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Follow-up Interviews (follow-up + interview)
Selected AbstractsAdult versus adolescent onset of smoking: how are mood disorders and other risk factors involved?ADDICTION, Issue 8 2009Vladeta Ajdacic-Gross ABSTRACT Aims To examine the strength of association between smoking and mood disorders and the association between smoking and its traditional risk factors, comparing those who started smoking in adolescence with those who started smoking in early adulthood. Design and participants The analyses relied on prospective data from the Zurich Study. This longitudinal community study started in 1979 with a stratified sample of 591 participants aged 20/21 years, weighted towards those with mental disorders. Follow-up interviews were conducted at ages 23, 28, 30, 35 and 41. Measurements In this analysis the adult versus adolescent onset of smoking was regressed on the cumulative prevalence of mood disorders, personality characteristics measured by the Freiburg Personality Inventory, common risk factors such as parental smoking, conduct and school problems, troubles with the family and basic socio-demographic variables (sex, education). Findings In the Zurich Study cohort we found that 61.6% were former or current smokers, of whom 87% started smoking before the age of 20 and 13% after the age of 20. Adolescent onset of smoking was associated strongly with later major depression, dysthymia or bipolar disorders and, furthermore, with parental smoking, extroverted personality and discipline problems and rebelliousness in youth. However, only depression and dysthymia were associated with adult onset smoking and other risk factors associated with smoking were not so associated in this group. Conclusions Correlates of smoking onset in adolescence are mainly not applicable to the onset of smoking in young adulthood. Smoking onset beyond adolescence is an open research issue. [source] Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary riskHEALTH EXPECTATIONS, Issue 1 2002J. Michael Paterson MSc Objective,To assess the feasibility and acceptability of a patient workbook for self-assessing coronary risk. Design,Pilot study, with post-study physician and patient interviews. Setting and subjects,Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions. Interventions,The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow-up interviews were by interviewer-administered questionnaire. Main outcome measures,Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10-year risk of a coronary event measured before and after using the workbook. Results,It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1,80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre-workbook (mean (SD) %): 35.2 (16.9) vs. post-workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)). Conclusions,Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment. [source] Stimulant Medications: A Trade-off?JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2006The Lived Experience of Adolescents With ADHD PURPOSE.,The purpose of this study was to gain information and insight about prescription stimulant medication use among children and adolescents with attention deficit,hyperactivity disorder (ADHD) across developmental stages. DESIGN AND METHODS.,Investigators conducted semistructured qualitative interviews with 15 college students with ADHD. Follow-up interviews confirmed and validated information obtained during initial interviews. RESULTS.,Qualitative data analysis resulted in three global categories related to the use of prescription stimulant medication from childhood to late adolescence: (a) the early years, (b) "the trade-off," and (c) stimulant medications in college. PRACTICE IMPLICATIONS.,Increased education about prescription stimulant medications and closer management is needed to reduce side effects and minimize the risks of misuse. [source] The Overlap Syndrome of Depression and Delirium in Older Hospitalized PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2009Jane L. Givens MD OBJECTIVES: To measure the prevalence, predictors, and posthospitalization outcomes associated with the overlap syndrome of coexisting depression and incident delirium in older hospitalized patients. DESIGN: Secondary analysis of prospective cohort data from the control group of the Delirium Prevention Trial. SETTING: General medical service of an academic medical center. Follow-up interviews at 1 month and 1 year post-hospital discharge. PARTICIPANTS: Four hundred fifty-nine patients aged 70 and older who were not delirious at hospital admission. MEASUREMENTS: Depressive symptoms assessed at hospital admission using the 15-item Geriatric Depression Scale (cutoff score of 6 used to define depression), daily assessments of incident delirium from admission to discharge using the Confusion Assessment Method, activities of daily living at admission and 1 month postdischarge, and new nursing home placement and mortality determined at 1 year. RESULTS: Of 459 participants, 23 (5.0%) had the overlap syndrome, 39 (8.5%) delirium alone, 121 (26.3%) depression alone, and 276 (60.1%) neither condition. In adjusted analysis, patients with the overlap syndrome had higher odds of new nursing home placement or death at 1 year (adjusted odds ratio (AOR)=5.38, 95% confidence interval (CI)=1.57,18.38) and 1-month functional decline (AOR=3.30, 95% CI=1.14,9.56) than patients with neither condition. CONCLUSION: The overlap syndrome of depression and delirium is associated with significant risk of functional decline, institutionalization, and death. Efforts to identify, prevent, and treat this condition may reduce the risk of adverse outcomes in older hospitalized patients. [source] Two-Year Outcome of an Intervention Program for University Students Who Have Parents With Alcohol Problems: A Randomized Controlled TrialALCOHOLISM, Issue 11 2007Helena Hansson Background:, Only a few intervention studies aiming to change high-risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems. Method:, In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2-hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face-to-face interview and 6 self-completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist-90, Coping with