JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2008
Shawn N. Fraser
We examined social and psychological correlates of cardiovascular reactivity (CVR), or exaggerated heart rate (HR) and blood pressure (BP) responses to mental stress, in 45 men (mean age = 60.1, SD = 9.9) and 17 women (mean age = 9.9, SD = 11.8) prior to cardiac rehabilitation. HR and BP increased from rest to anticipation, and women had higher resting and preexercise BP. Anxiety was positively related to HR reactivity. HR reactivity was negatively related to self-efficacy in women and positively related to self-efficacy in men. Men and women with more self-efficacy had lower systolic blood pressure (SBP) reactivity, and anxiety was positively related to SBP reactivity in women. Results suggest that the relationship among psychosocial factors and CVR might differ among men and women. [source]

The clinical and cultural factors in classifying low back pain patients within Greece: a qualitative exploration of Greek health professionals

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2007
Evdokia V. Billis MSc
Abstract Rationale, aims and objectives, Identifying homogenous subgroups of low back pain (LBP) patients is considered a priority in musculoskeletal rehabilitation and is believed to enhance clinical outcomes. In order to achieve this, the specific features of each subgroup need to be identified. The aim of this study was to develop a list of clinical and cultural features that are included in the assessment of LBP patients in Greece, among health professionals. This ,list' will be, utilized in a clinical study for developing LBP subgroups. Methods, Three focus groups were conducted, each one comprising health professionals with homogenous characteristics and all coordinated by a single moderator. There were: 11 physiotherapists (PTs) with clinical experience in LBP patients, seven PTs specialized in LBP management, and five doctors with a particular spinal interest. The focus of discussions was to develop a list of clinical and cultural features that were important in the examination of LBP. Content analysis was performed by two researchers. Results, Clinicians and postgraduates developed five categories within the History (Present Symptoms, History of Symptoms, Function, Psychosocial, Medical History) and six categories within the Physical Examination (Observation, Neurological Examination, Active and Passive Movements, Muscle Features and Palpation). The doctors identified four categories in History (Symptomatology, Function, Psychosocial, Medical History) and an additional in Physical Examination (Special Tests). All groups identified three cultural categories; Attitudes of Health Professionals, Patients' Attitudes and Health System influences. Conclusion, An extensive Greek ,list' of clinical and cultural features was developed from the groups' analysis. Although similarities existed in most categories, there were several differences across the three focus groups which will be discussed. [source]

Self-Esteem and Socioeconomic Disparities in Self-Perceived Oral Health

JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2009
David Locker
Abstract Objective: To determine if psychosocial factors explain the socioeconomic disparities in self-perceived oral health that persist after controlling for oral status variables. Methods: Data came from the participants in the Canadian Community Health Survey 2003 who were residents in the city of Toronto. Oral health variables included self-rated oral health, a 13-item oral health scale, denture wearing, and having a tooth extracted in the previous year. The last two measures were regarded as proxy indicators of tooth loss. Psychosocial variables included a self-esteem scale, a depression scale, and single items measuring life satisfaction, life stress, and sense of cohesion. Socioeconomic status was assessed using total annual household income. Results: Interviews were completed with 2,754 dentate persons aged 20 years and over. Bivariate analyses confirmed that there were income gradients in self-rated oral health and scores on the oral health scale. Linear regression analyses confirmed that these persisted after controlling for age, gender, denture wearing, and having a tooth extracted in the previous year. In the model predicting self-rated oral health self-esteem, life satisfaction, stress, a sense of cohesion, and depression also contributed to the model, increased its explanatory power, and reduced the strength of but did not eliminate the association between income and self-rated oral health. Broadly, similar results were obtained when the oral health scale score was used as the dependent variable. In both analyses and all models, denture wearing had the strongest and most enduring effect. Conclusion: Psychosocial factors partly but do not wholly explain the socioeconomic disparities in self-perceived oral health in this population after controlling for tooth loss and denture wearing. Other variables need to be added to the models to increase their explanatory power. [source]

Psychosocial, Motivational, and Contextual Profiles of Youth Reporting Different Patterns of Substance Use During Adolescence

