[Variation in the pathology attended in out-patient Neurology Clinics: a demented future].

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Morera-Guitart, J; Pedro Cano, M J

2003-10-01

We analyze the changes observed between 1996 and 2001 in the distribution of the pathology attended and the follow up model used by the out-patient Neurology Clinic in the Marina Alta area, in order to confirm possible variations that may have repercussions for Human Resource needs in the provision of adequate neurological care. We prospectively registered the attendance records for visits made to the Out-patient Neurology Clinic of Marina Alta in 1996. The variation coefficients between both series were calculated and compared. The average age of patients increased in 5 years. The number of patients attended increased 42.3%, new patients 40%, visits 13%, the "Review visit/First Visit" ratio reduced 29%. The attendance of patients with Cognitive Impairment (Cog. Imp.) doubled. There were no changes in the origins of the patients. Requests due to Cog. Imp. and parkinsonism increased significantly from Primary Care and Emergency Department. The delay to be attended increased 23%. Discharges increased 43.9%, highlighting an increase of 144% observed in the Cog. Imp. group. Changes have been observed in: the age of the population studied; the follow up of patients; the delay in attending them; and the pathology attended, with a significant increase in demand due to neurodegenerative pathology (especially Cog. Imp.). All this requires an increase in care needs that the Health Service has not been able to assume, creating an incongruous care model: we suggest a direct follow up model and offer a consultancy model.

Maternal alcohol use disorder and child school attendance outcomes for non-Indigenous and Indigenous children in Western Australia: a population cohort record linkage study.

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Hafekost, Katherine; Lawrence, David; O'Leary, Colleen; Bower, Carol; Semmens, James; Zubrick, Stephen R

2017-07-11

Examine the relationship between maternal alcohol use disorder and child school attendance outcomes for non-Indigenous and Indigenous children in Western Australia. Population cohort study. Routinely collected linked administrative health, education and child protection data. Those in-scope for the study were women with a birth recorded on the Western Australian Midwives Notification System (1989-2007). Women who had an alcohol-related diagnosis (International Classification of Diseases Revisions 9/10) recorded on the Hospital Morbidity, Mental Health Inpatients and Outpatients, and Drug and Alcohol Office data sets formed the exposed group. The comparison cohort was frequency-matched to the exposed cohort based on maternal age within Indigenous status and child's year of birth. Child's school attendance was obtained from the Department of Education (2008-2012). Poor attendance was defined as alcohol use disorder was significantly associated with increased odds of poor attendance (non-Indigenous: OR=1.61, 95% CI 1.50 to 1.74; Indigenous: OR=1.66, 95% CI 1.54 to 1.79). With adjustment for maternal and child factors, there was no significant difference between the timing of alcohol diagnosis relative to pregnancy and attendance outcomes. The population attributable fraction was higher in the Indigenous cohort than the non-Indigenous cohort (6.0% vs 1.3%). Maternal alcohol use disorder was associated with a significantly increased odds of poor school attendance for non-Indigenous and Indigenous children. There was no significant difference between the timing of diagnoses and odds of poor school attendance. This suggests that the effect of maternal alcohol use disorder may not be driven by the neurodevelopmental effects of alcohol exposure in utero, but may be mediated through family or social factors for which we were unable to adjust. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya.

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Papas, Rebecca K; Sidle, John E; Gakinya, Benson N; Baliddawa, Joyce B; Martino, Steve; Mwaniki, Michael M; Songole, Rogers; Omolo, Otieno E; Kamanda, Allan M; Ayuku, David O; Ojwang, Claris; Owino-Ong'or, Willis D; Harrington, Magdalena; Bryant, Kendall J; Carroll, Kathleen M; Justice, Amy C; Hogan, Joseph W; Maisto, Stephen A

2011-12-01

Dual epidemics of human immunodeficiency virus (HIV) and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted six-session gender-stratified group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV-infected out-patients in Eldoret, Kenya. Randomized clinical trial comparing CBT against a usual care assessment-only control. A large HIV out-patient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration. Seventy-five HIV-infected out-patients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking. Percentage of drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Time line Follow back method. There were 299 ineligible and 102 eligible out-patients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30-day follow-up were large [d=0.95, P=0.0002, mean difference=24.93, 95% confidence interval (CI): 12.43, 37.43 PDD; d=0.76, P=0.002, mean difference=2.88, 95% CI: 1.05, 4.70 DDD]. Randomized participants attended 93% of the six CBT sessions offered. Reported alcohol abstinence at the 90-day follow-up was 69% (CBT) and 38% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college-educated therapists in the United States. Treatment effect sizes were comparable to alcohol intervention studies conducted in the United States. Cognitive-behavioral therapy can be adapted successfully to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV-infected Kenyan out-patients. © 2011 The Authors, Addiction © 2011

Factors affecting poor attendance for outpatient physiotherapy by patients discharged from Mthatha General Hospital with a stroke

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N.P. Ntamo

2013-12-01

Full Text Available Background: Stroke is a major cause of disability inthe world and its long term effects require adherence to physiotherapyprotocols for optimal rehabilitation. Clinical impression of data fromMthatha General Hospital (MGH Physiotherapy Department revealedthat there was poor attendance of outpatient physiotherapy by strokepatients discharged from MGH and this had negative effects on outcomesand health care costs.Objective: To determine the extent and the socio-demographic reasonsfor poor attendance for outpatient physiotherapy by stroke patients.Methods: An observational descriptive study was conducted using arandomly selected sample of 103 stroke patients from a population of 139who attended physiotherapy in MGH in 2007. Structured interviews wereconducted and SPSS was used for data analysis.Results: The majority (86% of patients did not attend physiotherapy until discharge from the Physiotherapy Department. Themajor reasons for poor attendance were lack of finances (95%, migration to other areas (36%, and living a long distance fromMGH (38%.Conclusion: Almost 9 out of 10 stroke patients fail to attend for outpatient physiotherapy because of lack of finances.Recommendation: Development of a Provincial Rehabilitation Policy with specific reference to decentralization of rehabilitationservices to address unavailability of physiotherapy services at clinics and health care centers which are proximal to the patients’residential areas is recommended.

The effectiveness of policy changes designed to increase the attendance rate for outpatient retinopathy of prematurity (ROP) screening examinations.

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Barry, Gerard P; Tauber, Kate; Emmanuel, Gregory; Horgan, Michael J; Simon, John W

2013-06-01

To determine the effectiveness of a series of policy changes designed to increase the attendance rate for outpatient retinopathy of prematurity (ROP) screening examinations. We retrospectively reviewed the records of consecutive neonatal intensive care unit patients before and after the implementation of policy changes. Policy changes included parent education forms, streamlined scheduling, and creation of a log for all patients seen. The primary outcome measure was attendance rates for the first outpatient appointment after discharge. The Fisher exact test was used to compare rates between the two groups. Before the policy was implemented, 22 of 52 (42%) neonates and their caregivers attended their first outpatient ROP screening examination on the recommended date. This rate improved significantly after policy implementation, when 46 of 57 (81%) neonates and their caregivers were seen on the recommended date (P attendance rates for initial outpatient ROP examinations and the number of patients who ultimately met criteria for conclusion of acute retinal screening examinations significantly improved after the implementation of new policies. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Conjoint moderate or high risk alcohol and tobacco use among male out-patients in Thailand

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Supa Pengpid

2016-03-01

Full Text Available Objective: To better understand conjoint alcohol and tobacco use among male hospital out-patients, the purposes of this study were: (1 to assess the prevalence of conjoint use and (2 to determine the factors associated with the conjoint alcohol use and tobacco use. Methods: In a cross-sectional survey, consecutive male out-patients from four district hospitals in Nakhon Pathom province in Thailand were assessed with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST, Hospital Anxiety and Depression Scale (HADS, selfreported chronic conditions and health-seeking behaviour. The sample included 2208 study participants, with a mean age of 36.2 years (SD = 11.7 and an age range of 18–60 years. Results: Overall, 34.5% of the male hospital out-patients were conjoint moderate or high-risk alcohol and tobacco users, and 31.1% were moderate or high-risk alcohol or tobacco users. In multivariate analysis, younger age, having primary or less education, being separated, divorced or widowed, not having diabetes and not being obese were associated with conjoint moderate or high-risk alcohol and tobacco use. Conclusion: High prevalence and several risk factors of conjoint alcohol and tobacco use were found among hospital male out-patients. The findings of this study call for dual-intervention approaches for both alcohol and tobacco.

Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

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Abdulrahman SA

2017-07-01

Full Text Available Surajudeen Abiola Abdulrahman,1,2 Lekhraj Rampal,1 Norlijah Othman,3 Faisal Ibrahim,1 Kadir Shahar Hayati,1 Anuradha P Radhakrishnan4 1Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, 2Department of Public Health Medicine, Penang Medical College, George Town, Penang, 3Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, 4Infectious Disease Clinic, Hospital Sungai Buloh, Sungai Buloh, Selangor, MalaysiaBackground: Inconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia.Patients and methods: This cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome – regular attendee and defaulter categories – based on the number of missed scheduled outpatient clinic appointments within a 6-month

Does alcohol contribute to accident and emergency department attendance in elderly people?

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van der Pol, V; Rodgers, H; Aitken, P; James, O; Curless, R

1996-01-01

OBJECTIVE: To evaluate the possible contribution of alcohol to presentation of elderly subjects at a hospital accident and emergency (A&E) department. METHODS: 105 patients aged 70 years and over who attended the department were interviewed by a single observer using a structured questionnaire based on previously validated general population surveys. Details of alcohol consumption within the previous 24 hours were recorded. Usual consumption of alcohol in the preceding 12 months was estimated by the quantity frequency method. Alcohol dependence was screened for by the CAGE questionnaire. An assessment of disability was made using the Barthel index. Breath alcohol was measured. RESULTS: In only 2% of attenders was alcohol thought to be a contributory factor. Breath alcohol measurements were technically unsatisfactory in this age group. Regular drinkers were functionally and socially more independent than non-regular drinkers. Drinking patterns in this age group may partly be determined by the physical ability to obtain alcohol. CONCLUSIONS: Alcohol was not found to be a major factor in A&E attendance in elderly people. PMID:8832344

Outpatient alcohol withdrawal management for Aboriginal and Torres Strait Islander peoples.

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Brett, Jonathan; Lawrence, Leanne; Ivers, Rowena; Conigrave, Kate

2014-08-01

There is concern from within Aboriginal and Torres Strait Islander communities about the lack of access to alcohol withdrawal management ('detox') services. Outpatient detox is described within national Australian guidelines as a safe option for selected drinkers. However, uncertainly exists as to how suited Aboriginal and Torres Strait Islander peoples are to this approach. 
 Consultations were conducted with stakeholders of four health services providing outpatient detox for Aboriginal and Torres Strait Islander peoples in NSW. Thematic analysis was performed to determine elements perceived as important for success. Key themes that emerged were individual engagement, flexibility, assessment of suitability, Aboriginal staff and community engagement, practical support, counselling, staff education and support, coping with relapse and contingency planning. 
 There is a need to improve access to alcohol detox services for Aboriginal and Torres Strait Islander peoples. The outpatient setting seems to be a feasible and safe environment to provide this kind of service for selected drinkers.

Changes in depression mediate the effects of AA attendance on alcohol use outcomes.

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Wilcox, Claire E; Tonigan, J Scott

2018-01-01

Depression may contribute to increased drinking in individuals with alcohol use disorder. Although Alcoholics Anonymous (AA) attendance predicts drinking reductions, there is conflicting information regarding the intermediary role played by reductions in depression. We explored whether AA attendance reduces depressive symptoms, the degree to which improvement in depression results in reductions in drinking, and in which subgroups these effects occur. 253 early AA affiliates (63% male) were recruited and assessed at baseline 3, 6, 9, 12, 18, and 24 months. Depression was measured using the Beck Depression Inventory (BDI) and was administered at baseline 3, 6, 12, 18, and 24 months. AA attendance and alcohol use outcomes were obtained with the Form 90. Mediation analyses were performed at early (3, 6, and 9 months) and late (12, 18, and 24 months) follow-up to investigate the degree to which reductions in depression mediated the effect of AA attendance on drinking, controlling for concurrent drinking. In addition, a series of moderated mediation analyses were performed using baseline depression severity as a moderator. At early follow-up, reductions in depression (6 months) mediated the effects of AA attendance (3 months) on later drinking (drinks per drinking day) (9 months) (b = -0.02, boot CI [-0.055, -0.0004]), controlling for drinking at 6 months. Baseline depression severity did not moderate the degree to which BDI mediated the effects of AA attendance on alcohol use (ps > .05). These findings provide further evidence that depression reduction is a mechanism by which AA attendance leads to reductions in alcohol use. Improving depression may help reduce alcohol use in individuals with AUD, and AA attendance may be an effective way to achieve that goal.

Factors associated with attendance in 12-step groups (Alcoholics Anonymous/Narcotics Anonymous) among adults with alcohol problems living with HIV/AIDS.

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Orwat, John; Samet, Jeffrey H; Tompkins, Christopher P; Cheng, Debbie M; Dentato, Michael P; Saitz, Richard

2011-01-15

Despite the value of 12-step meetings, few studies have examined factors associated with attendance among those living with HIV/AIDS, such as the impact of HIV disease severity and demographics. This study examines predisposing characteristics, enabling resources and need on attendance at Alcoholic Anonymous (AA) and Narcotics Anonymous (NA) meetings among those living with HIV/AIDS and alcohol problems. Secondary analysis of prospective data from the HIV-Longitudinal Interrelationships of Viruses and Ethanol study, a cohort of 400 adults living with HIV/AIDS and alcohol problems. Factors associated with AA/NA attendance were identified using the Anderson model for vulnerable populations. Generalized estimating equation logistic regression models were fit to identify factors associated with self-reported AA/NA attendance. At study entry, subjects were 75% male, 12% met diagnostic criteria for alcohol dependence, 43% had drug dependence and 56% reported attending one or more AA/NA meetings (past 6 months). In the adjusted model, female gender negatively associated with attendance, as were social support systems that use alcohol and/or drugs, while presence of HCV antibody, drug dependence diagnosis, and homelessness associated with higher odds of attendance. Non-substance abuse related barriers to AA/NA group attendance exist for those living with HIV/AIDS, including females and social support systems that use alcohol and/or drugs. Positive associations of homelessness, HCV infection and current drug dependence were identified. These findings provide implications for policy makers and treatment professionals who wish to encourage attendance at 12-step meetings for those living with HIV/AIDS and alcohol or other substance use problems. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Alcohol use and alcohol use disorder among male outpatients in a primary care setting in rural Puducherry

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Akkilagunta Sujiv

2015-01-01

Full Text Available Context: Alcohol use contributes to considerable morbidity and mortality worldwide. Screening for alcohol use and alcohol use disorder (AUD at the primary care level can help in reducing this burden. While several community studies have been conducted to estimate the AUD, there apparently are no studies on opportunistic screening in a primary care setting in India. Aims: The aim was to estimate the prevalence of alcohol use and AUD in a primary care setting. Settings and Design: A hospital-based cross-sectional study was conducted among adult male outpatients in a primary care setting in Puducherry, South India. Subjects and Methods: Male outpatients aged 18 and above were interviewed for alcohol use. Current alcohol users were screened for AUD using World Health Organization - AUD identification test (AUDIT questionnaire, respectively. Statistical Analysis Used: Proportions were used to describe the study population and the main study findings. The Chi-square test was used to find out the association between sociodemographic factors and alcohol use. Results: Of 256 subjects studied, 39.8% were found to be current alcohol users and 10.9% had AUD (AUDIT score ≥8. The sociodemographic factors did not show any association with an alcohol use in the current setting. Conclusion: Based on the findings of the present study, four current alcohol users are to be screened to identify one patient with AUD. Screening at the primary health care level can help in identifying the risk group and thus help in reducing the morbidity and mortality due to alcohol use in the population.

Computer tablet or telephone? A randomised controlled trial exploring two methods of collecting data from drug and alcohol outpatients.

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Hobden, Breanne; Bryant, Jamie; Carey, Mariko; Sanson-Fisher, Rob; Oldmeadow, Christopher

2017-08-01

Both computerised and telephone surveys have potential advantages for research data collection. The current study aimed to determine the: (i) feasibility, (ii) acceptability, and (iii) cost per completed survey of computer tablet versus telephone data collection for clients attending an outpatient drug and alcohol treatment clinic. Two-arm randomised controlled trial. Clients attending a drug and alcohol outpatient clinic in New South Wales, Australia, were randomised to complete a baseline survey via computer tablet in the clinic or via telephone interview within two weeks of their appointment. All participants completed a three-month follow-up survey via telephone. Consent and completion rates for the baseline survey were significantly higher in the computer tablet condition. The time taken to complete the computer tablet survey was lower (11min) than the telephone condition (17min). There were no differences in the proportion of consenters or completed follow-up surveys between the two conditions at the 3-month follow-up. Acceptability was high across both modes of data collection. The cost of the computer tablet condition was $67.52 greater per completed survey than the telephone condition. There is a trade-off between computer tablet and telephone data collection. While both data collection methods were acceptable to participants, the computer tablet condition resulted in higher consent and completion rates at baseline, therefore yielding greater external validity, and was quicker for participants to complete. Telephone data collection was however, more cost-effective. Researchers should carefully consider the mode of data collection that suits individual study needs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prevalence of Alcohol Use and Associated Factors in Urban Hospital Outpatients in South Africa

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Hendry Van der Heever

2011-06-01

Full Text Available The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6% consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT. Two in five patients (40.5% were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings.

Treatment outcome of alcohol use disorder outpatients with or without medically assisted detoxification

NARCIS (Netherlands)

Merkx, Maarten J. M.; Schippers, Gerard M.; Koeter, Maarten W. J.; de Wildt, Wencke A. J. M.; Vedel, Ellen; Goudriaan, Anna E.; van den Brink, Wim

2014-01-01

Little is known about the incremental effects of medically assisted detoxification on outpatient treatment for alcohol use disorders. The objective of this study was to compare drinking outcomes in a psychosocial treatment program between two groups of heavy drinking patients who had an alcohol use

Patterns and sources of alcohol consumption preceding alcohol-affected attendances to a New Zealand hospital emergency department.

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Das, Manidipa; Stewart, Rebecca; Ardagh, Michael; Deely, Joanne M; Dodd, Stuart; Bartholomew, Nadia V; Pearson, Scott; Spearing, Ruth; Williams, Tracey; Than, Martin

2014-08-29

To perform a descriptive study of the drinking behaviour (amounts, types, sources of alcohol consumed) preceding alcohol-affected presentations to Christchurch Hospital Emergency Department (ED). Over 336 hours in the ED, patients with recent alcohol consumption or alcohol-related attendances were identified, classified as alcohol-affected or alcohol- unaffected, and invited to consent to answering questions on types, amounts and sources of alcohol consumed in the drinking session preceding or implicated in their ED attendance. Demographic information and level of intoxication were also recorded. Data were summarised descriptively. Alcohol-affected patients were more frequently young (16-25 years) and male. Median alcohol consumption was 14 (range 1 to 71) standard drinks. Beer was the most popular beverage (34%), but spirits (23%), ready-to-drink mixes (21%) and wine (20%) were also popular. Liquor stores (45%) were the most popular source of alcohol, followed by on-licence premises (25%), and supermarkets (21%). The popularity of different types of beverages and their source varied according to patient age and gender. Consumption of large amounts, as well as allegedly 'safe' amounts, of a range of alcoholic beverages, most commonly from an off-licence source, contributed to alcohol-affected presentations to the ED. Beverage and source popularity varied by age and gender.

An investigation into why patients do not attend for out-patient radiology appointments

International Nuclear Information System (INIS)

Lyon, Rebecca; Reeves, Pauline J.

2006-01-01

Introduction: Patients who do not attend (DNA) for out-patient hospital appointments cause delays in the diagnosis and subsequent treatment of their own, and other patient's, illnesses, with potentially hazardous consequences. This also impacts upon waiting lists. Failure to attend is viewed as a specific type of non-compliance and social cognition theories have been applied to previous studies in an attempt to uncover the reasons why patients choose not to keep their appointments. Methods: A case-control study was conducted throughout the X-ray departments of a District General type of NHS Trust, using telephone interview questionnaires based on the Health Belief Model, in an attempt to identify any significant differences between attenders and non-attenders, so that likely non-attenders could be targeted. Results: Principal reasons for non-attendance were that the patient forgot or that they did not receive their appointment. The results differed from previous research, in that specific health beliefs were not the primary reasons for non-attendance. Departments that gave patients the opportunity to arrange their appointments for a mutually convenient time had exceptionally low DNA rates, as did those which had rigorous confirmation systems in place

7-year trajectories of Alcoholics Anonymous attendance and associations with treatment

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Kaskutas, Lee Ann; Bond, Jason; Avalos, Lyndsay Ammon

2009-01-01

Although many members of Alcoholics Anonymous (AA) are introduced to AA during treatment, the relationship between treatment and AA attendance over time is unknown. This paper describes four latent classes of AA attendance among 586 dependent alcoholics interviewed by telephone 1, 3, 5 and 7 years after baseline, and models the relationship between treatment exposure and AA attendance in each class. There was a low AA group (averaging fewer than 5 meetings at most follow-ups), a medium AA group (about 50 meetings a year at each follow-up), a descending AA group (about 150 meetings year 1, then decreasing steeply), and a high AA group (about 200 meetings at 1 year, then decreasing gradually by year 7). Declines in meeting attendance were not always accompanied by decreases in abstinence. After accounting for the effect of time on AA attendance (i.e., the “ups-and-downs” that occur over time), treatment exposure was minimally related to AA attendance in all but the descending AA group, where it was negatively associated (p<.001). Considering AA patterns over time highlights a different role for treatment in AA attendance than what is gleaned from analyses at single timepoints. PMID:19632789

Reasons for attending a general emergency outpatient clinic versus a regular general practitioner - a survey among immigrant and native walk-in patients in Oslo, Norway.

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Ruud, Sven Eirik; Hjortdahl, Per; Natvig, Bård

2017-03-01

To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Cross-sectional study using a multilingual anonymous questionnaire. Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday-Friday, 08:00-23:00) during 2 weeks in September 2009. We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Patients' reasons for attending an emergency outpatient clinic versus their RGP. Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46-4.46)] and Asia [OR = 2.32 (95% CI: 1.42-3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Access to primary care provided by an RGP affects patients' use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services. KEY POINTS Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients' use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo. Lack of

Prevalence of problem alcohol use among patients attending primary care for methadone treatment

LENUS (Irish Health Repository)

Ryder, Niamh

2009-06-11

Abstract Background Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. Methods We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. Results We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. Conclusion Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make

Prevalence of problem alcohol use among patients attending primary care for methadone treatment.

LENUS (Irish Health Repository)

Ryder, Niamh

2012-02-01

BACKGROUND: Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed to determine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. METHODS: We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. RESULTS: We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28-41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. CONCLUSION: Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this

Could inter-agency working reduce emergency department attendances due to alcohol consumption?

Science.gov (United States)

Benger, J; Carter, R

2008-06-01

Excess alcohol consumption and associated harms in terms of health, crime and disorder have been highlighted by the government and media, causing considerable public concern. This study quantified the number of patient attendances at an urban adult and children's emergency department (ED) directly attributable to alcohol intoxication, and investigated ways in which the inter-agency sharing of anonymised information could be used to design, implement and monitor interventions to reduce these harms. Intoxicated patients attending either the adult or children's ED were prospectively identified by qualified nursing staff and anonymised data collected by a dedicated researcher. Collaboration and data sharing between health, police, social services, university experts and local authorities was achieved through the establishment of steering and operational groups with agreed objectives and the formation of a shared anonymised database. The proportion of patients attending the ED as a result of alcohol intoxication was 4% in adults and <1% in children. 70% of patients were male, with a mean age of 30 years, and 72% attended between 20.00 and 08.00 h. The most common reason for ED attendance was accident (34%), followed closely by assault (30%). 27% of patients had done most of their drinking at home, 36% in a pub and 16% in a nightclub. Inter-agency collaboration proved highly successful: pooling of anonymised data created a much clearer picture of the extent of the problem and immediately suggested strategies for intervention. The initiative to achieve inter-agency collaboration and data sharing was highly successful, with clear potential for the development and implementation of interventions that will reduce ED attendance due to excess alcohol consumption.

The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals.

Science.gov (United States)

Fearnley, David; Kerse, Ngaire; Nixon, Garry

2016-09-01

INTRODUCTION Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery. AIM The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents. METHODS A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated. RESULTS The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732. DISCUSSION This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.

Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment

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Preuss UW

2012-05-01

Full Text Available Ulrich W Preuss,1 Jörg Zimmermann,2,3 Gabriele Schultz,2 Anna Watzke,2 Peggy Schmidt,4 Bärbel Löhnert,5 Michael Soyka2,61Department of Psychiatry, Psychotherapy and Psychosomatics, University of Halle-Wittenberg, Halle, Germany; 2Ev Krankenhaus Bethanien GmbH, Fachklinik Gristower Wiek, Johanna-Odebrecht-Stiftung, Germany; 3Karl-Jaspers-Klinik, Fachkrankenhaus für Psychiatrie und Psychotherapie, Psychiatrieverbund Oldenburger Land, Germany; 4Department of Psychiatry, Ludwig-Maximilians-Universität Munich, Germany; 5Klientenzentrierte Problemberatung, Dachau/Munich, Germany; 6Privatklinik Meiringen, Meiringen, Switzerland Background: Rehabilitation treatment noncompletion is considered a risk factor for long term relapse in alcohol-dependent individuals. The aim of this analysis of in- and outpatients in alcohol dependence rehabilitation in Germany is to identify social, mental, and somatic risk profiles for treatment noncompletion.Methods: A total of 92 individuals from an outpatient program and 303 individuals from two inpatient rehabilitation treatment units in three different locations in Germany were recruited and assessed with a structured interview and several measures of psychopathology (personality disorders, anxiety, depression, and impulsivity at treatment admission, with termination at 12 months follow-up. Participants were subdivided into treatment completers and noncompleters for any reason.Results: A total of 10.2% of inpatients and 16.1% of outpatients did not complete treatment. Compared with treatment completers, noncompleters had a significantly lower rate of continuous abstinence at 1-year follow-up, more recent alcohol consumption before admission, and a higher rate of borderline personality disorders. Among inpatients, an elevated rate of lifetime mental disorders, depression, and suicide attempts was found among treatment noncompleters; among outpatients, treatment noncompleters were more often than completers to be

Drinking Refusal Self-Efficacy and Intended Alcohol Consumption During a Mass-Attended Youth Event.

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Jongenelis, Michelle I; Pettigrew, Simone; Biagioni, Nicole

2018-04-16

Mass-attended youth events represent a substantial public health challenge due to high levels of alcohol consumption and corresponding high rates of alcohol-related harm. Although previous research has documented the protective effect of high drinking refusal self-efficacy (DRSE) on alcohol consumption in general, there is a lack of research examining the role of DRSE in reducing consumption during mass-attended youth events and the factors associated with DRSE in these contexts. This study aimed to identify potentially modifiable factors that influence DRSE and drinking intentions to inform interventions designed to reduce alcohol-related harm during mass-attended events. Australian secondary school students (n = 586; 70% female) in their final two years of high school completed an online survey assessing their alcohol consumption intentions for Schoolies, their perceived degree of DRSE, and other individual and environmental factors. Path analysis was used to assess a mediational model examining factors associated with DRSE and alcohol consumption intentions. DRSE was found to be significantly associated with intended alcohol consumption during Schoolies. Specifically, leavers who believed they would not be able to refuse others' offers of alcoholic drinks reported significantly greater alcohol consumption intentions. Results also revealed that DRSE was enhanced in those respondents who believed there would be a variety of non-drinking activities and non-alcoholic beverages available to them during Schoolies. Results suggest the need to increase leavers' confidence in their ability to refuse unwanted alcoholic beverages and highlight the importance of providing celebration options that do not involve alcohol consumption.

Reasons for attending a general emergency outpatient clinic versus a regular general practitioner – a survey among immigrant and native walk-in patients in Oslo, Norway

Science.gov (United States)

2017-01-01

Objective To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Design Cross-sectional study using a multilingual anonymous questionnaire. Setting Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday–Friday, 08:00–23:00) during 2 weeks in September 2009. Subjects We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Main outcome measures Patients’ reasons for attending an emergency outpatient clinic versus their RGP. Results Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46–4.46)] and Asia [OR = 2.32 (95% CI: 1.42–3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Conclusions and implications Access to primary care provided by an RGP affects patients’ use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services. Key points Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients’ use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians

Pattern of Disease among Patients Attending Cardiology Outpatient Department of a Private Hospital of Mymensingh, Bangladesh.

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Paul, G K; Sen, B; Khan, M K; Bhowmik, T K; Khan, T A; Roy, A K

2018-04-01

Epidemiologic transition is taking place in every part of the world. Cardiovascular diseases became the most common cause of death accounting for 30% of deaths worldwide, with 80% of the burden now occurring in developing countries. The objective of the study was to assess the Pattern of disease among patients attending Cardiology outpatient department of a private hospital. The cross sectional descriptive type of observational study was conducted among 550 patients attending Cardiology outpatient department (COPD) of Sodesh Hospital, Mymensingh, Bangladesh from March 2016 to June 2016. All the new patients attending COPD of Sodesh Hospital were selected purposively for the study. Data were collected by interview, physical examination and laboratory investigations of patients using a case record form. Mean age of the patients was 45.1 years with a SD of 15.6 years. Among the patients male were 291(52.9%), a bit higher than the female 259(47.1%). It was observed that more than half of the patients (281, 51.1%) visited cardiologist with non-cardiac problems. Less than one third of the patients (169, 30.7%) attended with cardiac problems and 100(18.2%) patients visited with both cardiac and non-cardiac problems. Among the cardiac diseases and symptoms hypertension was on the top of the list 176(65.4%). Ischemic heart diseases was present in 35(13.0%) and palpitation was in 30(11.1%) patients. On the other hand among the non-cardiac diseases or presentations, 121(43.1%) patients had non-specific chest pain, 63(22.4%) had shortness of breath and 17(6.1%) had diabetes mellitus. Hypertension was found the most frequent cardiovascular disease (65.4%) followed by ischemic heart disease (13.0%). More than half (51.1%) of the patients visit cardiologist with non-cardiac problems. Screening at the level of general practitioner (GP) and appropriate referral system can reduce extreme burden of patients to the cardiologists in the Cardiology outpatient department.

38 CFR 17.82 - Contracts for outpatient services for veterans with alcohol or drug dependence or abuse...

Science.gov (United States)

2010-07-01

... services for veterans with alcohol or drug dependence or abuse disabilities. 17.82 Section 17.82 Pensions... Agencies § 17.82 Contracts for outpatient services for veterans with alcohol or drug dependence or abuse... sponsored residents to adjust to and maintain freedom from dependence on or involvement with alcohol or drug...

Decisions to Attend and Drink at Party Events: The Effects of Incentives and Disincentives and Lifetime Alcohol and Antisocial Problems.

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Finn, Peter R; Gerst, Kyle; Lake, Allison; Bogg, Tim

2017-09-01

Alcohol use disorders are associated with patterns of impulsive/risky decision making on behavioral economic decision tasks, but little is known about the factors affecting drinking-related decisions. The effects of incentives and disincentives to attend and drink at hypothetical alcohol-related party events as a function of lifetime (LT) alcohol and antisocial problems were examined in a sample of 434 young adults who varied widely in LT alcohol and antisocial problems. Moderate and high disincentives substantially discouraged decisions to attend the party events and were associated with decisions to drink less at the party events. High versus low party incentives were associated with more attendance decisions. LT antisocial problems were associated with being less deterred from attending by moderate and high disincentives. LT alcohol problems were associated with greater attendance at high party incentive contexts. LT alcohol problems were associated with drinking more at the majority of events; however, the results indicate that young adults with high levels of alcohol problems moderate their drinking in response to moderate and high disincentives. Finally, attendance and drinking decisions on this hypothetical task were significantly related to actual drinking practices. The results suggest that antisocial symptoms are associated with a reduced sensitivity to the potential negative consequences of drinking, while alcohol problems are associated with a greater sensitivity to the rewarding aspects of partying. The results also underline the value of directly assessing drinking-related decisions in different hypothetical contexts as well as assessing decisions about attendance at risky drinking events in addition to drinking amount decisions. Copyright © 2017 by the Research Society on Alcoholism.

Changes in Nutrition-Related Behaviors in Alcohol-Dependent Patients After Outpatient Detoxification: The Role of Chocolate.

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Stickel, Anna; Rohdemann, Maren; Landes, Tom; Engel, Katharina; Banas, Roman; Heinz, Andreas; Müller, Christian A

2016-01-01

Previous studies have reported changes in nutrition-related behaviors in alcohol-dependent patients after alcohol detoxification, but prospective studies assessing the effects of these changes on maintaining abstinence are lacking. To assess changes in craving and consumption of chocolate and other sweets over time up to six months after outpatient alcohol detoxification treatment and to detect differences in abstinent versus nonabstinent patients. One hundred and fifty alcohol-dependent patients were included in this prospective observational study. Participants completed self-report questionnaires on nutrition-related behaviors and craving before detoxification treatment (baseline, t1), one week (t2), one month (t3), and six months later (t4). Significant changes in craving for and consumption of chocolate as well as in craving for other sweets were observed over time. Increases were most prominent within the first month. Patients who remained abstinent until t3 consumed three times more chocolate than nonabstainers. One quarter of the patients switched from being rare (t1) to frequent (t3) chocolate eaters, and 84% of these remained abstinent until t3. No significant correlations were found between craving for alcohol and craving for or consumption of chocolate or other sweets. In the first month after outpatient alcohol detoxification treatment, significant changes in nutrition-related behaviors were observed. These changes were not associated with alcohol craving. For a subgroup, increasing the frequency of chocolate consumption might be a temporary protective factor with respect to alcohol relapse.

Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors

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Nicoli Tamie Yoshimi

2016-06-01

Full Text Available ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments Social Phobia Inventory (SPIN, Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19 and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes were also investigated. Results The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3% patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence.

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics.

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Blæhr, Emely Ek; Væggemose, Ulla; Søgaard, Rikke

2018-04-13

Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI -9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. ISRCTN

Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients' daily lives.

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Trull, Timothy J; Wycoff, Andrea M; Lane, Sean P; Carpenter, Ryan W; Brown, Whitney C

2016-11-01

Cannabis and alcohol are the most commonly used (il)licit drugs world-wide. We compared the effects of cannabis and alcohol use on within-person changes in impulsivity, hostility and positive affect at the momentary and daily levels, as they occurred in daily life. Observational study involving ecological momentary assessments collected via electronic diaries six random times a day for 28 consecutive days. Out-patients' everyday life contexts in Columbia, MO, USA. Ninety-three adult psychiatric out-patients (85% female; mean = 30.9 years old) with borderline personality or depressive disorders, who reported using only cannabis (n = 3), only alcohol (n = 58) or both (n = 32) at least once during the study period. Real-time, standard self-report measures of impulsivity, hostility and positive affect, as impacted by momentary reports of cannabis and alcohol use. Cannabis use was associated with elevated feelings of impulsivity at the day level [b = 0.83, 95% confidence interval (CI) = 0.17-1.49] and increased hostility at the momentary (b = 0.07, 95% CI = 0.01-0.12) and person (b = 0.81, 95% CI = 0.15-1.47) level. Alcohol use was associated with elevated feelings of impulsivity at the momentary (b = 0.42, 95% CI = 0.13-0.71) and day levels (b = 0.82, 95% CI = 0.22-1.41) and increased positive affect at the momentary (b = 0.12, 95% CI = 0.06-0.18) and day (b = 0.33, 95% CI = 0.16-0.49) levels. Cannabis and alcohol use are associated with increases in impulsivity (both), hostility (cannabis) and positive affect (alcohol) in daily life, and these effects are part of separate processes that operate on different time-scales (i.e. momentary versus daily). © 2016 Society for the Study of Addiction.

Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis.

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Kelly, John F; Hoeppner, Bettina; Stout, Robert L; Pagano, Maria

2012-02-01

Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self-efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways. Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders. Nine clinical sites within the United States. Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out-patient (n = 952) comparing three out-patient treatments (Project MATCH). AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. Among out-patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%. While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Domestic violence against women attending gynecologic outpatient clinics.

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Nojomi, Marzieh; Agaee, Saideh; Eslami, Samira

2007-07-01

Violence against women and threat of violence are some of the main barriers to women's empowerment and equal participation in the society. However, they often go unnoticed and undocumented and therefore unresolved. For women, one of every five years of healthy life lost because of injury, disease, or premature death is attributable to violence. The aim of this study was to identify the prevalence of domestic violence in women attending three obstetric and gynecologic clinics in Tehran, and to determine the association between domestic violence and demographic factors. One thousand women, 15-64 years old, attending three obstetric and gynecologic clinics affiliated to Iran University of Medical Sciences in Tehran were invited to participate in a cross-sectional survey with self-administered questionnaire. The association between demographic factors (age, level of education, religious believes, annual income, job, husband's employment status, drug and alcohol abuse, previous custody of husbands) and domestic violence was assessed by questionnaire. Five hundred and ninety out of the 1000 women had experienced at least one form of violence (physical, mental, not sexual) from their husbands, 196 women had experienced some forms of controlling behavior and mental violence, and 361 women had been physically threatened. Low level of education in women, nongovernmental job, previous custody, psychiatric disorders of men, and coercive marriage for women were associated with an increased risk of domestic violence. With the high prevalence of domestic violence, health workers should not ignore the seriousness of domestic violence. Health and social personnel should be appropriately trained before "asking all cases" becomes a policy within health and social services.

Pattern of Dermatological Cases Attending Skin-VD Outpatient Department in a Medical College Hospital of Bangladesh

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Abu Baker

2011-07-01

Full Text Available Background: The pattern of skin diseases varies from one country to another and even from region to region of the same country. We are geographically placed in the tropical region with natural outcome of communicable diseases. We conducted this cross sectional study in a tertiary hospital of Bangladesh keeping the proposition in mind that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh. Objectives: To classify the diseases attending the Skin & VD outpatient department of Enam Medical College Hospital (EMCH and to draw comments and recommendations on the basis of findings. Materials and Methods: All patients irrespective of age and sex attending the OPD of Skin-VD Department of Enam Medical College Hospital during a 2-year time-period (from January 2009 to December 2010 were included in the study. Structured questionnaire, check-list and face-to-face interview (whenever necessary were used as tools of data collection. Statistical analyses were done by SPSS version Windows 11.1. Results: Total number of patients was 12100. Most of the patients were aged (>18 years; 64.28%, dominated by male (61.63%, married (56.1%, literate (71.11%, coming from far (>5 km; 63.5% and of middle class origin (59.73%. Out of the total cases, maximum (23.42% were diagnosed as eczema, followed by infectious diseases (17%, acne (8.69% and psoriasis (6.36%. Conclusion: In this study we found infectious diseases to occupy the second position next to eczema and our findings nullify the proposition that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh.

Depression symptoms in people with diabetes attending outpatient podiatry clinics for the treatment of foot ulcers

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Pearson, Sue; Nash, Toni; Ireland, Vanessa

2014-01-01

Background The purpose of this study was to examine the prevalence of depressive symptoms, diabetes self-management, and quality of life in people with diabetes and foot ulcers. Ulcer status, mortality and amputations were also assessed at six months follow-up. Methods This was a cross-sectional survey of people attending outpatient podiatry clinics at a major tertiary referral hospital. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Diabetes self-care was ass...

Disentangling contributions of bar attendance, drinking, and other factors to elevated acute alcohol problems on the U.S.-Mexico border.

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Mills, Britain A; Caetano, Raul; Vaeth, Patrice A C; Reingle Gonzalez, Jennifer M

2015-11-01

Levels of drinking are unusually elevated among young adults on the U.S.-Mexico border, and this elevation can be largely explained by young border residents' unusually high frequency of bar attendance. However, this explanation complicates interpretation of high alcohol problem rates that have also been observed in this group. Because bar environments can lower the threshold for many types of problems, the extent to which elevated alcohol problems among young border residents can be attributed to drinking per se-versus this common drinking context-is not clear. Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). After developing structural models of acute alcohol problems, estimates were subjected to path decompositions to disentangle the common and distinct contributions of drinking and bar attendance to problem disparities on and off the border. Additionally, models were estimated under varying degrees of adjustment to gauge the sensitivity of the results to sociodemographic, social-cognitive, and environmental sources of confounding. Consistent with previous findings for both drinking and other problem measures, acute alcohol problems were particularly elevated among young adults on the border. This elevation was entirely explained by a single common pathway involving bar attendance frequency and drinking. Bar attendance did not predict acute alcohol problems independently of drinking, and its effect was not moderated by border proximity or age. The common indirect effect and its component effects (of border youth on bar attendance, of bar attendance on drinking, and of drinking on problems) were surprisingly robust to adjustment for confounding in all parts of the model (e.g., fully adjusted indirect effect: b = 0.11, SE = 0.04, p Bar attendance and associated increases in drinking play a key, unique role in the high levels of acute alcohol problems among the border

HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention.

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Velloza, Jennifer; Watt, Melissa H; Abler, Laurie; Skinner, Donald; Kalichman, Seth C; Dennis, Alexis C; Sikkema, Kathleen J

2017-11-01

Alcohol use is associated with increased HIV-risk behaviors, including unprotected sex and number of sex partners. Alcohol-serving venues can be places to engage in HIV-related sexual risk behaviors, but are also important sites of social support for patrons, which may mitigate risks. We sought to examine the relationship between alcohol-serving venue attendance, social support, and HIV-related sexual risk behavior, by gender, in South Africa. Adult patrons (n = 496) were recruited from six alcohol-serving venues and completed surveys assessing frequency of venue attendance, venue-based social support, and recent sexual behaviors. Generalized estimating equations tested associations between daily venue attendance, social support, and sexual behaviors, separately by gender. Interaction effects between daily attendance and social support were assessed. Models were adjusted for venue, age, education, and ethnicity. Daily attendance at venues was similar across genders and was associated with HIV-related risk behaviors, but the strength and direction of associations differed by gender. Among women, daily attendance was associated with greater number of partners and higher proportion of unprotected sex. Social support was a significant moderator, with more support decreasing the strength of the relationship between attendance and risk. Among men, daily attendance was associated with a lower proportion of unprotected sex; no interaction effects were found for attendance and social support. Frequent venue attendance is associated with additional HIV-related risks for women, but this risk is mitigated by social support in venues. These results were not seen for men. Successful HIV interventions in alcohol-serving venues should address the gendered context of social support and sexual risk behavior.

Longitudinal cohort study of depression, post-traumatic stress, and alcohol use in South African women who attend alcohol serving venues.

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Abler, Laurie A; Sikkema, Kathleen J; Watt, Melissa H; Eaton, Lisa A; Choi, Karmel W; Kalichman, Seth C; Skinner, Donald; Pieterse, Desiree

2014-08-06

In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudinal relationship between psychological distress and alcohol use among South African women who attend alcohol serving venues. Four waves of data were collected over the course of a year from 560 women in a Cape Town township who attended drinking venues. At each assessment wave, participants reported depressive symptoms, post-traumatic stress symptoms, and alcohol use. Multilevel growth models were used to: 1) assess the patterns of alcohol use; 2) examine how depressive symptoms uniquely, post-traumatic stress symptoms uniquely, and depressive and post-traumatic stress symptoms together were associated with alcohol use; and 3) characterize the within person and between person associations of depressive symptoms and post-traumatic stress symptoms with alcohol use. Women reported high levels of alcohol use throughout the study period, which declined slightly over time. Post-traumatic stress symptoms were highly correlated with depressive symptoms. Modeled separately, both within person and between person depressive and post-traumatic stress symptoms were uniquely associated with alcohol use. When modeled together, significant between person effects indicated that women who typically have more post-traumatic stress symptoms, when controlling for depressive symptoms, are at risk for increased alcohol use; however, women with more depressive symptoms, controlling for post-traumatic stress symptoms, do not have differential risk for alcohol use. Significant within person effects indicated an

Predictors of dropout in an outpatient treatment for problem drinkers including cognitive-behavioral therapy and the opioid antagonist naltrexone.

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Vuoristo-Myllys, Salla; Lahti, Jari; Alho, Hannu; Julkunen, Juhani

2013-11-01

This study investigated predictors of dropout in an outpatient treatment program for problem drinking that included individual cognitive-behavioral therapy combined with naltrexone. Specifically, we investigated whether sociodemographic factors, severity of alcohol dependence, history of problem drinking, or intensity of alcohol craving assessed at the beginning of the treatment predicted dropout from an outpatient program among a sample of 372 patients (65% male). We also investigated whether the effectiveness of the treatment (the change in alcohol consumption and symptoms of alcohol craving) or adherence to naltrexone was related to dropout. Predictors of dropout were investigated using an analysis of covariance with the number of attended treatment sessions as an independent variable. Our results demonstrated that the treatment entry factors predictive of dropout were younger age, lower severity of alcohol dependence, better ability to resist and control alcohol use, and lower obsession with alcohol. In addition, those who dropped out were more likely to begin the program by abstaining from alcohol and had lower adherence to naltrexone use than those who completed the program. The length of stay for treatment was not related to change in alcohol consumption. Patients with less severe alcohol-related problems may lack motivation for treatment, specifically cognitive-behavioral therapy and naltrexone. These patients may benefit more from less intensive treatments.

Alcohol consumption in patients with cardiovascular diseases (results of the survey of cardiac patients in outpatient practice

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O. D. Ostroumova

2015-01-01

Full Text Available Aim. To study the frequency and characteristics of alcohol use in outpatients with cardiovascular diseases and to determine their preferences regarding the help in limiting alcohol consumption.Material and methods. Voluntary and anonymous survey using AUDIT-C and CAGE questionnaires was conducted in 199 patients. The data of 182 patients (82 women and 100 men, mean age 56.4±5.8 years was included in the analysis.Results. Arterial hypertension (70%, heart rhythm disorders (25%, ischemic heart disease (20%, functional class I-II chronic heart failure (21% predominated among all clinical entities. Positive AUDIT-C test was found in 30% of men and 7.3% of women. 17% of men and 23.2% of women did not use alcohol at all. Positive responses to all 4 questions of the CAGE test were given by 3% of men and none of women, positive answers to 3 questions – by 15% of men and none of women, to 2 questions - by 17% of men and 11% of women. Positive answer to the question about the need to reduce alcohol consumption was given by 36% of men and 13.4% of women.Conclusion. Simultaneous testing using AUDIT-C and CAGE questionnaires in outpatients with cardiovascular diseases allows identifying a subgroup of patients (more in men who have a potential problem with an excessive alcohol consumption and need to reduce the intake of alcoholic beverages.

Alcohol and drug use in students attending a student health centre.

LENUS (Irish Health Repository)

Cahill, E

2010-09-01

Alcohol and drug use amongst 3rd level students in Ireland is a concern and has been reported previously in the CLAN Survey. The aim of our study was to determine the alcohol and drug use and any alcohol associated adverse consequences amongst students attending the health centre of University College Cork (UCC). 178 (98.3%) of the 181 students who replied reported having ever drunk alcohol. 157 (91.3%) students drank spirits in the past year v 148 (86.5%) who drank beer\\/cider v 135 (78.5%) who drank wine. 81 (44.8%) students reported binge drinking at least once weekly. 48 (26.5%) students used cannabis in the past year v 12 (6.9%) who used cocaine and 7 (4%) who used ecstasy. All students who drink reported at least one adverse consequence. 114 (63%) of students report adverse consequences of other peoples drinking. The changing drinking behaviour of female students is of particular concern.

Attendance and alcohol use at parties and bars in college: a national survey of current drinkers.

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Harford, Thomas C; Wechsler, Henry; Seibring, Mark

2002-11-01

This study examines attendance and alcohol use at parties and bars among college students by gender, residence, year in school and legal drinking age. The study participants were respondents in the 1997 and 1999 Harvard School of Public Health College Alcohol Study (CAS). The combined sample consisted of 12,830 students (61% women) who reported use of alcohol in the past 30 days prior to interview. Their responses provided information on attendance and alcohol use at parties (dormitory, fraternity, off campus) and off-campus bars. Logistic regression analyses examined the influence of gender, residence, year in school and legal drinking age related to attendance, drinking/non-drinking and heavy drinking (5 or more drinks) at each select setting. Consistent with the literature, fraternity/ sorority parties were occasions of heavy drinking (49%) among drinkers in those settings, yet they drew upon smaller proportions of students (36%) when compared to off-campus parties (75%) and off-campus bars (68%). Off-campus parties (45%) and bars (37%) were also occasions for heavy drinking among drinkers in these settings. College residence was shown to relate to differential exposure to drinking settings, but residence had less impact on the decision to drink and the level of heavy drinking. Attendance at parties decreased with advance in school years, but attendance at off-campus bars increased. Although heavy drinking at off-campus bars decreased with advancing grade year in school, slightly higher proportions of under-age students (41%) compared to students of legal drinking age (35%) exhibited heavy drinking at off-campus bars. The identification of high-risk settings and their correlates serves to better understand the development of heavy drinking on college campuses. Off-campus parties, as compared to campus parties and bars, may pose greater difficulties related to successful intervention.

Differences between craving and health-related quality of life in patients with alcohol dependence with or without dual pathology in outpatient treatment: A descriptive study.

Science.gov (United States)

Robles-Martínez, María; García-Carretero, Miguel Ángel; Gibert, Juan; Palma-Álvarez, Raúl Felipe; Abad, Alfonso Carlos; Sorribes, Marta; Roncero, Carlos

2018-01-23

Dual diagnosis is the coexistence of an addictive disorder and another mental disorder. The objective is to estimate cravings and self-reported quality of life in a sample of patients with alcoholic dependence, with or without dual pathology, who attend an outpatient treatment centre. A cross-sectional study of 112 patients (56 dual and 56 non-dual), diagnosed with alcohol dependence according to DSM-IV-TR. The presence of cravings is determined by the Multidimensional Alcohol Craving Scale and quality of life through the SF-36 Health Questionnaire. There are no statistically significant differences in cravings in either subgroup; the latter tend to refer to lower alcohol cravings than non-dual patients. The dual patients have a worse quality of life in all categories evaluated, highlighting a worse quality of life in the categories: social function, emotional role, vitality and general health. Females present a lower quality of life emphasising those of social function and emotional role. No differences were detected in relation to cravings between the 2 groups. In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, we should consider focusing on the evaluation of cravings and quality of life. In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, it is necessary to consider cravings and quality of life, since these parameters are important for the evaluation of patients with alcohol dependence. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) and prevalence of alcohol use among Iranian psychiatric outpatients.

Science.gov (United States)

Noorbakhsh, Simasadat; Shams, Jamal; Faghihimohamadi, Mohamadmahdi; Zahiroddin, Hanieh; Hallgren, Mats; Kallmen, Hakan

2018-01-30

Iran is a developing and Islamic country where the consumption of alcoholic beverages is banned. However, psychiatric disorders and alcohol use disorders are often co-occurring. We used the Alcohol Use Disorders Identification Test (AUDIT) to estimate the prevalence of alcohol use and examined the psychometric properties of the test among psychiatric outpatients in Teheran, Iran. AUDIT was completed by 846 consecutive (sequential) patients. Descriptive statistics, internal consistency (Cronbach alpha), confirmatory and exploratory factor analyses were used to analyze the prevalence of alcohol use, reliability and construct validity. 12% of men and 1% of women were hazardous alcohol consumers. Internal reliability of the Iranian version of AUDIT was excellent. Confirmatory factor analyses showed that the construct validity and the fit of previous factor structures (1, 2 and 3 factors) to data were not good and seemingly contradicted results from the explorative principal axis factoring, which showed that a 1-factor solution explained 77% of the co-variances. We could not reproduce the suggested factor structure of AUDIT, probably due to the skewed distribution of alcohol consumption. Only 19% of men and 3% of women scored above 0 on AUDIT. This could be explained by the fact that alcohol is illegal in Iran. In conclusion the AUDIT exhibited good internal reliability when used as a single scale. The prevalence estimates according to AUDIT were somewhat higher among psychiatric patients compared to what was reported by WHO regarding the general population.