Parents' Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow-up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported. Results:, All participants finished the baseline assessment, accepted and completed the intervention. Ninety-five percent of the students completed the 24-month follow-up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12-month follow-up to the 24-month follow-up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12-month follow-up. The improvements in coping behavior achieved at the 12-month follow-up remained at the 24-month follow-up for all the 3 groups, i.e., regardless of intervention program. Conclusion:, Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1-year results with effects of alcohol intervention with or without a combination with coping intervention. [source] Quality of light and quality of life , the effect of lighting adaptation among people with low visionOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2004Gunilla Brunnström Abstract Purpose:, The study has investigated the effect of lighting on the daily activities (ADL) of the visually impaired in their homes by comparison before and after light adjustments were made in the kitchen, hall and bathroom. It has also investigated the additional effects on the quality of life after providing task lighting in the living room. Method:, A total of 56 people were consecutively recruited from those receiving lighting adaptation help by the Low Vision Clinic in Göteborg. Ten persons did not complete the study. After medical examinations, lighting standards and psychosocial factors were charted. After lighting improvements were carried out in the kitchen, hall and bathroom, the subjects were randomly divided into two groups, an intervention and a comparison group. The task lighting in the living room was also improved for those included in the intervention group. Follow-up interviews to determine ADL and quality of life were performed 6 months after lighting adaptation. Results:, A marked effect on quality of life of the lighting in the living room was found for the intervention group. The effect on ADL of the basic lighting adaptation in kitchen, hall and bathroom for both groups was significant for tasks carried out on the working surface in the kitchen. Other activities in the kitchen and in the bathroom tended to improve but changes were not significant. Conclusion:, The results confirm that it is possible to increase quality of life by improving the lighting conditions. [source] Environmental responsibility in SMEs: does it deliver competitive advantage?BUSINESS STRATEGY AND THE ENVIRONMENT, Issue 3 2004Mike Simpson Small and medium sized enterprises (SMEs) can gain a competitive advantage and create sustainable business by adopting environmental good practices. However, the perceptions of SMEs and their approach to environmental improvements suggest that there are some fundamental misunderstandings and difficulties in achieving this in practice. A questionnaire-based study of SMEs and their responses to the current requirements of environmental good practice was carried out in South Yorkshire. Follow-up interviews and factory visits were also carried out. The study aimed to assess the ability of SMEs to create a competitive advantage by adopting environmental good practice and making environmental improvements to their business. The main findings were that most organizations surveyed believed environmental issues to be issues affecting their business. However, the meeting of these requirements was seen as a cost that was not transferable to customers in terms of added benefits and few organizations could show that it led to a competitive advantage. Copyright © 2004 John Wiley & Sons, Ltd and ERP Environment. [source] Different strokes: regulatory styles and environmental strategy in the North-American oil and gas industryBUSINESS STRATEGY AND THE ENVIRONMENT, Issue 6 2001Sanjay Sharma The environmental management and policy literature presents competing arguments for and against different styles of environmental regulations , command-and-control versus flexible regulations that enable voluntary actions. On the one hand, it is argued that firms will not adopt minimum environmental standards without command-and-control regulations and that such regulations may actually result in competitive benefits for first movers. On the other hand, the literature argues that command-and-control regulations stifle innovation and that flexible regulations encourage proactive environmental strategies that lead to competitive benefits for organizations. This study compared the environmental strategies and competitiveness of oil and gas firms in two different regulatory contexts , the command-and-control based US environmental regulations and the flexible collaborative Canadian context. The study found no significant differences in the degree to which firms within the two contexts were more or less proactive in their environmental strategies or in the extent of competitiveness associated with corporate environmental strategies. Follow-up interviews with 12 Canadian and US companies indicated that regulations appeared to be more important drivers of corporate environmental practices at initial stages and eventually other external and internal drivers became more important influences on corporate environmental strategies. Copyright © 2001 John Wiley & Sons, Ltd and ERP Environment [source] FS13.2 Intervention on work-related skin problems among gut cleanersCONTACT DERMATITIS, Issue 3 2004Mari-Ann Flyvholm Work-related skin problems are frequent in the food processing industry. A randomised intervention study with a one-year follow up was carried out among gut cleaners in order to prevent work-related skin problems due to wet work. The effects of the intervention were primarily measured by telephone interviews using questionnaires based on a standardized questionnaire for work-related skin diseases and exposure (NOSQ-2002).