JOURNAL OF RESEARCH ON ADOLESCENCE, Issue 1 2007
Alison Bryant Ludden
This research examined patterns of substance use and academic factors among a sample of 733 African-American and European-American adolescents from a metropolitan area. First, youth were classified into 11th grade high, moderate, or no substance use groups and classified as users, initiators, desistors, and nonusers based on eighth and 11th grade use. Nonusers did not differ in eighth grade from 11th grade moderate users and initiators over time. Eighth graders who reported misbehavior and having low-achieving friends were more likely to be high 11th grade users and users at both grades. Direct achievement effects were not found; however, interactions indicated achievement was protective when paired with having fun at school, high task value, and low levels of socioeconomic status (SES); and was a risk factor when paired with positive self regard, low fun at school and high SES. Cluster analyses indicated the most prevalent group of substance users reported high grades, social reasons for going to school, and having friends who do well in school. [source]

Psychosocial counseling in Parkinson's disease

MOVEMENT DISORDERS, Issue S4 2002
Article first published online: 29 JUL 200
[source]

Current awareness in prenatal diagnosis

PRENATAL DIAGNOSIS, Issue 9 2009
Article first published online: 28 AUG 200
In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of prenatal diagnosis. Each bibliography is divided into 21 sections: 1 Reviews; 2 General Interest; 3 Normal Fetal Development; 4 Preimplantation Genetic Diagnosis; 5 First Trimester Diagnosis; 6 Second Trimester Diagnosis; 7 Fetal Imaging: General; Ultrasound; MRI; 8 Maternal Serum Screening for Aneuploidy; 9 Screening for Carriers of Genetic Abnormality; 10 Molecular Cytogenetics: Metaphase Cytogenetics/FISH; Array CGH; 11 Fetal Cells in Maternal Circulation; 12 Fetal DNA/RNA in Maternal Body Fluids; 13 Fetal Therapy; 14 Psychosocial and Ethical Aspects; 15 Epidemiology and Environmental Factors; 16 Developmental and Placental Pathology; 17 Genetic Counseling. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted [source]

Current awareness in prenatal diagnosis

PRENATAL DIAGNOSIS, Issue 4 2009
Article first published online: 30 MAR 200
In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of prenatal diagnosis. Each bibliography is divided into 20 sections: 1 Reviews; 2 General Interest; 3 Normal Fetal Development; 4 Preimplantation Genetic Diagnosis; 5 First Trimester Diagnosis; 6 Second Trimester Diagnosis; 7 Fetal Imaging: General; Ultrasound; MRI; 8 Maternal Serum Screening for Aneuploidy; 9 Screening for Carriers of Genetic Abnormality; 10 Molecular Cytogenetics: Metaphase Cytogenetics/FISH; Array cGH; 11 Fetal Cells in Maternal Circulation; 12 Fetal DNA/RNA in Maternal Body Fluids; 13 Fetal Therapy; 14 Psychosocial and Ethical Aspects; 15 Epidemiology and Environmental Factors; 16 Developmental and Placental Pathology; 17 Genetic Counseling. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted [source]

Current awareness in prenatal diagnosis

PRENATAL DIAGNOSIS, Issue 3 2009
Article first published online: 26 FEB 200
In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of prenatal diagnosis. Each bibliography is divided into 20 sections: 1 Reviews; 2 General Interest; 3 Normal Fetal Development; 4 Preimplantation Genetic Diagnosis; 5 First Trimester Diagnosis; 6 Second Trimester Diagnosis; 7 Fetal Imaging: General; Ultrasound; MRI; 8 Maternal Serum Screening for Aneuploidy; 9 Screening for Carriers of Genetic Abnormality; 10 Molecular Cytogenetics: Metaphase Cytogenetics/FISH; Array cGH; 11 Fetal Cells in Maternal Circulation; 12 Fetal DNA/RNA in Maternal Body Fluids; 13 Fetal Therapy; 14 Psychosocial and Ethical Aspects; 15 Epidemiology and Environmental Factors; 16 Developmental and Placental Pathology; 17 Genetic Counseling. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted [source]

Psychosocial and sociodemographic correlates of benefit-finding in men treated for localized prostate cancer