Effects of long-term AA attendance and spirituality on the course of depressive symptoms in individuals with alcohol use disorder.

Science.gov (United States)

Wilcox, Claire E; Pearson, Matthew R; Tonigan, J Scott

2015-06-01

Alcohol use disorder (AUD) is associated with depression. Although attendance at Alcoholics Anonymous (AA) meetings predicts reductions in drinking, results have been mixed about the salutary effects of AA on reducing depressive symptoms. In this single-group study, early AA affiliates (n = 253) were recruited, consented, and assessed at baseline, 3, 6, 9, 12, 18, and 24 months. Lagged growth models were used to investigate the predictive effect of AA attendance on depression, controlling for concurrent drinking and treatment attendance. Depression was measured using the Beck Depression Inventory (BDI) and was administered at baseline 3, 6, 12, 18, and 24 months. Additional predictors of depression tested included spiritual gains (Religious Background and Behavior questionnaire [RBB]) and completion of 12-step work (Alcoholics Anonymous Inventory [AAI]). Eighty-five percent of the original sample provided follow-up data at 24 months. Overall, depression decreased over the 24 month follow-up period. AA attendance predicted later reductions in depression (slope = -3.40, p = .01) even after controlling for concurrent drinking and formal treatment attendance. Finally, increased spiritual gains (RBB) also predicted later reductions in depression (slope = -0.10, p = .02) after controlling for concurrent drinking, treatment, and AA attendance. In summary, reductions in alcohol consumption partially explained decreases in depression in this sample of early AA affiliates, and other factors such as AA attendance and increased spiritual practices also accounted for reductions in depression beyond that explained by drinking. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Understanding reasons for asthma outpatient (non)‐attendance and exploring the role of telephone and e‐consulting in facilitating access to care: exploratory qualitative study

Science.gov (United States)

van Baar, J D; Joosten, H; Car, J; Freeman, G K; Partridge, M R; van Weel, C; Sheikh, A

2006-01-01

Objective To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. Design Exploratory qualitative study using in depth interviews. Setting Hospital outpatient clinic in West London. Participants Nineteen patients with moderate to severe asthma (12 “attenders” and 7 “non‐attenders”). Results Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non‐attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non‐face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter. Conclusions Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing

Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic.

Science.gov (United States)

Onishi, Hideki; Ishida, Mayumi; Tanahashi, Iori; Takahashi, Takao; Ikebuchi, Kenji; Taji, Yoshitada; Kato, Hisashi; Akechi, Tatsuo

2018-02-26

Wernicke's encephalopathy (WE) is a neuropsychiatric disorder caused by a thiamine deficiency. Although WE has been recognized in cancer patients, it can be overlooked because many patients do not exhibit symptoms that are typical of WE, such as delirium, ataxia, or ocular palsy. Furthermore, outpatients with WE who intermittently present at psycho-oncology clinics have not been described as far as we can ascertain. This report describes two patients who did not exhibit the complete classic triad of symptoms among a series with cancer and WE, and who attended a psycho-oncology outpatient clinic. Result Case 1, a 76-year-old woman with pancreatic cancer and liver metastasis, periodically attended a psycho-oncology outpatient clinic. She presented with delirium and ataxia as well as appetite loss that had persisted for 8 weeks. We suspected WE, which was confirmed by low serum thiamine levels and the disappearance of delirium after thiamine administration. Case 2, a 79-year-old man with advanced stomach cancer, was referred to a psycho-oncology outpatient clinic with depression that had persisted for about 1 month. He also had appetite loss that had persisted for several weeks. He became delirious during the first visit to the outpatient clinic. Our initial suspicion of WE was confirmed by low serum thiamine levels and the disappearance of delirium after thiamine administration. The key indicator of a diagnosis of WE in both patients was appetite loss. Significance of results This report emphasizes awareness of WE in the outpatient setting, even when patients do not exhibit the classical triad of WE. Appetite loss might be the key to a diagnosis of WE in the absence of other causes of delirium.

Psychoactive substances, alcohol and tobacco consumption in HIV-infected outpatients.

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Jacquet, Jean-Marc; Peyriere, Hélène; Makinson, Alain; Peries, Marianne; Nagot, Nicolas; Donnadieu-Rigole, Hélène; Reynes, Jacques

2018-06-01

To assess the alcohol consumption, tobacco addiction and psychoactive substance use (PSU) of people living with HIV (PLHIV). Cross-sectional study in an HIV outpatient unit. Autoquestionnaire systematically proposed to all patients during their usual clinical care visit during a 6-months period, for alcohol (AUDIT test), tobacco (Short Fagerstrom Test) and PSU (ASSIST V3.0 test). Of 1334 distributed questionnaires, 1018 PLHIV responded: 76.8% were men [528 patients were MSM), and the median age was 49 years (interquartile range: 42-46). A prevalence of excessive alcohol drinking was found in 22% [95% confidence interval (CI) 19.5-24.7%] and 44.6% (CI 41.5-47.7%) were current smokers, with high dependence in 29.1% (CI 24.9-33.7%). The prevalence of PSU was 37.8% (CI 34.8-41%) in the past 3 months: cannabis 27.7%, poppers 16.4%, cocaine 8.9%, psychotropic medications 7.1%, gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL) 4.7%, stimulants 3.1%, synthetic cathinones 2.7%, hallucinogens 1.5%. In the past 3 months, PSU was more prevalent in MSM than in non-MSM patients (46 versus 30%, P poppers) 31.0 versus 1.1%, GHB/GBL 7.8 versus 0.8%, stimulants 5.0 versus 1.1%, synthetic cathinones 4.9 versus 0.3%, and hallucinogens 2.3 versus 0.5%. Given the high prevalence of PSU and other addictions (alcohol and smoking) among PLHIV, and particularly among MSM, a systematic screening of PSU and other addictions should be part of routine clinical care.

Cancer incidence among patients with alcohol use disorders--long-term follow-up

DEFF Research Database (Denmark)

Thygesen, Lau Caspar; Mikkelsen, Pernille; Andersen, Tina Veje

2009-01-01

AIMS: The aim of this study was to compare the cancer morbidity in a large cohort of patients with alcohol use disorders in the general Danish population. METHODS: We included 15,258 men and 3552 women free of cancer when attending the Copenhagen Outpatient Clinic for Alcoholics in the period from......, but not of breast cancer and colorectal cancer, in patients with alcohol use disorders....... incidence of colon, rectal or urinary bladder cancer. CONCLUSIONS: In conclusion, this study confirms the well-established association between high alcohol intake and cancer of the upper digestive tract and liver. In addition, the results indicate a significantly elevated occurrence of renal cancer...

Erectile Dysfunction Among Men Attending Surgical Outpatients ...

African Journals Online (AJOL)

E‑mail: aotakure@yahoo.com. INTRODUCTION. Erectile dysfunction (ED) is the inability of a man to ... African traditional herbal practitioner.[4]. ED is commonly seen among men with hypertension,[5] diabetic ... Seventy percent neither smoked cigarette nor drank alcohol, 21.3% drank alcohol and 9% took both alcohol.

Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior.

Science.gov (United States)

Kiene, Susan M; Lule, Haruna; Sileo, Katelyn M; Silmi, Kazi Priyanka; Wanyenze, Rhoda K

2017-01-19

Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators. In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators. Twelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95-2.77) and two or more conditions (AOR 12.77, 95% CI 7.97-20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ 2 24.68, p risk for risky sex (AOR 2.18, 95% CI 1.64-2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression. This study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an

Augmenting Outpatient Alcohol Treatment as Usual With Online Alcohol Avoidance Training: Protocol for a Double-Blind Randomized Controlled Trial.

Science.gov (United States)

Bratti-van der Werf, Marleen Kj; Laurens, Melissa C; Postel, Marloes G; Pieterse, Marcel E; Ben Allouch, Somaya; Wiers, Reinout W; Bohlmeijer, Ernst T; Salemink, Elske

2018-03-01

Recent theoretical models emphasize the role of impulsive processes in alcohol addiction, which can be retrained with computerized Cognitive Bias Modification (CBM) training. In this study, the focus is on action tendencies that are activated relatively automatically. The aim of the study is to examine the effectiveness of online CBM Alcohol Avoidance Training using an adapted Approach-Avoidance Task as a supplement to treatment as usual (TAU) in an outpatient treatment setting. The effectiveness of 8 online sessions of CBM Alcohol Avoidance Training added to TAU is tested in a double-blind, randomized controlled trial with pre- and postassessments, plus follow-up assessments after 3 and 6 months. Participants are adult patients (age 18 years or over) currently following Web-based or face-to-face TAU to reduce or stop drinking. These patients are randomly assigned to a CBM Alcohol Avoidance or a placebo training. The primary outcome measure is a reduction in alcohol consumption. We hypothesize that TAU + CBM will result in up to a 13-percentage point incremental effect in the number of patients reaching the safe drinking guidelines compared to TAU + placebo CBM. Secondary outcome measures include an improvement in health status and a decrease in depression, anxiety, stress, and possible mediation by the change in approach bias. Finally, patients' adherence, acceptability, and credibility will be examined. The trial was funded in 2014 and is currently in the active participant recruitment phase (since May 2015). Enrolment will be completed in 2019. First results are expected to be submitted for publication in 2020. The main purpose of this study is to increase our knowledge about the added value of online Alcohol Avoidance Training as a supplement to TAU in an outpatient treatment setting. If the added effectiveness of the training is proven, the next step could be to incorporate the intervention into current treatment. Netherlands Trial Register NTR5087; http

ALCOHOL DEPENDENCE IN GASTROENTEROLOG YOUTPATIENT ON A PUBLIC HOSPITAL

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Mariana de Andrade PRANKE

2017-09-01

Full Text Available ABSTRACT BACKGROUND: Alcoholism and alcoholic liver disease are both considered worldwide health problems. OBJECTIVE: The prevalence of alcohol dependence, the associated risk factors and the concordance between the prevalence found and the data collected during the medical visit were evaluated. METHODS: A prospective study evaluating gastroenterology outpatients at a public tertiary hospital was conducted. Two specific questionnaires to assess alcohol dependence were applied: Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE and The Alcohol Use Disorder Identification Test (AUDIT. Data on comorbidities, clinical diagnosis and assessment of alcohol consumption by the attending physician were collected through medical records. RESULTS: One hundred and seventy eight patients were interviewed, of which 119 (66.9% were women and 59 (33.1% were men, with mean age of 57 years. Thirty-three (18.5% of the 178 patients were considered alcohol-dependent by the CAGE questionnaire. Thirteen (7.3% patients scored 8 points or more on the AUDIT questionnaire. The agreement (kappa between these questionnaires was 0.37 (P<0.001. The most consumed drink was beer. The median daily consumption of dependent patients was 64 g. None of the patients were undergoing treatment in a specific treatment center, and 14/33 (42.4% patients considered themselves alcoholics. Only in 17/33 (51.5% there was information about alcoholism in their respective medical records. In the bivariate analysis, male gender (P<0.001, onset of alcohol consumption before the age of 15 (P=0.003, daily alcohol consumption in the last 12 months (P<0.001 and smoking (P<0.001 were identified as risk factors. After multivariate analysis, only male gender (P=0.009 and smoking (P=0.001 were associated with alcoholism. CONCLUSION: The present study demonstrated a high prevalence of alcohol dependence in the gastroenterology outpatient clinic, being predominantly associated with male gender and

Menstrual disturbances and fertility in chronic alcoholic women

DEFF Research Database (Denmark)

Becker, U; Tønnesen, H; Kaas-Claesson, N

1989-01-01

. 28%, P less than 0.001) and miscarriages (23% vs. 8%, P less than 0.05) than controls, but due to a higher number of pregnancies in the alcoholic group the proportion of abortions and miscarriages did not differ significantly. No differences existed between the groups regarding frequency of difficult......Data on menstrual pattern, gynecological disorders and infertility were obtained from 51 chronic alcoholic women aged 20--42 years attending an outpatient clinic for alcoholics, using 51 randomly drawn age-matched healthy women as controls. A higher variability (P less than 0.05) in the duration...... of both menstrual cycle and menstrual flow was recorded in the chronic alcoholic women during active alcoholism. A higher frequency (P less than 0.05) of menstrual disturbances (70% vs. 55%) and uterine curettages (38% vs. 16%) were found in the alcoholic women. The latter reported more abortions (63% vs...

Eating behavior and body image perception of pregnant women attending a high-risk outpatient center

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Raquel Guimarães Nobre

2014-06-01

Full Text Available Objective: To investigate the eating behavior and body image perception in pregnant women attending a high-risk outpatient center. Methods: A quantitative, cross-sectional, observational study conducted with 28 overweight pregnant women attending the first consultation in the nutrition outpatient center of a maternity hospital in Fortaleza-CE, from December 2010 to February 2011. It has been used a pre-established form containing data on the characterization of the sample (socioeconomic, obstetric, and nutritional, the BES (Binge Eating Scale to assess binge eating and BSQ (Body Shape Questionnaire to assess the severity or absence of body image disorder. The variables were presented as mean ± standard deviation and simple frequency and percentage. The Pearson’s correlation was used to verify the relation between body image and binge eating, considering p <0.05. Results: The pregnant women studied had a mean age of 29.4 ± 6.3 years and mean gestational age of 24.6 ± 8.2 weeks. It was found a prevalence of 71.5% (n=20 of body image disorder and 17.8% (n=5 of binge eating. It was also observed a direct and significant correlation between the body image perception and the degree of binge eating (r=0.4358, p=0.020. Conclusion: The high rate of body image disorder positively related to a significant binge eating indicates an unfavorable adjustment of this group of pregnant women to alterations in weight and body shape and size, which are inherent to pregnancy, standing out as group that needs special attention by the professional team. doi:10.5020/18061230.2014.p256

Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study.

Science.gov (United States)

Sebelefsky, Christian; Karner, Denise; Voitl, Jasmin; Klein, Frederic; Voitl, Peter; Böck, Andreas

2015-10-01

Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level. © The Author(s) 2015.

Atheists, agnostics and Alcoholics Anonymous.

Science.gov (United States)

Tonigan, J Scott; Miller, W R; Schermer, Carol

2002-09-01

In spite of the strong emphasis in AA on spiritual beliefs and practices, findings are mixed about the importance of such beliefs in predicting AA affiliation. This study of the Project MATCH outpatient (N = 952) and aftercare (N = 774) samples tested three hypotheses about the role of client God belief and subsequent AA attendance and benefit, taking into account that some individuals may, in fact, deny the existence of a God. Longitudinal analyses were conducted (N = 1,526) investigating client God beliefs, AA attendance, patterns of AA attendance and alcohol use. Assessments were conducted at intake and in 3-month intervals using the Form 90, Religious Behaviors and Background, and the Alcoholics Anonymous Inventory. 12-Step treatment was significantly more likely to promote pre-post shifts in client God beliefs, and atheist and agnostic clients attended AA significantly less often throughout follow-up relative to clients self-labeled as spiritual and religious. AA attendance, however, was significantly associated with increased abstinence and reductions in drinking intensity regardless of God belief. Finally, no differences in percent days abstinence and drinking intensity were found between atheist and agnostic versus spiritual and religious clients, but clients unsure about their God belief reported significantly higher drinking frequency relative to the other groups. God belief appears to be relatively unimportant in deriving AA-related benefit, but atheist and agnostic clients are less likely to initiate and sustain AA attendance relative to spiritual and religious clients. This apparent reticence to affiliate with AA ought to be clinically recognized when encouraging AA participation.

[Evaluation of motivation to quit smoking in outpatients attending smoking cessation clinic].

Science.gov (United States)

Stokłosa, Anna; Skoczylas, Agnieszka; Rudnicka, Anna; Bednarek, Michał; Krzyzanowski, Krystian; Górecka, Dorota

2010-01-01

The success in smoking cessation depends not only on a method of treatment but also on patient motivation. The aim of this study was to estimate the motivation and the main reason to quit smoking among outpatients attending smoking cessation clinic. One hundred and eleven patients (50 men and 61 women), mean age 58, filled in a motivation test, nicotine dependence test and a questionnaire of the clinic. The main motivation to quit was for the health reasons (83%). Mean motivation test result was 6.93; mean nicotine addiction evaluated in dependence test was 5.49. Eighty seven percent of patients were ready to quit smoking during one month (36% in 24 hours; 23% in one week; 28% in four weeks). There was no significant difference between men and women. The main motivation to quit smoking were the health reasons as well among men as women. There was no correlation between the readiness to quit smoking determined as time to quit attempt and the motivation test.

Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study.

NARCIS (Netherlands)

Baar, J.D. van; Joosten, H.; Car, J.; Freeman, G.; Partridge, M.R.; Weel, C. van; Sheikh, A.

2006-01-01

OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews.

Alcohol Use and Mental Health Conditions Among Black College Males: Do Those Attending Postsecondary Minority Institutions Fare Better Than Those at Primarily White Institutions?

Science.gov (United States)

Barry, Adam E; Jackson, Zachary; Watkins, Daphne C; Goodwill, Janelle R; Hunte, Haslyn E R

2017-07-01

While there is a sizeable body of research examining the association between alcohol use and mental health conditions among college students, there are sparse investigations specifically focusing on these associations among Black college students. This is concerning given Black college students face different stressors compared with their non-Black peers. Black males appear especially at risk, exhibiting increased susceptibility to mental health issues and drinking in greater quantities and more frequently than Black females. This investigation examined the association between alcohol consumption and mental health conditions among Black men attending institutions of higher education in the United States and sought to determine differences between Black men attending predominantly White institutions (PWIs) compared with those attending postsecondary minority institutions. Final sample included 416 Black men, 323 of which attended a PWI. Data were from the National College Health Assessment. Black men attending a PWI reported significantly greater levels of alcohol consumption and significantly more mental health conditions. Attendance at a minority-serving institution was associated with fewer mental health conditions among Black men. Future studies should seek to replicate these findings and conduct culturally sensitive and gender-specific research examining why Black men at PWIs report greater alcohol consumption and more mental health conditions than their peers attending postsecondary minority institutions.

The Cost-effectiveness of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency and Outpatient Medical Settings.

Science.gov (United States)

Barbosa, Carolina; Cowell, Alexander; Bray, Jeremy; Aldridge, Arnie

2015-06-01

This study analyzed the cost-effectiveness of delivering alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency departments (ED) when compared to outpatient medical settings. A probabilistic decision analytic tree categorized patients into health states. Utility weights and social costs were assigned to each health state. Health outcome measures were the proportion of patients not drinking above threshold levels at follow-up, the proportion of patients transitioning from above threshold levels at baseline to abstinent or below threshold levels at follow-up, and the quality-adjusted life years (QALYs) gained. Expected costs under a provider perspective were the marginal costs of SBIRT, and under a societal perspective were the sum of SBIRT cost per patient and the change in social costs. Incremental cost-effectiveness ratios were computed. When considering provider costs only, compared to outpatient, SBIRT in ED cost $8.63 less, generated 0.005 more QALYs per patient, and resulted in 13.8% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained. Alcohol SBIRT generates costs savings and improves health in both ED and outpatient settings. EDs provide better effectiveness at a lower cost and greater social cost reductions than outpatient. Copyright © 2015 Elsevier Inc. All rights reserved.

Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Sanatinia Rahil

2012-08-01

Full Text Available Abstract Background Over the last 30 years the number of people who drink alcohol at harmful levels has increased in many countries. There have also been large increases in rates of sexually transmitted infections. Available evidence suggests that excessive alcohol consumption and poor sexual health may be linked. The prevalence of harmful alcohol use is higher among people attending sexual health clinics than in the general population, and a third of those attending clinics state that alcohol use affects whether they have unprotected sex. Previous research has demonstrated that brief intervention for alcohol misuse in other medical settings can lead to behavioral change, but the clinical- and cost-effectiveness of this intervention on sexual behavior have not been examined. Methods We will conduct a two parallel-arm, randomized trial. A consecutive sample of people attending three sexual health clinics in London and willing to participate in the study will be screened for excessive alcohol consumption. Participants identified as drinking excessively will then be allocated to either active treatment (Brief Advice and referral for Brief Intervention or control treatment (a leaflet on healthy living. Randomization will be via an independent and remote telephone randomization service and will be stratified by study clinic. Brief Advice will comprise feedback on the possible health consequences of excessive alcohol consumption, written information about alcohol and the offer of an appointment for further assessment and Brief Intervention. Follow-up data on alcohol use, sexual behavior, health related quality of life and service use will be collected by a researcher masked to allocation status six months later. The primary outcome for the study is mean weekly alcohol consumption during the previous three months, and the main secondary outcome is the proportion of participants who report unprotected sex during this period. Discussion Opportunistic

Pattern and predictors of alcohol use disorders in a family practice in Nigeria.

Science.gov (United States)

Obadeji, Adetunji; Oluwole, Lateef O; Dada, Mobolaji U; Ajiboye, Adedotun S

2015-01-01

Primary care has been identified as a key setting for the reduction of alcohol-related harm, while general practitioners are expected to play a significant role. The study aimed at identifying pattern of, and factors that are associated with alcohol use disorders (AUDs) among patients attending Family Medicine unit of State University Teaching Hospital. Sample was selected through a random sampling from a population of patients, aged 18-65 years, attending the general medical out-patients unit of the hospital from January to April 2013. A pretested, semi-structured questionnaire was administered, incorporating sociodemographics and the diagnoses made by the attending Physician. The participants also completed the alcohol use disorders identification test (AUDIT) questionnaire and the patient health questionnaire-9. The prevalence of AUDs among the population of general out-patients was 9.7%. The AUDIT scores of the participants range from 0 to 29 with a mean of 1.3 (standard deviation = 4.08). AUDs were significantly associated with gender, level of education, occupational class, and the presence of significant depressive symptoms (P < 0.05). There was no statistically significant association found for age, employment status, marital status, and religion. The prevalence of AUDs among population studied was lower compared with a similar study in similar setting, but however, significant. AUDs were predicted by gender, lower education level, occupational group, and the presence of significant depressive symptoms mostly in the mild to moderate form. Identifying the group at risk in clinical setting may go a long way in reducing the adverse effect of AUDs in our society.

Improving feedback from outpatient medical appointments attended by escorted psychiatric patients in the North London Forensic Service.

Science.gov (United States)

McCurdy, Kathleen; Croxford, Anna

2015-01-01

It is well established that patients with mental illness are known to have a high level of morbidity and mortality compared to the general population. This is particularly prominent in long-stay psychiatric patients, such as those in secure settings. The Royal College of Psychiatrists recommends that psychiatrists should promote the physical health of their patients and liaise with other specialties. However, there is evidence that communication between psychiatry and other specialties is poor. A survey was carried out at the North London Forensic Service in June 2014. This looked at the views of clinical staff about the frequency and quality of feedback obtained when inpatients attend outpatient hospital appointments at local general hospitals. This survey highlighted the general perception among staff that feedback is poor, with 68.43% of respondents saying that they were "very unsatisfied" or "unsatisfied" with the level and quality of feedback. Clinical staff felt that many patients who attended hospital outpatient appointments, even when escorted by staff, returned with little or no feedback. This was confirmed by a baseline audit across 3 wards showing that details of the appointment (date, time, hospital, and specialty) were only documented in 54.5% of cases and the content of the appointment documented in even fewer cases. A form was designed by junior doctors that provided a simple framework of 6 questions to be answered at the outpatient clinic about the problem, diagnosis, and further actions needed. This was introduced and its impact assessed with a 3-month and 6-month audit of electronic notes, as well as a follow-up survey after 6 months. The audit showed significant improvement in the quality of feedback about the appointment at both the 3-month and 6-month point. The follow-up survey showed that 70% of respondents were aware of the form and 100% of those who were aware of the form had used it at least once and found it helpful. The general

Awareness of childhood blindness in parents attending Paediatrics Ophthalmology outpatient department

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Radhika Paranjpe

2016-01-01

Full Text Available Background: Blindness is defined by World Health Organisation as having a visual acuity of <3/60 in the better eye. Thirty-seven million people are blind worldwide. One million and four hundred thousand are children. The causes of blindness in children vary according to region and socioeconomic development. The aim of our study is to identify a range of potential issues relating to parental awareness and perceptions of common eye diseases affecting children. Materials and Methods: The type of study was population-based, prospective, cross-sectional study conducted on parents of 200 children ranging from 0 to 16 years of age, attending Paediatric Ophthalmology clinic during the month of August and September 2014. This was an open-ended questionnaire-based study and only the participants who consented were enrolled in the study. Results: The most common eye problem detected among 200 of children was refractive errors. The incidence of refractive errors was found to be 103 out of 200 (51.5%. This is followed by 71 (35.5% cases of squint/strabismus. Of 200 parents, 150 (75% think the present eye condition of their child will reduce the eyesight. However, they did not know about the nature of the eye problem. Forty-four (22% parents did not know anything about the eye condition of their child. Seventy (35% parents were apprehensive about the use of spectacles in the children suffering from refractive errors. One hundred and six (53% parents came to know about the eye problem of their child from the teacher of the child and 63 (31.5% parents got information from their family doctor. Conclusions: As the number of mothers attending the eye department with the child is high, so there is more need of educating the mothers about the eye conditions of the child. Education and socioeconomic conditions affect the knowledge and awareness level of the parents regarding eye problems. Most of the children attending outpatient department were found to be in the

Psychopathological profile and prevalence of dual pathology on patients with alcoholic dependence undergoing outpatient treatment.

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García-Carretero, Miguel A; Novalbos-Ruiz, José P; Robles-Martínez, María; Jordán-Quintero, María A; O'Ferrall-González, Cristina

2017-01-01

Assess the prevalence of dual pathology in patients with alcohol dependence and describe the psychopathological profile of mental disorders, impulsiveness, ADHD presence and craving. It is a cross-sectional study about dual pathology, carried out on 102 patients undergoing outpatient treatment. The presence of dual pathology is established by means of the MINI-5 interview and the MCMI-III test; DSM-IV being used as the alcohol abuse criteria. Impulsiveness, ADHD presence, craving and quality of life were measured through SIS, ASRSv1, MACS and SF-36. The prevalence of dual pathology ranges from 45.1% to 80.4% according to MCMI-III and MINI-5, respectively. The most frequent pathologies are current major depressive episodes, followed by current generalized anxiety disorders, suicide risk and current dysthymia disorders; 73.2% of dual patients present a moderate and intense global score according to MACS, 56.1% got a meaningful score in impulsiveness according to SIS and 41.5% has highly consistent symptoms with ADHD. As regards quality of life, 53.7% of the sample had bad mental health. In the case of dual patients consuming other substances, 30% had a history of bipolar disorders and 10% had a high suicide risk. The prevalence of psychiatric comorbidity in patients with alcohol dependence undergoing outpatient treatment varies depending on the detection method, MINI being the one identifying a greater number of cases. More than half of dual patients present impulsive behavior, a bad mental health state and high craving levels. Special attention should be paid to dual patients consuming other substances.

Awareness and practices of oral hygiene and its relation to sociodemographic factors among patients attending the general outpatient department in a tertiary care hospital of Kolkata, India

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Bobby Paul

2014-01-01

Full Text Available Background: Periodontal diseases, dental caries, malocclusion, and oral cancer are the most prevalent dental diseases affecting people in the Indian community. Objective: The study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD. Materials and Methods: A cross-sectional study was conducted among 224 patients attending the general OPD of the SSKM Hospital, Kolkata, India, from 1 April to 30 April, 2013. The study tool was a pre-designed and pre-tested semi-structured schedule. Results: About 69.20% of the participants used a toothbrush with toothpaste as a method of cleaning their teeth; 35.71% brushed twice in a day; 33.03% brushed both in the morning and at bedtime; and 8.93% used mouthwash. About 40.62% visited the dentist during the last six months; among them 61.18% attended because of pain. Almost three-fourth of the participants knew that tooth decay and bad breath were the effects of not cleaning the teeth. It was known to 71.42, 63.39, 70.53, and 73.21% of the respondents, respectively, that excess sweet, cold drink, alcohol, and smoking/pan chewing were bad for dental health. Television was the source of knowledge to 57.14% of the participants and 35.71% acquired their knowledge from a dentist. Females, literates, urban residents, users of mouthwash, and regular visitors to the dentist had good oral hygiene practices. Conclusion: Oral health awareness and practices among the study population are poor and need to improve.

The alcohol use disorders identification test (AUDIT: validation of a Nepali version for the detection of alcohol use disorders and hazardous drinking in medical settings

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Pradhan Bickram

2012-10-01

Full Text Available Abstract Background Alcohol problems are a major health issue in Nepal and remain under diagnosed. Increase in consumption are due to many factors, including advertising, pricing and availability, but accurate information is lacking on the prevalence of current alcohol use disorders. The AUDIT (Alcohol Use Disorder Identification Test questionnaire developed by WHO identifies individuals along the full spectrum of alcohol misuse and hence provides an opportunity for early intervention in non-specialty settings. This study aims to validate a Nepali version of AUDIT among patients attending a university hospital and assess the prevalence of alcohol use disorders along the full spectrum of alcohol misuse. Methods This cross-sectional study was conducted in patients attending the medicine out-patient department of a university hospital. DSM-IV diagnostic categories (alcohol abuse and alcohol dependence were used as the gold standard to calculate the diagnostic parameters of the AUDIT. Hazardous drinking was defined as self reported consumption of ≥21 standard drink units per week for males and ≥14 standard drink units per week for females. Results A total of 1068 individuals successfully completed the study. According to DSM-IV, drinkers were classified as follows: No alcohol problem (n=562; 59.5%, alcohol abusers (n= 78; 8.3% and alcohol dependent (n=304; 32.2%. The prevalence of hazardous drinker was 67.1%. The Nepali version of AUDIT is a reliable and valid screening tool to identify individuals with alcohol use disorders in the Nepalese population. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT ≥11 for both the gender and hazardous drinkers (with AUDIT ≥5 for males and ≥4 for females. For alcohol dependence/abuse the cut off values was ≥9 for both males and females. Conclusion The AUDIT questionnaire is a good screening instrument for detecting alcohol use disorders in patients attending a university

Traumatic stress and the mediating role of alcohol use on HIV-related sexual risk behavior: results from a longitudinal cohort of South African women who attend alcohol-serving venues.

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Abler, Laurie; Sikkema, Kathleen J; Watt, Melissa H; Pitpitan, Eileen V; Kalichman, Seth C; Skinner, Donald; Pieterse, Desiree

2015-03-01

In South Africa, alcohol contributes to the HIV epidemic, in part, by influencing sexual behaviors. For some, high levels of alcohol consumption may be driven by previous traumatic experiences that result in traumatic stress. The purpose of this study was to quantify the longitudinal association between traumatic stress and unprotected sex among women who attend drinking venues and to assess whether this association was explained by mediation through alcohol use. Data were collected in 4 waves over a year from a prospective cohort of 560 women who regularly attended alcohol-serving venues in a Cape Town township. Longitudinal mixed models examined (1) the relationship between traumatic stress and counts of unprotected sex and (2) whether alcohol use mediated the association between traumatic stress and unprotected sex. Most women reported elevated traumatic stress (80%) and hazardous alcohol use (88%) at least once during the study period. In models adjusted for covariates, traumatic stress was associated with unprotected sex (b = 0.28, SE = 0.06, t = 4.82, P traumatic stress was associated with alcohol use (b = 0.27, SE = 0.02, t = 14.25, P traumatic stress on unprotected sex. These results highlight the need to address traumatic stress among female venue patrons as an important precursor of HIV risk due to alcohol use.

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India

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Selvaraj, Kalaiselvi; Srinivasan, Manikandan; Duraisamy, Venkatachalam; Ramaswamy, Gomathi; Venugopal, Vinayagamurthy; Chinnakali, Palanivel

2016-01-01

Background: Recently, under National Health Mission alternate systems of Medicine are mainstreamed in public health care system. Effective action plan generation, logistic arrangement and roll out of these alternate systems of Medicine needs understanding on profile of morbidities among attendees who come to these facilities. Objectives: This study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities. Materials and Methods: A facility based cross sectional study was conducted among elderly person (60 years and above) attending Siddha outpatient department (OPD) from two of the randomly selected sub district level siddha facilities in Erode district, Tamil Nadu, India. Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. Morbidities were summarized in terms of proportions based on age and gender. Age and sex specific differentials on specific morbidities were compared using ‘z’ test. Results: Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities diagnosed and treated among elderly attending the siddha OPD. There was a predilection towards elderly male for morbidities such as bronchial asthma and hemiplegia compared to elderly female. Similarly, higher proportions of lumbar spondylosis, hypertension and fungal skin diseases were reported among aged 80 years or more compared to elderly aged 60-79 years. Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile

Alcohol misuse in Greece: a 15-year experience from a specialized outpatient service.

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Pomini, V; Mellos, L; Paparrigopoulos, T; Liappas, J

2014-01-01

Alcohol use in Greece is traditionally diffused among its population. According to general population surveys, three out of four Greeks aged 12-64 referred to alcohol consumption during the last year and 10% reported at least one episode of alcohol abuse during the last month. Furthermore, the large majority of young people aged 13-18 reported lifetime use of alcohol and 14.8% of them reported more than three episodes of alcohol abuse during the last month. Apparently, cultural factors have influenced the pattern of alcohol consumption and the ensuing alcohol-related problems during the last two decades. The "Athena" Service is an outpatient therapeutic unit for the management of substance misusers and their families. It is a specialized abstinence-oriented service that does not administer substance substitutes; mental health professionals of the service work as a multidisciplinary team. Motivational approaches, individual cognitive-behavioural psychotherapy and family interventions of a systemic orientation are the principal therapeutic techniques applied. Adjunctive medication is prescribed whenever mild to moderate concomitant psychopathology is detected. Support measures such as provisional use of medication, use of antagonistic agents or brief hospitalization can be provided if deemed necessary. No strict time limits are applied regarding treatment duration and discharge from the program. During the period 1998-2013, a total of 1511 individuals with alcohol-related problems addressed the service. The changing pattern of substance misuse over the last fifteen years can be summarized as follows: (a) there is a gradually increasing number of women misusing substances; (b) there is an increasing proportion of young adults reporting multi-substance use with concurrent psychiatric disorders; (c) there is an increasing proportion of young adults regularly using/misusing substances; (d) there is a decreasing proportion of middle-aged individuals presenting with

Patterns of Alcohol and Other Drug Use Associated with Major Depression among Gay Men Attending General Practices in Australia

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Holt, Martin; Bryant, Joanne; Newman, Christy E.; Paquette, Dana M.; Mao, Limin; Kidd, Michael R.; Saltman, Deborah C.; Kippax, Susan C.

2012-01-01

Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social,…

Neuroendocrine response to GABA-B receptor agonism in alcohol-dependent individuals: Results from a combined outpatient and human laboratory experiment.

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Farokhnia, Mehdi; Sheskier, Mikela B; Lee, Mary R; Le, April N; Singley, Erick; Bouhlal, Sofia; Ton, Timmy; Zhao, Zhen; Leggio, Lorenzo

2018-04-14

Gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the nervous system, plays an important role in biobehavioral processes that regulate alcohol seeking, food intake, and stress response. The metabotropic GABA-B receptor has been investigated as a potential therapeutic target for alcohol use disorder, by using orthosteric agonists (e.g., baclofen) and positive allosteric modulators. Whether and how pharmacological manipulation of the GABA-B receptor, in combination with alcohol intake, may affect feeding- and stress-related neuroendocrine pathways remains unknown. In the present randomized, double-blind, placebo-controlled study, thirty-four alcohol-dependent individuals received baclofen (30 mg/day) or placebo in a naturalistic outpatient setting for one week, and then performed a controlled laboratory experiment which included alcohol cue-reactivity, fixed-dose priming, and self-administration procedures. Blood samples were collected, and the following neuroendocrine markers were measured: ghrelin, leptin, amylin, glucagon-like peptide-1 (GLP-1), insulin, prolactin, thyroid-stimulating hormone, growth hormone, cortisol, and adrenocorticotropic hormone (ACTH). During the outpatient phase, baclofen significantly increased blood concentrations of acyl-ghrelin (p = 0.01), leptin (p = 0.01), amylin (p = 0.004), and GLP-1 (p = 0.02). Significant drug × time-point interaction effects for amylin (p = 0.001) and insulin (p = 0.03), and trend-level interaction effects for GLP-1 (p = 0.06) and ACTH (p = 0.10) were found during the laboratory experiment. Baclofen, compared to placebo, had no effect on alcohol drinking in this study (p's ≥ 0.05). Together with previous studies, these findings shed light on the role of the GABAergic system and GABA-B receptors in the shared neurobiology of alcohol-, feeding-, and stress-related behaviors. Copyright © 2018. Published by Elsevier Ltd.

An indirect haemagglutination test for demonstration of gonococcal antibodies using gonococcal pili as antigen. II. Serological investigation of patients attending a dermato-venereological outpatients clinic in Copenhagen

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Reimann, K; Lind, I; Andersen, Klaus Ejner

1980-01-01

A total of 1223 serum specimens were obtained from 649 consecutive patients attending a dermatovenereological out-patient clinic in Copenhagen with a request for venereal disease control. The sera were examined for gonococcal antibodies by both a gonococcal complement fixation test (GCF) and an i...

Malignancies in HIV/AIDS patients attending an outpatient clinic in Vitória, State of Espírito Santo, Brazil

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Lauro Ferreira da Silva Pinto Neto

2012-12-01

Full Text Available INTRODUCTION: The present study investigated cancer prevalence and associated factors among HIV-infected individuals attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. METHODS: A sectional study was conducted among HIV infected adults attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. Demographic, epidemiological and clinical data were abstracted from medical records, including cancer diagnoses; nadir and current CD4 cell count, HIV viral load, time on antiretroviral treatment (ART, type of ART and smoking status. RESULTS: A total of 730 (91.3% patients were included in the study. Median age was 44.0 [interquartile range (IQR: 35-50.3] years; median time since HIV diagnosis was 5.5 years (IQR: 2-10; 60% were male; and 59% were white. Thirty (4.1% cases of cancer were identified of which 16 (53% were AIDS defining cancers and 14 (47% were non-AIDS defining malignancies. Patients diagnosed with cancer presented higher chance of being tobacco users [OR 2.2 (95% CI: 1.04-6.24]; having nadir CD4 ≤200 cells/mm³ [OR 3.0 (95% CI: 1.19-7.81] and higher lethality [OR 13,3 (95% CI: 4,57-38,72]. CONCLUSIONS: These results corroborate the importance of screening for and prevention of non-AIDS defining cancers focus in HIV-infected population, as these cancers presented with similar frequency as AIDS defining cancers.

Outpatient Vascular Intervention: A Two-Year Experience

International Nuclear Information System (INIS)

Macdonald, Sumaira; Thomas, Steven M.; Cleveland, Trevor J.; Gaines, Peter A.

2002-01-01

Purpose: To retrospectively analyze the outcome of a range of interventional vascular procedures performed on outpatients. Methods: Suitability for outpatient procedures was assessed according to agreed protocols. An episode was defined as any procedure/s through a single access site at one attendance. Retrospective case-note review was performed. Results: There were 693 outpatient episodes between April 1998 and May 2000 (290 interventional, and 403 diagnostic procedures),comprising 25% (693/2769) of the total workload. Follow-up is available in 214; 38 of these were transfers from outlying hospitals and were excluded from analysis. One hundred and seventy-six were true outpatients. There were 98 iliac and 46 femoropopliteal interventions,2 aortic stents, 1 renal and 5 upper-limb angioplasties (PTAs), 5 embolizations, 8 Hickman lines, 1 line stripping, 3 atherectomies, 1 dialysis-graft PTA and 6 bypass-graft PTAs. Sixty-eight closure devices were used. Twelve patients were converted to inpatients (6.8%,12/176). The readmission rate was 3.4% (6/176). The reattendance rate was 1.1% (2/176), both subsequently attending for outpatient duplex ultrasound examination to exclude pseudoaneurysm. The major complication rate was 3.4% and the delayed major complication rate was 1.7%. Conclusion: Outpatient vascular intervention is safe with appropriate protocols and with careful patient selection. Local vascular services benefit from the release of inpatient beds

A study of tobacco and substance abuse among mentally ill outpatients in a tertiary care general hospital

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Anju Gupta

2016-01-01

Full Text Available Background: The comorbidity of substance abuse and mental disorder is known to exist and may cause many diagnostic, prognostic, and management difficulties. Indian data are sparse in this area. Objectives: The aim of the study was to identify the prevalence and pattern of substance abuse in psychiatric outpatients and to examine the relation between demographic variables and drug abuse pattern. Materials and Methods: Medical records of the patients attending psychiatry outpatient clinic at a tertiary care general hospital over a 3-month period were reviewed. Information was obtained from medical chart and Drug Abuse Monitoring Scale pro forma about substance abuse. Psychiatric diagnosis made by a qualified psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition diagnostic criteria, as recorded in the case record form, was used. Observation: The results revealed that 50.8% (half of all psychiatry outpatients were using one or more substances including tobacco in the last month prior to registration (1 month prevalence and 28.35% were using substances at any time in their life prior to the last month (lifetime prevalence. Male patients had 6 to 8 times higher substance abuse than female patients. Tobacco and alcohol were found to be the most common substances of abuse, followed by cannabis. Part-time and full-time employed male patients consumed more alcohol and tobacco than unemployed patients. Conclusions: Substance abuse was common among mentally ill outpatients and could be the cause of various health hazards and hence requires due attention.

Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy.

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Foschi, Claudio; Marangoni, Antonella; D'Antuono, Antonietta; Nardini, Paola; Compri, Monica; Bellavista, Sara; Filippini, Andrea; Bacchi Reggiani, Maria Letizia; Cevenini, Roberto

2014-04-09

We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing. L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046). LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001).Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010). Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.

Clinical management methods for out-patients with alcohol dependence

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Boulze Isabelle

2006-02-01

Full Text Available Abstract Background In France outpatient centres for the care of alcoholics are healthcare establishments providing medical, psychological and social support. Although they meet the practical needs of these patients, their degree of use in each of these domains and the respective mobilisation of different skills by the care team are not well understood. Our aim was therefore to determine in detail the management involved as a function of the severity of alcohol dependence. For this purpose, all the procedures involved were compiled in a thesaurus describing its type (psychological, medical, social, reception, its scheduled or unscheduled nature, its method (face-to-face, telephone, letter and its duration. The severity of dependence was evaluated using the Addiction Severity Index (ASI. Results 45 patients were included and followed-up during 291 ± 114 days. The mean initial ASI scores (± SD were: medical (M = 0.39 ± 0.3, working-income (ER = 0.5 ± 0.3, alcohol (A = 0.51 ± 0.2, illicit drugs (D = 0.07 ± 0.08, legal (L = 0.06 ± 0.13, familial and social environment (FS = 0.34 ± 0.26, psychological (P = 0.39 ± 0.22. The total number of procedures was 1341 (29.8 per patient corresponding to 754.4 hours (16.7 per patient. The intensity of management peaked during the first month of treatment, and then declined rapidly; the maximum incidence of abstinence was observed during the 3rd month of management. Interviews with patients, group therapy and staff meetings represented 68.7%, 9.9% and 13.9% of all procedures, respectively. In patients with severe dependence, as compared to moderate, management was twice as intense in the psychological and social domains, but not in the medical domain. The ASI questionnaire was completed a second time by 24 patients, after an average of 3.2 months. The improvement was significant in the M, A, D and P domains only. Conclusion This study provided an overview of the methods employed in managing a sample of

Investigating the effect of Alcohol Brief Interventions within accident and emergency departments using a data informatics methodology.

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Baldacchino, Alex; O'Rourke, Louise; Humphris, Gerry

2018-07-01

Alcohol Brief Interventions (ABI) have been implemented throughout Scotland since 2008 and aim to reduce hazardous drinking through a Scottish Government funded initiative delivered in a range of settings, including Accident and Emergency (A and E) departments. To study the extent to which Alcohol Brief Interventions (ABI) are associated with later health service use. An opportunistic informatics approach was applied. A unique patient identifier was used to link patient data with core datasets spanning two years previous and two years post ABI. Variables included inpatient attendance, outpatient attendance, psychiatric admissions, and A and E attendance and prescribing. Patients (N = 1704) who presented at A and E departments who reported an average alcohol consumption of more than 8 units daily received the ABI. Fast Alcohol Screening Test (FAST) was used to assess patients for hazardous alcohol consumption. Multilevel linear modelling was employed to predict post-intervention utilisation using pre-ABI variables and controlling for person characteristics and venue. Significant decrease in A and E usage was found at one and two years following the ABI intervention. Previous health service use was predictive of later service use. A single question (Item 4) on the FAST was predictive of A and E attendance at one and two years. This investigation and methodology used provide support for the delivery of the ABI. However, it cannot be ascertained whether this is due to the ABI or simply is a result of making contact with a specialist in the addiction field. Copyright © 2018 Elsevier B.V. All rights reserved.

Suicide risk and alcohol and drug abuse in outpatients with HIV infection and Chagas disease.

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Guimarães, Patrícia M; Passos, Sonia R; Calvet, Guilherme A; Hökerberg, Yara H; Lessa, José L; Andrade, Carlos A de

2014-01-01

To evaluate psychiatric comorbidities in outpatients receiving care for HIV and Chagas disease at Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. Cross-sectional study with a consecutive sample of 125 patients referred to an outpatient psychiatric clinic from February to December 2010. The Mini International Neuropsychiatric Interview (MINI) was used. Factors associated with more frequent mental disorders were estimated by odds ratios (OR) with 95% confidence intervals (95%CI) by multiple logistic regression. Seventy-six (60.8%) patients with HIV, 40 (32%) patients with Chagas disease, and nine (7.2%) patients with human T-lymphotropic virus were interviewed. The majority were women (64%), with up to 8 years of formal education (56%), and unemployed (81.6%). The median age was 49 years. Suicide risk (n=71) (56%), agoraphobia (n=65) (52%), major depressive episode (n=56) (44.8%), and alcohol/drug abuse (n=43) (34.4%) predominated, the latter being directly associated with lower family income (OR = 2.64; 95%CI 1.03-6.75) and HIV infection (OR = 5.24; 95%CI 1.56-17.61). Suicide risk was associated with non-white skin color (OR = 2.21; 95%CI 1.03-4.75), unemployment (OR = 2.72; 95%CI 1.01-7.34), and diagnosis of major depression (OR = 3.34; 95%CI 1.54-7.44). Measures targeting adverse socioeconomic conditions and psychiatric and psychological monitoring and care should be encouraged in this population, considering the association with abuse of alcohol/other psychoactive drugs and suicide risk.

Associations between the phosphatidylethanol (PEth) alcohol biomarker and self-reported alcohol use in a sample of HIV-infected outpatient drinkers in western Kenya

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Papas, Rebecca K.; Gakinya, Benson N.; Mwaniki, Michael M.; Keter, Alfred K.; Lee, Hana; Loxley, Michelle P.; Klein, Debra A.; Sidle, John E.; Martino, Steve; Baliddawa, Joyce B.; Schlaudt, Kathryn L.; Maisto, Stephen A.

2016-01-01

Background To counteract the syndemics of HIV and alcohol in sub-Saharan Africa, international collaborations have developed interventions to reduce alcohol consumption. Reliable and accurate methods are needed to estimate alcohol use outcomes. A direct alcohol biomarker called phosphatidylethanol (PEth) has been shown to validate heavy, daily drinking, but the literature indicates mixed results for moderate and non-daily drinkers, including among HIV-infected populations. This study examined the associations of the PEth biomarker with self-report alcohol use at 2 time points in 127 HIV-infected outpatient drinkers in western Kenya. Methods Participants were consecutively enrolled in a randomized clinical trial to test the efficacy of a behavioral intervention to reduce alcohol use in Eldoret, Kenya. They endorsed current alcohol use, and a minimum score of 3 on the Alcohol Use Disorders Identification Test-Consumption or consuming ≥ 6 drinks per occasion at least monthly in the past year. Study interviews and blood draws were conducted at baseline and at 3 months post-treatment from July 2012 through September 2013. Alcohol use was assessed using the Timeline Followback questionnaire. Blood samples were analyzed for presence of the PEth biomarker and were compared to self-reported alcohol use. We also conducted semi-structured interviews with 14 study completers in February through March 2014. Results Baseline data indicated an average of moderate-heavy alcohol use: 50% drinking days and a median of 4.5 drinks per drinking day. At baseline, 46% of women (31 of 67) and 8% of men (5 of 60) tested negative for PEth (p<.001). At the 3-month follow-up, 93% of women (25 of 27) and 97% of men (30 of 31) who reported drinking tested positive, while 70% of women (28 of 40) and 35% of men (10 of 29) who denied drinking tested negative for PEth. Interviews were consistent with self-reported alcohol use among 13 individuals with negative baseline results. Conclusions These

Coping mediates the effects of cognitive-behavioral therapy for alcohol use disorder among out-patient clients in Project MATCH when dependence severity is high.

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Roos, Corey R; Maisto, Stephen A; Witkiewitz, Katie

2017-09-01

There is inconsistent evidence that alcohol-specific coping is a mechanism of change in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). Our primary aim was to test whether baseline dependence severity moderates the mediational effect of CBT on drinking outcomes via coping. Secondary data analysis of Project MATCH , a multi-site alcohol treatment trial in which participants, recruited in out-patient and aftercare arms, were randomized to three treatments: CBT, motivational enhancement therapy (MET) and Twelve-Step facilitation (TSF). Nine research sites in the United States. A total of 1063 adults with AUD. The primary outcomes were percentage days abstinent and percentage heavy drinking days at the 1-year follow-up. Coping was assessed with the Processes of Change Questionnaire . Dependence severity was measured with the Alcohol Dependence Scale . Among the full available sample (across treatment arms), there were no significant moderated mediation effects. Double moderated mediation analyses indicated that several moderated mediation effects were moderated by treatment arm (all P cognitive-behavioral therapy for alcohol use disorder was conditional on dependence severity. End-of-treatment coping mediated the positive treatment effects of cognitive-behavioral therapy on 1-year drinking outcomes among out-patient clients when dependence severity was high, but not when dependence severity was low or moderate. © 2017 Society for the Study of Addiction.

Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders.

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Hammond, Christopher J; Niciu, Mark J; Drew, Shannon; Arias, Albert J

2015-04-01

Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence.

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Moraes, Edilaine; Campos, Geraldo M; Figlie, Neliana B; Laranjeira, Ronaldo; Ferraz, Marcos B

2010-01-01

The purpose of this study was to compare the cost-effectiveness of conventional outpatient treatment for alcoholic patients (CT) with this same conventional treatment plus home visits (HV), a new proposal for intervention within the Brazilian outpatient treatment system. A cost-effectiveness evaluation alongside a 12-week randomized clinical trial was performed. We identified the resources utilized by each intervention, as well as the cost according to National Health System (SUS), Brazilian Medical Association (AMB) tables of fees, and others based on 2005 data. The incremental cost-effectiveness ratio (ICER) was estimated as the main outcome measure - abstinent cases at the end of treatment. There were 51.8% abstinent cases for HV and 43.1% for CT, a clinically relevant finding. Other outcome measures, such as quality of life, also showed significant improvements that favored HV. The baseline scenario presented an ICER of USD 1,852. Sensitivity analysis showed an ICER of USD 689 (scenario favoring HV) and USD 2,334 (scenario favoring CT). The HV treatment was found to be cost-effective according to the WHO Commission on Macroeconomics and Health. 2009 S. Karger AG, Basel.