* The intervention activities included an evidence-based prevention program and an evidence-based method for implementation. Six of the 18 participating departments were randomly assigned to the intervention group and the remaining 12 departments to the comparison group. A total of 644 employees responded in the baseline interview and 622 in the follow-up interview carried out a year later. The participation rates were 87,5% and 71,6% respectively. Among the 495 participants answering in both interviews the frequency of eczema on hands or forearms within the past 3 months was reduced significantly by more than 25% in the intervention departments. A minor increase was observed in the comparison departments. This study has shown that even in jobs without the possibility to reduce high exposure to wet work work-related skin problems can be reduced by proper preventive measures. *) Susitaival P, Flyvholm M-A, Meding B, Kanerva L, Lindberg M, Svensson Å, Ólafsson JH. Contact Dermatitis 2003;49:70,76. [source] Disability payments, drug use and representative payees: an analysis of the relationshipsADDICTION, Issue 7 2003James A. Swartz ABSTRACT Aims This study attempted to determine: if US federal cash disability payments increase the use of cocaine or opiates among those requalifying for supplemental security income (SSI) disability benefits compared with those who lost benefits; if drug use peaks at the beginning of the month after the receipt of the disability cash disbursement; and if money management by representative payees of requalifying SSI recipients suppresses drug use. Design A multi-site, prospective, 2 year longitudinal design was used with follow-up interviews conducted every 6 months. Urine samples were collected at the final three follow-up interviews. Setting Data were collected in Chicago, IL, Los Angeles, CA, and Seattle, WA, USA. Participants This study used a randomly selected sample of 740 former recipients of SSI who had received disability benefits for drug addiction and alcoholism (DA&A) in 1996, were between the ages of 21 and 59 years, had not received concurrent social security disability insurance and provided testable urine samples and complete self-report data for at least one follow-up interview. Measurements Independent variables included demographics, SSI status at follow-up, representative payee status, drug treatment participation and income. Time of drug testing was operationalized as the first 10 days of the month versus the last 20,21 days based on when the urine sample was collected. The dependent variables were cocaine and opiate use, determined by urinalysis results. Findings Participants were 28% more likely to test positive for cocaine use in the first 10 days of the month than later in the month. This effect was general across all subjects and was not restricted to those receiving SSI benefits. No such effect was found for opiate use. Receiving SSI benefits did not increase cocaine or opiate use generally, nor did having a representative payee suppress use. Conclusions The findings do not support the contentions that federal cash benefits appreciably increase drug use or that representative payees discourage use, at least when use is defined dichotomously. The ,check effect' for cocaine use appears to be general and not confined to those receiving federal cash benefits. The lack of a ,check effect' for opiate use is probably the result of the difference between a relatively steady state of opiate use associated with addiction and a binge pattern of cocaine use triggered by suddenly flush resources. [source] Laparoscopic nephropexy: Treatment outcome and quality of lifeINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2004YOSHIYUKI MATSUI Abstract Background:, The recent introduction of laparoscopic procedures has markedly altered urological surgery. Laparoscopic nephropexy has attracted the attention of urologists as a treatment for nephroptosis. Herein, we describe our experiences and quality-of-life outcome of laparoscopic nephropexy and discuss its indications and surgical techniques. Methods:, From May 1998 to February 2002, six female patients, ranging in age from 20 to 64 years (median age 39.8 years), with symptomatic nephroptosis underwent laparoscopic nephropexy. Mean preoperative downward kidney displacement was 2.25 vertebral bodies (range 2,2.5) and all affected kidneys were tilted at orthostasis. One patient underwent nephropexy through the transperitoneal approach and the remaining patients underwent nephropexy through the retroperitoneal approach. To evaluate surgical results, postoperative follow-up interview (pain visual analog scale and the short-form 36 (SF-36) health survey questionnaire) and objective examinations were performed. Results:, All procedures were accomplished without complication. Postoperative intravenous pyelography correctly confirmed fixed kidney in both supine and erect positions. All patients reported an improvement of symptoms approximately 1 month after nephropexy and no symptoms have recurred during the follow-up period (range 6.3,50.7 months). On the SF-36, two domains, including role limitations due to emotional problems (RE) and mental health (MH), exhibited significant improvement postoperatively (P = 0.0405 and P = 0.0351, respectively). Conclusions:, Laparoscopic, in particular retroperitoneoscopic, nephropexy yields excellent outcomes and greatly improves general health-related quality of life, particularly mental status, as a minimally invasive treatment for symptomatic nephroptosis. [source] Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission , a multicentre cohort studyJOURNAL OF CLINICAL NURSING, Issue 9 2007Brigit L Roberts RN, IC Cert Aims and objective., To examine the relationship between observed delirium in ICU and patients' recall of factual events up to two years after discharge. Background., People, the environment, and procedures are frequently cited memories of actual events encountered in ICU. These are often perceived as stressors to the patients and the presence of several such stressors has been associated with the development of reduced health-related quality of life or post-traumatic stress syndrome. Design., Prospective cohort study using interview technique. Method., The cohort was assembled from 152 patients who participated in a previously conducted multi-centre study of delirium incidence in Australian ICUs. The interviews involved a mixture of closed- and open-ended questions. Qualitative responses regarding factual memories were analysed using thematic analysis. A five-point Likert scale with answers from ,always' to ,never' was used to ask about current experiences of dream, anxiety, sleep problems, fears, irritability