PSYCHO-ONCOLOGY, Issue 11 2006
David P. Kinsinger
Abstract Background: Prostate cancer (PCa) treatment involves decrements in quality of life such as decreased sexual functioning and urinary/bowel incontinence. Prior work in other cancers has identified positive consequences (e.g. personal growth) following diagnosis and treatment, a phenomenon that has been referred to as benefit-finding (BF) and positively related to quality of life. Method: The present study evaluated demographic and psychosocial correlates of BF in men treated for localized PCa. Participants were 250 men who were 6,18 months post treatment, who completed measures of coping strategies, perceived social support, and BF. Results: In regression models both coping and social support were positively related to BF scores, even after controlling for income, education and ethnic identification. Conclusion: Active coping strategies and greater perceived social support are important correlates of greater BF following localized PCa treatment. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy

PSYCHO-ONCOLOGY, Issue 1 2004
Kelly A. Metcalfe
The purpose of this study was to determine the current psychosocial functioning of women who had previously had a bilateral prophylactic mastectomy. Women in the province of Ontario who had undergone prophylactic mastectomy between 1991 and 2000 were asked to complete questionnaires that assessed psychological distress, sexual activity, overall satisfaction with decision to have a prophylactic mastectomy, and body image. Ninety-seven percent of the women were satisfied with their decision to have a prophylactic mastectomy, but young women (<50 years) were less likely to report satisfaction than older women (p=0.001). Women with a strong family history of breast cancer or a BRCA1 or BRCA2 mutation experienced more cancer-related distress than those with a limited family history. Women who had reconstruction following mastectomy reported higher levels of satisfaction with general body shape and appearance than those without reconstruction. In conclusion, the majority of women were satisfied with their decision to undergo prophylactic mastectomy and were not experiencing abnormal levels of psychological distress, low levels of sexual activity, or difficulties with body image. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Relational Aggression and Adverse Psychosocial and Physical Health Symptoms Among Urban Adolescents

PUBLIC HEALTH NURSING, Issue 6 2009
Jessica Roberts Williams
ABSTRACT Objectives: The purpose of this study was to examine relational aggression and its relationship with adverse psychosocial and physical health symptoms among urban, African American youth. Design and Sample: Quantitative, cross-sectional survey design. The sample consisted of 185 predominantly African American (95.1%) seventh-grade students (mean age: 13.0; female: 58%) attending 4 urban middle schools. Measures: The Children's Social Behavior Scale and Social Experience Questionnaire were used to measure relational aggression and relational victimization. The Pediatric Symptom Checklist was used to assess psychosocial difficulties, including internalizing behaviors, externalizing behaviors, and attention problems. Physical health symptoms were measured with questions about colds/flu, headaches, and stomach aches. Results: 2-way multivariate analysis of variance revealed significant differences in externalizing behavior, with perpetrators reporting higher levels than nonperpetrators. Victims reported more internalizing behavior than nonvictims; however, this was only significant for males. For females, significant negative effects on health outcomes were found, resulting from the interaction of perpetration and victimization. Conclusions: Findings suggest that relational aggression is a common occurrence among urban, minority adolescents and may result in adverse health outcomes. These results provide several avenues for future research and implications for healthcare practice. Intervention strategies are needed to prevent relational aggression and continual or subsequent adverse health symptoms. [source]

ORIGINAL RESEARCH,PAIN: Pain, Psychosocial, Sexual, and Psychophysical Characteristics of Women with Primary vs.