Prevalence of unrecognized depression and associated factors among patients attending medical outpatient department in Adare Hospital, Hawassa, Ethiopia

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Tilahune AB

2016-10-01

Full Text Available Asres Bedaso Tilahune,1 Gezahegn Bekele,1 Nibretie Mekonnen,2 Eyerusalem Tamiru2 1School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Department of Medical Case Team, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia Abstract: Depression is an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about him or herself and thinks about things. Depression is one of the most common mental disorders affecting 121 million people in the world, and it frequently goes unrecognized among patients. It is estimated that 5%–10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. An institution-based cross-sectional study design was implemented to determine the magnitude and associated factors of unrecognized depression among patients attending the adult medical outpatient department in Adare Hospital, Hawassa, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, among 326 patients selected using systematic random sampling technique. Data were collected using the interviewer-administered technique. A structured questionnaire was used to collect data on sociodemographic characteristics and other independent variables. Depression was assessed using the Patient Health Questionnaire 9. Data were entered and analyzed using SPSS 20. The level of significance was determined at P<0.05. About 326 patients were interviewed, of whom 186 (57.1% were males. The mean age of participant was 34 with standard deviation of ±13.1 years. Current substance users accounted for 106 (32.5% of the total participants. Of 326 respondents, 80 (24.5% had significant depressive symptoms, while the detection rate of depression by the clinician was 0%. Depression was associated with female sex (adjusted odds ratio [AOR] =1.63 [1.14–2.34], age >60 years (AOR =4

Suicide risk and alcohol and drug abuse in outpatients with HIV infection and Chagas disease

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Patrícia M. Guimarães

2014-05-01

Full Text Available Objective: To evaluate psychiatric comorbidities in outpatients receiving care for HIV and Chagas disease at Instituto de Pesquisa Clínica Evandro Chagas (IPEC, Fundação Oswaldo Cruz (Fiocruz, Rio de Janeiro, Brazil. Methods: Cross-sectional study with a consecutive sample of 125 patients referred to an outpatient psychiatric clinic from February to December 2010. The Mini International Neuropsychiatric Interview (MINI was used. Factors associated with more frequent mental disorders were estimated by odds ratios (OR with 95% confidence intervals (95%CI by multiple logistic regression. Results: Seventy-six (60.8% patients with HIV, 40 (32% patients with Chagas disease, and nine (7.2% patients with human T-lymphotropic virus were interviewed. The majority were women (64%, with up to 8 years of formal education (56%, and unemployed (81.6%. The median age was 49 years. Suicide risk (n=71 (56%, agoraphobia (n=65 (52%, major depressive episode (n=56 (44.8%, and alcohol/drug abuse (n=43 (34.4% predominated, the latter being directly associated with lower family income (OR = 2.64; 95%CI 1.03-6.75 and HIV infection (OR = 5.24; 95%CI 1.56-17.61. Suicide risk was associated with non-white skin color (OR = 2.21; 95%CI 1.03-4.75, unemployment (OR = 2.72; 95%CI 1.01-7.34, and diagnosis of major depression (OR = 3.34; 95%CI 1.54-7.44. Conclusion: Measures targeting adverse socioeconomic conditions and psychiatric and psychological monitoring and care should be encouraged in this population, considering the association with abuse of alcohol/other psychoactive drugs and suicide risk.

Pattern of attendance and predictors of default among Nigerian ...

African Journals Online (AJOL)

Objective: To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital. Method: This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured ...

Trends of HIV-1, HIV-2 and dual infection in women attending outpatient clinics in Senegal, 1990–2009

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Heitzinger, K; Sow, P S; Badiane, N M Dia; Gottlieb, G S; N’Doye, I; Toure, M; Kiviat, N B; Hawes, S E

2013-01-01

Summary We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal. PMID:23104745

A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS)

DEFF Research Database (Denmark)

Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete

2010-01-01

The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS).......The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS)....

A single mothers' group for mothers of children attending an outpatient psychiatric clinic: preliminary results.

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McNamee, J E; Lipman, E L; Hicks, F

1995-09-01

To provide a preliminary report of data from 2 support groups for single mothers, all of whom were mothers of children attending a child outpatient psychiatric clinic. The groups' 2 purposes were: 1. to assess the feasibility of adding structured evaluation to a common clinical intervention; 2. to improve single mothers' parenting skills through raised levels of self-esteem, increased capacity for family functioning and reduced levels of depression. Three structured evaluation instruments were used to measure the domains of self-esteem, family functioning and depression. These instruments were given to both groups of women on 3 occasions: 1. before the group; 2. after the group; 3. at a follow-up session 4 months after group termination. Open-ended questions were also asked at group termination. The questionnaire response rate was 100%; overall response rate for the 3 open-ended questions was 89%. Comparisons of pre-group and post-group scores showed that there was a significant increase in self-esteem (p parenting skills. Methodologic concerns and future directions are discussed.

Psychiatric comorbidity and plasma levels of 2-acyl-glycerols in outpatient treatment alcohol users. Analysis of gender differences.

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García Marchena, Nuria; Araos, Pedro; Pavón, Francisco Javier; Ponce, Guillermo; Pedraz, María; Serrano, Antonia; Arias, Francisco; Romero-Sanchiz, Pablo; Suárez, Juan; Pastor, Antoni; De la Torre, Rafael; Torrens, Marta; Rubio, Gabriel; Rodríguez de Fonseca, Fernando

2016-09-29

Alcohol addiction is associated with high psychiatric comorbidity. Objective stratification of patients is necessary to optimize care and improve prognosis. The present study is designed to gain insights into this challenge by addressing the following objectives: a) to estimate the prevalence of psychiatric comorbidities in a sample of outpatients seeking treatment for alcohol use disorder, b) to describe the existence of gender differences and c) to validate 2-acyl-glycerols as biomarkers of alcohol use disorder and/or psychiatric comorbidity. One hundred and sixty-two patients were recruited and evaluated with the semi-structured interview PRISM. The presence of psychopathology was associated with a greater number of criteria for alcohol abuse and dependence according to DSM-IV-TR. We found gender differences in psychiatric comorbidity, e.g., mood disorder, as well as in comorbid substance use disorders. The prevalence of lifetime psychiatric comorbidity was 68.5%, with mood disorders the most frequent (37%), followed by attention deficit disorder (24.7%) and anxiety disorders (17.9%). Substance-induced disorders were more frequent in mood and psychotic disorders, whereas the primary disorders were more prevalent in patients with comorbid anxiety disorders. We found that 2-acyl-glycerols were significantly decreased in comorbid anxiety disorders in alcohol dependent patients in the last year, which makes them a potential biomarker for this psychopathological condition.

Residentes em psiquiatria têm documentado problemas relacionados ao álcool em pacientes ambulatoriais? Do psychiatry residents document outpatients' alcohol problems?

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Clarissa Mendonça Corradi-Webster

2009-12-01

Full Text Available INTRODUÇÃO: O consumo de álcool por pacientes que fazem tratamento psiquiátrico pode trazer inúmeras consequências negativas. Os objetivos deste estudo foram identificar o uso problemático de álcool entre pacientes psiquiátricos ambulatoriais e verificar se esse consumo foi documentado nos prontuários por residentes de psiquiatria. MÉTODO: Estudo descritivo, transversal, realizado em serviço ambulatorial de clínica psiquiátrica de hospital universitário localizado em Ribeirão Preto (SP. Foi utilizada uma amostra de conveniência formada por pacientes psiquiátricos ambulatoriais (n = 127. A coleta de dados foi realizada por meio de entrevista (dados sociodemográficos e instrumento de rastreamento de abuso de álcool - CAGE e pela leitura de todas as anotações feitas por residentes de psiquiatria nos prontuários dos pacientes entrevistados (ficha para coleta de dados do prontuário. Para a análise dos dados, foram utilizados os pontos de corte > 1 e > 2 para o CAGE. RESULTADOS: Com CAGE > 1, 33,9% pontuaram positivo (n = 43 e, entre estes, 60,5% (n = 26 não tinham registros em seus prontuários sobre o uso de álcool (qui-quadrado = 20,12; p 2, 16,5% pontuaram positivo (n = 21 e, entre estes, 38,1% (n = 8 não tinham registros em seus prontuários referentes ao consumo de bebidas alcoólicas (qui-quadrado = 29,10; p INTRODUCTION: Consumption of alcohol by psychiatric patients can lead to many negative consequences. The objectives of this study were to identify the problematic use of alcohol in a group of psychiatric outpatients and to verify if this consumption was documented in their medical records by psychiatry medical residents. METHODS: Descriptive and cross-sectional study, carried out at the psychiatric outpatient clinic of a university hospital located in Ribeirão Preto, stat of São Paulo, Brazil. A convenience sample comprising 127 psychiatric outpatients was used. Data were collected using an interview

Nutritional intake and status in persons with alcohol dependency

DEFF Research Database (Denmark)

Wilkens Knudsen, Anne; Jensen, Jens-Erik Beck; Nordgaard-Lassen, Inge

2014-01-01

Malnutrition increases the risk of developing alcohol-related complications. The aim of this study was to describe nutrient intake, nutritional status and nutrition-related complications in a Danish population of outpatients with alcohol dependency.......Malnutrition increases the risk of developing alcohol-related complications. The aim of this study was to describe nutrient intake, nutritional status and nutrition-related complications in a Danish population of outpatients with alcohol dependency....

Influenza and other respiratory virus infections in outpatients with medically attended acute respiratory infection during the 2011-12 influenza season.

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Zimmerman, Richard K; Rinaldo, Charles R; Nowalk, Mary Patricia; Gk, Balasubramani; Thompson, Mark G; Moehling, Krissy K; Bullotta, Arlene; Wisniewski, Stephen

2014-07-01

Respiratory tract infections are a major cause of outpatient visits, yet only a portion is tested to determine the etiologic organism. Multiplex reverse transcriptase polymerase chain reaction (MRT-PCR) assays for detection of multiple viruses are being used increasingly in clinical settings. During January-April 2012, outpatients with acute respiratory illness (≤ 7 days) were tested for influenza using singleplex RT-PCR (SRT-PCR). A subset was assayed for 18 viruses using MRT-PCR to compare detection of influenza and examine the distribution of viruses and characteristics of patients using multinomial logistic regression. Among 662 participants (6 months-82 years), detection of influenza was similar between the MRT-PCR and SRT-PCR (κ = 0.83). No virus was identified in 267 (40.3%) samples. Commonly detected viruses were human rhinovirus (HRV, 15.4%), coronavirus (CoV, 10.4%), respiratory syncytial virus (RSV, 8.4%), human metapneumovirus (hMPV, 8.3%), and influenza (6%). Co-detections were infrequent (6.9%) and most commonly occurred among those infections (P = 0.008), nasal congestion was more frequent in CoV, HRV, hMPV, influenza and RSV infections (P = 0.001), and body mass index was higher among those with influenza (P = 0.036). Using MRT-PCR, a viral etiology was found in three-fifths of patients with medically attended outpatient visits for acute respiratory illness during the influenza season; co-detected viruses were infrequent. Symptoms varied by viral etiology. © 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Internet-based attentional bias modification training as add-on to regular treatment in alcohol and cannabis dependent outpatients: a study protocol of a randomized control trial.

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Heitmann, Janika; van Hemel-Ruiter, Madelon E; Vermeulen, Karin M; Ostafin, Brian D; MacLeod, Colin; Wiers, Reinout W; DeFuentes-Merillas, Laura; Fledderus, Martine; Markus, Wiebren; de Jong, Peter J

2017-05-23

The automatic tendency to attend to and focus on substance-related cues in the environment (attentional bias), has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, contribute to treatment outcome and the reduction of relapse rates. Based on some promising research findings, we designed a study to test the clinical relevance of ABM as an add-on component of regular intervention for alcohol and cannabis patients. The current protocol describes a study which will investigate the effectiveness and cost-effectiveness of a newly developed home-delivered, multi-session, internet-based ABM (iABM) intervention as an add-on to treatment as usual (TAU). TAU consists of cognitive behavioural therapy-based treatment according to the Dutch guidelines for the treatment of addiction. Participants (N = 213) will be outpatients from specialized addiction care institutions diagnosed with alcohol or cannabis dependency who will be randomly assigned to one of three conditions: TAU + iABM; TAU + placebo condition; TAU-only. Primary outcome measures are substance use, craving, and rates of relapse. Changes in attentional bias will be measured to investigate whether changes in primary outcome measures can be attributed to the modification of attentional bias. Indices of cost-effectiveness and secondary physical and psychological complaints (depression, anxiety, and stress) are assessed as secondary outcome measures. This randomized control trial will be the first to investigate whether a home-delivered, multi-session iABM intervention is (cost-) effective in reducing relapse rates in alcohol and cannabis dependency as an add-on to TAU, compared with an active and a waiting list control group. If proven effective, this ABM intervention could be easily implemented as a home-delivered component of current TAU. Netherlands Trial Register, NTR5497 , registered on 18th September 2015.

Screening of alcohol use disorders in psychiatric outpatients: influence of gender, age, and psychiatric diagnosis.

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Sánchez Autet, Mónica; Garriga, Marina; Zamora, Francisco Javier; González, Idilio; Usall, Judith; Tolosa, Leticia; Benítez, Concepción; Puertas, Raquel; Arranz, Belén

2017-07-14

Alcohol use disorders (AUD) are 2 times higher among psychiatric patients than in the general population. The under-recognition of this dual diagnosis can entail several negative outcomes. Early assessment with a screening tool like the CAGE questionnaire could be an opportunity to improve patients' prognoses. The objective of this study is to assess AUD risk in an outpatient psychiatric sample with a modified CAGE, considering the influence of age, gender and clinical psychiatric diagnosis. An observational, multicentric, descriptive study was carried out. The 4-item CAGE scale, camouflaged in a healthy lifestyle questionnaire, was implemented, using a cut-off point of one. 559 outpatients were assessed. 54% were female and the average age was 50.07 years. 182 patients presented a CAGE score ≥1 (45.1% of men and 21.9% of women). Gender was the strongest predictor of a positive result in CAGE, as men were 3.03 times more likely to score ≥1 on the CAGE questionnaire (p < .001, 95% CI: 0.22-0.49). Patients with bipolar and personality disorders had the highest rates of CAGE scores ≥1 (45.2 and 44.9%, respectively), with a significant association between diagnosis and a positive score (p = .002). Patients above 60 years were 2.5 times less likely to score ≥1 on the CAGE (p = .017, 95% CI: 0.19-0.85). Specific screening questionnaires, like the CAGE scale, can be an easy and useful tool in the assessment of AUD risk in psychiatric outpatients. Male patients with a bipolar or personality disorder present a higher risk of AUD.

The Profile and Urological Service Needs of Outpatients Attending a ...

African Journals Online (AJOL)

This study strives to and meets this important objective. Objective: To establish the epidemiology of outpatient urology patients and their service needs as seen in a tertiary centre in the Western region of Kenya. Design: Hospital based observational, descriptive, prospective, cross sectional study. Setting: The Urology ...

the profile and urological service needs of outpatients attending a ...

African Journals Online (AJOL)

A peek into the outpatient services would, therefore, give an insight into the common medical problems in a given discipline. (1). This study has similar demographic features to one done on inpatients in the same institution two years earlier and confirms the generally accepted knowledge that urology is a specialty dealing.

Telephone reminders reduced the non-attendance rate in a gastroenterology outpatient clinic

DEFF Research Database (Denmark)

Jeppesen, Maja Haunstrup; Ainsworth, Mark Andrew

2015-01-01

INTRODUCTION: Non-attendance is a global health-care problem. The aim of the present study was 1) to investigate if a telephone reminder could reduce the non-attendance rate, 2) to study reasons for non-attendance and 3) to evaluate if a permanent implementation would be economically advantageous......,705). Patients in the following three-month period were reminded by telephone one weekday in advance of their appointment, when possible (intervention group, n = 2,479). Non-attending patients in the intervention group received a questionnaire. Based on the results, a financial cost-benefit analysis was made...

Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use

Science.gov (United States)

Jiménez-Murcia, Susana; Del Pino-Gutiérrez, Amparo; Fernández-Aranda, Fernando; Granero, Roser; Hakänsson, Anders; Tárrega, Salomé; Valdepérez, Ana; Aymamí, Neus; Gómez-Peña, Mónica; Moragas, Laura; Baño, Marta; Sauvaget, Anne; Romeu, Maria; Steward, Trevor; Menchón, José M.

2016-01-01

Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program. Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each. Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes. Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment. PMID:27065113

Patrón de consumo de alcohol en pacientes captados en salas de urgencias Alcohol consumption patterns in patients attending emergency rooms

Directory of Open Access Journals (Sweden)

Jorge Luis López-Jiménez

1998-11-01

Full Text Available Objetivo. Describir los patrones de consumo de alcohol en personas de 15 años y más, captadas en los servicios de urgencias de ocho hospitales de la Ciudad de México. Material y métodos. La información se obtuvo mediante autorreportes. El levantamiento de los datos se realizó en cada hospital durante una semana completa, las 24 horas del día. Se incluyó a los pacientes que notificaron su consumo en los últimos doce meses. Resultados. De 2 523 individuos entrevistados, 63% informó haber consumido bebidas alcohólicas, entre las que destacan los destilados y la cerveza; 56.8% informó que, al menos una vez durante el último año, se había embriagado. En el patrón de consumo predomina la ingestión de baja frecuencia y alta cantidad (46.9%; sin embargo, se encontraron variaciones por sexo y edad principalmente, y se notificaron problemas asociados. Conclusiones. La descripción de patrones de consumo de alcohol en diferentes grupos poblacionales es relevante en el estudio de problemas personales, familiares y sociales asociados con la ingesta de alcohol.Objective. To describe the alcohol consumption patterns in patients of 15 or more years of age, attending the emergency room of 8 possible hospitals in Mexico City. Material and methods. The information was obtained by self-report. Data were raised at each hospital for one whole week, 24 hours per day. It includes patients who reported alcohol consumption during the 12 months previous to the survey. Results. Of the 2 523 interviewed subjects 63% had ingested alcoholic beverages, in particular, spirits and beer; 58% admitted having been drunk at least once in the past year. The predominating alcohol consumption pattern is low frequency and high quantity (46.9%; however, variations were found according to sex and age and associated problems are reported. Conclusions. The description of alcohol consumption patterns in different population groups is relevant in the study of personal, family

Ethical issues in a stage 1 cognitive-behavioral therapy feasibility study and trial to reduce alcohol use among HIV-infected outpatients in western Kenya.

Science.gov (United States)

Papas, Rebecca K; Gakinya, Benson N; Baliddawa, Joyce B; Martino, Steve; Bryant, Kendall J; Meslin, Eric M; Sidle, John E

2012-07-01

Epidemics of both HIV/AIDS and alcohol abuse in sub-Saharan Africa have spurred the conduct of local behavioral therapy trials for these problems, but the ethical issues involved in these trials have not been fully examined. In this paper, we discuss ethical issues that emerged during the conduct of a behavioral intervention adaptation and trial using cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. The study was performed within our multinational collaboration, the USAID-Academic Model Providing Access to Healthcare Partnership. We discuss relevant ethical considerations and how we addressed them.

Comparison of outpatient medically attended and community-level influenza-like illness-New York City, 2013-2015.

Science.gov (United States)

Russell, Kate E; Fowlkes, Ashley; Stockwell, Melissa S; Vargas, Celibell Y; Saiman, Lisa; Larson, Elaine L; LaRussa, Philip; Di Lonardo, Steve; Popowich, Michael; St George, Kirsten; Steffens, Andrea; Reed, Carrie

2018-05-01

Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.

Alcohol problems, mental disorder and mental health among suicide attempters 5-9 years after treatment by child and adolescent outpatient psychiatry.

Science.gov (United States)

Skarbø, Tove; Rosenvinge, Jan H; Holte, Arne

2006-01-01

Many studies report associations between alcohol problems, mental disorder, mental health and suicidal behaviour. Still, more knowledge is needed about possible differential characteristics of these factors in risk groups. This naturalistic and retrospective study included former patients who received emergency treatment in child and adolescent outpatient clinics for their mental health problems. One hundred patients were personally interviewed 5-9 years after treatment referral about alcohol problems and mental disorders. Also, they completed questionnaires about 11 indicators of mental health. At the follow-up, those who had attempted suicide during the follow-up period had more alcohol problems and mental disorders than the non-attempters. However, no association was found between suicide attempt in the follow-up period and the mental health indicators. Among the attempters, a high psychological burden as indicated by mental health disorders and poor mental health were associated with suicide re-attempt (lifetime) and an intention to die.

Socio-Demographic, Clinical and Behavioral Characteristics Associated with a History of Suicide Attempts among Psychiatric Outpatients: A Case Control Study in a Northern Mexican City.

Science.gov (United States)

Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Arnaud-Gil, Carlos Alberto; Hernández-Tinoco, Jesús; Molina-Espinoza, Luis Fernando; Rábago-Sánchez, Elizabeth

2014-03-01

Little is known about the epidemiology of suicide attempts among psychiatric outpatients in Mexico. This study was aimed to determine the socio-demographic, clinical and behavioral characteristics associated with suicide attempts in psychiatric outpatients in two public hospitals in Durango, Mexico. Two hundred seventy six psychiatric outpatients (154 suicide attempters and 122 patients without suicide attempt history) attended the two public hospitals in Durango City, Mexico were included in this study. Socio-demographic, clinical and behavioral characteristics were obtained retrospectively from all outpatients and compared in relation to the presence or absence of suicide attempt history. Increased prevalence of suicide attempts was associated with mental and behavioral disorders due to psychoactive substance use (F10-19) (P=0.01), schizophrenia, schizotypal and delusional disorders (F20-29) (P=0.02), mood (affective) disorders (F30-39) (Purban residence (OR=2.31, 95% CI: 1.17-4.57; P=0.01), memory impairment (OR=1.91, 95% CI: 1.07-3.40; P=0.02), alcohol consumption (OR=2.39, 95% CI: 1.21-4.70; P=0.01), and sexual promiscuity (OR=3.90, 95% CI: 1.74-8.77; PMexico. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients.

Cancer morbidity in alcohol abusers

DEFF Research Database (Denmark)

Tønnesen, H; Møller, Henrik; Andersen, J R

1994-01-01

Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared with th...... and the liver are confirmed. In addition, this study indicates an increased occurrence of cancer of the prostate gland, pleura and uterine cervix in alcohol abusers.......Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared...... with that of the total Danish population. On average the 15,214 men were observed for 12.9 years and the 3,093 women for 9.4 years. The overall morbidity of cancer was increased significantly. Of the men, 1,441 developed cancer [relative risk (RR) = 1.6; 95% confidence interval (CI) = 1.5-1.7], while 182 women did (RR...

Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients.

Science.gov (United States)

Ledgerwood, David M; Arfken, Cynthia L

2017-12-01

Most treatment for gambling disorder is provided on an outpatient basis. Only a small number of jurisdictions in North America provide higher levels of gambling treatment, such as residential or intensive outpatient (IOP) care, despite the potential need for these services. Further, there appear to be few guidelines for determining appropriate level of gambling treatment. The aim of the present study was to assess the appropriateness of higher levels of problem gambling care among clients receiving outpatient treatment. Problem gamblers and their therapists independently completed questionnaires that assessed the need and desire for residential and IOP treatment. About 42% of problem gambling outpatients noted that they would be "probably" or "definitely" willing to attend residential treatment, and about half indicated they would be equally likely to attend IOP. Therapists recommended about a third of their clients as appropriate for higher levels of care. For both client and therapist assessments, there was a significant association between desire or recommendation for level of treatment and severity of gambling and co-occurring problems. Further, therapist recommendations for level of care were significantly associated with client willingness to attend higher levels of treatment. Our data reveal the potential need for higher levels of care for problem gambling, as evaluated by clients and their therapists. Policy implications for the funding of residential and IOP treatment are discussed.

Examination of breath alcohol concentration (BrAC) levels, alcohol use disorders identification test (AUDIT-C) classification, and intended plans for getting home among bar-attending college students.

Science.gov (United States)

Martin, Ryan J; Chaney, Beth H; Cremeens-Matthews, Jennifer

2015-06-01

The college student population is one of the heaviest drinking demographic groups in the US and impaired driving is a serious alcohol-related problem. The objective of this study is to better understand the relationship between alcohol-related behaviors and "plans to get home" among a sample of college students. We conducted four anonymous field studies to examine associations between breath alcohol concentration (BrAC) levels, Alcohol Use Disorders Identification Test (AUDIT-C) classification, and plans for getting home among a sample of bar-attending college students (N = 713). The vast majority of participants in our sample (approximately 95%) were not intending to drive and the average BrAC% of those intending to drive was .041. Our one-way ANOVAs indicated that (1) participants classified by the AUDIT-C as not having an alcohol problem had a significantly lower BrAC% than those classified as having a potential problem and (2) participants planning to drive had a significantly lower BrAC% than those with a plan that did not involve them driving and those without a plan to get home. Although it is encouraging that most of our sample was not intending to drive, it is important to continue to attempt to reduce impaired driving in this population. This study helps college health professionals and administrators to better understand the relationship between alcohol-related behaviors and plans to get home among college students. © American Academy of Addiction Psychiatry.

Alcohol Consumption and Risky Sexual Behavior Among Persons Attending Alcohol Consumption Venues in Gaborone, Botswana.

Science.gov (United States)

Lama, Tsering Pema; Kumoji, E 'Kuor; Ketlogetswe, Ditsotlhe; Anderson, Marina; Brahmbhatt, Heena

2016-02-01

Alcohol use is a known key risk factor associated with risky sexual behavior that contributes to HIV transmission. This cross-sectional study used time location sampling to investigate alcohol use and risky sexual behaviors that occurred after ingesting alcohol among 609 patrons of alcohol venues in Gaborone, Botswana. Alcohol Use Disorders Identification Test (AUDIT) scores were categorized as low (1-7), medium (8-15), and high (16+) for analysis. Logistic regression models stratified by gender assessed the association between alcohol use and condom use at last sex after drinking alcohol. Among females, the odds of condom use during last sex after drinking alcohol were significantly lower for high compared to low AUDIT scores (AOR = 0.17, 95% CI 0.06-0.54). Among males, factors significantly associated with condom use at last sex after alcohol use were low levels of education (primary level compared to university and above AOR = 0.13; 95% CI 0.03-0.55) and beliefs that alcohol use did not increase risky sexual behaviors (AOR = 0.26; 95% CI 0.11-0.62). HIV prevention interventions should target females and emphasize sexual risks associated with alcohol use.

Alcohol and Other Drug Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa

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Petal Petersen Williams

2014-01-01

Full Text Available Little is known about the nature and extent of alcohol and other drug (AOD use among pregnant women in Cape Town, South Africa, despite the very high levels of AOD use in this part of the country. A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1% were intentionally subsampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Urinalyses showed that 8.8% (95% CI: 6.7–10.9 of the subsample tested positive for at least one illicit drug. This is higher than the self-reported prevalence (3.6%. In addition, 19.6% (95% CI: 16.3–22.8 of the sub-sample tested positive for alcohol which is lower than the self-reported prevalence (36.9%. There are high levels of substance use among pregnant women attending public sector antenatal clinics. There is a need for routine screening for AOD use and appropriate responses depending on the women’s level of risk.

Predictors of Alcohol Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa.

Science.gov (United States)

Petersen-Williams, Petal; Mathews, Catherine; Jordaan, Esmé; Parry, Charles D H

2017-12-08

Little is known about the nature and extent of substance use among pregnant women in Cape Town (South Africa) despite the very high levels of substance use and related consequences such as FASD in this part of the country. The aim of the study was to determine predictors of alcohol use among pregnant women. A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs) in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1%) were intentionally sub-sampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Univariate and multivariate statistical procedures were used to determine factors predictive of alcohol use. Findings highlight various demographic, social and partner substance use predictors for both self-reported and biologically verified alcohol use in two different models. Being Coloured, having a marital status other than being married, experiencing violence or aggression in the past 12 months compared to more than 12 months ago, having a partner who drinks, and partner drug use are all independently associated with higher odds of self-reported alcohol use. In contrast, only partner tobacco use is independently associated with higher odds of biologically verified alcohol use. Knowing the risk factors for alcohol use in pregnancy is important so that intervention efforts can accurately target those women in need of services. Intervention programs addressing risk factors of high-risk pregnant women are needed.

Financial impact of surgical training on hospital economics: an income analysis of 1184 out-patient clinic consultations.

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Fitzgerald, J E F; Ravindra, P; Lepore, M; Armstrong, A; Bhangu, A; Maxwell-Armstrong, C A

2013-01-01

In many countries healthcare commissioning bodies (state or insurance-based) reimburse hospitals for their activity. The costs associated with post-graduate clinical training as part of this are poorly understood. This study quantified the financial revenue generated by surgical trainees in the out-patient clinic setting. A retrospective analysis of surgical out-patient ambulatory care appointments under 6 full-time equivalent Consultants (Attendings) in one hospital over 2 months. Clinic attendance lists were generated from the Patient Access System. Appointments were categorised as: 'new', 'review' or 'procedure' as per the Department of Health Payment by Results (PbR) Outpatient Tariff (Outpatient Treatment Function Code 104; Outpatient Procedure Code OPRSI1). During the study period 78 clinics offered 1184 appointments; 133 of these were not attended (11.2%). Of those attended 1029 had sufficient detail for analysis (98%). 261 (25.4%) patients were seen by a trainee. Applying PbR reimbursement criteria to these gave a projected annual income of £GBP 218,712 (€EU 266,527; $USD 353,657) generated by 6 surgical trainees (Residents). This is equivalent to approximately £GBP 36,452 (€EU 44,415; $USD 58,943) per trainee annually compared to £GBP 48,732 (€EU 59,378; $USD 78,800) per Consultant. This projected yearly income off-set 95% of the trainee's basic salary. Surgical trainees generated a quarter of the out-patient clinic activity related income in this study, with each trainee producing three-quarters of that generated by a Consultant. This offers considerable commercial value to hospitals. Although this must offset productivity differences and overall running costs, training bodies should ensure hospitals offer an appropriate return. In a competitive market hospitals could be invited to compete for trainees, with preference given to those providing excellence in training. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights

Effectiveness of mobile-phone short message service (SMS reminders for ophthalmology outpatient appointments: Observational study

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Car Josip

2008-05-01

Full Text Available Abstract Background Non-attendance for hospital outpatient appointments is a significant problem in many countries. It causes suboptimal use of clinical and administrative staff and financial losses, as well as longer waiting times. The use of Short Message Service (SMS appointment reminders potentially offers a cost-effective and time-efficient strategy to decrease non-attendance and so improve the efficiency of outpatient healthcare delivery. Methods An SMS text message was sent to patients with scheduled appointments between April and September 2006 in a hospital ophthalmology department in London, reminding them of their appointments. This group acted as the intervention group. Controls were patients with scheduled ophthalmology appointments who did not receive an SMS or any alternative reminder. Results During the period of the study, 11.2% (50/447 of patients who received an SMS appointment reminder were non-attenders, compared to 18.1% (1720/9512 who did not receive an SMS reminder. Non-attendance rates were 38% lower in patients who received an SMS reminder than in patients who did not receive a reminder (RR of non-attendance = 0.62; 95% CI = 0.48 – 0.80. Conclusion The use of SMS reminders for ophthalmology outpatient appointments was associated with a reduction of 38% in the likelihood of patients not attending their appointments, compared to no appointment reminder. The use of SMS reminders may also be more cost-effective than traditional appointment reminders and require less labour. These findings should be confirmed with a more rigorous study design before a wider roll-out.

[Investigation of the frequency of alcohol related problems in Józsefváros, Budapest. Data and conclusions of three surveys conducted among doctors and outpatients].

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Kalapos, Miklós Péter

2012-08-12

The role of permanent alcohol consumption in the development of diseases is well-known. To study the occurrence of alcohol related problems among patients of a municipal pulmonology out-patient clinic as well as in the family practice of three physicians. In addition, a survey was performed among physicians of a municipal health service and also among family practitioners working in the same district by investigating health problems, habits and professional careers of physicians, and their addictive problems, their attitude toward addict patients and their opinion upon chemical dependency. CAGE-test was used to examine the presence of alcohol problem and a questionnaire was constructed for the study undertaken among physicians. The response rate was 60.18% and 32.98% among patients who visited the pulmonology out-patient clinic and their family physician, respectively. Among those who responded to the test, as many as 6.02% and 4.82% of the cases would need a further medical examination to make clear whether alcohol related health problem was present or not, whilst 9.77% and 11.67% of the patients proved to be alcohol dependent, respectively. The response rate in the survey among physicians was 41.28%. As stated, physicians not only screen the patients for alcohol and drug dependence, but also refer them to a specialist. The general experience seems to oppose this statement. The majority of health professionals considered chemical dependence as a chronic disease, whereas a kind of moral judgment of the problem was also seen, particularly among family physicians. If they had the opportunity to choose whom to treat: an alcoholic or a drug dependent patient, the majority of them would treat patients brought under the first category. The CAGE test revealed alcohol problem in three family physicians, but none in specialists. Nearly all physicians consumed coffee, but the majority of them were non-smokers. As the risk for committing suicide is higher among physicians

38 CFR 18.453 - Drug and alcohol addicts.

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2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Drug and alcohol addicts... Social Services § 18.453 Drug and alcohol addicts. A recipient that operates a general hospital or outpatient facility may not discriminate, with regard to a drug or alcohol abuser or alcoholic who is...

An audit of influenza and pneumococcal vaccination in rheumatology outpatients

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Mitchell William S

2007-07-01

Full Text Available Abstract Background Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients. Method We audited a sample of 101 patients attending hospital rheumatology outpatient clinics on any form of disease modifying treatment by clinical questionnaire and medical record perusal. Further data were collected from the local immunisation coordinating agency and analysed by logistic regression modelling. Results Although there was a high rate of awareness with regard to immunisation, fewer patients on major immunosuppressants were vaccinated than patients with additional clinical risk factors against influenza (53% vs 93%, p Conclusion Influenza and pneumococcal immunisation is suboptimal amongst patients on current immunosuppressant treatments attending rheumatology outpatient clinics. Raising awareness amongst patients may not be sufficient to improve vaccination rates and alternative strategies such as obligatory pneumococcal vaccination prior to treatment initiation and primary care provider education need to be explored.

Alcohol consumption among pregnant women attending the ante ...

African Journals Online (AJOL)

Background: As efforts to reduce maternal and childhood mortality rates continue to yield results in Nigeria, it is time to put more emphases on the health of children. Alcohol consumption is one of the few modifiable risk factors for poor pregnancy outcome. This study assessed the consumption of alcohol among pregnant ...

Determinants of frequent attendance in Danish general practice

DEFF Research Database (Denmark)

Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne

2016-01-01

. below recommended level), and hormone therapy in women (1.52; 1.42-1.63) were all significant determinants of frequent attendance. CONCLUSIONS: In addition to pre-existing medical conditions, gender, socio-demographic and gender-specific factors, lifestyle (obesity, smoking, exercise and alcohol use.......57-0.69, >4 years higher education vs. no vocational training) and employment (0.61; 0.57-0.65) were inversely associated with frequent attendance. Finally, obesity (1.54; 1.14-2.08), smoking (1.21; 1.12-1.30, current vs. never), physical activity (0.84; 0.80-89), alcohol consumption (0.83; 0.78-0.87 above vs...

A family history of Type 1 alcoholism differentiates alcohol consumption in high cortisol responders to stress.

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Brkic, Sejla; Söderpalm, Bo; Söderpalm Gordh, Anna

2015-03-01

The differentiation between high and low cortisol responders to stress is of interest in determining the risk factors which may, along with genetic vulnerability, influence alcohol intake. Thirty-two healthy volunteers, family history positive to alcoholism (FHP, n = 16) and family history negative (FHN, n = 16) attended two laboratory sessions during which alcohol or placebo was offered. There were no differences in consumption of alcohol or placebo between FHP and FHN subjects. STUDY 2: Fifty-eight healthy social drinkers, FHP (n = 27) and FHN (n = 31) attended two laboratory sessions. They were administered either alcohol or placebo in both sessions they attended. All subjects underwent either a stress task (the Trier Social Stress Test, TSST) or a stress-free period, at two separate occasions, before being offered beverage. After the salivary cortisol analysis, subjects in each group were divided into high (HCR) or low (LCR) cortisol responders. After stress, subjects who were FHP-HCR consumed more alcohol than FHN-HCR. There were no differences in the placebo intake between FHP and FHN subjects regardless of their cortisol response. This result indicates that stress promotes alcohol consumption only in subjects with a family history of Type 1 alcoholism who show an increase in cortisol response to stress. This behaviour is similar to that previously observed in alcohol dependent individuals after stress and thus could represent an endophenotype posing a risk for future development of alcohol use disorders. Copyright © 2015. Published by Elsevier Inc.

Drinking patterns and biochemical signs of alcoholic liver disease in Danish and Greenlandic patients with alcohol addiction

DEFF Research Database (Denmark)

Lavik, Berit; Holmegaard, Claes; Becker, Ulrik

2006-01-01

. This study was designed to document the prevalence of alcoholic liver diseases in Greenlanders with a high alcohol intake, and to describe and compare the populations of patients with alcohol addiction in Greenland and Denmark. STUDY DESIGN: Clinical cross-sectional study of patients attending alcohol...

43 CFR 17.251 - Drug and alcohol addicts.

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2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Drug and alcohol addicts. 17.251 Section... Drug and alcohol addicts. A recipient that operates a general hospital or outpatient facility may not discriminate in admission or treatment against a drug or alcohol abuser or addict who is suffering from a...

Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions.

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Chavez, Laura J; Williams, Emily C; Lapham, Gwen T; Rubinsky, Anna D; Kivlahan, Daniel R; Bradley, Katharine A

2016-05-01

Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP; 2007-2011) who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C ≥ 5) was estimated for each year. Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation.

22 CFR 142.63 - Drug and alcohol addicts.

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2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Drug and alcohol addicts. 142.63 Section 142.63... § 142.63 Drug and alcohol addicts. A recipient to which this subpart applies that operates a general hospital or outpatient facility may not discriminate in admission or treatment against a drug or alcohol...

Avaliação dos Tipos 1 e 2 de alcoolismo de Cloninger em homens participantes de um programa de tratamento ambulatorial Evaluation of Cloninger's Type I and Type II alcoholism in male alcoholics in an outpatient treatment program

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Mário Sérgio Ribeiro

2008-01-01

Full Text Available CONTEXTO: A classificação Tipo 1/Tipo 2 de Cloninger é uma das mais estudadas tipologias de alcoolismo. OBJETIVOS: Testar a aplicabilidade dessa tipologia, caracterizar os subtipos identificados e avaliar seu comportamento ante um programa terapêutico. MÉTODOS: Partindo das variáveis descritas por Cloninger et al., 16 características de 308 homens alcoolistas tratados ambulatorialmente foram submetidas à análise de cluster para identificação de dois subgrupos (clusters. Posteriormente, efetivaram-se cruzamentos de dados para testar possível associação dos clusters identificados com variáveis demográficas e clínicas. RESULTADOS: Pacientes do cluster 1 foram caracterizados por início mais tardio dos problemas relacionados ao álcool, menos problemas sociais e maior sentimento de culpa em relação a seu consumo. O cluster 2 incluiu pacientes com história familiar de alcoolismo mais evidente, características anti-sociais mais presentes, mais uso disfuncional de outras substâncias psicoativas e piores níveis de adesão ao tratamento. CONCLUSÕES: Os resultados evidenciaram a diferenciada associação dos clusters a variáveis de tratamento e prognóstico; em sua maior parte foram coerentes com a classificação Tipo 1/Tipo 2 e reforçam a tese de que o simples diagnóstico de dependência ao álcool não é suficiente para atender às necessidades terapêuticas de subgrupos específicos de pacientes.BACKGROUND: Cloninger's Type 1/Type 2 classification is one of the most frequently studied alcoholism typologies. OBJECTIVES: To test the applicability of this typology, to characterize the identified subtypes and to evaluate their behavior in a therapeutic program. METHODS: Starting from variables described by Cloninger et al., 16 characteristics of 308 alcoholic men attending an outpatient treatment program were submitted to Cluster analysis for identification of two subgroups (clusters. Cross-tabulations were then performed to

Viral and atypical bacterial infections in the outpatient pediatric cystic fibrosis clinic

DEFF Research Database (Denmark)

Olesen, Hanne Vebert; Nielsen, Lars P; Schiotz, Peter Oluf

2006-01-01

BACKGROUND: Respiratory viral and atypical bacterial infections are associated with pulmonary exacerbations and hospitalisations in cystic fibrosis patients. We wanted to study the impact of such infections on children attending the outpatient clinic. METHODS: Seventy-five children were followed...

76 FR 14980 - National Institute on Alcohol Abuse and Alcoholism; National Institute on Drug Abuse; Notice of...

Science.gov (United States)

2011-03-18

... Alcohol Abuse and Alcoholism; National Institute on Drug Abuse; Notice of Meeting Pursuant to section 10(a... meeting of the National Advisory Council on Alcohol Abuse and Alcoholism and the National Advisory Council on Drug Abuse. The meeting will be open to the public, with attendance limited to space available...

Psychiatric morbidity in elderly patients attending OPD of tertiary care centre in western region of Nepal

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Prakash Thapa

2014-01-01

Full Text Available Context: Aging of population is currently a global phenomenon. At least one in 5 people over the age of 65 years will suffer from a mental disorder by 2030. Study of psychiatric morbidities in this age group is essential to prepare for upcoming challenges. Aims: To find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. Settings and Design: Retrospective review; Psychiatric outpatient department of Manipal Teaching Hospital, Pokhara, Nepal. Materials and Methods: Data for patients ≥ 65 years of age attending the psychiatric outpatient department of Manipal Teaching Hospital, Pokhara, Nepal, from 1 st January 2012 to 15 th January 2013 were collected retrospectively in a predesigned proforma. Statistical Analysis Used: Risk of having different psychiatric disorders was estimated using odds ratio. Results: The mean age of 120 patients included in this study was 69.67 (SD = 5.94 years. Depressive disorder (26.7% was the most common diagnosis. There was no statistically significant difference in psychiatric disorders in >75 years compared with ≤75 years except for dementia [odd ratio (OR (≤75 years/>75 years=0.055, 95% confidence interval (CI=0.016; 0.194]. Alcohol dependence syndrome [OR (male/female=7.826, 95% CI = 1.699;36.705] and dementia [OR (male/female=3.394, 95% CI = 1.015;11.350] was more common in males. Conclusions: Depressive disorder was the most common psychiatric morbidity among the elderly patients. The odds suffering from dementia increased with increasing age. The odds of having alcohol related problems and dementia were more in males compared with females.

Characteristics of adults with anxiety or depression treated at an internet clinic: comparison with a national survey and an outpatient clinic.

Science.gov (United States)

Titov, Nickolai; Andrews, Gavin; Kemp, Alice; Robinson, Emma

2010-05-28

There is concern that people seeking treatment over the Internet for anxiety or depressive disorders may not resemble the general population or have less severe disorders than patients attending outpatient clinics or cases identified in community surveys. Thus the response to treatment in Internet based trials might not generalize. We reviewed the characteristics of applicants to an Australian Internet-based treatment clinic for anxiety and depression, and compared this sample with people from a national epidemiological survey and a sample of patients at a specialist outpatient anxiety and depression clinic. Participants included 774 volunteers to an Internet clinic, 454 patients at a specialist anxiety disorders outpatient clinic, and 627 cases identified in a national epidemiological survey. Main measures included demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale (K-10), the 12-item World Health Organisation Disability Assessment Schedule second edition (WHODAS-II), the Penn State Worry Questionnaire (PSWQ), the Body Sensations Questionnaire (BSQ), the Automatic Cognitions Questionnaire (ACQ), the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). The severity of symptoms of participants attending the two clinics was similar, and both clinic samples were more severe than cases in the epidemiological survey. The Internet clinic and national samples were older and comprised more females than those attending the outpatient clinic. The Internet clinic sample were more likely to be married than the other samples. The Internet clinic and outpatient clinic samples had higher levels of educational qualifications than the national sample, but employment status was similar across groups. The Internet clinic sample have disorders as severe as those attending an outpatient clinic, but with demographic characteristics more consistent with the national sample. These data indicate that the benefits of Internet

Characteristics of adults with anxiety or depression treated at an internet clinic: comparison with a national survey and an outpatient clinic.

Directory of Open Access Journals (Sweden)

Nickolai Titov

2010-05-01

Full Text Available There is concern that people seeking treatment over the Internet for anxiety or depressive disorders may not resemble the general population or have less severe disorders than patients attending outpatient clinics or cases identified in community surveys. Thus the response to treatment in Internet based trials might not generalize.We reviewed the characteristics of applicants to an Australian Internet-based treatment clinic for anxiety and depression, and compared this sample with people from a national epidemiological survey and a sample of patients at a specialist outpatient anxiety and depression clinic. Participants included 774 volunteers to an Internet clinic, 454 patients at a specialist anxiety disorders outpatient clinic, and 627 cases identified in a national epidemiological survey. Main measures included demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale (K-10, the 12-item World Health Organisation Disability Assessment Schedule second edition (WHODAS-II, the Penn State Worry Questionnaire (PSWQ, the Body Sensations Questionnaire (BSQ, the Automatic Cognitions Questionnaire (ACQ, the Social Interaction Anxiety Scale (SIAS and the Social Phobia Scale (SPS.The severity of symptoms of participants attending the two clinics was similar, and both clinic samples were more severe than cases in the epidemiological survey. The Internet clinic and national samples were older and comprised more females than those attending the outpatient clinic. The Internet clinic sample were more likely to be married than the other samples. The Internet clinic and outpatient clinic samples had higher levels of educational qualifications than the national sample, but employment status was similar across groups.The Internet clinic sample have disorders as severe as those attending an outpatient clinic, but with demographic characteristics more consistent with the national sample. These data indicate that the benefits

Social anxiety symptoms across diagnoses among outpatients attending a tertiary care mood and anxiety disorders service.

Science.gov (United States)

Graystone, H J; Garner, M J; Baldwin, D S

2009-04-01

Social phobia is a common, persistent and disabling anxiety disorder in which co-existing depressive symptoms are common. However the prevalence of social anxiety symptoms in patients with other mood and anxiety disorders is uncertain. In consecutive patients attending a tertiary referral mood and anxiety disorders service, depressive symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS) and social anxiety symptoms by the Liebowitz Social Anxiety Scale (LSAS). The Clinical Global Impression of Severity (CGI-S) was completed following the appointment. 75 patients (48 women, 27 men; mean age 45.9 years) completed the study. 38 had a single diagnosis and 37 co-morbid diagnoses: 15 patients had bipolar disorder, 35 unipolar depressive disorder, 19 an anxiety disorder, and 6 other disorders. Independent samples t-tests and one-way between-subjects ANOVA revealed that the severity of social anxiety symptoms but not depressive symptoms was significantly greater in patients with co-morbid diagnoses (LSAS 73.7 vs 54.2, t(72)=2.44, pdepression or bipolar disorder (respectively; LSAS 78.8 vs 59.4 vs 50.0, F(2, 65)=3.13, p=.05; MADRS 22.2 vs 19.8 vs 17.5, F(2, 66)depression (R(2)=0.376, pdepressive and social anxiety symptoms across a range of diagnoses. Depressive and social anxiety symptoms were most severe but least well correlated among tertiary care outpatients with anxiety disorders, emphasising the need for comprehensive evaluation and treatment.

76 FR 78015 - National Institute on Alcohol Abuse and Alcoholism; Notice of Meeting

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2011-12-15

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as... . (Catalogue of Federal Domestic Assistance Program Nos. 93.271, Alcohol Research Career Development Awards for...

76 FR 39406 - National Institute on Alcohol Abuse and Alcoholism; Notice of Meeting

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2011-07-06

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as.... (Catalogue of Federal Domestic Assistance Program Nos. 93.271, Alcohol Research Career Development Awards for...

77 FR 24726 - National Institute on Alcohol Abuse and Alcoholism; Notice of Meeting

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2012-04-25

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as... Assistance Program Nos. 93.273, Alcohol Research Programs; 93.701, ARRA Related Biomedical Research and...

77 FR 43604 - National Institute on Alcohol Abuse and Alcoholism; Notice of Meeting

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2012-07-25

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... and the discussions could disclose confidential trade secrets or commercial property such as.... (Catalogue of Federal Domestic Assistance Program Nos. 93.273, Alcohol Research Programs; 93.701, ARRA...

78 FR 45541 - National Institute on Alcohol Abuse and Alcoholism; Notice of Meeting

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2013-07-29

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as.... (Catalogue of Federal Domestic Assistance Program Nos. 93.273, Alcohol Research Programs, National Institutes...

Outpatient treatment of alcohol use disorders among subjects 60+ years: design of a randomized clinical trial conducted in three countries (Elderly Study).

Science.gov (United States)

Andersen, Kjeld; Bogenschutz, Michael P; Bühringer, Gerhard; Behrendt, Silke; Bilberg, Randi; Braun, Barbara; Ekstrøm, Claus Thorn; Forcehimes, Alyssa; Lizarraga, Christine; Moyers, Theresa B; Nielsen, Anette Søgaard

2015-11-14

The proportion of 60+ years with excessive alcohol intake varies in western countries between 6-16 % among men and 2-7 % among women. Specific events related to aging (e.g. loss of job, physical and mental capacity, or spouse) may contribute to onset or continuation of alcohol use disorders (AUD). We present the rationale and design of a multisite, multinational AUD treatment study for subjects aged 60+ years. 1,000 subjects seeking treatment for AUD according to DSM-5 in outpatient clinics in Denmark, Germany, and New Mexico (USA) are invited to participate in a RCT. Participants are randomly assigned to four sessions of Motivational Enhancement Treatment (MET) or to MET plus an add-on with eight sessions based on the Community Reinforcement Approach (CRA), which include a new module targeting specific problems of older adults. A series of assessment instruments is applied, including the Form-90, Alcohol Dependence Scale, Penn Alcohol Craving Scale, Brief Symptom Inventory and WHO Quality of Life. Enrolment will be completed by April 2016 and data collection by April 2017. The primary outcome is the proportion in each group who are abstinent or have a controlled use of alcohol six months after treatment initiation. Controlled use is defined as maximum blood alcohol content not exceeding 0.05 % during the last month. Total abstinence is a secondary outcome, together with quality of life andcompliance with treatment. The study will provide new knowledge about brief treatment of AUD for older subjects. As the treatment is manualized and applied in routine treatment facilities, barriers for implementation in the health care system are relatively low. Finally, as the study is being conducted in three different countries it will also provide significant insight into the possible interaction of service system differences and related patient characteristics in predictionof treatment outcome. Clinical Trials.gov NCT02084173 , March 7, 2014.

78 FR 20932 - National Institute on Alcohol Abuse and Alcoholism; Notice of Meeting

Science.gov (United States)

2013-04-08

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as... Assistance Program Nos. 93.273, Alcohol Research Programs, National Institutes of Health, HHS) Dated: April 2...

Exercise as adjunctive treatment for alcohol use disorder

DEFF Research Database (Denmark)

Roessler, Kirsten K.; Bilberg, Randi; Søgaard Nielsen, Anette

2017-01-01

AIMS: To examine whether physical activity as an adjunct to outpatient alcohol treatment has an effect on alcohol consumption following participation in an exercise intervention of six months' duration, and at 12 months after treatment initiation. METHODS: The study is a randomized controlled stu...... was protective against excessive drinking following treatment. A dose-response effect of exercise on drinking outcome supports the need for implementing physically active lifestyles for patients in treatment for alcohol use disorder.......AIMS: To examine whether physical activity as an adjunct to outpatient alcohol treatment has an effect on alcohol consumption following participation in an exercise intervention of six months' duration, and at 12 months after treatment initiation. METHODS: The study is a randomized controlled study...... regression model was used to evaluate the odds of excessive drinking among the three groups, based on intention-to-treat. Changes in level of physical activity in all three groups were tested by using a generalized linear mixed model. A multiple linear model was used to test if there was an association...

A virtual outpatient department provides a satisfactory patient experience following endoscopy.

