational Resources Information Center

    Smith, Dana K.; Chamberlain, Patricia; Eddy, J. Mark

    2010-01-01

    Although effective outpatient treatments have been identified for the well-documented negative outcomes associated with delinquency and substance use, effective treatments for youths in out-of-home care are rare. In this study, 12- and 18-month substance use outcomes were examined for a sample of 79 boys who were randomly assigned to…

  15. Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse.

    ERIC Educational Resources Information Center

    Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse.

    A national representative survey of primary care physicians (N=648) was conducted to determine how they deal with patients who have substance abuse problems. The survey revealed how physicians identify substance abuse in their patients, what efforts they make to help these patients, and what barriers they find to effective diagnosis and treatment.…

  16. Initiation of Substance Use by Adolescents after One Year in Residential Youth Care

    ERIC Educational Resources Information Center

    Monshouwer, Karin; Kepper, Annelies; van den Eijnden, Regina; Koning, Ina; Vollebergh, Wilma

    2015-01-01

    Background: Several studies have shown that substance use levels among adolescents living in residential youth care are high. However, it is not clear to what extent adolescents initiate (heavy) substance during their stay and to what extent these rates are higher than would be expected based on their risk profile. Objective: The aim of the…

  17. [Conceptualizations on care for persons with dementia in nursing homes].

    PubMed

    Rodríguez-Martín, Beatriz; Martínez-Andrés, María; Notario-Pacheco, Blanca; Martínez-Vizcaíno, Vicente

    2016-03-01

    Despite the importance of family perceptions when analyzing care for the elderly in nursing homes, little is said about this aspect. This study aims to identify preferences and areas for improvement in care for persons with dementia, as perceived by families. A qualitative study was performed, based on Grounded Theory, combining two data collection techniques (participant observation and in-depth interviews) in a theoretical sample of institutionalized persons with dementia. The ideal model of care for persons with dementia, as perceived by participants, was based on specialized and individualized care and family participation in the care provided. Areas for improvement included aspects pertaining to specialized training in geriatrics, human relations, and the culture of institutional work. Faced with the current trend towards technification of care, families are now demanding personalized, small-scale care in which they form an active part of the team.

  18. Substance use disorder patient privacy and comprehensive care in integrated health care settings.

    PubMed

    Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven

    2016-02-01

    The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care.

  19. Personal network recovery enablers and relapse risks for women with substance dependence.

    PubMed

    Brown, Suzanne; Tracy, Elizabeth M; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung O

    2015-03-01

    We examined the experiences of women in treatment for substance dependence and their treatment providers about personal networks and recovery. We conducted six focus groups at three women's intensive substance abuse treatment programs. Four coders used thematic analysis to guide the data coding and an iterative process to identify major themes. Coders identified social network characteristics that enabled and impeded recovery and a reciprocal relationship between internal states, relationship management, and recovery. Although women described adding individuals to their networks, they also described managing existing relationships through distancing from or isolating some members to diminish their negative impact on recovery. Treatment providers identified similar themes but focused more on contextual barriers than the women. The focus of interventions with this population should be on both internal barriers to personal network change such as mistrust and fear, and helping women develop skills for managing enduring network relationships.

  20. Personality, sexuality, and substance use as predictors of sexual risk taking in college students.

    PubMed

    Turchik, Jessica A; Garske, John P; Probst, Danielle R; Irvin, Clinton R

    2010-09-01

    Sexual risk taking among college students is common and can lead to serious consequences, such as unintended pregnancies and sexually transmitted infections. This study utilized responses from 310 undergraduate psychology students aged 18 to 23 to examine personality, sexuality, and substance use predictors of sexual risk behaviors over a six-month period. Data were collected from 2005 to 2006 at a medium-sized Midwestern U.S. university. Results indicated that greater alcohol and recreational drug use, higher extraversion, and lower agreeableness were related to sexual risk taking in men. For women, greater alcohol and drug use, higher sexual excitation, and lower sexual inhibition were predictive of sexual risk taking. Among women, but not men, sensation seeking was found to mediate the relationship between the four significant substance use, personality, and sexuality variables and sexual risk taking. Implications for sexual risk behavior prevention and intervention programming are discussed.

  1. Personal Network Recovery Enablers and Relapse Risks for Women With Substance Dependence

    PubMed Central

    Brown, Suzanne; Tracy, Elizabeth M.; Jun, MinKyoung; Park, Hyunyong; Min, Meeyoung O.

    2015-01-01

    We examined the experiences of women in treatment for substance dependence and their treatment providers about personal networks and recovery. We conducted six focus groups at three women’s intensive substance abuse treatment programs. Four coders used thematic analysis to guide the data coding and an iterative process to identify major themes. Coders identified social network characteristics that enabled and impeded recovery and a reciprocal relationship between internal states, relationship management, and recovery. Although women described adding individuals to their networks, they also described managing existing relationships through distancing from or isolating some members to diminish their negative impact on recovery. Treatment providers identified similar themes but focused more on contextual barriers than the women. The focus of interventions with this population should be on both internal barriers to personal network change such as mistrust and fear, and helping women develop skills for managing enduring network relationships. PMID:25231945

  2. Personality disorders and retention in a therapeutic community for substance dependence.

    PubMed

    Samuel, Douglas B; LaPaglia, Donna M; Maccarelli, Lisa M; Moore, Brent A; Ball, Samuel A

    2011-01-01

    Although therapeutic community (TC) treatment is a promising intervention for substance use disorders, a primary obstacle to successful treatment is premature attrition. Because of their prevalence within substance use treatment facilities, personality disorder (PD) diagnoses have been examined as predictors of treatment completion. Prior research on TC outcomes has focused almost exclusively on antisocial personality disorder (ASPD), and the results have been mixed. This study extends previous research by examining the impact of the 10 Axis II PDs on early (first 30 days) attrition as well as overall time to dropout in a 9-month residential TC. Survival analyses indicated that borderline was the only PD negatively related to overall program retention. In contrast, ASPD, as well as histrionic PD, were related to very early attrition, but not to overall program retention. Early assessment and identification of at-risk individuals may improve treatment retention and outcome for TC treatment.

  3. Homosexuality and illegal residency status in relation to substance abuse and personality traits among Mexican nationals.

    PubMed

    Tori, C D

    1989-09-01

    Maladaptive behavioral and personality reactions to severe stressors among Mexican homosexual men were assessed by comparing substance abuse and Rorschach data obtained from three samples: (a) homosexuals residing illegally in the United States (n = 40), (b) homosexuals living in Mexico (n = 21) and (c) heterosexuals living illegally in the United States (n = 25). The results of orthogonal contrasts showed very similar personality structure and substance abuse patterns among the participants in the two homosexual groups. As predicted, these men were found to be using alcohol or drugs to a greater extent than the heterosexual controls. Rorschach findings indicated that the homosexual subjects were experiencing dysphoric mood and distorted perceptions; they were also having significant difficulties coping with an environment that was discerned as increasingly dangerous. These results are relevant to the stress reduction hypothesis of addiction and provide quantitative information regarding the extent of psychopathology in this underserved Hispanic population.

  4. Personality Disorders and Retention in a Therapeutic Community for Substance Dependence

    PubMed Central

    Samuel, Douglas B.; LaPaglia, Donna M.; Maccarelli, Lisa M.; Moore, Brent A.; Ball, Samuel A.

    2013-01-01

    Although therapeutic community (TC) treatment is a promising intervention for substance use disorders, a primary obstacle to successful treatment is premature attrition. Because of their prevalence within substance use treatment facilities, personality disorder (PD) diagnoses have been examined as predictors of treatment completion. Prior research on TC outcomes has focused almost exclusively on antisocial personality disorder (ASPD), and the results have been mixed. The current study extends previous research by examining the impact of the 10 Axis II PDs on early (first 30 day) attrition as well as overall time to dropout in a 9-month residential TC. Survival analyses indicated that borderline was the only PD negatively related to overall program retention. In contrast, ASPD, as well as histrionic PD, were related to very early attrition but not to overall program retention. Early assessment and identification of at-risk individuals may improve treatment retention and outcome for TC treatment. PMID:21999502

  5. PHARMACEUTICAL AND PERSONAL CARE PRODUCTS AS ...

    EPA Pesticide Factsheets

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In contrast to other types of pollutants, PPCPs owe their origins in the environment directly to their worldwide, universal, frequent, highly dispersed, and individually small but aggregate/cumulative usage and disposal by multitudes of individuals. An overview of this multi-faceted issue can be found at a U.S. EPA web site (http://www.epa.gov/neriesdl/chemistry/phanna/index.htm), which also provides a reprint of a review article published in Environmental Health Perspectives as well as many other resources including several chapters from a new American Chemical Society book. PPCPs can enter the environment following their ingestion or application by the user or administration to domestic animals. Disposal of unused/expired PPCPs in landfills and to domestic sewage are additional routes to the environment. Domestic sewage treatment plants are not specifically engineered to remove PPCPS; the efficiencies with which they are removed from sewage vary from nearly complete to ineffective. The aquatic environment serves as the major, ultimate receptacle for most PPCPS. Little is known with respect to actual or even potential adverse effects on non-target species; human exposure via drinking wate

  6. The role of antisocial and borderline personality features in substance dependence among incarcerated females.

    PubMed

    Chapman, Alexander L; Cellucci, Tony

    2007-06-01

    This study examined the association of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) with substance dependence among incarcerated females (N=105) as well as the influence of the co-occurrence of BPD and ASPD on psychosocial functioning in substance-dependent participants. The severity of BPD and ASPD both were associated with drug dependence, but BPD was not associated with alcohol dependence. After controlling for ASPD severity, BPD severity was no longer associated with drug dependence. The ASPD features of criminal activity and recklessness were most uniquely associated with drug and alcohol dependence (respectively). None of the BPD features was uniquely associated with alcohol or drug dependence after controlling for ASPD. A co-occurring BPD diagnosis was associated with mood disturbance and experiential avoidance among substance-dependent participants. An ASPD diagnosis was associated with an earlier age at first arrest, along with greater childhood abuse and severity of alcohol dependence. These findings have important implications for further understanding and developing ways to help substance-dependent incarcerated females.

  7. Family Care for Persons with Developmental Disabilities: A Growing Commitment.

    ERIC Educational Resources Information Center

    Agosta, J. M., Ed.; Bradley, V. J., Ed.

    The report presents findings from a study of family-based care for persons with developmental disabilities. The first of four parts introduces the problems of family-based care and presents perspectives of parents and of persons with developmental disabilities. Part 2, on responding to the needs of families, includes a review of historical and…

  8. 42 CFR 440.167 - Personal care services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care...

  9. A Research Agenda to Advance the Coordination of Care for General Medical and Substance Use Disorders.

    PubMed

    Quinn, Amity E; Rubinsky, Anna D; Fernandez, Anne C; Hahm, Hyeouk Chris; Samet, Jeffrey H

    2017-04-01

    The separation of addiction care from the general medical care system has a negative impact on patients' receipt of high-quality medical care. Clinical and policy-level strategies to improve the coordination of addiction care and general medical care include identifying and engaging patients with unhealthy substance use in general medical settings, providing effective chronic disease management of substance use disorders in primary care, including patient and family perspectives in care coordination, and implementing pragmatic models to pay for the coordination of addiction and general medical care. This Open Forum discusses practice and research recommendations to advance the coordination of general medical and addiction care. The discussion is based on the proceedings of a national meeting of experts in 2014.

  10. The Impact of Borderline Personality Disorder on Residential Substance Abuse Treatment Dropout among Men

    PubMed Central

    Tull, Matthew T.; Gratz, Kim L.

    2011-01-01

    Background Research is increasingly focusing on identifying factors distinguishing patients who complete versus dropout of residential substance abuse treatment. One potentially relevant factor that has received relatively little attention is borderline personality disorder (BPD). Method This study sought to examine the effect of BPD on residential substance abuse treatment dropout within a sample of 159 male patients with substance use disorders – a population often understudied with regard to BPD and at high-risk for treatment dropout. Patients were administered a structured diagnostic interview to establish BPD diagnoses. Patients were then followed throughout the course of residential substance abuse treatment to identify those who completed treatment and those who prematurely dropped out of treatment. Results Patients with BPD were significantly more likely to prematurely dropout of treatment, and this finding remained even when taking into account relevant covariates (i.e., court-ordered treatment status, contract duration, and major depressive disorder). Further, patients with BPD were more likely to experience center-initiated dropout as opposed to voluntary withdrawal from treatment. Conclusions These findings add to the literature on BPD-SUD co-occurrence, suggesting that the presence of co-occurring BPD among male SUD patients may increase the risk for dropout from residential substance abuse treatment, necessitating targeted interventions focused on decreasing dropout within this patient subgroup. PMID:21907503

  11. Aggression, impulsivity, personality traits, and childhood trauma of prisoners with substance abuse and addiction.

    PubMed

    Cuomo, Chiara; Sarchiapone, Marco; Giannantonio, Massimo Di; Mancini, Michele; Roy, Alec

    2008-01-01

    The aim of our study is then to analyze psychological and judicial features of a subgroup of inmates with substance abuse. Prisoners with substance abuse (n = 312) were compared to prisoners without substance abuse (n = 591). Recruited inmates completed a semistructured interview for collection of sociodemographic and judicial data and a battery of psychometric tests for assessement of aggression, impulsivity, depression, personality traits, hostility, resilience, and childhood trauma. Substance abusers had on average multiple incarcerations (78.8%), more juvenile convictions (60.2%), more violent behaviors during detention (29.8%), and a history of one or more suicide attempts (20.8%). They also had higher scores on subscales for childhood trauma, higher scores for psychoticism and neuroticism, higher impulsivity levels, worse resilience, increased hostility, and prevalent suicidal ideation. Prisoners with substance abuse constitute a subgroup with increased judiciary and psychiatric issues, possibly due to early life history and psychological characteristics, such as high impulsivity and aggressiveness, poor resilience, and higher suicidal risk.

  12. Efficacy of Dual Focus Mutual Aid for Persons with Mental Illness and Substance Misuse

    PubMed Central

    Rosenblum, Andrew; Matusow, Harlan; Fong, Chunki; Vogel, Howard; Uttaro, Thomas; Moore, Thomas L.; Magura, Stephen

    2014-01-01

    Background Previous studies have indicated that persons with co-occurring mental health and substance use problems can benefit by attending dual-focus mutual aid groups. However, to date, a trial to test the efficacy of these groups has not been published. Method This study randomly assigned 203 substance misusing clients attending a mental health or dual-diagnosis facility to either a dual-focus 12-step group (Double Trouble in Recovery; DTR) or a waiting list control group. Participants were followed for 3–6 months. The primary outcome was substance use (days used in the past 30 with saliva testing to detect under-reporting); secondary outcomes included psychiatric medication adherence, attendance at traditional (single-focus) 12-step meetings (e.g., AA/NA); and improvement in mental health and substance use problems (quality of life). Multilevel model (MLM) regression was used to analyze the nested effect of participants within 8 facilities (7 in New York City and 1 in Michigan). Regression imputation was used to adjust for drug use under-reporting. Results At follow-up 79% of the subjects were interviewed. In intent to treat analysis, DTR subjects compared with control subjects used alcohol (p=.03) and any substances (p=.02) on fewer days. DTR compared with control subjects were also more likely to rate themselves as experiencing better mental health and fewer substance use problems (p=.001). There were no effects for DTR on drug use only, medication adherence or NA/AA attendance. Conclusion Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial. PMID:24342419

  13. Application of environmental sensitivity theories in personalized prevention for youth substance abuse: a transdisciplinary translational perspective.

    PubMed

    Thibodeau, Eric L; August, Gerald J; Cicchetti, Dante; Symons, Frank J

    2016-03-01

    Preventive interventions that target high-risk youth, via one-size-fits-all approaches, have demonstrated modest effects in reducing rates of substance use. Recently, substance use researchers have recommended personalized intervention strategies. Central to these approaches is matching preventatives to characteristics of an individual that have been shown to predict outcomes. One compelling body of literature on person × environment interactions is that of environmental sensitivity theories, including differential susceptibility theory and vantage sensitivity. Recent experimental evidence has demonstrated that environmental sensitivity (ES) factors moderate substance abuse outcomes. We propose that ES factors may augment current personalization strategies such as matching based on risk factors/severity of problem behaviors (risk severity (RS)). Specifically, individuals most sensitive to environmental influence may be those most responsive to intervention in general and thus need only a brief-type or lower-intensity program to show gains, while those least sensitive may require more comprehensive or intensive programming for optimal responsiveness. We provide an example from ongoing research to illustrate how ES factors can be incorporated into prevention trials aimed at high-risk adolescents.

  14. Providing care to transgender persons: a clinical approach to primary care, hormones, and HIV management.

    PubMed

    Williamson, Catherine

    2010-01-01

    Transgender (TG) persons have had historically difficult interactions with health care providers, leading to limited care and risks for a broad spectrum of health problems. This is of particular concern for TG persons with or at risk for HIV infection. This article discusses care providers' roles in establishing TG-friendly clinical care sites; conducting appropriate and thorough physical examinations for TG patients; managing hormones, especially in conjunction with antiretroviral therapy; and engaging TG persons in education about prevention and treatment of HIV.

  15. Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care

    PubMed Central

    Entwistle, Vikki A.; Watt, Ian S.

    2013-01-01

    Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. PMID:23862598

  16. Job satisfaction amongst aged care staff: exploring the influence of person-centered care provision.

    PubMed

    Edvardsson, David; Fetherstonhaugh, Deirdre; McAuliffe, Linda; Nay, Rhonda; Chenco, Carol

    2011-10-01

    There are challenges in attracting and sustaining a competent and stable workforce in aged care, and key issues of concern such as low staff job satisfaction and feelings of not being able to provide high quality care have been described. This study aimed to explore the association between person-centered care provision and job satisfaction in aged care staff. Residential aged care staff (n = 297) in Australia completed the measure of job satisfaction and the person-centered care assessment tool. Univariate analyses examined relationships between variables, and multiple linear regression analysis explored the extent to whichperceived person-centredness could predict job satisfaction of staff. Perceived person-centred care provision was significantly associated with job satisfaction, and person-centred care provision could explain nearly half of the variation in job satisfaction. The regression model with the three person-centered care subscales as predictor variables accounted for 40% of the variance in job satisfaction. Personalizing care had the largest independent influence on job satisfaction, followed by amount of organizational support and degree of environmental accessibility. Personalizing care and amount of organizational support had a statistically significant unique influence. As person-centered care positively correlated with staff job satisfaction, supporting staff in providing person-centered care can enhance job satisfaction and might facilitate attracting and retaining staff in residential aged care. The findings reiterate a need to shift focus from merely completing care tasks and following organizational routines to providing high quality person-centered care that promotes the good life of residents in aged care.

  17. Premorbid Personality Disorders in Male Schizophrenic Patients with or without Comorbid Substance Use Disorder: Is Dual Diagnosis Mediated by Personality Disorder?

    PubMed Central

    ALTUNSOY, Neslihan; ŞAHİNER, Şafak Yalçın; CİNGİ KÜLÜK, Merve; OKAY, Tuncer; ULUSOY KAYMAK, Semra; AYDEMİR, Çiğdem; GÖKA, Erol

    2015-01-01

    Introduction Although substance abuse is an important clinical problem in schizophrenic patients, very little evidence explains why these patients use drugs and alcohol. This study therefore aimed to examine whether premorbid personality disorders affect substance abuse. Methods The sample included 40 male schizophrenic patients with and 40 male schizophrenic patients without substance use disorder comorbidity who had applied to Ankara Numune Research and Training Hospital. Each participant and a family member were interviewed in a structured clinical interview that addressed premorbid personality disorders. Results Altogether, 32 patients (80%) in the group with comorbidity and 28 (70%) in the group without comorbidity had a premorbid personality disorder. Antisocial (35% vs. 0%; p<.001) and borderline (37.5% vs. 5%; p=.001) personality disorders were more often detected in the group with comorbidity, while avoidant (10% vs. 35%; p=.014) and obsessive–compulsive (0% vs. 15%; p=.026) personality disorders were less frequently found in this group. Comparing the group with comorbidity with premorbid personality types, schizophrenic patients with premorbid antisocial personality disorder were more frequently unemployed and hospitalized as well as had an earlier onset age of schizophrenia (p=.034, p=.038 and p=.035, respectively). Schizophrenic patients with premorbid borderline personality disorder had a significantly earlier onset age of substance use (19±5; p=.028). Conclusion Schizophrenic patients with substance use comorbidity variously differ from those without comorbidity and some of these differences may be associated with premorbid personality disorders. PMID:28360728

  18. Validation of a system of classifying female substance abusers on the basis of personality and motivational risk factors for substance abuse.

    PubMed

    Conrod, P J; Pihl, R O; Stewart, S H; Dongier, M

    2000-09-01

    This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion-hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted-hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.

  19. Characteristics Predicting Community Care for Mentally Impaired Older Persons.

    ERIC Educational Resources Information Center

    Nardone, Maryann

    1980-01-01

    Availability of nursing home beds was a strong predictor of institutional care. Higher rates of community care occurred where there were greater expenditures for protective, legal, chore, day care and social/recreation services and, in which there were more older persons in poverty and fewer women working. (Author)

  20. Characteristics Predicting Community Care for Mentally Impaired Older Persons.

    ERIC Educational Resources Information Center

    Nardone, Maryann

    1980-01-01

    Availability of nursing home beds was a strong predictor of institutional care. Higher rates of community care occurred where there were greater expenditures for protective, legal, chore, day care and social/recreation services and, in which there were more older persons in poverty and fewer women working. (Author)

  1. Is patient-centered care the same as person-focused care?

    PubMed

    Starfield, Barbara

    2011-01-01

    Both patient-centered and person-focused care are important, but they are different. In contrast to patient-centered care (at least as described in the current literature with assessments that are visit-based), person-focused care is based on accumulated knowledge of people, which provides the basis for better recognition of health problems and needs over time and facilitates appropriate care for these needs in the context of other needs. That is, it specifically focuses on the whole person. Proposed enhancements and innovations to primary care do not appear to address person-focused care. Tools to assess person-focused care are available and deserve more widespread use in primary care.

  2. Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered.

    PubMed

    Washburn, Allyson M; Grossman, Melanie

    2017-07-01

    Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work's PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood's concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.

  3. Personalized prostate cancer care: from screening to treatment

    PubMed Central

    Conran, Carly A; Brendler, Charles B; Xu, Jianfeng

    2016-01-01

    Unprecedented progress has been made in genomic personalized medicine in the last several years, allowing for more individualized healthcare assessments and recommendations than ever before. However, most of this progress in prostate cancer (PCa) care has focused on developing and selecting therapies for late-stage disease. To address this issue of limited focus, we propose a model for incorporating genomic-based personalized medicine into all levels of PCa care, from prevention and screening to diagnosis, and ultimately to the treatment of both early-stage and late-stage cancers. We have termed this strategy the “Pyramid Model” of personalized cancer care. In this perspective paper, our objective is to demonstrate the potential application of the Pyramid Model to PCa care. This proactive and comprehensive personalized cancer care approach has the potential to achieve three important medical goals: reducing mortality, improving quality of life and decreasing both individual and societal healthcare costs. PMID:27184548

  4. Relations of Personality to Substance Use Problems and Mental Health Disorder Symptoms in Two Clinical Samples of Adolescents

    ERIC Educational Resources Information Center

    Battista, Susan R.; Pencer, Alissa; McGonnell, Melissa; Durdle, Heather; Stewart, Sherry H.

    2013-01-01

    There is a high overlap between substance misuse and mental health disorders in adolescents. Certain personality traits (i.e., sensation seeking, impulsivity, hopelessness, and anxiety sensitivity) may be related to increased risk for mental health symptoms and/or substance misuse. The current study examined the relationships between personality…

  5. Relations of Personality to Substance Use Problems and Mental Health Disorder Symptoms in Two Clinical Samples of Adolescents

    ERIC Educational Resources Information Center

    Battista, Susan R.; Pencer, Alissa; McGonnell, Melissa; Durdle, Heather; Stewart, Sherry H.

    2013-01-01

    There is a high overlap between substance misuse and mental health disorders in adolescents. Certain personality traits (i.e., sensation seeking, impulsivity, hopelessness, and anxiety sensitivity) may be related to increased risk for mental health symptoms and/or substance misuse. The current study examined the relationships between personality…

  6. How personal and standardized coordination impact implementation of integrated care.

    PubMed

    Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

    2015-10-02

    Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal

  7. Substance use disorders: realizing the promise of pharmacogenomics and personalized medicine.

    PubMed

    Hutchison, Kent E

    2010-01-01

    Current pharmacological and psychosocial approaches to the treatment of alcohol dependence may best be described as modestly effective, and it is unlikely that a magic bullet for the treatment of any substance use disorder will ever be developed. Rather, it seems more likely that there will be a number of treatment options, each of which will target different mechanisms. Thus, future treatment gains are likely to depend on the ability to match individuals with the treatment most likely to benefit them, which in turn is contingent on our ability to understand the mechanisms that drive the maintenance of substance use disorders on an individual level. On a more global scale, this type of effort has been described as "personalized medicine" and has focused largely on the human genome as a source of information that can be used to match individuals to treatments. This review enumerates barriers to realizing the potential of personalized medicine for substance use disorders and identifies opportunities to overcome those barriers, which involve the development of translational approaches that focus on the development of brain-based phenotypes that serve as the target of both treatment development and of genetic research.

  8. ASAM Patient Placement Criteria treatment levels: do they correspond to care actually received by homeless substance abusing adults?

    PubMed

    O'Toole, Thomas P; Freyder, Paul J; Gibbon, Jeanette L; Hanusa, Barbara J; Seltzer, Debora; Fine, Michael J

    2004-01-01

    We report findings from a community-based two-city survey of homeless adults comparing the level of substance abuse treatment assigned to them using the ASAM Patient Placement Criteria with care actually received during the previous 12 months. Overall 531 adults were surveyed with 382 meeting DSM-IIIR criteria of being in need of treatment or having a demand for treatment. Of those with a treatment need, 1.5% met criteria for outpatient care, 40.3% intensive outpatient/partial hospitalization care, 29.8% medically monitored care and 28.8% managed care levels. In contrast, of those receiving treatment (50.5%, 162 persons), almost all care received by this cohort was either inpatient or residential based (83.6%). Unsheltered homeless persons and those without insurance were significantly more likely to report not receiving needed treatment. Lack of treatment availability or capacity, expense, and changing one's mind while on a wait list were the most commonly cited reasons for no treatment.

  9. Medicaid-financed residential care for persons with mental retardation.

    PubMed

    Lakin, K C; Hall, M J

    1990-12-01

    Two sources of Medicaid support for persons with mental retardation and related conditions (MR/RC) are examined, the intermediate care facility for the mentally retarded (ICF/MR) program and the home and community-based services (HCBS) waiver. Results indicate that Medicaid support through the ICF/MR program has shown little recent growth in terms of number of persons served, although expenditures continue to increase. Medicaid's HCBS waiver is being used increasingly by States to support residential placement because of its greater flexibility and more individualized approach relative to ICF/MR care. Use of Medicaid to finance care for persons with MR/RC varies considerably across States.

  10. The affordable care act and treatment for "substance use disorders:" implications of ending segregated behavioral healthcare.

    PubMed

    McLellan, A Thomas; Woodworth, Abigail Mason

    2014-01-01

    The Affordable Care Act (2010) and the Mental Health Parity and Addiction Equity Act (2008) are expected to transform substance abuse prevention and treatment in the United States. In this paper, we outline the potential disruption to the existing specialty care delivery system, and describe the opportunities for treatment providers and health services researchers.

  11. Residential Treatment of Substance Abusing Adolescents: Trends in the Post-Managed Care Era

    ERIC Educational Resources Information Center

    MacMaster, Samuel A.; Ellis, Rodney A.; Cooper, Lyle

    2005-01-01

    This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis…

  12. Perspectives of College Students and Their Primary Health Care Providers on Substance Abuse Screening and Intervention

    ERIC Educational Resources Information Center

    Baldwin, Julie A.; Johnson, Rhonda M.; Gotz, Nina K.; Wayment, Heidi A.; Elwell, Kristan

    2006-01-01

    The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care -provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires…

  13. Multiple OPR genes influence personality traits in substance dependent and healthy subjects in two American populations.