and/or mood swings. Scoring ranged from 6 to 30 with a mid-point value of 18 indicating a threshold value for the diagnosis of post-traumatic stress syndrome. A P -value of <0·05 was considered significant for all analyses. Results., Forty-one (40%) out of 103 potential participants consented to take part in the follow-up interview; 18 patients (44%) had been delirious and 23 patients (56%) non-delirious during the ICU admission. The non-participants (n = 62) formed a control group to ensure a representative sample; 83% (n = 34) reported factual memories either with or without recall of dreaming. Factual memories were significantly less common (66% cf. 96%) in delirious patients (OR 0·09, 95%CI 0·01,0·85, p = 0·035). Five topics emerged from the thematic analysis: ,procedures', ,staff', ,comfort', ,visitors', and ,events'. Based on the current experiences, five patients (12%, four non-delirious and one delirious) scored ,18 indicative of symptoms of post-traumatic stress syndrome; this did not reach statistical significance. Memory of transfer out of ICU was less frequent among the delirious patients (56%, n = 10) than among the non-delirious patients (87%, n = 20) (p = 0·036). Conclusion., Most patients have factual memories of their ICU stay. However, delirious patients had significantly less factual recall than non-delirious patients. Adverse psychological sequelae expressed as post-traumatic stress syndrome was uncommon in our study. Every attempt must be made to ensure that the ICU environment is as hospitable as possible to decrease the stress of critical illness. Post-ICU follow-up should include filling in the ,missing gaps', particularly for delirious patients. Ongoing explanations and a caring environment may assist the patient in making a complete recovery both physically and mentally. Relevance to clinical practice., This study highlights the need for continued patient information, re-assurance and optimized comfort. While health care professionals cannot remove the stressors of the ICU treatments, we must minimize the impact of the stay. It must be remembered that most patients are aware of their surroundings while they are in the ICU and it should, therefore, be part of ICU education to include issues regarding all aspects of patient care in this particularly vulnerable subset of patients to optimize their feelings of security, comfort and self-respect. [source] Are single fractions of radiotherapy suitable for plantar fasciitis?JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2004Fabian Schwarz Summary The use of radiotherapy for plantar fasciitis has never been reported in Australasia and is scarcely found in the English language medical literature, but it is commonly used in Europe, especially in Germany. In Europe, treatment courses consisting of multiple small fractions have been associated with high levels of pain relief. In the present report, the use of single fractions or radiotherapy was evaluated by reviewing seven consecutive patients referred for treatment and by applying objective and subjective criteria for pain relief. One patient died of unrelated causes soon after treatment and one declined to receive radiotherapy. Four patients each received a single dose of 8 Gy resulting in complete pain relief. One patient was treated with 8 Gy and 12 weeks later was retreated achieving partial pain relief. A follow-up interview was conducted after a mean of 15.6 months, ranging from 1.5 to 30 months. No acute or late effects occurred; however, the possibility that delayed effects may yet occur, particularly carcinogenesis, cannot be excluded. Radiotherapy for this common condition should be investigated further as it might be safer and more effective than other methods currently in use. [source] SBIRT Outcomes in Houston: Final Report on InSight, a Hospital District-Based Program for Patients at Risk for Alcohol or Drug Use ProblemsALCOHOLISM, Issue 8 2009The InSight Project Research Group Background:, Screening, Brief Intervention, and Referral to Treatment (SBIRT) services have been implemented as the standard of care for patients in the Harris County Hospital District (HCHD). The present analysis addresses alcohol and drug use for patients admitted over a 39-month period from July 1, 2005 through September 30, 2008. Methods:, Patients were screened for alcohol and drug use at medical admission. Those who were positive received further assessment and were transitioned to receive services as appropriate. A sample of consenting patients who were positive and received services was contacted at 6 months for a follow-up interview. Using an intent-to-treat (ITT) protocol, the analysis included all patients who were assigned for follow-up, including those with completed follow-ups as well as those who could not be contacted at follow-up. Patients not contacted at follow-up were assumed to have maintained their baseline drug and alcohol consumption levels. Results:, Of 59,760 patients who were screened by generalists (primarily nurses, physicians, and medical care technicians), 15,241 (26%) were positive and received further assessment and services. The 6-month follow-up interview completion rate was 66%. The ITT sample consisted of all 1,937 patients who were assigned for follow-up. There was an overall reduction in the number of patients reporting any days of heavy drinking from 70% at intake to 37% at 6-month follow-up and a reduction in the mean number of days of heavy drinking from 7.8 days at intake to 4.1 days at follow-up. The number of patients reporting any days of drug use was 82% at intake versus 33% at follow-up, and the mean number of days of drug use declined from 8.3 days at intake to 4.2 days at follow-up. Conclusions:, The results were consistent with but of greater magnitude than most other studies reporting positive outcomes for SBIRT patients. Drug use and heavy alcohol use were found to decrease substantially from admission to follow-up. This finding holds good for all levels of drug or alcohol misuse severity, with the highest severity patients showing the largest decreases. Future studies are needed to control for potential regression to the mean effects and to develop improved understanding of differences in outcomes by race/ethnicity. [source] Long-term follow-up of impulse control disorders