Science.gov (United States)

Ryan, Elizabeth M; Rogers, Ailín C; Hanly, Ann M; McCawley, Niamh; Deasy, Joseph; McNamara, Deborah A

2014-03-01

The purpose of this study was to investigate telephone follow-up of post-endoscopy patients as an alternative to attendance at the outpatient department. Access to outpatient appointments is often a target for improvement in healthcare systems. Increased outpatient clinic capacity is not feasible without investment and extra manpower in an already constrained service. Outpatient attendance was audited at a busy colorectal surgical service. A subset of patients appropriate for follow-up in a "virtual outpatient department" (VOPD) were identified. A pilot study was designed and involved telephone follow-up of low-risk endoscopic procedures. Patient satisfaction was assessed using the Medical Interview Satisfaction Scale (MISS), which is a standardised survey of patient satisfaction with healthcare experiences. This was conducted via anonymous questionnaire at the end of the study. Of a total of 166 patients undergoing endoscopy in the time period, 79 were prospectively recruited to VOPD follow-up based on eligibility criteria. Overall, 67 (84.8 %) were successfully followed up by telephone consultation; nine patients (11.4 %) were contacted by mail. The remaining three patients (3.8 %) were brought back to the OPD. Patients recruited were more likely to be younger (55.82 ± 14.96 versus 60.78 ± 13.97 years, P = 0.029) and to have had normal examinations (49.4 versus 31.0 %, χ (2) = 5.070, P = 0.025). Nearly three quarters of patients responded to the questionnaire. The mean scores for all four aspects of the MISS were satisfactory, and overall patients were satisfied with the VOPD experience. VOPD is a target for improved healthcare provision, with improved efficiency and a high patient satisfaction rate.

Validation of the French version of the alcohol, smoking and substance involvement screening test (ASSIST in the elderly

Directory of Open Access Journals (Sweden)

Khan Riaz

2012-06-01

Full Text Available Abstract Background Substance use disorders seem to be an under considered health problem amongst the elderly. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST, was developed by the World Health Organization to detect substance use disorders. The present study evaluates the psychometric properties of the French version of ASSIST in a sample of elderly people attending geriatric outpatient facilities (primary care or psychiatric facilities. Methods One hundred persons older than 65 years were recruited from clients attending a geriatric policlinic day care centre and from geriatric psychiatric facilities. Measures included ASSIST, Addiction Severity Index (ASI, Mini-International Neuropsychiatric Interview (MINI-Plus, Alcohol Use Disorders Identification Test (AUDIT, Revised Fagerstrom Tolerance Questionnaire-Smoking (RTQ and MiniMental State(MMS. Results Concurrent validity was established with significant correlations between ASSIST scores, scores from ASI, AUDIT, RTQ, and significantly higher ASSIST scores for patients with a MINI-Plus diagnosis of abuse or dependence. The ASSIST questionnaire was found to have high internal consistency for the total substance involvement along with specific substance involvement as assessed by Cronbach’s α, ranging from 0.66, to 0.89 . Conclusions The findings demonstrate that ASSIST is a valid screening test for identifying substance use disorders in elderly.

75 FR 80511 - National Institute on Alcohol Abuse And Alcoholism; Notice of Closed Meeting

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2010-12-22

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as... Domestic Assistance Program Nos.: 93.271, Alcohol Research Career Development Awards for Scientists and...

75 FR 47819 - National Institute on Alcohol Abuse and Alcoholism; Notice of Closed Meeting

Science.gov (United States)

2010-08-09

... attendance limited to space available. Individuals who plan to attend and need special assistance, such as... applications and the discussions could disclose confidential trade secrets or commercial property such as... Domestic Assistance Program Nos.: 93.271, Alcohol Research Career Development Awards for Scientists and...

A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic

International Nuclear Information System (INIS)

Chow, Edward; Fung, KinWah; Panzarella, Tony; Bezjak, Andrea; Danjoux, Cyril; Tannock, Ian

2002-01-01

Purpose: To develop a predictive model for survival from the time of presentation in an outpatient palliative radiotherapy clinic. Methods and Materials: Sixteen factors were analyzed prospectively in 395 patients seen in a dedicated palliative radiotherapy clinic in a large tertiary cancer center using Cox's proportional hazards regression model. Results: Six prognostic factors had a statistically significant impact on survival, as follows: primary cancer site, site of metastases, Karnofsky performance score (KPS), and fatigue, appetite, and shortness of breath scores from the modified Edmonton Symptom Assessment Scale. Risk group stratification was performed (1) by assigning weights to the prognostic factors based on their levels of significance, and (2) by the number of risk factors present. The weighting method provided a Survival Prediction Score (SPS), ranging from 0 to 32. The survival probability at 3, 6, and 12 months was 83%, 70%, and 51%, respectively, for patients with SPS ≤13 (n=133); 67%, 41%, and 20% for patients with SPS 14-19 (n=129); and 36%, 18%, and 4% for patients with SPS ≥20 (n=133) (p<0.0001). Corresponding survival probabilities based on number of risk factors were as follows: 85%, 72%, and 52% (≤3 risk factors) (n=98); 68%, 47%, and 24% (4 risk factors) (n=117); and 46%, 24%, and 11% (≥5 factors) (n=180) (p<0.0001). Conclusion: Clinical prognostic factors can be used to predict prognosis among patients attending a palliative radiotherapy clinic. If validated in an independent series of patients, the model can be used to guide clinical decisions, plan supportive services, and allocate resource use

Retention predictors related to intensive outpatient programs for substance use disorders.

Science.gov (United States)

Veach, L J; Remley, T P; Kippers, S M; Sorg, J D

2000-08-01

The purpose of this research was to expand knowledge in the current literature regarding treatment retention in intensive outpatient substance abuse treatment programs. The sample in this study participated in a hospital-based program accredited by the Joint Commission on Accreditation for Health Organizations (JCAHO) that utilized the Minnesota model. Specifically, this inquiry investigated whether treatment retention would be predicted by gender, age, employment status, number of problems on the treatment plan, whether the referral was related to driving while intoxicated (DWI), marital status, race, and whether each of the following substance problems was listed as the client's primary DSM-IV diagnosis: alcohol dependence, cocaine dependence, polysubstance dependence, opioid dependence, sedative/hypnotic dependence, cannabis dependence, other (or unknown) dependence, alcohol abuse, cannabis abuse, amphetamine abuse, and caffeine intoxication. Findings indicated that those retained in treatment, when compared to those who dropped out, had significantly more problems on their treatment plans, were more likely to be alcoholics, were less often cocaine addicts, and were more likely to be employed. The results of this study suggest that clients with this profile have increased likelihood of being retained in intensive outpatient substance abuse treatment programs.

Do young people attending addiction services differ from those attending youth mental health services?

Science.gov (United States)

Christie, Grant; Merry, Sally; Robinson, Elizabeth

2010-07-01

We aimed to describe and compare the self-reported substance use, psychopathology and psychosocial morbidity in adolescents attending two adolescent outpatient services, a triage-based mental health service and an engagement-focused addiction service in Auckland, New Zealand. A naturalistic cross-section of 131 (addiction service = 67, mental health service = 64) 14-18-year-old boys and girls attending each service completed a standardised screening and assessment instrument, the Drug Use Screening Inventory-Revised. The Drug Use Screening Inventory-Revised measures self-reported problems across 10 domains of functioning, including substance use, behaviour, psychiatric symptoms and school and family functioning. Descriptive statistics were used to provide an overview of the self-reported morbidity in each group and t-tests were used to determine differences between the two groups. Adolescents attending the addiction service reported significantly more problems with substance use, school performance and peer relationships than those attending the mental health service. There was no significant difference in reported psychiatric symptoms, behavioural problems, social competency, health problems, family problems, difficulties in work functioning or leisure time between the two groups. Young people presenting to engagement-focused substance use services report similar difficulties to those at mental health services across most areas of psychosocial functioning. Addiction services may require equivalent staffing expertise and workforce development to that in mental health to effectively meet young people's needs.

Alcohol Consumption among Urban, Suburban, and Rural Veterans Affairs Outpatients

Science.gov (United States)

Williams, Emily C.; McFarland, Lynne V.; Nelson, Karin M.

2012-01-01

Purpose: United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care-based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol…

quality of glycaemic control in ambulatory diabetics at the out-patient

African Journals Online (AJOL)

hi-tech

2003-08-08

Aug 8, 2003 ... Conclusion: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin ...

Substance use problems reported by historically Black college students: combined marijuana and alcohol use versus alcohol alone.

Science.gov (United States)

Rhodes, Warren A; Peters, Ronald J; Perrino, Carrol S; Bryant, Sharronne

2008-06-01

Using secondary data analysis,this study compares alcohol and other drug (AOD) problems experienced by African-American students attending a historically Black university who use alcohol only versus those who use alcohol plus marijuana. Results indicate that students who used marijuana plus alcohol experienced more AOD problems than their counterparts who used alcohol only. The current findings are similar to previous research with a majority White college student population.

Alcohol use disorder and associated factors among human immunodeficiency virus infected patients attending antiretroviral therapy clinic at Bishoftu General Hospital, Oromiya region, Ethiopia.

Science.gov (United States)

Bultum, Jemal Abdella; Yigzaw, Niguse; Demeke, Wubit; Alemayehu, Mekuriaw

2018-01-01

Alcohol consumption among patients with HIV/AIDS increases the burden of the disease. HIV/AIDS is an epidemic among Sub-Saharan African countries. Excessive use of alcohol causes a large degree of health problems, social and economic burden in societies. However, the prevalence and associated factors of alcohol use disorder among this group of people has not been studied very well. Therefore, this study sought to assess the magnitude and associated factors of alcohol use disorder among HIV patients attending the antiretroviral (ART) clinic. A hospital based cross sectional study design was conducted at Bishoftu General Hospital from May to June 2015. Systematic random sampling technique was used to select the study participants. Data was collected by face to face interview and chart review. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol use disorder. Bivariate and multivariate logistic regression analysis was carried out to identify associated factors and P-value < 0.05 was taken as statistically significant. A total of 527 participants were enrolled in the study with a response rate of 100%. The prevalence of alcohol use disorder (AUD) was 14.2%. Factors associated with alcohol use disorder were educational status AOR = 8.5 (95%CI: 1.70, 42.99), social support AOR = 0.5(95%CI: 0.26, 0.95), cigarette smoking AOR = 3.49(95%CI: 1.01, 12.13), khat chewing AOR = 5.11 (95% CI: 1.60, 16.33), family history of alcohol use AOR = 3.58 (95% CI: 1.52, 8.47), and missing ART drugs AOR 3.05 (95% CI: 1.302, 7.131). The prevalence of alcohol use disorder was high as compared to similar epidemiological studies. Educational status, social support, cigarette smoking, khat chewing, and family history of alcohol use were independent predictors. Providing health education about alcohol use and proper screening of alcohol use disorder among patients with HIV/AIDS is crucial. Strengthening the referral linkage with the psychiatric unit will decrease the

Prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Directory of Open Access Journals (Sweden)

Waja T

2016-11-01

Full Text Available Tsegereda Waja,1 Jemal Ebrahim,2 Zegeye Yohannis,1 Asres Bedaso2 1Department of Psychiatry, Amanuel Mental Specialized Hospital, Addis Ababa, 2School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia Introduction: Alcohol use disorders represent one of the leading causes of preventable death, illness, and injury in many societies throughout the world. Heavy alcohol consumption has multiple negative consequences for people with epilepsy such as precipitation of seizure, exacerbation of seizure, poor seizure control, increased side effects of antiepileptic drugs, noncompliance to antiepileptic drugs, alcohol withdrawal seizures, long-term hospital admission, status epilepticus, sudden unexpected death, and premature mortality. Methods: An institution-based cross sectional study was conducted from April 15, 2014 to May 15, 2014 with the aim of assessing prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. A total of 413 randomly selected epileptic patients were included in this study. Data were structured using the 10-item Alcohol Use Disorders Identification questionnaire. Data were analyzed using SPSS Version 20. Bivariate and multivariate logistic regression analyses were performed to study the association, and variables with P-value <0.05 were considered as having a statistically significant association at 95% confidence interval. Results: A total of 423 study participants were selected, of whom 413 completely filled the questionnaire making the response rate 97.6%. The mean age of the respondents was 31.9 years with standard deviation of ±10.97, and 248 (60% were males. The prevalence of alcohol use disorder was 17.4%. Educational status (grade 9–12 (adjusted odds ratio [AOR] =3.25, [1.21, 8.69], not living with family members (AOR =1.89, [1.06, 3.39], availability of house (AOR

MotivATE: A Pretreatment Web-Based Program to Improve Attendance at UK Outpatient Services Among Adults With Eating Disorders.

Science.gov (United States)

Muir, Sarah; Newell, Ciarán; Griffiths, Jess; Walker, Kathy; Hooper, Holly; Thomas, Sarah; Thomas, Peter W; Arcelus, Jon; Day, James; Appleton, Katherine M

2017-07-26

In the UK, eating disorders affect upward of 725,000 people per year, and early assessment and treatment are important for patient outcomes. Around a third of adult outpatients in the UK who are referred to specialist eating disorder services do not attend, which could be related to patient factors related to ambivalence, fear, and a lack of confidence about change. This lack of engagement has a negative impact on the quality of life of patients and has implications for service costs. To describe the development of a Web-based program ("MotivATE") designed for delivery at the point of referral to an eating disorder service, with the aim of increasing service attendance. We used intervention mapping and a person-based approach to design the MotivATE program and conducted a needs assessment to determine the current impact of service nonattendance on patients (via a review of the qualitative evidence) and services (through a service provision survey to understand current issues in UK services). Following the needs assessment, we followed the five steps of program development outlined by Bartholomew et al (1998): (1) creating a matrix of proximal program objectives; (2) selecting theory-based intervention methods and strategies; (3) designing and organizing the program; (4) specifying adoption and implementation plans; and (5) generating program evaluation plans. The needs assessment identified current nonattendance rates of 10%-32%. We defined the objective of MotivATE as increasing attendance rates at an eating disorder service and considered four key determinants of poor attendance: patient ambivalence about change, low patient self-efficacy, recognition of the need to change, and expectations about assessment. We chose aspects of motivational interviewing, self-determination theory, and the use of patient stories as the most appropriate ways to enable change. Think-aloud piloting with people with lived experience of an eating disorder resulted in positive feedback

The prevalence of underweight is increased in chronic pancreatitis outpatients and associates with reduced life quality.

Science.gov (United States)

Olesen, Søren S; Frandsen, Louise Kuhlman; Poulsen, Jakob Lykke; Vestergaard, Peter; Rasmussen, Henrik Højgaard; Drewes, Asbjørn M

Underweight is a well-known complication of chronic pancreatitis (CP), but little is known about its prevalence in the outpatient setting. We investigated the prevalence of underweight in outpatients with CP and its association with quality of life (QOL) and various risk factors. This was a cross-sectional study of 166 outpatients with CP that was conducted at a tertiary referral center. The primary outcome was the prevalence of underweight (body mass index [BMI] pancreatic insufficiency (EPI), pain severity, pain pattern (constant versus intermittent), opioid use, and smoking and drinking habits were analyzed for their association with BMI. Patients with CP had a decreased mean BMI compared with controls (22.9 ± 4.2 kg/m 2 versus 26.8 ± 5.2 kg/m 2 ; P associated with underweight, including physical functioning (P = 0.024). Alcoholic etiology (P = 0.002), EPI (P = 0.004), and constant pain (P = 0.026) were independently associated with low BMI. One quarter of outpatients with CP are underweight and report reduced life quality compared with their normal-weight counterparts. EPI, alcoholic etiology, and pain-related symptoms are independent risk factors. Our findings emphasize the need for a multidisciplinary approach in the handling of patients with CP that focuses on alcohol cessation and the appropriate treatment of pain and EPI. Copyright © 2017 Elsevier Inc. All rights reserved.

Drugs, alcohol and sexual health: opportunities to influence risk behaviour

Directory of Open Access Journals (Sweden)

Keaney Francis

2008-06-01

Full Text Available Abstract Background Alcohol and drug consumption can affect judgment and may contribute towards an increased likelihood of engaging in risky sexual behaviour. In this cross sectional survey of clients attending STI services levels of drug and alcohol use were assessed using two standardised drug and alcohol screening instruments (the PAT and the SDS. Findings The rates of hazardous alcohol consumption were similar to those found among patients attending A&E departments. Approximately 15% of clients indicated possible dependence on alcohol or other drugs, and these clients were likely to cite their substance use as related to their attendance, and to accept the offer of help or advice. Conclusion The use of brief screening instruments as part of routine clinical practice is recommended. The STI clinic is well placed to identify substance use and to offer advice and/or onward referral to specialist services.

Study of H. pylori infection in children with recurrent abdominal pain attending the pediatrics outpatient clinic of Zagazig University Hospitals.

Science.gov (United States)

Badr, M A; El-Saadany, Hosam F; Ali, Adel S A; Abdelrahman, D

2012-12-01

This study assessed the prevalence of H. pylori infection in children with recurrent abdominal pain attending the Outpatient Pediatric Clinic of Zagazig University Hospitals. The study was conducted on 100 children suffering from different GIT symptoms mainly recurrent abdominal pain, they were categorized into 3 categories according to their ages. First category below 5 years, second category between 5 and 10 years and last category above 10 years. All subjects underwent full history taking, clinical examination and laboratory investigations. Protozoa infection was in 29% of patients, helminthes 10%, chronic constipation 4% and UTI 4%. The patients with apparent etiology were excluded. The data do not support the hypothesis that there is a direct role for H. pylori infection as a causative agent for Recurrent Abdominal Pain (RAP) in children. The mean +/- SD of age of patients were 5.7 +/- 3.7, with range of 1:18 years. Male to female ratio was 1:1.1. H. pylori serum IgG antibodies were in 26 patients (43.3%) and 24 controls (p = 0.71), and H. pylori stool Ag in stool of 22 cases and 20 controls (p = 0.7).

Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.

Science.gov (United States)

Williams, E R; Guthrie, E; Mackway-Jones, K; James, M; Tomenson, B; Eastham, J; McNally, D

2001-03-01

Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.

Cancer morbidity in alcohol abusers

DEFF Research Database (Denmark)

Tønnesen, H; Møller, Henrik; Andersen, J R

1994-01-01

Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared...... colonic (RR = 1.0; 95% CI 0.8-1.3) or rectal cancer (RR = 1.0; CI 0.7-1.3) than expected. The risk of breast cancer in women was slightly increased (RR = 1.3; 95% CI 0.9-1.7), but not statistically significant. Thus, the associations between alcohol and cancer of the upper digestive and respiratory tract...... and the liver are confirmed. In addition, this study indicates an increased occurrence of cancer of the prostate gland, pleura and uterine cervix in alcohol abusers....

Validation and results of a questionnaire for functional bowel disease in out-patients

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Skordilis Panagiotis

2002-05-01

Full Text Available Abstract Background The aim was to evaluate and validate a bowel disease questionnaire in patients attending an out-patient gastroenterology clinic in Greece. Methods This was a prospective study. Diagnosis was based on detailed clinical and laboratory evaluation. The questionnaire was tested on a pilot group of patients. Interviewer-administration technique was used. One-hundred-and-forty consecutive patients attending the out-patient clinic for the first time and fifty healthy controls selected randomly participated in the study. Reliability (kappa statistics and validity of the questionnaire were tested. We used logistic regression models and binary recursive partitioning for assessing distinguishing ability among irritable bowel syndrome (IBS, functional dyspepsia and organic disease patients. Results Mean time for questionnaire completion was 18 min. In test-retest procedure a good agreement was obtained (kappa statistics 0.82. There were 55 patients diagnosed as having IBS, 18 with functional dyspepsia (Rome I criteria, 38 with organic disease. Location of pain was a significant distinguishing factor, patients with functional dyspepsia having no lower abdominal pain (p Conclusions This questionnaire for functional bowel disease is a valid and reliable instrument that can distinguish satisfactorily between organic and functional disease in an out-patient setting.

Comparison of student learning in the out-patient clinic and ward round.

Science.gov (United States)

Davis, M H; Dent, J A

1994-05-01

In undergraduate medical education there is a trend away from ward-based teaching towards out-patient and community-based teaching. To study the potential effects of this altered emphasis on student learning, a pilot group of final-year medical students at the University of Dundee was asked to keep individual structured log-books. These contained details of patients seen during their 3-week orthopaedic attachment in both a ward and out-patient setting. A comparison of perceived learning in the two settings showed that students learned more from attending an out-patient clinic than a ward round, but did not make full use of the learning potential of either. The setting did not particularly influence the balance of learning as categorized here but only the ward round supplied experience of surgical complications. The amount of learning taking place in an out-patient clinic was influenced by student ability, measured by examination performance, but not by clinic work-load. The implications of increased use of out-patient clinics and the advantages and disadvantages of the approach employed are discussed. It is concluded that in the situation studied student learning in the outpatient setting is as good as or superior to the ward setting but should not totally replace it.

Recurring alcohol-related care between 1998 and 2007 among people treated for an alcohol-related disorder in 1997: A register study in Stockholm County

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Kåreholt Ingemar

2011-07-01

Full Text Available Abstract Background Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care. Method All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n = 2735. Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication. Results Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care. Conclusions While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree.

Outpatient treatment of alcohol use disorders among subjects 60+ years

DEFF Research Database (Denmark)

Andersen, Kjeld; Bogenschutz, Michael P; Bühringer, Gerhard

2015-01-01

BACKGROUND: The proportion of 60+ years with excessive alcohol intake varies in western countries between 6-16 % among men and 2-7 % among women. Specific events related to aging (e.g. loss of job, physical and mental capacity, or spouse) may contribute to onset or continuation of alcohol use...... into the possible interaction of service system differences and related patient characteristics in predictionof treatment outcome. TRIAL REGISTRATION: Clinical Trials.gov NCT02084173 , March 7, 2014....

[A cross-sectional survey on personality disorder in mental disorder outpatients in Shanghai].

Science.gov (United States)

Zhang, Tian-Hong; Xiao, Ze-Ping; Wang, Lan-Lan; Dai, Yun-Fei; Zhang, Hai-Yin; Qiu, Jian-Yin; Tao, Ming-Yi; Wang, Zhen; Wang, Xiao; Yu, Jun-Han; Wu, Yan-Ru; Jiang, Wen-Hui

2010-08-01

To study the prevalence and risk factors for personality disorder (PD) outpatients attending in for psychiatric and psychological counseling in Shanghai. 3075 subjects were sampled by systematic sampling method from outpatients in psycho-counseling clinics and psychiatric clinics in Shanghai Mental Health Center. Based on DSM-IV criteria, personality disorders were assessed by both questionnaires (personality diagnostic questionnaire, PDQ-4+) and interviews (structured clinical interview for DSM-IV Axis II, SCID-II). Logistic regression analysis was performed to determine the significant independent contributor to PD. 71.3% of the outpatients were found having pathological personality by using questionnaire of self rating PD scale. 982 outpatients (31.9%) met criteria for at least one personality disorder by using structured clinical interview. Younger age (OR = 1.8, 95%CI: 1.5 - 2.1), single or divorced (OR = 1.6, 95%CI: 1.4 - 1.9), psychological counseling outpatients (OR = 1.2, 95%CI: 1.1 - 1.3), mood and outpatients with neurosis disorders (OR = 1.7, 95%CI: 1.4 - 2.0) were more frequently assigned as personality disorders. Data from logistic regression analysis showed that patients of tender age, not nurtured and raised by their parents, with introvert characters were related risk factors of PD. High prevalence rate of PD was found in this sample of Chinese outpatients, especially in those psychological counseling outpatients with mood or neurosis disorders. More attention should be paid to the recognition and intervention of PD in outpatients with mental disorders.

An audit of influenza and pneumococcal vaccination in rheumatology outpatients.

Science.gov (United States)

Sowden, Evin; Mitchell, William S

2007-07-04

Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients. We audited a sample of 101 patients attending hospital rheumatology outpatient clinics on any form of disease modifying treatment by clinical questionnaire and medical record perusal. Further data were collected from the local immunisation coordinating agency and analysed by logistic regression modelling. Although there was a high rate of awareness with regard to immunisation, fewer patients on major immunosuppressants were vaccinated than patients with additional clinical risk factors against influenza (53% vs 93%, p risk factors was confirmed as significant in determining vaccination status by logistic regression for both influenza (OR 10.89, p < 0.001) and streptococcus pneumoniae (OR 4.55, p = 0.002). The diagnosis of rheumatoid arthritis was also found to be a significant factor for pneumococcal vaccination (OR 5.1, p = 0.002). There was a negative trend suggesting that patients on major immunosuppressants are less likely to be immunised against pneumococcal antigen (OR 0.35, p = 0.067). Influenza and pneumococcal immunisation is suboptimal amongst patients on current immunosuppressant treatments attending rheumatology outpatient clinics. Raising awareness amongst patients may not be sufficient to improve vaccination rates and alternative strategies such as obligatory pneumococcal vaccination prior to treatment initiation and primary care provider education need to be explored.

The effectiveness of SMS Reminders and the impact of patient characteristics on missed appointments in a public dental outpatient clinic

Directory of Open Access Journals (Sweden)

Emilia Bellucci

2017-03-01

Full Text Available This paper reports on the Failure To Attend (FTA rate of appointments as well as patients following the implementation of SMS reminders in a public dental outpatient service.  Given the ineffectiveness of the intervention and a highly representative patient’s profile, this paper identifies the demographic characteristics of patients who miss all of their appointments.  Data on appointment attendance, patient demographics and dental service type was collected over a time period of 46 consecutive months.  Using descriptive and inferential statistics (chi-square, two sample tests and Marascuilo procedure we found the SMS intervention was ineffective in reducing the FTA rates. Further, patients associated with high rates of non-attendance exhibited one or more of the following characteristics: male; age 26 – 44; non-concession card holders; a person of Indigenous, local, Asian or African descent, and of refugee status, persons living in low socio-economic areas; and appointments in General Care and Student Clinics. Whilst the literature overwhelmingly attributes SMS reminders to improving the attendance rate of patients in outpatient clinics, our contradictory findings suggest a more targeted approach in settings whose patients exhibit strong characteristics associated with non-attendance.

AA Attendance and Abstinence for Dually Diagnosed Patients: A Meta-Analytic Review.

Science.gov (United States)

Scott Tonigan, J; Pearson, Matthew R; Magill, Molly; Hagler, Kylee J

2018-05-29

There is consensus that best clinical practice for dual diagnosis (DD) is integrated mental health and substance use treatment augmented with Alcoholics Anonymous (AA) attendance. This is the first quantitative review of the direction and magnitude of the association between AA attendance and alcohol abstinence for DD patients. A systematic literature search (1993-2017) identified 22 studies yielding 24 effect sizes that met our inclusion criteria (8,075 patients). Inverse-variance weighting of correlation coefficients (r) was used to aggregate sample-level findings and study aims were addressed using random and mixed effect models. Sensitivity and publication bias analyses were conducted to assess the likelihood of bias in the overall estimate of AA-related benefit. AA exposure and abstinence for DD patients were significantly and positively associated (r w =.249; 95% CI.203-.293; Tau=.097). There was also significant heterogeneity in the distribution of effect sizes, (Q(23)=90.714, pAA-related benefit did not differ between 6 (k=7) and 12 (k=12) month follow-up, (Q=.068, pAA benefit was not adversely or substantively impacted by pooling RCT and observational samples (Q=.763, pAA (Q=.023, pAA) is common and, in many cases, DD patients who attend AA will report higher rates of alcohol abstinence relative to DD patients who do not attend AA. This article is protected by copyright. All rights reserved.

Dropout rates and factors associated with dropout from treatment among elderly patients attending the outpatient services of a tertiary care hospital.

Science.gov (United States)

Grover, Sandeep; Dua, Devakshi; Chakrabarti, Subho; Avasthi, Ajit

2018-01-01

This study aimed to evaluate the "dropout" rates from treatment and associated factors among elderly patients attending a tertiary care psychiatry outpatient facility. Data of 1422 patients aged ≥60 years, attending the walk-in clinic were evaluated. Out of 1422 patients, 406 (28.55%) belonged to the "dropout" group. In the "dropout" group, the age of patients was significantly higher than the followed-up group, and a higher proportion of patients were >70 years old. Significantly lower proportion of patients with diagnosis of depressive disorders belonged to the "dropout" group and significantly higher proportion of patients with "other" diagnoses belonged to the dropped out group. In patients with depressive disorders, a higher proportion of the patients in the "dropout" group were Hindu by religion (68.7% vs. 58.7%; χ 2 = 4.26; P = 0.03). In patients with bipolar disorder, patients in the "dropout" group had significantly higher income (Rs. 13,323 [standard deviation [SD] = 16,769] vs. 5681 [SD = 9422]; t -test value: 2-25; P = 0.028) and lesser proportion of patients were of the male gender (63.15 vs. 86.95%; Mann-Whitney U value = 257.5; P = 0.039). In the group of other diagnoses, a higher proportion of patients in the "dropout" group were currently single (32.3% vs. 18.7%; χ 2 = 4.12; P = 0.042), from rural locality (63.1% vs. 46.72%; χ 2 = 4.33; P = 0.037) and were not prescribed medications (40% vs. 22.4%; χ 2 = 6.05; P = 0.04). Dropout from treatment among elderly patients is associated with higher age, not being prescribed medications, and diagnosis other than the affective disorders, psychotic disorders, and the cognitive disorders.

Alcoholics' selective attention to alcohol stimuli: automated processing?

Science.gov (United States)

Stormark, K M; Laberg, J C; Nordby, H; Hugdahl, K

2000-01-01

This study investigated alcoholics' selective attention to alcohol words in a version of the Stroop color-naming task. Alcoholic subjects (n = 23) and nonalcoholic control subjects (n = 23) identified the color of Stroop versions of alcohol, emotional, neutral and color words. Manual reaction times (RTs), skin conductance responses (SCRs) and heart rate (HR) were recorded. Alcoholics showed overall longer RTs than controls while both groups were slower in responding to the incongruent color words than to the other words. Alcoholics showed longer RTs to both alcohol (1522.7 milliseconds [ms]) and emotional words (1523.7 ms) than to neutral words (1450.8 ms) which suggests that the content of these words interfered with the ability to attend to the color of the words. There was also a negative correlation (r = -.41) between RT and response accuracy to alcohol words for the alcoholics, reflecting that the longer time the alcoholics used to respond to the color of the alcohol words, the more incorrect their responses were. The alcoholics also showed significantly greater SCRs to alcohol words (0.16 microSiemens) than to any of the other words (ranging from 0.04-0.08 microSiemens), probably reflecting the emotional significance of the alcohol words. Finally, the alcoholics evidenced smaller HR acceleration to alcohol (1.9 delta bpm) compared to neutral (2.8 delta bpm), which could be related to difficulties alcoholics experience in terminating their attention to the alcohol words. These findings indicate that it is difficult for alcoholics to regulate their attention to alcohol stimuli, suggesting that alcoholics' processing of alcohol information is automated.

Feasibility, Acceptability, and Impact of a Web-based Gratitude Exercise among Individuals in Outpatient Treatment for Alcohol Use Disorder

Science.gov (United States)

Krentzman, Amy R.; Mannella, Kristin A.; Hassett, Afton L.; Barnett, Nancy P.; Cranford, James A.; Brower, Kirk J.; Higgins, Margaret M.; Meyer, Piper S.

2015-01-01

This mixed-methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the ‘Three Good Things’ exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder (AUD). Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily emails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g., feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable, and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery. PMID:27076837

EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic.

Science.gov (United States)

Ikdahl, Eirik; Rollefstad, Silvia; Olsen, Inge C; Kvien, Tore K; Hansen, Inger Johanne Widding; Soldal, Dag Magnar; Haugeberg, Glenn; Semb, Anne Grete

2015-01-01

EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

EULAR Task Force Recommendations on Annual Cardiovascular Risk Assessment for Patients with Rheumatoid Arthritis: An Audit of the Success of Implementation in a Rheumatology Outpatient Clinic

Directory of Open Access Journals (Sweden)

Eirik Ikdahl

2015-01-01

Full Text Available Objective. EULAR recommendations for cardiovascular disease (CVD risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA. We evaluated the recording of CVD risk factors (CVD-RF in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC and a structured arthritis clinic (AC. Methods. In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. Results. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE: 21.0. Conclusion. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

Does Age Moderate the Effect of Spirituality/Religiousness in Accounting for Alcoholics Anonymous Benefit?

Science.gov (United States)

Montes, K S; Tonigan, J S

2017-01-01

Gains in spiritual/religious (S/R) practices among Alcoholics Anonymous (AA) members are associated with reductions in drinking. This study had the following aims: (a) examine spirituality/religiousness as a mediator of the relationship between AA attendance and reductions in drinking behavior to replicate past research findings and to (b) examine age-cohort as a moderator of the mediational analyses given that empirical evidence (e.g., generational differences in spirituality) suggests that age may influence the acquisition of gains in spirituality/religiousness during AA as well as the expression of these gains on drinking behavior. Measures were administered to 253 participants recruited from community-based AA and outpatient treatment programs at baseline, 3, 6, 9, and 12-months, and 210 (83%) participants provided complete data to test study aims. Gains in S/R practices mediated the relationship between AA attendance and increased abstinence, but not drinking intensity. Simple slopes analyses indicated a positive association between AA attendance and gains in S/R practices among younger AA affiliates but not older AA affiliates in the moderated-mediational analyses. However, age was not found to moderate the global mediational effect. The results from the current study inform efforts to increase positive change in AA affiliates' drinking behavior by highlighting specific aspects of S/R practices that should be targeted based on the age of an AA affiliate.

Depression symptoms in people with diabetes attending outpatient podiatry clinics for the treatment of foot ulcers.

Science.gov (United States)

Pearson, Sue; Nash, Toni; Ireland, Vanessa

2014-01-01

The purpose of this study was to examine the prevalence of depressive symptoms, diabetes self-management, and quality of life in people with diabetes and foot ulcers. Ulcer status, mortality and amputations were also assessed at six months follow-up. This was a cross-sectional survey of people attending outpatient podiatry clinics at a major tertiary referral hospital. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Diabetes self-care was assessed using the Summary of Diabetes Self Care Activities (SDSCA) measure. Health-related quality of life was measured using the physical component summary score (PCS) and the mental component summary score (MCS) of the SF-12. Of the 60 participants in the study 14 (23.3%) reported mild symptoms of depression (PHQ score 5-9) and 17 (28.3%) moderate to severe depressive symptoms (PHQ score > 9). Twenty-one (35%) met the criteria for previously recognized depression (on antidepressants and/or a diagnosis of depression in the last 12 months) and 17 (28.3%) for depression not previously recognized (PHQ > 4). Seventeen (28%) participants had been receiving antidepressant treatment for a median duration of 104 weeks (IQR 20, 494 weeks). Despite antidepressant treatment 12 participants (70.6% of those taking antidepressants) still reported moderate to severe depressive symptoms at the time of the study. Patients with PHQ scores > 4 reported poorer adherence to diabetes self-care activities including general diet, exercise, blood sugar monitoring and foot care when compared to those participants with PHQ scores  4 compared with no deaths and 2 amputations in participants with PHQ scores diabetes and foot ulcers. Depressive symptoms were associated with overall poorer diabetes self-management and health-related quality of life (HRQoL). There was no association between depressive symptoms and ulcer outcomes at six-months follow-up.

Conjoint moderate or high-risk alcohol and tobacco use among ...

African Journals Online (AJOL)

Objective: To better understand conjoint alcohol and tobacco use among male hospital out-patients, the purposes of this study were: (1) to assess the prevalence of conjoint use and (2) to determine the factors associated with the conjoint alcohol use and tobacco use. Methods: In a cross-sectional survey, consecutive male ...

Use of emergency care services by immigrants—a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic.

Science.gov (United States)

Ruud, Sven Eirik; Aga, Ruth; Natvig, Bård; Hjortdahl, Per

2015-10-07

The Oslo Accident and Emergency Outpatient Clinic (OAEOC) experienced a 5-6% annual increase in patient visits between 2005 and 2011, which was significantly higher than the 2-3% annual increase among registered Oslo residents. This study explored immigrant walk-in patients' use of both the general emergency and trauma clinics of the OAEOC and their concomitant use of regular general practitioners (RGPs) in Oslo. A cross-sectional survey of walk-in patients attending the OAEOC during 2 weeks in September 2009. We analysed demographic data, patients' self-reported affiliation with the RGP scheme, self-reported number of OAEOC and RGP consultations during the preceding 12 months. The first approach used Poisson regression models to study visit frequency. The second approach compared the proportions of first- and second-generation immigrants and those from the four most frequently represented countries (Sweden, Pakistan, Somalia and Poland) among the patient population, with their respective proportions within the general Oslo population. The analysis included 3864 patients: 1821 attended the Department of Emergency General Practice ("general emergency clinic"); 2043 attended the Section for Orthopaedic Emergency ("trauma clinic"). Both first- and second-generation immigrants reported a significantly higher OAEOC visit frequency compared with Norwegians. Norwegians, representing 73% of the city population accounted for 65% of OAEOC visits. In contrast, first- and second-generation immigrants made up 27% of the city population but accounted for 35% of OAEOC visits. This proportional increase in use was primarily observed in the general emergency clinic (42% of visits). Their proportional use of the trauma clinic (29%) was similar to their proportion in the city. Among first-generation immigrants only 71% were affiliated with the RGP system, in contrast to 96% of Norwegians. Similar finding were obtained when immigrants were grouped by nationality. Compared to

The uptake of influenza and pneumococcal vaccination among immunocompromised patients attending rheumatology outpatient clinics.

LENUS (Irish Health Repository)

Haroon, Muhammad

2011-07-01

PURPOSE AND OBJECTIVES: The patients using immunosuppressive agents are considered at high risk for acquiring different infections. Accordingly, international guidelines recommend vaccinating such patients against influenza and pneumococcal organisms. The aims of this study were two-fold: (1) to assess the influenza and pneumococcal vaccination uptake among our rheumatology outpatients who are immunosuppressed; (2) to identify the factors influencing immunisation uptake among our sample of patients.

Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems.

Science.gov (United States)

Sarkola, Taisto; Kahila, Hanna; Gissler, Mika; Halmesmäki, Erja

2007-11-01

To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland. A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register. Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital. There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.

Stimulation of appetite by alcohol.

OpenAIRE

Hetherington, M. M.; Cameron, F.; Wallis, D. J.; Pirie, L. M.

2001-01-01

To investigate the effects of alcohol on appetite and food intake, 26 males attended the laboratory on three occasions. On each occasion, they were given a standard breakfast. Visual analog scale ratings of hunger, desire to eat and fullness (appetite ratings) were recorded from before breakfast until their return to the laboratory for lunch. Thirty minutes before lunch, subjects either rested (baseline), were given 330 ml of a no-alcohol lager (264 kJ: no-alcohol condition) or 330 m...

Routine screening for depression and quality of life in outpatients with congestive heart failure.

Science.gov (United States)

Holzapfel, Nicole; Zugck, Christian; Müller-Tasch, Thomas; Löwe, Bernd; Wild, Beate; Schellberg, Dieter; Nelles, Manfred; Remppis, Andrew; Katus, Hugo; Herzog, Wolfgang; Jünger, Jana

2007-01-01

The influence of depression and perceived quality of life (QoL) on symptom perception and prognosis in congestive heart failure is well known. The authors therefore introduced routine questionnaire screening for these parameters in patients attending their outpatient heart failure clinic (N=320). The authors found QoL to be significantly reduced, and almost every third patient screened positive for a depressive disorder. These patients got a clearly-defined treatment offer. The present study demonstrates that screening for depression and QoL is feasible without being too complex or time-consuming and easily implementable in an interdisciplinary outpatient setting.

Alcohol intoxication at Swedish football matches: A study using biological sampling to assess blood alcohol concentration levels among spectators.

Directory of Open Access Journals (Sweden)

Natalie Durbeej

Full Text Available Alcohol use and alcohol-related problems, including accidents, vandalism and violence, at sporting events are of increased concern in Sweden and other countries. The relationship between alcohol use and violence has been established and can be explained by the level of intoxication. Given the occurrence of alcohol use and alcohol-related problems at sporting events, research has assessed intoxication levels measured through biological sampling among spectators. This cross-sectional study aimed to assess the level of alcohol intoxication among spectators at football matches in the Swedish Premier Football League. Spectators were randomly selected and invited to participate in the study. Alcohol intoxication was measured with a breath analyser for Blood Alcohol Concentration levels, and data on gender, age, and recent alcohol use were gathered through a face-to-face interview. Blood Alcohol Concentration samples from 4420 spectators were collected. Almost half (46.8% had a positive Blood Alcohol Concentration level, with a mean value of 0.063%, while 8.9% had a Blood Alcohol Concentration level ≥ 0.1%, with a mean value of 0.135%. Factors that predicted a higher Blood Alcohol Concentration level included male gender (p = 0.005, lower age (p < 0.001, attending a local derby (p < 0.001, alcohol use prior to having entered the arena (p < 0.001, attending a weekend match (p < 0.001, and being a spectator at supporter sections (p < 0.001. About half of all spectators at football matches in the Swedish Premier Football League drink alcohol in conjunction with the match. Approximately one tenth have a high level of alcohol intoxication.

Alcohol Use and Alcohol-Related Seizures in Patients With Epilepsy

Directory of Open Access Journals (Sweden)

Michael Hamerle

2018-06-01

Full Text Available Purpose: This study aimed to assess alcohol consumption and the occurrence of alcohol-related seizures in patients with epilepsy within the last 12 months.Methods: In an epilepsy outpatient clinic, a standardized questionnaire was used to collect data retrospectively from consecutive adult epilepsy patients who had been suffering from the disease for at least 1 year. Logistic regression analyses were performed to identify independent predictors.Results: A total of 310 patients with epilepsy were included. Of these, 204 subjects (65.8% consumed alcohol within the last 12 months. Independent predictors for alcohol use were antiepileptic drug monotherapy (OR 1.901 and physicians' advice that a light alcohol intake is harmless (OR 4.102. Seizure worsening related to alcohol consumption was reported by 37 of the 204 patients (18.1% who had used alcohol. All 37 subjects had consumed large quantities of alcohol prior to the occurrence of alcohol-related seizures regardless of their usual alcohol-drinking behavior. The amount of alcohol intake prior to alcohol-related seizures was at least 7 standard drinks, which is equivalent to 1.4 L of beer or 0.7 L of wine. In 95% of cases, alcohol-related seizures occurred within 12 h after cessation of alcohol intake. Independent predictors for alcohol-related seizures were generalized genetic epilepsy (OR 5.792 and chronic heavier alcohol use (OR 8.955.Conclusions: Two-thirds of interviewed subjects had consumed alcohol within the last 12 months. This finding may be an underestimate due to patients' self-reporting and recall error. In all cases, the occurrence of alcohol related-seizures was associated with timely consumption of considerably large amounts of alcohol. Thus, a responsible alcohol intake seems to be safe for most patients with epilepsy. However, subjects with epilepsy and especially those with generalized genetic epilepsy should be made aware of an increased risk for seizures related to heavy

Alcohol consumption among pregnant women attending the ante ...

African Journals Online (AJOL)

2014-04-02

Apr 2, 2014 ... Ordinioha and Brisibe: Alcohol consumption by pregnant women in South‑South Nigeria. 14. Nigerian Journal ... that they may have, and social and family supports for .... through the mass media, 21 (18.42%) read it in the internet, while 13 .... while all the Muslim respondents and Christians of the. 7th Day ...

A prospective examination of disease management program use by complex cardiac outpatients.

Science.gov (United States)

Gravely, Shannon; Reid, Robert D; Oh, Paul; Ross, Heather; Stewart, Donna E; Grace, Sherry L

2012-01-01

The use of disease management programs (DMPs) by patients with cardiovascular disease (CVD) is associated with improved outcomes. Although rates of cardiac rehabilitation (CR) use are well established, less is known about other DMPs. The objectives of this study were to describe the degree of DMP utilization by CVD outpatients, and examine factors related to use. This study represents a secondary analysis of a larger prospective cohort study. In hospital, 2635 CVD inpatients from 11 hospitals in Ontario Canada completed a survey that assessed factors affecting DMP utilization. One year later, 1803 participants completed a mailed survey that assessed DMP utilization. One thousand seventy-three (59.5%) participants reported using at least 1 DMP. Overall, 951 (52.7%) reported participating in cardiac rehabilitation, and among participants with a comorbid indication, 212 (41.2%) reported attending a diabetes education centre, 28 (25.9%) attended stroke rehabilitation, 35 (12.9%) used a heart failure clinic, and 13 (11.7%) attended a smoking cessation program. A multinomial logistic regression analysis showed that compared with no DMP use, participants that attended 1 or multiple programs were younger, married, diagnosed with a myocardial infarction, less likely to have had a percutaneous coronary intervention and had higher perceptions of personal control over their heart condition. There were few differences between participants that used 1 vs multiple DMPs, however, having diabetes or comorbid stroke significantly increased the likelihood of multiple DMP use. Approximately 40% of CVD outpatients do not access DMPs. An integrated approach to vascular disease management appears warranted. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Association between nutritional status and subjective health status in chronically ill children attending special schools

NARCIS (Netherlands)

K.F.M. Joosten (Koen); K. van der Velde (Kelly); P. Joosten (Pieter); H. Rutten (Hans); J.M. Hulst (Jessie); K. Dulfer (Karolijn)

2016-01-01

textabstractPurpose: In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the

A multi-site randomized study to compare the effects of Eye Movement Desensitization and Reprocessing (EMDR) added to TAU versus TAU to reduce craving and drinking behavior in alcohol dependent outpatients: study protocol

OpenAIRE

Markus, W.; Weert-van Oene, G.H. de; Becker, E.S.; Jong, C.A.J. de

2015-01-01

Background Addiction constitutes a major public health problem, and despite treatment, relapse rates remain very high. Preliminary findings suggest that Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based treatment for PTSD, may also reduce craving and relapse rates when applied in substance abuse. This study aims to determine the feasibility, efficacy and effectiveness of EMDR when added to treatment as usual (TAU) for addiction in alcohol dependent outpatients, compared ...

[Importance of an outpatient record in obstetric anesthesia].

Science.gov (United States)

Lanza, V; Mercadante, S; Pignataro, A; Guglielmo, L; Villari, P; Di Fiore, G; Sapio, M; De Michele, P; Vegna, G

1991-01-01

A computerised record was used to collect data following an anesthesiological check-up of pregnant women at approximately 30 weeks of pregnancy. The record was input onto a portable PC in the anesthesia outpatient clinic, memorized on disk (3.5") and then transferred onto a PC network (one PC for each operating theatre) for "real time" consultation of each patient's data. All pregnant women attending the antenatal clinico were also given a folder illustrating epidural anesthetic techniques. Seven hundred and nine outpatient visits have been performed over the past two years with a 62% utilisation ratio. The collection of data using a computerised system allows a rapid and efficacious system of communication to be set up among the membranes of the anesthesiological team, thus encouraging the use of epidural techniques during labour. The distribution of the folder also facilitated the task of the anesthetist who found that pregnant women visiting the anesthesia clinic were already familiar with the epidural technique.

Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors

OpenAIRE

Yoshimi, Nicoli Tamie; Campos, Luana Moraes; Simão, Maria Odete; Torresan, Ricardo Cezar; Torres, Albina Rodrigues

2016-01-01

ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 5...

Randomized Controlled Trial of Antiseptic Hand Hygiene Methods in an Outpatient Surgery Clinic.

Science.gov (United States)

Therattil, Paul J; Yueh, Janet H; Kordahi, Anthony M; Cherla, Deepa V; Lee, Edward S; Granick, Mark S

2015-12-01

Outpatient wound care plays an integral part in any plastic surgery practice. However, compliance with hand hygiene measures has shown to be low, due to skin irritation and lack of time. The objective of this trial was to determine whether single-use, long-acting antiseptics can be as effective as standard multiple-use hand hygiene methods in an outpatient surgical setting. A prospective, randomized controlled trial was performed in the authors' outpatient plastic surgery clinic at Rutgers New Jersey Medical School, Newark, NJ to compare the efficacy of an ethyl alcohol-based sanitizer (Avagard D Instant Hand Aniseptic, 3M Health Care, St. Paul, MN), a benzalkonium chloride-based sanitizer (Soft & Shield, Bioderm Technologies, Inc, Trenton, NJ, distributed by NAPP Technologies, Hackensack, NJ ), and soap and- water handwashing. Subjects included clinic personnel, who were followed throughout the course of a 3-hour clinic session with hourly hand bacterial counts taken. During the course of the trial, 95 subjects completed the clinic session utilizing 1 of the hand hygiene methods (36 ethyl alcohol-based sanitizer, 38 benzalkonium chloride-based sanitizer, and 21 soap-and-water handwashing). There was no difference between hand bacterial counts using the different methods at 4 hourly time points (P greater than 0.05). Hand bacterial counts increased significantly over the 3-hour clinic session with the ethyl alcohol-based sanitizer (9.24 to 21.90 CFU, P less than 0.05), benzalkonium chloride-based sanitizer (6.69 to 21.59 CFU, P less than 0.05), and soap-and-water handwashing (8.43 to 22.75 CFU, P less than 0.05). There does not appear to be any difference in efficacy between single-use, long-acting sanitizer, and standard multiple-use hand hygiene methods. Hand bacterial counts increased significantly over the course of the 3-hour clinic session regardless of the hand hygiene measure used. Hand condition of subjects was improved with the ethyl alcohol

Do dietetic patients in a regional area attend a drop-in diabetes outpatient clinic? Proof-of-concept observational study.

Science.gov (United States)

Byrne, Clare; Roth, Rachel; Donnelly, Julianne; Dicker, Gill; Palmer, Michelle

2018-06-01

Drop-in clinics may be an alternative patient-centred approach to traditional appointment systems. However patient uptake in Allied Health settings is unknown. Given the limited literature, this observational prospective project tested whether patients with diabetes would present to a drop-in clinic, and whether the types and volume of patients would change due to introduction of a drop-in clinic. Alongside a referral-based booked individual appointment service (standard care (SC)), a drop-in clinic was introduced allowing patients to present without appointment. Patient data was collected from medical chart and outpatient appointment systems over 30 months. High category patient criteria included HbA1c>7.5%. Data was compared between drop-in and SC groups using chi-squared and ANOVA tests. Of 150 eligible patients, more drop-in patients (n = 76) presented over 15 months than SC patients booked in the 15 months before (n = 41) or 15 months after (n = 33) the drop-in clinic commenced. Drop-ins were 12 years older and less likely to have Type 1 Diabetes Mellitus (T1DM) than SC patients (p appeal to older patients with Type 2 Diabetes Mellitus, but not to younger patients or patients with T1DM. The types, volume, and attendance rates of SC patients was similar before and after commencement of the drop-in clinic. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices

International Nuclear Information System (INIS)

Wilde, N.T.; Bungay, P.; Johnson, L.; Asquith, J.; Butterfield, J.S.; Ashleigh, R.J.

2006-01-01

Aim: To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device. Materials and methods: A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture. Patients were kept flat for 15 min and allowed to fully mobilize at 60 min. Puncture sites were scored for visible bruising, haematoma and pain at discharge and on outpatient follow-up. Patient preference for future outpatient treatment was assessed. Results: Fifty-seven outpatients underwent 81 punctures. Forty-eight (84%) patients underwent iliac angioplasty; of those 42% underwent stent placement. Six patients (10%) required inpatient admission, five secondary to failed suture deployment. One patient had a non-closer-related puncture site intimal flap occlusion successfully repaired at surgery. Fifty-one (90%) patients discharged with a mean time of 157 min (60-280 min). Forty-six (92%) patients had no visible bruising or palpable haematoma on discharge. No patient had a haematoma greater than 2.5 cm. No discharged patient required readmission. Thirty percent reported a moderate to severe groin pain score (2-5/5) at discharge, increasing to 40% at follow-up. Forty-seven (98%) of the 48 patients, who expressed a preference, would be happy to undergo outpatient treatment again. Conclusion: Outpatient treatment is feasible, well tolerated and preferable to patients, but 10% will require inpatient admission. A planned post-procedure analgesia regimen or advice should be considered

Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices

Energy Technology Data Exchange (ETDEWEB)

Wilde, N.T. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Bungay, P. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Johnson, L. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Asquith, J. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Butterfield, J.S. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Ashleigh, R.J. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom)]. E-mail: Ray.Ashleigh@smuht.nhs.uk

2006-12-15

Aim: To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device. Materials and methods: A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture. Patients were kept flat for 15 min and allowed to fully mobilize at 60 min. Puncture sites were scored for visible bruising, haematoma and pain at discharge and on outpatient follow-up. Patient preference for future outpatient treatment was assessed. Results: Fifty-seven outpatients underwent 81 punctures. Forty-eight (84%) patients underwent iliac angioplasty; of those 42% underwent stent placement. Six patients (10%) required inpatient admission, five secondary to failed suture deployment. One patient had a non-closer-related puncture site intimal flap occlusion successfully repaired at surgery. Fifty-one (90%) patients discharged with a mean time of 157 min (60-280 min). Forty-six (92%) patients had no visible bruising or palpable haematoma on discharge. No patient had a haematoma greater than 2.5 cm. No discharged patient required readmission. Thirty percent reported a moderate to severe groin pain score (2-5/5) at discharge, increasing to 40% at follow-up. Forty-seven (98%) of the 48 patients, who expressed a preference, would be happy to undergo outpatient treatment again. Conclusion: Outpatient treatment is feasible, well tolerated and preferable to patients, but 10% will require inpatient admission. A planned post-procedure analgesia regimen or advice should be considered.