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009
Secondary Provoked Vestibulodynia
ABSTRACT Introduction., Women with provoked vestibulodynia (PVD), a common cause of dyspareunia, are typically considered a homogeneous group. However, research suggests that differences on some factors (e.g., medical history, pain characteristics, psychological functioning, treatment response) exist based upon whether the pain was present at first intercourse (primary PVD: PVD1) or developed at some later point (secondary PVD: PVD2). Aims., The purpose of this study was to examine differences in demographic variables, pain characteristics, psychosocial and psychosexual adjustment, and pain sensitivity between women with PVD1 and PVD2. Methods., Twenty-six women suffering from PVD (13 with PVD1 and 13 with PVD2) completed a screening assessment, a standardized gynecological examination, an interview, questionnaires, and a quantitative sensory testing session. Main Outcome Measures., These included pain ratings during the gynecological examination and interview, scores on measures of psychosocial/sexual functioning (e.g., Short Form-36 [SF-36] Health Survey, Female Sexual Function Index), and thresholds and pain ratings during thermal sensory testing over the dominant forearm and vulvar vestibule. Results., The women with PVD1 were more likely to be nulliparous, but they were not significantly different from the women with PVD2 on other demographic variables or in their pain ratings during the gynecological examination. The women with PVD1 reported lower levels of social and emotional functioning and heightened anxiety surrounding body exposure during sexual activity, and they also displayed lower heat pain tolerance over the forearm and lower heat detection and pain thresholds at the vulvar vestibule than the women with PVD2. Conclusions., The findings from this study support previous research indicating that women with PVD1 and PVD2 differ in a number of domains. Further research is needed to confirm and elaborate on these findings. Sutton KS, Pukall C, and Chamberlain S. Pain, psychosocial, sexual, and psychophysical characteristics of women with primary vs. secondary provoked vestibulodynia. J Sex Med 2009;6:205,214. [source]

Psychosocial and marketing challenges for Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single-site Surgery

BJU INTERNATIONAL, Issue 6b 2010
Sashi S. Kommu
First page of article [source]

Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2004
Eileen Vizard
Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source]

Survival following an acute coronary syndrome: a pet theory put to the test

ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010
G. B. Parker
Objective:, The aim of this study was to revisit findings from previous studies reporting that pet ownership improves outcome following an admission for acute coronary syndrome (ACS). Method:, Four hundred and twenty-four patients admitted to a cardiac unit with an ACS completed questions regarding pet ownership in hospital. Rates of cardiac death and readmission were assessed 1 year following hospitalization. Results:, Pet owners were more likely to experience a death or readmission following their hospitalization, after controlling for key psychosocial and medical covariates. When dog and cat owners were considered separately, cat ownership was significantly associated with increased risk of death or readmission. Conclusion:, In this independent study, pet ownership at baseline, and cat ownership in particular, was associated with increased cardiac morbidity and mortality in the year following an admission for an acute coronary syndrome, a finding contrary to previous reports. [source]

Prejudice and schizophrenia: a review of the ,mental illness is an illness like any other' approach

ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2006
J. Read
Objective:, Many anti-stigma programmes use the ,mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia. Method:, The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes. Results:, The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as ,illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. Conclusion:, An evidence-based approach to reducing discrimination would seek a range of alternatives to the ,mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice. [source]

A controlled randomized treatment study: the effects of a cognitive remediation program on adolescents with early onset psychosis

ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2004
T. Ueland
Objective: To examine if a cognitive remediation program could be a positive supplement to a psychoeducational treatment program for adolescents with early onset psychosis. Method: Twenty-six subjects, randomly assigned to cognitive remediation (n = 14) or control group (n = 12), were assessed on cognitive, clinical, psychosocial and behavioural measures. Results: No significant between-group differences in pre- and post-treatment scores were found. This may be due to low statistical power. Exploratory within-group analyses showed that the training group improved on five of the 10 cognitive, and three of the five functioning outcome measures, while the control group improved on three of the cognitive, and one functioning outcome variable. Conclusion: Based on these results we cannot conclude that the addition of this cognitive remediation program, yields better results than psychoeducation alone. However, within-group analyses indicate that on specific cognitive functions, as well as on some functioning outcome measures, the remediation program may have a positive effect. [source]

Suicide, suicidality and suicide prevention in affective disorders

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2003
H. J. Möller
Objective:, It is well known that functional psychiatric disorders are one of the main causes of suicidal behaviour. This paper discusses the epidemiology and risk factors of suicidal behaviour in affective disorders and goes on to describe the treatment and prevention of such suicidal behaviour. Method:, A narrative overview of relevant epidemiological and drug studies. Results:, About 60,70% of patients with acute depression experience suicidal ideas. There is a high incidence of suicide (10,15%) in depressive patients. Psychopharmacological treatment with antidepressants and/or mood stabilizers is the most successful approach to avoid the risk of suicidal behaviour. In addition, psychotherapeutic and psychosocial interventions are of importance. Conclusion:, Suicidal behaviour and suicide must be considered when treating patients with affective disorders. The complex causation of suicidality has to be borne in mind when considering methods of suicide prevention. In order to obtain the best results, psychosocial, psychotherapeutic and psychopharmacological approaches should be combined, depending on the risk factors of each individual patient. [source]