    PubMed

    Luo, Xingguang; Zuo, Lingjun; Kranzler, Henry; Zhang, Huiping; Wang, Shuang; Gelernter, Joel

    2008-10-05

    Personality traits are among the most complex quantitative traits. Certain personality traits are associated with substance dependence (SD); genetic factors may influence both. Associations between opioid receptor (OPR) genes and SD have been reported. This study investigated the relationship between OPR genes and personality traits in a case-control sample. We assessed dimensions of the five-factor model of personality in 556 subjects: 250 with SD [181 European-Americans (EAs) and 69 African-Americans (AAs)] and 306 healthy subjects (266 EAs and 40 AAs). We genotyped 20 OPRM1 markers, 8 OPRD1 markers, and 7 OPRK1 markers, and 38 unlinked ancestry-informative markers in these subjects. The relationships between OPR genes and personality traits were examined using MANCOVA, controlling for gene-gene interaction effects and potential confounders. Associations were decomposed by Roy-Bargmann Stepdown ANCOVA. We found that personality traits were associated as main or interaction effects with the haplotypes, diplotypes, alleles and genotypes at the three OPR genes (0.002 < P < 0.046 from MANCOVA; 0.0004 < P < 0.049 from ANCOVA). Diplotype TTAGGA/TTCAGA at OPRM1 had main effects on Extraversion (P = 0.008), and diplotypes OPRM1(insertion mark)TTCAGA/TTCAGA and OPRD1(insertion mark)CAC/TAC had interaction effects on Openness (P = 0.010) after conservative correction for multiple testing. The present study demonstrates that the genes encoding the mu-, delta-, and kappa-opioid receptors may contribute to variation in personality traits. Further, the three OPR genes have significant interaction effects on personality traits. This work provides additional evidence that personality traits and SD have a partially overlapping genetic basis.

  14. Multiple OPR genes influence personality traits in substance dependent and healthy subjects in two American populations

    PubMed Central

    Luo, Xingguang; Zuo, Lingjun; Kranzler, Henry; Zhang, Huiping; Wang, Shuang; Gelernter, Joel

    2011-01-01

    Background Personality traits are among the most complex quantitative traits. Certain personality traits are associated with substance dependence (SD); genetic factors may influence both. Associations between opioid receptor (OPR) genes and SD have been reported. This study investigated the relationship between OPR genes and personality traits in a case-control sample. Methods We assessed dimensions of the five-factor model of personality in 556 subjects: 250 with SD [181 European-Americans (EAs) and 69 African-Americans (AAs)] and 306 healthy subjects (266 EAs and 40 AAs). We genotyped 20 OPRM1 markers, 8 OPRD1 markers, and 7 OPRK1 markers, and 38 unlinked ancestry-informative markers in these subjects. The relationships between OPR genes and personality traits were examined using MANCOVA, controlling for gene-gene interaction effects and potential confounders. Associations were decomposed by Roy-Bargmann Stepdown ANCOVA. Results Personality traits were associated as main or interaction effects with the haplotypes, diplotypes, alleles and genotypes at the three OPR genes (0.002personality traits. Further, the three OPR genes have significant interaction effects on personality traits. This work provides additional evidence that personality traits and SD have a partially overlapping genetic basis. PMID:18213616

  15. Personality disorders as maladaptive, extreme variants of normal personality: borderline personality disorder and neuroticism in a substance using sample.

    PubMed

    Samuel, Douglas B; Carroll, Kathleen M; Rounsaville, Bruce J; Ball, Samuel A

    2013-10-01

    Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors' findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits.

  16. PERSONALITY DISORDERS AS MALADAPTIVE, EXTREME VARIANTS OF NORMAL PERSONALITY: BORDERLINE PERSONALITY DISORDER AND NEUROTICISM IN A SUBSTANCE USING SAMPLE

    PubMed Central

    Samuel, Douglas B.; Carroll, Kathleen M.; Rounsaville, Bruce J.; Ball, Samuel A.

    2014-01-01

    Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors’ findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits. PMID:24044664

  17. Antisocial personality, substance abuse, and exposure to parental violence in males referred for domestic violence.

    PubMed

    McBurnett, K; Kerckhoff, C; Capasso, L; Pfiffner, L J; Rathouz, P J; McCord, M; Harris, S M

    2001-10-01

    This study investigated whether childhood disruptive behavior (hyperactivity, oppositional-defiance, conduct problems) plus adult psychopathic adjustment are associated with domestic violence. Adult males (n = 66) in diversion programs completed the Wender Utah Rating Scale (WURS), MMPI Psychopathic Deviate scale (PD), Conflict Tactics Scales representing themselves and their parents, and substance use measures. Substance use and lifespan antisocial personality (measured by high WURS and PD scores) were robust predictors of verbal and moderate physical domestic abuse. Violence in the family of origin was associated with abuse when tested alone, but failed to exhibit unique association with abuse when other predictors were taken into account. The possibility that antisocial batterers respond to contingencies by moderating physical harm, while persisting at psychological harm, is discussed.

  18. Comorbidity of Borderline Personality Disorder and Lifetime Substance Use Disorders in a Nationally Representative Sample.

    PubMed

    Carpenter, Ryan W; Wood, Phillip K; Trull, Timothy J

    2016-06-01

    Borderline personality disorder (BPD) is comorbid with substance use disorders (SUDs). However, most epidemiological work on BPD and SUDs has collapsed nonalcohol substances into a drug use disorder indicator, potentially obscuring patterns of association between BPD and individal SUDs. Using a nationally representative sample (National Epidemiologic Survey on Alcohol and Related Conditions; N = 34,481), the authors examined the association between lifetime BPD and nine lifetime SUDs. First, the authors examined the bivariate association of BPD and each SUD. BPD was associated with all nine SUDs. Second, they added relevant covariates (demographic variables, additional psychopathology) to each model. Seven SUDs remained significant. Finally, to account for shared variance across SUDs, the authors conducted a multivariate logistic regression with the nine SUDs and covariates as predictors. Alcohol, cocaine, and opiate use disorder were the only significant SUD predictors, indicating a unique association between BPD and these three SUDs. Future research should explore factors involved in the association of BPD with these specific SUDs.

  19. Managed care, networks and trends in hospital care for mental health and substance abuse treatment in Massachusetts: 1994-1999.

    PubMed

    Fleming, Elaine; Lien, Hsienming; Ma, Ching-To Albert; McGuire, Thomas G

    2003-03-01

    Rates of inpatient care for mental health and substance abuse treatment have been reported to fall after the introduction of managed care, but the actual decline may be overstated. Almost all managed care impact studies are based on pre-post comparisons, which have two drawbacks: secular downward trends may be attributed to a managed care effect and self-selection may exaggerate the impact of managed care. Therefore it is useful to examine long-term population-based trends in use associated with the growth of managed care. This paper examines trends in inpatient care for mental health and substance abuse treatment in Massachusetts between 1994 and 1999 by service provider and payer. We analyze how managed care impacts the trends in mental health and substance abuse care. We provide an overview of the health market in Massachusetts and compare trends in mental health and substance abuse services with all inpatient services. To analyze the impact of managed care, we compare the per discharge cost of managed care and fee for service plans in Medicare and Medicaid. Finally, we examine the role played by hospital networks in managed care. The reduction in service costs for mental health and substance abuse, about 25% in six years, is mostly due to the decline in the average cost per inpatient episode. This is only slightly greater than the decline in costs for all inpatient care. Managed care has reduced both the quantity (average length of stay) and intensity of health care (expenditure per day). Simulations suggest that the creation of hospital networks by managed care accounts for around 50% of the differential between the average costs of the HMO and FFS sectors. We find that the cost reductions in mental health and substance abuse services are larger than for physical health, but not by much. The average length of stay and average day cost is lower for managed care plans than for FFS plans, and much of this difference is attributable to the hospitals managed care

  20. Borderline personality disorder in the primary care setting.

    PubMed

    Dubovsky, Amelia N; Kiefer, Meghan M

    2014-09-01

    Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients.

  1. Social exclusion, personal control, self-regulation, and stress among substance abuse treatment clients.

    PubMed

    Cole, Jennifer; Logan, T K; Walker, Robert

    2011-01-01

    The purpose of this study was to examine the relationship of social exclusion, personal control, and self-regulation to perceived stress among individuals who participated in publicly funded substance abuse treatment. Participants entered treatment between June 2006 and July 2007 and completed a 12-month follow-up survey by telephone (n=787). The results of the OLS regression analysis indicate that individuals with greater social exclusion factors (e.g. greater economic hardship, lower subjective social standing, greater perceived discrimination), lower perceived control of one's life, and lower self-regulation had higher perceived stress. Furthermore, a significant interaction was found suggesting a stress-buffering effect of personal control between subjective social standing and perceived stress. Interestingly, income status was not significantly related to perceived stress, while economic hardship, which assesses participants' inability to meet basic expenses, was significantly associated with perceived stress. Future research should examine how to integrate the AA/NA teaching about powerlessness and its role in recovery with the importance of increased personal control and self-control in decreasing perceived stress. Implications for future research and substance abuse treatment are discussed.

  2. Personality and substance use: psychometric evaluation and validation of the Substance Use Risk Profile Scale (SURPS) in English, Irish, French, and German adolescents.

    PubMed

    Jurk, Sarah; Kuitunen-Paul, Sören; Kroemer, Nils B; Artiges, Eric; Banaschewski, Tobias; Bokde, Arun L W; Büchel, Christian; Conrod, Patricia; Fauth-Bühler, Mira; Flor, Herta; Frouin, Vincent; Gallinat, Jürgen; Garavan, Hugh; Heinz, Andreas; Mann, Karl F; Nees, Frauke; Paus, Tomáš; Pausova, Zdenka; Poustka, Luise; Rietschel, Marcella; Schumann, Gunter; Struve, Maren; Smolka, Michael N

    2015-11-01

    The aim of the present longitudinal study was the psychometric evaluation of the Substance Use Risk Profile Scale (SURPS). We analyzed data from N = 2,022 adolescents aged 13 to 15 at baseline assessment and 2 years later (mean interval 2.11 years). Missing data at follow-up were imputed (N = 522). Psychometric properties of the SURPS were analyzed using confirmatory factor analysis. We examined structural as well as convergent validity with other personality measurements and drinking motives, and predictive validity for substance use at follow-up. The hypothesized 4-factorial structure (i.e., anxiety sensitivity, hopelessness, impulsivity [IMP], and sensation seeking [SS]) based on all 23 items resulted in acceptable fit to empirical data, acceptable internal consistencies, low to moderate test-retest reliability coefficients, as well as evidence for factorial and convergent validity. The proposed factor structure was stable for both males and females and, to lesser degree, across languages. However, only the SS and the IMP subscales of the SURPS predicted substance use outcomes at 16 years of age. The SURPS is unique in its specific assessment of traits related to substance use disorders as well as the resulting shortened administration time. Test-retest reliability was low to moderate and comparable to other personality scales. However, its relation to future substance use was limited to the SS and IMP subscales, which may be due to the relatively low-risk substance use pattern in the present sample. Copyright © 2015 by the Research Society on Alcoholism.

  3. Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

    PubMed Central

    Tai, Betty; Volkow, Nora D.

    2016-01-01

    Addiction is a chronic brain disease with consequences that remain problematic years after discontinuation of use. Despite this, treatment models focus on acute interventions and are carved out from the main health care system. The Patient Protection and Affordable Care Act (2010) brings the opportunity to change the way substance use disorder (SUD) is treated in the United States. The treatment of SUD must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses. The partnering of the health care system with substance abuse treatment programs could dramatically expand the benefits of prevention and treatment of SUD. Expanding roles of health information technology and nonphysician workforces, such as social workers, are essential to the success of a chronic care model. PMID:23731411

  4. Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

    PubMed Central

    Farrell, Caitlin; Sorensen-Alawad, Amy; Palmisano, Joseph N.; Chaisson, Christine; Walley, Alexander Y.

    2014-01-01

    Abstract The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs. PMID:24428768

  5. Older people, personal hygiene, and skin care.

    PubMed

    Cowdell, Fiona

    2011-01-01

    Skin health is essential for well being in older people. Personal hygiene is fundamental to skin health, but a lack of evidence exists about effective practices. An evidence base, disseminated through nursing education and patient health promotion, must be developed.

  6. History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression.

    PubMed

    Evren, Cuneyt; Cinar, Ozgul; Evren, Bilge; Celik, Selime

    2011-11-30

    The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss-Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n=66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.

  7. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS) AS ENVIRONMENTAL POLLUTANTS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  8. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS: DIVERSE GALAXY OF ENVIRONMENTAL POLLUTANTS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  9. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS) AS ENVIRONMENTAL POLLUTANTS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  10. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS: DIVERSE GALAXY OF ENVIRONMENTAL POLLUTANTS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  11. Policies and procedures for establishing a national registry of persons exposed to hazardous substances (National Exposure Registry)

    SciTech Connect

    Not Available

    1988-01-01

    In the document, the Agency for Toxic Substances and Disease Registry (ATSDR) procedures for meeting the statutory mandate for a registry of persons exposed to hazardous substances are described. The rationale for and purpose of the Exposure Registry is to address health issues at hazardous waste sites and emergency chemical spills. The registry activity specifically addresses long-term health issues related to the exposures of hazardous substances and/or mixtures of hazardous substances. The creation of the registry is meant to provide--through the creation of large, valid data files--information needed by researchers to elucidate the presence or absence of the long-term health effects.

  12. 'Designer drugs': update on the management of novel psychoactive substance misuse in the acute care setting.

    PubMed

    Smith, Christopher D; Robert, Stefanie

    2014-08-01

    The use of novel psychoactive substances ('legal highs' or 'designer drugs') is increasing worldwide. Patients misusing such substances have been reported to experience severe or prolonged side effects requiring admission to acute or critical care wards. These complications can be life threatening if misdiagnosed or mismanaged. As physicians have traditionally had less involvement with the management of such patients compared with their colleagues in emergency departments an update in the management of such patients is indicated. Here we present a summary of the management of those novel substances with the potential for serious complications based on a review of current literature.

  13. Insecure Attachment Styles and Increased Borderline Personality Organization in Substance Use Disorders.

    PubMed

    Hiebler-Ragger, Michaela; Unterrainer, Human-Friedrich; Rinner, Anita; Kapfhammer, Hans-Peter

    Previous research has linked insecure attachment styles and borderline personality organization to substance use disorder (SUD). However, it still remains unclear whether those impairments apply to different kinds of SUDs to the same extent. Therefore, in this study we sought to investigate potential differences regarding attachment deficits and borderline personality organization in two different SUD inpatient groups and furthermore in comparison to healthy controls. A total of 66 (24 female) inpatients diagnosed with alcohol use disorder (AUD), 57 (10 female) inpatients diagnosed with polydrug use disorder (PUD), and 114 (51 female) healthy controls completed the Borderline Personality Inventory and the Attachment Style Questionnaire. Compared to healthy controls, AUD and PUD inpatients showed significant deficits in all attachment parameters (p < 0.01) as well as a significantly increased amount of borderline personality organization (p < 0.01). No differences between AUD and PUD inpatients were observed (p > 0.05). Our results indicate that the drug(s) of choice cannot be regarded as an indicator for the extent of attachment deficits or personality pathology. These initial findings are mainly limited by the rather small sample size as well as just a single point of measurement. Future research might also consider further covariates such as comorbidity or psychotropic medication. © 2016 S. Karger AG, Basel.

  14. Person-Centered Care: A Definition and Essential Elements.

    PubMed

    2016-01-01

    Improving healthcare safety, quality, and coordination, as well as quality of life, are important aims of caring for older adults with multiple chronic conditions and/or functional limitations. Person-centered care is an approach to meeting these aims, but there are no standardized, agreed-upon parameters for delivering such care. The SCAN Foundation charged a team from the American Geriatrics Society (AGS) in collaboration with a research and clinical team from the Keck School of Medicine of the University of Southern California to provide the evidence base to support a definition of person-centered care and its essential elements. An interprofessional panel of experts in person-centered care principles and practices that the AGS convened developed this statement.

  15. 42 CFR 440.167 - Personal care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal...

  16. Promoting Patient- and Family-Centered Care Through Personal Stories.

    PubMed

    Johnson, Beverley H

    2016-03-01

    Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among patients, their families, and health care professionals. It redefines the relationships in health care by placing an emphasis on collaborating with patients of all ages, and their families, at all levels of care, in all health care settings, and in organizational change and improvement. This collaboration ensures that health care is responsive to an individual's priorities, preferences, and values. In patient- and family-centered care, patients define their "family" and determine how they and their family will participate in care and decision making. While patient- and family-centered care can improve the experience of care, safety, and quality, it also can improve the learning environment for students and trainees. The author shares personal stories to illustrate the core concepts of patient- and family-centered care, when they are present in health care interactions, and when they are not. Drawing from these stories and the author's experience in working with academic medical centers and other health care organizations over many decades, recommendations for changes in medical education are suggested that can contribute to the development of a health care workforce with the skills and commitment to partner respectfully, effectively, and authentically with patients and families. The implementation of the Affordable Care Act gives new impetus for building a health care delivery system and related educational programs to support patient- and family-centered practice.

  17. Testing a Dynamic Automated Substance Use Intervention Model for Youths Exiting Foster Care.

    PubMed

    Braciszewski, Jordan M; Stout, Robert L; Tzilos, Golfo K; Moore, Roland S; Bock, Beth C; Chamberlain, Patricia

    With an ever increasing gap between need and availability for substance use services, more scalable and efficient interventions are needed. For youth in the foster care system, this gap is dramatic and expands as they leave care. Effective prevention services are strongly needed for this group of vulnerable young people. We propose a novel technology-driven intervention for preventing problematic substance use among youth receiving foster care services. This intervention approach would extend the work in brief computerized interventions by adding a text message-based booster, dynamically tailored to each individual's readiness to change. It also combats many barriers to service receipt. Dynamically tailored interventions delivered through technologies commonly used by adolescents and young adults have the strong potential to reduce the burden of problematic substance use.

  18. Testing a Dynamic Automated Substance Use Intervention Model for Youths Exiting Foster Care

    PubMed Central

    Braciszewski, Jordan M.; Stout, Robert L.; Tzilos, Golfo K.; Moore, Roland S.; Bock, Beth C.; Chamberlain, Patricia

    2015-01-01

    With an ever increasing gap between need and availability for substance use services, more scalable and efficient interventions are needed. For youth in the foster care system, this gap is dramatic and expands as they leave care. Effective prevention services are strongly needed for this group of vulnerable young people. We propose a novel technology-driven intervention for preventing problematic substance use among youth receiving foster care services. This intervention approach would extend the work in brief computerized interventions by adding a text message-based booster, dynamically tailored to each individual’s readiness to change. It also combats many barriers to service receipt. Dynamically tailored interventions delivered through technologies commonly used by adolescents and young adults have the strong potential to reduce the burden of problematic substance use. PMID:27081290

  19. Linking Antisocial Behavior, Substance Use, and Personality: An Integrative Quantitative Model of the Adult Externalizing Spectrum

    PubMed Central

    Krueger, Robert F.; Markon, Kristian E.; Patrick, Christopher J.; Benning, Stephen D.; Kramer, Mark D.

    2008-01-01

    Antisocial behavior, substance use, and impulsive and aggressive personality traits often co-occur, forming a coherent spectrum of personality and psychopathology. In the current research, the authors developed a novel quantitative model of this spectrum. Over 3 waves of iterative data collection, 1,787 adult participants selected to represent a range across the externalizing spectrum provided extensive data about specific externalizing behaviors. Statistical methods such as item response theory and semiparametric factor analysis were used to model these data. The model and assessment instrument that emerged from the research shows how externalizing phenomena are organized hierarchically and cover a wide range of individual differences. The authors discuss the utility of this model for framing research on the correlates and the etiology of externalizing phenomena. PMID:18020714

  20. Evolving health care through personal genomics.

    PubMed

    Rehm, Heidi L

    2017-04-01

    With the rapid evolution of next-generation DNA sequencing technologies, the cost of sequencing a human genome has plummeted, and genomics has started to pervade health care across all stages of life - from preconception to adult medicine. Challenges to fully embracing genomics in a clinical setting remain, but some approaches are starting to overcome these barriers, such as community-driven data sharing to improve the accuracy and efficiency of applying genomics to patient care.

  1. Demographic Characteristics and Rates of Progress of Deaf and Hard of Hearing Persons Receiving Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Moore, Dennis; McAweeney, Mary

    2007-01-01

    A lack of demographic information and data related to the achievement of short-term goals during substance abuse treatment among persons who are deaf or hard of hearing dictated the need for the study. New York State maintains a database on all individuals who participate in treatment. Within this database, 1.8% of persons in treatment for…

  2. Clinical Characteristics and Staff Training Needs of Two Substance Use Disorder Treatment Programs Specialized for Persons with Disabilities

    ERIC Educational Resources Information Center

    Moore, Dennis; Lorber, Cathy

    2004-01-01

    The clinical aspects and staff training needs for two substance use disorder (SUD) treatment programs that serve persons with co-existing disabilities are described. The article addresses SUD prevalence among persons with disabilities and the corresponding specialized treatment needs and accommodations that may be necessary. The philosophical…

  3. Demographic Characteristics and Rates of Progress of Deaf and Hard of Hearing Persons Receiving Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Moore, Dennis; McAweeney, Mary

    2007-01-01

    A lack of demographic information and data related to the achievement of short-term goals during substance abuse treatment among persons who are deaf or hard of hearing dictated the need for the study. New York State maintains a database on all individuals who participate in treatment. Within this database, 1.8% of persons in treatment for…

  4. HIV risk behaviors in male substance abusers with and without antisocial personality disorder.

    PubMed

    Kelley, J L; Petry, N M

    2000-07-01

    Antisocial personality disorder (ASP) is common in male substance abusers and may be associated with increased human immunodeficiency virus (HIV) risk behaviors. In this study, 91 male substance abusers were recruited from the community, and 42% met diagnostic criteria for ASP. Although ASP and non-ASP subjects demonstrated equivalent knowledge about HIV, subjects with ASP participated in more risky behaviors. On a lifetime measure of drug risk behaviors, ASP subjects reported higher rates of intravenous drug use (IVDU), frequency of needle-sharing, and number of equipment-sharing partners and lower rates of needle-cleaning. On a measure of past-month risk behaviors, ASP subjects reported higher rates of IVDU and lower rates of needle-cleaning. Subjects with ASP also reported greater participation in lifetime sexual risk behaviors, including number of sexual partners and frequency of anal sex. These findings suggest that clients entering substance abuse treatment programs should be screened for ASP, and clients identified with ASP should be provided risk-reduction interventions early in treatment.

  5. Confidentiality protections versus collaborative care in the treatment of substance use disorders

    PubMed Central

    2013-01-01

    Practitioners in federally-assisted substance use disorder (SUD) treatment programs are faced with increasingly complex decisions when addressing patient confidentiality issues. Recent policy changes, intended to make treatment more available and accessible, are having an impact on delivery of SUD treatment in the United States. The addition of electronic health records provides opportunity for more rapid and comprehensive communication between patients’ primary and SUD care providers while promoting a collaborative care environment. This shift toward collaborative care is complicated by the special protections that SUD documentation receives in SUD treatment programs, which vary depending on what care is provided and the setting where the patient is treated. This article explores the special protections for substance abuse documentation, discrepancies in treatment documentation, ways to deal with these issues in clinical practice, and the need for more knowledge about how to harmonize treatment in the SUD and primary care systems. PMID:23972141

  6. Personality traits and career satisfaction of health care professionals.

    PubMed

    Richardson, John D; Lounsbury, John W; Bhaskar, Tripti; Gibson, Lucy W; Drost, Adam W

    2009-01-01

    Based on Holland's theorizing that vocational satisfaction arises from a good match between one's personality and career choice, one purpose of the study was to examine broad and narrow personality traits that characterize health care workers in comparison with professionals from other occupations. Also investigated were ways in which characteristic traits of health care workers were related to career satisfaction. Professionals utilizing the services of eCareerfit.com responded to online surveys that have been demonstrated to produce reliable and valid measures of broad and narrow personality traits and levels of career satisfaction. An independent sample t test was used to compare means of health care workers with those from other occupations. Pearson product-moment correlations were then computed to assess relationships between the traits and career satisfaction of health care professionals. Two traits that were particularly strong among health care workers were also significantly correlated with career satisfaction: work drive and conscientiousness. Other traits were found to be significantly related to career satisfaction in health care but were not uniquely high in the sample of health care professionals. To increase career satisfaction of health care professionals and thus to improve retention rates, administrators should consider focusing on recruiting and selecting individuals with higher levels of key personality traits.

  7. A Training Program for Personal Care Home Aides

    ERIC Educational Resources Information Center

    Ackerman, Shirley; Bradshaw, Barbara R.

    1978-01-01

    This paper describes and analyzes a model demonstration project developed to train family care home operators and personal care home aides. The focus is on skills in using a social-adaptive approach on a multiplicity of levels. Conceptual material, examination of attitudes and values, and introduction of specific skills are major emphases. (Author)

  8. Mexican American Males Providing Personal Care for Their Mothers

    ERIC Educational Resources Information Center

    Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

    2011-01-01

    We know little about Mexican American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a…

  9. Mexican American Males Providing Personal Care for Their Mothers

    ERIC Educational Resources Information Center

    Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

    2011-01-01

    We know little about Mexican American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a…

  10. Intelligence, Feeling, Caring: Some Personal Perceptions.

    ERIC Educational Resources Information Center

    Wrenn, C. Gilbert

    Counselor education had its professional debut in the 20th century. This book is a personal collection of memories, advice, and perceptions of C. Gilbert Wrenn, a pioneer in counselor training. Although the volume is intended for everyone, it is especially aimed at the scores of former Ph.D. students, colleagues, and friends accumulated over the…

  11. Impulsivity as a common process across borderline personality and substance use disorders.

    PubMed

    Bornovalova, Marina A; Lejuez, C W; Daughters, Stacey B; Zachary Rosenthal, M; Lynch, Thomas R

    2005-09-01

    Borderline personality disorder (BPD) is a significant public health problem characterized by persistent problems with emotional, behavioral, cognitive, and interpersonal functioning. Research indicates an especially high rate of comorbidity between BPD and Substance Use Disorders (SUD). In trying to better understand, and therefore improve the assessment, prevention, and treatment of these disorders, researchers have considered the role of impulsivity. Indeed, impulsivity consistently has been shown to be a biologically-based, heritable characteristic with emergent psychological properties linked to the development and maintenance of BPD and SUD. Following from a previous review of the comorbidity between BPD and SUD (Trull, T. J., Sher, K. J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: A review and integration. Clinical Psychology Review, 20, 235-253), the current manuscript revisits the role of impulsivity as a common process across these disorders with a specific focus on the multidimensional nature of impulsivity and its interaction with trait and state negative affectivity.

  12. The economic burden of personality disorders in mental health care.

    PubMed

    Soeteman, Djøra I; Hakkaart-van Roijen, Leona; Verheul, Roel; Busschbach, Jan J V

    2008-02-01

    Some evidence suggests that personality disorders are associated with a high economic burden due to, for example, a high demand on psychiatric, health, and social care services. However, state-of-the-art cost studies for the broad range of personality disorder diagnoses are lacking. The present study examines the direct medical costs, as well as the indirect costs, of patients seeking mental health treatment with DSM-IV personality disorders. The 1740 subjects included in this study were recruited from March 2003 to March 2006 from 6 different mental health care institutes in the Netherlands specializing in the psychotherapeutic treatment of personality disorders. The direct and indirect costs were assessed using the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness. Personality disorders were diagnosed using the Structured Interview for DSM-IV Personality. The mean total costs of the personality disorder group in the 12 months prior to treatment were 11,126 euros per patient. Two thirds (66.5%) of these costs consisted of direct medical costs, while the remaining costs were related to productivity losses. Borderline and obsessive-compulsive personality disorders were uniquely associated with increased mean total costs. Treatment-seeking patients with personality disorders pose a high economic burden on society, a burden substantially higher than that found in, for instance, depression or generalized anxiety disorder. These high societal costs present a strong argument in favor of prioritizing effective personality disorder treatments in reimbursement decisions.