Burden of medically attended influenza infection and cases averted by vaccination — United States, 2013/14 through 2015/16 influenza seasons

Science.gov (United States)

Jackson, Michael L.; Phillips, C. Hallie; Benoit, Joyce; Jackson, Lisa A.; Gaglani, Manjusha; Murthy, Kempapura; McLean, Huong Q.; Belongia, Edward A.; Malosh, Ryan; Zimmerman, Richard; Flannery, Brendan

2018-01-01

Background In addition to preventing hospitalizations and deaths due to influenza, influenza vaccination programs can reduce the burden of outpatient visits for influenza. We estimated the incidence of medically-attended influenza at three geographically diverse sites in the United States, and the cases averted by vaccination, for the 2013/14 through 2015/16 influenza seasons. Methods We defined surveillance populations at three sites from the United States Influenza Vaccine Effectiveness Network. Among these populations, we identified outpatient visits laboratory-confirmed influenza via active surveillance, and identified all outpatient visits for acute respiratory illness from healthcare databases. We extrapolated the total number of outpatient visits for influenza from the proportion of surveillance visits with a positive influenza test. We combined estimates of incidence, vaccine coverage, and vaccine effectiveness to estimate outpatient visits averted by vaccination. Results Across the three sites and seasons, incidence of medically attended influenza ranged from 14 to 54 per 1,000 population. Incidence was highest in children aged 6 months to 9 years (33 to 70 per 1,000) and lowest in adults aged 18-49 years (21 to 27 per 1,000). Cases averted ranged from 9 per 1,000 vaccinees (Washington, 2014/15) to 28 per 1,000 (Wisconsin, 2013/14). Discussion Seasonal influenza epidemics cause a considerable burden of outpatient medical visits. The United States influenza vaccination program has caused meaningful reductions in outpatient visits for influenza, even in years when the vaccine is not well-matched to the dominant circulating influenza strain. PMID:29249545

Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway.

Science.gov (United States)

Teodorescu, Dinu-Stefan; Heir, Trond; Hauff, Edvard; Wentzel-Larsen, Tore; Lien, Lars

2012-08-01

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions. © 2012 The Authors. Scandinavian Journal of Psychology © 2012 The Scandinavian Psychological Associations.

Attachment style and readiness for psychotherapy among psychiatric outpatients.

Science.gov (United States)

Kealy, David; Tsai, Michelle; Ogrodniczuk, John S

2017-06-01

Ninety-two adults attending outpatient mental health services completed measures of attachment style and readiness to engage in psychotherapy. Correlation and linear regression analyses found anxious attachment to be positively associated with treatment-seeking distress and found avoidant attachment to be negatively associated with openness to personal disclosure in the therapy relationship. Insecure attachment may influence prospective patients' readiness for psychotherapy. Patients with an avoidant attachment style may need assistance in preparing for the relational aspects of psychotherapy. © 2016 The British Psychological Society.

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India

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Kalaiselvi Selvaraj

2016-01-01

Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services.

Internet use of parents before attending a general pediatric outpatient clinic: does it change their information level and assessment of acute diseases?

Science.gov (United States)

Sebelefsky, Christian; Voitl, Jasmin; Karner, Denise; Klein, Frederic; Voitl, Peter; Böck, Andreas

2016-08-18

Before seeing a pediatrician, parents often look online to obtain child health information. We aimed to determine the influence of IUC (internet use regarding the reason for consultation) on their subjective information level, their assessment of acute diseases and the change in this assessment. Secondary objectives were to identify the most commonly used online resources and factors with an influence on IUC. This cross-sectional observational study was conducted at a general pediatric outpatient clinic located in Vienna, Austria. An anonymous, voluntary and 14-items-containing questionnaire served to gather all data. A total number of 500 questionnaires were collected. Of the parents attending the outpatient clinic, 21 % use the internet before the appointment (= IUC). Most common online resources utilized for this purpose are websites run by doctors (61.3 %), the outpatient clinic's homepage (56.3 %), Google (40 %), Wikipedia (32.5 %), health advisory services provided by doctors (28.7 %), health portals (21.3 %) and health forums and communities (18.8 %). The information level in terms of the reason for consultation is rated as good by 50.6 %, as average by 46.7 % and as insufficient by 2.7 % (internet users: 42.7 %, 55.3 %, 1.9 %). Acute diseases of the children are estimated to be mild by 58.4 %, to be moderate by 41.1 % and to be severe by 0.5 % (internet users: 54.9 %, 45.1 %, 0 %). After having used any source of information, this assessment is unchanged in 82.8 %, acute diseases are rated as more severe in 13.8 % and as less severe in 3.4 % (internet users: 79.2 %, 16.7 %, 4.2 %). Internet users and non-users do not differ with respect to their information level (p = 0.178), the assessment of acute diseases (p = 0.691) and the change in this assessment (p = 0.999). A higher education level of parents (mothers: p = 0.025, fathers: p = 0.037), a young age of their children (p = 0.012) and acute diseases of

Longitudinal cohort study of depression, post-traumatic stress, and alcohol use in South African women who attend alcohol serving venues

OpenAIRE

Abler, Laurie A; Sikkema, Kathleen J; Watt, Melissa H; Eaton, Lisa A; Choi, Karmel W; Kalichman, Seth C; Skinner, Donald; Pieterse, Desiree

2014-01-01

Background In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudina...

Barriers to dental attendance in older patients

LENUS (Irish Health Repository)

Shanahan, D

2017-04-01

Health professionals in Ireland are increasingly concerned about the quality of oral health in older patients. The aim of this study is to identify the obstacles that face this age-group when accessing dental care, so that we are in a better position to address them. A questionnaire was completed by 105 patients attending a geriatric outpatient clinic. Over 50 percent of respondents had not attended a dentist in over 36 months, for the reasons that \\'I have no problem or need for treatment’ (62%) and ‘I have no teeth, and therefore I have no need to go’ (54%). While it is common to assume that no teeth means no need to see a dentist, research shows that regular dental visits are vital for ensuring the early screening of oral cancer and other mucosal pathologies, and the optimisation of existing rosthesis\\/restorations. The chief recommendation of this paper is thus to provide better education and access to older people on the importance of visiting the dentist.

Depression and Anxiety in a Cardiovascular Outpatient Clinic: A Descriptive Study

OpenAIRE

Baktash Bayani MD; Shakila Yousefi Msc; Mahtab Bayani MD; Maryam Shirmohammadi Msc; Abdollatif Alimoradi Msc; Homa Falsoleiman MD; Narges Yazdi Msc; Mohammad Arbabi MD

2011-01-01

Objective: Cardiac diseases are psycho-somatic disorders, and psychological aspects play an essential role in their initiation and exacerbation. The aim of this study was to gain appropriate knowledge in the epidemiology of co-morbid depression and anxiety disorder in cardiovascular outpatients.Method: This study is descriptive with a sample of patients attending a cardio-vascular clinic. 238 individuals were included in this study using a consecutive sampling method. The study instrument was...

Knowledge, Attitude, and Practice Regarding the Risk of Cardiovascular Diseases in Patients Attending Outpatient Clinic in Kuantan, Malaysia.

Science.gov (United States)

Mohammad, Nursyafiza B; Rahman, Nor Azlina A; Haque, Mainul

2018-01-01

Cardiovascular disease (CVD) is a leading cause of death around the world including Malaysia. Ischemic heart disease (IHD) is the single largest cause of death in the developed countries and is one of the main contributors to the disease burden in developing countries. This was a cross-sectional study conducted to determine knowledge, attitude, and practice (KAP) regarding the risk of CVD in patients attending an outpatient clinic in Kuantan, Malaysia. A total of 100 patients comprising 52 male and 48 female subjects were selected through convenient sampling method. Of the total subjects, 86% were Malays. The mean scores (standard deviation) for KAP were 60.75±4.823, 54.36±8.711, and 33.43±4.046, respectively, whereas the maximum scores obtained by the subjects for KAP were 71, 65, and 43, respectively. Regarding questions related to knowledge, 88% subjects knew irregular eating pattern can cause disease and the benefits of vegetable intake. Most subjects recognized that smoking and obesity were CVD risk factors. Regarding questions related to attitude, 96% agreed that exercise can prevent CVD. More than half of the subjects followed healthy lifestyle. There were statistically significant differences observed in knowledge level between sexes ( P = 0.046) and races ( P = 0.001). Nevertheless, there was no statistically significant difference observed in KAP across different education levels of the subjects regarding the risk of CVD ( P -value = 0.332, 0.185, and 0.160, respectively). This study revealed that patients had good knowledge and attitude regarding CVD risk factors. Yet, the number of smokers is still quite high. Development of better public information system is essential for the well-being of the society.

A multi-site randomized study to compare the effects of Eye Movement Desensitization and Reprocessing (EMDR) added to TAU versus TAU to reduce craving and drinking behavior in alcohol dependent outpatients: study protocol.

Science.gov (United States)

Markus, Wiebren; de Weert-van Oene, Gerdien H; Becker, Eni S; DeJong, Cor A J

2015-03-18

Addiction constitutes a major public health problem, and despite treatment, relapse rates remain very high. Preliminary findings suggest that Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based treatment for PTSD, may also reduce craving and relapse rates when applied in substance abuse. This study aims to determine the feasibility, efficacy and effectiveness of EMDR when added to treatment as usual (TAU) for addiction in alcohol dependent outpatients, compared to TAU only. A single blinded study in which 100 adult patients with a primary DSM-IV-TR diagnosis of alcohol dependence or abuse receiving treatment in one of six Dutch outpatient addiction care facility sites, will be enrolled. After baseline assessment participants will be allocated to one of two treatment conditions (allocation ratio of 1:1) using a stratified (per site, per care pathway), blocked randomization procedure. The intervention consists of EMDR (seven weekly 90 minute sessions) + TAU or TAU only. Assessments are scheduled pre-treatment (t0), post-treatment (t0 + eight weeks), and one and six months post treatment. The effects of both treatment arms are compared on indices of (a) drinking behavior, (b) mediators, moderators and predictors of treatment outcome, (c) quality of life and d) safety, acceptability and feasibility of treatment. Repeated measures ANOVA's will be conducted using an intention-to-treat and per-protocol approach. Multiple imputation will be used to deal with missing values when possible. This study adapts and extends the standard EMDR treatment for traumatized patients for use with patients with alcohol use disorders without psychological trauma. ClinicalTrial.gov: NCT01828866.

Estimating Renal Function in the Elderly Malaysian Patients Attending Medical Outpatient Clinic: A Comparison between Creatinine Based and Cystatin-C Based Equations.

Science.gov (United States)

Jalalonmuhali, Maisarah; Elagel, Salma Mohamed Abouzriba; Tan, Maw Pin; Lim, Soo Kun; Ng, Kok Peng

2018-01-01

To assess the performance of different GFR estimating equations, test the diagnostic value of serum cystatin-C, and compare the applicability of cystatin-C based equation with serum creatinine based equation for estimating GFR (eGFR) in comparison with measured GFR in the elderly Malaysian patients. A cross-sectional study recruiting volunteered patients 65 years and older attending medical outpatient clinic. 51 chromium EDTA ( 51 Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations using serum creatinine (CKD-EPIcr) as well as serum cystatin-C (CKD-EPIcys) were calculated. A total of 40 patients, 77.5% male, with mean measured GFR 41.2 ± 18.9 ml/min/1.73 m 2 were enrolled. Mean bias was the smallest for 4-MDRD; meanwhile, CKD-EPIcr had the highest precision and accuracy with lower limit of agreement among other equations. CKD-EPIcys equation did not show any improvement in GFR estimation in comparison to CKD-EPIcr and MDRD. The CKD-EPIcr formula appears to be more accurate and correlates better with measured GFR in this cohort of elderly patients.

Utilization of health care services by depressed patients attending ...

African Journals Online (AJOL)

2011-06-15

Jun 15, 2011 ... all patients attending the general out‑patient department from 16 years of age and above and those who consented to participate. Excluded were patients who abuse alcohol or drugs, patients with past history of psychiatric illness other than depression, patients with altered sensorium and those who failed ...

Alcoholics anonymous, other 12-step movements and psychotherapy in the US population, 1990.

Science.gov (United States)

Room, R; Greenfield, T

1993-04-01

Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self-reported utilization of a variety of sources of personal support and counselling for alcohol and other problems. Respondents were queried about lifetime attendance and number of times they went to identified sources of help in the prior year. Twelve-step groups included Alcoholics Anonymous, Al-Anon, Adult Children of Alcoholics, and other non-alcohol-oriented groups like Gamblers Anonymous, Narcotics Anonymous, and Overeaters Anonymous; additional questions inquired about support or therapy groups and individual counselling for non-alcohol problems. Of the US adult population, 9% have been to an AA meeting at some time, 3.6% in the prior year, only about one-third of these for problems of their own. About half these percentages, mostly women, have attended Al-Anon. Of the same population, 13.3% indicate ever attending a 12-step meeting (including non-alcohol-oriented groups), 5.3% in the last year. During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counselling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12-months) reported going to anyone including AA for a problem (of their own) related to drinking.

The characteristics, management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan

Directory of Open Access Journals (Sweden)

Chen-Ju Lin

2014-06-01

Conclusion: Individuals who harmed themselves had a high rate of psychiatric morbidity and interpersonal problems. However, their adherence to psychiatric outpatient aftercare was low. Improved identification of the needs of patients with suicidal tendencies who did not attend outpatient services will have implications for future services provided to this patient population, and will better enable medical personnel to most effectively assist in suicide attempt interventions.

TO DETERMINE THE PERSONALITY TRAITS, CLINICAL CHARACTERISTICS AND COGNITIVE FUNCTIONS IN BIPOLAR DISORDER PATIENTS WITH COMORBID ALCOHOL USE DISORDERS

Directory of Open Access Journals (Sweden)

Ahalya Thinaharan

2016-12-01

Full Text Available BACKGROUND Comorbidity of bipolar disorder and substance use disorder is common. It is difficult to treat bipolar disorder patients with comorbid alcohol use disorder since the disease course is more severe and they have greater difficulties in cognitive functions than those without alcohol use. Whether alcohol negatively affects specific cognitive functions or the deficits are more diffuse in nature is unclear. Alcoholic bipolar patients present with high scores in openness to experience and neuroticism personality traits. Personality to an extent mediates the co-occurrence of substance use in bipolar disorder. Thus, identifying these personality traits in bipolar or substance use disorder patients, will help us to prevent the co-occurrence of the second disorder. The aim of the study is to evaluate the clinical characteristics, personality traits and cognitive functions of patients with bipolar and comorbid alcohol use disorders. MATERIALS AND METHODS A sample of 100 patients, 50 with bipolar and alcohol use disorder (cases and 50 with bipolar disorder (controls attending tertiary care hospital outpatient department at Chennai was selected. Alcohol status was assessed using AUDIT (alcohol use disorder identification test and SADQ (severity of alcohol dependence questionnaire. Personality was assessed using NEO-five factor inventory. Cognition was assessed using frontal lobe assessment battery, Stroop test, DSST (digit symbol substitution test and verbal N back test. RESULTS The cases group had more number of hospitalisations and mixed episodes than control group. They also performed poorer on frontal lobe assessment battery, Stroop test and digit symbol substitution test. Duration of alcohol use was associated positively with total number of hospitalisations and number of episodes. The cases group scored significantly higher on the personality traits of neuroticism and openness to experience. CONCLUSION The study confirmed the higher

Alcohol use disorder-related sick leave and mortality: a cohort study.

Science.gov (United States)

Wedegaertner, Felix; Geyer, Siegfried; Arnhold-Kerri, Sonja; Sittaro, Nicola-Alexander; te Wildt, Bert

2013-01-30

Alcohol use disorders (AUDs) are associated with the highest all-cause mortality rates of all mental disorders. The majority of patients with AUDs never receive inpatient treatment for their AUD, and there is lack of data about their mortality risks despite their constituting the majority of those affected. Absenteeism from work (sick leave) due to an AUD likely signals worsening. In this study, we assessed whether AUD-related sick leave was associated with mortality in a cohort of workers in Germany. 128,001 workers with health insurance were followed for a mean of 6.4 years. We examined the associations between 1) AUD-related sick leave managed on an outpatient basis and 2) AUD-related psychiatric inpatient treatment, and mortality using survival analysis, and Cox proportional hazard regression models (separately by sex) adjusted for age, education, and job code classification. We also stratified analyses by sick leave related to three groups of alcohol-related conditions (all determined by International Classification of Diseases 9th ed. (ICD-9) codes): alcohol abuse and dependence; alcohol-induced mental disorder; and alcohol-induced medical conditions. Outpatient-managed AUD-related sick leave was significantly associated with higher mortality (hazard ratio (HR) 2.90 (95% Confidence interval (CI) 2.24-3.75) for men, HR 5.83 (CI 2.90-11.75) for women). The magnitude of the association was similar for receipt of AUD-related psychiatric inpatient treatment (HR 3.2 (CI 2.76-3.78) for men, HR 6.5 (CI 4.41-9.47) for women). Compared to those without the conditions, higher mortality was observed consistently for outpatients and inpatients across the three groups of alcohol-related conditions. Those with alcohol-related medical conditions who had AUD-related psychiatric inpatient treatment appeared to have the highest mortality. Alcohol use disorder-related sick leave as documented in health insurance records is associated with higher mortality. Such sick leave does

Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

Directory of Open Access Journals (Sweden)

Claudiu Avram

2010-12-01

Full Text Available The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization, patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization, or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization. Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01, systolic blood pressure (p=0.002, total cholesterol (p<0.001, LDLcholesterol(p<0.001 and non-HDL cholesterol (p=0.004 in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.

Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: a comparative evaluation in community-based addiction treatment centers

NARCIS (Netherlands)

Vedel, Ellen; Emmelkamp, Paul M. G.; Schippers, Gerard M.

2008-01-01

BACKGROUND: Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol

Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: A comparative evaluation in community-based addiction treatment centers

NARCIS (Netherlands)

Vedel, E.; Emmelkamp, P.M.G.; Schippers, G.M.

2008-01-01

Background: Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol

Incidence of cardiovascular and cerebrovascular disease in Danish men and women with a prolonged heavy alcohol intake

DEFF Research Database (Denmark)

Hvidtfeldt, Ulla Arthur; Frederiksen, M.E.; Thygesen, L.C.

2008-01-01

significant higher incidence rates than would be expected in a standard population were observed for cardiovascular diseases (e.g., ischemic heart diseases, men: SIR = 1.76; 95% CI 1.69-1.83; women: SIR = 2.44; 95% CI 2.19-2.73) and cerebrovascular diseases (e.g., hemorrhagic stroke, men: SIR = 2.71; 95% CI 2...... rates of cardio- and cerebrovascular diseases than the population in general. METHODS: The cohort comprised 19,185 subjects (15,368 men and 3,817 women) who attended outpatient clinics for alcohol abusers within the Copenhagen Hospital Corporation (1954 to 1992). Incidence rates were standardized (SIR......) according to sex, age and calendar time to compare subjects' cardio- and cerebrovascular incidence with that of the general population of Copenhagen. RESULTS: During the period 1977 to 2001 a total of 9,397 events of cardio- and cerebrovascular disease were observed. In both men and women, statistically...

Practical outpatient pharmacotherapy for alcohol use disorder

Science.gov (United States)

Kim, Youngjung; Hack, Laura M; Ahn, Elizabeth S

2018-01-01

Alcohol use disorder (AUD) is commonly encountered in clinical practice. A combination of psychosocial intervention and pharmacotherapy is the cornerstone of AUD treatment. Despite their efficacy, safety and cost-effectiveness, clinicians are reluctant to prescribe medications to treat individuals with AUD. Given the high rate of relapse with psychosocial intervention alone, increasing patient access to this underutilized treatment has the potential to improve clinical outcome in this difficult-to-treat population. Herein, we provide practical pharmacotherapy strategies to improve treatment outcome for AUD. We review the efficacy and side effects of both on- and off-label agents with a particular focus on clinical applicability. Recommendations are supported by findings from randomized controlled trials (RCT) and meta-analyses selected to be representative, where possible, of current treatment guidelines. The goal of this paper is to help readers use pharmacotherapy with greater confidence when treating patients with AUD. PMID:29445407

Practical outpatient pharmacotherapy for alcohol use disorder

Directory of Open Access Journals (Sweden)

Youngjung Kim

2018-02-01

Full Text Available Alcohol use disorder (AUD is commonly encountered in clinical practice. A combination of psychosocial intervention and pharmacotherapy is the cornerstone of AUD treatment. Despite their efficacy, safety and cost-effectiveness, clinicians are reluctant to prescribe medications to treat individuals with AUD. Given the high rate of relapse with psychosocial intervention alone, increasing patient access to this underutilized treatment has the potential to improve clinical outcome in this difficult-to-treat population. Herein, we provide practical pharmacotherapy strategies to improve treatment outcome for AUD. We review the efficacy and side effects of both on- and off-label agents with a particular focus on clinical applicability. Recommendations are supported by findings from randomized controlled trials (RCT and meta-analyses selected to be representative, where possible, of current treatment guidelines. The goal of this paper is to help readers use pharmacotherapy with greater confidence when treating patients with AUD.

Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah, Iran.

Science.gov (United States)

Khazaie, Habibolah; Rezaie, Leeba; de Jong, Desiree M

2013-01-01

Outpatient psychiatric treatment provides both psychotherapy and pharmacotherapy for a large portion of psychiatric patients. Dropping out, or early termination of treatment, may be considered a common barrier to outpatient's psychiatric treatment. There are limited studies on this issue in Iran. The current study aimed to examine rates, predictors and reasons of dropping out of an outpatient psychiatric treatment. In this 6-month cohort study, 1500 outpatients who visited 10 psychiatrist's offices in the Iranian city of Kermanshah were recruited and followed for 2 years (2009-2011) for recommended treatments including admission to hospital, pharmacotherapy, psychotherapy and a combination of both psychotherapy and pharmacotherapy. Characteristics of patients who dropped out of the current study were collected, and reasons for dropping out were collected via phone or in person interview. Dropouts were prevalent in prescribed treatments. Pretreatment (primary) dropout rates in psychotherapy treatment were 4 times greater than dropout rates in pharmacotherapy treatment (80% and 20%, respectively). There were significance differences between dropouts and non-dropouts of pharmacotherapy with respect to patient characteristics; younger age, male gender, low level of education, unemployment, lack of insurance, new cases and divorce were more prevalent among dropouts (Preasons for dropping out included overslept and too ill to attend treatment and fear of becoming addicted to prescribed psychotropic medication (30% and 18%, respectively). Lack of confidence in therapist ability and lack of confidence in the efficacy of the treatment were more prevalent in patients who dropped out of psychotherapy (Preasons for dropping out and strategies to reduce rates of dropouts is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

The effectiveness of SMS Reminders and the impact of patient characteristics on missed appointments in a public dental outpatient clinic

OpenAIRE

Emilia Bellucci; Lasitha Dharmasena; Lemai Nguyen; Hanny Calache

2017-01-01

This paper reports on the Failure To Attend (FTA) rate of appointments as well as patients following the implementation of SMS reminders in a public dental outpatient service.  Given the ineffectiveness of the intervention and a highly representative patient’s profile, this paper identifies the demographic characteristics of patients who miss all of their appointments.  Data on appointment attendance, patient demographics and dental service type was collected over a time period of 46 consecut...

Perception of stroke in Croatia--knowledge of stroke signs and risk factors amongst neurological outpatients.

Science.gov (United States)

Vuković, V; Mikula, I; Kesić, M J; Bedeković, M R; Morović, S; Lovrencić-Huzjan, A; Demarin, V

2009-09-01

The aim of this hospital-based survey was to determine baseline stroke knowledge in Croatian population attending the outpatient services at the Department of Neurology. A multiple choice questionnaire was designed, divided into three sections: (i) demographic data, (ii) knowledge of stroke risk factors and stroke signs and (iii) actions the patients would undertake if confronted with risk of stroke and information resources regarding health. The analysis included 720 respondents (54.9% women). The respondents most frequently indicated stroke symptoms as following: speech disorder 82%, paresthesiae on one side of the body 71%, weakness of arm or leg 55%, unsteady gait 55%, malaise 53%, monocular loss of vision 44%. The risk factors most frequently identified were hypertension 64%, stress 61%, smoking 59%, elevated lipids 53%, obesity 52%, coagulation disorder 47%, alcoholism 45%, low-physical activity 42%, elderly age 39%, cardiac diseases 38%, weather changes 34%, drugs 33% and diabetes 32%. If confronted with stroke signs 37% of respondents would consult the general practitioner and 31% would call 911 or go to a neurologist. Amongst patients with a risk factor, only diabetics were aware that their risk factor might cause stroke (P risk factors for stroke. The results of our study will help to create and plan programmes for improvement of public health in Croatia.

Estimating Renal Function in the Elderly Malaysian Patients Attending Medical Outpatient Clinic: A Comparison between Creatinine Based and Cystatin-C Based Equations

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Maisarah Jalalonmuhali

2018-01-01

Full Text Available Background. To assess the performance of different GFR estimating equations, test the diagnostic value of serum cystatin-C, and compare the applicability of cystatin-C based equation with serum creatinine based equation for estimating GFR (eGFR in comparison with measured GFR in the elderly Malaysian patients. Methods. A cross-sectional study recruiting volunteered patients 65 years and older attending medical outpatient clinic. 51 chromium EDTA (51Cr-EDTA was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA, four-variable Modification of Diet in Renal Disease (4-MDRD, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI equations using serum creatinine (CKD-EPIcr as well as serum cystatin-C (CKD-EPIcys were calculated. Results. A total of 40 patients, 77.5% male, with mean measured GFR 41.2±18.9 ml/min/1.73 m2 were enrolled. Mean bias was the smallest for 4-MDRD; meanwhile, CKD-EPIcr had the highest precision and accuracy with lower limit of agreement among other equations. CKD-EPIcys equation did not show any improvement in GFR estimation in comparison to CKD-EPIcr and MDRD. Conclusion. The CKD-EPIcr formula appears to be more accurate and correlates better with measured GFR in this cohort of elderly patients.

Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease.

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Hogan, D; Lan, L T T; Diep, D T N; Gallegos, D; Collins, P F

2017-02-01

Nutritional screening and assessment is not currently part of routine clinical practice in Vietnam. Therefore, the present study aimed to investigate the utility of the commonly used methods for identifying malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). A cross-sectional pilot study and a larger retrospective study were carried out in outpatients with COPD who were attending a respiratory clinic in Ho Chi Minh City, Vietnam. Routine clinical data were collected [body mass index (BMI), forced expiratory volume in 1 s (FEV 1 )]. Nutritional screening and assessment were performed using the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA) as the gold standard to diagnose malnutrition. In total, 393 outpatients had documented BMI and 29 were prospectively assessed using SGA: males, n = 25; females, n = 4; mean (SD) age 69.7 (9.6) years; mean (SD) BMI 21.0 (3.4) kg m -2 ; mean (SD) FEV 1 percentage predicted 57.0% (19.7%). Malnutrition risk was identified in 20.7% (n = 6) of patients using the MST (38% sensitivity; 94% specificity). However, 45% (n = 13) were diagnosed as malnourished using the SGA (31% mild/moderate; 14% severe). All malnourished patients not identified by the MST had evidence of muscle wasting. BMI had a strong negative correlation with muscle wasting as assessed using the SGA (r = -0.857, n = 28; P Vietnamese outpatients with COPD. A BMI threshold of <21 kg m -2 appears to represent a useful and pragmatic cut-off point for identifying outpatients requiring comprehensive nutritional assessment and support. © 2016 The British Dietetic Association Ltd.

Impact of animal-assisted therapy for outpatients with fibromyalgia.

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Marcus, Dawn A; Bernstein, Cheryl D; Constantin, Janet M; Kunkel, Frank A; Breuer, Paula; Hanlon, Raymond B

2013-01-01

Animal-assisted therapy using dogs trained to be calm and provide comfort to strangers has been used as a complementary therapy for a range of medical conditions. This study was designed to evaluate the effects of brief therapy dog visits for fibromyalgia patients attending a tertiary outpatient pain management facility compared with time spent in a waiting room. Open label with waiting room control. Tertiary care, university-based, outpatient pain management clinic. A convenience sample of fibromyalgia patients was obtained through advertisements posted in the clinic. Participants were able to spend clinic waiting time with a certified therapy dog instead of waiting in the outpatient waiting area. When the therapy dog was not available, individuals remained in the waiting area. OUTCOME MEASURES.: Self-reported pain, fatigue, and emotional distress were recorded using 11-point numeric rating scales before and after the therapy dog visit or waiting room time. Data were evaluated from 106 therapy dog visits and 49 waiting room controls, with no significant between-group demographic differences in participants. Average intervention duration was 12 minutes for the therapy dog visit and 17 minutes for the waiting room control. Significant improvements were reported for pain, mood, and other measures of distress among patients after the therapy dog visit, but not the waiting room control. Clinically meaningful pain relief (≥2 points pain severity reduction) occurred in 34% after the therapy dog visit and 4% in the waiting room control. Outcome was not affected by the presence of comorbid anxiety or depression. Brief therapy dog visits may provide a valuable complementary therapy for fibromyalgia outpatients. Wiley Periodicals, Inc.

Risky sexual behavior among married alcoholic men.

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Hall, Julie H; Fals-Stewart, William; Fincham, Frank D

2008-04-01

The current study explored whether the wives of men entering alcoholism treatment are at risk for sexually transmitted infections (STIs) exposure as a result of their husbands' sexual risk behaviors. The extramarital relationships of married alcoholic men entering outpatient treatment (n = 125) were compared with those of a demographically matched community sample of nonalcoholic married men (n = 125). The proportion of alcoholic men who reported 1 or more extramarital affairs in the previous year (14%) was significantly higher than that of the community sample (4%). Additionally, only 2 alcoholic husbands and 1 nonalcoholic husband reported that his wife was aware of the extramarital relationship. For both groups, none of the men who engaged in extramarital relationships reported consistent use of condoms when having sexual intercourse with their wives or with their extramarital partners. These results suggest that wives of alcoholic men are unknowingly placed at risk for indirect exposure to STIs as a result of their husbands' sexual risk behaviors. Thus, infidelity in treatment-seeking alcohol-abusing men represents a significant public health issue. (c) 2008 APA, all rights reserved.

Classification and clinical features of headache patients: an outpatient clinic study from China.

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Wang, Yunfeng; Zhou, Jiying; Fan, Xiaoping; Li, Xuelian; Ran, Li; Tan, Ge; Chen, Lixue; Wang, Kuiyun; Liu, Bowen

2011-10-01

This study aimed to analyze and classify the clinical features of headache in neurological outpatients. A cross-sectional study was conducted consecutively from March to May 2010 for headache among general neurological outpatients attending the First Affiliated Hospital of Chongqing Medical University. Personal interviews were carried out and a questionnaire was used to collect medical records. Diagnosis of headache was according to the International classification of headache disorders, 2nd edition (ICHD-II). Headache patients accounted for 19.5% of the general neurology clinic outpatients. A total of 843 (50.1%) patients were defined as having primary headache, 454 (27%) secondary headache, and 386 (23%) headache not otherwise specified (headache NOS). For primary headache, 401 (23.8%) had migraine, 399 (23.7%) tension-type headache (TTH), 8 (0.5%) cluster headache and 35 (2.1%) other headache types. Overall, migraine patients suffered (1) more severe headache intensity, (2) longer than 6 years of headache history and (3) more common analgesic medications use than TTH ones (p headaches than migraine patients, and typically headache frequency exceeded 15 days/month (p headache patients were defined as chronic daily headache. Almost 20% of outpatient visits to the general neurology department were of headache patients, predominantly primary headache of migraine and TTH. In outpatient headaches, more attention should be given to headache intensity and duration of headache history for migraine patients, while more attention to headache frequency should be given for the TTH ones.

Religious beliefs and alcohol control policies: a Brazilian nationwide study

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Giancarlo Lucchetti

2014-03-01

Full Text Available Objective: The connection between lower alcohol use and religiousness has been extensively examined. Nevertheless, few studies have assessed how religion and religiousness influence public policies. The present study seeks to understand the influence of religious beliefs on attitudes toward alcohol use. Methods: A door-to-door, nationwide, multistage population-based survey was carried out. Self-reported religiousness, religious attendance, and attitudes toward use of alcohol policies (such as approval of public health interventions, attitudes about drinking and driving, and attitudes toward other alcohol problems and their harmful effects were examined. Multiple logistic regression was used to control for confounders and to assess explanatory variables. Results: The sample was composed of 3,007 participants; 57.3% were female and mean age was 35.7 years. Religiousness was generally associated with more negative attitudes toward alcohol, such as limiting hours of sale (p < 0.01, not having alcohol available in corner shops (p < 0.01, prohibiting alcohol advertisements on TV (p < 0.01, raising the legal drinking age (p < 0.01, and raising taxes on alcohol (p < 0.05. Higher religious attendance was associated with less alcohol problems (OR: 0.61, 95%CI 0.40-0.91, p = 0.017, and self-reported religiousness was associated with less harmful effects of drinking (OR: 0.61, 95%CI 0.43-0.88, p = 0.009. Conclusions: Those with high levels of religiousness support more restrictive alcohol policies. These findings corroborate previous studies showing that religious people consume less alcohol and have fewer alcohol-related problems.

Developing, implementing and evaluating a model for an outpatient self-harm service.

Science.gov (United States)

Brand, Fiona; Lascelles, Karen

2017-05-10

Aim To reduce the incidence of self-harming behaviour and improve well-being and experience of care for individuals who present regularly to the emergency department in one hospital following self-harm, by providing outpatient care. Method This was a 12-month nurse-led practice development project to develop, implement and evaluate a brief-intervention outpatient service for individuals who presented to the emergency department following self-harm and who were identified as being at risk of further self-harm. The service improvement was informed by an action research process and the principles of appreciative inquiry. Findings The project provided a short-term outpatient follow-up service, known as Brief Interventions in Repeat Self Harm (BIRSH), to patients who presented to the emergency department following self-harm, and who were considered at risk of further self-harm. The intervention enabled the clinician to validate the patient's distress and offer them short-term outpatient follow-up care. The BIRSH sessions were offered to 38 patients. A total of 26 patients attended one or more BIRSH session, and all of these individuals showed a reduction in the number of presentations to the emergency department following self-harm in the six months following the intervention, compared to the six months before the intervention. Conclusion The BIRSH outpatient service appears to have been a contributory factor in reducing self-harm for patients who engaged with the service. The service improvement was informed by an action research process and the principles of appreciative inquiry, which provided a positive, focused approach to the practice development project.

Interpersonal Influence and Alcohol-Related Interventions in the College Environment.

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Thomas, Richard W.; Seibold, David R.

A study examined the interpersonal influence strategies reported by college students in two alcohol-related situations--a drunk driving intervention situation and a non-driving alcohol abuse situation. Subjects, 489 undergraduate students attending a large midwestern university, a large central midwestern university, or a mid-sized upper…

Assessing Whether Religious Behaviors and Positive and Negative Affect are Associated with Alcohol Use and Abuse Among a Sample of College Students Living in the Midwest.

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Carmack, Chakema C; Lewis, Rhonda K

2016-06-01

Alcohol use and abuse are a problem on college campuses. Religious behaviors (religious attendance, prayer, and importance) have been shown to be a protective factor against alcohol use among college students. This study examined the role religious behaviors and positive and negative affect had on drinking (alcohol use and alcohol to intoxication). College students (765) completed an online survey. The results showed that college students who attended religious services were less likely to use alcohol than those who did not attend religious services. The results have important implications for college administrators and policy makers. Limitations and future research will be discussed.

Gamma-glutamyltransferase, aspartate aminotransferase and alkaline phosphatase as markers of alcohol consumption in out-patient alcoholics

DEFF Research Database (Denmark)

Gluud, C; Andersen, I; Dietrichson, O

1981-01-01

and alkaline phosphatase in 18% and 7%. Neither the activity of gamma-glutamyltransferase, aspartate aminotransferase nor alkaline phosphatase showed any significant (P greater than 0.05) correlation with the history of alcohol consumption. The activities of gamma-glutamyltransferase and aspartate...

Alcohol Consumption and Injury among Canadian Adolescents: Variations by Urban-Rural Geographic Status

Science.gov (United States)

Jiang, Xuran; Li, Dongguang; Boyce, William; Pickett, William

2008-01-01

Context: The impact of alcohol consumption on risks for injury among rural adolescents is an important and understudied public health issue. Little is known about whether relationships between alcohol consumption and injury vary between rural and urban adolescents. Purpose: To examine associations between alcohol and medically attended injuries by…

The opinion of Greek parents on the advantages and disadvantages of the outpatient pediatric oncology setting.

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Matziou, Vasiliki; Servitzoglou, Marina; Vlahioti, Efrosini; Deli, Haralampia; Matziou, Theodora; Megapanou, Efstathia; Perdikaris, Pantelis

2013-12-01

The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward. The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010. According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000). According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Alcoholic ingestion and alcohol abuse in university students at Jequié-BA

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Marcos Henrique Fernandes

2008-01-01

Full Text Available Introduction: Epidemiologic researches about psychoactive substance use have shown an up-and-coming situation to abusive consumption of alcohol in adolescent and young-adult groups. This consumption over come the knowledge about damage caused by abusive of these substances, especially for the population part who is in the “top of life experiences”; the university students. Aim: To estimate the prevalence of the alcoholic ingestion and alcohol abuse in university students at Jequié-BA, and to verify the association between the alcoholic ingestion and alcohol abuse with the gender, race, smoking and graduation area. Methods: Prevalence study with probabilistic randomized sample (n = 129 of a population of 3,644 university students, registered in three universities. It was used a Questionnaire contends socio-demographic data, asking for the alcoholic ingestion and test CAGE to abuse. Results: It has been found prevalence of 63.6% to alcohol ingestion, 21.7% of high risk in abuse, and 8.5% of alcohol abuse. Although they have not been gotten association statistics between these variable and gender, race, graduation area and smoking; the data had demonstrated highest rates of alcohol abuse, and high risk in developing in students of masculine gender, medium brown race, who attend a graduation course in the health area. Those who have used of the tobacco had presented percentile greater of high risk in becoming alcohol consumer abusive. Conclusions: Intent for data found, as much alcohol ingestion as abuse, since they reflect the necessity of prevention politics to the alcoholic abusive ingestion in this population

Smoking and alcohol cessation intervention in relation to radical cystectomy

DEFF Research Database (Denmark)

Lauridsen, Susanne Vahr; Thomsen, Thordis; Kaldan, Gudrun

2017-01-01

BACKGROUND: Despite smoking and risky alcohol drinking being modifiable risk factors for cancer as well as postoperative complications, perioperative cessation counselling is often ignored. Little is known about how cancer patients experience smoking and alcohol interventions in relation to surgery....... Therefore the aim of this study was to explore how bladder cancer patients experience a perioperative smoking and alcohol cessation intervention in relation to radical cystectomy. METHODS: A qualitative study was conducted in two urology out-patient clinics. We conducted semi-structured in-depth interviews...... with 11 purposively sampled persons who had received the smoking and alcohol cessation intervention. The analysis followed the steps contained in the thematic network analysis. RESULTS: Two global themes emerged: "smoking and alcohol cessation was experienced as an integral part of bladder cancer surgery...

Assessment of Alcohol and Tobacco Use Disorders Among Religious Users of Ayahuasca

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Paulo Cesar Ribeiro Barbosa

2018-04-01

Full Text Available The aims of this study were to assess the impact of ceremonial use of ayahuasca—a psychedelic brew containing N,N-dimethyltryptamine (DMT and β-carboline —and attendance at União do Vegetal (UDV meetings on substance abuse; here we report the findings related to alcohol and tobacco use disorder. A total of 1,947 members of UDV 18+ years old were evaluated in terms of years of membership and ceremonial attendance during the previous 12 months. Participants were recruited from 10 states from all major regions of Brazil. Alcohol and tobacco use was evaluated through questionnaires first developed by the World Health Organization and the Substance Abuse and Mental Health Services Administration. Analyses compared levels of alcohol and tobacco use disorder between the UDV and a national normative sample (n = 7,939. Binomial tests for proportions indicated that lifetime use of alcohol and tobacco was higher in UDV sample compared to the Brazilian norms for age ranges of 25–34 and over 34 years old, but not for the age range of 18–24 years old. However, current use disorders for alcohol and tobacco were significantly lower in the UDV sample than the Brazilian norms. Regression analyses revealed a significant impact of attendance at ayahuasca ceremonies during the previous 12 months and years of UDV membership on the reduction of alcohol and tobacco use disorder.

Alcohol consumption and use of health care services in people with severe mental illness and stressful childhood experiences.

Science.gov (United States)

Schneeberger, Andres R; Huber, Christian G; Seixas, Azizi; Muenzenmaier, Kristina H; Lang, Undine E; Castille, Dorothy; Larkin, Stefan; Link, Bruce G

2017-01-01

People who suffer from severe mental illness often present with histories of abuse during childhood. Alcohol use disorders is a common co-morbidity of survivors of childhood abuse and neglect. This study analyzes the effects of stressful childhood experiences, a proxy for trauma, on the frequency of alcohol consumption and the utilization of health care services in a population of people with severe mental illness. There were 111 men (mean age: 35 years) and 72 women (mean age: 40.0 years) with severe mental illness that were recruited from psychiatric outpatient clinics in New York City. The analysis focused on lifetime prevalence of stressful childhood experiences, alcohol consumption, and utilization of health care services over time. The longitudinal data were analyzed over 12 months with a level-2 model (multilevel modeling). Out of the participants, 41.5% reported a history of more than four types of abusive experiences. There were 33.3% that had a DSM-IV diagnosis of alcohol abuse and 27.3% qualified for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of alcohol dependence throughout their lives. Stressful childhood experiences predicted an increased frequency of alcohol consumption over time. People with histories of childhood abuse had more often been to outpatient clinics and 12-step programs, but at the same time showed lower frequency rates of psychiatrist visits and visits to outpatient clinics. Childhood abuse is prevalent in people with severe mental illness and is related to an increased alcohol consumption. Despite an increased need of health care services, affected persons might encounter more barriers to access them.

Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

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Shantna Kumari

2014-01-01

Full Text Available Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP. Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalized. The study sample included 130 patients receiving outdoor treatment from a Psychiatric Hospital and a matched group of 140 patients receiving treatment from COP of the same hospital. Demographic and clinical details of the patients were recorded on a specially designed proforma. Modified felt stigma scale and Rosenberg self-esteem scale were used to assess stigma and self-esteem, respectively. Results: On the modified felt stigma scale, the mean (±standard deviation [SD] score of psychiatric hospital outpatients (31.89 ± 6.51 was significantly higher than the scores of patients attending COP (29.20 ± 6.80. On Rosenberg self-esteem scale, mean (±SD scores of patients with psychosis (17.98 ± 1.69 was significantly lower compared to scores of patients with epilepsy (21.83 ± 1.60. There was no significant correlation between stigma and self-esteem. Conclusion: As psychiatric hospital outpatients have significantly more self-stigma when compared to patients attending community outreach camps, the availability of more community outreach camps along with educating people about psychiatric illnesses may help in lowering stigma of psychiatric disorders.

Prevalence of Internet use amongst an elective spinal surgery outpatient population.

Science.gov (United States)

Baker, Joseph F; Devitt, Brian M; Kiely, Paul D; Green, James; Mulhall, Kevin J; Synnott, Keith A; Poynton, Ashley R

2010-10-01

Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these. We distributed a self-designed questionnaire to patients attending elective spinal outpatient clinics. Data including demographics, history of surgery, number of visits, level of satisfaction with previous consultations, access to the internet, possession of health insurance, and details regarding use of the internet to research one's spinal complaint were collected. 213 patients completed the questionnaire. 159 (75%) had access to the internet. Of this group 48 (23%) used the internet to research their spinal condition. Increasing age, higher education level, and possession of health insurance were all significantly associated with access to the internet (p internet use while possession of insurance weakly predicted non-use (p internet access is consistent with national statistics and use is comparable to previous reports. Approximately, one quarter of outpatients will use the internet to research their spinal condition. Should we use this medium to disseminate information we need to be aware some groups may not have access.

Prevalence of Internet use amongst an elective spinal surgery outpatient population.

LENUS (Irish Health Repository)

Baker, Joseph F

2010-10-01

Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these. We distributed a self-designed questionnaire to patients attending elective spinal outpatient clinics. Data including demographics, history of surgery, number of visits, level of satisfaction with previous consultations, access to the internet, possession of health insurance, and details regarding use of the internet to research one\\'s spinal complaint were collected. 213 patients completed the questionnaire. 159 (75%) had access to the internet. Of this group 48 (23%) used the internet to research their spinal condition. Increasing age, higher education level, and possession of health insurance were all significantly associated with access to the internet (p < 0.05). A higher education level predicted greater internet use while possession of insurance weakly predicted non-use (p < 0.05). In our practice, internet access is consistent with national statistics and use is comparable to previous reports. Approximately, one quarter of outpatients will use the internet to research their spinal condition. Should we use this medium to disseminate information we need to be aware some groups may not have access.

Mental Health and Substance Use Characteristics of Flight Attendants Enrolled in an In-Patient Substance Abuse Treatment Program

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Horton, Gail; Diaz, Naelys; McIlveen, John; Weiner, Michael; Mullaney, Donald

2011-01-01

The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol dependency than drug dependency. A high proportion of participants reported clinical levels of…

The association between nutritional status and frailty characteristics among geriatric outpatients.

Science.gov (United States)

Kurkcu, M; Meijer, R I; Lonterman, S; Muller, M; de van der Schueren, M A E

2018-02-01

Frailty is a common clinical syndrome in older adults and is associated with an increased risk of poor health outcomes, e.g. falls, disability, hospitalization, and mortality. Nutritional status might be an important factor contributing to frailty. This study aims to describe the association between nutritional status and characteristics of frailty in patients attending a geriatric outpatient clinic. Clinical data was collected of 475 patients who visited the geriatric outpatient department of a Dutch hospital between 2005 and 2010. Frailty was determined by: incontinence, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Nutritional status was represented by the Mini Nutritional Assessment (MNA) and plasma concentrations of several micronutrients, whereby MNAnutritional status could prove usefulness in early clinical detection and prevention of frailty. Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Prevalence of hypertension and its risk factors among individuals attending outpatient department of rural health training centre, Haldwani

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Janki Bartwal

2014-03-01

Full Text Available Introduction: Hypertension is one of the major health and development challenges of the 21st century, which, for most countries, has developed together with rapid cultural and social changes, ageing populations, increasing urbanization, dietary changes, reduced physical activity, and other unhealthy behaviours. Objectives: 1 To find out the prevalence of Hypertension in study subjects 2 To identify the risk factors associated with Hypertension. Materials and Methods: A Cross-sectional study was carried out among 369 individuals of 30 years and above attending Out Patient Department (OPD in Rural Health Training Centre (RHTC under the Department of Community Medicine, Government Medical College, Haldwani during June 2013-August 2013. A pretested predesigned questionnaire was used to collect demographic data by interview technique .The blood pressure was recorded and classified using JNC VII criteria to grade hypertension. Data was compiled, entered & analyzed using SPSS version 20. Results: Among 369 patients, the prevalence of hypertension was 41.7%; out of this, 28.7% were aware of their hypertensive status while 13% were newly diagnosed cases. The association between hypertension with increase in age, family history of hypertension, increase salt intake, consuming mixed diet, increase waist circumference, waist hip ratio and body mass index was found significant. Physical inactivity, gender, tobacco and alcohol consumption were not significantly associated with hypertension. Conclusions: The prevalence of hypertension in rural area is relatively high. Extensive efforts are required for raising the awareness level & regular screening of high-risk population is recommended for preventing the complications & disability.

[Alcohol dependence in homeless men. Incidence, development and determinants].

Science.gov (United States)

Dufeu, P; Podschus, J; Schmidt, L G

1996-11-01

Against the background of the complex relationship of alcoholism and homelessness, we investigated the question of whether homeless alcoholics and those with homes differed regarding biographical and clinical variables. Therefore, 49 of 72 (68.1%) homeless male visitors to a city kitchen in the center of Berlin, who had fulfilled the ICD-10 criteria for the alcohol-dependence syndrome, were compared with 141 outpatients of the addiction research unit of the Department of Psychiatry of the Free University of Berlin. It was found that homeless alcoholics had more psychosocial disadvantages than other alcoholics. They had been raised more frequently in families with an alcoholic father or mother and a higher number of children. The level of education and job qualification was lower in the homeless alcoholics. Early homelessness was predicted by a lack of sexual behavior (no partnership experienced) and a family history of alcoholism. In the interview, homeless alcoholics reported fewer symptoms of alcohol-dependence syndrome than other alcoholics; however, the first symptoms had been experienced earlier. Alcohol-related somatic and psychological consequences were reported more frequently in alcoholics with homes, whereas social problems were more common in the homeless subjects. The results are discussed in the light of methodological limitations and other reports on the topic.

Change in alcohol outlet density and alcohol-related harm to population health (CHALICE

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Fone David

2012-06-01

Full Text Available Abstract Background Excess alcohol consumption has serious adverse effects on health and violence-related harm. In the UK around 37% of men and 29% of women drink to excess and 20% and 13% report binge drinking. The potential impact on population health from a reduction in consumption is considerable. One proposed method to reduce consumption is to reduce availability through controls on alcohol outlet density. In this study we investigate the impact of a change in the density of alcohol outlets on alcohol consumption and alcohol-related harms to health in the community. Methods/Design A natural experiment of the effect of change in outlet density between 2005–09, in Wales, UK; population 2.4 million aged 16 years and over. Data on outlets are held by the 22 local authorities in Wales under The Licensing Act 2003. The study outcomes are change in (1 alcohol consumption using data from annual Welsh Health Surveys, (2 alcohol-related hospital admissions using the Patient Episode Database for Wales, (3 Accident & Emergency department attendances between midnight–6am, and (4 alcohol-related violent crime against the person, using Police data. The data will be anonymously record-linked within the Secure Anonymised Information Linkage Databank at individual and 2001 Census Lower Super Output Area levels. New methods of network analysis will be used to estimate outlet density. Longitudinal statistical analysis will use (1 multilevel ordinal models of consumption and logistic models of admissions and Accident & Emergency attendance as a function of change in individual outlet exposure, adjusting for confounding variables, and (2 spatial models of the change in counts/rates of each outcome measure and outlet density. We will assess the impact on health inequalities and will correct for population migration. Discussion This inter-disciplinary study requires expertise in epidemiology and public health, health informatics, medical statistics

Helicobacter pylori in out-patients of a general practitioner

DEFF Research Database (Denmark)

Rothenbacher, D; Bode, G; Winz, T

1997-01-01

Data on prevalence and determinants of Helicobacter pylori infection in well-defined populations are scarce. We investigated the prevalence and determinants of active H. pylori infection in a population of out-patients attending a general practitioner in Southern Germany. Infection status.......4%). Prevalence of H. pylori infection increased with age from 10.8% (95% CI 5.7-18.1%) in the age group 15-29 years to 30.8% (95% CI 22.1-40.6%) in the age group 60-79 years and was 20.3%, 30.4% and 28.2% for the age groups 30-39, 40-49 and 50-59 years, respectively. Education and childhood living conditions...