in Parkinson's diseaseMOVEMENT DISORDERS, Issue 1 2008Eugenia Mamikonyan MS Abstract Recent studies have linked dopamine agonist (DA) usage with the development of impulse control disorders (ICDs) in Parkinson's disease (PD). Little is known about optimal management strategies or the long-term outcomes of affected patients. To report on the clinical interventions and long-term outcomes of PD patients who developed an ICD after DA initiation. Subjects contacted by telephone for a follow-up interview after a mean time period of 29.2 months. They were administered a modified Minnesota Impulse Disorder Interview for compulsive buying, gambling, and sexuality, and also self-rated changes in their ICD symptomatology. Baseline and follow-up dopamine replacement therapy use was recorded and verified by chart review. Of 18 subjects, 15 (83.3%) participated in the follow-up interview. At follow-up, patients were receiving a significantly lower DA levodopa equivalent daily dosage (LEDD) (Z = ,3.1, P = 0.002) and a higher daily levodopa dosage (Z = ,1.9, P = 0.05), but a similar total LEDD dosage (Z = ,0.47, P = 0.64) with no changes in Unified Parkinson's Disease Rating Scale motor score (Z = ,1.3, P = 0.19). As part of ICD management, 12 (80.0%) patients discontinued or significantly decreased DA treatment, all of whom experienced full or partial remission of ICD symptoms by self-report, and 10 (83.3%) of whom no longer met diagnostic criteria for an ICD. For PD patients who develop an ICD in the context of DA treatment, discontinuing or significantly decreasing DA exposure, even when offset by an increase in levodopa treatment, is associated with remission of or significant reduction in ICD behaviors without worsening in motor symptoms. © 2007 Movement Disorder Society [source] Effects of self-reported health conditions and pesticide exposures on probability of follow-up in a prospective cohort studyAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2010Martha P. Montgomery MHS Abstract Background We investigated the potential for selection bias due to non-participation in the follow-up of a large prospective cohort study. Methods Licensed pesticide applicators (52,395 private; 4,916 commercial) in the Agricultural Health Study provided demographic, health, and pesticide exposure information at enrollment (1993,1997) and in a 5-year follow-up telephone interview. Factors associated with non-participation in the follow-up were identified using multiple logistic regression. Potential for selection bias was evaluated by comparing exposure,disease associations between the entire cohort and the follow-up subset. Results Sixty-six percent of private and 60% of commercial applicators completed the follow-up interview. Private and commercial applicators who did not complete the follow-up reported at enrollment younger age, less education, lower body mass index, poorer health behaviors but fewer health conditions, and lower pesticide use. Estimates of exposure,disease associations calculated with and without non-participants did not indicate strong selection bias. Conclusions Differences between non-participants and participants in the follow-up interview were generally small, and we did not find significant evidence of selection bias. However, the extent of bias may depend on the specific exposure and outcome under study. Am. J. Ind. Med. 53:486,496, 2010. © 2009 Wiley-Liss, Inc. [source] Prevalence of multiple sclerosis in Västerbotten County in northern SwedenACTA NEUROLOGICA SCANDINAVICA, Issue 4 2001P. Sundström Objective , To estimate the prevalence and clinical characteristics of multiple sclerosis (MS) in Västerbotten County in northern Sweden. Methods,Individuals with MS were identified from several sources. A follow-up interview and/or examination was performed in 94% of cases still living in the area during 1997,99. Onset adjusted prevalence and a definition of onset symptoms were applied. Results, A total of 313 cases were identified, resulting in an onset adjusted crude prevalence of MS for January 1990 of 125/105 (95% confidence interval (CI): 112,140). Female predominance was evident (163/105 (95% CI: 142,187) vs 86/105 (95% CI: 71,104)). Diagnostic coding registers were the most important source for identification of cases. Conclusions, The crude prevalence of MS in Västerbotten was higher than previous reports from other major areas in Scandinavia. The adjusted prevalence was significantly higher when compared with a previous study from Göteborg, south-western Sweden. The methodology used in this study gives a high degree of case ascertainment and increases the comparability of multiple sclerosis epidemiological studies. [source] Cost-effectiveness of extended buprenorphine,naloxone treatment for opioid-dependent youth: data from a randomized trialADDICTION, Issue 9 2010Daniel Polsky ABSTRACT Aims The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine,naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth. Design Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling. Participants 152 patients aged 15,21 years. Measurements Data were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12. Findings The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25 049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100 000 per QALY. Conclusions Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth. [source] Using sensation seeking to target adolescents for substance use interventionsADDICTION, Issue 3 2010James D. Sargent ABSTRACT Aims This study examines the predictive validity of sensation seeking as a predictor of adolescent substance use, in order to optimize targeting for substance use prevention programs. Design Longitudinal study. Setting Random-digit dial telephone survey. Participants A total of 6522 US adolescents aged 10,14 years at baseline, resurveyed at 8-month intervals for three subsequent waves. Measurements Two outcomes were assessed,onset of binge drinking (more than five drinks in a short time) and established smoking (>100 cigarettes life-time). Sensation seeking level was assessed at baseline. Logistic regression was used to predict onset of substance use at any follow-up wave as a function of sensation seeking. The receiver operating characteristics curve was used to illustrate how well sensation seeking predicted