  13. Person-centred care dialectics-Inquired in the context of palliative care.

    PubMed

    Öhlén, Joakim; Reimer-Kirkham, Sheryl; Astle, Barbara; Håkanson, Cecilia; Lee, Joyce; Eriksson, Marjukka; Sawatzky, Richard

    2017-10-01

    Although a widely used concept in health care, person-centred care remains somewhat ambiguous. In the field of palliative care, person-centred care is considered a historically distinct ideal and yet there continues to be a dearth of conceptual clarity. Person-centred care is also challenged by the pull of standardization that characterizes much of health service delivery. The conceptual ambiguity becomes especially problematic in contemporary pluralistic societies, particularly in the light of continued inequities in healthcare access and disparities in health outcomes. Our aim was to explicate premises and underlying assumptions regarding person-centred care in the context of palliative care with an attempt to bridge the apparently competing agendas of individualization versus standardization, and individuals versus populations. By positioning person-centredness in relation to the hermeneutics of the self according to Paul Ricœur, dialectics between individualization and standardization, and between individuals and populations were constructed. The competing agendas were related in a dialectic manner in the way that population health is of importance for the individual, and standardization is of importance for the population. The analysis suggests that person-centred care is an ethical stance, which gives prominence to both suffering and capability of the individual as a person. The dialectic analysis points towards the importance of extending person-centred care to encompass population and societal perspectives and thereby avoiding a problematic tendency of affiliating person-centred care with exclusively individualistic perspectives. Considerations for person-centred palliative care on micro-, meso- and macrolevels conclude the paper. © 2017 John Wiley & Sons Ltd.

  14. A Guide for the Personal Care Attendant: Independent Living with Attendant Care.

    ERIC Educational Resources Information Center

    Board, Mary Ann; And Others

    The first of three booklets on attendant care of severely disabled persons is addressed to the personal care attendants (PCAs). An introductory section reviews the basic concepts of independent living, noting the role of PCAs in promoting independence. Discussions of congenital and acquired disability are followed by information on equipment and…

  15. PHARMACEUTICAL AND PERSONAL CARE PRODUCTS AS UBIQUITOUS POLLUTANTS FROM PERSONAL USE AND ACTIVITIES

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In...

  16. POLLUTION FROM PERSONAL ACTIONS AND ACTIVITIES - PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS)

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  17. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS) AS ENVIRONMENTAL POLLUTANTS: POLLUTION FROM PERSONAL ACTIONS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typicall...

  18. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCP'S) AS ENVIRONMENTAL POLLUTANTS: POLLUTION FROM PERSONAL ACTIONS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  19. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS) AS ENVIRONMENTAL POLLUTANTS: POLLUTION FROM PERSONAL ACTIONS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typicall...

  20. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCP'S) AS ENVIRONMENTAL POLLUTANTS: POLLUTION FROM PERSONAL ACTIONS

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  1. POLLUTION FROM PERSONAL ACTIONS AND ACTIVITIES - PHARMACEUTICALS AND PERSONAL CARE PRODUCTS (PPCPS)

    EPA Science Inventory

    The occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants is a multifaceted issue whose scope of concerns continues to expand. PPCPs comprise thousands of distinct chemicals from numerous therapeutic and consumer classes. They typical...

  2. PHARMACEUTICAL AND PERSONAL CARE PRODUCTS AS UBIQUITOUS POLLUTANTS FROM PERSONAL USE AND ACTIVITIES

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In...

  3. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS AS UBIQUITOUS POLLUTANTS FROM PERSONAL USE AND ACTIVITIES

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In...

  4. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS AS UBIQUITOUS POLLUTANTS FROM PERSONAL USE AND ACTIVITIES

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environment. In...

  5. The person with amputation and their life care plan.

    PubMed

    Meier, Robert H; Choppa, Anthony J; Johnson, Cloie B

    2013-08-01

    This article describes the collaborative relationship between the physiatrist and life care planner/case manager when preparing a life care plan for a person with an amputation. The complexities and interrelationship of physical, emotional, and pain issues require medical expertise and knowledge for the development of prognosis and relevant recommendations. The life care plan requires coordination between medical and rehabilitation professionals to address the impact of amputation and its associated impairment on all life roles.

  6. Personal health care expenditures, by State: 1966-82

    PubMed Central

    Levit, Katharine R.

    1985-01-01

    Spending per capita for health care in the United States varies dramatically by State and region. In 1982, personal health care costs per capita ranged from a low of $857 in South Carolina to a high of $1,508 in Massachusetts. The focus of this article is State and regional variation in spending levels and the mix of health care services purchased. Possible causes for these differences are presented. PMID:10311335

  7. The relationship between medical care costs and personal bankruptcy.

    PubMed

    Brotman, Billie Ann

    2006-01-01

    The number of personal bankruptcy filings has broken records over the last few years. Filings for nonbusiness bankruptcy protection totaled 1,650,279 in 2003, an increase of 9.6 percent between the years 2002 and 2003. This article examines the relationship in the United States between personal bankruptcy filings, and medical care costs and coverage. There seems to be a positive, statistically significant relationship between medical care costs and nonbusiness bankruptcy numbers; however, medical care coverage has limited or no explanatory value as a factor explaining total nonbusiness bankruptcy filings. The regression models suggest a weak or no relationship between the number of nonbusiness bankruptcy filings and health insurance coverage.

  8. Molecular imaging for personalized cancer care.

    PubMed

    Kircher, Moritz F; Hricak, Hedvig; Larson, Steven M

    2012-04-01

    Molecular imaging is rapidly gaining recognition as a tool with the capacity to improve every facet of cancer care. Molecular imaging in oncology can be defined as in vivo characterization and measurement of the key biomolecules and molecularly based events that are fundamental to the malignant state. This article outlines the basic principles of molecular imaging as applied in oncology with both established and emerging techniques. It provides examples of the advantages that current molecular imaging techniques offer for improving clinical cancer care as well as drug development. It also discusses the importance of molecular imaging for the emerging field of theranostics and offers a vision of how molecular imaging may one day be integrated with other diagnostic techniques to dramatically increase the efficiency and effectiveness of cancer care.

  9. Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse.

    PubMed

    Delmonico, R L; Hanley-Peterson, P; Englander, J

    1998-12-01

    Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.

  10. Delineating selection and mediation effects among childhood personality and environmental risk factors in the development of adolescent substance abuse.

    PubMed

    Hicks, Brian M; Johnson, Wendy; Durbin, C Emily; Blonigen, Daniel M; Iacono, William G; McGue, Matt

    2014-01-01

    Utilizing the large, longitudinal Minnesota Twin Family Study (N = 2510; 96 % European American ancestry), we examined the influence of several person-environment transactions on adolescent substance abuse. We focused on the two childhood personality traits found to be most predictive of substance abuse in this sample-socialization (willingness to follow rules and endorse conventional values) and boldness (social engagement and assurance, stress resilience, thrill seeking)-and the environmental variables of antisocial and prosocial peers, academic engagement, parent-child relationship quality, and stressful life events. Path analysis revealed that low socialization had a selection effect for each environmental risk factor, that is, socialization at age 11 predicted environmental risk at age 14, after controlling for the stability of the environmental variables from ages 11 to 14. Antisocial peers and academic engagement at age 14 then mediated some of the risk of low socialization on substance abuse at age 17, but the majority of risk for substance abuse was accounted for by the stability of socialization from age 11 to 14. Boldness at age 11 also increased risk for substance abuse, but did so primarily via a direct effect. The findings help to parse the nature of person-environment transactions across multiple personality traits and contextual risk factors that contribute to adolescent substance abuse.

  11. Delineating Selection and Mediation Effects among Childhood Personality and Environmental Risk Factors in the Development of Adolescent Substance Abuse

    PubMed Central

    Hicks, Brian M.; Johnson, Wendy; Durbin, C. Emily; Blonigen, Daniel M.; Iacono, William G.; McGue, Matt

    2014-01-01

    Utilizing the large, longitudinal Minnesota Twin Family Study (N = 2510; 96% European American ancestry), we examined the influence of several person-environment transactions on adolescent substance abuse. We focused on the two childhood personality traits found to be most predictive of substance abuse in this sample—socialization (willingness to follow rules and endorse conventional values) and boldness (social engagement and assurance, stress resilience, thrill seeking)—and the environmental variables of antisocial and prosocial peers, academic engagement, parent-child relationship quality, and stressful life events. Path analysis revealed that low socialization had a selection effect for each environmental risk factor, that is, socialization at age 11 predicted environmental risk at age 14, after controlling for the stability of the environmental variables from ages 11 to 14. Antisocial peers and academic engagement at age 14 then mediated some of the risk of low socialization on substance abuse at age 17, but the majority of risk for substance abuse was accounted for by the stability of socialization from age 11 to 14. Boldness at age 11 also increased risk for substance abuse, but did so primarily via a direct effect. The findings help to parse the nature of person-environment transactions across multiple personality traits and contextual risk factors that contribute to adolescent substance abuse. PMID:24337735

  12. Co-occurring mental illness, substance use disorders, and antisocial personality disorder among clients of forensic mental health services.

    PubMed

    Ogloff, James R P; Talevski, Diana; Lemphers, Anthea; Wood, Melisa; Simmons, Melanie

    2015-03-01

    Despite the number of studies investigating co-occurring disorders, and more recently, co-occurring disorders and criminal offending, few studies have considered samples from forensic mental health services. The present study was conducted to investigate the relationship between mental illness, substance use disorders, antisocial personality disorder, and offending. The prevalence of co-occurring disorders was investigated in 130 male offenders who had contact with the statewide forensic mental health service in Victoria, Australia. Offense histories and severity of offending were compared among participants diagnosed with a single mental illness (or no mental illness), co-occurring mental illness and substance use, and co-occurring disorders plus antisocial personality disorder. The majority of participants had co-occurring mental and substance use disorders; a significant minority met the criteria for antisocial personality disorder. Participants with co-occurring mental illness and substance use disorders, and those who had an additional diagnosis of antisocial personality disorder, were responsible for more serious and frequent offending than those with mental illness alone. Forensic mental health services must take into account the effect that co-occurring disorders have on clients' functioning and offending. Those who work with people with psychiatric disabilities and co-occurring substance use disorders must ensure that the substance disorders are addressed to help ensure recovery from the mental illness and to reduce the likelihood of offending. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  13. Consumers' Valuation of Primary Care-Based Treatment Options for Mental and Substance Use Disorders.

    PubMed

    Epstein, Andrew J; Barry, Colleen L; Fiellin, David A; Busch, Susan H

    2015-08-01

    Most individuals with substance use disorders and with mental disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. The advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented. However, less is known about consumers' valuation of these options. The authors assessed monetary valuation of these treatment types compared with usual care in a specialty treatment setting. Contingent valuation methods were used in a Web-based randomized vignette experiment that involved 2,146 individuals who screened positive for a drug or alcohol use disorder or a mental disorder. Participants valued a primary care-based treatment visit over usual care in a specialty treatment setting by $9.00 and a collaborative care visit over usual care in a specialty treatment setting by $5.85.

  14. Substance abuse screening and brief intervention for adolescents in primary care.

    PubMed

    Pitts, Sarah; Shrier, Lydia A

    2014-10-01

    Adolescent substance use is common and is associated with serious mental, physical, and social risks, warranting systematic screening in the primary care setting. It is important for clinicians to become familiar with Screening, Brief Intervention, and Referral to Treatment (SBIRT), including administration of validated screening tools to identify level of risk associated with substance use and application of appropriate brief interventions. Positive reinforcement and brief advice is indicated for those adolescents with no or minimal risk for a substance use disorder. Providing a brief intervention using motivational interviewing strategies with subsequent close clinical follow-up is warranted when an adolescent meets criteria for a mild to moderate substance use disorder. Referral to treatment is recommended in cases of severe substance use. Immediate action, including breaking confidentiality, may be necessary when an adolescent's behavior raises acute safety concerns. Making time to interview adolescents alone is essential. It is also important to review the limitations of confidentiality with patients and parents/guardians and offer them strategies to discuss sensitive issues with their adolescents. Available resources for adolescents, parents/guardians, and clinicians regarding the risks of adolescent substance use and evidence-based treatment options can be used to support implementation of SBIRT in adolescent primary care.

  15. Initiation and engagement in chronic disease management care for substance dependence.

    PubMed

    Kim, Theresa W; Saitz, Richard; Cheng, Debbie M; Winter, Michael R; Witas, Julie; Samet, Jeffrey H

    2011-05-01

    Substance dependence treatment is often episodic and not well coordinated with healthcare for common comorbidities. Chronic disease/care management (CDM), longitudinal, patient-centered care delivered by multidisciplinary health professionals, may be well suited to treat substance dependence (SD). To examine initiation and engagement with CDM care for SD located in a primary medical setting. We prospectively studied substance dependent participants enrolled in a trial of CDM addiction care. Primary study outcomes, based upon Washington Circle performance measures, were 14-day initiation of CDM care and 30-day engagement with CDM care. Factors associated with these outcomes were determined using multivariable logistic regression models. We also estimated the proportion of participants who eventually attended at least two visits and four visits by the end of the study (Kaplan-Meier method). Of 282 participants, approximately half of the cohort (45%, 95% Confidence Interval [CI] 39-51%) met criteria for 14-day initiation and 23% (95% CI 18-28%) for 30-day engagement with CDM care. Most participants attended two or more (81%, 95% CI 76-85%) and four or more CDM visits (62%, 95% CI 56-68%). Major depressive episode (AOR 2.60, 95% CI 1.39, 4.87) was associated with higher odds of 14-day initiation; younger age, female sex, and higher alcohol addiction severity were associated with lower odds of 30-day engagement with CDM care. People with SD appear to be willing to initiate and engage with CDM care in a primary medical care setting. CDM care has the potential to improve the quality of care for people with addictions. Copyright © 2010. Published by Elsevier Ireland Ltd.

  16. Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States.

    PubMed

    Hartzler, Bryan; Dombrowski, Julia C; Williams, Jason R; Crane, Heidi M; Eron, Joseph J; Geng, Elvin H; Mathews, Christopher; Mayer, Kenneth H; Moore, Richard D; Mugavero, Michael J; Napravnik, Sonia; Rodriguez, Benigno; Donovan, Dennis M

    2017-06-13

    Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18-29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.

  17. Providing whole-person care: integrating behavioral health into primary care.

    PubMed

    Freeman, Jan Sweet

    2015-01-01

    Integrated primary care in a patient-centered medical home is the best way to invite patients to engage in better self-care, to move from provider-based care to team-based care, and to address whole-person needs. However, primary care-whether rural or urban, public or private-cannot become the default mental health system for North Carolinians with severe mental illness.

  18. Contracting, prompting and reinforcing substance use disorder continuing care.

    PubMed

    Lash, Steven J; Burden, Jennifer L; Parker, Jefferson D; Stephens, Robert S; Budney, Alan J; Horner, Ronnie D; Datta, Santanu; Jeffreys, Amy S; Grambow, Steven C

    2013-04-01

    The contracting, prompting and reinforcing (CPR) aftercare intervention has improved treatment adherence and outcomes in a number of clinical trials. In multisite randomized clinical trial 92 graduates of two intensive substance use disorder programs who received CPR were compared to 91 who received standard treatment (STX). The CPR group evidenced increased frequency of aftercare group therapy attendance and near significant findings suggested that more CPR than STX participants completed 3 months (76 vs. 64%), 6 months (48 vs. 35%), and 9 months (35 vs. 22%) of aftercare. However, the groups did not differ on the majority of attendance measures and had similar abstinence rates at the 3-month (67% CPR vs. 71% STX), 6-month (52% CPR vs. 51% STX), and 12-month (the primary outcome measure; 48% CPR vs. 49% STX) follow-up points. Exploratory analyses suggest that CPR might be more effective among participants not required to attend aftercare. The incremental capital and labor cost of CPR compared to STX was $98.25 per participant.

  19. Psycho-education for substance use and antisocial personality disorder: a randomized trial.

    PubMed

    Thylstrup, Birgitte; Schrøder, Sidsel; Hesse, Morten

    2015-11-14

    Antisocial personality disorder often co-exists with drug and alcohol use disorders. This trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n = 96) delivered by site clinicians (n = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure. Overall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score (p = .018) and in PDA (p = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up. Moderate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder. ISRCTN registry, ISRCTN67266318 , 17/7/2012.

  20. Substance use disorders: Recent advances in treatment and models of care.

    PubMed

    Abou-Saleh, Mohammed T

    2006-09-01

    Drug and alcohol misuse is a global health problem with great health economic costs to substance misusers, their families, and their communities. It is associated with high physical and psychiatric morbidity, and with high mortality. There are serious obstacles to its treatment, including the stigma associated with it. Major advances in assessment and treatment have enabled health professionals to tackle drug and alcohol problems in a variety of settings, including primary care setting. This overview focuses on recent advances in the treatment of substance use disorders and on optimal models of care and services, with reference to studies conducted in the United Arab Emirates. Community surveys in Dubai and Al-Ain have shown a high prevalence of these disorders. It is proposed that these problems be dealt with in primary care settings, and it has been found that primary health care workers have a key role to play and are often in an ideal position to coordinate the community's response.

  1. Public managed care and service access in outpatient substance abuse treatment units.

    PubMed

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey A

    2011-10-01

    The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment.

  2. Evidence-Based Care of the Patient with Borderline Personality Disorder.

    PubMed

    Antai-Otong, Deborah

    2016-06-01

    Borderline personality disorder (BPD) is a complex, serious, and high-cost psychiatric disorder. The high prevalence of patients with BPD and co-occurring depression, eating disorders, and substance-use disorders in primary care and mental health settings contribute to their high use of resources in these practice settings. Regardless of treatment challenges associated with BPD, researchers suggest a more positive outlook in the treatment of this complex psychiatric condition. This article focuses on areas in which nurses can strengthen their understanding of underpinnings and multimodal approaches, assess the patient's immediate needs, and manage distressful emotional states and impulsivity.

  3. Psychosocial care of persons with severe burns.

    PubMed

    Blakeney, Patricia E; Rosenberg, Laura; Rosenberg, Marta; Faber, A W

    2008-06-01

    Treatment of people with burn injuries includes recovery of optimal function for survivors to fully participate in society, psychologically and physically. Increased likelihood of physical survival has led to greater concern for potential psychological morbidity for the burn survivor. Based on research and on many years of clinical experience in providing psychosocial care to burned children and adults, the authors outline their approach to assisting burn survivors and their families through the arduous process of recovery from admission through critical care, inpatient recuperation and reintegration upon hospital discharge. A philosophy of rehabilitation, a process that may occur for many months or years after patients' discharge from their acute hospitalization, is presented in the form of seven guidelines for working with burn survivors.

  4. A Two Year Longitudinal Outcome Study of Addicted Health Care Professionals: An Investigation of the Role of Personality Variables

    PubMed Central

    Angres, Daniel; Bologeorges, Stephanie; Chou, Jessica

    2013-01-01

    The co-morbidity of personality disorders (PDs) and other dysregulatory personality patterns with addiction have been well-established, although few studies have examined this interplay on long-term sobriety outcome. In addition, health care professionals suffering from addiction have both a significant public health impact and a unique set of treatment and recovery challenges. The aim of this study was to investigate if personality variables differentiated sobriety outcome in this population over a two year interval. A clinical sample of health care professionals participated in a substance abuse hospital treatment program individually tailored with respect to personality. Participants took the Temperament and Character Inventory and the Millon Clinical Multiaxial Inventory at intake, and were tracked two years post-discharge to determine sobriety status. Univariate analyses showed antisocial personality, female gender, and alcohol dependence were independent predictors of relapse, however a significant relationship between personality and substance use did not exist in multivariate analysis when controlling for demographic variables The lack of multivariate relationships demonstrates the heterogeneity in self-report measures of personality, which suggests the interplay of personality and addiction is complex and individualized. PMID:23531922

  5. Appropriate medical care for persons in detention.

    PubMed

    Idris, I

    2003-03-01

    The people who are in detention are screened by the Medical Officer of the Prison and if they are found to be unwell, these prisoners will be accommodated in the sickbay and medical treatment will be provided. If their sickness needs further investigations and management, they will be sent to the Government Hospital. If the prisoners are found to have infectious or contagious diseases, steps will be taken to prevent the spread of these diseases to other prisoners in the prison. Prisoners are given time to exercise to maintain good health and their clothing are regularly washed to make sure that they will not contract skin diseases, e.g. scabies, ringworm, etc. The Prison Department since 1989 has increasing numbers of HIV positive prisoners. The Department complies with this problem by sending staff for courses, lectures and seminars so that they will be able to handle these prisoners more efficiently in the prison. When these HIV/AIDS prisoners' condition turns bad, they are usually transferred to a Government Hospital. Another of the Prison Department's prominent medical problem among the prisoners is drug addiction. Staff trained with skill and techniques are counselors for the drug related prisoners. Realizing and in anticipation that the sickbays in the prisons are going to be full of HIV/AIDS prisoners and drug related prisoners, special attention will be given to more allocation to upgrade the sickbays in the prison. White attires will be provided to the sick prisoners in the sickbays so that they will look neat and clean. More doctors, medical assistants and nurses will be employed so that appropriate medical care or rather more appropriate medical care can be provided to the sick prisoners in the prisons. The Prison Department is in the process of privatizing medical care for prisoners in the prison and the Department is also trying to convert some prisons to be medical prisons so that adequate medical care can be given to the sick prisoners.

  6. Ability of Substance Abusers to Escape Detection on the Minnesota Multiphasic Personality Inventory–Adolescent (MMPI-A) in a Juvenile Correctional Facility

    PubMed Central

    Stein, L. A. R.; Graham, John R.

    2010-01-01

    The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once under instructions to fake good (FG). Under SI, substance scales correctly classified about 60% to 85% of adolescents. Under FG, substance- and non-substance-abusing juveniles produced lower scores on substance scales. However, the Lie Scale (L) was able to detect more than 75% of deceptive profiles and about 77% of honest profiles. When scale L and the best substance scale were used in combination, only about 18% of faking substance abusers were not identified as either substance abusers or as underreporting. For feigning substance abusers, only about 10% of substance abusers were detected, with about 72% being categorized as faking and needing further assessment. PMID:15695741

  7. Is Personality Associated with Health Care Use by Older Adults?

    PubMed Central

    Friedman, Bruce; Veazie, Peter J; Chapman, Benjamin P; Manning, Willard G; Duberstein, Paul R

    2013-01-01

    Context The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults’ use of acute and long-term care services. Methods Data were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the “Big Five” personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations. Findings Our hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services—probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users—but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits. Conclusions Personality traits are associated with Medicare beneficiaries’ use of many expensive health care services, findings that have implications for health services research and

  8. Is personality associated with health care use by older adults?

    PubMed

    Friedman, Bruce; Veazie, Peter J; Chapman, Benjamin P; Manning, Willard G; Duberstein, Paul R

    2013-09-01

    The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults' use of acute and long-term care services. Data were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the "Big Five" personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations. Our hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services-probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users-but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits. Personality traits are associated with Medicare beneficiaries' use of many expensive health care services, findings that have implications for health services research and policy. Accordingly, person-centered interventions

  9. Further evidence of self-medication: personality factors influencing drug choice in substance use disorders.

    PubMed

    McKernan, Lindsey Colman; Nash, Michael R; Gottdiener, William H; Anderson, Scott E; Lambert, Warren E; Carr, Erika R

    2015-06-01

    According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and

  10. ADH1A variation predisposes to personality traits and substance dependence.

    PubMed

    Zuo, Lingjun; Gelernter, Joel; Kranzler, Henry R; Stein, Murray B; Zhang, Huiping; Wei, Feng; Sen, Srijan; Poling, James; Luo, Xingguang

    2010-03-05

    Human personality traits are strong predictors or characteristics of many psychiatric disorders including substance dependence (SD). Recently, significant associations between alcohol dehydrogenase type 1A gene (ADH1A) and SD have been reported, which led us to investigate the impact of ADH1A variation on personality traits and risk of SD. Five hundred fifty-eight subjects with SD [398 European-Americans (EAs) and 160 African-Americans (AAs)], 517 college students (384 EAs and 133 European-origin Hispanics), and 448 healthy subjects (385 EAs, 48 AAs, and 15 European-origin Hispanics) participated. Personality traits were assessed in 247 subjects with SD (179 EAs and 68 AAs), all 517 college students, and 332 healthy subjects (285 EAs, 40 AAs, and 7 European-origin Hispanics). The relationships between ADH1A and personality traits were comprehensively examined using stepwise multivariate analysis of covariance (MANCOVA), and then decomposed by stepwise analysis of covariance (ANCOVA). The relationship between ADH1A and SD was examined using stepwise logistic regression analysis. Admixture effects on analyses were considered. Overall, Agreeableness and Conscientiousness were associated with the diplotypes, haplotypes, genotypes, and/or alleles of ADH1A in three of four phenotype groups including EA SD subjects, healthy subjects, and AA SD subjects (1.7 x 10(-4) personality traits and SD.

  11. ADH1A variation predisposes to personality traits and substance dependence

    PubMed Central

    Zuo, Lingjun; Gelernter, Joel; Kranzler, Henry R.; Stein, Murray B.; Zhang, Huiping; Wei, Feng; Sen, Srijan; Poling, James; Luo, Xingguang

    2010-01-01

    Background Human personality traits are strong predictors or characteristics of many psychiatric disorders including substance dependence (SD). Recently, significant associations between ADH1A and SD have been reported, which led us to investigate the impact of ADH1A variation on personality traits and risk of SD. Methods Five hundred fifty-eight subjects with SD [398 European-Americans (EAs) and 160 African-Americans (AAs)], 517 college students (384 EAs and 133 European-origin Hispanics) and 448 healthy subjects (385 EAs, 48 AAs and 15 European-origin Hispanics) participated. Personality traits were assessed in 247 subjects with SD (179 EAs and 68 AAs), all 517 college students, and 332 healthy subjects (285 EAs, 40 AAs and 7 European-origin Hispanics). The relationships between ADH1A and personality traits were comprehensively examined using stepwise multivariate analysis of covariance (MANCOVA), and then decomposed by stepwise analysis of covariance (ANCOVA). The relationship between ADH1A and SD was examined using stepwise logistic regression analysis. Admixture effects on analyses were considered. Results Overall, Agreeableness and Conscientiousness were associated with the diplotypes, haplotypes, genotypes and/or alleles of ADH1A in three of four phenotype groups including European-American SD subjects, healthy subjects, and African-American SD subjects (1.7×10-4≤p≤0.055), but not college students. Neuroticism was associated with diplotype, haplotypes and genotypes in African-American SD subjects (0.001≤p≤0.031). In addition, SD was associated with diplotypes, haplotypes, genotypes and/or alleles of ADH1A (0.008≤p≤0.060). Conclusions The present study demonstrates that the ADH1A variation may contribute to the genetic component of variation in personality traits and SD. PMID:19526455

  12. Readiness to Change in Adolescents Screening Positive for Substance Use in Urban Primary Care Clinics

    ERIC Educational Resources Information Center

    Stevens, Jack; McGeehan, Jennifer; Kelleher, Kelly J.

    2010-01-01

    Primary care physicians often perceive patients as unlikely to decrease their substance use and suggest this reluctance to change diminishes their willingness to screen and intervene. The literature on readiness to change has primarily focused on adults, and the available studies on adolescents have largely included hospitalized and/or…

  13. Fostering Humane Care of Dying Persons in Long-Term Care. Guidebook for Staff Development Instructors.

    ERIC Educational Resources Information Center

    Wilson, Sarah A.; Daley, Barbara

    This guide is intended for staff development instructors responsible for inservice education on the topic of fostering humane care for dying persons in long-term care. The introduction discusses the guide's development based on input from administrators, staff, and families of residents in long-term care facilities and focus group interviews in…

  14. Do Personality Traits Moderate the Impact of Care Receipt on End-of-Life Care Planning?

    ERIC Educational Resources Information Center

    Ha, Jung-Hwa; Pai, Manacy

    2012-01-01

    Purpose of the Study: This study examines (a) the association between being a care recipient and end-of-life care planning (EOLCP) and (b) the extent to which personality traits moderate the relationship between care receipt and EOLCP. Design and Methods: Data are drawn from the Wisconsin Longitudinal Study, a survey of Wisconsin high school…

  15. Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening.

    PubMed

    Dawson-Rose, Carol; Draughon, Jessica E; Zepf, Roland; Cuca, Yvette P; Huang, Emily; Freeborn, Kellie; Lum, Paula J

    Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3 months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p < .001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed.

  16. Decision support system based semantic web for personalized patient care.

    PubMed

    Douali, Nassim; De Roo, Jos; Jaulent, Marie-Christine

    2012-01-01

    Personalized medicine may be considered an extension of traditional approaches to understanding and treating diseases, but with greater precision. A profile of a patient's genetic variation can guide the selection of drugs or treatment protocols that minimize harmful side effects or ensure a more successful outcome. In this paper we describe a decision support system designed to assist physicians for personalized care, and methodology for integration in the clinical workflow. A reasoning method for interacting heterogeneous knowledge and data is a necessity in the context of personalized medicine. Development of clinical decision support based semantic web for personalized patient care is to achieve its potential and improve the quality, safety and efficiency of healthcare.