Gender differences in unipolar depression: an update of epidemiological findings and possible explanations

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2003
C. Kuehner
Objective: To give an update on epidemiological findings on sex differences in the prevalence of unipolar depression and putative risk factors. Material and methods: Systematic review of the literature. Results: Recent epidemiological research yields additional evidence for a female preponderance in unipolar depression, holding true across different cultural settings. Current explanations include artefacts, genetic, hormonal, psychological and psychosocial risk factors. Rather consistently, intrapsychic and psychosocial gender role related risk factors have been identified which may contribute to the higher depression risk in women. Gender role aspects are also reflected in endocrine stress reactions and possibly influence associated neuropsychological processes. Conclusion: There is a need for more integrative models taking into account psychological, psychosocial, and macrosocial risk factors as well as their interactions, which also connect these factors with physiological and endocrine responses. Furthermore, it is conceivable that across the life span, as well as across cultural settings, individual risk factors will add with varying emphasis to the higher prevalence of depression in women. [source]

Persistent poor glycaemic control in adult Type 1 diabetes.

DIABETIC MEDICINE, Issue 12 2004
A closer look at the problem
Abstract Around 25% of the adult Type 1 diabetes population is in persistent poor glycaemic control and thus at increased risk of developing microvascular complications. We here discuss correlates of long-standing poor glycaemic control and review the efficacy of clinical strategies designed to overcome persistent poor control. Only a few studies have identified determinants and correlates of long-standing poor glycaemic control in Type 1 diabetes. There is some evidence implicating genetic factors, as well as lower economic status, and psychological factors, including lack of motivation, emotional distress, depression and eating disorders. Ways of improving glycaemic control include strategies to enable self-management, e.g. motivational strategies, coping-orientated education, psychosocial therapies, and/or intensifying insulin injection therapy plus continuous subcutaneous insulin infusion. Long-standing poor glycaemic control appears to be a heterogeneous and complex phenomenon, for which there is no simple, single solution. Comprehensive psycho-medical assessment in diabetes care may prove useful in tailoring interventions. Further research is warranted, to increase our understanding how psychosocial and biomedical factors, separately and in interaction, determine poor outcomes in Type 1 diabetes. [source]

Emergency Safe Spaces in Haiti and the Solomon Islands

DISASTERS, Issue 3 2010
Josh Madfis
This paper provides background information on emergency Safe Spaces for children and specific information for responses in Haiti and the Solomon Islands. In 2007, both countries experienced natural disasters that resulted in internal displacement of thousands of people. The Save the Children Alliance created Safe Spaces for children living in camps for internally displaced persons. The project sought to accomplish ,B-SAFE' strategies through emergency education, psychosocial, and protection interventions. The B-SAFE strategies are to (B)uild relationships, cooperation, and respect among peers; to (S)creen for high-risk children and youth; (A)ctive, structured learning and life saving information; to (F)acilitate children's natural resilience and a return to normalcy; and to (E)stablish a sense of security and self-esteem. The project made use of child and parent surveys and observation tools that measured B-SAFE indicators. Analysed data demonstrated an improvement in children's behavior participating in the programme. [source]

Pharmacogenomics in Cardiovascular Medicine

DRUG DEVELOPMENT RESEARCH, Issue 3 2004
John F. Carlquist
Abstract The completion of the Human Genome Project (HGP) holds promise for further insight into how genetic differences contribute to an individual's response to a medicine(s). Even before the completion of the HGP, cardiovascular medicine was thrust into the arena of pharmacogenomics by the observation that many drugs, cardiovascular and noncardiovascular, promote cardiac arrhythmias. It is now recognized that these adverse responses as well as beneficial responses to cardiovascular medicines can be influenced by alterations in the genes for metabolizing enzymes, drug transporters, and drug targets. To the present, much basic information regarding gene,drug interactions has accumulated, but translation to clinical care has been slow. It is anticipated that the pace of clinical cardiovascular pharmacogenomics will increase as the result of better-designed studies and technological advances. The final adoption of this area of investigation into clinical practice will also be influenced by financial, psychosocial, and legal factors. Drug Dev. Res. 62:180,190, 2004. © 2004 Wiley-Liss, Inc. [source]

Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment

ADDICTION, Issue 10 2010
Hendrik G. Roozen
ABSTRACT Aims Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs. Methods The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model. Results CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11,5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28,3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically for four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window. Conclusion CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes. [source]

Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands

ADDICTION, Issue 2 2010
Peter Blanken
ABSTRACT Aims To describe 4-year treatment retention and treatment response among chronic, treatment-resistant heroin-dependent patients offered long-term heroin-assisted treatment (HAT) in the Netherlands. Design Observational cohort study. Setting and intervention Out-patient treatment in specialized heroin treatment centres in six cities in the Netherlands, with methadone plus injectable or inhalable heroin offered 7 days per week, three times per day. Prescription of methadone plus heroin was supplemented with individually tailored psychosocial and medical support. Participants Heroin-dependent patients who had responded positively to HAT in two randomized controlled trials and were eligible for long-term heroin-assisted treatment (n = 149). Measurements Primary outcome measures were treatment retention after 4 years and treatment response on a dichotomous, multi-domain response index, comprising physical, mental and social health and illicit substance use. Findings Four-year retention was 55.7% [95% confidence interval (CI): 47.6,63.8%]. Treatment Response was significantly better for patients continuing 4 years of HAT compared to patients who discontinued treatment: 90.4% versus 21.2% [difference 69.2%; odds ratio (OR) = 48.4, 95% CI: 17.6,159.1]. Continued HAT treatment was also associated with an increasing proportion of patients without health problems and who had stopped illicit drug and excessive alcohol use: from 12% after the first year to 25% after 4 years of HAT. Conclusions Long-term HAT is an effective treatment for chronic heroin addicts who have failed to benefit from methadone maintenance treatment. Four years of HAT is associated with stable physical, mental and social health and with absence of illicit heroin use and substantial reductions in cocaine use. HAT should be continued as long as there is no compelling reason to stop treatment. [source]

Anabolic,androgenic steroid dependence: an emerging disorder

ADDICTION, Issue 12 2009
Gen Kanayama
ABSTRACT Aims Anabolic,androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects. Method We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database. Results About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be adapted slightly for cumulatively acting drugs such as AAS. Conclusions AAS dependence is a valid diagnostic entity, and probably a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies. [source]

Adolescent inhalant use, abuse and dependence

ADDICTION, Issue 7 2009
Brian E. Perron
ABSTRACT Aims To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design Cross-sectional survey with structured psychiatric interviews. Setting Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11,20); more than one-third (38.6%, n = 279) reported life-time inhalant use. Measurements Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems. Findings Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users. Conclusions Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed. [source]

Determinants of continuity and change over 10 years in young women's smoking

ADDICTION, Issue 3 2009
Liane McDermott
ABSTRACT Aims To examine prospectively continuity and change in smoking behaviour and associated attributes over a 10-year period. Design, setting and participants Participants (initially aged 18,23 years) in the Australian Longitudinal Study on Women's Health completed postal questionnaires in 1996, 2000, 2003 and 2006. The analysis sample was 6840 women who participated in all surveys and provided complete smoking data. Measurements Outcome variables were transitions in smoking behaviour between surveys 1 and 2, 2 and 3, 3 and 4 and 1 and 4. Attributes that differentiated continuing smokers from quitters, relapsers from ex-smokers and adopters from never smokers were examined for each survey period. Explanatory variables included previous smoking history, demographic, psychosocial, life-style risk behaviour and life-stage transition factors. Findings Over 10 years, 23% of participants either quit, re-started, adopted or experimented with smoking. Recent illicit drug use and risky or high-risk drinking predicted continued smoking, relapse and smoking adoption. Marriage or being in a committed relationship was associated significantly with quitting, remaining an ex-smoker and not adopting smoking. Living in a rural or remote area and lower educational attainment were associated with continued smoking; moderate and high physical activity levels were associated positively with remaining an ex-smoker. Conclusions Life-style and life-stage factors are significant determinants of young women's smoking behaviour. Future research needs to examine the inter-relationships between tobacco, alcohol and illicit drug use, and to identify the determinants of continued smoking among women living in rural and remote areas. Cessation strategies could examine the role of physical activity in relapse prevention. [source]