substance use as a function of different cut-off points for defining high sensation seeking, and area under the receiver operating characteristics curve (AROC) was the metric of predictive validity. Findings Of 5834 participants with one or more follow-up assessments, 5634 reported no binge drinking and 5802 were not established smokers at baseline, of whom 717 (12.7% of 5634) reported binge drinking and 144 (2.5% of 5802) reported established smoking at one or more follow-up interviews. Sensation seeking predicted binge drinking moderately well [AROC = 0.71 (95% confidence interval 0.69, 0.73)] and was a significantly better predictor of established smoking onset [AROC = 0.80 (0.76, 0.83)]. For binge drinking, predictive validity was significantly lower in blacks; for established smoking it was significantly higher for Hispanics. Implications for two targeting interventions are discussed. Conclusions Sensation seeking works moderately well at identifying adolescents at risk for onset of binge drinking and established smoking. This study offers a guide for determining the appropriate targeting cut-off value, based on intervention efficacy, costs and risks. [source] Doing harm reduction better: syringe exchange in the United StatesADDICTION, Issue 9 2009Don C. Des Jarlais ABSTRACT Objective To trace the growth of syringe exchange programs (SEPs) in the United States since 1994,95 and assess the current state of SEPs. Methods Annual surveys of US SEPs known to North American Syringe Exchange Network (NASEN). Surveys mailed to executive directors with follow-up interviews by telephone and/or e-mail. Response rates have varied between 70% and 88% since surveys were initiated in 1996. Results The numbers of programs known to NASEN have increased from 68 in 1994,95 to 186 in 2007. Among programs participating in the survey, numbers of syringes exchanged have increased from 8.0 million per year to 29.5 million per year, total annual budgets have increased from $6.3 to $19.6 million and public funding (from state and local governments) has increased from $3.9 to $14.4 million. In 2007, 89% of programs permitted secondary exchange and 76% encouraged it. Condoms, referrals to substance abuse treatment, human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) counseling and testing and naloxone for overdose were among the most commonly provided services in addition to basic syringe exchange. Each of these services was provided by 40% or more of SEPs in 2007. Conclusions While syringe exchange has remained controversial in the United States, there has been very substantial growth in numbers of programs, syringes exchange and program budgets. Utilizing secondary exchange to reach large numbers of injecting drug users and utilizing SEPs as a new platform for providing health and social services beyond basic syringe exchange have been the two major organizational strategies in the growth of SEPs in the United States. [source] Feasibility and validity of low-budget telephonic follow-up interviews in routine outcome monitoring of substance abuse treatmentADDICTION, Issue 7 2009Suzan C.C. Oudejans ABSTRACT Aims Routine outcome monitoring (ROM) is receiving growing attention. However, follow-up interviews are time-consuming and costly. This study examines the feasibility and validity of low-budget telephonic follow-up interviews for ROM in a substance abuse treatment centre (SATC). Design Observational study using data collected for routine outcome monitoring. Setting The study was performed in a SATC in an urban area in the Netherlands. Participants Feasibility and validity were assessed on data of 2325 patients. Measurements Data on pre-treatment socio-demographic and clinical characteristics were collected using electronic patient records (EPRs) and the European version of the Addiction Severity Index (EuropASI). Data on intensity of treatment were also collected through the EPRs. Telephonic follow-up interviews were conducted between 9 and 10 months after intake. Findings A 53% follow-up rate was achieved; 35% of the patients could not be contacted, 3% explicitly refused and in 8% other reasons accounted for non-participation. About 50% of the interviews took place in the intended time-frame. Costs were ,40 ($57) per completed interview. There were indications of selection bias, because patients with cocaine as their primary problem and patients with polysubstance abuse were under-represented in the follow-up sample; the presence of these disorders is associated with negative treatment outcome. Conclusions Implementing telephonic low-budget follow-up interviews for ROM is feasible, but selection bias threatens internal validity of data, limiting generalization to the total treatment population. Increased efforts to track patients for follow-up may improve generalization. [source] Twelve-Step affiliation and 3-year substance use outcomes among adolescents: social support and religious service attendance as potential mediatorsADDICTION, Issue 6 2009Felicia W. Chi ABSTRACT Aims Twelve-Step affiliation among adolescents is little understood. We examined 12-Step affiliation and its association with substance use outcomes 3 years post-treatment intake among adolescents seeking chemical dependency (CD) treatment in a private, managed-care health plan. We also examined the effects of social support and religious service attendance on the relationship. Design We analyzed data for 357 adolescents, aged 13,18, who entered treatment at four Kaiser Permanente Northern California CD programs between March 2000 and May 2002 and completed both baseline and 3-year follow-up interviews. Measures Measures at follow-up included alcohol and drug use, 12-Step affiliation, social support and frequency of religious service attendance. Findings At 3 years, 68 adolescents (19%) reported attending any 12-Step meetings, and 49 (14%) reported involvement in at least one of seven 12-Step activities, in the previous 6 months. Multivariate logistic regression analyses indicated that after controlling individual and treatment factors, 12-Step attendance at 1 year was marginally significant, while 12-Step attendance at 3 years was associated with both alcohol and drug abstinence at 3 years [odds ratio (OR) 2.58, P < 0.05 and OR 2.53, P < 0.05, respectively]. Similarly, 12-Step activity involvement