  17. Paradoxes of Personal Responsibility in Mental Health Care.

    PubMed

    Lakeman, Richard

    2016-12-01

    Personal responsibility is widely considered important in mental health recovery as well as in popular models of alcohol and drug treatment. Neo-liberal socio-political rhetoric around consumerism in health care often assumes that people are informed and responsible for their own choices and behaviour. In the mental health care context and especially in emergency or crisis settings, personal responsibility often raises particular paradoxes. People often present whose behaviour does not conform to the ideals of the responsible consumer; they may seek and/or be granted absolution from irresponsible behaviour. This paradox is explored and clinicians are urged to consider the context-bound nature of personal responsibility and how attributions of personal responsibility may conflict with policy and their own professional responsibilities to intervene to protect others.

  18. A Practical Clinical Trial of Coordinated Care Management to Treat Substance Use Disorders among Public Assistance Beneficiaries

    ERIC Educational Resources Information Center

    Morgenstern, Jon; Hogue, Aaron; Dauber, Sarah; Dasaro, Christopher; McKay, James R.

    2009-01-01

    This study tested whether coordinated care management (CCM), a continuity of care intervention for substance use disorders (SUD), improved rates of abstinence when compared with usual welfare management for substance-using single adults and adults with dependent children applying for public assistance. The study was designed as a practical…

  19. A Practical Clinical Trial of Coordinated Care Management to Treat Substance Use Disorders among Public Assistance Beneficiaries

    ERIC Educational Resources Information Center

    Morgenstern, Jon; Hogue, Aaron; Dauber, Sarah; Dasaro, Christopher; McKay, James R.

    2009-01-01

    This study tested whether coordinated care management (CCM), a continuity of care intervention for substance use disorders (SUD), improved rates of abstinence when compared with usual welfare management for substance-using single adults and adults with dependent children applying for public assistance. The study was designed as a practical…

  20. The personal impact of home-care nursing: an alternative perspective to home-care satisfaction.

    PubMed

    Porter, Eileen J

    2008-04-01

    In this phenomenological study, I aimed to describe the personal impact of home-care nursing and to compare the findings to domains of the construct of home-care satisfaction (HCS). I report data from interviews with 11 women (ages 82 to 96) who had home-care nurses during a 3-year period. None of the women mentioned satisfaction, but when asked about their nurses, they shared memorable incidents exemplifying how home-care nursing was relevant to their personal goals. Using a previously developed descriptive phenomenological method, I discerned this feature of personal-social context (or life-world) as the main finding: Being Aware of What Stands Out for Me About Having a Nurse at Home. This main finding had six descriptors, including Sensing that the Nurse Knows How to Do What Nurses Do and Linking the Nurse's Help to Sustaining Myself Here. I compared the findings to domains of HCS on three parameters, including evaluation of satisfaction versus relevance of nursing activities. I concluded that compared with satisfaction with home care, the personal impact of home-care nursing was a more basic interest to the women and that the perceived relevance of nursing activities is an important standard for appraising that impact. I recommend that researchers use phenomenological methods to discern life-world descriptors of the personal impact of home-care nursing and use those descriptors to develop indicators to measure the personal impact of home-care nursing.

  1. The relationship between parenting types and older adolescents' personality, academic achievement, adjustment, and substance use.

    PubMed

    Weiss, L H; Schwarz, J C

    1996-10-01

    The purpose of the present study was to examine Baumrind's T3 conceptual framework using a multiple informant design and an older adolescent population. With 178 college students and their families as participants, the present study found many of the predicted relations between parents' child-rearing style (Authoritative, Democratic, Nondirective, Nonauthoritarian-Directive, Authoritarian-Directive, and Unengaged) and their adolescent children's behavior in the 4 domains assessed: personality, adjustment, academic achievement, and substance use. The differences between parenting types on the criterion measures were not as large as reported in Baumrind's study, and significant effects were predominantly due to the poor scores from children with Unengaged and Authoritarian-Directive parents. The results are discussed in terms of their implications for the Authoritative parenting type, the utility of using a typology, and areas for future research.

  2. Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders.

    PubMed

    Schindler, Andreas; Sack, Peter-Michael

    2015-11-01

    Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.

  3. Trajectories of personal control in cancer patients receiving psychological care.

    PubMed

    Zhu, Lei; Schroevers, Maya J; van der Lee, Marije; Garssen, Bert; Stewart, Roy E; Sanderman, Robbert; Ranchor, Adelita V

    2015-05-01

    This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns of psychological symptoms between trajectories. This naturalistic study focused on 241 cancer patients receiving psychological care at psycho-oncology institutions. Data were collected before the initiation of psychological care, and 3 and 9 months thereafter. Latent class growth analysis was applied to identify personal control trajectories. Three personal control trajectories were identified: enduring improvement (41%), temporary improvement (50%), and deterioration (9%). Education and baseline physical symptoms distinguished these trajectories. In the whole group, improvements in personal control were associated with improvements in psychological symptoms. Patients at distinct trajectories reported different levels of psychological symptoms, but did not differ in their courses of psychological symptoms. Patients in the enduring and temporary control improvement groups experienced significant psychological symptoms reductions over time, whereas patients in the control deterioration group maintained high psychological symptoms. Improvements in personal control seem to depend on initial control level: those who start with the highest control levels show subsequent improvements, whereas those with the lowest control levels show subsequent deterioration. Copyright © 2014 John Wiley & Sons, Ltd.

  4. Female families' experiences of caring for persons with schizophrenia.

    PubMed

    Mizuno, Eriko; Takataya, Kumiko; Kamizawa, Naotoshi; Sakai, Ikue; Yamazaki, Yoko

    2013-04-01

    The caring experiences of female families of persons with schizophrenia were described through exploring the families' descriptions of their experiences. Focus group interviews were conducted with 11 family caregivers. According to content analysis, the experiences revealed five major themes: early family experiences, family perceptions of illness and relatives with schizophrenia, family burden and suffering, family attitudes toward relatives with schizophrenia, and family thoughts about society and mental health resources. Also, the families had strength to overcome considerable adversity. It is needed for professionals to listen to family caregivers' narratives carefully and improve the support by focusing on accepting their experiences and histories with persons with schizophrenia.

  5. The future of highly personalized health care.

    PubMed

    Robson, Barry; Garnier, Jean

    2002-01-01

    We can surely lean well towards the optimistic in envisioning health care. In the world 10-25 years ahead of us. This optimism is based on rapid developments in genomics, the essential basis of molecular medicine, and on advances in computer power. At the time of writing this paper, the Human Genome Project was planned to have a working draft by 2000 and indeed completion was announced on June 26th from Washington. This paper describes the situation and vision at that time. Though there has been much subsequent more thought about the influence of genomics on healthcare, the aspirations and visions have not fundamentally changed from those of 2000, except for the greater attention to practical details that comes from increased confidence in the practicality of the vision.

  6. Time ethics for persons with dementia in care homes.

    PubMed

    Egede-Nissen, Veslemøy; Jakobsen, Rita; Sellevold, Gerd S; Sørlie, Venke

    2013-02-01

    The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological-hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients.

  7. The financial hazard of personalized medicine and supportive care.

    PubMed

    Carrera, Pricivel M; Olver, Ian

    2015-12-01

    Personalized medicine is revolutionizing the delivery of oncological care, promising benefits both at the patient and health system levels. The cost of targeted therapies, unfortunately, is becoming more expensive and unaffordable. Where supportive care in cancer concerns the prevention and management of the adverse effects of cancer and its treatment and is the thrust of the Multinational Association of Supportive Care in Cancer, financing of and value in personalized medicine is an important area of research and engagement for the association. Discussing patients' concerns with and identifying those at most risk for the financial hazard of cancer treatment and offering financial counseling and assistance and/or referral to support networks are potential key areas for (exploring and providing) better supportive care. The time is now to turn the concern of patients and their carers, providers, and other advocates regarding the affordability of cancer treatment into a collective cause towards coordinated action.

  8. Mexican-American Males Providing Personal Care for their Mothers

    PubMed Central

    Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

    2011-01-01

    We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act “against taboo”; and this approach is a new way to fulfill family obligations. PMID:21643486

  9. PHARMACEUTICAL AND PERSONAL CARE PRODUCTS IN ...

    EPA Pesticide Factsheets

    There is no abstract available for this product. If further information is requested, please refer to the bibliographic citation and contact the person listed under Contact field. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subtask 1: To integrate state-of-the-art technologies (polar organic chemical integrative samplers, advanced solid-phase extraction methodologies with liquid chromatography/electrospray/mass spectrometry) and apply them to studying the sources and fate of a select list of PPCPs. Application and improvement of analytical methodologies that can detect non-volatile, polar, water-soluble pharmaceuticals in source waters at levels that could be environmentally significant (at concentrations less than parts per billion, ppb). IAG with USGS ends in FY05. APM 20 due in FY05.Subtask 2: Coordination of interagency research and public outreach activities for PPCPs. Participate on NSTC Health and Environment subcommittee working group on PPCPs. Web site maintenance and expansion, invited technical presentations, invited articles for peer-reviewed journals, interviews for media, responding to public inquiries. S

  10. Training substance abuse treatment staff to care for co-occurring disorders.

    PubMed

    Hunter, Sarah B; Watkins, Katherine E; Wenzel, Suzanne; Gilmore, Jim; Sheehe, John; Griffin, Belle

    2005-04-01

    Although co-occurring disorders have been associated with poorer substance abuse treatment outcomes and higher costs of care, few individuals with co-occurring disorders receive appropriate mental health care. This article describes the design and implementation of an intervention to improve the quality of mental health care provided in outpatient substance abuse treatment programs without requiring new treatment staff. The intervention focuses on individuals with affective and anxiety disorders and consists of three components: training and supervising staff, educating and activating clients, and linking with community resources. We evaluated three treatment programs (one intervention and two comparison) for the first component by having program staff complete both self-administered questionnaires and semistructured interviews. Staff knowledge and attitudes about co-occurring disorders, job satisfaction, and morale all indicated an improvement at the intervention relative to the comparison sites. The evaluation is still under way; results for implementation of the other two components and for outcomes will be reported later.

  11. Personal care satisfaction among aged and physically disabled Medicaid beneficiaries.

    PubMed

    Khatutsky, Galina; Anderson, Wayne L; Wiener, Joshua M

    2006-01-01

    We analyzed survey data from 2,325 Medicaid home and community-based services (HCBS) beneficiaries in six States to estimate satisfaction with personal care services. We constructed an eight-item scale rating various aspects of paid assistance and estimated satisfaction for the total sample and for older and younger persons with disabilities. Younger persons with significant health problems and those residing in group settings were less satisfied. Higher unmet need for assistance with activities of daily living (ADLs), and instrumental activities of daily living (IADLs) was associated with decreased satisfaction, and matching race between a client and paid caregiver was associated with significantly increased satisfaction in all age groups.

  12. Home care of the ventilator-dependent person.

    PubMed

    Gilmartin, M; Make, B

    1983-11-01

    Discharge of the ventilator-dependent person from a hospital requires careful advance planning by hospital personnel and rehabilitation of the patient to assure maximal functional ability in the home. The patient and family should be taught the techniques necessary for both routine and emergency care in the home. Respiratory equipment, including the type of mechanical ventilator best suited to the patient's needs and the home environment, and disposable supplies must be obtained, and payment from third-party payers must be assured. Equipment placement and the ability of the patient to perform self-care and activities of daily living following discharge can be facilitated by integrating results of a home care evaluation into the patient's rehabilitation program. Trips of gradually longer duration out of the hospital allow the patient to gain confidence in his ability to care for himself. Responsibilities for follow-up in the home can be shared by respiratory home care companies, visiting nurses, and pulmonary physicians.

  13. Personal care assistants' experiences of caring for people on home mechanical ventilation.

    PubMed

    Israelsson-Skogsberg, Åsa; Lindahl, Berit

    2017-03-01

    The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations. © 2016 Nordic College of Caring Science.

  14. The Standardized Assessment of Personality-Abbreviated Scale as a screening instrument for personality disorders in substance-dependent criminal offenders.

    PubMed

    Jansen, Brigitte P M; Damen, Katinka F M; Hoffman, Tonko O; Vellema, Sietske L

    2013-05-01

    Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted.

  15. Impact of a formulary on personal care homes in Manitoba.

    PubMed Central

    Yakabowich, M R; Keeley, G; Montgomery, P R

    1994-01-01

    OBJECTIVE: To assess the impact of a formulary on drug expenditures and prescribing trends in personal care homes (nursing homes). DESIGN: Quasi-experimental analysis of a drug prescription database before and after implementation of the formulary. SETTING: Personal care homes in Manitoba. PATIENTS: Residents occupying the 6848 beds of the 88 personal care homes that did not already have a formulary. INTERVENTION: Formulary, introduced Apr. 1, 1987. MAIN OUTCOME MEASURES: Drug expenditures from Apr. 1, 1985, to Mar. 31, 1990; proportion of residents receiving a prescription by drug class and rate of prescriptions of nonformulary drugs in the year before and 2 years after the formulary was introduced. MAIN RESULTS: The total drug expenditures per bed remained constant during the first year after the formulary was implemented, even though the annual drug inflation rate was 9.8% on average during the study period. Expenditures 2 and 3 years after implementation rose by 9.4% and 5.8% respectively. Those for specific agents and drug classes targeted as being inappropriate for long-term care decreased greatly because of reduced prescribing. Expenditures for some other drug classes increased mainly because newer, more expensive agents were used. The mean drug expenditure per bed varied widely between homes; neither size nor location were found to correlate with drug expenditure, but adherence to the formulary did predict personal care homes with decreased expenditures. CONCLUSIONS: A formulary in personal care homes can improve therapeutic management. The impact on cost containment was not as strong after the first year, although expenditures remained less than the rate of inflation for drug costs. PMID:8174030

  16. Person-Centered Care Practices in Long-Term Care in the Deep South.

    PubMed

    Jacobs, M Lindsey; Snow, A Lynn; Parmelee, Patricia A; Davis, Jullet A

    2016-04-01

    The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.

  17. Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users

    PubMed Central

    Masferrer, Laura; Caparrós, Beatriz

    2017-01-01

    Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of “Risk of suicide”. Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD. PMID:28335530

  18. Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users.

    PubMed

    Masferrer, Laura; Caparrós, Beatriz

    2017-03-20

    Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of "Risk of suicide". Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD.

  19. Perceptions of an Adapted Mindfulness Program for Persons Experiencing Substance Use Disorders and Traumatic Brain Injury.

    PubMed

    Kristofersson, Gisli K; Beckers, Tom; Krueger, Rick

    Of the 1.4 million Americans who sustain traumatic brain injuries (TBIs) each year up to half experience substance use disorders (SUDs). This often leads to various issues such as increased rates of mental health problems and delay or lack of return to full employment. The purpose of this program evaluation was to describe Vinland National Center's (Vinland's) client and staff perceptions of a 4-week mindfulness-based intervention adapted from the original mindfulness-based stress reduction program for persons experiencing SUDs and TBIs. It focused on the possible relevance and applicability of mindfulness practice for this population. Four focus groups were conducted based on Krueger's methods in conducting focus groups: two with Vinland staff members and two focus groups with residents. The analysis of staff focus groups revealed general staff satisfactions with the intervention. A general consensus was that the mindfulness intervention fitted well with the needs of Vinland's clients and their current program. Client feedback further revealed general satisfaction with the mindfulness curriculum. No adverse effects were noted related to the mindfulness intervention. The results of this program evaluation suggest that implementing a mindfulness-based intervention for persons experiencing SUDs/TBIs warrants further investigation.

  20. Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: results from a national telephone household probability sample.

    PubMed

    McCauley, Jenna L; Kilpatrick, Dean G; Walsh, Kate; Resnick, Heidi S

    2013-04-01

    To examine post-rape substance use, associated post rape medical and social concern variables, and past year substance abuse among women reporting having received medical care following a most recent or only lifetime incident of rape. Using a subsample of women who received post-rape medical care following a most recent or only rape incident (n=104) drawn from a national household probability sample of U.S. women, the current study described the extent of peritraumatic substance use, past year substance misuse behaviors, post-rape HIV and pregnancy concerns, and lifetime mental health service utilization as a function of substance use at time of incident. One-third (33%) of women seeking post-rape medical attention reported consuming alcohol or drugs at the time of their rape incident. Nearly one in four (24.7%) and one in seven (15%) women seeking medical attention following their most recent rape incident endorsed drug (marijuana, illicit, non-medical use of prescription drugs, or club drug) use or met substance abuse criteria, respectively, in the past year. One in twelve (8.4%) women reported at least monthly binge drinking in the past year. Approximately two-thirds of women reported seeking services for mental health needs in their lifetime. Post-rape concerns among women reporting peritraumatic substance use were not significantly different from those of women not reporting such use. Substance use was reported by approximately one-third of women and past year substance abuse was common among those seeking post-rape medical care. Implications for service delivery, intervention implementation, and future research are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: Results from a national telephone household probability sample

    PubMed Central

    McCauley, Jenna L.; Kilpatrick, Dean G.; Walsh, Kate; Resnick, Heidi S.

    2013-01-01

    Objective To examine post-rape substance use, associated post rape medical and social concern variables, and past year substance abuse among women reporting having received medical care following a most recent or only lifetime incident of rape. Method Using a subsample of women who received post-rape medical care following a most recent or only rape incident (n=104) drawn from a national household probability sample of U.S. women, the current study described the extent of peritraumatic substance use, past year substance misuse behaviors, post-rape HIV and pregnancy concerns, and lifetime mental health service utilization as a function of substance use at time of incident. Results One-third (33%) of women seeking post-rape medical attention reported consuming alcohol or drugs at the time of their rape incident. Nearly one in four (24.7%) and one in seven (15%) women seeking medical attention following their most recent rape incident endorsed drug (marijuana, illicit, non-medical use of prescription drugs, or club drug) use or met substance abuse criteria, respectively, in the past year. One in twelve (8.4%) women reported at least monthly binge drinking in the past year. Approximately two-thirds of women reported seeking services for mental health needs in their lifetime. Post-rape concerns among women reporting peritraumatic substance use were not significantly different from those of women not reporting such use. Conclusions Substance use was reported by approximately one-third of women and past year substance abuse was common among those seeking post-rape medical care. Implications for service delivery, intervention implementation, and future research are discussed. PMID:23380490

  2. Alcohol-Dependent Subjects Show Different Personality Traits Compared With Subjects With Multiple Substance Dependence: Preliminary Data.

    PubMed

    Koller, Gabi; Preuss, Ullrich; Lü, Osman; Soyka, Michael; Pogarell, Oliver

    2015-01-01

    We compared personality traits of 27 persons with multiple substance dependence with personality data of 52 alcohol-dependent persons regarding their personality traits and disorders (obtained by using SCID-II, TCI and NEO FFI). Both patient groups were free of any other mental disorder. In SKD-II, we found significant differences in the male group in dependent and scizotypic personality disorder. There were no significant differences in the female group, but sample was very small. We also found significant differences between alcohol-dependent and multiple substance-dependent persons in extraversion and novelty seeking. We detected significant differences in personality disorders evaluated by SCID-II. Temperament and character items—as evaluated by NEO FFI and TCI—showed also significant differences in personality traits. Given the limited number of subjects, the data should be regarded as preliminary until replicated in a larger sample. Nevertheless, the findings may be of clinical relevance with respect to prognosis or individualized treatment. These findings should be treated with caution until replicated.

  3. Evaluating personal health care and health promotion web sites.

    PubMed

    Lang, J R; Collen, A

    2005-01-01

    An exemplary sample of web sites relevant to personal health care and health promotion was chosen and evaluated. Both quantitative and qualitative data were converged to assess and rank the sites on nine attributes. The sites provided a definitive range of value and variety of presentations, health care and health promotion information, and services covering the virtual choices currently available to users of the Internet. Discussion focused on methodological approaches and issues of web site evaluation serving the public interest, health care, and health promotion.

  4. Promoting personalization in social care services for older people.

    PubMed

    Xie, Chengqiu; Hughes, Jane; Sutcliffe, Caroline; Chester, Helen; Challis, David

    2012-01-01

    This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.

  5. The association between personal care products and lung function.

    PubMed

    Dales, Robert E; Cakmak, Sabit; Leech, Judith; Liu, Ling

    2013-02-01

    Chemical exposures are important determinants of respiratory health. The objective of the present study was to determine the association between the use of personal care products, which may contain respirable components, and lung function. Using questionnaire and spirometry data collected during the Canadian Health Measures population survey, the association was tested between 1-second forced expiratory volume (FEV(l)) and forced vital capacity (FVC) expressed as a percentage of predicted, and the frequency of use of personal care products categorized as eye makeup, fragrances, hairstyle products, lipstick, and scented body products. Five thousand sixteen of the 5604 participants in the survey reported using at least one personal care product in the past 3 months. Among men and women, an interquartile increase in hairstyle products was associated with an approximate 2% decrease in both FEV(1) and FVC (P < .05). Among women, each product category was associated with a significant decrease in lung function with the largest observed effect being a 4.08% (95% confidence interval, 7.71-0.45) decrease in FVC associated with an interquartile range increase in the frequency of use of scented body products. This study provides data suggesting that using personal care products may have a small adverse effect on lung function. Further research is warranted to investigate this possibility. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  6. [Refusal of personal hygiene care and nursing responsibility].

    PubMed

    Peyé, Anne

    2013-03-01

    Situations of patients refusing personal hygiene care are frequent. Sources of difficulties and questioning for caregivers, they can lead to maltreatment. In order to avoid this pitfall, it is essential to support the teams in their approach around representations of caregiving and nursing responsibility.

  7. 42 CFR 440.167 - Personal care services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... with intellectual disabilities, or institution for mental disease that are— (1) Authorized for...

  8. Up Close and Personal: Theorising Care Work in Adult Education

    ERIC Educational Resources Information Center

    John, Vaughn M.

    2016-01-01

    How do we account for the close personal bonds and deeply caring relationships forged by educators with learners in many adult educational encounters? The literature is relatively silent on the emotional and relational basis to adult educator work. This is a serious silence, given the stressful nature of adult education in developing contexts such…

  9. Up Close and Personal: Theorising Care Work in Adult Education

    ERIC Educational Resources Information Center

    John, Vaughn M.

    2016-01-01

    How do we account for the close personal bonds and deeply caring relationships forged by educators with learners in many adult educational encounters? The literature is relatively silent on the emotional and relational basis to adult educator work. This is a serious silence, given the stressful nature of adult education in developing contexts such…

  10. Interpersonal Complexity: A Cognitive Component of Person-Centered Care

    ERIC Educational Resources Information Center

    Medvene, Louis; Grosch, Kerry; Swink, Nathan

    2006-01-01

    Purpose: This study concerns one component of the ability to provide person-centered care: the cognitive skill of perceiving others in relatively complex terms. This study tested the effectiveness of a social motivation for increasing the number of psychological constructs used to describe an unfamiliar senior citizen. Design and Methods:…

  11. Personal Care Services Utilization by Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Harrington, Charlene; Kang, Taewoon

    2010-01-01

    This study examined factors associated with the use of personal care services (PCS) and the amount of authorized hours in California in 2004-2005. Of those Medicaid-eligible individuals with developmental disabilities living at home, 31% received PCS. When we controlled for client need, gender, and age, individuals who were Asian/Pacific…

  12. Selecting Students with Personal Characteristics Relevant to Pharmaceutical Care.

    ERIC Educational Resources Information Center

    Wright, Sandra S.; Miederhoff, Patrick A.

    1999-01-01

    Proposes that pharmacy schools incorporate formal assessments of self-reported empathy in the admissions process to assess personal qualities necessary for patient counseling and other aspects of pharmaceutical care. Comparison of two approaches to measuring self-reported empathy (forced-choice format, direct self-ratings) found the first more…

  13. Selecting Students with Personal Characteristics Relevant to Pharmaceutical Care.

    ERIC Educational Resources Information Center

    Wright, Sandra S.; Miederhoff, Patrick A.

    1999-01-01

    Proposes that pharmacy schools incorporate formal assessments of self-reported empathy in the admissions process to assess personal qualities necessary for patient counseling and other aspects of pharmaceutical care. Comparison of two approaches to measuring self-reported empathy (forced-choice format, direct self-ratings) found the first more…

  14. Person-centred care: Principle of Nursing Practice D.

    PubMed

    Manley, Kim; Hills, Val; Marriot, Sheila

    This is the fifth article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. This article discusses Principle D, the provision of person-centred care.

  15. Antisocial personality disorder in Turkish substance dependent patients and its relationship with anxiety, depression and a history of childhood abuse.

    PubMed

    Evren, Cuneyt; Kural, Sevil; Erkiran, Murat

    2006-01-01

    The prevalence of antisocial personality disorder (ASPD) in treatment-seeking Turkish substance dependent patients and the relationship of ASPD with clinical characteristics were studied. Participants were 132 inpatients with substance dependence according to the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. The clinician applied a semi-structured socio-demographic form, SCID-I, SCID-II, Childhood Abuse and Neglect Questionnaire (CANQ), Michigan Alcoholism Screening Test (MAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Among the 132 substance dependent patients, 31 (23.5%) had ASPD diagnosis and 56 (42.4%) had no personality disorder or personality traits. Rate of childhood physical abuse, childhood verbal abuse, childhood neglect, suicide attempt history, self-destructive behavior and lifetime major depression were higher among patients with ASPD. Also mean scores of BDI, BAI and MAST were higher among patients with ASPD. The high rate of ASPD found among Turkish substance dependent patients suggests that special attention must be paid to identify ASPD in this group. Findings in this study showed that there is an association between ASPD and childhood abuse, lifetime major depression and severity of substance use.

  16. The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures

    PubMed Central

    Musich, Shirley; Wang, Shaohung; Hawkins, Kevin

    2016-01-01

    Abstract The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management. PMID:26871762

  17. Perspectives and strategies of alternative methods used in the risk assessment of personal care products.

    PubMed

    Quantin, P; Thélu, A; Catoire, S; Ficheux, H

    2015-11-01

    Risk assessment for personal care products requires the use of alternative methods since animal testing is now totally banned. Some of these methods are effective and have been validated by the "European Union Reference Laboratory for alternatives to animal testing"; but there is still a need for development and implementation of methods for specific endpoints. In this review, we have focused on dermal risk assessment because it is the prime route of absorption and main target organ for personal care products. Within this field, various areas must be assessed: irritation, sensitisation and toxicokinetic. Personal care product behaviour after use by the consumer and potential effects on the environment are also discussed. The purpose of this review is to show evolution and the prospects of alternative methods for safety dermal assessment. Assessment strategies must be adapted to the different chemical classes of substances studied but also to the way in which they are used. Finally, experimental and theoretical technical parameters that may impact on measured effects have been identified and discussed.

  18. Michigan Health Care Costs Review. Personal Health Care Expenditures, 1966-1981. Number 1.

    ERIC Educational Resources Information Center

    Michigan State Office of Health and Medical Affairs, Lansing.

    Data are presented describing expenditures for personal health services in Michigan from 1977 to 1981. The rapid growth in expenditures is illustrated, as well as the rates of growth in expenditures, for major categories of health services. Personal health expenditures are defined as payments for care directly provided to patients: specifically,…

  19. Feasibility and Acceptability of an Audio Computer-Assisted Self-Interview Version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in Primary Care Patients

    PubMed Central

    Spear, Suzanne E.; Shedlin, Michele; Gilberti, Brian; Fiellin, Maya; McNeely, Jennifer

    2016-01-01

    Background This study explores the feasibility and acceptability of a computer self-administered approach to substance use screening from the perspective of primary care patients. Methods Forty-eight patients from a large safety net hospital in New York City completed an audio computer-assisted self-interview (ACASI) version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and a qualitative interview to assess feasibility and acceptability; comprehension; comfort with screening questions; and preferences for screening mode (interviewer or computer). Qualitative data analysis organized the participants’ feedback into major themes. Results Participants overwhelmingly reported being comfortable with the ACASI ASSIST. Mean administration time was 5.2 minutes (range 1.6 – 14.8). The major themes from the qualitative interviews were 1) ACASI ASSIST is feasible and acceptable to patients, 2) Social stigma around substance use is a barrier to patient disclosure, and 3) ACASI screening should not preclude personal interaction with providers. Conclusions The ACASI ASSIST is an appropriate and feasible approach to substance use screening in primary care. Because of the highly sensitive nature of substance use, screening tools must explain the purpose of screening, assure patients that their privacy is protected, and inform patients of the opportunity to discuss their screening results with their provider. PMID:26158798

  20. Managed care and technical efficiency in outpatient substance abuse treatment units.

    PubMed

    Alexander, J A; Wheeler, J R; Nahra, T A; Lemak, C H

    1998-11-01

    This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.