Hospital admission and mortality rates in anorexia nervosa: experience from an integrated medical-psychiatric outpatient treatment.

Science.gov (United States)

De Filippo, E; Signorini, A; Bracale, R; Pasanisi, F; Contaldo, F

2000-12-01

To evaluate the effectiveness of an integrated medical-psychiatric treatment of major eating disorders. Historical cohort study. Outpatient Unit for Protein Energy Malnutrition of the Department of Clinical and Experimental Medicine, "Federico II" University of Naples, time of study: January 1994 to December 1997 PARTICIPANTS: 147 female patients with restrictive or bulimic anorexia nervosa (mean age 19.8 +/- 13.7, BMI 14.7 +/- 2.1 Kg/m2) consecutively attending the outpatient unit between January 1994 and December 1997. Hospitalization and mortality rates were evaluated up to Jan 1999 with a minimum follow-up of 18 months. There were 23 admissions to the Clinical Nutrition ward for 19 patients (i.e. 12.9%) mostly due to severe protein energy malnutrition, and 2 deaths, only 1 strictly related to anorexia (mortality rate 0.7%). Integrated outpatient medical-psychiatric treatment for major eating disorders is an effective and inexpensive procedure that reduces mortality and admissions due to medical complications in the medium term.

Pregnant Women and Alcohol Use in the Bosomtwe District of the ...

African Journals Online (AJOL)

Drinking alcohol in pregnancy is a serious public health concern worldwide. This study sought to determine the magnitude and socio-demograhic characteristics of pregnant women attending Antenatal clinic in the Bosomtwe district, Ghana who drank alcohol and to assess their general knowledge about the effects of ...

Alcohol Use and Antisocial Behavior in Late Adolescence: Characteristics of a Sample Attending a GED Program

Science.gov (United States)

Owens, Meredith Reesman; Bergman, Andrea

2010-01-01

This study examined peer deviance, disinhibition, and ADHD symptoms as differential predictors of alcohol use, alcohol use disorder symptoms, and antisocial behavior. It was hypothesized that peer deviance would most strongly predict alcohol use while disinhibition and ADHD would predict alcohol use disorder symptoms and antisocial behavior.…

Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh

OpenAIRE

Rukhsana Parvin; Shekhar Bhattacharjee; Swapna Bhattacharjee

2013-01-01

Background: Cough variant asthma (CVA) is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional...

Moderating Effects of Positive Parenting and Maternal Alcohol Use on Emerging Adults’ Alcohol Use: Does Living At Home Matter?

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Cleveland, Michael J.; Reavy, Racheal; Mallett, Kimberly A.; Turrisi, Rob; White, Helene R.

2014-01-01

Positive parenting behaviors and parental modeling of alcohol use are consistent predictors of offspring’s alcohol use. Recent research extends these findings to emerging adult children and confirms continued parental influence beyond adolescence. This paper examines how maternal warmth and supervision moderate the effects of mother’s heavy alcohol use on their offspring’s alcohol use among a sample of non-college-attending emerging adults. Three-way interactions were used to examine if these moderating effects differed between emerging adults who lived at home and those with other living arrangements. Separate analyses within gender were used to further examine these associations. Participants were 245 emerging adults between ages 18–22 years with no post-secondary education (59% female) who were selected from a national probability-based Internet panel. Path analyses indicated that, regardless of living arrangements, male emerging adults who were more likely to witness their mother getting drunk were themselves more likely to engage in risky drinking. However, among female emerging adults, similarity between mothers’ and daughters’ drunkenness was strongest among participants who resided with their family and also reported low levels of maternal warmth. This study extends previous research by indicating that the effects of maternal modeling of heavy alcohol use on emerging adults’ heavy alcohol use depend upon several factors, including the gender of the child and the family context. Implications of the study findings are discussed in terms of expanding the scope of a parent-based intervention (PBI) to all emerging adults, including those who do not attend colleges or universities. PMID:24583277

[Comorbidity of panic disorder and alcoholism in a sample of 100 alcoholic patients].

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Segui, J; Salvador, L; Canet, J; Herrera, C; Aragón, C

1994-01-01

Among one hundred patients with alcohol dependence (DSM-III-R) studied in a drug abuse center in the "Bajo Llobregat" area (Barcelona industrial belt it was detected that 27% had life time rate of panic disorder. The age of onset of alcoholism was earlier than the one for panic disorder. In 78.8% of these patients alcoholismo appeared first. 70.4% refer worsening of the panic attacks when drinking large amounts of alcohol. Patients with Panic Disorder: a) are younger (p < 0.05); b) have attended school longer and have higher education (p < 0.01); c) have more alcoholism family history (p < 0.05); d) have more major depressive disorders (0.05) and dysthimic disorder (p < 0.01); e) Worse social functioning according to the GAS (p < 0.01); f) higher score for the Psychological disorders Scale (p < 0.001) and a lower performance at work (p < 0.001) measured by the ASI. The clinical significance of these findings is discussed.

Efficacy of Outpatient Aftercare for Adolescents with Alcohol Use Disorders: A Randomized Controlled Study

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Kaminer, Yifrah; Burleson, Joseph A.; Burke, Rebecca H.

2008-01-01

The effectiveness of active aftercare for adolescents with alcohol use disorders in maintaining treatment gains is evaluated. Findings show that active aftercare interventions were effective in slowing the posttreatement relapse of alcohol use in adolescents. Impacts of active aftercare on number of drinking days and heavy drinking days are also…

Cross-border policy effects on alcohol outcomes: drinking without thinking on the u.s.-Mexico border?

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Mills, Britain A; Caetano, Raul; Vaeth, Patrice

2014-11-01

Rates of alcohol-related outcomes are sensitive to policy differences in politically distinct, adjacent territories. Factors that shape these cross-border effects, particularly when the policy differences are longstanding, remain poorly understood. We compared the ability of 2 classes of variables with theoretical relevance to the U.S.-Mexico border context-bar attendance and alcohol-related social-cognitive variables-to explain elevated drinking on the U.S. side of the border relative to other areas of the United States. Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). Structural equation models were used to test drinking context (frequency of bar attendance) and 6 different social-cognitive variables (including alcohol-related attitudes, norms, motives, and beliefs) as mediators of border effects on a composite drinking index. The border effect on drinking varied by age (with younger adults showing a stronger effect), consistent with previous findings and known risk factors in the region. Contrary to theoretical expectations, 6 different social-cognitive variables-despite relating strongly with drinking-were comparable in border and nonborder areas (within and across age) and played no role in elevated drinking on the border. Conversely, elevated drinking among border youth was mediated by bar attendance. This mediated moderation effect held after adjusting for potential sociodemographic and neighborhood-level confounders. Increased drinking among U.S.-Mexico border youth is explained by patterns of bar attendance, but not by more permissive alcohol-related social-cognitive variables in border areas: Border youth attend bars and drink more than their nonborder counterparts, despite having comparable alcohol-related beliefs, attitudes, norms, and motives for use. Alcohol's heightened availability and visibility on both sides of the border may create opportunities for

Compulsory treatment of 50 alcoholic drunken drivers

African Journals Online (AJOL)

1983-02-12

Feb 12, 1983 ... Fifty alcoholic drunken drivers receivi~g treatment as part of a suspended ... rehabilitation centres (1 patient died too early to allow for adequate .... Prison sentences were imposed on 10 (of whom 1 subsequently re-attended ...

The ties that bind: bonding versus bridging social capital and college student party attendance.

Science.gov (United States)

Buettner, Cynthia K; Debies-Carl, Jeffrey S

2012-07-01

This study explored the relationship between bonding and bridging social capital and college student attendance at alcohol-present parties, a common method for building informal social networks. A random sample of students (n = 6,291; 52% female) from a large public midwestern university completed a survey regarding their alcohol use and party-related behaviors on targeted weekends. The survey also included questions regarding students' living arrangements, romantic relationships, and membership in student and community organizations. Based on a dichotomous logistic regression analysis, we concluded that the act of attending parties largely serves as a complement to, rather than a substitute for, more conventional and formal social capital. Membership in bonding groups is associated with increased odds of party attendance, and bridging exerts no direct effect on party attendance. However, bridging capital does mitigate the effect of bonding capital, reducing its apparent tendency to promote or contribute to partying. Off-campus parties may offer an informal supplement to more conventional social capital as students establish themselves in their new context. These findings may have implications for structural decisions (e.g., number of roommates) as well as the design of context-based prevention programs that address students' need to quickly build social capital without exposing both themselves and the students around them to the harms associated with high-risk drinking.

The current situation of treatment systems for alcoholism in Korea.

Science.gov (United States)

Kim, Jee Wook; Lee, Boung Chul; Kang, Tae-Cheon; Choi, Ihn-Geun

2013-02-01

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.

Prescription of hypnotics and tranquilisers at the Geneva prison's outpatient service in comparison to an urban outpatient medical service.

Science.gov (United States)

Elger, Bernice S; Goehring, Catherine; Revaz, Sylvie Antonini; Morabia, Alfredo

2002-01-01

Examine whether an overconsumption of tranquillizers exists in prison and discuss possible reasons. Comparative study during three weeks at Geneva: prison outpatient service and Medical Policlinic (MP) of the University Hospital. When comparing the 113 (prison) and 151 (MP) male patients younger than 39 years, we found important differences concerning the quality and quantity of prescriptions of psychoactive drugs: ten times more prison patients than patients from the MP were treated with benzodiazepines (BZD). The differences persisted even when considering only prisoners who were not known to be street drug, alcohol or long time BZD consumers. The differences cannot be explained by the high percentage of drug addicts in prison. Our results suggest the importance of factors related to the prison environment.

Alcohol use behaviors among pharmacy students.

Science.gov (United States)

Oliver, Wesley; McGuffey, Grant; Westrick, Salisa C; Jungnickel, Paul W; Correia, Christopher J

2014-03-12

To identify reasons for drinking, determine the patterns of alcohol abuse, and explore relationships between drinking motives and alcohol abuse patterns in pharmacy students. A cross-sectional anonymous, voluntary, self-administered paper survey instrument was administered to first-year (P1) through third-year (P3) pharmacy students as part of a professional seminar. Survey instruments were completed by 349 pharmacy students (95.9% cooperation rate). Using the Alcohol Use Disorders Identification Test criteria, 23.2% of students reported hazardous or harmful use and 67.2% of students reported consuming alcohol at hazardous levels during the past year. Students who were male (37.0%), single (25.3%), and attended the main campus (26.2%) were more likely than their counterparts to report hazardous or harmful alcohol use. Pharmacy students reported social motives as the most common reason for drinking; however, coping and enhancement motives were more predictive of harmful or hazardous alcohol use. Approximately 1 in 4 pharmacy students (23%) reported hazardous or harmful alcohol use. Education about the dangers of alcohol abuse and intervention programs from colleges and schools of pharmacy are recommended to help address this issue.

Effects of tooth scaling reminders for dental outpatients.

Science.gov (United States)

Cheng, Chi-Chia J; Li, Chung-Yi; Hu, Yih-Jin; Shen, Hsi-Che; Huang, Shay-Min

2013-06-01

We investigated the effect of sending reminders for patients to attend appointments for tooth scaling. A total of 389 outpatients were assigned to three intervention groups (reminders sent by postcard, mobile-phone text message or telephone call) and one control group. Reminders accompanied by short health education messages were sent to patients in each of the intervention groups. The outpatient revisiting behaviour of the patients was monitored. Patients who were reminded to come in for tooth scaling were 2.6 (95% CI 1.3-5.4) to 2.9 (CI 1.1-7.8) times more likely to revisit compared to those who were not reminded. For every one point increase in the patient satisfaction score, patients were 3.8 (CI 1.2-11.6) times more likely to revisit. Patients with a high level of patient satisfaction and who had also received a reminder had the highest return rates (26%). Most patients (89-96%) had good feelings regarding the reminders; 65% of the patients agreed that reminders had enhanced their intention to revisit; 91% of patients hoped to continue to receive reminders concerning broader dental health information. A reminder combined with health education is an effective way of improving preventative dental visiting behaviour.

Pathological narcissism and somatic symptoms among men and women attending an outpatient mental health clinic.

Science.gov (United States)

Kealy, David; Tsai, Michelle; Ogrodniczuk, John S

2016-09-01

To explore the relationship between types of pathological narcissism and somatic symptoms among psychiatric outpatients. Patients (N = 95) completed measures of somatic symptoms, narcissistic grandiosity and vulnerability, and psychiatric symptoms. Relationships among variables were analysed using t-tests and correlations, controlling for psychiatric distress. Somatic symptoms were positively associated with two types of narcissistic dysfunction. Among women there was a positive association between somatic symptoms and narcissistic vulnerability, but not grandiosity. Among men, somatic symptoms were positively associated with narcissistic grandiosity, but not vulnerability. The connection between narcissistic pathology and somatic symptom severity appears to differ based on gender. Further research is needed to confirm and extend this preliminary finding.

Lived Experience of Thai Women with Alcohol Addiction

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Kulnaree Hanpatchaiyakul, Ph.D., RN

2017-12-01

Full Text Available Summary: Purpose: This study explored the lived experiences of Thai women in relation to alcohol addiction in treatment. Methods: Twelve women aged 20 to 65 years, were participated. The participants were recruited from two special hospitals and one outpatient clinic in a general hospital. Descriptive phenomenology was applied to analyze the transcripts of the individual interviews. Result: The explored phenomenon of Thai women experiencing alcohol addiction included four essential aspects, (1 feeling inferior and worthless (2 feeling physically and emotionally hurt, (3 fearing physical deterioration and premature death, and (4 feeling superior and powerful. Through these different aspects of Thai women's lived experiences, the following essence was synthesized. The essence of the lived experience of alcohol addiction among the studied Thai women was ambivalence between feeling inferior and worthless and feeling superior and powerful when acting as a man. Drinking alcohol lessened life's difficulties and fears; for example, of violence, bodily demolition, premature death and marginalization from family and society. Conclusion: Thai women who experience alcohol addiction are treated with gender-related double standards when trying to undo gender traditional roles. Their marginalization from family and society deepens making them even more vulnerable to the positive side effects of alcohol drinking. Keywords: alcoholism, alcohol drinking, gender identity, violence

Limited referral to nephrologists from a tertiary geriatric outpatient clinic despite a high prevalence of chronic kidney disease and anaemia

Directory of Open Access Journals (Sweden)

Boudville Neil

2012-08-01

Full Text Available Abstract Background Chronic kidney disease (CKD is increasing in prevalence world-wide with the largest growth being in the elderly. The aim of this study was to examine the prevalence of CKD in a geriatric outpatient clinic within a tertiary hospital and its association with anaemia and mortality with a focus on the referral patterns towards nephrologists. Methods Retrospective study utilising administrative databases. The cohort was defined as all patients that attended the geriatric outpatient clinics of a single tertiary hospital within the first 3 months of 2006. Patients were followed for 18 months for mortality and referral to a nephrologist. Results The mean Glomerular filtration rate (eGFR of the 439 patients was 67.4 ± 29.1 mL/min/1.73 m2 (44% 2. 11.8% had a haemoglobin 2 (p = 0.0092. Kidney function and anaemia were significantly associated with mortality on multivariate analysis (p = 0.019 and p = 0.0074. After 18 months, 8.8% of patients with CKD were referred to a nephrologist. Conclusion Despite a high prevalence of CKD in patients attending a geriatric outpatient clinic and its association with anaemia and mortality, few of these patients were referred to a nephrologist. An examination of the reasons behind this bias is required.

Mixing an energy drink with an alcoholic beverage increases motivation for more alcohol in college students.

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Marczinski, Cecile A; Fillmore, Mark T; Henges, Amy L; Ramsey, Meagan A; Young, Chelsea R

2013-02-01

There has been a dramatic rise in the consumption of alcohol mixed with energy drinks (AmEDs) in social drinkers. It has been suggested that AmED beverages might lead individuals to drink greater quantities of alcohol. This experiment was designed to investigate whether the consumption of AmEDs would alter alcohol priming (i.e., increasing ratings of wanting another drink) compared with alcohol alone. Participants (n = 80) of equal gender attended 1 session where they were randomly assigned to receive 1 of 4 doses (0.91 ml/kg vodka, 1.82 ml/kg energy drink, 0.91 ml/kg vodka mixed with 1.82 ml/kg energy drink [AmED], or a placebo beverage). Alcohol-induced priming of the motivation to drink was assessed by self-reported ratings on the Desire for Drug questionnaire. The priming dose of alcohol increased the subjective ratings of "desire" for more alcohol, consistent with previous research that small doses of alcohol can increase the motivation to drink. Furthermore, higher desire ratings over time were observed with AmEDs compared with alcohol alone. Finally, ratings of liking the drink were similar for the alcohol and AmED conditions. An energy drink may elicit increased alcohol priming. This study provides laboratory evidence that AmED beverages may lead to greater motivation to drink versus the same amount of alcohol consumed alone. Copyright © 2012 by the Research Society on Alcoholism.

Food insecurity and alcohol use among pregnant women at alcohol-serving establishments in South Africa.

Science.gov (United States)

Eaton, Lisa A; Pitpitan, Eileen V; Kalichman, Seth C; Sikkema, Kathleen J; Skinner, Donald; Watt, Melissa H; Pieterse, Desiree; Cain, Demetria N

2014-06-01

South Africa has the highest rate of fetal alcohol syndrome (FAS) in the world. While efforts have been made to curb the high rate of FAS, little is known about situational factors that may contribute to alcohol use during pregnancy. In the current paper, we focus on the role of food insecurity and its relationship to alcohol use among pregnant women. Women completed computer-assisted interviews. Generalized linear modeling was used in all analyses. Women attending alcohol-serving establishments in a township in Cape Town, South Africa were recruited for the study. Five hundred sixty women were sampled and 95 women reported being pregnant. High levels of alcohol use were reported among pregnant women: 65 % of women consumed alcohol at least every month and 29 % consumed alcohol as often as two to three times per week. Thirty-four percent of the women reported having six or more drinks per occasion on at least a weekly basis. The majority (87 %) of pregnant women reported experiencing some form of food insecurity (e.g., food unavailable, eating less) in the past month. Alcohol use was significantly associated with food insecurity, even when controlling for relevant demographic variables. Intervention with pregnant women who consume alcohol is urgently needed. Future research should focus on understanding the intersection of food insecurity and alcohol, and how the experience of food insecurity may contribute to greater rates of alcohol use and abuse among pregnant women.

Top priorities for alcohol regulators in the United States: protecting public health or the alcohol industry?

Science.gov (United States)

Mart, Sarah M

2012-02-01

This paper describes alcohol industry involvement in the 2010 annual conference proceedings of the National Conference of State Liquor Administrators (NCSLA) in the United States. The author attended the conference, observed conference attendees and panelists and identified key themes in the panel sessions. The NCSLA Annual Meeting took place 20-24 June 2010 in New Orleans, Louisiana. NCSLA meeting attendees and panelists were professionals from state alcohol control systems; federal government agencies; and companies representing the alcohol industry. The total number of conference attendees and participants were counted as well as the number of attendees and participants from regulator, industry and public health sectors. More than two-thirds (72.2%) of the 187 conference attendees were from alcohol producers, importers, wholesalers, retailers or their attorneys. Nearly two-thirds (65.0%) of the 40 panelists were from the alcohol industry. The author of this paper was the only attendee, and the only panelist, representing public health policy. The National Conference of State Liquor Administrators in the United States is dominated by the global companies that produce, import, distribute and sell alcohol, highlighting a lack of public health considerations within the Association's liquor control agenda [corrected]. © 2012 Alcohol Justice.

Does alcohol increase the risk of preterm delivery?

DEFF Research Database (Denmark)

Kesmodel, Ulrik; Olsen, Sjúrður Fróði; Secher, Niels Jørgen

2000-01-01

We evaluated the association between alcohol intake during pregnancy and preterm delivery. Women attending routine antenatal care at Aarhus University Hospital, Denmark, from 1989–1991 and 1992–1996 were eligible. We included 18,228 singleton pregnancies in the analyses. We obtained prospective...... information on alcohol intake at 16 and 30 weeks of gestation, other lifestyle factors, maternal characteristics, and obstetrical risk factors from self-administered questionnaires and hospital files. For women with alcohol intake of 1–2, 3–4, 5–9, and >=10 drinks/week the risk ratio (RR) of preterm delivery...

Sexual dysfunction in men with alcoholic liver cirrhosis. A comparative study

DEFF Research Database (Denmark)

Jensen, S B; Gluud, C

1985-01-01

Sexual dysfunction in men with alcoholic cirrhosis was investigated in young (less than 56 years) outpatients with steady female partners. Sixty-one per cent (11/18) claimed sexual dysfunction, with erectile dysfunction and/or reduced sexual desire being the most common symptoms. Comparing patien...... less than 0.025) raised prevalence of sexual dysfunction when compared to men without chronic disease (matched for age and duration of partnership).......Sexual dysfunction in men with alcoholic cirrhosis was investigated in young (less than 56 years) outpatients with steady female partners. Sixty-one per cent (11/18) claimed sexual dysfunction, with erectile dysfunction and/or reduced sexual desire being the most common symptoms. Comparing patients...... with (n = 11) and without (n = 7) sexual dysfunction, no significant differences were found concerning a number of pertinent clinical variables. This should be interpreted with caution, however, owing to the small number of patients in each group. The prevalence and type of sexual dysfunction were...

Attendance at Prescribed Pelvic Floor Physical Therapy in a Diverse, Urban Urogynecology Population.

Science.gov (United States)

Shannon, Megan Brady; Genereux, Madeleine; Brincat, Cynthia; Adams, William; Brubaker, Linda; Mueller, E R; Fitzgerald, Colleen M

2017-11-11

Pelvic floor physical therapy (PFPT) is a common and effective treatment for several pelvic floor disorders, but there is limited knowledge about adherence to the therapy or what factors influence attendance. To determine rates of PFPT attendance (initiation and completion) as well as correlates of PFPT attendance. Retrospective cohort analysis. Urban outpatient clinics at a tertiary medical center treating women with pelvic floor disorders. Patients prescribed PFPT during the time period January 1, 2014, through January 1, 2015. Number of PFPT visits recommended and attended; diagnoses associated with PFPT referral. Two-thirds of participants (66%; 118/180) initiated PFPT but less than one-third (29%; 52/180) completed the full treatment course. On univariate analysis, age, body mass index, diagnosis requiring PFPT treatment, marital or employment status, insurance type, number of comorbidities, incontinence status on examination, and stage of prolapse did not differ between PFPT initiators and noninitiators. Those who self-identified as Hispanic were less likely to initiate PFPT when compared with non-Hispanic patients, although this only trended toward significance (odds ratio 0.40, 95% confidence interval 0.14-1.09; exact P = .078). Two thirds (66%) of patients initiated PFPT but less than one third (29%) completed the treatment course. There appears to be an opportunity to augment PFPT attendance, as well as explore racial disparities in attendance. To be determined. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Is alcohol more dangerous than heroin? The physical, social and financial costs of alcohol.

Science.gov (United States)

Lee, Geraldine A; Forsythe, Marcus

2011-07-01

A recent paper claimed in its classification of harmful substances, that alcohol is more dangerous than heroin. This paper aims to weigh up some of the evidence in the literature on the physical, social and financial effects of alcohol and the associated disease burden. We will also explore alcohol within the context of emergency department (ED) presentations. Reasons for ED attendance can be overtly and directly alcohol related such as alcohol intoxication, assaults, injuries and falls and indirectly such as child neglect, psychological problems and chronic diseases. Alcohol is often viewed as an isolated incident or factor for ED presentations but there are data that refute this perception. In ED, the priority is to treat the patient and their primary complaint, however it may be appropriate to screen for alcohol use, give advice and potentially offer an intervention to the patient. With the recent UK and Australian guidelines on reducing health risks from drinking alcohol, the ED has the ability to play an active role in reducing the harmful effects of alcohol through screening, advising and undertaking intervention as appropriate. However this cannot be achieved in isolation but within the broader political and health policy framework. There is now a growing body of literature supporting the need to make alcohol less affordable, less easy to buy and reducing alcohol advertising. Although alcohol is a legal substance, this paper concludes that examining the wider effects in physical, social and financial terms, alcohol is more dangerous than heroin. It has become an endemic problem in society affecting the individual and the whole community. Copyright © 2011 Elsevier Ltd. All rights reserved.

Iron deficiency anaemia in reproductive age women attending obstetrics and gynecology outpatient of university health centre in Al-Ahsa, Saudi Arabia.

Science.gov (United States)

Taha, Asia; Azhar, Saira; Lone, Talib; Murtaza, Ghulam; Khan, Shujaat Ali; Mumtaz, Amara; Asad, Muhammad Hassham Hassan Bin; Kousar, Rozina; Karim, Sabiha; Tariq, Imran; Ul Hassan, Syed Saeed; Hussain, Izhar

2014-01-01

Iron deficiency is the most common nutritional disorder in the world. The aim of this questionnaire based survey study was to determine the prevalence of iron deficiency anemia in reproductive age women, and their relation to variables such as age, marital status, education with those attending obstetrics and gynecology outpatient of King Faisal University Health Centre in Al-Ahsa in eastern region of Kingdom of Saudi Arabia. This study was conducted for the period of 6 month staring from September 2012 to February 2013. The questionnaire had three sections on personal information: their educational indicators, gynecological clinical history, and hematological indices. The average age was 25.97±7.17 years. According to the gynecological clinical history of the respondents, 15 (48.4%) respondents were pregnant while 16 (51.6%) were not pregnant. There was significant effect of pregnancy status on Hb level. Majority of the anemic respondents 15/17 were married. Moreover 14/17 anemic women were experiencing severe menstrual bleeding, 11/17 respondents were pregnant. 54.8% of respondents were hemoglobin deficient while 77.4% were found to have low Hct. In 87.1 % of the respondents, transferrin saturation was found to be abnormal. In this study iron deficiency anemia is quite prevalent in the university community especially among pregnant women. The fetus's and newborn infant's iron status depends on the iron status of the pregnant woman and therefore, iron deficiency in the mother-to-be means that growing fetus probably will be iron deficient as well. Thus iron deficiency anemia during pregnancy in well-educated set up needs more attention by the concerned authorities.

Evaluation of knowledge, attitude, and behavior about harmful effects of the sun and sun protection among patients attending an outpatient clinic

Directory of Open Access Journals (Sweden)

Sevim Terzi

2017-03-01

Full Text Available Background and Design: The aim of the study was to evaluate harmful effects of sun exposure and knowledge, attitude and behaviors related to sun protection among patients attending our outpatient clinic. Materials and Methods: A total of 400 patients (171 male and 229 female aged between 16 and 89 years were included in this study. Subjects were requested to fill out a questionnaire composed of 52 questions. In the first part of the questionnaire, patients’ socio-demographic characteristics, history of sunburn, first-degree relatives with a history of skin cancer; in the second part, knowledge about harmful effects of sun and sun protection were inquired. In the third part, patient attitude and behaviors related to sun protection was evaluated. Results: Our results revealed that 69.25% of patients had satisfactory level of knowledge. While the level of knowledge was not affected by economic status, place of residence, skin type and presence of skin cancer in participants or their first-degree relatives, it was found to be increased with increasing educational level. The patients were found to prefer avoiding mid-day sun (75.5% and staying in the shade (64.8% chiefly as sun protection methods and 45.3% of patients were found to use sunscreens. Most frequently preferred sources of information about harmful effects of the sun and sun protection methods were found to be television, magazines and newspapers (76.3%, doctor’s advice and internet, respectively. Conclusion: Although a satisfactory level of knowledge about harmful effects of the sun and protection methods was found, it was observed that individuals could not convert their knowledge into the sun protection behavior

Comparison of Volume Status in Asymptomatic Haemodialysis and Peritoneal Dialysis Outpatients

Directory of Open Access Journals (Sweden)

Eugenia Papakrivopoulou

2012-03-01

Full Text Available Background: The majority of haemodialysis (HD patients gain weight between dialysis sessions and thereby become volume overloaded, whereas peritoneal dialysis (PD is a more continuous technique. Cardiovascular mortality and hypertension is increased with both treatment modalities. We therefore wished to compare volume status in PD and HD to determine whether PD patients are chronically volume overloaded, as a risk factor for cardiovascular mortality. Study Design, Setting and Participants:We retrospectively audited 72 healthy HD patients and 115 healthy PD patients attending a university hospital dialysis centre for routine outpatient treatment, who had multi-frequency bioimpedance measurements of extracellular water to total body water (ECW/TBW. Results: The groups were well matched for age, sex, weight and ethnicity, PD patients had greater urine output [1,075 (485–1,613 vs. 42.5 (0–1,020 ml/day, p Conclusions: Overhydration is common in healthy stable PD outpatients, and ECW volumes in PD patients are not dissimilar to those of pre-dialysis HD patients. The role of chronic volume overload as a risk factor for cardiovascular disease needs further investigation.

Resident trainees do not affect patient satisfaction in an outpatient gastroenterology clinic: a prospective study conducted in a Canadian gastroenterology clinic.

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Brahmania, Mayur; Young, Madison; Muthiah, Chetty; Ilnyckyj, Alexandra; Duerksen, Donald; Moffatt, Dana C

2015-10-01

There is little literature regarding how a gastroenterology trainee affects a patient's interpretation of care during outpatient clinic visits. Improving patient satisfaction is desirable and benefits may include enhanced patient compliance as well as providing trainees with areas for improvement. To evaluate patient satisfaction in an outpatient gastroenterology clinic when seen by a trainee and attending physician versus an attending physician alone. The secondary objective was to evaluate physician characteristics that play a role in creating a positive clinical experience. A randomized prospective survey study was conducted over an 11-month period (July 2012 to June 2013) at St Boniface Hospital (Winnipeg, Manitoba). Two gastroenterology fellows (postgraduate year 4 and 5) and nine internal medicine residents (postgraduate year 1 to 3) comprised the 'trainee' role, while three academic clinicians comprised the 'attending' role. Patients included individuals seen for an initial consultation and were >18 years of age. A total of 211 patients comprised the final study group, with 118 in the attending group and 93 in the trainee group. In univariate analysis, patients more often had a very good experience when seen by an attending physician alone versus a trainee and attending physician (73% versus 56%; P=0.016); however, on multivariate analysis, there was no significant difference in patient satisfaction (OR 0.89; P=0.931). Physician factors found to be associated with high patient satisfaction on multivariate analysis included: addressing all patient concerns (OR 27.56; P=0.021); giving the patient a preliminary diagnosis (OR 78.02; P=0.006); and feeling the physician was thorough (OR 72.53; P=0.029). The present study did not reveal a difference in patient satisfaction if a patient sees an attending physician alone or with a trainee. Moreover, to improve patient satisfaction in a gastroenterology clinic, physicians should address all patient concerns, provide a

How Do Individuals Develop Alcohol Use Disorder After Bariatric Surgery? A Grounded Theory Exploration.

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Yoder, Ruth; MacNeela, Padraig; Conway, Ronan; Heary, Caroline

2018-03-01

Bariatric surgery is the most effective treatment for severe obesity. However, following Roux-en-Y gastric bypass (RYGB) surgery, a small minority of patients develop new-onset alcohol use disorder (AUD), the aetiology of which is poorly understood. The aim is to construct a theory to explain the development of AUD among a sample of individuals who reported problematic drinking following RYGB. Semi-structured interviews were conducted with eight RYGB patients diagnosed with AUD attending a multi-disciplinary outpatient weight management service at a public hospital in the Republic of Ireland. A constructivist grounded theory methodology was used to analyse interview transcripts. Participants' main concern was identified as 'unresolved psychological issues' which were managed by 'external coping mechanisms', namely, 'eating to cope'. After RYGB, comfort eating was no longer possible to the same extent. Following a 'honeymoon period', participants' need for an external coping mechanism resurfaced. 'Filling the void' provides a framework to explain how participants managed the symptoms of their unresolved psychological issues through 'behavioural substitution', that is, drinking alcohol instead of eating. The theoretical framework of 'filling the void' adds to contemporary research that conceptualises AUD behavioural substitution as 'addiction transfer' by describing the process by which the phenomenon occurs as well as the characteristics of participants. The clinical implication of this research is to advocate for a reshaping of treatment of RYGB patients, with increased psychological input following surgery.

Influence of pretreatment coping strategies on the outcome of outpatient treatment of Danish alcohol abusers

DEFF Research Database (Denmark)

Bussey Rask, Marie; Jørgensen, Tina; Pinnerup Jensen, Jeanette

2006-01-01

An important issue regarding treatment for alcohol abuse is the high rate of relapse following treatment. In the research on treatment of alcohol abuse, the concept of coping has been proposed as a relevant factor in the relationship between relapse crises and treatment outcome. The present study...

Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

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Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

2014-01-01

To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return

Nurses in the provision of outpatient care for women with malignant fungating wounds in the breasts

Directory of Open Access Journals (Sweden)

Flávia Firmino

2014-06-01

Full Text Available This study aimed to analyze accounts of nurses who undertake the dressing of fungating wounds of women with breast cancer, and to outline contributions to the nursing care. This is qualitative research, carried out in November 2010 with interviews and thematic analysis involving five nurses from the outpatient department of a public hospital in the city of Rio de Janeiro, specializing in the treatment of breast cancer. Categories were elaborated corresponding to the practice of outpatient nursing; the cancer wound; and, indications for the nursing care. It is concluded that there is a need for specific knowledge in the area of oncology nursing, professional involvement, technical skill and autonomy, the forming of a therapeutic group, clinical attendance interfacing with the palliative approach, and collaborative work as a team.

Accuracy of serological testing for the diagnosis of prevalent neurocysticercosis in outpatients with epilepsy, Eastern Cape Province, South Africa.

Directory of Open Access Journals (Sweden)

Humberto Foyaca-Sibat

2009-12-01

Full Text Available Few studies have estimated prevalence of neurocysticercosis (NCC among persons with epilepsy in sub-Saharan Africa. While the limitations of serological testing in identification of NCC are well known, the characteristics of persons who are misdiagnosed based on serology have not been explored. The first objective of this pilot study was to estimate the prevalence of NCC in epilepsy outpatients from an area of South Africa endemic for cysticercosis. The second objective was to estimate the accuracy of serological testing in detecting NCC in these outpatients and characterize sources of disagreement between serology and neuroimaging.All out-patients aged 5 or older attending the epilepsy clinic of St. Elizabeth's Hospital in Lusikisiki, Eastern Cape Province, between July 2004 and April 2005 were invited to participate. Epidemiological data were collected by local study staff using a standardized questionnaire. Blood samples were tested by ELISA for antibody and antigen for Taenia solium. Four randomly chosen, consenting participants were transported each week to Mthatha for brain CT scan. The proportion of persons with epilepsy attending St. Elizabeth clinic with CT-confirmed NCC was 37% (95% CI: 27%-48%. Using CT as the gold standard, the sensitivity and specificity of antibody testing for identifying NCC were 54.5% (36.4%-71.9% and 69.2% (52.4%-83.0%, respectively. Sensitivity improved to 78.6% (49.2%-95.3% for those with active lesions. Sensitivity and specificity of antigen testing were considerably poorer. Compared to false negatives, true positives more often had active lesions. False positives were more likely to keep pigs and to have seizure onset within the past year than were true negatives.The prevalence of NCC in South African outpatients with epilepsy is similar to that observed in other countries where cysticercosis is prevalent. Errors in classification of NCC using serology alone may reflect the natural history of NCC.

Data sharing for prevention: a case study in the development of a comprehensive emergency department injury surveillance system and its use in preventing violence and alcohol-related harms.

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Quigg, Zara; Hughes, Karen; Bellis, Mark A

2012-10-01

To examine emergency department (ED) data sharing via a local injury surveillance system and assess its contribution to the prevention of violence and alcohol-related harms. 6-year (2004-2010) exploratory study analysing injury attendances to one ED in the North West of England using descriptive and trend analyses. Over the 6-year period, there were 242,796 ED injury attendances, including 21,683 for intentional injuries. Compared with unintentional injury patients, intentional injury patients were more likely to be men, aged 18-34 years, live in the most deprived communities, have attended the ED at night/weekends, have been injured in a public place and have consumed alcohol prior to the injury. Detailed data collected on alcohol and violence-related ED attendances were shared with local partners to monitor local trends and inform prevention activity including targeted policing and licensing enforcement. Over the 6-year period, intentional ED injury attendances decreased by 35.6% and alcohol-related assault attendances decreased by 30.3%. The collection of additional ED data on assault details and alcohol use prior to injury, and its integration into multi-agency policy and practice, played an important role in driving local violence prevention activity. Further research is needed to assess the direct contribution ED data sharing makes to reductions in violence.

An evaluation of the Australian Football League Central Australian Responsible Alcohol Strategy 2005-07.

Science.gov (United States)

Mentha, Ricky; Wakerman, Johne

2009-12-01

In 2004, the Australian Football League Central Australia (AFLCA) implemented the Responsible Alcohol Strategy (RAS), which aimed to decrease alcohol consumption at matches, and to promote healthy lifestyle messages to the youth of Central Australia participating in Australian Rules football. The evaluation adopted a pre- and post-implementation design to monitor a number of performance indicators. The evaluation analysed routinely collected data from AFLCA, its Security Company, Alice Springs Police Department and Alice Springs Hospital; we surveyed AFLCA staff, club officials and umpires; and undertook direct observation at AFLCA events. The volume of alcohol sold at matches decreased. Survey data indicate decreased alcohol related violence, improved spectator behaviour and decreased spectator attendances. Police data suggest declining alcohol-related and violent behaviours, but trends were not statistically significant. Alice Springs Hospital injury admission data indicate a non-significant interaction between year and season effect. In a community context of high alcohol consumption and high rates of interpersonal violence, the strategies implemented were successful in decreasing alcohol consumption and related undesirable behaviours at football games. However, these measures have resulted in unintended consequences: decreased numbers of spectators attending games, decreased canteen sales and falling sponsorship. The decreased revenue has raised serious issues about sustainability of the alcohol intervention, and stimulated discussions with government and others about strategies to maintain this important alcohol reduction policy.

Alcoholic Liver Disease and Malnutrition

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McClain, Craig J.; Barve, Shirish S.; Barve, Ashutosh; Marsano, Luis

2013-01-01

Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol. The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy. PMID:21284673

COMPARISON OF SERUM LIPID PROFILE IN MIDDLE AGED ALCOHOLICS & NON ALCOHOLICS

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Bhanuprakash

2016-03-01

Full Text Available INTRODUCTION Alcoholism has become a major burden in developing countries like India, especially in rural areas. Multiple reasons like financial burden of being low socio economic status, heavy field work leading to physical stress & mental stress. Added to this illiteracy, lack of knowledge about ill effects of alcohol, people consume it regularly & become addictive. AIMS & OBJECTIVES The present study was conducted to study the lipid profile of alcoholics & compare them with normal subjects. MATERIALS & METHODS 30 males between the age group of 35-60 years who consumed alcohol (>250 ml/day regularly for more than 15 years in Chittoor and surrounding villages were recruited for the study group. 30 subjects of same age group attending SVIMS OPD, Tirupathi were taken as control group. Fasting serum lipid profile was done on both the groups by collecting their venous blood samples. RESULTS We found that serum cholesterol (234.66+10.34, Triglycerides (178.38+8.8, (LDL Low density lipoprotein (160.6+10.3 & (VLDL Very Low density lipoprotein (35.09+7.56 were significantly (p<0.05 higher in study group than compared to control group. Whereas High density lipoprotein HDL was significantly lower in study group (38.2 than control group (41.2. CONCLUSION Alcohol consumption leads to liver diseases which may present with clinical and biochemical features, mainly impaired serum lipid profile.

Alcoholism and the Hispanic: A Mutual Concern = El Alcoholismo y Los Hispanos Una Preocupacion Nacional. Proceedings of the National Hispanic Conference on Alcoholism (San Antonio, Texas, September 7-10, 1981).

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AVANTE International Systems Corp., San Antonio, TX.

Written in Spanish and English, the proceedings include 6 papers and the recommendations presented at the conference on alcoholism and alcohol-related problems among Hispanics attended by approximately 400 participants, representing 29 states, Puerto Rico, and Mexico. "The Challenge of the 1980's: Action Through Unity" discusses the need for unity…

42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

Science.gov (United States)

2010-10-01

... outpatient prospective payment system. 419.21 Section 419.21 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM... Excluded From the Hospital Outpatient Prospective Payment System § 419.21 Hospital outpatient services...

Patient involvement in rheumatology outpatient service design and delivery: a case study.

Science.gov (United States)

de Souza, Savia; Galloway, James; Simpson, Carol; Chura, Radka; Dobson, Joanne; Gullick, Nicola J; Steer, Sophia; Lempp, Heidi

2017-06-01

Patient involvement is increasingly recognized as important within the UK National Health Service to ensure that services delivered are relevant to users' needs. Organizations are encouraged to work with service users to achieve excellence in care. Patient education can improve health outcomes and reduce health-care costs. Mobile technologies could play a vital role in this. Patient-centred development of innovative strategies to improve the experience of rheumatology outpatients. The Group Rheumatology Initiative Involving Patients (GRIIP) project was set up in 2013 as a joint venture between patients, clinicians, academics and management at a London hospital. The project saw (i) the formation of an independent patient group which provided suggestions for service improvement - outcomes included clearer signs in the outpatient waiting area, extended phlebotomy opening hours and better access to podiatry; (ii) a rolling patient educational evening programme initiated in 2014 with topics chosen by patient experts - feedback has been positive and attendance continues to grow; and (iii) a mobile application (app) co-designed with patients launched in 2015 which provides relevant information for outpatient clinic attendees and data capture for clinicians - downloads have steadily increased as users adopt this new technology. Patients can effectively contribute to service improvement provided they are supported, respected as equals, and the organization is willing to undergo a cultural change. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Who needs inpatient detox? Development and implementation of a hospitalist protocol for the evaluation of patients for alcohol detoxification.

Science.gov (United States)

Stephens, John R; Liles, E Allen; Dancel, Ria; Gilchrist, Michael; Kirsch, Jonathan; DeWalt, Darren A

2014-04-01

Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates. To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol's implementation. Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation. Patients presenting for alcohol detoxification. Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification. Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation. We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation (p = 0.037). There was no difference in readmission rate or length of stay. Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions.

Prospective Controlled Assessment of Impact of Feedback on Gastroenterology Trainees in Outpatient Practice.

LENUS (Irish Health Repository)

Harewood, Gavin C

2011-03-29

BACKGROUND AND AIMS: Previous studies have demonstrated the value of systematic feedback in enhancing endoscopic procedure performance. It remains unknown whether feedback may play a role in modifying physician performance in outpatient practice. This study aimed to assess the impact of systematic feedback on duration of office visits of gastroenterology (GI) trainees in outpatient practice. METHODS: Patients attending a GI outpatient department in an academic medical center were prospectively followed over 4 months. The duration of office visits for consecutive patients seen by five GI fellows of similar experience level were recorded for 2 months (pre-feedback); confidential feedback was then provided to each fellow on a weekly basis for 2 months detailing their individual consultation times and the comparative, anonymous times of the other fellows (post-feedback). RESULTS: Over the course of the study, 1,647 outpatients were seen by five GI fellows. Pre-feedback consultation durations differed significantly with one fellow taking 2.5 times longer than their colleague. Following feedback, times shortened significantly for all fellows, with the greatest impact observed in those trainees taking longer at baseline. There were no significant differences in satisfaction levels among patients seen by each trainee. CONCLUSIONS: There was a wide disparity in the consultation times among GI fellows. Systematic feedback shortened times among all trainees and enhanced uniformity by having the greatest impact among those fellows taking longer at baseline. Routine provision of feedback may be valuable in enhancing uniformity of outpatient practice although clinicians should ensure that shortening consultation visits does not compromise quality of patient care. Future larger studies of feedback in this setting will be enhanced by incorporating objective measures of quality of care and patient satisfaction.

Prospective controlled assessment of impact of feedback on gastroenterology trainees in outpatient practice.

LENUS (Irish Health Repository)

Harewood, Gavin C

2012-02-01

BACKGROUND AND AIMS: Previous studies have demonstrated the value of systematic feedback in enhancing endoscopic procedure performance. It remains unknown whether feedback may play a role in modifying physician performance in outpatient practice. This study aimed to assess the impact of systematic feedback on duration of office visits of gastroenterology (GI) trainees in outpatient practice. METHODS: Patients attending a GI outpatient department in an academic medical center were prospectively followed over 4 months. The duration of office visits for consecutive patients seen by five GI fellows of similar experience level were recorded for 2 months (pre-feedback); confidential feedback was then provided to each fellow on a weekly basis for 2 months detailing their individual consultation times and the comparative, anonymous times of the other fellows (post-feedback). RESULTS: Over the course of the study, 1,647 outpatients were seen by five GI fellows. Pre-feedback consultation durations differed significantly with one fellow taking 2.5 times longer than their colleague. Following feedback, times shortened significantly for all fellows, with the greatest impact observed in those trainees taking longer at baseline. There were no significant differences in satisfaction levels among patients seen by each trainee. CONCLUSIONS: There was a wide disparity in the consultation times among GI fellows. Systematic feedback shortened times among all trainees and enhanced uniformity by having the greatest impact among those fellows taking longer at baseline. Routine provision of feedback may be valuable in enhancing uniformity of outpatient practice although clinicians should ensure that shortening consultation visits does not compromise quality of patient care. Future larger studies of feedback in this setting will be enhanced by incorporating objective measures of quality of care and patient satisfaction.

Risk factors and complications in type 2 diabetes outpatients

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Ellen Fernandes Flávio Silva

Full Text Available Summary Objective: Our study investigated type 2 diabetes mellitus (T2DM outpatients attending a university hospital in Montes Claros, MG, to estimate the prevalence of risk factors and their association with diabetes complications. Method: This was a quantitative, documental, retrospective and analytical study. Medical records of 95 outpatients with T2DM treated in this hospital from 2011 to 2015 were analyzed. Data were collected according to a structured questionnaire surveying sociodemographic, anthropometric and biochemical data and clinical and lifestyle aspects. Regression analysis was used to evaluate the association between risk factor variables and complications. Results: With a mean age of 54 years, the study population showed irregular blood glucose control, despite the use of hypoglycemic medication, and did not have a healthy lifestyle. The main complication reported was high blood pressure (HBP, occurring in 70.9% of patients. The prevalence of complications was positively associated with patients receiving insulin treatment (p=0.042 and multidisciplinary monitoring (p=0.050. Conclusion: The associations identified reflect the condition of patients that were already treating diabetes and its complications, especially HBP. The characteristics of the study population indicate the need to improve clinical follow-up and increase motivation for healthy behaviors.

[Factors Associated with Stress Check Attendance: Possible Effect of Timing of Annual Health Examination].

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Ishimaru, Tomohiro; Hattori, Michihiro; Nagata, Masako; Kuwahara, Keisuke; Watanabe, Seiji; Mori, Koji

2018-01-01

The stress check program has been part of annual employees' health screening since 2015. Employees are recommended, but not obliged, to undergo the stress check offered. This study was designed to examine the factors associated with stress check attendance. A total of 31,156 Japanese employees who underwent an annual health examination and a stress check service at an Occupational Health Service Center in 2016 participated in this study. Data from the annual health examination and stress check service included stress check attendance, date of attendance (if implemented), gender, age, workplace industry, number of employees at the workplace, and tobacco and alcohol consumption. Data were analyzed using multiple logistic regression. The mean rate of stress check attendance was 90.8%. A higher rate of stress check attendance was associated with a lower duration from the annual health examination, age ≥30 years, construction and transport industry, and 50-999 employees at the workplace. A lower rate of stress check attendance was associated with medical and welfare industry and ≥1,000 employees at the workplace. These findings provide insights into developing strategies for improving the rate of stress check attendance. In particular, stress check attendance may improve if the stress check service and annual health examination are conducted simultaneously.

Elderly outpatient profile and predictors of falls

Directory of Open Access Journals (Sweden)

Grace Angélica de Oliveira Gomes

Full Text Available CONTEXT AND OBJECTIVESFalls are a serious public health problem and are one of the biggest reasons for hospitalization, morbidity and mortality among elderly people. Moreover, few studies on predictors of falls have been conducted in low and middle income countries. The aim here was to identify elderly outpatient profiles according to sociodemographic, clinical, physical and functional variables and correlate them with occurrences of falls among these subjects.DESIGN AND SETTINGCross-sectional descriptive study forming part of the project “Quality of Life of Frail Elderly People”, carried out in Campinas, Brazil.METHODSThe subjects were 145 elderly individuals (76.3 ± 7.8 years old, of whom 65% were women, who were living in the city of Campinas or nearby and were attended at the geriatric outpatient clinic of a University Hospital. Sociodemographic, clinical, physical and functional data, as well as fall occurrence data, were gathered. Cluster analyses and comparisons between groups were carried out.RESULTSCluster analysis identified two distinct groups related to the study variables, and the determinants for this distinction were: gender, marital status, physical performance, handgrip strength and functional independence. These groups were compared according to occurrences of falls over the last year, and significant differences between them were found.CONCLUSIONSThe results showed that greater occurrences of falls were associated with a profile of elderly people comprising female gender, single status, lower muscle strength and physical performance regarding balance and gait, and lower independence in motor tasks for activities of daily living.

The alcohol withdrawal syndrome.

LENUS (Irish Health Repository)

McKeon, A

2008-08-01

The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike. Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy. Many patients with AWS have multiple management issues (withdrawal symptoms, delirium tremens, the Wernicke-Korsakoff syndrome, seizures, depression, polysubstance abuse, electrolyte disturbances and liver disease), which requires a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

Effects of acute doses of prosocial drugs methamphetamine and alcohol on plasma oxytocin levels.

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Bershad, Anya K; Kirkpatrick, Matthew G; Seiden, Jacob A; de Wit, Harriet

2015-06-01

Many drugs, including alcohol and stimulants, demonstrably increase sociability and verbal interaction and are recreationally consumed in social settings. One drug, 3,4-methylenedioxymethamphetamine (MDMA, ecstasy), seems to produce its prosocial effects by increasing plasma oxytocin levels, and the oxytocin system has been implicated in responses to several other drugs of abuse. Here, we sought to investigate the effects of 2 other "social" drugs on plasma oxytocin levels--methamphetamine and alcohol. Based on their shared capacity to enhance sociability, we hypothesized that both methamphetamine and alcohol would increase plasma oxytocin levels. In study 1, 11 healthy adult volunteers attended 3 sessions during which they received methamphetamine (10 mg or 20 mg) or placebo under double-blind conditions. Subjective drug effects, cardiovascular effects, and plasma oxytocin levels were measured at regular intervals throughout the sessions. In study 2, 8 healthy adult volunteers attended a single session during which they received 1 beverage containing placebo, and then a beverage containing alcohol (0.8 g/kg). Subjective effects, breath alcohol levels, and plasma oxytocin levels were measured at regular intervals. Both methamphetamine and alcohol produced their expected physiological and subjective effects, but neither of these drugs increased plasma oxytocin levels. The neurobiological mechanisms mediating the prosocial effects of drugs such as alcohol and methamphetamine remain to be identified.

Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

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Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, Michael

2018-05-04

To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed. Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed. The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%). One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Obstructive sleep apnea syndrome in patients attending a psychiatry outpatient service: a case series].

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Tamayo Martínez, Nathalie; Rosselli Cock, Diego

Obstructive sleep apnea syndrome (OSAS) is a condition associated with multiple negative outcomes. People with mental illness might be at increased risk of having it, given that medication given has adverse effects on weight and there are alterations in sleep associated with them; however, there are few studies in this population. Describe the patients and the results of polysomnography ordered based on clinical symptoms in a psychiatric outpatient clinic between 2012 and 2014. A case series in which medical records were evaluated. 58 patients who underwent polysomnography, 89% of them had OSAS, 16% were obese and 19% were been treated with benzodiazepines. This is a condition that must be considered during the clinical evaluation of patients with mental illness, since its presence should make clinicians think about drug treatment and follow up. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Reducing Sex under the Influence of Drugs or Alcohol for Patients in Substance Abuse Treatment

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Calsyn, Donald A.; Crits-Christoph, Paul; Hatch-Maillette, Mary A.; Doyle, Suzanne R.; Song, Yong S.; Coyer, Susan; Pelta, Sara

2009-01-01

Aims In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. Design Men in methadone maintenance (n=173) or outpatient psychosocial treatment (n=104) completed assessments at baseline, 3- and 6-months post intervention. Participants were randomly assigned to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI), or HIV education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. Findings Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (tintervention=−2.16, p=.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial outpatient treatment, were associated with engaging in SUI. Conclusions Overall a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up. PMID:20078464

Person-centred care in nurse-led outpatient rheumatology clinics: Conceptualization and initial development of a measurement instrument.