was associated significantly with 30-day alcohol and drug abstinence. There are possible mediating effects of social support and religious service attendance on the relationship between post-treatment 12-Step affiliation and 3-year outcomes. Conclusions The findings suggest the importance of 12-Step affiliation in maintaining long-term recovery, and help to understand the mechanism through which it works among adolescents. [source] Alcohol use trajectories among adults in an urban area after a disaster: evidence from a population-based cohort studyADDICTION, Issue 8 2008Magdalena Cerda ABSTRACT Alcohol use increased in the New York City (NYC) metropolitan area in the first months after the 11 September 2001 terrorist attacks. Aims To investigate alcohol use trajectories in the NYC metropolitan area in the 3 years after 11 September and examine the relative contributions of acute exposure to the attacks and ongoing stressors to these trajectories. Design We used a population-based cohort of adults recruited through a random-digit-dial telephone survey in 2002; participants completed three follow-up interviews over 30 months. Setting The NYC metropolitan area. Participants A total of 2752 non-institutionalized adult residents of NYC. Measurements We used growth mixture models to assess trajectories in levels of total alcohol consumption and bingeing in the past 30 days, and predictors of these trajectories. Findings We identified five trajectories of alcohol consumption levels and three bingeing trajectories. Predictors of higher levels of use over time included ongoing stressors, traumatic events and lower income. Ongoing exposure to stressors and low income also play a central role in bingeing trajectories. Conclusions While point-in-time mass traumatic events may matter in the short term, their contribution subsides over time. Accumulated stressors and traumatic events, in contrast, lead to higher levels of consumption among respondents already vulnerable to high alcohol use. Interventions to mitigate post-disaster stressors may have substantial benefit in reducing alcohol abuse in the medium- to long term. [source] Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up studyADDICTION, Issue 1 2008Michael Gossop ABSTRACT Aims This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. Methods Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4,5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. Findings Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. Conclusions NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups. [source] Disability payments, drug use and representative payees: an analysis of the relationshipsADDICTION, Issue 7 2003James A. Swartz ABSTRACT Aims This study attempted to determine: if US federal cash disability payments increase the use of cocaine or opiates among those requalifying for supplemental security income (SSI) disability benefits compared with those who lost benefits; if drug use peaks at the beginning of the month after the receipt of the disability cash disbursement; and if money management by representative payees of requalifying SSI recipients suppresses drug use. Design A multi-site, prospective, 2 year longitudinal design was used with follow-up interviews conducted every 6 months. Urine samples were collected at the final three follow-up interviews. Setting Data were collected in Chicago, IL, Los Angeles, CA, and Seattle, WA, USA. Participants This study used a randomly selected sample of 740 former recipients of SSI who had received disability benefits for drug addiction and alcoholism (DA&A) in 1996, were between the ages of 21 and 59 years, had not received concurrent social security disability insurance and provided testable urine samples and complete self-report data for at least one follow-up interview. Measurements Independent variables included demographics, SSI status at follow-up, representative payee status, drug treatment participation and income. Time of drug testing was operationalized as the first 10 days of the month versus the last 20,21 days based on when the urine sample was collected. The dependent variables were cocaine and opiate use, determined by urinalysis results. Findings Participants were 28% more likely to test positive for cocaine use in the first 10 days of the month than later in the month. This effect was general across all subjects and was not restricted to those receiving SSI benefits. No such effect was found for opiate use. Receiving SSI benefits did not increase cocaine or opiate use generally, nor did having a representative payee suppress use. Conclusions The findings do not support the contentions that federal cash benefits appreciably increase drug use or that representative payees discourage use, at least when use is defined dichotomously. The ,check effect' for cocaine use appears to be general and not confined to those receiving federal cash benefits. The lack of a ,check effect' for opiate use is probably the result of the difference between a relatively steady state of opiate use associated with addiction and a binge pattern of cocaine use triggered by suddenly flush resources. [source] Testing via news videos: an exploratory studyINTERNATIONAL JOURNAL OF APPLIED LINGUISTICS, Issue 2 2010Zhang Jing This case study investigated five test-takers' use of news videos in a listening-to-summarize task, and the extent to which the different strategies they employed in processing the visual and the audio elements of the videos affected their performance. It reports the significant features of the visual and audio elements that the test-takers made use of, and the interaction between these elements and test-takers' personal characteristics and summarization performance. Data was collected via verbal reports and follow-up interviews. A discussion of the findings follows in connection with the use of videos in testing and teaching listening comprehension skills, and suggestions for future research are made. [source] Re-estimating the prevalence of psychiatric disorders in a nationally representative sample of persons receiving care for HIV: results from the HIV cost and services utilization studyINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2002PhD Maria Orlando Abstract The objective of this study was to obtain accurate estimates of the prevalence