  1. The Relation Between Antisocial and Borderline Personality Symptoms and Early Maladaptive Schemas in a Treatment Seeking Sample of Male Substance Users

    PubMed Central

    Shorey, Ryan C.; Anderson, Scott; Stuart, Gregory L.

    2014-01-01

    Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non-substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment (n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. PMID:23650153

  2. Outcomes for medicaid clients with substance abuse problems before and after managed care.

    PubMed

    McFarland, Bentson H; Deck, Dennis D; McCamant, Lynn E; Gabriel, Roy M; Bigelow, Douglas A

    2005-01-01

    Medicaid conversion from fee for service to managed care raised numerous questions about outcomes for substance abuse treatment clients. For example, managed care criticisms include concerns that clients will be undertreated (with too short and/or insufficiently intense services). Also of interest are potential variations in outcome for clients served by organizations with assorted financial arrangements such as for-profit status versus not-for-profit status. In addition, little information is available about the impact of state Medicaid managed care policies (including client eligibility) on treatment outcomes. Subjects of this project were Medicaid clients aged 18-64 years enrolled in the Oregon Health Plan during 1994 (before substance abuse treatment managed care, N = 1751) or 1996-1997 (after managed care, N = 14,813), who were admitted to outpatient non-methadone chemical dependency treatment services. Outcome measures were retention in treatment for 90 days or more, completion of a treatment program, abstinence at discharge, and readmission to treatment. With the exception of readmission, there were no notable differences in outcomes between the fee for service era clients versus those in capitated chemical dependency treatment. There were at most minor differences among various managed care systems (such as for-profit vs not-for-profit). However, duration of Medicaid eligibility was a powerful predictor of positive outcomes. Medicaid managed care does not appear to have had an adverse impact on outcomes for clients with substance abuse problems. On the other hand, state policies influencing Medicaid enrollment may have substantial impact on chemical dependency treatment outcomes.

  3. Too frightened to care? Accounts by district nurses working with clients who misuse substances.

    PubMed

    Peckover, Sue; Chidlaw, Robert G

    2007-05-01

    Drug misusers have complex health and social care needs, and experience considerable difficulties in accessing the assessment, care and treatment that they require. Despite the development of specialist services in many parts of the UK, substance misuse is often marginalised within mainstream general healthcare, and many practitioners are unprepared for the challenges of working with this client group. The present paper reports findings from a qualitative study that aimed to explore district nurses' understandings and practices in relation to discrimination and inequalities issues. The research took place during 2003 in two city-based primary care trusts in the North of England. Semistructured interviews were undertaken with 18 'G' grade district nurses. The authors present findings that highlight some of the challenges and tensions district nurses encounter when providing care to clients who misuse substances. The discourses of 'prejudice' and 'risk' were intertwined throughout the data, and served to shape service provision for clients who misuse substances. This was reflected in the district nurses' accounts of their own practice and that of other services, suggesting that these clients receive suboptimal care. The discourse of 'risk' was also used by district nurses to construct themselves as 'vulnerable', and this helped to explain some of their own practices of care provision. Many participants acknowledged their limited knowledge and experience of working with this client group. There is an urgent need for district nurses and other health professionals to develop their practice with these clients, who may present as both vulnerable and dangerous, in order to ensure that care is provided equitably and safely.

  4. Health Care and Mortality among Persons with Severe Mental Illness.

    PubMed

    Gal, Gilad; Munitz, Hanan; Levav, Itzhak

    2017-04-01

    Reports show disparities in the health care of persons with severe mental illness (SMI), including in countries with universal health insurance. However, the moderating effect on disparities of specific mental health legislation is yet to be studied. The study aimed to investigate equality of health care for people with SMI in a country with a national health insurance and a comprehensive rehabilitation law for persons with mental disabilities. A case-control epidemiological study compared health services (laboratory tests, visits to specialists, and medications) provided to users with and without a history of schizophrenia and bipolar disorder ( N = 52,131) and with regard to a subgroup of users with diabetes ( n = 16,280). In addition, we examined the mortality rates of the study population. While service users with schizophrenia were somewhat less likely to meet the same indexes of care as controls, those with bipolar disorder did not differ from their counterparts. Yet, mortality risk among service users with schizophrenia and bipolar disorder was 2.4 and 1.7 times higher, respectively. Rates of services to persons with SMI and comorbid diabetes did not differ from their counterparts. In Israel, a country with a national health insurance and a rehabilitation law for persons with mental disabilities, service users with bipolar disorder receive equitable levels of general health care. For users with schizophrenia, the disparities exist in some of the health care measures but to a smaller extent than in other countries with universal health insurance. In contrast, mortality rates are elevated in persons with SMI.

  5. The Ability of Individuals with Psychoactive Substance Use Disorders to Escape Detection by the Personality Assessment Inventory.

    ERIC Educational Resources Information Center

    Fals-Stewart, William

    1996-01-01

    The ability of individuals with psychoactive substance use disorders to dissimulate successfully on the Personality Assessment Inventory (PAI) was evaluated with 236 adults from treatment, nonclinical, control, and forensically referred groups. Findings indicate that the PAI scales measuring drug and alcohol problems are susceptible to…

  6. Criminal recidivism in offenders with personality disorders and substance use disorders over 8 years of time at risk.

    PubMed

    Walter, Marc; Wiesbeck, Gerhard A; Dittmann, Volker; Graf, Marc

    2011-04-30

    Personality disorders (PD) and substance use disorders (SUD) lead to high violent criminality. The influence of co-morbidity on recidivism remains unclear. Recidivism of 379 offenders was assessed at 8 years of follow-up. Sixty-nine percent of PD+SUD, 45% of SUD- and 33% of PD- subjects showed any recidivism. However, violent recidivism was highest in the PD- group.

  7. The Ability of Individuals with Psychoactive Substance Use Disorders to Escape Detection by the Personality Assessment Inventory.

    ERIC Educational Resources Information Center

    Fals-Stewart, William

    1996-01-01

    The ability of individuals with psychoactive substance use disorders to dissimulate successfully on the Personality Assessment Inventory (PAI) was evaluated with 236 adults from treatment, nonclinical, control, and forensically referred groups. Findings indicate that the PAI scales measuring drug and alcohol problems are susceptible to…

  8. Personality Correlates of the Common and Unique Variance across Conduct Disorder and Substance Misuse Symptoms in Adolescence

    ERIC Educational Resources Information Center

    Castellanos-Ryan, Natalie; Conrod, Patricia J.

    2011-01-01

    Externalising behaviours such as substance misuse (SM) and conduct disorder (CD) symptoms highly co-ocurr in adolescence. While disinhibited personality traits have been consistently linked to externalising behaviours there is evidence that these traits may relate differentially to SM and CD. The current study aimed to assess whether this was the…

  9. Personality Correlates of the Common and Unique Variance across Conduct Disorder and Substance Misuse Symptoms in Adolescence

    ERIC Educational Resources Information Center

    Castellanos-Ryan, Natalie; Conrod, Patricia J.

    2011-01-01

    Externalising behaviours such as substance misuse (SM) and conduct disorder (CD) symptoms highly co-ocurr in adolescence. While disinhibited personality traits have been consistently linked to externalising behaviours there is evidence that these traits may relate differentially to SM and CD. The current study aimed to assess whether this was the…

  10. Internalized stigma among patients with substance use disorders at a tertiary care center in India.

    PubMed

    Sarkar, Siddharth; Balhara, Yatan Pal Singh; Kumar, Saurabh; Saini, Vinay; Kamran, Akriti; Patil, Vaibhav; Singh, Swarndeep; Gyawali, Shreeya

    2017-09-12

    Internalized stigma among individuals with substance use disorders is a major barrier for accessing mental health services. This study aimed to assess internalized stigma among individuals with substance use disorders and to assess the relationship of internalized stigma with the quality of life. This cross-sectional study recruited 201 patients with a clinical diagnosis of at least opioid or alcohol use disorder according to Diagnostic and Statistical Manual 5 at a public-funded tertiary care center in India. The study participants were interviewed using a sociodemographic questionnaire, the Internalized Stigma of Mental Illness Scale (ISMIS), and the World Health Organization's Quality of Life (WHOQOL-Bref) questionnaire. Seven participants (3.5% of the sample) had mild stigma according to ISMI scores, 62 (30.8%) had moderate stigma, and 132 (65.7%) had severe stigma. The various quality-of-life domains generally had a negative correlation with the internalized stigma scores. Participants using opioids as the primary substance of use were more likely to have severe internalized stigma. The experience of internalized stigma and dissatisfaction with quality of life is quite high among people suffering with substance use disorders in India. These results emphasize the need for interventions to reduce internal perception of stigma and improve the quality of life of individuals with substance use disorders.

  11. Ability of Substance Abusers to Escape Detection on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) in a Juvenile Correctional Facility

    ERIC Educational Resources Information Center

    Stein, L. A. R.; Graham, John R.

    2005-01-01

    The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once…

  12. Ability of Substance Abusers to Escape Detection on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) in a Juvenile Correctional Facility

    ERIC Educational Resources Information Center

    Stein, L. A. R.; Graham, John R.

    2005-01-01

    The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once…

  13. Substance abuse In Middle Eastern adolescents living in two different countries: spiritual, cultural, family and personal factors.

    PubMed

    Badr, Lina Kurdahi; Taha, Asma; Dee, Vivien

    2014-08-01

    It is estimated that the percentage of students using illicit substances by sixth grade has tripled over the last decade not only in developed countries but in developing countries as well probably due to the transition to a more Western society. Although much has been done to understand the mechanisms underlying substance abuse, few studies have been conducted with minority ethnic and religious groups such as Middle Eastern Youth. The primary goal of this study was to determine whether there are differences in factors contributing to substance abuse in adolescents from Lebanon versus the U.S.A. and to decipher the role of spirituality, religion, and culture among other factors that may influence substance abuse. A correlational cross-sectional design was used with adolescents living in two different countries: Los Angeles, California and Beirut, Lebanon. Muslim adolescents had significantly less rates of alcohol and substance use than Christians in both Lebanon and Los Angeles. More years lived in the U.S.A. increases the likelihood of abuse for both Muslims and Christians. Attachment to God and family was negatively associated with substance abuse. These results among others facilitate a better understanding of the influence of culture, religion, family and personal factors on substance abuse. Culturally sensitive interventions could benefit from the findings of this pilot study.

  14. Fostering person-centered care among nursing students: creative pedagogical approaches to developing personal knowing.

    PubMed

    Schwind, Jasna K; Beanlands, Heather; Lapum, Jennifer; Romaniuk, Daria; Fredericks, Suzanne; LeGrow, Karen; Edwards, Susanna; McCay, Elizabeth; Crosby, Jamie

    2014-06-01

    Person-centered care (PCC) is grounded in principles of respect, autonomy, and empowerment and requires the development of interpersonal relationships. For nursing students to engage in PCC, they need to intentionally develop personal knowing, which is an essential attribute of therapeutic relationships. Developing personal knowing, as well as professional knowledge, positions students to enact PCC in their practice. Faculty members play a vital role in fostering the development of personal knowing by creating opportunities for students in which genuine and respectful dialogue, reflection, self-awareness, and critical thinking can take place. This article explores several creative approaches faculty have used to actualize these qualities in their teaching-learning encounters with nursing students at various stages of their students' professional development. These approaches offer experiential teaching-learning opportunities that foster the development of personal knowing, as well as constructive and respectful relationships between faculty and students, therefore laying the groundwork for PCC in practice settings.

  15. Making fair decisions about financing care for persons with AIDS.

    PubMed Central

    Roper, W L; Winkenwerder, W

    1988-01-01

    An estimated 40 percent of the nation's 55,000 persons with acquired immunodeficiency syndrome (AIDS) have received care under the Medicaid Program, which is administered by the Health Care Financing Administration (HCFA) and funded jointly by the Federal Government and the States. In fiscal year 1988, Medicaid will spend between $700 and $750 million for AIDS care and treatment. Medicaid spending on AIDS is likely to reach $2.4 billion by fiscal year 1992, an estimate that does not include costs of treatment with zidovudine (AZT). Four policy principles are proposed for meeting this new cost burden in a way that is fair, responsive, efficient, and in harmony with our current joint public-private system of health care financing. The four guidelines are to (a) treat AIDS as any other serious disease, without the creation of a disease-specific entitlement program; (b) bring AIDS treatment financing into the mainstream of the health care financing system, making it a shared responsibility and promoting initiatives such as high-risk insurance pools: (c) give States the flexibility to meet local needs, including Medicaid home care and community-based care services waivers; (d) encourage health care professionals to meet their obligation to care for AIDS patients. PMID:3131823

  16. Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

    PubMed

    Chan, Ya-Fen; Lu, Shou-En; Howe, Bill; Tieben, Hendrik; Hoeft, Theresa; Unützer, Jürgen

    2016-02-01

    Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. This was an observational study using patient registry. The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.

  17. End-of-Life Care Policies in Flemish Residential Care Facilities Accommodating Persons with Intellectual Disabilities

    ERIC Educational Resources Information Center

    D'Haene, I.; Pasman, H. R. W.; Deliens, L.; Bilsen, J.; Mortier, F.; Stichele, R. Vander

    2010-01-01

    Objective: This article aims to describe the presence, content and implementation strategies of written policies on end-of-life decisions in Flemish residential care facilities (RCFs) accommodating persons with intellectual disabilities (ID), and to describe training, education and quality assessments of end-of-life care. Methods: A…

  18. End-of-Life Care Policies in Flemish Residential Care Facilities Accommodating Persons with Intellectual Disabilities

    ERIC Educational Resources Information Center

    D'Haene, I.; Pasman, H. R. W.; Deliens, L.; Bilsen, J.; Mortier, F.; Stichele, R. Vander

    2010-01-01

    Objective: This article aims to describe the presence, content and implementation strategies of written policies on end-of-life decisions in Flemish residential care facilities (RCFs) accommodating persons with intellectual disabilities (ID), and to describe training, education and quality assessments of end-of-life care. Methods: A…

  19. Personal Health Care of Residents: Preferences for Care outside of the Training Institution

    ERIC Educational Resources Information Center

    Dunn, Laura B.; Moutier, Christine; Hammond, Katherine A. Green; Lehrmann, Jon; Roberts, Laura Weiss

    2008-01-01

    Objective: The personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy. Methods: A self-report survey was distributed in 2000-2001…

  20. Personal Health Care of Residents: Preferences for Care outside of the Training Institution

    ERIC Educational Resources Information Center

    Dunn, Laura B.; Moutier, Christine; Hammond, Katherine A. Green; Lehrmann, Jon; Roberts, Laura Weiss

    2008-01-01

    Objective: The personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy. Methods: A self-report survey was distributed in 2000-2001…

  1. The relation between antisocial and borderline personality symptoms and early maladaptive schemas in a treatment seeking sample of male substance users.

    PubMed

    Shorey, Ryan C; Anderson, Scott; Stuart, Gregory L

    2014-01-01

    Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non-substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment (n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. Antisocial (ASPD) and Borderline (BPD) personality disorder symptoms are prevalence among individuals seeking substance abuse treatment. Early maladaptive schemas are believed to underlie the development of ASPD and BPD symptoms, and are also prevalence among individuals seeking substance use treatment. Findings from the current study suggest that specific early maladaptive schema domains predict ASPD and BPD symptoms in a substance abuse treatment seeking sample of adult males. The treatment of ASPD and BPD among men seeking substance use treatment may want to focus on early maladaptive schemas. Copyright © 2013 John Wiley & Sons, Ltd.

  2. Abuse experiences, substance use, and reproductive health in women seeking care at an emergency department.

    PubMed

    Sutherland, Melissa A; Fantasia, Heidi Collins; McClain, Natalie

    2013-07-01

    Abuse experiences can have negative health consequences for women. Many women present to the emergency department for episodic, nonemergent care and may have unique needs as survivors of abuse. The purpose of this study was to describe child sexual abuse experiences, intimate partner violence, substance use, and reproductive health outcomes in a sample of adult women who were seeking care from a rural emergency department to better understand the health care needs of this unique population. One hundred forty-five adult women (18-45 years old) were recruited at an emergency department in the southeastern United States. Questionnaires were used to assess for demographic characteristics, history of child sexual abuse (CSA), intimate partner violence, reproductive health, and substance use. In the sample, 42.8% of women (n = 62) reported a positive history of CSA and 34.7% of women (n = 49) experienced intimate partner physical violence during the past year. More than 46% of the women (n = 65) had harmful drinking patterns in the past year and more than 50% reported some type of substance use in the past 3 months. Women who experienced CSA had a significantly greater number of lifetime sexual partners, were more likely to report pain with sexual intercourse, and were more likely to report a medical history of an abnormal Papanicolaou smear. The women in this sample had high rates of abuse, harmful drinking patterns, and substance use and were at risk for sexually transmitted infections. Through screening for lifetime violence, including sexual violence, emergency nurses can be an important liaison between women who have experienced CSA and appropriate referrals within the health care system. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  3. Substance abuse and personality disorder comorbidity in adolescent outpatients: are girls more severely ill than boys?

    PubMed

    Korsgaard, Hans Ole; Torgersen, Svenn; Wentzel-Larsen, Tore; Ulberg, Randi

    2016-01-01

    Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender. The sample consisted of 153 adolescents, aged 14-17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality. 18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD. We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and

  4. Oregon's transition to a managed care model for Medicaid-funded substance abuse treatment: steamrolling the glass menagerie.

    PubMed

    D'Ambrosio, Ryan; Mondeaux, Frank; Gabriel, Roy M; Laws, Katherine E

    2003-05-01

    The approval of a Health Care Financing Administration (now called Centers for Medicare and Medicaid Services) 1115 Medicaid waiver in Oregon allowed the state to design and implement an expanded publicly funded health care system, the Oregon Health Plan (OHP). Integral to OHP is the administration of physical and behavioral health services, including outpatient substance abuse treatment, through contracted managed care organizations. The two overarching changes to the outpatient substance abuse treatment system were expanded Medicaid eligibility and new operating procedures for the outpatient substance abuse treatment system. The authors used grounded theory to examine the effects of this transition on the treatment system, with an emphasis on the experiences of treatment providers.

  5. Clinical Utility of the Cross-Cultural (Chinese) Personality Assessment Inventory (CPAI-2) in the Assessment of Substance Use Disorders among Chinese Men

    ERIC Educational Resources Information Center

    Cheung, Fanny M.; Cheung, Shu Fai; Leung, Freedom

    2008-01-01

    This study examined the clinical utility of the Cross-Cultural (Chinese) Personality Inventory (CPAI-2) in differentiating the personality characteristics of Chinese men with substance use disorders from other psychiatric patients and normal control participants. The CPAI-2 profile of 121 Chinese men with substance use disorders was contrasted…

  6. Personal recovery in individuals diagnosed with substance use disorder (SUD) and co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

    PubMed

    Kronenberg, Linda M; Verkerk-Tamminga, Roeliene; Goossens, Peter J J; van den Brink, Wim; van Achterberg, Theo

    2015-08-01

    The process of personal recovery in people diagnosed with substance use disorder and comorbid attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) was mapped. Four general themes representing four consecutive stages in the recovery process were identified in both client groups: (1) crisis and diagnosis; (2) dealing with agitation, symptoms, and burden; (3) reorganization of life; and (4) meaningful life. However, the personal recovery outcomes and the need for support were different for the two clients groups. Based on these findings, mental health nurses can offer recovery supporting care tailored to the challenging needs of these clients. For the SUD+ADHD group, overall, a coaching attitude is preferred. For the SUD+ASD group, overall, instructional, supportive and directive attitude is needed. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42

    ERIC Educational Resources Information Center

    Sacks, Stanley; Ries, Richard K.

    2005-01-01

    This Treatment Improvement Protocol (TIP) provides guidelines for counselors and others working in the field of co-occurring substance use and mental disorders. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content…

  8. Substance Abuse Treatment for Persons with Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2005

    2005-01-01

    Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS), are best-practice guidelines for the treatment of substance use disorders. CSAT draws on the experience…

  9. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT: POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS

    EPA Science Inventory



    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environ...

  10. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT: POLLUTION FROM PERSONAL ACTIONS, ACTIVITIES, AND BEHAVIORS

    EPA Science Inventory



    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPS) in the environment highlights the immediate, intimate, and inseparable connection between the individual activities of consumers and their environ...

  11. Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization

    PubMed Central

    Campbell, Cynthia I.; Chi, Felicia; Sterling, Stacy; Kohn, Carolyn; Weisner, Constance

    2009-01-01

    Purpose Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation could compromise other SU abstinence. This study examines self-initiated tobacco cessation and 12-month alcohol and drug abstinence in adolescents entering SU treatment in a private, managed care organization. Results Self-initiated tobacco cessation at 6 months, and at both 6 and 12 months, were related to higher odds of drug abstinence but not alcohol abstinence. Conclusion Self-initiated tobacco cessation was not related to poor SU outcomes, and may be important to maintaining drug abstinence. Implementing tobacco cessation efforts in SU treatment can be challenging, but comprised SU outcomes may not be a barrier. The positive associations for drug abstinence and lack of associations for alcohol abstinence could be due to differences in motivation, medical conditions, or to the illicit nature of drug use. Tobacco use has serious long-term health consequences, and tobacco cessation efforts in adolescent SU treatment programs need further research. PMID:19010600

  12. Characteristics of private-sector managed care for mental health and substance abuse treatment.

    PubMed

    Garnick, D W; Hendricks, A M; Dulski, J D; Thorpe, K E; Horgan, C

    1994-12-01

    This study examined diversity during the late 1980s in managed care programs for mental health, alcohol abuse, and drug abuse to identify ways in which research can generate more meaningful data on the effectiveness of utilization review programs. Telephone interviews were conducted with representatives of utilization review programs for employee health insurance plans in 31 firms that employed 2.1 million people in 1990. Questions addressed qualifications of personnel, clinical criteria to authorize care, integration with employee assistance plans, penalties for not complying with utilization review procedures, outpatient review, and carve out of mental health and substance abuse review. Large variations in utilization review programs were found. Programs employed a range of review personnel and used a variety of clinical criteria to authorize care. More than two-thirds did not carve out mental health and substance abuse review from medical-surgical review. Some firms' employee assistance plans were integrated with utilization review programs, while others remained unintegrated. Penalties for not following program procedures varied widely, as did review of outpatient services. Because of trends toward even more diversity in utilization review programs in the 1990s, research that identifies the specific features of managed care programs that hold most promise for controlling costs while maintaining quality of care will increasingly be needed.

  13. Cleanser, Detergent, Personal Care Product, and Pretreatment Evaluation

    NASA Technical Reports Server (NTRS)

    Adam, Niklas; Carrier, Chris; Vega, Leticia; Casteel, Michael; Verostko, chuck; Pickering, Karen

    2011-01-01

    The purpose of the Cleanser, Detergent, Personal Care Product, and Pretreatment Evaluation & Selection task is to identify the optimal combination of personal hygiene products, crew activities, and pretreatment strategies to provide the crew with sustainable life support practices and a comfortable habitat. Minimal energy, mass, and crew time inputs are desired to recycle wastewater during long duration missions. This document will provide a brief background on the work this past year supporting the ELS Distillation Comparison Test, issues regarding use of the hygiene products originally chosen for the test, methods and results used to select alternative products, and lessons learned from testing.

  14. Noncontingent reinforcement of disruptive behaviors in personal care home settings.

    PubMed

    Yury, Craig A

    2013-06-01

    The purpose of this case study was to examine the potential of using noncontingent reinforcement (NCR) to reduce the frequency of disruptive behaviors of three elderly persons in personal care home (PCH) settings. Assessment indicated that participants were engaging in the disruptive behaviors to obtain social attention from PCH staff. Social attention, up to 1 min of staff making eye contact with the participant and directing positive verbal statements toward the participant, was given on a fixed time interval (from morning through early evening) beginning every 20 min and fading to every 30 min. Results indicate that NCR reduced the frequency of the disruptive behaviors.

  15. Infrastructure for Personalized Medicine at Partners HealthCare

    PubMed Central

    Weiss, Scott T.; Shin, Meini Sumbada

    2016-01-01

    Partners HealthCare Personalized Medicine (PPM) is a center within the Partners HealthCare system (founded by Massachusetts General Hospital and Brigham and Women’s Hospital) whose mission is to utilize genetics and genomics to improve the care of patients in a cost effective manner. PPM consists of five interconnected components: (1) Laboratory for Molecular Medicine (LMM), a CLIA laboratory performing genetic testing for patients world-wide; (2) Translational Genomics Core (TGC), a core laboratory providing genomic platforms for Partners investigators; (3) Partners Biobank, a biobank of samples (DNA, plasma and serum) for 50,000 Consented Partners patients; (4) Biobank Portal, an IT infrastructure and viewer to bring together genotypes, samples, phenotypes (validated diagnoses, radiology, and clinical chemistry) from the electronic medical record to Partners investigators. These components are united by (5) a common IT system that brings researchers, clinicians, and patients together for optimal research and patient care. PMID:26927187

  16. Person-centered care and speech and language therapy.

    PubMed

    DiLollo, Anthony; Favreau, Christin

    2010-05-01

    Person-centered care (PCC) has become the foundation for practice in many areas of health care provision. Research has suggested that providing PCC may improve therapy outcomes, client satisfaction, and perceived quality of care, as well as address aspects of evidence-based practice. As members of the health care provider community, speech-language pathologists (SLPs) will be expected to provide PCC as part of their therapeutic interactions. Some research, however, has indicated that SLPs have a tendency to provide more structured, task-oriented therapies. In this article, a working definition of PCC is described, along with a pilot study designed to investigate the use of PCC by student SLP clinicians. Results from this study indicated no increase in the use of PCC as student clinicians gained clinical experience and suggested that current approaches to clinical supervision and grading may play a role in reducing the amount of PCC provided by student clinicians. Thieme Medical Publishers.

  17. Externalizing pathology and the five-factor model: a meta-analysis of personality traits associated with antisocial personality disorder, substance use disorder, and their co-occurrence.

    PubMed

    Ruiz, Mark A; Pincus, Aaron L; Schinka, John A

    2008-08-01

    In this meta-analysis we examined Five-Factor Model of personality (FFM) characteristics of externalizing disorders. Two pathologies, Antisocial Personality Disorder (APD) and Substance Use Disorder (SUD), have significant levels of co-occurrence that may be due to shared personality traits. Results from 63 samples (N = 15,331) were analyzed in order to summarize and compare five-factor results for APD, SUD, and co-occurring APD/SUD. Shared and unique personality features were identified at both the domain and the facet level of the FFM. Moderation analyses indicated that sample source (clinical versus community) and diagnosis (psychopathy versus DSM-based APD) accounted for some of the variability at the domain level. Results are discussed with respect to personality and externalizing disorders.

  18. Linking "big" personality traits to anxiety, depressive, and substance use disorders: a meta-analysis.

    PubMed

    Kotov, Roman; Gamez, Wakiza; Schmidt, Frank; Watson, David

    2010-09-01

    We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66 meta-analyses. The review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1,076 to 75,229). All diagnostic groups were high on neuroticism (mean Cohen's d = 1.65) and low on conscientiousness (mean d = -1.01). Many disorders also showed low extraversion, with the largest effect sizes for dysthymic disorder (d = -1.47) and social phobia (d = -1.31). Disinhibition was linked to only a few conditions, including SUD (d = 0.72). Finally, agreeableness and openness were largely unrelated to the analyzed diagnoses. Two conditions showed particularly distinct profiles: SUD, which was less related to neuroticism but more elevated on disinhibition and disagreeableness, and specific phobia, which displayed weaker links to all traits. Moderator analyses indicated that epidemiologic samples produced smaller effects than patient samples and that Eysenck's inventories showed weaker associations than NEO scales. In sum, we found that common mental disorders are strongly linked to personality and have similar trait profiles. Neuroticism was the strongest correlate across the board, but several other traits showed substantial effects independent of neuroticism. Greater attention to these constructs can significantly benefit psychopathology research and clinical practice.

  19. Personal care workers in Australian aged care: retention and turnover intentions.

    PubMed

    Radford, Katrina; Shacklock, Kate; Bradley, Graham

    2015-07-01

    This study examined factors influencing personal care workers' intentions to stay or leave Australian aged care employment - especially for older workers. Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation. © 2013 John Wiley & Sons Ltd.