One size does not fit all: how the tobacco industry has altered cigarette design to target consumer groups with specific psychological and psychosocial needs

ADDICTION, Issue 11 2003
Benjamin Lê Cook
ABSTRACT Aims To identify whether the tobacco industry has targeted cigarette product design towards individuals with varying psychological/psychosocial needs. Design Internal industry documents were identified through searches of an online archival document research tool database using relevancy criteria of consumer segmentation and needs assessment. Findings The industry segmented consumer markets based on psychological needs (stress relief, behavioral arousal, performance enhancement, obesity reduction) and psychosocial needs (social acceptance, personal image). Associations between these segments and smoking behaviors, brand and design preferences were used to create cigarette brands targeting individuals with these needs. Conclusions Cigarette brands created to address the psychological/psychosocial needs of smokers may increase the likelihood of smoking initiation and addiction. Awareness of targeted product development will improve smoking cessation and prevention efforts. [source]

The application of computer touch-screen technology in screening for psychosocial distress in an ambulatory oncology setting

EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2002
A. ALLENBY DN, MEDST
The objective of the study was to evaluate the acceptability and feasibility of computer touch-screen technology as a method for patients to report psychosocial functioning in an ambulatory cancer clinic. Patients participating in a randomized trial evaluating the use of self-reported psychosocial information in the clinical encounter were surveyed. The patients completed the Cancer Needs Questionnaire (CNQ), European Organization for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the Beck Depression Inventory , Short Form (BDI) using a touch-screen computer. The time taken to complete the questionnaires was recorded electronically. Patients completed a seven-item pen and paper survey to assess acceptability of the process. Of the 450 patients, 244 (54%) were 60 years or older. Although over half the patients had no prior computer experience, nearly all found the touch screen easy to use and the instructions easy to understand. Each question was answered by at least 447 (99.3%) patients. The average time to complete the CNQ was 9.1 min, EORTC QLQ-C30 4.0 min and BDI 3.1 min. Factors influencing time to completion were prior use of computers, physical condition, education and overall level of needs. The study found that the use of computer touch-screen technology is an acceptable and efficient method for obtaining self-reported information on quality of life, cancer needs and psychological distress. [source]

Chronic cognitive sequelae after traumatic brain injury are not related to growth hormone deficiency in adults

EUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2010
D. Pavlovic
Objective:, The objective of the study was to asses the possible influence of hypothalamo,pituitary deficiencies, and growth hormone (GH) deficiency in particular, on cognition in adult patients with traumatic brain injury (TBI). TBI is a recently identified risk factor for cognitive deficits and hypopituitarism. Even the patients with favorable outcome after TBI may present with persistent bodily, psychosocial, and cognitive impairments, resembling patients with untreated partial or complete pituitary insufficiency. Design:, We performed retrospective and cross-sectional study of endocrine and cognitive function in TBI in 61 patients (aged 37.7 ± 1.7 years) of both sexes (44 m,17 f), at least 1 year after TBI (3.9 ± 0.6 years). Serum insulin-like growth factor 1 (IGF-I), thyroxin, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (in men), prolactin, and cortisol were measured, and GH secretion was assessed by growth hormone releasing hormone (GHRH) + growth hormone releasing peptide-6 (GHRP-6) test. Cognitive function was assessed by using a standard neuropsychological battery. Results:, GH deficiency (GHD) and GH insufficiency (GHI) were found in 20 patients (32.8%). After adjustment for confounders [age, body mass index (BMI), education level, time elapsed from TBI], there were no significant differences in results of neuropsychological tests between patients with TBI with GHD, GHI, and normal GH secretion. There were no correlations of neuropsychological variables with stimulated peak GH secretion or IGF-I level. Conclusions:, GHD persists long after the TBI, independently of trauma severity and age at traumatic event. GH secretion is more sensitive to TBI than other pituitary hormones. No evidence is found for an association of cognitive function impairment and somatotropic axis impairment in adult patients tested more than 1 year after the TBI. [source]