of psychiatric disorder in the population represented by the HIV Costs and Services Utilization Study cohort. We constructed logistic regression models to predict DSM-IV diagnoses of depression, generalized anxiety disorder, panic, and dysthymia among a subsample of the HCSUS cohort who in separate interviews completed the CIDI-SF and the full CIDI diagnostic interview. Diagnoses were predicted using responses to the CIDI-SF as well as other variables contained in the baseline and first follow-up interviews. Resulting regression equations were applied to the entire baseline and first follow-up samples to obtain new estimates of the prevalence of disorder. Compared to estimates based on the CIDI-SF alone, estimates obtained from this procedure provide a more accurate representation of the prevalence of the presence of any one of these four psychiatric disorders in this population, yielding more correct classifications and a lower false-positive rate. Prevalence rates reported in this study are as much as 16% lower than rates estimated using the CIDI-SF alone, but are still considerably higher than estimates for the general community population. Copyright © 2002 Whurr Publishers Ltd. [source] Ginger compress therapy for adults with osteoarthritisJOURNAL OF ADVANCED NURSING, Issue 10 2010Tessa Therkleson therkleson t. (2010) Ginger compress therapy for adults with osteoarthritis. Journal of Advanced Nursing,66(10), 2225,2233. Abstract Aim., This paper is a report of a study to explicate the phenomenon of ginger compresses for people with osteoarthritis. Background., Osteoarthritis is claimed to be the leading cause of musculoskeletal pain and disability in Western society. Management ideally combines non-pharmacological strategies, including complementary therapies and pain-relieving medication. Ginger has been applied externally for over a thousand years in China to manage arthritis symptoms. Method., Husserlian phenomenological methodology was used and the data were collected in 2007. Ten purposively selected adults who had suffered osteoarthritis for at least a year kept daily diaries and made drawings, and follow-up interviews and telephone conversations were conducted. Findings., Seven themes were identified in the data: (1) Meditative-like stillness and relaxation of thoughts; (2) Constant penetrating warmth throughout the body; (3) Positive change in outlook; (4) Increased energy and interest in the world; (5) Deeply relaxed state that progressed to a gradual shift in pain and increased interest in others; (6) Increased suppleness within the body and (7) More comfortable, flexible joint mobility. The essential experience of ginger compresses exposed the unique qualities of heat, stimulation, anti-inflammation and analgesia. Conclusion., Nurses could consider this therapy as part of a holistic treatment for people with osteoarthritis symptoms. Controlled research is needed with larger numbers of older people to explore further the effects of the ginger compress therapy. [source] Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocolJOURNAL OF ADVANCED NURSING, Issue 10 2009Joanna Smith Abstract Title., Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol. Aim., This paper outlines the protocol for a study aimed at exploring parent's involvement during professional,parent interactions and decisions about their child's care in the context of suspected shunt malfunction. Background., Hydrocephalus is a long-term condition treated primarily by the insertion of a shunt that diverts fluid from the brain to another body compartment. Shunts frequently malfunction, and parents of children with shunted hydrocephalus are responsible for recognizing and responding to shunt complications. Parents feel that interactions with professionals when they seek healthcare advice for their child do always not encourage active participation in care decisions. Methods., The study design is based on qualitative methodologies: a combination of conversation analysis applied to consultation recordings of professional,parent interactions when a child is admitted to hospital with suspected shunt malfunction, and semi-structured follow-up interviews with the same participants within 2 weeks of the consultation. Participants., This is a prospective study and participants will be purposefully selected. Parents of children who have been admitted to hospital with suspected shunt malfunction and healthcare professionals responsible for the initial assessment of the child will be invited to participate. Discussion., The study will identify how decisions about a child's care are negotiated between parents and healthcare professionals at key stages of the care pathway. In addition, examining interactions between healthcare professionals and parents may identify approaches that support or hinder parents in contributing to the decision-making processes when they seek advice from healthcare professionals. [source] Physicians "Missing in Action": Family Perspectives on Physician and Staffing Problems in End-of-Life Care in the Nursing HomeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2005Renée R. Shield PhD Objectives: To understand the roles of physicians and staff in nursing homes in relation to end-of-life care through narrative interviews with family members close to a decedent. Design: Qualitative follow-up interviews with 54 respondents who had participated in an earlier national survey of 1,578 informants. Setting: Brown University interviewers conducted telephone interviews with participants throughout the United States. Participants: The 54 participants agreed to a follow-up qualitative interview and were family members or close to the decedent. Measurements: A five-member, multidisciplinary team to identify overarching themes taped, transcribed, and then coded interviews. Results: Respondents report that healthcare professionals often insufficiently address the needs of dying patients in nursing homes and that "missing in action" physicians and insufficient staffing create extra burdens on dying nursing home residents and their families. Conclusion: Sustained efforts to increase the presence of physicians and improve staffing in nursing homes are suggested to improve end-of-life care for dying residents in nursing homes. [source] | |||||||||||||||||||||||||||||||