  20. Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable.

    PubMed

    David, Sean P; Johnson, Samuel G; Berger, Adam C; Feero, W Gregory; Terry, Sharon F; Green, Larry A; Phillips, Robert L; Ginsburg, Geoffrey S

    2015-01-01

    Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system.

  1. Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable

    PubMed Central

    David, Sean P.; Johnson, Samuel G.; Berger, Adam C.; Feero, W. Gregory; Terry, Sharon F.; Green, Larry A.; Phillips, Robert L.; Ginsburg, Geoffrey S.

    2015-01-01

    Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system. PMID:26195686

  2. Alexithymia is not a stable personality trait in patients with substance use disorders.

    PubMed

    de Haan, Hein; Joosten, Evelien; Wijdeveld, Toon; Boswinkel, Peter; van der Palen, Job; De Jong, Cor

    2012-06-30

    The construct of alexithymia as a vulnerability factor for substance use disorders (SUD) is under debate, because of conflicting research results regarding alexithymia as a state or trait phenomenon. The absolute and relative stability of alexithymia were evaluated in a pre-post design as part of a randomised controlled trial, controlling for several co-variates. Assessments were done with the Toronto Alexithymia Scale (TAS-20) and the Addiction Severity Index (EuropASI) at baseline and follow-up of a 3-month trial of inpatient Cognitive Behavioural Therapy (CBT) with or without a Shared Decision Making intervention for 187 SUD patients. Paired sample t-tests and analyses of variance were performed to assess absolute stability, intraclass correlation coefficients were calculated for relative stability and multivariate linear regression models were used to evaluate the relation between co-variates and change in alexithymia. Mean level reduction of total TAS-20 and two subfactors demonstrated no absolute stability, but change in alexithymia differed for patients with low, moderate and high alexithymia scores. Relative stability of alexithymia was moderate to high for the total population, but differed according to low, moderate and high alexithymia scores. The EuropASI "psychiatry" domain, covering anxiety and depression, was related to alexithymia, but CBT-related variables were not. In conclusion, alexithymia is partly a state-dependent phenomenon, but not a stable personality trait in this SUD population.

  3. Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients.

    PubMed

    Byrne, Shannon A; Cherniack, Martin G; Petry, Nancy M

    2013-09-01

    Opioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. Using data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n=22) and those not receiving (n=93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. Both an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps<.05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio=5.66; 95% confidence interval=1.58-20.28). These results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. Instruments for assessing Person Centered Care in Gerontology.

    PubMed

    Martínez, Teresa; Suárez-Álvarez, Javier; Yanguas, Javier

    2016-05-01

    The assessment of Person Centered Care (PCC) is internationally recognised as an approach of great interest for improving the quality of care of the elderly. The aim of this research is to review the procedures and instruments used in the assessment of services using this approach. The measurement instruments designed to assess elderly care services from PCC were reviewed, particularly residential services, day centers and home help. The main databases, research articles, and specialized websites were consulted. Four observational instruments for the assessment of Person Centered Care are described; five for the assessment of physical space; six aimed at discovering users’ opinions; one which records family opinions, and five aimed at professionals, as well as several qualitative tools for self-assessment of centers. Due to the diversity of instruments available for assessing PCC, and in order to avoid partial evaluations of attention, a combined strategy of assessment is recommended as well as integrating these measures into a broader service evaluation which includes the different strands related to care quality.

  5. Caregivers' incongruence: emotional strain in caring for persons with stroke.

    PubMed

    Pierce, Linda L; Thompson, Teresa L; Govoni, Amy L; Steiner, Victoria

    2012-01-01

    Guided by Friedemann's framework, the purpose of this study was to examine the dimensions of new family caregivers' emotional strain in caring for persons with stroke. Seventy-three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web-based intervention and its e-mail discussion. In this secondary data analysis, 2,148 e-mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers' emotional strain. Rigorous content analysis was applied to these data. The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. Caregivers worried about themselves and their care recipient, sharing feelings of being just "plain tired." The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. This study informs nurses about new family caregivers' emotional strain, or incongruence in Friedemann's terms, from their viewpoint and provides direction for supportive education interactions. © 2012 Association of Rehabilitation Nurses.

  6. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT: AN OVERVIEW - POLLUTION FROM PERSONAL ACTIONS, ACTIVITES, AND BEHAVIORS

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPs) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

  7. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT: AN OVERVIEW - POLLUTION FROM PERSONAL ACTIONS, ACTIVITES, AND BEHAVIORS

    EPA Science Inventory

    Perhaps more so than with any other class of pollutants, the occurrence of pharmaceuticals and personal care products (PPCPs) in the environment highlights the immediate, intimate, and inseparable connection between the personal activities of individual citizens and their environ...

  8. The Association between Foster Care and Substance Abuse Risk Factors and Treatment Outcomes: An Exploratory Secondary Analysis

    ERIC Educational Resources Information Center

    Blome, Wendy Whiting; Shields, Joseph; Verdieck, Mary Jeanne

    2009-01-01

    The child welfare and substance abuse systems are integrally linked through the children and families they both serve. There is a dearth of knowledge, however, on how children who have experienced foster care fare when they are treated for substance abuse issues as adults. This article presents an exploratory study using the Alcohol and Drug…

  9. The Association between Foster Care and Substance Abuse Risk Factors and Treatment Outcomes: An Exploratory Secondary Analysis

    ERIC Educational Resources Information Center

    Blome, Wendy Whiting; Shields, Joseph; Verdieck, Mary Jeanne

    2009-01-01

    The child welfare and substance abuse systems are integrally linked through the children and families they both serve. There is a dearth of knowledge, however, on how children who have experienced foster care fare when they are treated for substance abuse issues as adults. This article presents an exploratory study using the Alcohol and Drug…

  10. Substance Use in Adolescent Psychiatric Outpatients: Self-Report, Health Care Providers' Clinical Impressions, and Urine Screening

    ERIC Educational Resources Information Center

    Holzer, Laurent; Pihet, Sandrine; Passini, Christina Moses; Feijo, Isabelle; Camus, Didier; Eap, Chin

    2014-01-01

    Purpose: To determine the prevalence of substance use among adolescent psychiatric outpatients using a variety of data sources. Method: Using a questionnaire, 3-month prevalence of substance use data were obtained from 50 adolescents and their health care providers. Adolescents' self-reports and providers' clinical impressions were compared with…

  11. Substance Use in Adolescent Psychiatric Outpatients: Self-Report, Health Care Providers' Clinical Impressions, and Urine Screening

    ERIC Educational Resources Information Center

    Holzer, Laurent; Pihet, Sandrine; Passini, Christina Moses; Feijo, Isabelle; Camus, Didier; Eap, Chin

    2014-01-01

    Purpose: To determine the prevalence of substance use among adolescent psychiatric outpatients using a variety of data sources. Method: Using a questionnaire, 3-month prevalence of substance use data were obtained from 50 adolescents and their health care providers. Adolescents' self-reports and providers' clinical impressions were compared with…

  12. Spectrophotometric determination of triclosan in personal care products

    NASA Astrophysics Data System (ADS)

    Lu, Huihui; Ma, Hongbing; Tao, Guanhong

    2009-09-01

    A spectrophotometric method for the determination of triclosan in personal care products was proposed. It was based on the reaction of sodium nitrite with p-sulfanilic acid in an acidic medium to form diazonium ion, with which triclosan further formed an azo compound in an alkaline medium. The resulting yellow colored product has a maximum absorption at 452 nm. A good linear relationship ( r = 0.9999) was obtained in the range of 0-30 mg L -1 triclosan. A detection limit of 0.079 g L -1 was achieved and the relative standard deviation was 0.24% ( n = 11) at 14 mg L -1 triclosan. The proposed method has been applied to the analyses of triclosan in several personal care products and the results were in good agreement with those obtained by high-performance liquid chromatography.

  13. Movement Advocacy, Personal Relationships, and Ending Health Care Disparities.

    PubMed

    Chin, Marshall H

    2017-01-01

    Deep-rooted structural problems drive health care disparities. Compounding the difficulty of attaining health equity, solutions in clinics and hospitals require the cooperation of clinicians, administrators, patients, and the community. Recent protests over police brutality and racism on campuses across America have opened fresh wounds over how best to end racism, with lessons for achieving health equity. Movement advocacy, the mobilizing of the people to raise awareness of an injustice and to advocate for reform, can break down ingrained structural barriers and policies that impede health equity. However, simultaneously advocates, clinicians, and health care organizations must build trusting relationships and resolve conflict with mutual respect and honesty. Tension is inherent in discussions about racial and ethnic disparities. Yet, tension can be constructive if it forces self-examination and spurs systems change and personal growth. We must simultaneously advocate for policy reform, build personal relationships across diverse groups, and honestly examine our biases.

  14. [Talk to them: Narrative care within a person-centered care framework].

    PubMed

    Villar, Feliciano; Serrat, Rodrigo

    The aim of this paper is to highlight the importance of narrative care in the attention of older people who receive care in institutions, underlining how its use provides a better understanding of the Person Centered Care (PCC) model and valuable strategies to put it into practice. To achieve this goal, firstly, we describe the relevance of a narrative approach for understanding the experience of the old person who receive care in institutions, with regards to individual aspects as well as to her/his relationships with professionals and the institutional discourse which contextualize these relationships. Secondly, we specify different ways in which the use of narratives could have an impact on the improvement of the quality of attention and well-being of older people receiving care in institutions. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Personality and Medical Illness Burden Among Older Adults in Primary Care

    PubMed Central

    Chapman, Benjamin P.; Lyness, Jeffrey M.; Duberstein, Paul

    2012-01-01

    Objective To examine the association between Five Factor Model personality traits (Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness) and physician-quantified aggregate morbidity in a sample of older adults in primary care. Methods A total of 449 primary care patients, ranging in age from 65 to 97 years (75 ± 6.9 (mean ± standard deviation)), completed the Neo-Five Factor Inventory (NEO-FFI) and extensive interviews. A physician-investigator completed the Cumulative Illness Rating Scale (CIRS), a well-validated measure of aggregate morbidity based on a review of medical records. Results Bivariate analyses demonstrated that all five domains of the NEO-FFI were associated with CIRS scores. Multivariate regression controlling for age, gender, education, depression, smoking, hypertension, total cholesterol, alcohol or substance misuse, and other personality traits showed that greater Conscientiousness was independently associated with lower CIRS scores (β = −0.10, t(435) = −1.96, p = .05). Other independent predictors of less morbidity were younger age, absence of hypertension, and lower levels of depression. Conclusion Our results point toward the necessity of considering Conscientiousness and other personality traits in studies of risk factors for aggregate morbidity. More detailed characterization of at-risk populations will increase the likelihood of constructing informed and effective prevention, intervention, and policy initiatives. PMID:17401059

  16. Personality and medical illness burden among older adults in primary care.

    PubMed

    Chapman, Benjamin P; Lyness, Jeffrey M; Duberstein, Paul

    2007-04-01

    To examine the association between Five Factor Model personality traits (Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness) and physician-quantified aggregate morbidity in a sample of older adults in primary care. A total of 449 primary care patients, ranging in age from 65 to 97 years (75 +/- 6.9 (mean +/- standard deviation)), completed the Neo-Five Factor Inventory (NEO-FFI) and extensive interviews. A physician-investigator completed the Cumulative Illness Rating Scale (CIRS), a well-validated measure of aggregate morbidity based on a review of medical records. Bivariate analyses demonstrated that all five domains of the NEO-FFI were associated with CIRS scores. Multivariate regression controlling for age, gender, education, depression, smoking, hypertension, total cholesterol, alcohol or substance misuse, and other personality traits showed that greater Conscientiousness was independently associated with lower CIRS scores (beta = -0.10, t(435) = -1.96, p = .05). Other independent predictors of less morbidity were younger age, absence of hypertension, and lower levels of depression. Our results point toward the necessity of considering Conscientiousness and other personality traits in studies of risk factors for aggregate morbidity. More detailed characterization of at-risk populations will increase the likelihood of constructing informed and effective prevention, intervention, and policy initiatives.

  17. Validating female psychopathy subtypes: differences in personality, antisocial and violent behavior, substance abuse, trauma, and mental health.

    PubMed

    Hicks, Brian M; Vaidyanathan, Uma; Patrick, Christopher J

    2010-01-01

    Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems, including symptoms of posttraumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to nonviolent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities.

  18. Validating Female Psychopathy Subtypes: Differences in Personality, Antisocial and Violent Behavior, Substance Abuse, Trauma, and Mental Health

    PubMed Central

    Hicks, Brian M.; Vaidyanathan, Uma; Patrick, Christopher J.

    2010-01-01

    Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems including symptoms of post-traumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to non-violent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. PMID:20582155

  19. [Household care for ill and disabled persons: challenges for the Mexican health care system].

    PubMed

    Nigenda, Gustavo; López-Ortega, Mariana; Matarazzo, Cecilia; Juárez-Ramírez, Clara

    2007-01-01

    To identify the pattern of time devoted by members of Mexican households to providing care to ill and disabled family members. To analyze the mechanisms used by families to provide care to an ill or disabled member. The database of the 2002 National Survey of Time Use was explored to accomplish the first objective. The second objective was accomplished by collecting primary data through in-depth interviews and focal groups in Coahuila, Sinaloa, Zacatecas, Jalisco, Oaxaca and Yucatán from June to December 2004. It was estimated that 1,738,756 persons spent time providing care to ill persons and 1,496,616 to disabled persons, over the reference period of the survey. There are important differences in the dedication of hours by gender and education level. Moreover, households tend to reorganize their structure to provide care to ill and disabled members. Women tend to have more responsibilities in the process. There are important differences in the care of ill and of the disabled in terms of the physical and emotional stress produced in the caregiver. The implications of results in the care of ill and disabled populations are highly relevant for the future of the Mexican health care system. Population aging and the increase of chronic diseases call for a reinforced relationship between institutional and household care so as to complement capacities, a situation already taking place in other countries.

  20. Flexible learning to support safe, person-centred care.

    PubMed

    Rae, Ann

    2012-02-01

    Effective Practitioner is an educational initiative that supports nurses, midwives and allied health professionals to deliver person-centred, safe and effective care. It offers access to flexible work-based learning and development resources. This article describes the progress of the initiative and sets out the expected effects on service delivery, as well as exploring the Scottish context and the initiative's relevance to the rest of the UK and abroad.

  1. Personality and Health Care Decision-Making Style

    PubMed Central

    Flynn, Kathryn E.; Smith, Maureen A.

    2008-01-01

    Using the Wisconsin Longitudinal Study Graduate Survey (N = 5,830), a population-based cohort of older adults (most aged 63–66 years), we explored relationships between five factors of personality and four preference types that account for multiple components of the health care decision-making process (information exchange, deliberation, and selection of treatment choice). After adjustment for personal, health, social, and economic factors, we found that increased conscientiousness and openness to experience and decreased agreeableness and neuroticism corresponded to preferring the most active decision-making style compared with the least active. A better understanding of how personality traits relate to patient decision-making styles may help clinicians tailor treatment discussions to the needs and preferences of individual patients. PMID:17906167

  2. Towards personalized care for persons with spinal cord injury: a study on patients' perceptions

    PubMed Central

    Garrino, Lorenza; Curto, Natascia; Decorte, Rita; Felisi, Nadia; Matta, Ebe; Gregorino, Silvano; Actis, M. Vittoria; Marchisio, Cecilia; Carone, Roberto

    2011-01-01

    Objective/background A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled ‘Experimentation and evaluation of personalized healthcare for patients with spinal cord injury’, which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting. Design Qualitative research study. The interview format was based on a narrative approach. Methods Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data. Results Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition. Conclusions Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients

  3. Usage pattern of personal care products in California households.

    PubMed

    Wu, Xiangmei May; Bennett, Deborah H; Ritz, Beate; Cassady, Diana L; Lee, Kiyoung; Hertz-Picciotto, Irva

    2010-11-01

    Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of ∼30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated. Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderately correlated, which may impact aggregate exposures. Use frequencies observed in this study were generally in the same range as those reported in the EPA Exposure Factor Handbook, but we found differences for some individual products. Our study provides additional data on population-based usage patterns of a large collection of commonly used personal care products pertaining to several age groups and socio-demographic strata. This information will be valuable for exposure and risk assessments. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey.

    PubMed

    D'Aunno, Thomas; Friedmann, Peter D; Chen, Qixuan; Wilson, Donna M

    2015-08-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system.

  5. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

    PubMed Central

    D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

    2016-01-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

  6. Understanding persons with psychological distress in primary health care.

    PubMed

    Arvidsdotter, Tina; Marklund, Bertil; Kylén, Sven; Taft, Charles; Ekman, Inger

    2016-12-01

    The purpose of this study was to gain more knowledge and a deeper understanding of experiences of persons living with psychological distress who seek help in primary care. Psychological distress is a state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life. The lack of effective care for and difficulty in identifying psychological distress is frustrating for patients and health professionals alike. The aim was therefore to gain more knowledge about the experience of living with psychological distress. Twelve persons (nine women and three men) aged 23-51 years were interviewed. Analyses were based on a phenomenological hermeneutic method and indicated that psychological distress may be seen as an imbalance (incongruence) between the self and the ideal self, which slowly breaks down a person's self-esteem. This imbalance was described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one's grip on life. It seems to be associated with a gradual depletion of existential capacities and lead to dissatisfaction, suffering, poor self-esteem and lack of control. As psychological distress may be a forerunner to mental, physical and emotional exhaustion, there is a need to initiate preventive or early interventions to avoid mental, physical and emotional chaos in such patients. Patients' with psychological distress need to be involved in a person-centred salutogenic dialogue with health professionals to become aware of and strengthen their own capacities to regain health and well-being.

  7. A profile of substance abusers using the emergency services in a tertiary care hospital in Sikkim.

    PubMed

    Bhalla, Akhil; Dutta, Sanjiba; Chakrabarti, Amit

    2006-10-01

    Sikkim, a state in Northeast India with a population of more than 500,000 and inhabited by indigenous population of Lepchas, Bhutias and Nepalis, lies in the foothills of the Himalayas sharing borders with Tibet, Nepal and Bhutan. Northeast India is a major source of injection drug users (IDUs) and associated HIV/AIDS. Alcohol use is traditionally prevalent in Sikkim and recently, IDU behaviour has also been reported, although systematic information on epidemiology and treatment availability of substance abuse in Sikkim is not available. To study the sociodemographic and drug use profile of substance abusers using the emergency services in a tertiary care hospital. A retrospective chart review was used. Patients with history of current drug use seeking emergency services for any medical or surgical consequence incident to substance abuse from July 2000 to June 2005 (60 months) were included in the study. Data were generated from emergency case register, hospital records and case sheets. SPSS 10.0 was used for data analysis. Out of 54 patients seeking emergency services with substance abuse (1.16% of all psychiatric consultations), alcohol abusers were 77.8% and other opioid abusers 14.8%. Prevalence of IDU was 16.66%. Common opioids abused were dextrpropoxyphene and pentazocine, both analgesics. A significant number of patients (46.3%) had a history of >20 days/month frequency of abuse. Median of duration of abuse with all drugs was 12 years, while that with IDU population was 3 years. Alcohol withdrawal was the commonest cause (57.4%) of reporting to the emergency. Psychiatric comorbidity was found among 7.4%. Commonest medications used were chlordiazepoxide and clonidine, for withdrawal and naltrexone, for substitution. No standardized treatment protocol for substitution treatment was available. This is an initial attempt to study the sociodemographic and drug use profile of substance abusers in Sikkim. Demographic and socioeconomic characteristics of substance

  8. Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study

    PubMed Central

    Beckwith, Curt; Castonguay, Breana Uhrig; Trezza, Claudia; Bazerman, Lauri; Patrick, Rudy; Cates, Alice; Olsen, Halli; Kurth, Ann; Liu, Tao; Peterson, James; Kuo, Irene

    2017-01-01

    Background HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender. Methods We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender. Results Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender

  9. Patients with substance use and personality disorders: a comparison of patient characteristics, treatment process, and outcomes in Swiss and U.S. substance use disorder programs.

    PubMed

    Moggi, Franz; Giovanoli, Anna; Buri, Caroline; Moos, Bernice S; Moos, Rudolf H

    2010-01-01

    Cross-cultural comparisons may increase our understanding of different models of substance use treatment and help identify consistent associations between patients' characteristics, treatment conditions, and outcomes. The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swiss and the United States (U.S.) residential SUD treatment programs and examine the relationship of program characteristics to 1-year outcomes. A prospective, naturalistic design was used to compare 132 demographically matched Swiss and U.S. male patients drawn from a sample of 10 Swiss and 15 U.S. public treatment programs. Patients completed comparable inventories at admission, discharge, and 1-year follow-up. Compared to Swiss SUD-PD patients, U.S. SUD-PD patients had more severe substance use and psychosocial problems at admission and follow-up. More intensive treatment and a stronger emphasis on patients' involvement were related to better outcomes for both Swiss and U.S. SUD-PD patients. There may be some cross-cultural consistency in the associations between treatment characteristics and SUD-PD patients' outcomes. Treatment evaluation findings from representative programs in one country may apply elsewhere and contribute to our overall knowledge about how to improve SUD-PD patients' outcomes.

  10. (Ad)ministering love: providing family foster care to infants with prenatal substance exposure.

    PubMed

    Marcellus, Lenora

    2008-09-01

    A significant percentage of children in foster care in North America are younger than 1 year of age and are in foster care because of parental substance use and other social challenges. Infants might present with specific health and behavioral issues that are challenging to manage within the foster family home environment; foster families require specialized skills and knowledge to manage these issues. In this article, the author describes a constructivist grounded theory of the process of becoming and providing family foster caregiving in the context of caring for infants with prenatal alcohol and/or drug exposure. The basic social process of (ad)ministering love was identified. The author further describes the three phases of this process and the core concepts within each phase.

  11. Individual care and personal space in assisted living in Sweden.

    PubMed

    Nord, Catharina

    2011-01-01

    This article presents a qualitative research project, which explores the relationship between individual care and personal space in assisted living in Sweden. The results were generated from 15-months of observational fieldwork and 22 individual interviews with staff members and ten residents. The research revealed two spatial levels significant to individual care practice: the higher level of architectural spatial configuration and the lower level of spatial micro-conditions. Inflexibility at the first level had to be compensated for by staff strategies at the second. Advantageous conditions at both levels offer a dynamic architectural situation to the staff, in which individual care may arise and thrive. Copyright © 2010 Elsevier Ltd. All rights reserved.

  12. Using Functional Needs and Personal Care Assistance Rather Than Disability Status During Chronic Care Triage in Community Mass Care.

    PubMed

    Fannin, Athena; Brannen, Donald E; Howell, Melissa; Martin, Shari

    2015-06-01

    To evaluate Medical Reserve Corps volunteers and public health workers in conducting chronic care triage by use of a rubric prior to sheltering to connect survivors with services. Participants were randomly assigned to 1 of 3 algorithms or a control group during a simulated disaster scenario and were asked to rate 20 survivors arriving at a chronic care triage station with situation-appropriate transport services. Survivors were simulated on the basis of the expected disability distributions of mobility, sensory-visual, cognition, medical devices, capacity to perform activities of daily living (ADLs), age (18 to 90 years), weight, and gender expected in the general population but expanded to 90% of those presenting. Mean percentage correct scores were assessed by using one-way analysis of variance. Accounting for personal care assistance and service methodology during chronic care triage increased efficiency by up to 8% in meeting chronic care health service needs during disaster community mass care management. A chronic care triage process as part of community mass care management that considers the availability of personal care assistance and service methodology will enhance the allocation of functional needs support services and increase compliance with Americans with Disabilities Act requirements regarding not segregating persons because of disability. (Disaster Med Public Health Preparedness. 2015;9:265-274).

  13. Pathways to care: narratives of American Indian adolescents entering substance abuse treatment.

    PubMed

    Novins, Douglas K; Spicer, Paul; Fickenscher, Alexandra; Pescosolido, Bernice

    2012-06-01

    Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were Compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service

  14. Pathways to Care: Narratives of American Indian Adolescents Entering Substance Abuse Treatment

    PubMed Central

    Novins, Douglas K.; Spicer, Paul; Fickenscher, Alexandra; Pescosolido, Bernice

    2012-01-01

    Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent’s pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model’s emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service

  15. Can health care providers recognise a fibromyalgia personality?

    PubMed

    Da Silva, José A P; Jacobs, Johannes W G; Branco, Jaime C; Canaipa, Rita; Gaspar, M Filomena; Griep, Ed N; van Helmond, Toon; Oliveira, Paula J; Zijlstra, Theo J; Geenen, Rinie

    2017-01-01

    To determine if experienced health care providers (HCPs) can recognise patients with fibromyalgia (FM) based on a limited set of personality items, exploring the existence of a FM personality. From the 240-item NEO-PI-R personality questionnaire, 8 HCPs from two different countries each selected 20 items they considered most discriminative of FM personality. Then, evaluating the scores on these items of 129 female patients with FM and 127 female controls, each HCP rated the probability of FM for each individual on a 0-10 scale. Personality characteristics (domains and facets) of selected items were determined. Scores of patients with FM and controls on the eight 20-item sets, and HCPs' estimates of each individual's probability of FM were analysed for their discriminative value. The eight 20-item sets discriminated for FM, with areas under the receiver operating characteristic curve ranging from 0.71-0.81. The estimated probabilities for FM showed, in general, percentages of correct classifications above 50%, with rising correct percentages for higher estimated probabilities. The most often chosen and discriminatory items were predominantly of the domain neuroticism (all with higher scores in FM), followed by some items of the facet trust (lower scores in FM). HCPs can, based on a limited set of items from a personality questionnaire, distinguish patients with FM from controls with a statistically significant probability. The HCPs' expectation that personality in FM patients is associated with higher levels for aspects of neuroticism (proneness to psychological distress) and lower scores for aspects of trust, proved to be correct.

  16. Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders.

    PubMed

    Outcalt, Jared; Dimaggio, Giancarlo; Popolo, Raffaele; Buck, Kelly; Chaudoin-Patzoldt, Kelly A; Kukla, Marina; Olesek, Kyle L; Lysaker, Paul H

    2016-01-01

    Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits. Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting. Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology. Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery. Published by Elsevier Inc.

  17. The vital blend of clinical competence and compassion: How patients experience person-centred care.

    PubMed

    Sharp, Sandra; McAllister, Margaret; Broadbent, Marc

    2016-01-01

    Person-centred care is a policy priority for health services seeking to assure the public they provide safe, high-quality care, in keeping with rising consumer expectations. However, study of person-centred care rarely includes acute-care patients' perspectives. In 2013, semi-structured interviews were held with 10 former patients of an Australian regional health service and examined via thematic analysis to understand patients' experiences of nursing care, interpret findings in the context of person-centred care principles and identify ways to enhance and support compassionate, person-centred care in everyday nursing practice. Clinically competent care, delivered compassionately through a positive nurse-patient relationship, resulted in personal, emotional or spiritual responses that were the catalyst for patient empowerment and participation in care, and a positive outlook toward recovery. Nurses wishing to implement person-centred care need to recognise the importance of prioritising human connection and compassion in conjunction with clinical competence.

  18. Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients.

    PubMed

    Evren, Cuneyt; Cınar, Ozgul; Evren, Bilge

    2012-08-01

    The aim of this study was to evaluate possible interactions between severity of borderline personality features (BPFs), dissociative experiences, and alexithymia among substance-dependent men while controlling for their current age, depression, and anxiety. Participants were 200 substance-dependent men consecutively admitted to a dependency treatment unit. The Borderline Personality Inventory, the Toronto Alexithymia Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory were administered to all participants. Severity of negative affect, alexithymia, dissociative experiences, and BPF were correlated with each other. Being younger, severity of dissociative experiences, difficulty in identifying feelings, depression, and trait anxiety predicted the severity of BPF in linear regression analysis. These findings suggest that alexithymia and dissociative experiences may be a way of coping with depression and chronic anxiety, but they also seem to be related to the severity of BPF independent of the negative affect and from each other. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Demographic characteristics and rates of progress of deaf and hard of hearing persons receiving substance abuse treatment.