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Bala, Sidona-Valentina; Forslind, Kristina; Fridlund, Bengt; Samuelson, Karin; Svensson, Björn; Hagell, Peter

2018-06-01

Person-centred care (PCC) is considered a key component of effective illness management and high-quality care. However, the PCC concept is underdeveloped in outpatient care. In rheumatology, PCC is considered an unmet need and its further development and evaluation is of high priority. The aim of the present study was to conceptualize and operationalize PCC, in order to develop an instrument for measuring patient-perceived PCC in nurse-led outpatient rheumatology clinics. A conceptual outpatient PCC framework was developed, based on the experiences of people with rheumatoid arthritis (RA), person-centredness principles and existing PCC frameworks. The resulting framework was operationalized into the PCC instrument for outpatient care in rheumatology (PCCoc/rheum), which was tested for acceptability and content validity among 50 individuals with RA attending a nurse-led outpatient clinic. The conceptual framework focuses on the meeting between the person with RA and the nurse, and comprises five interrelated domains: social environment, personalization, shared decision-making, empowerment and communication. Operationalization of the domains into a pool of items generated a preliminary PCCoc/rheum version, which was completed in a mean (standard deviation) of 5.3 (2.5) min. Respondents found items easy to understand (77%) and relevant (93%). The Content Validity Index of the PCCoc/rheum was 0.94 (item level range, 0.87-1.0). About 80% of respondents considered some items redundant. Based on these results, the PCCoc/rheum was revised into a 24-item questionnaire. A conceptual outpatient PCC framework and a 24-item questionnaire intended to measure PCC in nurse-led outpatient rheumatology clinics were developed. The extent to which the questionnaire represents a measurement instrument remains to be tested. Copyright © 2018 John Wiley & Sons, Ltd.

Attention and alcohol cues: a role for medial parietal cortex and shifting away from alcohol features?

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Thomas Edward Gladwin

2013-12-01

Full Text Available Attention plays a central role in theories of alcohol dependence; however, its precise role in alcohol-related biases is not yet clear. In the current study, social drinkers performed a spatial cueing task designed to evoke conflict between automatic processes due to incentive salience and control exerted to follow task-related goals. Such conflict is a potentially important task feature from the perspective of dual-process models of addiction. Subjects received instructions either to direct their attention towards pictures of alcoholic beverages, and away from non-alcohol beverages; or to direct their attention towards pictures of non-alcoholic beverages, and away from alcohol beverages. A probe stimulus was likely to appear at the attended location, so that both spatial and non-spatial interference was possible. Activation in medial parietal cortex was found during Approach Alcohol versus Avoid Alcohol blocks. This region is associated with the, possibly automatic, shifting of attention between stimulus features, suggesting that subjects may have shifted attention away from certain features of alcoholic cues when attention had to be directed towards an upcoming stimulus at their location. Further, activation in voxels close to this region was negatively correlated with riskier drinking behavior. A tentative interpretation of the results is that risky drinking may be associated with a reduced tendency to shift attention away from potentially distracting task-irrelevant alcohol cues. The results suggest novel hypotheses and directions for future study, in particular towards the potential therapeutic use of training the ability to shifting attention away from alcohol-related stimulus features.

Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study

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Khan Riaz

2011-08-01

Full Text Available Abstract Background Despite the importance of heavy drinking and alcohol dependence among patients with opiate and cocaine dependence, few studies have evaluated specific interventions within this group. The aim of the present study was to evaluate the impact of screening with the Alcohol Use Disorders Identification Test (AUDIT and of brief intervention (BI on alcohol use in a sample of patients treated for opioid or cocaine dependence in a specialized outpatient clinic. Methods Adult outpatients treated for opioid or cocaine dependence in Switzerland were screened for excessive alcohol drinking and dependence with the AUDIT. Patients with AUDIT scores that indicated excessive drinking or dependence were randomized into two groups--treatment as usual or treatment as usual together with BI--and assessed at 3 months and 9 months. Results Findings revealed a high rate (44% of problematic alcohol use (excessive drinking and dependence among patients with opiate and cocaine dependence. The number of drinks per week decreased significantly between T0 (inclusion and T3 (month 3. A decrease in average AUDIT scores was observed between T0 and T3 and between T0 and T9 (month 9. No statistically significant difference between treatment groups was observed. Conclusions In a substance abuse specialized setting, screening for alcohol use with the AUDIT, followed by feedback on the score, and use of alcohol BI are both possibly useful strategies to induce changes in problematic alcohol use. Definitive conclusions cannot, however, be drawn from the study because of limitations such as lack of a naturalistic group. An important result of the study is the excellent internal consistency of AUDIT in a population treated for opiate or cocaine dependence.

Lived Experience of Thai Women with Alcohol Addiction.

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Hanpatchaiyakul, Kulnaree; Eriksson, Henrik; Kijsomporn, Jureerat; Östlund, Gunnel

2017-12-01

This study explored the lived experiences of Thai women in relation to alcohol addiction in treatment. Twelve women aged 20 to 65 years, were participated. The participants were recruited from two special hospitals and one outpatient clinic in a general hospital. Descriptive phenomenology was applied to analyze the transcripts of the individual interviews. The explored phenomenon of Thai women experiencing alcohol addiction included four essential aspects, (1) feeling inferior and worthless (2) feeling physically and emotionally hurt, (3) fearing physical deterioration and premature death, and (4) feeling superior and powerful. Through these different aspects of Thai women's lived experiences, the following essence was synthesized. The essence of the lived experience of alcohol addiction among the studied Thai women was ambivalence between feeling inferior and worthless and feeling superior and powerful when acting as a man. Drinking alcohol lessened life's difficulties and fears; for example, of violence, bodily demolition, premature death and marginalization from family and society. Thai women who experience alcohol addiction are treated with gender-related double standards when trying to undo gender traditional roles. Their marginalization from family and society deepens making them even more vulnerable to the positive side effects of alcohol drinking. Copyright © 2017. Published by Elsevier B.V.

The effects of acute alcohol intoxication on the cognitive mechanisms underlying false facial recognition.

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Colloff, Melissa F; Flowe, Heather D

2016-06-01

False face recognition rates are sometimes higher when faces are learned while under the influence of alcohol. Alcohol myopia theory (AMT) proposes that acute alcohol intoxication during face learning causes people to attend to only the most salient features of a face, impairing the encoding of less salient facial features. Yet, there is currently no direct evidence to support this claim. Our objective was to test whether acute alcohol intoxication impairs face learning by causing subjects to attend to a salient (i.e., distinctive) facial feature over other facial features, as per AMT. We employed a balanced placebo design (N = 100). Subjects in the alcohol group were dosed to achieve a blood alcohol concentration (BAC) of 0.06 %, whereas the no alcohol group consumed tonic water. Alcohol expectancy was controlled. Subjects studied faces with or without a distinctive feature (e.g., scar, piercing). An old-new recognition test followed. Some of the test faces were "old" (i.e., previously studied), and some were "new" (i.e., not previously studied). We varied whether the new test faces had a previously studied distinctive feature versus other familiar characteristics. Intoxicated and sober recognition accuracy was comparable, but subjects in the alcohol group made more positive identifications overall compared to the no alcohol group. The results are not in keeping with AMT. Rather, a more general cognitive mechanism appears to underlie false face recognition in intoxicated subjects. Specifically, acute alcohol intoxication during face learning results in more liberal choosing, perhaps because of an increased reliance on familiarity.

Pathological gambling in treatment-seeking alcoholics: a national survey in France.

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Nalpas, Bertrand; Yguel, Jacques; Fleury, Benoît; Martin, Sandrine; Jarraud, Delphine; Craplet, Michel

2011-01-01

To estimate the prevalence of pathological gambling (pG) in people addicted to alcohol and drugs, particularly those with alcohol use disorders (AUDs), including new forms of gambling such as video and on-line games; and to update the socio-demographic profile of people suffering from both AUD and pG. A cross-sectional survey was conducted in 1 week of 2009 in 55 French addiction treatment centres, including all consecutive patients attending that centre, using an anonymous questionnaire which included a tool specific for pG screening, the DEBA-jeu questionnaire (Détection et Besoin d'Aide en regard du Jeu Excessif). A total of 2790 patients entered the study. The most frequent reason for attending the Addiction Centres was AUD (77%). According to the DEBA test, 6.5% of the patients were pathological gamblers and 12% were subsyndromal gamblers. pG affected all age groups and did not decrease with abstinence from alcohol. pG was significantly associated with male sex [relative risk (RR) = 2.4; P < 0.001)] and, at a lower level of significance, with homelessness (RR = 1.52; P = 0.03) and unemployment (RR = 1.47; P = 0.04). pG appears to be a common feature of the French people with alcohol and drug disorders. Apart from male sex, no parameter had discriminatory power sufficient to target pG screening on a specific subgroup. Therefore, any patient attending a centre for drug or AUD should be asked about his gambling. Moreover, clinical teams should be trained to treat this addiction.

Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

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Margrit Löbner

Full Text Available OBJECTIVE: To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient and setting-specific rehabilitation outcomes. METHODS: The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years. Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%. The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale, pain intensity (numeric analog scale, health-related quality of life (Short Form 36 Health Survey, subjective prognosis of gainful employment (SPE-scale as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. RESULTS: The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%. Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%. Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56% compared to only one third of the inpatient rehabilitees (33% returned to work three months after disc surgery (p<.001. CONCLUSION: The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures

The impact of alcohol-related presentations on a New Zealand hospital emergency department.

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Stewart, Rebecca; Das, Manidipa; Ardagh, Michael; Deely, Joanne M; Dodd, Stuart; Bartholomew, Nadia; Pearson, Scott; Spearing, Ruth; Williams, Tracey; Than, Martin

2014-08-29

To determine the impact of alcohol-related presentations on the Christchurch Hospital Emergency Department (ED). Over 42 8-hour shifts (2 weeks) between 15 November 2013 and 9 December 2013, patients attending the ED with recent alcohol consumption were classified as screen-positive (consumed alcohol in the 4 hours prior to presentation) or not. A subset of screen-positive patients was classified as impact-positive (alcohol consumption clearly contributed to the reason for presenting). Data were analysed in relation to days/shifts for gender, age, disruptive behaviour, medical reasons for presenting, and completeness of ED records. Of the 3619 patients screened in the study, 268 (7.4%) and 182 (5%) were screen-positive and impact-positive, respectively. Most patients attended the ED on the weekends (58%: 105/182), particularly on Saturday night (31%; 56/182). More males (118) than females (64) were impact-positive. Of the impact-positive males, most were 16-25 years old (37%; 44/118) or 41-61 years old (32%; 38/118), attended the ED on weekend night shifts (24%; 28/118), and sought treatment for non- interpersonal trauma (38%; 45/118) or interpersonal trauma due to violence (17%; 20/118). Of the female impact-positive patients, most were 16-25 years old (41%; 26/64) or 41-60 years old (33%; 21/64), and presented for deliberate self-harm (36%; 23/64) or non-interpersonal trauma (27%; 17/64). Of the 182 impact-positive patients, 86% (156) were recorded in the ED computer system. Alcohol-related presentations had a significant impact on the ED, particularly on weekends. Teenagers, young adults and middle-aged adults contributed to the alcohol-related patient impact on weekends. Male patients were a significant burden on Saturday evening and night shifts.

Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India.

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Singh, Shivaram Prasad; Padhi, Pradeep Kumar; Narayan, Jimmy; Singh, Ayaskanta; Pati, Girish Kumar; Nath, Preetam; Parida, Prasant Kumar; Mishra, Sunil

2016-11-01

The aim of this study is to estimate the socioeconomic impact of alcohol use on patients with alcoholic liver disease (ALD) and their families. The demographic and socioeconomic data were collected from hospitalized ALD patients and attendants using a self designed non validated questionnaire and analyzed. Study subjects included 100 consecutive ALD patients (all males). Sixty percent were between 30 and 50 years. Most were married (96 %), literate (63 %), either businessmen (37 %) or employed (30 %) and belonged to middle socioeconomic class. Ninety percent started alcohol use before age 30 years and half during teenage. Mean alcohol intake was 190 mL/day (mean duration 23 years); 60 % consumed alcohol daily. Concomitant tobacco abuse was noted in 79 %. Average expenditure on alcohol was Rs 3800/month. Average hospitalizations for ALD related problems was 2.6 times/year with average expenditure of INR 30,000 (~440 US$) during each hospitalization. For treatment expenses, 86 % of patients borrowed money from friends/relatives, 36 % used saving deposits, and 4 % sold personal belongings. Eleven percent lost their job, and 7 % sold immovable property. In 43 % of cases, children were deprived of education. Besides, 52 % had disturbed social and family life, 34 % abused their spouse, 20 % suffered accidents, and 37 % indulged in physical violence. Majority of ALD patients and their families had disturbed social and family life and incurred severe financial loss arising of alcohol use.

A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance.

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Hung, Susanna Lok Lam; Fu, Sau Nga; Lau, Po Shan; Wong, Samuel Yeung Shan

2015-01-31

This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting. We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed. Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance. Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education

Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features.

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Rush, A John; Zimmerman, Mark; Wisniewski, Stephen R; Fava, Maurizio; Hollon, Steven D; Warden, Diane; Biggs, Melanie M; Shores-Wilson, Kathy; Shelton, Richard C; Luther, James F; Thomas, Brandi; Trivedi, Madhukar H

2005-07-01

This study evaluated the clinical and sociodemographic features associated with various degrees of concurrent comorbidity in adult outpatients with nonpsychotic major depressive disorder (MDD). Outpatients enrolled in the STAR*D trial completed the Psychiatric Diagnostic Screening Questionnaire (PDSQ). An a priori 90% specificity threshold was set for PDSQ responses to ascertain the presence of 11 different concurrent DSM-IV Axis I disorders. Of 1376 outpatients, 38.2% had no concurrent comorbidities, while 25.6% suffered one, 16.1% suffered two, and 20.2% suffered three or more comorbid conditions. Altogether, 29.3% met threshold for social anxiety disorder, 20.8% for generalized anxiety disorder, 18.8% for posttraumatic stress disorder, 12.4% for bulimia, 11.9% for alcohol abuse/dependence, 13.4% for obsessive-compulsive disorder, 11.1% for panic disorder, 9.4% for agoraphobia, 7.3% for drug abuse/dependence, 3.7% for hypochondriasis, and 2.2% for somatoform disorder. Those with more concurrent Axis I conditions had earlier ages at first onset of MDD, longer histories of MDD, greater depressive symptom severity, more general medical comorbidity (even though they were younger than those with fewer comorbid conditions), poorer physical and mental function, health perceptions, and life satisfaction; and were more likely to be seen in primary care settings. Participants had to meet entry criteria for STAR*D. Ascertainment of comorbid conditions was not based on a structured interview. Concurrent Axis I conditions (most often anxiety disorders) are very common with MDD. Greater numbers of concurrent comorbid conditions were associated with increased severity, morbidity, and chronicity of their MDD.

Faster self-paced rate of drinking for alcohol mixed with energy drinks versus alcohol alone.

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Marczinski, Cecile A; Fillmore, Mark T; Maloney, Sarah F; Stamates, Amy L

2017-03-01

The consumption of alcohol mixed with energy drinks (AmED) has been associated with higher rates of binge drinking and impaired driving when compared with alcohol alone. However, it remains unclear why the risks of use of AmED are heightened compared with alcohol alone even when the doses of alcohol consumed are similar. Therefore, the purpose of this laboratory study was to investigate if the rate of self-paced beverage consumption was faster for a dose of AmED versus alcohol alone using a double-blind, within-subjects, placebo-controlled study design. Participants (n = 16) of equal gender who were social drinkers attended 4 separate test sessions that involved consumption of alcohol (1.97 ml/kg vodka) and energy drinks, alone and in combination. On each test day, the dose assigned was divided into 10 cups. Participants were informed that they would have a 2-h period to consume the 10 drinks. After the self-paced drinking period, participants completed a cued go/no-go reaction time (RT) task and subjective ratings of stimulation and sedation. The results indicated that participants consumed the AmED dose significantly faster (by ∼16 min) than the alcohol dose. For the performance task, participants' mean RTs were slower in the alcohol conditions and faster in the energy-drink conditions. In conclusion, alcohol consumers should be made aware that rapid drinking might occur for AmED beverages, thus heightening alcohol-related safety risks. The fast rate of drinking may be related to the generalized speeding of responses after energy-drink consumption. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[The characteristics of sexual offenders abusing alcohol in view of forensic-psychiatric assessments].

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Juszczak, Dariusz; Korzeniewski, Krzysztof; Czupryńska, Katarzyna; Furs, Maciej

2015-06-01

The relationship between alcohol consumption and sexual crime appears to be unquestionable. However, the mechanisms that lead to violence and aggression under the influence of alcohol are not entirely understood in this group of offenders. The aim of this paper was to attempt answering the question: what are the features characterizing sexual offenders declaring alcohol abuse. The research material consisted of 180 forensic psychiatric- sexology assessments issued by experts from Outpatient Psychiatric Clinic in 10 Military Hospital Clinic in Bydgoszcz between 2004 to 2012. A specially designed questionnaire titled "Charter of Diagnosis of Factors Determining Criminal Sexual Activity" has been used. Relevant statistical dependences were observed. The obtained results show that, a alcohol abuse has a sexual criminogenic effect especially in the coincidence that there are sustainable personality abnormalities and organic CNS damage. The conducted study prove that the sexual perpetrators who abuse alcohol have a poor level of social functioning and brought up in dysfunction families having alcoholic problems. © 2015 MEDPRESS.

Study of the prevalence and association of ocular chlamydial conjunctivitis in women with genital infection by Chlamydia trachomatis, Mycoplasma genitalium and Candida albicans attending outpatient clinic.

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Khattab, Rania Abdelmonem; Abdelfattah, Maha Mohssen

2016-01-01

To determine the association between chlamydial conjunctivitis and genital infection by Chlamydia trachomatis, Mycoplasma genitalium and Candida albicans, in addition to the possible relationship between cultured bacterial pathogens and oculogenital chlamydial infection. This study was performed on 100 (50 symptomatic and 50 asymptomatic) women attending the Gynecological and Obstetric outpatient clinic of Alzahra hospital, Alazhar University. Simultaneously a conjunctival swab was taken from these patients. Polymerase chain reaction (PCR) was done on DNA extracted from both vaginal and conjunctival swab samples. Culture for both vaginal and conjunctival swabs was also done. Candida albicans was the predominant organism isolated by culture in 20% and 40% of conjunctival and vaginal swabs respectively. By the PCR method, ocular Chlamydia trachomatis was present in 60% of symptomatic women, while genital Chlamydia trachomatis infection was present in 30% of symptomatic women. The results of this method also indicated that 25/50 (50%) vaginal swabs were positive with PCR for Candida albicans versus 15/50 (30%) were PCR positive in conjunctival swab. Mycoplasma genitalium was present in only 10% of vaginal swabs. Concomitant oculogenital PCR positive results for Chlamydia trachomatis and Candida albicans were 30% and 28% respectively. Ocular Chlamydia trachomatis was associated with genital Chlamydia trachomatis in a high percentage of women followed by Candida albicans. Cultured bacterial organisms do not play a role in enhancement of Chlamydia trachomatis infection.

Impact of drug awareness and treatment camps on attendance at a community outreach de-addiction clinic

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Om Prakash Giri

2015-01-01

Full Text Available Background: Substance misuse is an increasing problem in urban and rural India. The utility of community-based interventions and preventive strategies are increasingly emphasized in this context. The drug de-addiction and treatment center, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, has been running a drug de-addiction and treatment clinic at Kharar Civil Hospital, Kharar, District Mohali, Punjab, since 1998. As part of an effort to enhance this community outreach program, community-based drug awareness and treatment camps have been organized since March 2004 in villages in and around Tehsil Kharar of Mohali. Aim: To study the impact of the drug awareness and treatment camps on the attendance of patients at the community outreach drug de-addiction and treatment clinic at Kharar Civil Hospital. Methods: Sociodemographic and clinical variables, including treatment outcome-related variables, of patients attending the clinic at Kharar Civil Hospital, before and after the camps were compared. Discussion and Conclusion: The study showed a positive impact on drug awareness and treatment camps held in the community on outpatient attendance at a community outreach clinic, with attendance increasing more than 1.8 times.

A preliminary, randomized trial of aerobic exercise for alcohol dependence.

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Brown, Richard A; Abrantes, Ana M; Minami, Haruka; Read, Jennifer P; Marcus, Bess H; Jakicic, John M; Strong, David R; Dubreuil, Mary Ella; Gordon, Alan A; Ramsey, Susan E; Kahler, Christopher W; Stuart, Gregory L

2014-07-01

Interventions targeting physical activity may be valuable as an adjunct to alcohol treatment, but have been relatively untested. In the current study, alcohol dependent, physically sedentary patients were randomized to: a 12-week moderate-intensity, group aerobic exercise intervention (AE; n=25) or a brief advice to exercise intervention (BA-E; n=23). Results showed that individuals in AE reported significantly fewer drinking and heavy drinking days, relative to BA-E during treatment. Furthermore adherence to AE strengthened the beneficial effect of intervention on alcohol use outcomes. While high levels of moderate-intensity exercise appeared to facilitate alcohol recovery regardless of intervention arm, attending the group-based AE intervention seemed to further enhance the positive effects of exercise on alcohol use. Study findings indicate that a moderate intensity, group aerobic exercise intervention is an efficacious adjunct to alcohol treatment. Improving adherence to the intervention may enhance its beneficial effects on alcohol use. Copyright © 2014 Elsevier Inc. All rights reserved.

Anticonvulsants for alcohol withdrawal.

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Minozzi, Silvia; Amato, Laura; Vecchi, Simona; Davoli, Marina

2010-03-17

Alcohol abuse and dependence represents a most serious health problem worldwide with major social, interpersonal and legal interpolations. Besides benzodiazepines, anticonvulsants are often used for the treatment of alcohol withdrawal symptoms. Anticonvulsants drugs are indicated for the treatment of alcohol withdrawal syndrome, alone or in combination with benzodiazepine treatments. In spite of the wide use, the exact role of the anticonvulsants for the treatment of alcohol withdrawal has not yet bee adequately assessed. To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal. We searched Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases. Randomized controlled trials (RCTs) examining the effectiveness, safety and overall risk-benefit of anticonvulsants in comparison with a placebo or other pharmacological treatment. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy. Two authors independently screened and extracted data from studies. Fifty-six studies, with a total of 4076 participants, met the inclusion criteria. Comparing anticonvulsants with placebo, no statistically significant differences for the six outcomes considered.Comparing anticonvulsant versus other drug, 19 outcomes considered, results favour anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score): 3 studies, 262 participants, MD -1.04 (-1.89 to -0.20), none of the other comparisons reached statistical significance.Comparing different anticonvulsants no statistically significant differences in the two outcomes considered.Comparing anticonvulsants plus other drugs versus other drugs (3 outcomes considered), results

Elderly outpatient profile and predictors of falls.

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Gomes, Grace Angélica de Oliveira; Cintra, Fernanda Aparecida; Batista, Fernanda Sotelo; Neri, Anita Liberalesso; Guariento, Maria Elena; Sousa, Maria da Luz Rosario de; D'Elboux, Maria José

2013-01-01

CONTEXT AND OBJECTIVES Falls are a serious public health problem and are one of the biggest reasons for hospitalization, morbidity and mortality among elderly people. Moreover, few studies on predictors of falls have been conducted in low and middle income countries. The aim here was to identify elderly outpatient profiles according to sociodemographic, clinical, physical and functional variables and correlate them with occurrences of falls among these subjects. DESIGN AND SETTING Cross-sectional descriptive study forming part of the project "Quality of Life of Frail Elderly People", carried out in Campinas, Brazil. METHODS The subjects were 145 elderly individuals (76.3 ± 7.8 years old), of whom 65% were women, who were living in the city of Campinas or nearby and were attended at the geriatric outpatient clinic of a University Hospital. Sociodemographic, clinical, physical and functional data, as well as fall occurrence data, were gathered. Cluster analyses and comparisons between groups were carried out. RESULTS Cluster analysis identified two distinct groups related to the study variables, and the determinants for this distinction were: gender, marital status, physical performance, handgrip strength and functional independence. These groups were compared according to occurrences of falls over the last year, and significant differences between them were found. CONCLUSIONS The results showed that greater occurrences of falls were associated with a profile of elderly people comprising female gender, single status, lower muscle strength and physical performance regarding balance and gait, and lower independence in motor tasks for activities of daily living.

IBD patients in remission strongly prefer annual telephone calls by IBD nurse - compared to outpatient visits

DEFF Research Database (Denmark)

Bager, Palle; Hentze, Runa; Markussen, Toto

Aim: To investigate the willingness among IBD patients in remission to change regularly outpatient visits to annual telephone calls by an IBD nurse. To illuminate potential barriers for introducing Self Management (SM) in the handling of IBD patients. Background: Incidence of IBD is increasing...... by a telephone call by an IBD nurse. Furthermore an extended acute access to the hospital is needed if flare occurs. Patients and Methods: 150 consecutive IBD patients attending to the outpatient clinic at Aarhus University Hospital were presented to the SM approach. On a Likert scale they were asked to what...... extend they were willing to change to SM compared to current routine appointments. Results: 87 % of the patients ‘agreed’ or ‘almost agreed’ to adopt the SM approach. Many patients comment that it was an excellent and timesaving idea. Those who had doubts were mainly older males with a long history...

The epidemiology of assault-related hospital in-patient admissions and ED attendances.

LENUS (Irish Health Repository)

O'Farrell, A

2013-03-01

The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292\\/16079 (14%) of in-patient cases and 242\\/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.

Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

Science.gov (United States)

Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C.; König, Hans-Helmut; Riedel-Heller, Steffi G.

2014-01-01

Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and

The association between exposure to social media alcohol marketing and youth alcohol use behaviors in India and Australia.

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Gupta, Himanshu; Lam, Tina; Pettigrew, Simone; Tait, Robert J

2018-06-13

Alcohol marketing on social networking sites (SNS) is associated with alcohol use among young people. Alcohol companies adapt their online marketing content to specific national contexts and responses to such content differ by national settings. However, there exists very little academic work comparing the association between alcohol marketing on SNS and alcohol use among young people in different national settings and across different SNS. Therefore, we aimed to extend the limited existing work by investigating and comparing the association between self-reported exposure to alcohol marketing on three leading SNS (Facebook, YouTube, and Twitter) and alcohol use among young people in diverse national contexts (India and Australia). Cross-sectional, self-report data were obtained from a convenience sample of 631 respondents (330 in India; 301 in Australia) aged 13-25 years via online surveys. Respondents answered questions on their drinking behaviors and involvement with alcohol marketing on SNS. Many respondents from both countries reported interacting with alcohol content online, predominantly on Facebook, followed by YouTube and then Twitter. The interaction was primarily in the forms of posting/liking/sharing/commenting on items posted on alcohol companies' social media accounts, viewing the event page/attending the event advertised by an alcohol company via social media, and/or accessing an alcohol website. Multivariate analyses demonstrated significant associations between respondents' interaction with alcohol content and drinking levels, with effects differing by SNS, demographic group, and country. For example, having friends who shared alcohol-related content was an important predictor of usual alcohol consumption for Indian respondents (p social media platforms and national contexts. The results highlight the need to formulate and implement strategies to effectively regulate the SNS alcohol marketing, especially among younger SNS users.

An Analysis of the Last Clinical Encounter before Outpatient Mortality among Children with HIV Infection and Exposure in Lilongwe, Malawi.

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Chris A Rees

Full Text Available Human immunodeficiency virus (HIV contributes to nearly 20% of all deaths in children under five years of age in Malawi. Expanded coverage of antiretroviral therapy has allowed children to access treatment on an outpatient basis. Little is known about characteristics of the final outpatient encounter prior to mortality in the outpatient setting.This retrospective cohort study assessed clinical factors associated with mortality among HIV-exposed infants and HIV-infected children less than 18 years of age at the Baylor College of Medicine Abbott Fund Children's Center of Excellence in Lilongwe, Malawi. We compared clinical indicators documented from the final outpatient encounter for patients who died in the outpatient setting versus those who were alive after their penultimate clinical encounter.Of the 8,546 patients who were attended to over a 10-year period at the Baylor Center of Excellence, 851 had died (10%. Of children who died, 392 (46% were directly admitted to the hospital after their last clinical encounter and died as inpatients. Of the remaining 459 who died as outpatients after their last visit, 53.5% had a World Health Organization (WHO stage IV condition at their last visit, and 25% had a WHO stage III condition. Multivariate regression analysis demonstrated that poor nutritional status, female gender, shorter time as a patient, more clinical encounters in the prior month, if last visit was an unscheduled sick visit, and if the patient had lost weight since their prior visit independently predicted increased mortality in the outpatient setting after the final clinical encounter.Clinical indicators may assist in identifying children with HIV who have increased risk of mortality in the outpatient setting. Recognizing these indicators may aid in identifying HIV-infected children who require a higher level of care or closer follow-up.

Integrated care for comorbid alcohol dependence and anxiety and/or depressive disorder: study protocol for an assessor-blind, randomized controlled trial.

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Morley, Kirsten C; Baillie, Andrew; Sannibale, Claudia; Teesson, Maree; Haber, Paul S

2013-11-19

A major barrier to successful treatment in alcohol dependence is psychiatric comorbidity. During treatment, the time to relapse is shorter, the drop-out rate is increased, and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder. The treatment of alcohol dependence and psychological disorders is often the responsibility of different services, and this can hinder the treatment process. Accordingly, there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression. We aim to assess the effectiveness of a specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Following a three-week stabilization period (abstinence or significantly reduced consumption), participants will undergo complete formal assessment for anxiety and depression. Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either 1) integrated intervention (cognitive behavioral therapy) for alcohol, anxiety, and/or depression; or 2) usual counseling care for alcohol problems. Patients will then be followed up at weeks 12, 16, and 24. The primary outcome measure is alcohol consumption (total abstinence, time to lapse, and time to relapse). Secondary outcome measures include changes in alcohol dependence severity, depression, or anxiety symptoms and changes in clinician-rated severity of anxiety and depression. The study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service. ClinicalTrials.gov Identifier: NCT01941693.

How Do Females With PTSD and Substance Abuse View 12-Step Groups? An Empirical Study of Attitudes and Attendance Patterns.

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Najavits, Lisa M; de Haan, Hein; Kok, Tim

2015-01-01

Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur. We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD), the first study of its kind. Cross-sectional self-report data compared adults versus adolescents, and those currently attending self-help versus not attending. We also explored attendance in relation to perceptions of the PTSD/SUD relationship and symptom severity. Adults reported higher attendance at self-help than adolescents, both lifetime and currently. Among current attendees, adults also attended more weekly groups than adolescents. Yet only a minority of both age cohorts attended any self-help in the past week. Adults perceived a stronger relationship between PTSD and SUD than adolescents, but both age groups gave low ratings to the fact that self-help groups do not address PTSD. That item also had low ratings by both those currently attending and not attending self-help. Analysis of those not currently attending identified additional negative attitudes toward self-help (spirituality, addiction as a life-long illness, sayings, and the fellowship). Symptom severity was not associated with attendance, but may reflect a floor effect. Finally, a surprising finding was that all-female groups were not preferred by any subsample. Conclusions/Importance. Creative solutions are needed to address obstacles to self-help among this population. Addressing trauma and PTSD, not just SUD, was valued by females we surveyed, and may be more helpful than all-female groups per se.

Alcohol Use Disorders and Depression: Protective Factors in the Development of Unique versus Comorbid Outcomes

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Mason, W. Alex; Hawkins, J. David; Kosterman, Rick; Catalano, Richard F.

2010-01-01

This study examines protective factors for young adult alcohol use disorders, depression, and comorbid alcohol use disorders and depression. Participants were recruited from all fifth-grade students attending 18 Seattle elementary schools. Of the 1,053 students eligible, 808 (77%) agreed to participate. Youths were surveyed when they were 10 years…

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity.

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Gill, J; Chick, J; Black, H; Rees, C; O'May, F; Rush, R; McPake, B A

2015-12-01

Potential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socio-economic status on purchasing behaviour. Cross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. 639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in- and out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last week's or a 'typical' weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. Median consumption was 184.8 (IQR = 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Non-etheless, drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence

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Watanabe N

2012-08-01

Full Text Available Norio Watanabe,1,2 Keiko Yamamura,3 Yusuke Suzuki,4 Hiroyuki Umegaki,4 Katsuro Shigeno,5 Ryo Matsushita,1 Yoshimichi Sai,1 Ken-ichi Miyamoto,1 Kiyofumi Yamada61Department of Clinical Pharmacy, Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa, Japan; 2Department of Pharmacy, Hashima Municipal Hospital, Hashima, Gifu, Japan; 3Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 4Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; 5Department of Pharmacy Practice and Sciences, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 6Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Aichi, JapanAim: Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer's disease (AD, but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS was set up. The influence of this service on medication persistence was assessed in the present study.Methods: Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group. Each patient's and their caregiver's understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated.Results: The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73

One hundred years of alcoholism: the Twentieth Century.

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Mann, K; Hermann, D; Heinz, A

2000-01-01

The past 100 years witnessed the formation of a disease concept of alcoholism and a rapid increase in the knowledge of its aetiopathology and treatment options. In the first half of the century, public sanctions aimed at the abolition of alcoholism. In the United States, alcohol prohibition was revoked in the economic turmoil of the Great Depression. In Germany, proposed medical procedures to reduce the fertility of alcoholics had catastrophic consequences during the fascist dictatorship. A revived focus on alcoholics as patients with a right to medical treatment came out of self-organized groups, such as Alcoholics Anonymous. The current disease concept includes the psychosocial and neurobiological foundations and consequences of alcoholism. Neurobiological research points to the dispositional factor of monoaminergic dysfunction and indicates that neuroadaptation and sensitization may play a role in the maintenance of addictive behaviour. New treatment options include pharmacological approaches and indicate that behaviour and motivational therapy and the attendance of patient groups may equally reduce the relapse risk. The task of the future will be to apply scientific discoveries in the best interest of the patients and to support their efforts to be respected like subjects suffering from other diseases.

Costs of Medically Attended Acute Gastrointestinal Infections: The Polish Prospective Healthcare Utilization Survey.

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Czech, Marcin; Rosinska, Magdalena; Rogalska, Justyna; Staszewska, Ewa; Stefanoff, Pawel

The burden of acute gastrointestinal infections (AGIs) on the society has not been well studied in Central European countries, which prevents the implementation of effective, targeted public health interventions. We investigated patients of 11 randomly selected general practices and 8 hospital units. Each patient meeting the international AGI case definition criteria was interviewed on costs incurred related to the use of health care resources. Follow-up interview with consenting patients was conducted 2 to 4 weeks after the general practitioner (GP) visit or discharge from hospital, collecting information on self-medication costs and indirect costs. Costs were recalculated to US dollars by using the purchasing power parity exchange rate for Poland. Weighting the inpatient costs by age-specific probability of hospital referral by GPs, the societal cost of a medically attended AGI case was estimated to be US $168. The main cost drivers of direct medical costs were cost of hospital bed days (US $28), cost of outpatient pharmacotherapy (US $20), and cost of GP consultation (US $10). Patients covered only the cost of outpatient pharmacotherapy. Considering the AGI population GP consultation rate, the age-adjusted societal cost of medically attended AGI episodes was estimated at US $2222 million, of which 53% was attributable to indirect costs. Even though AGIs generate a low cost for individuals, they place a high burden on the society, attributed mostly to indirect costs. Higher resources could be allocated to the prevention and control of AGIs. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

A cultural and social cognitive model of differences in acculturation orientations, alcohol expectancies, and alcohol-related risk behaviors among Hispanic college students.

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Des Rosiers, Sabrina E; Schwartz, Seth J; Zamboanga, Byron L; Ham, Lindsay S; Huang, Shi

2013-04-01

The present study used a cultural and social cognitive conceptual framework to investigate whether alcohol expectancies and valuations would mediate the associations between specific acculturation orientations and alcohol-related risk behaviors. The sample comprised 1,527 Hispanic students attending colleges and universities in diverse regions of the United States. Respondents completed self-report measures of Hispanic and American cultural practices; alcohol expectancies and valuations; and self-reported frequency of hazardous alcohol use, binge drinking, sexual activity under the influence of alcohol, driving under the influence of alcohol, and riding with a drunk driver. Latent class analysis was used to classify participants into acculturation orientations. Results indicated that acculturation orientations were differentially associated with alcohol-related risk outcomes, with separated bicultural and low bicultural orientations inversely related to all of the alcohol-related risk behaviors except for riding with a drunk driver. Negative expectancy valuations were positively associated with endorsement of binge drinking and drunk driving and negative expectancies were negatively associated with binge drinking, drunk driving, and riding with a drunk driver. With the exception of sexual activity under the influence of alcohol, the associations between acculturation orientations and alcohol-related risk behaviors were partially mediated by positive alcohol expectancies. Our findings provided relevant data that are informative for preventing alcohol and related risk behaviors among Hispanic college students. © 2012 Wiley Periodicals, Inc.

Diet, Alcohol Consumption and Serum Lipid Levels of Elderly Men ...

African Journals Online (AJOL)

Methodology: Elderly subjects attending quarterly medical lectures organized by a non-governmental organization at the Federal Medical Centre, Asaba were recruited. Information on diet, alcohol consumption and hypertension were obtained and serum lipids were determined using standard cholesterol / low density ...

Cost-effectiveness of screening and referral to an alcohol health worker in alcohol misusing patients attending an accident and emergency department: a decision-making approach.

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Barrett, Barbara; Byford, Sarah; Crawford, Mike J; Patton, Robert; Drummond, Colin; Henry, John A; Touquet, Robin

2006-01-04

We present the cost and cost-effectiveness of referral to an alcohol health worker (AHW) and information only control in alcohol misusing patients. The study was a pragmatic randomised controlled trial conducted from April 2001 to March 2003 in an accident and emergency department (AED) in a general hospital in London, England. A total of 599 adults identified as drinking hazardously according to the Paddington Alcohol Test were randomised to referral to an alcohol health worker who delivered a brief intervention (n = 287) or to an information only control (n = 312). Total societal costs, including health and social services costs, criminal justice costs and productivity losses, and clinical measures of alcohol consumption were measured. Levels of drinking were observably lower in those referred to an AHW at 12 months follow-up and statistically significantly lower at 6 months follow-up. Total costs were not significantly different at either follow-up. Referral to AHWs in an AED produces favourable clinical outcomes and does not generate a significant increase in cost. A decision-making approach revealed that there is at least a 65% probability that referral to an AHW is more cost-effective than the information only control in reducing alcohol consumption among AED attendees with a hazardous level of drinking.

Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15-30 years) with type 1 diabetes mellitus: a systematic review.

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Hynes, Lisa; Byrne, Molly; Dinneen, Sean F; McGuire, Brian E; O'Donnell, Máire; Mc Sharry, Jennifer

2016-11-01

Regular clinic attendance is recommended to facilitate self-management of diabetes. Poor attendance is common among young adults with type 1 diabetes mellitus (DM). This systematic review aimed to produce a narrative synthesis of the evidence regarding factors which promote or impede regular attendance at adult diabetes clinics among young adults (15-30 years) with type 1 DM. Studies reporting facilitators and barriers to clinic attendance were identified by searching four electronic databases, checking reference lists, and contacting diabetes research networks. A total of 12 studies (8 quantitative and 4 qualitative) met the inclusion criteria. Young adult's experiences transitioning from paediatric to adult diabetes care can influence attendance at the adult clinic positively if there is a comprehensive transition programme in place, or negatively if the two clinics do not communicate and provide adequate support. Post-transition, relationship development and perceptions of the value of attending the clinic are important for regular attendance. Controlled research is required to better understand decisions to attend or not attend outpatient services among people with chronic conditions. Service delivery must be sensitive to the developmental characteristics of young adults and tailored support may be required by young adults at greatest risk of non-attendance. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Thai men's experiences of alcohol addiction and treatment

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Kulnaree Hanpatchaiyakul

2014-05-01

Full Text Available Background: Men are overrepresented with regard to alcohol addiction and in terms of alcohol treatment worldwide. In Thailand, alcohol consumption continues to rise, but few of those afflicted with alcohol addiction attend alcohol treatment programs, even though there is universal care for all. No comprehensive studies have been done on men's experiences with addiction and alcohol treatment programs in Thailand. Objective: The aim of this study was to explore men's experiences in terms of the ‘pros and cons of alcohol consumption’ in order to identify the barriers that exist for Thai men with regard to alcohol addiction and the decision to stop drinking. Design: Purposive sampling was applied in the process of recruiting participants at an alcohol clinic in a hospital in Thailand. Thirteen men with alcohol addiction (aged 32–49 years were willing to participate and were interviewed in thematic interviews. The analysis of the data was done with descriptive phenomenology. Results: Through men's descriptions, three clusters of experiences were found that were ‘mending the body’, ‘drinking as payoff and doping related to work’, and ‘alcohol becoming a best friend’ as ways of describing the development of addiction. Conclusions: The results highlight the importance of addressing concepts of masculinity and related hegemonic ideas in order to decrease the influence of the barriers that exist for Thai men with alcohol addiction with regard to entering treatment and to stop drinking.

Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey.

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Oflaz, Serap; Guveli, Hulya; Kalelioglu, Tevfik; Akyazı, Senem; Yıldızhan, Eren; Kılıc, Kasım Candas; Basyigit, Sehnaz; Ozdemiroglu, Filiz; Akyuz, Fatma; Gokce, Esra; Bag, Sevda; Kurt, Erhan; Oral, Esat Timucin

2015-06-01

Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance. Copyright © 2015 Elsevier B.V. All rights reserved.

The effect of co-morbid depression and anxiety on the course and outcome of alcohol outpatient treatment

DEFF Research Database (Denmark)

Mellentin, Angelina Isabella; Nielsen, Bent; Stenager, Elsebeth

2015-01-01

Background: Studies examining the effect of alcohol treatment among patients with alcohol use disorders (AUD) and co-morbid depression and/or anxiety are few and show inconsistent, but mainly negative drinking outcomes. Aims: To describe the prevalence of anxiety and depression among Danish....... No difference was found between patients with and without co-morbidity. Conclusion: In contrast to the majority of prior studies, this study provides evidence that depression and anxiety do not have an effect on alcohol treatment. However, because of the naturalistic setting, a number of limitations should...

Risk factors for type 2 diabetes mellitus among patients attending a rural Kenyan hospital

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Masemiano P. Chege

2010-05-01

Objectives: To describe the risk factors for type 2 diabetes mellitus among patients attending the outpatient clinics in a rural mission hospital in Kenya. Method: Forty-five diabetics and forty-five non-diabetics, resident in this rural hospital’s catchment area for at least 10 years, were randomly selected from patients attending outpatient clinics. Diabetics in a stable condition (not requiring hospitalisation, whose fasting blood sugars were below 6.1 mmol/L, were matched for age and gender with the non-diabetics who came to the hospital for outpatient services. A pilot-tested questionnaire on demography, current and past dietary habits, social habits, and family history was used to collect data. Waist circumference, height and weight were measured and BMI calculated. Data was analysed using SPSS for Windows. The Kruskal–Wallis test was used to compare the medians for the continuous variables, while the chi-squared test was used for the categorical variables. The z-test was used to calculate the relative risk. Results: Ninety participants (26 males, 64 females. The mean age was 61.8 for diabetics and 61.4 for non-diabetics. Childhood starvation (relative risk 2.08, p = 0.0090 and use of cassava for sustenance during childhood starvation (relative risk 3.12, p = 0.0090 were identified as risk factors. Diabetes in close relatives, another risk factor for this population (relative risk 2.2, p = 0.0131. Abdominal obesity was a risk factor for this population (in females relative risk 2.0, p = 0.0010. Conclusion: The risk factors for type 2 diabetes mellitus described in this rural population include advancing age, diabetes in a first-degree relative and abdominal obesity. This is similar to what has been cited in other studies. At variance, we found that more than 50% of the diabetics reported having suffered malnutrition/starvation in childhood, with more than half of them reporting their dependence on cassava as the only food source during starvation.

Alcoholics and the emergency ward. Part I. Clinical characteristics.

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Fialkov, M J

1977-10-01

A study of White and Black (Black, Cape Coloured and Asiatic) male alcoholics who attended the psychiatric emergency service unit at Groote Schuur Hospital, Cape Town, is presented. The psychosocial and clinical characteristics are described and compared. In addition, the associated physical and psychiatric morbidity is tabulated.

An ecologically based model of alcohol-consumption decision making: evidence for the discriminative and predictive role of contextual reward and punishment information.

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Bogg, Tim; Finn, Peter R

2009-05-01

Using insights from Ecological Systems Theory and Reinforcement Sensitivity Theory, the current study assessed the utility of a series of hypothetical role-based alcohol-consumption scenarios that varied in their presentation of rewarding and punishing information. The scenarios, along with measures of impulsive sensation seeking and a self-report of weekly alcohol consumption, were administered to a sample of alcohol-dependent and non-alcohol-dependent college-age individuals (N = 170). The results showed scenario attendance decisions were largely unaffected by alcohol-dependence status and variations in contextual reward and punishment information. In contrast to the attendance findings, the results for the alcohol-consumption decisions showed alcohol-dependent individuals reported a greater frequency of deciding to drink, as well as indicating greater alcohol consumption in the contexts of complementary rewarding or nonpunishing information. Regression results provided evidence for the criterion-related validity of scenario outcomes in an account of diagnostic alcohol problems. The results are discussed in terms of the conceptual and predictive gains associated with an assessment approach to alcohol-consumption decision making that combines situational information organized and balanced through the frameworks of Ecological Systems Theory and Reinforcement Sensitivity Theory.

Assessment of nutritional status of children attending paediatric outpatient department at a tertiary care hospital

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Shreyash J Gandhi

2015-01-01

Full Text Available Background The nutrition status is always neglected issue of public health. The high prevalence of malnutrition in NFHS data gives alarm to work for the children who are assets of our country in future. Objectives To study the nutritional status of children attending pediatric OPD by anthropometric measurements and to know the health status of these children and their relation with nutritional status. Methods The nutritional profile of children of age group 0-5 years attending Paediatric OPD at New Civil Hospital (NCH, Surat was studied. Stratification to get equal representation of both gender by enrolling 50 boys and 50girls of each age group 0-6 months, 6-12 months, 1-2 years, 2-3 years, 3-4 years and 4-5 years was done. Total 600 children of age group of 0-5 years were enrolled. Results As per WHO growth standards, 17.5%, 46% and 39.33% children had wasting, stunting and underweight respectively. Total malnutrition cases were 386 with a prevalence of 64.3 %. Age group wise prevalence of under nutrition was highest in 37-48 months age group (69.2 %. As per assessment of nutritional status of children aged 6-60 months using MUAC, 45.8 % children have mild to moderate malnutrition whereas 1.8 % has severe malnutrition. Conclusion Malnutrition is more in boys compared to girls. Malnutrition was more prevalent in 12-60 months age group children and was found statistically significant. Reduction of malnutrition in 0-5 age group can be ensured by availability of supplementary feed.

Outpatient presentations to burn centers: data from the Burns Registry of Australia and New Zealand outpatient pilot project.

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Gabbe, Belinda J; Watterson, Dina M; Singer, Yvonne; Darton, Anne

2015-05-01

Most studies about burn injury focus on admitted cases. To compare outpatient and inpatient presentations at burn centers in Australia to inform the establishment of a repository for outpatient burn injury. Data for sequential outpatient presentations were collected at seven burn centers in Australia between December 2010 and May 2011 and compared with inpatient admissions from these centers recorded by the Burns Registry of Australia and New Zealand for the corresponding period. There were 788 outpatient and 360 inpatient presentations. Pediatric outpatients included more children burns (39% vs 24%). Adult outpatients included fewer males (58% vs 73%) and intentional injuries (3.3% vs 10%), and more scald (46% vs 30%) and contact burns (24% vs 13%). All pediatric, and 98% of adult, outpatient presentations involved a %TBSAburns presenting to burn centers differed to inpatient admission data, particularly with respect to etiology and burn severity, highlighting the importance of the need for outpatient data to enhance burn injury surveillance and inform prevention. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia.

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Hansen, Mette Vinther; Hjorth, Peter; Kristiansen, Christina Blanner; Vandborg, Kirsten; Gustafsson, Lea Nørgaard; Munk-Jørgensen, Povl

2016-06-01

Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose, serum lipids, and information on smoking and alcohol were obtained. On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care. © The Author(s) 2016.

Self-esteem in adolescents treated in an outpatient mental health setting.

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Modrcin-Talbott, M A; Pullen, L; Ehrenberger, H; Zandstra, K; Muenchen, B

1998-01-01

Although self-esteem is an important concept, nursing has only begun to focus on the significance of self-esteem as a mechanism for achieving wellness among adolescents, and as a variable for targeted intervention. Nursing studies identifying self-esteem as the primary focus of their research in an adolescent population seeking treatment in mental health settings are scarce. The Roy Adaptation Model's Theory of a Person as an Adaptive System was used to guide this descriptive, correlational study. Research examined the self-report of self-esteem on age, gender, smoking, exercise, depression, anger, and parental alcohol use in a sample of adolescents ages 12-19 years who were being treated in an outpatient mental health setting.

Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries.

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McDonald, Scott D; Mickens, Melody N; Goldberg-Looney, Lisa D; Mutchler, Brian J; Ellwood, Michael S; Castillo, Teodoro A

2017-03-13

Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. Cross-sectional. A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.

Combinations of Injunctions and Personality Types Determining Forms of Self-Destructive Behaviour in Alcohol-Dependent Clients: Findings of a Russian Observational Study

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Dmitri Shustov

2016-07-01

Full Text Available This observational study, conducted 2009-2012 with 190 male out-patient clients diagnosed with alcohol dependence and receiving psychotherapeutic treatment in Ryazan, Russia, investigated whether the patterns of self-destructive behaviours exhibited by the subjects were linked to their Personality Types and which combinations of injunctions were reflected in their main personality traits. Self-destructive behaviour was measured according to the 7 Alcoholic Self-Destructiveness Dimensions (ASD (Shustov 2005; data on alcohol abuse and preferred ASD were gathered through semi-structured interview; personality patterns and psychosocial functioning were assessed by means of clinical observation, semi-structured interview, the Personality Diagnostic Questionnaire: Version 4+ (Hyler, 1994 (Russian version and ICD-10 criteria except for Narcissistic Disorder diagnosed according to DSM-IV; 12 injunctions were assessed with The Drego Injunction Scale (Drego, 1994 (Russian version. When correlations were analysed, it was found that injunctions had a significant impact on the hamartic alcoholic script of the out-patient alcohol-dependent clients on the following continuum: Don’t Be, Don’t Think, Don’t Be a Child, Don’t Trust, Don’t Feel, Don’t Grow Up; client personality types had direct relationship with specific injunction patterns. Personality Types mediated the Alcoholic Self-Destructiveness Dimensions: the Classical Suicidal Dimension being associated with Borderline personality traits; Antisocial with the Antisocial personality; and Professional with the Narcissistic Personality.

Alcohol use and related problems among college students and their noncollege peers: the competing roles of personality and peer influence.