    PubMed

    Moore, Dennis; McAweeney, Mary

    A lack of demographic information and data related to the achievement of short-term goals during substance abuse treatment among persons who are deaf or hard of hearing dictated the need for the study. New York State maintains a database on all individuals who participate in treatment. Within this database, 1.8% of persons in treatment for substance use disorder (SUD) were also deaf or hard of hearing. As hypothesized, members of the deaf and hard of hearing sample were older, likelier to be white, and likelier to be female, relative to the SUD-only group. For both groups, alcohol, heroin, and cocaine had the highest rates of reported use. Achievement of short-term goals in the areas of alcohol use, drug use, vocational/educational goals, and overall goals indicated no differences between the deaf and hard of hearing group and the SUD-only group. Implications of these findings are discussed.

  20. Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders.

    PubMed

    Lysaker, Paul H; Olesek, Kyle; Buck, Kelly; Leonhardt, Bethany L; Vohs, Jenifer; Ringer, Jamie; Dimaggio, Giancarlo; Popolo, Raffaele; Outcalt, Jared

    2014-03-01

    Cluster C personality disorder traits have been observed in substance use disorders and linked with poorer outcome. One potential factor which may cause these disturbances in personality function is alexithymia, or the inability to name and express emotion. There may be other proximate factors which moderate the impact of alexithymia on the expression of cluster C traits, such as metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems. To examine the possibility that mastery mediated the effects of alexithymia on cluster C traits, we assessed each of these constructs using the Metacognitive Assessment Scale Abbreviated, Toronto Alexithymia Scale and SCID II among 58 adults in an early phase of recovery from substance misuse disorders in a residential setting. Results of a multiple regression revealed that, after controlling for symptom severity and severity of substance misuse history, metacognitive mastery moderated the effect of alexithymia on number of cluster C traits. A median split and subsequent ANCOVA revealed that participants with higher levels of alexithymia and poorer metacognitive mastery had more cluster C traits than the other groups. These findings may have clinical implications, suggesting that patients with substance use disorders may benefit from treatment which addresses metacognitive mastery.

  1. Association of COL25A1 with comorbid antisocial personality disorder and substance dependence.

    PubMed

    Li, Dawei; Zhao, Hongyu; Kranzler, Henry R; Oslin, David; Anton, Raymond F; Farrer, Lindsay A; Gelernter, Joel

    2012-04-15

    Antisocial personality disorder (ASPD) is a psychiatric disorder characterized by a long-term pattern of manipulating, exploiting, or violating the rights of others. Subjects ascertained for genetic studies of substance dependence (SD) and diagnosed with ASPD and comorbid SD were included in a two-stage genetic association study. In the discovery stage, 627 single nucleotide polymorphisms (SNPs) located in 179 candidate genes for addiction were analyzed in a case-control cohort and family-based cohort. The significant findings were replicated in an independent case-control cohort. One SNP, rs13134663, in the collagen XXV alpha 1 gene (COL25A1) was significantly associated with ASPD in both African Americans and European Americans (smallest p values were .0002 and .0004, respectively). There was also evidence of association with the same SNP in independent samples of African American and European American cases and control subjects (p = .035 and .033, respectively). Analysis of the combined set of case-control subjects yielded an allelic p value of 9 × 10(-6) with odds ratio (95% confidence interval) of 1.3 (1.16, 1.47) (smallest p = 1 × 10(-7); Bonferroni threshold p = .00012). The COL25A1 gene, located at chromosome 4q25, encodes the collagen-like Alzheimer amyloid plaque component precursor, a type II transmembrane protein specifically expressed in neurons; it co-localizes with amyloid β in senile plaques in Alzheimer disease brains. This SNP maps to the transcription factor binding site and is conserved in 17 vertebrates, including mice and rats. Our findings suggest that COL25A1 may be associated with ASPD, especially in the context of SD. Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders

    PubMed Central

    Gabrielian, Sonya; Bromley, Elizabeth; Hellemann, Gerhard S.; Kern, Robert S.; Goldenson, Nicholas I.; Danley, Megan E.; Young, Alexander S.

    2015-01-01

    Objective We sought to understand the housing trajectories of homeless consumers with serious mental illness (SMI) and co-occurring substance use disorders (SUD) and to identify factors that best-predicted achievement of independent housing. Methods Using administrative data, we identified homeless persons with SMI and SUD admitted to a residential rehabilitation program from 12/2008-11/2011. On a random sample (n=36), we assessed a range of potential predictors of housing outcomes, including symptoms, cognition, and social/community supports. We used the Residential Time-Line Follow-Back (TLFB) Inventory to gather housing histories since exiting rehabilitation and identify housing outcomes. We used recursive partitioning to identify variables that best-differentiated participants by these outcomes. Results We identified three housing trajectories: stable housing (n=14); unstable housing (n=15); and continuously engaged in housing services (n=7). Using recursive partitioning, two variables (symbol digit modalities test (SDMT), a neurocognitive speed of processing measure and Behavior and Symptom Identification Scale (BASIS)-relationships subscale, which quantifies symptoms affecting relationships) were sufficient to capture information provided by 26 predictors to classify participants by housing outcome. Participants predicted to continuously engage in services had impaired processing speeds (SDMT score<32.5). Among consumers with SDMT score≥32.5, those predicted to achieve stable housing had fewer interpersonal symptoms (BASIS-relationships score<0.81) than those predicted to have unstable housing. This model explains 57% of this sample's variability and 14% of this population's variability in housing outcomes. Conclusion As cognition and symptoms influencing relationships predicted housing outcomes for homeless adults with SMI and SUD, cognitive and social skills trainings may be useful for this population. PMID:25919839

  3. Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders.

    PubMed

    Gabrielian, Sonya; Bromley, Elizabeth; Hellemann, Gerhard S; Kern, Robert S; Goldenson, Nicholas I; Danley, Megan E; Young, Alexander S

    2015-04-01

    We sought to understand the housing trajectories of homeless consumers with serious mental illness (SMI) and co-occurring substance use disorders (SUD) and to identify factors that best predicted achievement of independent housing. Using administrative data, we identified homeless persons with SMI and SUD admitted to a residential rehabilitation program from December 2008 to November 2011. Our primary outcome measure was independent housing status. On a random sample (N = 36), we assessed a range of potential predictors of housing outcomes, including symptoms, cognition, and social/community supports. We used the Residential Time-Line Follow-Back (TLFB) Inventory to gather housing histories since exiting rehabilitation and to identify housing outcomes. We used Recursive Partitioning (RP) to identify variables that best differentiated participants by these outcomes. We identified 3 housing trajectories: stable housing (n = 14), unstable housing (n = 15), and continuously engaged in housing services (n = 7). In RP analysis, 2 variables (Symbol Digit Modalities Test [SDMT], a neurocognitive speed of processing measure, and Behavior and Symptom Identification Scale [BASIS-24] Relationships subscale, which quantifies symptoms affecting relationships) were sufficient to capture information provided by 26 predictors to classify participants by housing outcome. Participants predicted to continuously engage in services had impaired processing speeds (SDMT score < 32.5). Among consumers with SDMT score ≥ 32.5, those predicted to achieve stable housing had fewer interpersonal symptoms (BASIS-24 Relationships subscale score < 0.81) than those predicted to have unstable housing. This model explains 57% of this sample's variability and 14% of this population's variability in housing outcomes. Because cognition and symptoms influencing relationships predicted housing outcomes for homeless adults with SMI and SUD, cognitive and social skills training may be useful for this

  4. Precision Medicine With Point-of-Care Ultrasound: The Future of Personalized Pediatric Emergency Care.

    PubMed

    Kessler, David; Ng, Lorraine; Tessaro, Mark; Fischer, Jason

    2017-03-01

    The Precision Medicine Initiative spearheaded by the National Institute of Health has pioneered a new model of health care focused on health care delivery that is tailored to an individual. Medical advances have already provided clinicians with the tools to better predict treatment outcomes based on the individual needs of each patient's disease process. Three-dimensional printing allows medical devices and implants to be custom made-to-order. Technological advances in preoperative imaging have augmented the ability for surgeons to plan a specific surgical approach for each patient. In a similar vein, point-of-care ultrasound offers the emergency care provider an opportunity to move beyond protocols and provide precise medical care tailored to the acute needs of each ill or injured emergent patient. In this article, we explore several cutting-edge applications of point-of-care ultrasound that can help providers develop a personalized approach to resuscitation and emergent procedures in pediatrics.

  5. A comparison of mental health, substance use, and sexual risk behaviors between rural and non-rural transgender persons.

    PubMed

    Horvath, Keith J; Iantaffi, Alex; Swinburne-Romine, Rebecca; Bockting, Walter

    2014-01-01

    The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.

  6. A Comparison of Mental Health, Substance Use, and Sexual Risk Behaviors Between Rural and Non-Rural Transgender Persons

    PubMed Central

    HORVATH, KEITH J.; IANTAFFI, ALEX; SWINBURNE-ROMINE, REBECCA; BOCKTING, WALTER

    2014-01-01

    The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed. PMID:24380580

  7. Comparisons of substance abuse, high-risk sexual behavior and depressive symptoms among homeless youth with and without a history of foster care placement.

    PubMed

    Hudson, Angela L; Nandy, Karabi

    2012-10-01

    The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Approximately 26,000 young persons exit foster care annually in the United States. Once they 'age out' of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. The design is descriptive and cross-sectional. A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. The sample was majority male and white; ages were 16-25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. It is important that nurses, who serve homeless

  8. Using Personal Narratives for Curriculum Development about Substance Abuse and Older Adults

    ERIC Educational Resources Information Center

    Bial, Martha C.; Gutheil, Irene A.; Hanson, Meredith; White-Ryan, Linda

    2012-01-01

    This article reports on a project to sensitize graduate social work students taking courses in substance abuse to the needs of older adults. Graduate social work students at a major urban school of social work in the Northeast were recruited and trained to interview older adults with a history of substance abuse problems regarding their life…

  9. Using Personal Narratives for Curriculum Development about Substance Abuse and Older Adults

    ERIC Educational Resources Information Center

    Bial, Martha C.; Gutheil, Irene A.; Hanson, Meredith; White-Ryan, Linda

    2012-01-01

    This article reports on a project to sensitize graduate social work students taking courses in substance abuse to the needs of older adults. Graduate social work students at a major urban school of social work in the Northeast were recruited and trained to interview older adults with a history of substance abuse problems regarding their life…

  10. DSM-5 substance use disorders among adult primary care patients: Results from a multisite study.

    PubMed

    Wu, Li-Tzy; McNeely, Jennifer; Subramaniam, Geetha A; Brady, Kathleen T; Sharma, Gaurav; VanVeldhuisen, Paul; Zhu, He; Schwartz, Robert P

    2017-10-01

    There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients. This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined. Overall, 75.5% of the sample used any substance, including alcohol (62.0%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36.0% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD. These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Personal values related to primary care specialty aspirations.

    PubMed

    Schubot, D B; Cayley, W; Eliason, B C

    1996-01-01

    Two recent studies showed that personal values influence specialty choice. However, both studies assessed the perceived influence of values instead of measuring values directly. The present study measured and compared the values of aspirants to primary care versus other specialties. In 1993, first-year medical students, entering residents, and graduating residents at a private Midwestern medical school completed a questionnaire on their specialty aspirations and completed the Schwartz Values Survey, which measures the importance of 10 types of values: achievement, benevolence, conformity, hedonism, power, security, self-direction, stimulation, tradition, and universalism. A three-factor MANOVA (specialty aspiration, gender, level of training) was performed on the importance ratings. The three MANOVA main effects were significant. Primary care aspirants rated power and self-direction values lower and benevolence values higher than did aspirants to other specialties. Women gave higher ratings to universalism and benevolence and lower ratings to power, tradition, and conformity values than did men. Medical students rated security values lower than did the two resident groups. This study demonstrates the relationship of personal values and specialty choice and provides empirical support for admissions policies that incorporate personal values into the admissions process.

  12. Personal determinants of nurses' burnout in end of life care.

    PubMed

    Gama, Georgeana; Barbosa, Filipe; Vieira, Margarida

    2014-10-01

    Our aim is to identify socio-demographic, professional exposure to dying, training degree and personal factors relevant to burnout dimensions in nurses coping with death issues. A sample of 360 nurses (response rate 70.6%) from internal medicine, oncology, haematology and palliative care departments of five health institutions answered to a socio-demographic and professional questionnaire, Maslach Burnout Inventory, Death Attitude Profile Scale, Purpose in Life Test and Adult Attachment Scale. No significant differences were found between medical departments in burnout scores except when comparing those with palliative care department which showed significant lesser levels of emotional exhaustion (t = 2.71; p < .008) and depersonalization (t = 3.07; p < .003) and higher levels of personal accomplishment (t = -2.24; p < .027). By multiple regression analysis exhaustion and depersonalization are negative, sequentially determined respectively by purpose in life, dependent attachment, fear of death attitude and by purpose in life, dependent attachment, years of professional experience and personal accomplishment by positive purpose on life and secure attachment. We conclude for the protective value of factors such as meaning and purpose in life, secure attachment and attitude towards death, through the various burnout dimensions that shows the need to develop under and postgraduate training strategies in these specific areas. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  13. A person-centred segmentation study in elderly care: towards efficient demand-driven care.

    PubMed

    Eissens van der Laan, M R; van Offenbeek, M A G; Broekhuis, H; Slaets, J P J

    2014-07-01

    Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and

  14. Person-centered care--ready for prime time.

    PubMed

    Ekman, Inger; Swedberg, Karl; Taft, Charles; Lindseth, Anders; Norberg, Astrid; Brink, Eva; Carlsson, Jane; Dahlin-Ivanoff, Synneve; Johansson, Inga-Lill; Kjellgren, Karin; Lidén, Eva; Öhlén, Joakim; Olsson, Lars-Eric; Rosén, Henrik; Rydmark, Martin; Sunnerhagen, Katharina Stibrant

    2011-12-01

    Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness. Copyright © 2011 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  15. [Interaction of nurses and women caring informally for dependent persons].

    PubMed

    Delicado Useros, M V; Candel Parra, E; Alfaro Espín, A; López Máñez, M; García Borge, C

    2004-03-15

    To find the attitudes that primary care nurses in Albacete have towards family carers. Qualitative research using discussion groups. Primary care in Albacete: 5 health centres, 2 rural and 3 urban. Nurses following a primary care home visit programme, of both sexes, differing experience and training, and coming from both rural and urban areas took part. Exclusion criterion: nurses in management and administrative posts at time of recruitment. They were recruited by primary care nurses in line with the profiles of participants required. Information was collected through discussion in the groups, which was recorded and later transcribed for analysis. Those taking part in the 2 discussion groups had the following characteristics: 3 men and 8 women. 5 of them were from rural health centres (HC) and 6 from urban HC; 3 had under 2 years experience in the Home Visit Programme (HVP) and 8 had over 5 years experience in it; 5 completed their nursing studies before 1990, and 6 afterwards. In the chats it was clear that the broad experience of PC nurses made them aware of the health situation and quality of life of informal carers, of the loneliness of these and the inter-personal conflicts that occur in families when a situation of dependency arises. Nurses had their educational function towards the carers assumed despite the limitations. The view that the responsibility for the care of the dependent person is the family's was predominant, and a concern for lack of resources and support was appreciated. Nurses had a view of the carer as a resource and barely perceived her as a patient.

  16. Caregivers’ Incongruence: Emotional Strain in Caring for Persons with Stroke

    PubMed Central

    Pierce, Linda. L.; Thompson, Teresa L.; Govoni, Amy L.; Steiner, Victoria

    2012-01-01

    Seventy-three caregivers of persons with stroke who were new to that role participated in an interview every two weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a web-based intervention and its email discussion. In this secondary data analysis guided by Friedemann’s framework, 2148 email discussion messages plus 2455 narrative interview entries were used to examine dimensions of caregivers’ emotional strain in caring for persons with stroke. Rigorous content analysis was applied to these data. Three themes emerged: 1) being worried, 2) running on empty, and 3) losing self. Caregivers worried about themselves and their care recipient, sharing feelings of being just “plain tired.” They felt that their lives were lost to giving care. This study informs nurses about caregivers’ emotional strain, or incongruence in Friedemann’s terms, from their viewpoint and provides direction for supportive education interactions. PMID:22949279

  17. Massachusetts Substance Use Disorder Treatment Organizations' Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design.

    PubMed

    Quinn, Amity E; Stewart, Maureen T; Brolin, Mary; Horgan, Constance M; Lane, Nancy E

    2017-01-01

    The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations' responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in person June-December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms.

  18. An Exploratory Study into Health Care Policy for Persons with Intellectual Disabilities in Taiwan

    ERIC Educational Resources Information Center

    Lin, J. D.; Wu, J. L.; Yen, C. F.

    2004-01-01

    Although Taiwan has already had a higher quality of health care compared with other countries, there still is a need to review the quality and effectiveness of services provided. The lack of health care policy for persons with disabilities is a reflection of health care provision in Taiwan. Health care provision problems will limit persons with…

  19. Pronounced gender and age differences are evident in personal health care spending per person.

    PubMed

    Cylus, Jonathan; Hartman, Micah; Washington, Benjamin; Andrews, Kimberly; Catlin, Aaron

    2011-01-01

    This paper examines differences in national health care spending by gender and age. Our research found significant variations in per person spending by gender across age groups, health services, and types of payers. For example, in 2004 per capita health care spending for females was 32 percent more than for males. Per capita differences were most pronounced among the working-age population, largely because of spending for maternity care. Except for children, total spending for and by females was greater than that for and by males, for most services and payers. The gender difference in total spending was most pronounced in the elderly, as a result of the longer life expectancy of women.

  20. Improving the Care of Individuals with Schizophrenia and Substance Use Disorders: Consensus Recommendations

    PubMed Central

    ZIEDONIS, DOUGLAS M.; SMELSON, DAVID; ROSENTHAL, RICHARD N.; BATKI, STEVEN L.; GREEN, ALAN I.; HENRY, RENATA J.; MONTOYA, IVAN; PARKS, JOE; D. WEISS, ROGER

    2008-01-01

    National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction. In response to the need for user-friendly recommendations on the treatment of schizophrenia and addiction, a consensus conference of experts from academic institutions and state mental health systems was organized to 1) frame the problem from clinical and systems-level perspectives; 2) identify effective and problematic psychosocial, pharmacological, and systems practices; and 3) develop a summary publication with recommendations for improving current practice. The results of the consensus meeting served as the foundation for this publication, which presents a broad set of recommendations for clinicians who treat individuals with schizophrenia. “Integrated treatment” is the new standard for evidence-based treatment for this population and recommendations are given to help clinicians implement such integrated treatment. Specific recommendations are provided concerning screening for substance use disorders in patients with schizophrenia, assessing motivation for change, managing medical conditions that commonly occur in patients with dual diagnoses (e.g., cardiovascular disease, liver complications, lung cancer, HIV, and hepatitis B or C infections) and selecting the most appropriate medications for such patients to maximize safety and minimize drug interactions, use of

  1. The Experiences of Advanced Practice Nurses Caring for Patients with Substance Use Disorder and Chronic Pain.

    PubMed

    St Marie, Barbara

    2016-10-01

    Management of chronic pain is a challenge shared by healthcare providers in various clinical settings. The epidemic of opioid misuse has escalated this challenge. A gap exists in understanding barriers and facilitators to practices of advanced practice registered nurses (APRNs) caring for patients with chronic pain and substance use disorder (SUD). The purpose of this study was to examine the APRNs' experiences while caring for patients with coexisting SUD and chronic pain to help envision better ways to manage pain and direct educational initiatives. Qualitative narrative method. Telephone interviews. Twenty APRNs caring for patients with coexisting SUD and chronic pain were recruited nationwide through the American Society for Pain Management Nursing list serve. Semistructured interviews with thematic analysis. Participants identified 1) a shift of patients from other healthcare providers into the APRNs' practices; 2) barriers to accessing nonmedical modalities for managing pain, including insurance coverage, geographic location, and the patient's desire for only medication management; 3) the role of the APRN in caring for this population contained subthemes of educating and guiding patients through a process of change, applying risk strategies to keep patients safe, and educating colleagues on implementing risk management strategies while prescribing opioids. The APRNs identified barriers to providing care for patients with coexisting SUD and chronic pain. They also described the role of APRNs in providing focused education regarding risk management strategies for assessment, prescribing opioids to manage pain, and minimizing risk. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  2. Medicaid Waiver Personal Care Services: Results of a Statewide Survey

    PubMed Central

    Glass, Anne P.; Roberto, Karen A.; Brossoie, Nancy; Teaster, Pamela B.; Butler, Donna Q.

    2008-01-01

    Through a statewide telephone survey of 819 beneficiaries (or their proxies), we collected data regarding client and aide demographics, as well as clients' satisfaction, outcomes, perspectives on staff performance, and complaints associated with home-based personal care services provided under the Virginia Medicaid Elderly and Disabled (E&D) waiver. Most respondents indicated that services improved their lives, and they were generally satisfied. Opportunities for improvement exist, however, especially related to the amount of time spent with the client, the need for training, and communication issues. Ongoing use of client/family caregiver surveys is warranted to allow continued monitoring of service provision. PMID:19361116

  3. Looking Within: Intentions of Practice for Person-Centered Care.

    PubMed

    Ventres, William B

    2017-03-01

    In order to integrate the biological, psychological, social, and existential dimensions of care into my day-to-day clinical encounters with patients, I have worked to cultivate several intentions of practice. These intentions of practice-habits of mind that nurture my resolve to attend to patients as complex human beings- help me navigate my interactions with patients and families in ways that are simultaneously efficacious and therapeutic. When routinely recalled and adeptly implemented, they are what distinguish me as a competent and capable practitioner of person-centered care, when I am at my best, from when I am not. I present them here in hopes that others may find them useful as they progress down their ongoing paths as healing physicians.

  4. Substance Use and Mental Health Problems as Predictors of HIV Sexual Risk Behaviors among Adolescents in Foster Care

    ERIC Educational Resources Information Center

    Thompson, Ronald G., Jr.; Auslander, Wendy F.

    2011-01-01

    This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an…

  5. Substance Use and Mental Health Problems as Predictors of HIV Sexual Risk Behaviors among Adolescents in Foster Care

    ERIC Educational Resources Information Center

    Thompson, Ronald G., Jr.; Auslander, Wendy F.

    2011-01-01

    This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an…

  6. Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?

    PubMed Central

    Kemper, Peter; Weaver, France; Short, Pamela Farley; Shea, Dennis; Kang, Hyojin

    2008-01-01

    Objective To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n = 6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. PMID:18199190

  7. Integrating Public Health and Personal Care in a Reformed US Health Care System

    PubMed Central

    Chernichovsky, Dov

    2010-01-01

    Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access. Inefficiency is increased by the lack of an integrated system that could promote an optimal mix of personal medical care and population health measures. We advocate a health trust system to provide core medical benefits to every American, while improving efficiency and reducing redundancy. The major innovation of this plan would be to incorporate existing private health insurance plans in a national system that rebalances health care spending between personal and population health services and directs spending to investments with the greatest long-run returns. PMID:20019310

  8. Perceived Discrimination in Health Care and Mental Health/Substance Abuse Treatment Among Blacks, Latinos, and Whites.

    PubMed

    Mays, Vickie M; Jones, Audrey L; Delany-Brumsey, Ayesha; Coles, Courtney; Cochran, Susan D

    2017-02-01

    Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment. In a sample of 1099 adults (age 18-72) who indicated prior year mental health/substance abuse visits, we examined: experiences of discrimination that occurred during health care and mental health/substance abuse visits, ratings of treatment helpfulness, and reports of stopping treatment early. Fifteen percent of California adults reported discrimination during a health care visit and 4% specifically during mental health/substance abuse visits. Latinos, the uninsured, and those with past year mental disorders were twice as likely as others to report health care discrimination [adjusted odds ratio (AORs)=2.08, 2.77, and 2.51]. Uninsured patients were 7 times more likely to report discrimination in mental health/substance abuse visits (AOR=7.27, P<0.01). The most commonly reported reasons for health care discrimination were race/ethnicity for blacks (52%) and Latinos (31%), and insurance status for whites (40%). Experiences of discrimination in mental health/substance abuse visits were associated with less helpful treatment ratings for Latinos (AOR=0.09, P<0.05) and whites (AOR=0.25, P<0.01), and early treatment termination for blacks (AOR=13.38, P<0.05). Experiences of discrimination are associated with negative mental health/substance abuse treatment experiences and stopped treatment, and could be a factor in mental health outcomes.

  9. How Internet technology can improve the quality of care for substance use disorders.

    PubMed

    Cucciare, Michael A; Weingardt, Kenneth R; Humphreys, Keith

    2009-09-01

    By allowing for the efficient delivery of instructional content and the secure collection of self-report data regarding substance use and related problems, the Internet has tremendous potential to improve the effectiveness and accessibility of addiction treatment services. This article discusses some of the ways in which Internet technology can facilitate, complement and support the process of traditional clinician-delivered treatment for individuals with substance use disorders. Internet applications are being used to support a range of activities including (a) the assessment and feedback process that constitutes a central feature of brief motivational interventions, (b) the concurrent monitoring of individual level outcomes among patients who are currently enrolled in addiction treatment programs, (c) the continuing care and ongoing recovery of patients who have completed treatment, and (d) the delivery of clinical training in evidence based practices for addiction treatment providers. This emerging body of literature suggests that addiction counselors and program administrators can enhance the quality of clinician-delivered treatment by incorporating internet applications into existing processes of care. Internet applications provide an unparalleled opportunity to engage patients in the treatment process, incorporate real-time data into treatment planning, prevent relapse, and promote evidence-based treatment approaches.

  10. Screening instruments for substance use and brief interventions targeting adolescents in primary care: A literature review

    PubMed Central

    Pilowsky, Daniel J; Wu, Li-Tzy

    2013-01-01

    Background A review of the literature was conducted to examine substance use screening instruments commonly used with adolescents in medical settings, their comparative usefulness, and SBIRT (Screening, Brief Intervention, and Referral to Treatment). Methods We screened two databases (Ovid MEDLINE and PsycINFO) targeting journal articles dealing with screening for alcohol and drug use in adolescence as well as adolescent SBIRT. Results Adolescents preferred paper forms and computerized questionnaires over interviews with physicians or nurses. The CRAFFT was the best studied instrument for screening for alcohol/drug use and related problems, and is the only tool with data to support its use in medical settings. Other screening instruments require more testing/evaluation in more representative samples of adolescents in primary care settings. Long term follow-up data to establish the efficacy of SBIRT in adolescence are not available. Innovative computerized approaches to screening for substance use in this population have recently been proposed. Although promising, they require further evaluation. Conclusions The CRAFFT has the most consistent data to support its use in primary care settings. The effects of SBIRT in adolescence have not been adequately evaluated. Adolescents’ opinions and preferences for SBIRT should be studied to improve their acceptance. PMID:23454877

  11. Substance Use and Partner Violence among Urban Women Seeking Emergency Care

    PubMed Central

    Gilbert, Louisa; El-Bassel, Nabila; Chang, Mingway; Wu, Elwin; Roy, Lolita

    2013-01-01

    Growing evidence suggests intimate partner violence (IPV) and substance misuse are co-occurring problems that disproportionately affect low income urban women seeking care in emergency departments (EDs) and represent leading causes of injuries that result in ED visits. This paper examines temporal bi-directional associations between different types of drug and alcohol use and different types of IPV in a longitudinal study of a representative sample of 241 low income, urban women receiving emergency care from an ED in the Bronx, New York. After adjusting and matching for socio-demographics and potentially confounding multi-level risk and protective covariates, women who reported using heroin in the prior six months at Wave 1 were twice as likely as non-heroin using women to indicate any physical, injurious or sexual IPV at subsequent waves and were 2.7 times more likely to indicate experiencing an injury from IPV at subsequent waves. Crack or cocaine use in the past 6 months at Wave 1 was associated with an increased likelihood of injurious IPV and severe verbal abuse at subsequent waves. Findings also suggested that sexual IPV was significantly associated with subsequent use of crack or cocaine. The multiple bidirectional associations found linking these problems underscore the need for conducting routine screening for IPV and substance misuse among women in low income, urban EDs, and for improving linkages to services that will ultimately reduce the risk of morbidity, disability, and mortality related to these co-occurring problems. PMID:22023020

  12. Addressing substance use disorder in primary care: The role, integration, and impact of recovery coaches.

    PubMed

    Jack, Helen E; Oller, Devin; Kelly, John; Magidson, Jessica F; Wakeman, Sarah E

    2017-10-09

    Only 10% of people with substance use disorder (SUD) receive treatment, partially due to inadequate access to specialty SUD care and limited management within primary care. "Recovery coaches" (RCs), peers sharing the lived experience of addiction and recovery, are increasingly being integrated into primary care to help reach and treat people experiencing SUD, yet little is known about how their role should be defined or about their clinical integration and impact. In order to explore patient and RC perspectives on the RC role, we conducted semi-structured interviews with RCs (n = 5) and their patients (n = 16). Maximum variation sampling was used to select patients who displayed diversity across gender, RC, housing status, and number of contacts with an RC. We sampled until no new concepts emerged from additional interviews, and we used a semi-structured interview guide for data collection and recorded all interviews. To analyze interview transcripts, we employed the constant comparative method to assign inductively developed codes. Two coders separately coded all transcripts and reconciled code assignments. Four core RC activities were identified: system navigation, supporting behavior change, harm reduction, and relationship building. Across these activities, benefits of the RC role emerged, including accessibility, shared experiences, motivation of behavior change, and links to social services. Challenges of the RC model were also evident: patient discomfort with asking for help, lack of clarity in RC role, and tension within the care team. These findings shed light on RCs in primary care. Many patients and coaches perceived that RCs play a valuable role within primary care, providing both tangible system navigation and intangible, social support that promote recovery and might not otherwise be available. Enhanced communication between RCs and health center leadership in defining the RC role may help resolve ambiguity and related tensions between RCs and care

  13. Consumer-directed models of personal care: lessons from Medicaid.

    PubMed

    Doty, P; Kasper, J; Litvak, S

    1996-01-01

    "Consumer-directed" models of financing and services delivery are compared with models that emphasize professional control and accountability within the context of Medicaid-financed personal care services (PCS). The Medicaid PCS benefit finances aide or attendant services for low-income persons with functional disabilities to assist them with daily living tasks. Consumer-directed modes of service provision permit service recipients themselves to have greater choice and control over all aspects of service provision. Client surveys in three states found that clients were most satisfied with the program elements of Medicaid PCS services that gave them more choice and control. Case studies of how Medicaid PCS programs in particular states are administered indicate that the use of aides who are independent providers, unattached to a home health or home care agency, is a critical aspect of consumer direction. By itself, however, this factor does not guarantee consumer direction because other Medicaid PCS rules and regulations may restrict client choice and control.

  14. Surfactants, polymers and their nanoparticles for personal care applications.

    PubMed

    Somasundaran, P; Chakraborty, Soma; Qiang, Q; Deo, P; Wang, Jing; Zhang, Rui

    2004-01-01

    A "touch me not" plant folding up rapidly upon being attacked or microbes depositing on teeth or ocean vessels even under hostile conditions are examples in nature that provide inspiration for developing new classes of personal care release or deposition systems. In this paper, development of such systems based on polymer/surfactant colloid chemistry is explored for achieving transport and release of cosmetic and pharmaceutical molecules at desired rates at desired sites. The successful development of products depends upon understanding and utilizing key interactions among surfactants, polymers and hybrid polymers that are relevant to personal care products. Thus, the absorbed layers or tethers on the particulates can be manipulated for desired dispersion of actives or depositions on substrate under any and all conditions. New hybrid polymers and nanogels have been synthesized for tuning up nanodomains that can extract and deliver at will cosmetics/drugs/toxins by perturbing pH, temperature or ionic strength of the system. Particularly, hydrophobically modified polymers have features of both polymers and surfactants and due to the associative nature of the hydrophobic groups, such polymers can form intramolecular nanodomains for performing carrier functions. Nanogels developed recently include that of polyacrylamide, poly(acrylic acid) and starch nanogels modified for extraction and subsequent slow release of fragrances and overdosed toxic drugs. Binding and release processes were investigated using surface plasmon resonance and fluorescence spectroscopies, powerful techniques for monitoring short term and long term changes.

  15. THE RELATIONSHIP BETWEEN DISTRESS TOLERANCE AND ANTISOCIAL PERSONALITY DISORDER AMONG MALE INNER-CITY TREATMENT SEEKING SUBSTANCE USERS

    PubMed Central

    Daughters, Stacey B.; Sargeant, Marsha N.; Bornovalova, Marina A.; Gratz, Kim L.; Lejuez, C. W.

    2014-01-01

    There is currently limited research on the potential mechanisms underlying the development of antisocial personality disorder (ASPD). One such mechanism, distress tolerance (defined as an individual’s behavioral persistence in the face of emotional distress) may underlie the development of ASPD and its associated behavioral difficulties. It was hypothesized that substance users with ASPD would evidence significantly lower levels of distress tolerance than substance users without ASPD. To test this relationship, we assessed 127 inner-city males receiving residential substance abuse treatment with two computerized laboratory measures of distress tolerance. The mean age of the sample was 40.1 years (SD = 9.8) and 88.2% were African American. As expected, multiple logistic regression analyses indicated that distress intolerance significantly predicted the presence of an ASPD diagnosis, above and beyond key covariates including substance use frequency and associated Axis I and II psychopathology. Findings suggest that distress tolerance may be a key factor in understanding the development of ASPD, setting the stage for future studies expanding on the nature of this relationship, as well as the development of appropriate interventions for this at-risk group. PMID:18834298

  16. The relationship between distress tolerance and antisocial personality disorder among male inner-city treatment seeking substance users.

    PubMed

    Daughters, Stacey B; Sargeant, Marsha N; Bornovalova, Marina A; Gratz, Kim L; Lejuez, C W

    2008-10-01

    There is currently limited research on the potential mechanisms underlying the development of antisocial personality disorder (ASPD). One such mechanism, distress tolerance (defined as an individual's behavioral persistence in the face of emotional distress) may underlie the development of ASPD and its associated behavioral difficulties. It was hypothesized that substance users with ASPD would evidence significantly lower levels of distress tolerance than substance users without ASPD. To test this relationship, we assessed 127 inner-city males receiving residential substance abuse treatment with two computerized laboratory measures of distress tolerance. The mean age of the sample was 40.1 years (SD = 9.8) and 88.2% were African American. As expected, multiple logistic regression analyses indicated that distress intolerance significantly predicted the presence of an ASPD diagnosis, above and beyond key covariates including substance use frequency and associated Axis I and II psychopathology. Findings suggest that distress tolerance may be a key factor in understanding the development of ASPD, setting the stage for future studies expanding on the nature of this relationship, as well as the development of appropriate interventions for this at-risk group.

  17. Contrasting metacognitive, social cognitive and alexithymia profiles in adults with borderline personality disorder, schizophrenia and substance use disorder.

    PubMed

    Lysaker, Paul H; George, Sunita; Chaudoin-Patzoldt, Kelly A; Pec, Ondrej; Bob, Petr; Leonhardt, Bethany L; Vohs, Jenifer L; James, Alison V; Wickett, Amanda; Buck, Kelly D; Dimaggio, Giancarlo

    2017-11-01

    Deficits in the ability to recognize and think about mental states are broadly understood to be a root cause of dysfunction in Borderline Personality Disorder (PD). This study compared the magnitude of those deficits relative to other forms of serious mental illness or psychiatric conditions. Assessments were performed using the metacognition assessment scale-abbreviated (MAS-A), emotion recognition using the Bell Lysaker Emotion Recognition Test and alexithymia using the Toronto Alexithymia Scale among adults with schizophrenia (n = 65), Borderline PD (n = 34) and Substance Use disorder without psychosis or significant Borderline traits (n = 32). ANCOVA controlling for age revealed the Borderline PD group had significantly greater levels of metacognitive capacity on the MAS-A than the schizophrenia group and significantly lower levels of metacognitive capacity than the Substance Use group. Multiple comparisons revealed the Borderline PD group had significantly higher self-reflectivity and awareness of the other's mind than the schizophrenia group but lesser mastery and decentration on the MAS-A than substance use group, after controlling for self-report of psychopathology and overall number of PD traits. The Borderline PD and Schizophrenia group had significantly higher levels of alexithymia than the substance use group. No differences were found for emotion recognition. Results suggest metacognitive functioning is differentially affected in different mental disorders. Published by Elsevier B.V.

  18. Juvenile sex offenders: Personality profile, coping styles and parental care.

    PubMed

    Margari, Francesco; Lecce, Paola Alessandra; Craig, Francesco; Lafortezza, Elena; Lisi, Andrea; Pinto, Floriana; Stallone, Valentina; Pierri, Grazia; Pisani, Rossella; Zagaria, Giuseppina; Margari, Lucia; Grattagliano, Ignazio

    2015-09-30

    In recent years, there has been an increasing interest in juvenile sex offenders showing that this population is highly heterogeneous. The aim of the present study was to identify possible different profiles that could help understand the motivation behind offending, comparing 31 Juvenile Sexual Offenders (JSOs), 31 Juvenile Sexual Non Offenders (JSNOs) and 31 Juvenile Non Offenders (Control Group). A data collection form, the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) or Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Coping Inventory for Stressful Situations (CISS) and the Parental Bonding Inventory (PBI) were administered to all participants. The results show that JSOs differs from JNSOs in some domains, such as living in single-parent homes, while maintain some common aspects such as academic failure and previous sexual intercourse. Moreover, JNSOs showed more abnormal personality traits, such as Authority Problems, MacAndrew Alcoholism, Acknowledgement and Alcohol-Drug Problem Proneness compared to JSOs and the Control Group, while JSOs and JNSOs use a coping strategy more oriented to Avoidance and Distraction compared to the Control group. Finally, JSOs described the relationships with fathers characterized by higher care and protection than JNSOs. These findings provide additional evidence with respect the prevention and treatment of criminal sexual behavior in adolescent.

  19. The relevance of personality traits in impulsivity-related disorders: From substance use disorders and gambling disorder to bulimia nervosa.

    PubMed

    Del Pino-Gutiérrez, Amparo; Jiménez-Murcia, Susana; Fernández-Aranda, Fernando; Agüera, Zaida; Granero, Roser; Hakansson, Anders; Fagundo, Ana B; Bolao, Ferran; Valdepérez, Ana; Mestre-Bach, Gemma; Steward, Trevor; Penelo, Eva; Moragas, Laura; Aymamí, Neus; Gómez-Peña, Mónica; Rigol-Cuadras, Assumpta; Martín-Romera, Virginia; Menchón, José M

    2017-09-01

    Background and aims The main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity-compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype. Methods The sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity. Results Marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles. Discussion and conclusion Our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness.

  20. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis.

    PubMed

    Durvasula, Ramani; Miller, Theodore R

    2014-01-01

    Clinical management of HIV must account for the "triple diagnosis" of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990s, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention.

  1. Program directors' views of the effect of managed care on substance abuse programs in Los Angeles county.

    PubMed

    McNeese-Smith, D K

    1998-10-01

    This study sought information about the effect of managed care on substance abuse treatment programs through a survey of program directors. Fifty program directors who supervised a total of 134 substance abuse treatment programs in Los Angeles County completed a survey during the period from January to May 1997 on program changes made in response to managed care, major concerns, the advantages and disadvantages of managed care, and plans for further program changes to succeed in the managed care environment. Program directors reported that the most frequent change made in response to managed care was increased outreach and marketing. Their greatest concern in the managed care environment was being forced to provide the least costly service, rather than the best care for patients. Respondents identified an increased focus on outcomes as an advantage of managed care and restrictions on services due to contractual agreements as a disadvantage. Planned program changes addressed the areas of program structure, types of programs offered, staff composition, revenue generation, referral sources, prevention, outcome measures, relationships with other organizations, and accreditation and certification. Although some substance abuse treatment programs seem to be reducing their scope or preparing to close in response to managed care, others are developing strategies to survive and even thrive in this new economic environment.

  2. Human dermal exposure to galaxolide from personal care products.

    PubMed

    Correia, P; Cruz, A; Santos, L; Alves, A

    2013-06-01

    Musks are synthetic fragrances applied on personal care and household products as fixatives, by retarding the release of other fragrances with higher volatility. Galaxolide is the most used polycyclic musk since the 90th decade, and it has been detected in several environmental and biological matrices, particularly in human tissues and fluids. For exposure assessment purposes, large-monitoring data need to be obtained and rapid but reliable analytical techniques are requested. The main objective of this study is to develop and validate a new and fast analytical methodology to quantify galaxolide in personal care products and to apply this method to real matrices like skin care products (creams and lotions), shower products (soap bar), hair care products (shampoo and hair conditioner) and oral care products (toothpaste), to evaluate the human dermal exposure risk. A dispersive solid-phase extraction is proposed, using QuEChERS methodology, followed by HPLC with fluorescence detection. Some extraction parameters were studied, like the ratio of sample/solvent amounts, the homogenization time, the salt addition effect and the used sorbents. The validation parameters of the developed method were the following: a linearity range of 0.005-1.002 mg kg⁻¹ sample, a limit of detection of 0.001 mg kg⁻¹ sample, repeatability between 0.7% and 11.3% (variation coefficient of six standard injections), an intermediate precision of 2.5% (variation coefficient of six independent analysis of the same sample), mean recoveries ranging from 65% (soap bar) to 95% (body cream) and 3% of global uncertainty in most of the working range. The time of analysis, including the extraction steps, is 60 min, allowing a throughput of 4 samples h⁻¹ . Galaxolide was detected in all of the seven analysed products in concentrations ranging from 0.04 ± 0.01 mg kg⁻¹ sample (toothpaste) to 280.78 ± 8.19 mg kg⁻¹ sample (perfumed body cream), which may correspond to a significant estimated

  3. Care path of person with stroke: from onset to rehabilitation.

    PubMed

    Faria, Ana da Conceição Alves; Martins, Maria Manuela Ferreira Pereira da Silva; Schoeller, Soraia Dornelles; Matos, Leandro Oliveira de

    2017-01-01

    to describe the care path of the person with stroke goes through and to identify the important events in this path. qualitative descriptive exploratory research, using the semi-structured interview technique based on Meleis's Middle-Range Theory. The sample was composed of 13 people who became dependent after a stroke and were admitted to two hospital units in the region of Vale do Ave, Portugal. Data were collected between January and October 2013. Content analysis was used to analyze the data. The data revealed that the person's care path goes from recognition of the symptoms to preparation for hospital discharge. Adapting to the new situation of dependence brings the need for new competencies. The research aims to contribute to the improvement of nursing care regarding care for people with stroke including onset, recovery and rehabilitation, and home care. Descrever o percurso da pessoa com Acidente Vascular Encefálico e identificar os acontecimentos significativos neste percurso. Abordagem qualitativa e natureza exploratória- descritiva, valeu-se da técnica de entrevista semiestruturada baseada na Teoria de Médio Alcance de Meleis. Participaram 13 pessoas que se tornaram dependentes devido à Acidente Vascular Encefálico e recorreram a duas Unidades da região do Vale do Ave, Portugal. A colheita de dados deu-se durante Janeiro a Outubro de 2013. Para análise dos dados foi utilizada a análise de conteúdo. Os dados revelaram que o trajeto da pessoa vai desde o reconhecimento dos sintomas até à preparação da alta hospitalar. A dependência traz a necessidade de adquirir competências para se adaptar à nova situação. Espera-se contribuir para a melhoria dos cuidados de enfermagem no atendimento das pessoas acometidas com Acidente Vascular Encefálico, desde o acometimento, recuperação e reabilitação, até aos cuidados domiciliares.

  4. Differences in risk behaviors, care utilization, and comorbidities in homeless persons based on HIV status.

    PubMed

    Parker, R David; Dykema, Shana

    2014-01-01

    This cross-sectional pilot project measured differences by HIV status in chronic health conditions, primary care and emergency department use, and high-risk behaviors of homeless persons through self-report. Using selective random sampling, 244 individuals were recruited from a homeless shelter. The reported HIV prevalence was 6.56% (n = 16), with the odds of HIV higher in persons reporting crack cocaine use. HIV-infected persons were more likely to report a source of regular medical care and less likely to use the emergency department than uninfected persons. Validation of findings through exploration of HIV and health care access in homeless persons is needed to confirm that HIV-infected homeless persons are more likely to have primary care. Distinctions between primary care and specialty HIV care also need to be explored in this context. If findings are consistent, providers who care for the homeless could learn more effective ways to engage homeless patients.

  5. Personal Trainer Perceptions of Providing Nutrition Care to Clients: A Qualitative Exploration.

    PubMed

    Barnes, Katelyn; Ball, Lauren; Desbrow, Ben

    2017-04-01

    Personal trainers are well placed to provide basic nutrition care in line with national dietary guidelines. However, many personal trainers provide nutrition care beyond their scope of practice and this has been identified as a major industry risk due to a perceived lack of competence in nutrition. This paper explores the context in which personal trainers provide nutrition care, by understanding personal trainers' perceptions of nutrition care in relation to their role and scope of practice. Semistructured telephone interviews were conducted with 15 personal trainers working within Australia. Thematic analysis was used to identify key themes. All personal trainers reported to provide nutrition care and reported that nutrition care was an important component of their role. Despite this, many were unaware or uncertain of the scope of practice for personal trainers. Some personal trainers reported a gap between the nutrition knowledge they received in their formal education, and the knowledge they needed to optimally support their clients to adopt healthy dietary behaviors. Overall, the personal training context is likely to be conducive to providing nutrition care. Despite concerns about competence personal trainers have not modified their nutrition care practices. To ensure personal trainers provide nutrition care in a safe and effective manner, greater enforcement of the scope of practice is required as well as clear nutrition competencies or standards to be developed during training.

  6. Personality and alcohol/substance-use disorder patient relapse and attendance at self-help group meetings.

    PubMed

    Janowsky, D S; Boone, A; Morter, S; Howe, L

    1999-01-01

    This study evaluated the role of personality in the short-term outcome of alcohol/substance-use disorder patients. Detoxifying alcohol/substance-use disorder patients were administered the Myers-Briggs Type Indicator (MBTI), the Tridimensional Personality Questionnaire (TPQ), the Michigan Alcohol Screening Test (MAST), the CAGE Questionnaire, and the Beck Depression Inventory (BDI). These patients were subsequently evaluated over a 1-month period for relapse and attendance at self-help group meetings. High TPQ Persistence scale scores predicted abstinence. When the Thinking and Feeling groups were considered separately, and when these two groups were combined into a single group, high scores for the individual groups and the combined group (i.e. Thinking and Feeling types together) predicted abstinence. High TPQ Persistence scale scores and low Shyness with Strangers and Fear of Uncertainty subscale scores predicted attendance at self-help group meetings. High MBTI Extroversion and high MBTI Thinking scores also predicted attendance at self-help group meetings. When the Extroverted and Introverted types and the Thinking and Feeling types respectively were combined, as with abstinence, high scores predicted attendance at self-help group meetings. Age, gender, CAGE, MAST, and BDI scores did not predict outcome. The above information suggests that specific personality variables may predict abstinence and attendance at self-help group meetings in recently detoxified alcoholics, and this may have prognostic and therapeutic significance.

  7. The influence of individual and organizational factors on person-centred dementia care.

    PubMed

    Hunter, Paulette V; Hadjistavropoulos, Thomas; Thorpe, Lilian; Lix, Lisa M; Malloy, David C

    2016-07-01

    Although some individual and organizational contributors to person-centred care or quality of care have been studied, they have rarely been examined together. Our goal was to investigate the association of personal and organizational-environmental characteristics with self-reported person-centred behaviours in long-term residential care settings. We asked 109 long-term care staff from two Canadian long-term care homes to complete scales assessing self-reported person-centred care, organizational support for person-centred care, beliefs about personhood in dementia, and burnout. Independent variables included four employee background characteristics (age, gender, occupation, and years of education), beliefs about personhood in dementia, burnout, and three aspects of organizational support for person-centred care (the physical environment of residents, collaboration on care, and support from management). Dependent variables included five aspects of person-centred care: autonomy, personhood, knowing the person, comfort care, and support for relationships .We used multiple linear regression analysis and changes in R(2) to test variable associations. Including organizational variables in regression models resulted in statistically significant (p < .05) changes in R(2) for each of the five dependent variables. Including personal variables resulted in statistically significant changes in R(2) for some dependent variables, but not others. In particular, including employee background characteristics resulted in a statistically significant change in R(2) for comfort care, and including beliefs about personhood and burnout resulted in statistically significant changes in R(2) for personhood but not for other dependent variables. Organizational characteristics are associated with several aspects of person-centred dementia care. Individual characteristics, including gender, beliefs about personhood, and burnout, appear to be more important to some aspects of person

  8. 75 FR 34140 - Establishment of the Personal Care Attendants Workforce Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-16

    ... HUMAN SERVICES Establishment of the Personal Care Attendants Workforce Advisory Panel AGENCY: Community...: Notice. Authority: The Personal Care Attendants Workforce Advisory Panel is authorized under section 8002 of the Affordable Care Act, Pub. L. 111-148. The Committee is governed by provisions of Pub. L....

  9. Development and Initial Testing of a Measure of Person-Directed Care

    ERIC Educational Resources Information Center

    White, Diana L.; Newton-Curtis, Linda; Lyons, Karen S.

    2008-01-01

    Purpose: The purpose of the study was to empirically test items of a new measure designed to assess person-directed care (PDC) practices in long-term care. Design and Methods: After reviewing the literature, we identified five areas related to PDC: personhood, comfort care, autonomy, knowing the person, and support for relationships. We also…

  10. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    PubMed

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi(2) test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  11. Burden of care for persons with disabilities in Vietnam.

    PubMed

    Riewpaiboon, Arthorn; Van Minh, Hoang; Huong, Nguyen Thuy; Dung, Pham; Wright, E Pamela

    2014-11-01

    Vietnam has more than 6 million persons with disabilities (PWD), or 7.8% of the population. To provide better services for them, it is important to investigate the care they currently receive, and to obtain evidence on the health outcomes from that care. This study aimed to estimate the quality of life and functional status of a group of PWD in Vietnam and the cost of care they receive. This was an analytical study exploring the time and cost of informal care, the cost of illness (prevalence-based, patient perspective), quality of life using EuroQoL and functional status using the Barthel Index. The sample was selected from urban and rural areas of Quang Tri province in Central Vietnam, using systematic random sampling. Data were collected by face-to-face interviews, and in a 1-month diary recorded during July-August 2010 for summer and in December 2010 for winter. The costs are presented in 2010 USD values. The data were analysed by descriptive, univariate and multivariate statistics to summarise and explore the relationships among dependent and independent variables. The study sample included 210 PWD, with an average age of 38 years and duration of disability on average 26 years. The health-related quality of life measured in terms of the health utility score (0 = death, 1 = full health) was on average 0.44 and 0.39 in summer and winter respectively. The total cost of illness per year per case was USD 971 (83% of gross domestic product per capita); explanatory variables were the age of the PWD, receiving community-based rehabilitation, receiving government support and the severity of the disability. This illustrates the importance of services and support for reduction of the economic burden on the family. In conclusion, the results of this study provide information on the burden caused by disabilities in rural and urban households in Vietnam.

  12. Impact of hair-care products on FAEE hair concentrations in substance abuse monitoring.

    PubMed

    Gareri, Joey; Appenzeller, Brice; Walasek, Paula; Koren, Gideon

    2011-04-01

    Previous studies have indicated that the use of high-ethanol-content (>65%) hair-care products may elevate fatty acid ethyl ester (FAEE) concentrations in hair. In this case series, nine individuals were identified by FAEE analysis to be chronic alcohol abusers in the context of child-welfare substance abuse monitoring. Based on patient claims of moderate or no alcohol consumption, the presence of ethanol in the patients' hair-care regimens was investigated. Samples were additionally tested for the presence of ethyl glucuronide (EtG). From a total of nine patients, 12 hair samples were submitted for analysis. Patient histories were obtained as well as Material Safety Data Sheets (MSDS) listing hair-care product ethanol content. Hair samples were pre-washed to remove external contamination and analyzed for FAEE and EtG by GC-MS. According to the Society of Hair Testing consensus guidelines, FAEE levels exceeding 0.50 ng/mg and/or EtG levels exceeding 30 pg/mg indicate chronic excessive alcohol consumption. Upon initial analysis, the nine samples exhibited positive FAEE findings ranging from 0.496 to 4.984 ng/mg. MSDS review revealed the presence of ethanol from 10% to 95% by volume in at least one hair-care product used by each individual. Results of the EtG analysis ranged from 1.9 to 23.5 pg/mg. These findings indicate that regular use of products with ethanol content as low as 10% can impact FAEE results. EtG analysis should be used to confirm FAEE findings and appears to be unaffected by hair-care products, likely due to alternative mechanisms of incorporation.

  13. Improving quality of care in substance abuse treatment using five key process improvement principles.

    PubMed

    Hoffman, Kim A; Green, Carla A; Ford, James H; Wisdom, Jennifer P; Gustafson, David H; McCarty, Dennis

    2012-07-01

    Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.

  14. The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa.

    PubMed

    Collins, Pamela Y; Musisi, Seggane; Frehywot, Seble; Patel, Vikram

    2015-01-01

    The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders.

  15. The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa

    PubMed Central

    Collins, Pamela Y.; Musisi, Seggane; Frehywot, Seble; Patel, Vikram

    2015-01-01

    The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders. PMID:25783229

  16. Associations Between Maltreatment History and Severity of Substance Use Behavior in Youth in Foster Care.

    PubMed

    Gabrielli, Joy; Jackson, Yo; Brown, Shaquanna

    2016-09-22

    Substance use (SU) in youth remains a significant public health concern and a risk factor for morbidity and mortality in adolescents. The present study offers examination of the association between severity and chronicity of maltreatment history and SU in youth in foster care. Two hundred and ten (48% female) foster youth with a mean age of 12.71 years (SD = 2.95 years) completed surveys using an audio-computer-assisted self-interview program. Results revealed 31% of participants reported past-year SU, and substance users had a mean CRAFFT score of 3.43 (SD = 1.90). Reported age of SU onset was 11.08 years (SD = 2.21 years). The SU measurement model demonstrated excellent fit in this sample. Accounting for both youth age and youth placement type, the structural model with maltreatment predicting SU severity demonstrated strong model fit with a significant path between maltreatment and SU. Youth in residential facilities and older youth had higher rates of use than those residing in traditional foster home environments and younger youth. Findings provide additional support for the link between maltreatment experiences and SU severity in foster youth and suggest the need for screening and intervention services appropriate for this high-risk population.

  17. DSM-IV schizotypal personality disorder: a taxometric analysis among individuals with and without substance use disorders in the general population.

    PubMed

    Kerridge, Bradley T; Saha, Tulshi D; Hasin, Deborah S

    This study examined the underlying structure of DSM-IV schizotypal personality disorder (SPD) among individuals with and without a substance use disorder. Using a nationally representative sample of U.S. adults, taxometric analyses were conducted on SPD in the total sample and among individuals with and without a substance use disorder. The structure of SPD in the total sample and among individuals without substance use disorders was dimensional (comparison curve fit indices (CCFI): 0.440, 0.365) whereas a taxonic structure was demonstrated among individuals with a substance use disorder (CCFI: 0.679). Taxonicity underlying schizotypy and SPD in prior taxometric research may have been the result of sampling high risk subsamples of the population. Taxometric research on SPD and other personality psychopathology among high risk subgroups of the population can help elucidate the complex etiology of SPD and the role played by comorbid substance use disorders in the expressivity of these disorders.

  18. Utilization of Inpatient Care and its Determinants Among Persons With Intellectual Disabilities in Day Care Centres in Taiwan

    ERIC Educational Resources Information Center

    Lin, J. D.; Wu, J. L.; Lee, P. N.

    2004-01-01

    In Taiwan, current understanding is limited concerning the manner in which health services are utilized by persons with intellectual disabilities (ID). The objective of this study is to describe the patterns of inpatient care sought by persons with ID, and factors affecting inpatient care utilization. The primary method used in this study was a…

  19. Utilization of Inpatient Care and its Determinants Among Persons With Intellectual Disabilities in Day Care Centres in Taiwan

    ERIC Educational Resources Information Center

    Lin, J. D.; Wu, J. L.; Lee, P. N.

    2004-01-01

    In Taiwan, current understanding is limited concerning the manner in which health services are utilized by persons with intellectual disabilities (ID). The objective of this study is to describe the patterns of inpatient care sought by persons with ID, and factors affecting inpatient care utilization. The primary method used in this study was a…

  20. Controlled Substance-Related Beliefs and Use: Relationships to Undergraduates' Creative Personality Traits

    ERIC Educational Resources Information Center

    Plucker, Jonathan A.; McNeely, Andrea; Morgan, Carla

    2009-01-01

    The relationship between creativity and various mind-altering substances--especially alcohol--has been a popular topic among creativity researchers and the public at large. Yet experimental studies have found little evidence that alcohol use has a causal influence on creativity, with most studies of creative production showing negative or neutral…