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Quinn, Patrick D; Fromme, Kim

2011-07-01

Although alcohol use and related problems are highly prevalent in emerging adulthood overall, college students drink somewhat more than do their peers who do not attend college. The personal or social influences underlying this difference, however, are not yet well understood. The present study examined whether personality traits (i.e., self-regulation and sensation seeking) and peer influence (i.e., descriptive drinking norms) contributed to student status differences. At approximately age 22, 4-year college students (n = 331) and noncollege emerging adults (n = 502) completed web-based surveys, including measures of alcohol use, alcohol-related problems, personality, and social norms. College students drank only slightly more heavily. This small difference, however, reflected personality suppression. College students were lower in trait-based risk for drinking, and accounting for traits revealed a stronger positive association between attending college and drinking more heavily. Although noncollege emerging adults reported greater descriptive drinking norms for social group members, norms appeared to more strongly influence alcohol use among college students. Finally, despite drinking less, noncollege individuals experienced more alcohol-related problems. The association between attending college and drinking heavily may be larger than previously estimated, and it may be masked by biased selection into college as a function of both self-regulation and sensation seeking. Differing patterns of alcohol use, its predictors, and its consequences emerged for the college and noncollege samples, suggesting that differing intervention strategies may best meet the needs of each population.

Comorbid Illness, Bowel Preparation, and Logistical Constraints Are Key Reasons for Outpatient Colonoscopy Nonattendance

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Deepti Chopra

2016-01-01

Full Text Available Background. Colonoscopy nonattendance is a challenge for outpatient clinics globally. Absenteeism results in a potential delay in disease diagnosis and loss of hospital resources. This study aims to determine reasons for colonoscopy nonattendance from a Canadian perspective. Design. Demographic data, reasons for nonattendance, and patient suggestions for improving compliance were elicited from 49 out of 144 eligible study participants via telephone questionnaire. The 49 nonattenders were compared to age and sex matched controls for several potential contributing factors. Results. Nonattendance rates were significantly higher in winter months; the OR of nonattendance was 5.2 (95% CI, 1.6 to 17.0, p<0.001 in winter versus other months. Being married was positively associated with attendance. There was no significant association between nonattendance and any of the other variables examined. The top 3 reasons for nonattendance were being too unwell to attend the procedure, being unable to complete bowel preparation, or experiencing logistical challenges. Conclusions. Colonoscopy attendance rates appear to vary significantly by season and it may be beneficial to book more colonoscopies in the summer or overbook in the winter. Targets for intervention include more tailored teaching sessions, reminders, taxi chits, and developing a hospital specific colonoscopy video regarding procedure and bowel preparation requirements.

Characteristics of Adults with Anxiety or Depression Treated at an Internet Clinic: Comparison with a National Survey and an Outpatient Clinic

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Titov, Nickolai; Andrews, Gavin; Kemp, Alice; Robinson, Emma

2010-01-01

Background There is concern that people seeking treatment over the Internet for anxiety or depressive disorders may not resemble the general population or have less severe disorders than patients attending outpatient clinics or cases identified in community surveys. Thus the response to treatment in Internet based trials might not generalize. Methodology We reviewed the characteristics of applicants to an Australian Internet-based treatment clinic for anxiety and depression, and compared this...

Benfotiamine in treatment of alcoholic polyneuropathy: an 8-week randomized controlled study (BAP I Study).

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Woelk, H; Lehrl, S; Bitsch, R; Köpcke, W

1998-01-01

A three-armed, randomized, multicentre, placebo-controlled double-blind study was used to examine the efficacy of benfotiamine vs a combination containing benfotiamine and vitamins B6 and B12 in out-patients with severe symptoms of alcoholic polyneuropathy (Benfotiamine in treatment of Alcoholic Polyneuropathy, BAP I). The study period was 8 weeks and 84 patients fulfilled all the prerequisite criteria and completed the study as planned. Benfotiamine led to significant improvement of alcoholic polyneuropathy. Vibration perception (measured at the tip of the great toe) significantly improved in the course of the study, as did motor function. and the overall score reflecting the entire range of symptoms of alcoholic polyneuropathy. A tendency toward improvement was evident for pain and co-ordination; no therapy-specific adverse effects were seen.

Impact of Attendance Policies on Course Attendance among College Students

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Chenneville, Tiffany; Jordan, Cary

2008-01-01

The purpose of this study was twofold: (a) to investigate whether having a graded attendance policy would have an effect on course attendance among college students, and (b) to examine beliefs about education and attendance policies among college students. Results support the utility of graded attendance policies for increasing class attendance…

Alcohol-dependent patients receiving specialised outpatient care: an overview of gender issues Dependentes do álcool atendidos em ambulatório especializado: um olhar na questão do gênero

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Márcia Fonsi Elbreder

2010-01-01

Full Text Available OBJECTIVE: The objective of the present study, with focus on gender, was aimed at evaluating alcohol-dependent individual in terms of socio-demographic variables related to alcohol consumption and therapeutic interventions. METHODS: This is a retrospective cross-sectional study of 1,051 patients (833 men and 218 women, with diagnosis of alcohol dependence syndrome, according to ICD-10 criteria, who had sought treatment for the first time at a specialised health centre between 2000 and 2006. RESULTS: The results showed that women, compared to men, are more likely to be unemployed and without partner, in addition to having higher educational level, latter age of alcohol initiation, needing less outpatient alcohol detoxification program, consuming more fermented beverage, presenting less psychiatric comorbidities, and using less coadjutant medications during treatment. CONCLUSION: We can state that some peculiarities exist permeating both gender and alcohol consumption. A further focus on the characteristics of each population is needed to facilitate the adequate use of therapeutic interventions according to gender specificities.OBJETIVO: O objetivo do presente estudo, com foco no gênero, foi avaliar dependentes de álcool em termos de variáveis sociodemográficas, relacionadas ao consumo de álcool e intervenções terapêuticas. MÉTODOS: Este é um estudo retrospectivo transversal com 1.051 pacientes (833 homens e 218 mulheres, com diagnóstico de síndrome de dependência do álcool, de acordo com o CID-10, que procuraram tratamento pela primeira vez em um serviço especializado, entre 2000 e 2006. RESULTADOS: Os resultados mostraram que as mulheres, comparadas aos homens, eram desempregadas e sem companheiro, além de ter melhor nível educacional, iniciarem o consumo alcoólico mais tardiamente, necessitarem menos do programa de desintoxicação alcoólica ambulatorial, consumirem mais bebidas fermentadas, apresentarem menos comorbidades

Rates and Covariates of Recent Sexual and Physical Violence Against HIV-Infected Outpatient Drinkers in Western Kenya.

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Papas, Rebecca K; Gakinya, Benson N; Mwaniki, Michael M; Lee, Hana; Kiarie, Stella W; Martino, Steve; Loxley, Michelle P; Keter, Alfred K; Klein, Debra A; Sidle, John E; Baliddawa, Joyce B; Maisto, Stephen A

2017-08-01

Victimization from physical and sexual violence presents global health challenges. Partner violence is higher in Kenya than Africa. Violence against drinkers and HIV-infected individuals is typically elevated, so dual vulnerabilities may further augment risk. Understanding violence risks can improve interventions. Participants were 614 HIV-infected outpatient drinkers in western Kenya enrolled in a randomized trial to reduce alcohol use. At baseline, past 90-day partner physical and sexual violence were examined descriptively and in gender-stratified regression models. We hypothesized higher reported violence against women than men, and positive violence association with HIV stigma and alcohol use across gender. Women reported significantly more current sexual (26.3 vs. 5.7%) and physical (38.9 vs. 24.8%) victimization than men. Rates were generally higher than Kenyan lifetime national averages. In both regression models, HIV stigma and alcohol-related sexual expectations were significantly associated with violence while alcohol use was not. For women, higher violence risk was also conferred by childhood violence, past-year transactional sex, and younger age. HIV-infected Kenyan drinkers, particularly women, endorse high current violence due to multiple risk factors. Findings have implications for HIV interventions. Longitudinal research is needed to understand development of risk.

Amplified Fragment Length Polymorphism Fingerprinting for Identification of a Core Group of Neisseria gonorrhoeae Transmitters in the Population Attending a Clinic for Treatment of Sexually Transmitted Diseases in Amsterdam, The Netherlands

OpenAIRE

Spaargaren, Joke; Stoof, Jeroen; Fennema, Han; Coutinho, Roel; Savelkoul, Paul

2001-01-01

Amplified fragment length polymorphism analysis seems well suited for studying the epidemiology of isolates of Neisseria gonorrhoeae obtained from patients attending the Sexually Transmitted Disease Outpatient Clinic in Amsterdam, The Netherlands. It shows potential to identify the core group of transmitters.

Personality traits and psychiatric comorbidities in alcohol dependence

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M.F. Donadon

2016-01-01

Full Text Available Non-adaptive personality traits may constitute risk factors for development of psychiatric disorders such as depression and anxiety. We aim to evaluate associations and the predictive value of personality traits among alcohol-dependent individuals, with or without psychiatric comorbidities. The convenience sample comprised two groups of males over 18 years of age: one with subjects who had an alcohol dependence diagnosis (AG, n=110, and a control group without abuse and/or alcohol dependence diagnosis (CG, n=110. The groups were assessed by means of the Structured Clinical Interview DSM-IV (SCID-IV. AG participants were recruited among outpatients from the university hospital, whereas CG participants were recruited from a primary healthcare program. Data collection was done individually with self-assessment instruments. Parametric statistics were performed, and a significance level of P=0.05 was adopted. A positive correlation was observed between openness and the length of time that alcohol has been consumed, as were significant and negative correlations between conscientiousness and both the length of time alcohol has been consumed and the number of doses. For alcoholics, extraversion emerged as a protective factor against depression development (P=0.008 and tobacco abuse (P=0.007, whereas openness worked as a protective factor against anxiety (P=0.02. The findings point to specific deficits presented by alcoholics in relation to personality traits with or without psychiatric comorbidities and to the understanding that therapeutic approaches should favor procedures and/or preventive measures that allow more refined awareness about the disorder.

Personality traits and psychiatric comorbidities in alcohol dependence.

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Donadon, M F; Osório, F L

2016-01-01

Non-adaptive personality traits may constitute risk factors for development of psychiatric disorders such as depression and anxiety. We aim to evaluate associations and the predictive value of personality traits among alcohol-dependent individuals, with or without psychiatric comorbidities. The convenience sample comprised two groups of males over 18 years of age: one with subjects who had an alcohol dependence diagnosis (AG, n=110), and a control group without abuse and/or alcohol dependence diagnosis (CG, n=110). The groups were assessed by means of the Structured Clinical Interview DSM-IV (SCID-IV). AG participants were recruited among outpatients from the university hospital, whereas CG participants were recruited from a primary healthcare program. Data collection was done individually with self-assessment instruments. Parametric statistics were performed, and a significance level of P=0.05 was adopted. A positive correlation was observed between openness and the length of time that alcohol has been consumed, as were significant and negative correlations between conscientiousness and both the length of time alcohol has been consumed and the number of doses. For alcoholics, extraversion emerged as a protective factor against depression development (P=0.008) and tobacco abuse (P=0.007), whereas openness worked as a protective factor against anxiety (P=0.02). The findings point to specific deficits presented by alcoholics in relation to personality traits with or without psychiatric comorbidities and to the understanding that therapeutic approaches should favor procedures and/or preventive measures that allow more refined awareness about the disorder.

School attendance, health-risk behaviors, and self-esteem in adolescents applying for working papers.

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Suss, A L; Tinkelman, B K; Freeman, K; Friedman, S B

1996-01-01

Since health-risk behaviors are often encountered in clusters among adolescents, it was hypothesized that adolescents with poor school attendance would be associated with more health-risk behaviors (e.g., substance use, violence) than those who attend school regularly. This study assessed the relationship between poor school attendance and health-risk behaviors, and described health-risk behaviors and self-esteem among adolescents seeking employment. In this cross-sectional study, school attendance (poor vs. regular attendance) was related to health-risk behaviors by asking 122 subjects seen at a New York City Working Papers Clinic to complete both a 72-item questionnaire about their health-risk behaviors and the 58-item Coopersmith Self-Esteem School Form Inventory. Chi-square and Fisher's Exact Tests were performed. The poor and regular attenders of school differed significantly in only 5 out of 44 items pertaining to health-risk behaviors. Self-esteem measures for the two groups did not differ from one another or from national norms. In this sample, depression "in general" (global) and "at home," but not "at school," were associated significantly with suicidal thoughts/attempts and serious past life events (e.g. family conflict, sexual abuse). There were no significant associations between depression or self-esteem and illicit substance or alcohol use. We found few associations between poor school attendance and health-risk behaviors in this sample of employment-seeking adolescents. The poor and regular attenders of school were similar in most aspects of their health-risk behaviors and self-esteem.

Do Negative Emotions Predict Alcohol Consumption, Saturated Fat Intake, and Physical Activity in Older Adults?

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Anton, Stephen D.; Miller, Peter M.

2005-01-01

This study examined anger, depression, and stress as related to alcohol consumption, saturated fat intake, and physical activity. Participants were 23 older adults enrolled in either an outpatient or in-residence executive health program. Participants completed (a) a health-risk appraisal assessing medical history and current health habits, (b)…

Medicare Provider Utilization and Payment Data - Outpatient

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U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...

Metabolic syndrome among substance dependent men: A study from north India

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Surendra Kumar Mattoo

2013-01-01

Full Text Available Background: Substance abuse, alcohol in particular, is associated with increased risk of diabetes and metabolic syndrome (MS. The relationship between the substance abuse and MS is complex and the literature is sparse. Objectives: The present research was aimed to study the prevalence and predictors of MS among outpatients with substance dependence. Materials and Methods: Patients with substance dependence were recruited from a deaddiction center in North India, who attended outpatient clinic from 1 st January, 2010-31 st December, 2010. MS was assessed using International Diabetes Federation (IDF criteria. Results: Out of 250 subjects, 34 (13.6% of the subjects met the IDF criteria for MS and highest being in alcohol group (21.6%. The commonest abnormality was increased triglycerides (TG; 54% and increased waist circumference (36.8%. Age, body weight, body mass index, and obesity were significant predictor of MS. Conclusion: MS was highest in subjects with alcohol dependence with the commonest abnormality of TG and blood pressure. Hence, routine screening is advisable in this population to address emerging MS.

Eating Disorder Symptoms and Alcohol Use Among Adolescents in Substance Abuse Treatment

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Janelle E. Arias

2009-11-01

Full Text Available Objective: To examine the relationship of eating disorder (ED symptoms with the severity of alcohol use among adolescents in treatment for alcohol and other substance use disorders (AOSUDs. Method: A sample consisted of 177 adolescents who participated in outpatient AOSUD treatment programs in Connecticut. Chi square tests, one-way ANOVAs and Pearson’s correlation coefficients were used to describe the prevalence and correlates of any eating disorders, and the related symptoms. Multivariate regression was used to test the associations between ED symptoms and alcohol consumption. Results: 26.4% of the participants had at least one ED symptom, with the highest number of symptoms occurring in females. The number of ED symptoms was associated with increases in the number of times that they became intoxicated in the year before entering treatment, the number of alcohol-related social problems, and the number of alcohol-related physical symptoms after taking into consideration the effects of age and gender. Conclusions: The prevalence of symptoms of EDs is high in adolescents with AOSUDs, with the number of ED symptoms correlating with increased alcohol consumption. Further studies on the course and treatment of adolescents with AOSUDs and symptoms of EDs are warranted.

Psychosocial and clinical predictors of retention in outpatient alcoholism treatment Preditores psicossociais e clínicos de retenção ao tratamento para alcoolismo

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João Maria Corrêa Filho

2012-12-01

Full Text Available OBJECTIVE: One of the factors associated with low rates of compliance in the treatment for alcoholism seems to be the intensity of craving for alcohol. This study aimed to evaluate the associations between alcohol craving and biopsychosocial addiction model-related variables and to verify whether these variables could predict treatment retention. METHODS: The sample consisted of 257 male alcoholics who were enrolled in two different pharmacological trials conducted at the Universidade de São Paulo in Brazil. Based on four factors measured at baseline - biological (age, race, and family alcoholism, psychiatric (depression symptoms, social (financial and marital status, and addiction (craving intensity, severity of alcohol dependence, smoking status, drinking history, preferential beverage, daily intake of alcohol before treatment - direct logistic regression was performed to analyze these factors' influence on treatment retention after controlling for medication groups and AA attendance. RESULTS: Increasing age, participation in Alcoholics Anonymous groups, and beer preference among drinkers were independently associated with higher treatment retention. Conversely, higher scores for depression increased dropout rates. CONCLUSION: Health services should identify the treatment practices and therapists that improve retention. Information about patients' characteristics linked to dropouts should be studied to render treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions.OBJETIVO: Um dos fatores associados com baixas taxas de adesão ao tratamento para alcoolismo parece ser a intensidade da fissura pelo álcool. Este estudo objetiva avaliar a associação entre a fissura pelo álcool e variáveis relacionadas ao modelo biopsicossocial de dependência, bem como verificar se estas variáveis prevêem retenção ao tratamento. MÉTODO: A amostra foi composta por

Outpatient management of pediatric acute mastoiditis.

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Alkhateeb, Ahmed; Morin, Francis; Aziz, Haya; Manogaran, Mayuri; Guertin, William; Duval, Melanie

2017-11-01

Evaluate the Montreal Children's Hospital experience with outpatient management of uncomplicated acute mastoiditis with parenteral antibiotic therapy alone and determine if it is a safe alternative to inpatient management. A retrospective review of pediatric patients diagnosed with acute mastoiditis at a tertiary care pediatric hospital between 2013 and 2015 was performed. Patients with syndromes, immunodeficiency, cholesteatoma, chronic otitis media, cochlear implant in the affected ear, or incidental mastoid opacity were excluded. 56 children age 6 months to 15 years old were treated for acute mastoiditis, including 29 hospitalizations and 27 outpatients. Patients managed as outpatient with daily intravenous ceftriaxone had a 93% cure rate. Eighteen hospitalized and one outpatient had complications of acute mastoiditis. Children with complications were more likely to be febrile (p = 0.045). Two patients failed outpatient therapy and were admitted; one for myringotomy and piperacillin-tazobactam treatment and one required a mastoidectomy. 4/27 children treated as outpatient underwent myringotomy and tube insertion, 2 underwent myringotomy and tube along with admission and 21 did not require tube insertion. The average total duration of intravenous antibiotic therapy was respectively 4.9 and 18.9 days in the outpatient and hospitalized group. The average duration of admission was 5.9 days. Outpatient medical therapy of uncomplicated pediatric mastoiditis is safe, successful, and efficient. Benefits include efficient use of surgical beds, cost savings and patient and family convenience. Careful patient selection and close monitoring are keys for successful outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

Difficulties in emotion regulation mediate negative and positive affects and craving in alcoholic patients.

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Khosravani, Vahid; Sharifi Bastan, Farangis; Ghorbani, Fatemeh; Kamali, Zoleikha

2017-08-01

The aim of this study was to assess the mediating effects of difficulties in emotion regulation (DER) on the relations of negative and positive affects to craving in alcoholic patients. 205 treatment-seeking alcoholic outpatients were included. DER, positive and negative affects as well as craving were evaluated by the Difficulties in Emotion Regulation Scale (DERS), the Positive/Negative Affect Scales, and the Obsessive Compulsive Drinking Scale (OCDS) respectively. Clinical factors including depression and severity of alcohol dependence were investigated by the Alcohol Use Disorders Identification Test (AUDIT) and the Beck Depression Inventory-II (BDI-II) respectively. Results revealed that both increased negative affect and decreased positive affect indirectly influenced craving through limited access to emotion regulation strategies. It was concluded that limited access to emotion regulation strategies may be important in predicting craving for alcoholics who experience both increased negative affect and decreased positive affect. This suggests that treatment and prevention efforts focused on increasing positive affect, decreasing negative affect and teaching effective regulation strategies may be critical in reducing craving in alcoholic patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India

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N Saimadhavi

2013-01-01

Full Text Available Context: Currently there is a growing interest in oral health outcomes in how oral health affects quality of life. When oral health related quality of life measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective wellbeing becomes possible. In this context, we attempted to study the impact of oral diseases on quality of life, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Aims: To evaluate the impact of different oral diseases on quality of life using a modified OHIP-14 questionnaire, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Settings and Design: The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the study were included. Materials and Methods: The study sample was categorized in to two groups based upon the duration of the affecting disease - group 1 consisted of subjects suffering with chronic diseases and group 2 of subjects suffering with acute diseases. All the subjects were asked to fill up their responses in the given OHIP-14 questionnaires. The completed questionnaires were then collected and statistically analyzed. Statistical Analysis Used: To evaluate the role of age on QOL, age was divided in to 2 groups using median split procedure. For inter and intragroup comparisions, independent sample t test, anova followed by post hoc test and Chi-square tests were employed. Results: Chi square test revealed a moderately impaired quality of life among all the diseases investigated. On comparing the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability and the total

Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders

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ter Riet Gerben

2009-01-01

Full Text Available Abstract Background General Practitioners spend a disproportionate amount of time on frequent attenders. So far, trials on the effect of interventions on frequent attenders have shown negative results. However, these trials were conducted in short-term frequent attenders. It would be more reasonable to target intervention at persistent frequent attenders. Typical characteristics of persistent frequent attenders, as opposed to 1-year frequent attenders and non-frequent attenders, may generate hypotheses regarding modifiable factors on which new randomized trials may be designed. Methods We used the data of all 28,860 adult patients from 5 primary healthcare centers. Frequent attenders were patients whose attendance rate ranked in the (age and sex adjusted top 10 percent during 1 year (1-year frequent attenders or 3 years (persistent frequent attenders. All other patients on the register over the 3-year period were referred to as non-frequent attenders. The lists of medical problems coded by the GP using the International Classification of Primary Care (ICPC were used to assess morbidity. First, we determined which proportion of 1-year frequent attenders was still a frequent attender during the next two consecutive years and calculated the GPs' workload for these patients. Second, we compared morbidity and number of prescriptions for non-frequent attenders, 1-year frequent attenders and persistent frequent attenders. Results Of all 1-year frequent attenders, 15.4% became a persistent frequent attender equal to 1.6% of all patients. The 1-year frequent attenders (3,045; 10.6% were responsible for 39% of the face-to-face consultations; the 470 patients who would become persistent frequent attenders (1.6% were responsible for 8% of all consultations in 2003. Persistent frequent attenders presented more social problems, more psychiatric problems and medically unexplained physical symptoms, but also more chronic somatic diseases (especially diabetes

Can we rely on predicted basal metabolic rate in chronic pancreatitis outpatients?

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Olesen, Søren Schou; Holst, Mette; Køhler, Marianne; Drewes, Asbjørn Mohr; Rasmussen, Henrik Højgaard

2015-04-01

Malnutrition is a common complication to chronic pancreatitis (CP) and many patients need nutritional support. An accurate estimation of the basal metabolic rate (BMR) is essential when appropriate nutritional support is to be initiated, but in the clinical settings BMR is cumbersome to measure. We therefore investigated whether BMR can be reliable predicted from a standard formula (the Harris-Benedict equation) in CP outpatients. Twenty-eight patients with clinical stable CP and no current alcohol abuse were enrolled. Patients were stratified according to nutritional risk using the Nutrition Risk Screening 2002 system. Body composition was estimated using bioelectrical impedance. BMR was measured using indirect calorimetry and predicted using the Harris-Benedict equation based on anthropometric data. The average predicted BMR was 1371 ± 216 kcal/day compared to an average measured BMR of 1399 ± 231 kcal/day (P = 0.4). The corresponding limits of agreement were -347 to 290 kcal/day. Twenty-two patients (79%) had a measured BMR between 85 and 115% of the predicted BMR. When analysing patients stratified according to nutritional risk profiles, no differences between predicted and measured BMR were evident for any of the risk profile subgroups (all P > 0.2). The BMR was correlated to fat free mass determined by bioelectrical impedance (rho = 0.55; P = 0.003), while no effect modification was seen from nutritional risk stratification in a linear regression analysis (P = 0.4). The Harris-Benedict equation reliable predicts the measured BMR in four out of five clinical stable CP outpatients with no current alcohol abuse. Copyright © 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

COMORBID GAMBLING IN PERSONS SUFFERING FROM ALCOHOL DEPENDENCE

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Jagadeesan M. S

2016-07-01

Full Text Available BACKGROUND Gambling has been a part of human behaviour since prehistory. Past global studies show that rates of pathologic gambling are 4 to 10 times higher for substance abusers than for the general population. Alcohol dependence is also more common among parents of pathologic gamblers. Studies from India have been very few on this subject. OBJECTIVES The objectives were to analyse the prevalence of gambling behaviour in alcohol dependent individuals, to assess whether alcohol influence had effect on gambling behaviour, to analyse if gambling behaviour was associated with personality traits, to explore the possibility whether alcohol use & gambling behaviour in parents had influence on the gamblers. METHODS A sample of 100 consecutive male patients attending de-addiction OPD of a Government Tertiary Care Hospital in Chennai was selected. Those who had a diagnosis of alcohol dependence were screened for gambling and assessed using the South Oaks Gambling Screen (SOGS and Eysenck’s Personality Questionnaire. History of gambling behaviour and alcohol use in parents were correlated. RESULTS A high incidence of gambling related problems in alcohol dependent individuals was found. Among them, 24% had gambling related problems, of which 11% amounted to pathologic gambling. Age, Marital status, Residential locality, Economic status, Educational levels, or being under the influence of alcohol did not correlate with the gambling behaviour. Extrovert personality, alcohol dependence in father, and family history of gambling were more common in problem/pathologic gamblers.

Impact of patient education on quality of bowel preparation in outpatient colonoscopies.

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Modi, Chintan; Depasquale, Joseph R; Digiacomo, W Scott; Malinowski, Judith E; Engelhardt, Kristen; Shaikh, Sohail N; Kothari, Shivangi T; Kottam, Raghu; Shakov, Rada; Maksoud, Charbel; Baddoura, Walid J; Spira, Robert S

2009-01-01

High-quality bowel preparation is essential for successful outpatient colonoscopy. Currently, the rate of adequate bowel preparation for outpatient colonoscopy in the USA is low. Patients often fail to adhere to recommended preparation instructions. Limited literature exists on evaluating educational intervention as a means of improving the quality of bowel preparation prior to outpatient colonoscopy. Our objective was to determine the effect of an educational intervention on the quality of outpatient colonoscopy preparation. The secondary objective was to determine whether the quality of bowel preparation improves overall colonoscopy outcomes as measured by rate of polyp detection and caecal intubation time. A single-blinded, prospective, randomised, controlled trial was conducted in two inner-city gastroenterology clinics in the USA. One hundred and sixty-four subjects were enrolled and randomly assigned to one of two groups. The control group subjects received verbal and written instructions for colonoscopy. The intervention group subjects received the same instructions and were then asked to answer a questionnaire. The subjects' responses were reviewed and an additional explanation of the preparation process provided. An attending gastroenterologist determined the quality of each bowel preparation at the time of colonoscopy using the Universal Preparation Assessment Scale. The educational intervention had no impact on the overall quality of bowel preparation (P=0.12). However, the type of food (liquid vs solid) consumed during the 24 hours prior to the procedure (P=0.04) and the time since the last solid meal (P=0.03) did have an impact on preparation quality. Other significant factors included elapsed time to first bowel movement from the initiation of bowel preparation (P=0.05) and age younger than 55 (P=0.02). Adequate bowel preparation was associated with shorter total procedure (P=0.001) and caecal intubation (P=0.01) times. Our study failed to demonstrate

Knowledge, attitudes and practices about sun exposure and photoprotection in outpatients attending dermatology clinics at four hospitals in Lima, Peru.

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Thomas-Gavelan, Elizabeth; Sáenz-Anduaga, Eliana; Ramos, Willy; Sánchez-Saldaña, Leonardo; Sialer, María del Carmen

2011-01-01

To establish the knowledge, about sun exposure and photoprotection in outpatients treated at the dermatology clinics in four hospitals in Lima, Peru. A cross-sectional study was conducted involving a sample of 364 patients selected using a systematic random sampling process in the four participating hospitals. The selected patients were interviewed to determine their knowledge, behavior and practices in relation to sun exposure and photoprotection. The chi-square test was used to identify any significant differences between knowledge and practices. The mean age of the patients in this sample was 45.1 ± 21.4 years. Of the 364 patients, 55.9% were women and 54.8% had skin phototype IV. The principal risks related to sun exposure were skin cancer (80.5%) and sunburn (77.8%). Knowledge regarding sun protection was more evident in individuals with university/college education (pphotoprotection, 38.4% used these products daily, while 61.6% used them only occasionally. The use of photo-protectors differed significantly in accordance with the individual's education level (psolar protection. The level of awareness of the outpatients treated at the dermatology clinics in these four hospitals in Lima, Peru about the risks of sun exposure is acceptable; however, a large proportion fail to incorporate regular solar protection as a practice in their daily life.

The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities.

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Wieland, Jannelien; Van Den Brink, Annemarie; Zitman, Frans G

2015-01-01

There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care. To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID. We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review. Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder. There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.

Acupuncture for alcohol withdrawal: a randomized controlled trial.

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Trümpler, François; Oez, Suzan; Stähli, Peter; Brenner, Hans Dieter; Jüni, Peter

2003-01-01

Previous trials on acupuncture in alcohol addiction were in outpatients and focused on relapse prevention. Rates of dropout were high and interpretation of results difficult. We compared auricular laser and needle acupuncture with sham laser stimulation in reducing the duration of alcohol withdrawal. Inpatients undergoing alcohol withdrawal were randomly allocated to laser acupuncture (n = 17), needle acupuncture (n = 15) or sham laser stimulation (n = 16). Attempts were made to blind patients, therapists and outcome assessors, but this was not feasible for needle acupuncture. The duration of withdrawal symptoms (as assessed using a nurse-rated scale) was the primary outcome; the duration of sedative prescription was the secondary outcome. Patients randomized to laser and sham laser had identical withdrawal symptom durations (median 4 days). Patients randomized to needle stimulation had a shorter duration of withdrawal symptoms (median 3 days; P = 0.019 versus sham intervention), and tended to have a shorter duration of sedative use, but these differences diminished after adjustment for baseline differences. The data from this pilot trial do not suggest a relevant benefit of auricular laser acupuncture for alcohol withdrawal. A larger trial including adequate sham interventions is needed, however, to reliably determine the effectiveness of any type of auricular acupuncture in this condition.

A novel integration effort to reduce the risk for alcohol-exposed pregnancy among women attending urban STD clinics.

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Hutton, Heidi E; Chander, Geetanjali; Green, Patricia P; Hutsell, Catherine A; Weingarten, Kimberly; Peterson, Karen L

2014-01-01

Alcohol-exposed pregnancy (AEP) is a significant public health problem in the United States. Sexually transmitted disease (STD) clinics serve female clients with a high prevalence of heavy alcohol consumption coupled with ineffective contraceptive use. Project CHOICES (Changing High-Risk AlcOhol Use and Increasing Contraception Effectiveness) is an evidence-based, brief intervention to lower risk of AEP by targeting alcohol and contraceptive behaviors through motivational interviewing and individualized feedback. We describe our experience integrating and implementing CHOICES in STD clinics. This endeavor aligns with CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's program collaboration and service integration strategic priority to strengthen collaborative work across disease areas and integrate services provided by related programs at the client level.

Self-reported "communication technology" usage in patients attending a cardiology outpatient clinic in a remote regional hospital.

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Gandiya, Tariro; Dua, Anahita; King, Gerry; Mazzocco, Thomas; Hussain, Amir; Leslie, Stephen J

2012-04-01

This study assessed the perceived usage of, and attitudes toward, communication technologies (mobile phone and texting, e-mail, and the World Wide Web) in patients attending a cardiology clinic with a view to guiding future health service redesign. This was performed in a remote regional hospital serving both urban and rural populations. A self-completion questionnaire was completed by a convenience sample of 221 patients attending a general cardiology clinic. The questions asked about patients' access to and use of technology at home. Data collected also included age, gender, travel time to the clinic, mode of travel, and whether the respondent was accompanied to the clinic. Appropriate statistical tests were used with significance taken at the 0.05 level. Age was the strongest predictor of use of communication technologies, with younger patients more likely to use e-mail, Web, mobile phone, and texting. However, frequency of use of e-mail was not related to age. It is encouraging that over 99% of patients used at least one communication technology. This study has highlighted that there may be several potential barriers to the widespread implementation of communication technologies in general cardiology patients. Cognizance should be taken of these findings when attempting service redesign.

Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

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Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

2016-05-01

Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Alcohol use among adolescents in Serbia

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Lutula-Golo Dragana N.

2013-01-01

Full Text Available Introduction. European School Survey Project on Alcohol and Other Drugs (ESPAD, the largest international research project, was conducted for the first time in Serbia in 2008. Objective. The objective was to analyze data obtained by ESPAD research on alcohol use among secondary school first grade students, and particularly the difference in the use of alcohol by gender, type of school students attend, their place of residence and the territory among secondary school students in Serbia in 2008. Methods. Attitudes and practice related to alcohol use of 6,553 secondary school first grade students were analyzed. A standardized, internationally approved questionnaire, structured and designed for self­filling was used on a stratified, one­stage sample of students. The data received from the ESPAD research were processed by χ2 test to test the significance of differences between the observed characteristics, with the conclusion level of p<0.01. Results. Over three­quarters of students can easily buy beer or wine. More than one half can buy spirits and alcopops. 89.1% of students drank alcoholic beverages at least once in a lifetime and 78.2% in the last year. At least once in a lifetime 42.2% of students were drunk and 29.7% in the last year. At least once in the last month 32.0% of students had five or more drinks in a row. Boys consumed alcohol more frequently and got drunk more often than girls (p<0.01. Conclusion. This research emphasizes the need for creating a prevention of alcohol use and alcohol abuse program among adolescents and more consistent application of the existing regulations aiming to decrease alcohol use among adolescents in Serbia. [Projekat Ministarstva nauke Republike Srbije, br. 175087

Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography

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Murathan Kucuk

2017-01-01

Full Text Available By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r=0.27, p=0.083. Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.

Mobile information and communication in the hospital outpatient service.

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Jen, Wen-Yuan; Chao, Chia-Chen; Hung, Ming-Chien; Li, Yu-Chuan; Chi, Y P

2007-08-01

Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service. The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users. Initiated in a local hospital in Taiwan, the MOSS pilot project was developed to improve outpatient service quality and pursue higher patient safety. This study focuses on the development of the MOSS. The workflow, architecture and target users of the MOSS are delineated. In addition, there were two surveys conducted as part of this study. After a focus group of medical staff identified areas in which outpatient services might be improved by the MOSS, the first survey was administered to outpatients to confirm the focus group's intuitions. The second administration of the survey explored outpatient satisfaction after they used the MOSS service. With regard to outpatient attitudes, about 93% of participants agreed that the mobile outpatient service improved outpatient service quality. In the area of outpatient satisfaction, about 89% of participants indicated they were satisfied with the mobile outpatient service. Supported by our study finding, we propose that more diverse mobile outpatient services can be provided in the future.

Characteristics of workers attending the pneumoconiosis clinic for silicosis assessment in Hong Kong: retrospective study.

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Law, Y W; Leung, M C; Leung, C C; Yu, T S; Tam, C M

2001-12-01

To describe and analyse the baseline characteristics of workers attending the pneumoconiosis clinic for assessment of silicosis. Retrospective cross-sectional study. Outpatient clinic. One thousand and fifty-six patients with silica dust exposure attending the pneumoconiosis clinic for compensation assessment. Baseline demographic characteristics, lung function parameters, and radiographic findings. Six hundred and forty-eight patients were diagnosed with silicosis, of which 10 were female. Excluding the data on female patients, the mean duration of dust exposure was 24.2 years. The majority of patients were involved in caisson work and stone splitting. Most newly diagnosed patients had simple silicosis. Less than a quarter (24.8%) had progressive massive fibrosis. Lung function parameters at diagnosis were within the normal range. Pulmonary tuberculosis remained an important co-existing disease. The major cause of silicosis in Hong Kong is chronic silica dust exposure in the construction industry. Simple silicosis predominated at diagnosis, with normal lung function parameters seen in the majority of patients.

Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

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Marsh, Fiona; Kremer, Christian; Duffy, Sean

2004-03-01

To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Randomised controlled trial. The gynaecology clinic of a large teaching hospital. Ninety-seven women with abnormal uterine bleeding requiring investigation. Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

Psychiatric morbidity in spouses of patients with alcohol related disorders

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Aruna Dandu

2017-01-01

Full Text Available Context: Alcohol dependence is on rise world over, especially in developing countries such as India. According to the World Health Organization, about 30% of Indians consume alcohol, out of which 4%–13% are daily consumers and up to 50% of them, fall under the category of hazardous drinking. Another worrying trend from India is that the average age of initiation of alcohol use has reduced from 28 years during the 1980s to 17 years in 2007. In India, alcohol abuse also amounts to huge annual losses due to alcohol-related problems in workplaces. This was a cross-sectional, noninterventional study which was carried out at the Department of Psychiatry, Sri Venkateswara Ramnaraian Ruia Government General Hospital (SVRRGGH, Tirupati, Andhra Pradesh. Aim: The aim of this study was to determine the frequency and nature of psychiatric morbidity in spouses of patients with alcohol-related disorders (ARDs. Methods: Study design - Hospital-based cross-sectional study. Study setting - Psychiatry Department of SVRRGGH, Sri Venkateswara Medical College, Tirupati. Study period - October 1, 2014 to September 30, 2015. Study units - the spouses of adult patients attending the Department of Psychiatry, with a diagnosis of ARDs. After the ethical clearance from the Institutional Ethical Committee, the spouses of adult patients attending the Department of Psychiatry with a diagnosis of ARDs according to the International Classification of Diseases-10 classification of mental and behavioral disorders constitute the population for the investigation. After obtaining written informed consent from each of the concerned subjects, demographic details and history of psychiatric illness were noted as per the structured pro forma. Results: The age of the alcohol-dependent men and spouses of men with ADS ranged from 23 to 67 years (mean ± standard deviation [SD] 41.24 ± 10.101 and 21–60 years (mean ± SD 35.04 ± 8.98, respectively. Among the study population, 36.6% of

Alcohol consumers’ attention to warning labels and brand information on alcohol packaging: Findings from cross-sectional and experimental studies

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Inge Kersbergen

2017-01-01

Full Text Available Abstract Background Alcohol warning labels have a limited effect on drinking behavior, potentially because people devote minimal attention to them. We report findings from two studies in which we measured the extent to which alcohol consumers attend to warning labels on alcohol packaging, and aimed to identify if increased attention to warning labels is associated with motivation to change drinking behavior. Methods Study 1 (N = 60 was an exploratory cross-sectional study in which we used eye-tracking to measure visual attention to brand and health information on alcohol and soda containers. In study 2 (N = 120 we manipulated motivation to reduce drinking using an alcohol brief intervention (vs control intervention and measured heavy drinkers’ attention to branding and warning labels with the same eye-tracking paradigm as in study 1. Then, in a separate task we experimentally manipulated attention by drawing a brightly colored border around health (or brand information before measuring participants’ self-reported drinking intentions for the subsequent week. Results Study 1 showed that participants paid minimal attention to warning labels (7% of viewing time. Participants who were motivated to reduce drinking paid less attention to alcohol branding and alcohol warning labels. Results from study 2 showed that the alcohol brief intervention decreased attention to branding compared to the control condition, but it did not affect attention to warning labels. Furthermore, the experimental manipulation of attention to health or brand information did not influence drinking intentions for the subsequent week. Conclusions Alcohol consumers allocate minimal attention to warning labels on alcohol packaging and even if their attention is directed to these warning labels, this has no impact on their drinking intentions. The lack of attention to warning labels, even among people who actively want to cut down, suggests that there is room for

Alcohol consumers' attention to warning labels and brand information on alcohol packaging: Findings from cross-sectional and experimental studies.

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Kersbergen, Inge; Field, Matt

2017-01-26

Alcohol warning labels have a limited effect on drinking behavior, potentially because people devote minimal attention to them. We report findings from two studies in which we measured the extent to which alcohol consumers attend to warning labels on alcohol packaging, and aimed to identify if increased attention to warning labels is associated with motivation to change drinking behavior. Study 1 (N = 60) was an exploratory cross-sectional study in which we used eye-tracking to measure visual attention to brand and health information on alcohol and soda containers. In study 2 (N = 120) we manipulated motivation to reduce drinking using an alcohol brief intervention (vs control intervention) and measured heavy drinkers' attention to branding and warning labels with the same eye-tracking paradigm as in study 1. Then, in a separate task we experimentally manipulated attention by drawing a brightly colored border around health (or brand) information before measuring participants' self-reported drinking intentions for the subsequent week. Study 1 showed that participants paid minimal attention to warning labels (7% of viewing time). Participants who were motivated to reduce drinking paid less attention to alcohol branding and alcohol warning labels. Results from study 2 showed that the alcohol brief intervention decreased attention to branding compared to the control condition, but it did not affect attention to warning labels. Furthermore, the experimental manipulation of attention to health or brand information did not influence drinking intentions for the subsequent week. Alcohol consumers allocate minimal attention to warning labels on alcohol packaging and even if their attention is directed to these warning labels, this has no impact on their drinking intentions. The lack of attention to warning labels, even among people who actively want to cut down, suggests that there is room for improvement in the content of health warnings on alcohol packaging.

Contingency management for patients with dual disorders in intensive outpatient treatment for addiction.

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Kelly, Thomas M; Daley, Dennis C; Douaihy, Antoine B

2014-01-01

This quality improvement program evaluation investigated the effectiveness of contingency management for improving retention in treatment and positive outcomes among patients with dual disorders in intensive outpatient treatment for addiction. The effect of contingency management was explored among a group of 160 patients exposed to contingency management (n = 88) and not exposed to contingency management (no contingency management, n = 72) in a six-week partial hospitalization program. Patients referred to the partial hospitalization program for treatment of substance use and comorbid psychiatric disorders received diagnoses from psychiatrists and specialist clinicians according to the Diagnostic and Statistical Manual of the American Psychiatric Association. A unique application of the contingency management "fishbowl" method was used to improve the consistency of attendance at treatment sessions, which patients attended 5 days a week. Days attending treatment and drug-free days were the main outcome variables. Other outcomes of interest were depression, anxiety and psychological stress, coping ability, and intensity of drug cravings. Patients in the contingency management group attended more treatment days compared to patients in the no contingency management group; M = 16.2 days (SD = 10.0) versus M = 9.9 days (SD = 8.5), respectively; t = 4.2, df = 158, p contingency management and self-reported drug-free days. Contingency management is a valuable adjunct for increasing retention in treatment among patients with dual disorders in partial hospitalization treatment. Exposure to contingency management increases retention in treatment, which in turn contributes to increased drug-free days. Interventions for coping with psychological stress and drug cravings should be emphasized in intensive dual diagnosis group therapy.

Alcohol and Drug Use among Gang Members: Experiences of Adolescents Who Attend School

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Swahn, Monica H.; Bossarte, Robert M.; West, Bethany; Topalli, Volkan

2010-01-01

Background: Problems related to gangs have been noted in large cities and in many schools across the United States. This study examined the patterns of alcohol, drug use, and related exposures among male and female high school students who were gang members. Methods: Analyses were based on the Youth Violence Survey, conducted in 2004, and…

Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease.

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Westwood, Greta; Meredith, Paul; Atkins, Susan; Greengross, Peter; Schmidt, Paul E; Aspinall, Richard J

2017-09-01

Many people who die from alcohol related liver disease (ARLD) have a history of recurrent admissions to hospital, representing potential missed opportunities for intervention. Universal screening for alcohol misuse has been advocated but it is not known if this is achievable or effective at detecting individuals at high risk of ARLD. We systematically screened all admissions to the Acute Medical Unit (AMU) of a large acute hospital using an electronic data capture system in real time. Patients at an increasing risk of alcohol harm were referred for either brief intervention (BI) or further assessment by an Alcohol Specialist Nursing Service (ASNS). Additional data were recorded on admission diagnoses, alcohol unit consumption, previous attendances, previous admissions, length of stay and mortality. Between July 2011 and March 2014, there were 53,165 admissions and 48,211 (90.68%) completed screening. Of these, 1,122 (2.3%) were classified as "increasing", and 1,921 (4.0%) as "high" risk of alcohol harm. High risk patients had more hospital admissions in the three previous years (average 4.74) than the low (3.00) and increasing (2.92) risk groups (prisk patients also had more frequent emergency department (ED) attendances (7.68) than the lower (2.64) and increasing (3.81) groups (prisk group were seen by the ASNS and 1,135 (81.2%) had an Alcohol Use Disorders Identification Test (AUDIT) score over 20 with 527 (37.8%) recording the maximum value of 40. Compared to the other groups, high risk patients had a distinct profile of admissions with the most common diagnoses being mental health disorders, gastro-intestinal bleeding, poisoning and liver disease. Universal screening of admissions for alcohol misuse is feasible and identifies a cohort with frequent ED attendances, recurrent admissions and an elevated risk of ARLD. An additional group of patients at an increasing risk of alcohol harm can be identified in a range of common presentations. These patients can be

Male batterers' alcohol use and gambling behavior.

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Brasfield, Hope; Febres, Jeniimarie; Shorey, Ryan; Strong, David; Ninnemann, Andrew; Elmquist, Joanna; Andersen, Shawna M; Bucossi, Meggan; Schonbrun, Yael C; Temple, Jeff R; Stuart, Gregory L

2012-03-01

Little work has examined the interrelations among intimate partner violence (IPV), alcohol use, and gambling behavior, and no studies have examined these relationships among males court-ordered to batterer intervention programs (BIPs). The aim of the current investigation was to explore the associations between IPV, alcohol use, and gambling behavior among 341 males court-mandated to attend BIPs utilizing self-report measures. Voluntary, anonymous questionnaires were administered and completed during regularly scheduled BIP sessions. Compared to the general population, a higher percentage of the sample met criteria for pathological gambling (9%), and problem gambling (17%). Further, males exhibiting pathological gambling were more likely to be hazardous drinkers, and hazardous drinkers were more likely to exhibit pathological gambling. Additionally, pathological gamblers were at an increased risk for the perpetration of both physical and sexual aggression. Finally, gambling behavior uniquely predicted the perpetration of sexual aggression above and beyond alcohol use, impulsivity, and relationship satisfaction. The implications of these results for future research and intervention are discussed.

Wound healing outcomes in a diabetic foot ulcer outpatient clinic at an acute care hospital: a retrospective study.

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Lu, S H; McLaren, A-M

2017-10-01

Patients with diabetic foot ulcers (DFU) have an increased risk of lower extremity amputation. A retrospective chart review of patients with DFUs attending the Foot Treatment and Assessment chiropodist-led outpatient clinic at an inner-city academic hospital was conducted to determine wound healing outcomes and characteristics contributing to outcomes. We reviewed the complete clinical history of 279 patients with 332 DFUs spanning over a five-year period. The mean age of patients was 61.5±12.5 years and most patients (83.5%) had one DFU. The majority of wounds (82.5%) were in the forefoot. Overall, 267/332 (80.5%) wounds healed. A greater proportion of wounds healed in the forefoot (82.5%) and midfoot (87.1%) than hindfoot (51.9%; phealing. Our findings are the first to demonstrate the benefits of chiropodists leading an acute care outpatient clinic in the management of DFUs in Canada and delivers wound healing outcomes equivalent to or exceeding those previously published.

Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit

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A.C. Chaves

2005-09-01

Full Text Available The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50%, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9% female patients and 87 (29.1% male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20 was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8% scored > or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50% of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64% of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.

Childhood Household Dysfunction, Social Inequality and Alcohol Related Illness in Young Adulthood. A Swedish National Cohort Study.

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Karl Gauffin

Full Text Available The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973-82 (n = 872,912, which was followed from age 18 to 29-40 years. Cox regression analyses were used to calculate hazard ratios (HR for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7-2.5], two CHD indicators 5.6 [4.4-7.1], three or more indicators 9.4 [7.1-12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks-those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9-14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4-1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage.

Utilization of Dental Services in Public Health Center: Dental Attendance, Awareness and Felt Needs.

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Pewa, Preksha; Garla, Bharath K; Dagli, Rushabh; Bhateja, Geetika Arora; Solanki, Jitendra

2015-10-01

In rural India, dental diseases occur due to many factors, which includes inadequate or improper use of fluoride and a lack of knowledge regarding oral health and oral hygiene, which prevent proper screening and dental care of oral diseases. The objective of the study was to evaluate the dental attendance, awareness and utilization of dental services in public health center. A cross-sectional study was conducted among 251 study subjects who were visiting dental outpatient department (OPD) of public health centre (PHC), Guda Bishnoi, and Jodhpur using a pretested proforma from month of July 2014 to October 2014. A pretested questionnaire was used to collect the data regarding socioeconomic status and demographic factors affecting the utilization of dental services. Pearson's Chi-square test and step-wise logistic regression were applied for the analysis. Statistically significant results were found in relation to age, educational status, socioeconomic status and gender with dental attendance, dental awareness and felt needs. p-value dental services, thereby increasing the oral health status of the population.

[Vitreoretinal outpatient surgery: clinical and financial considerations].

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Creuzot-Garcher, C; Aubé, H; Candé, F; Dupont, G; Guillaubey, A; Malvitte, L; Arnavielle, S; Bron, A

2008-11-01

Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management. We report on the 6-month experience of outpatient surgery for vitreoretinal diseases. From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system. Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

AIDS risk among students attending Seventh-day Adventist school, in North America.

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Hopkins, G L; Hopp, J W; Marshak, H P; Neish, C; Rhoads, G

1998-04-01

In 1995, a survey was conducted among students attending 69 Seventh-day Adventist (SDA) high schools within the United States and Canada. The survey assessed the extent that these students practiced sexual and drug-use behaviors which place them at risk for contracting or transmitting the human immunodeficiency virus (HIV). A total of 1,748 respondents enrolled in grades 9 through 12 completed questionnaires similar to the instrument used in the 1993 Youth Risk Behavior Survey (YRBS). Data were collected and compared to results from the 1993 YRBS. Students who attended SDA parochial schools reported lower rates of sexual intercourse compared to YRBS school counterparts (16.3% vs. 53.1%) and lower rates of all substances measured. Furthermore, respondents were more likely to engage in substance use and sexual intercourse if they had at least one parent who used tobacco, alcohol, or marijuana, as reported by the students.

Psychiatric disorders in outpatients with borderline intellectual functioning: comparison with both outpatients from regular mental health care and outpatients with mild intellectual disabilities.

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Wieland, Jannelien; Kapitein-de Haan, Sara; Zitman, Frans G

2014-04-01

In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs). Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152). Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common. Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.

Event-related potentials during visual selective attention in children of alcoholics.

NARCIS (Netherlands)

van der Stelt, O.; Gunning, W.B.; Snel, J.; Kok, A.

1998-01-01

Event-related potentials (ERPs) were recorded from 50 7-18 yr old children of alcoholics (COAs) and 50 age- and sex-matched control children while they performed a visual selective attention task. The task was to attend selectively to stimuli with a specified color (red or blue) in an attempt to

Core components of clinical education: a qualitative study with attending physicians and their residents

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ALIREZA ESTEGHAMATI

2016-04-01

Full Text Available Introduction: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students’ knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents’ learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings. Methods: This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences. Results: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics. They see some of their attending physicians as role models. Conclusion: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve

Outpatient invasive radiologic procedures - Diagnostic and therapeutic

International Nuclear Information System (INIS)

Dublin, A.

1987-01-01

This book is a ''how-to'' book for radiologists who are planning to, or considering whether to establish outpatient practice in response to DRGs. It provides practical, expert advice on both the administrative and clinical sides of outpatient radiology. It focuses on the essentials of clinical practice in the outpatient setting - and how it differs from inpatient practice

Volume, structure and funding of specialized outpatient care at the outpatient Advisory Department of Mariinskaya hospital

Directory of Open Access Journals (Sweden)

E. M. Kutyrev

2015-01-01

Full Text Available With the development of technologies, and discovery of new methods of diagnostics and treatment of diseases, a shift of the disease towards chronic disease is observed. Growth in prosperity will increase average life expectancy and mean age of population. Year after year, the elderly sector grows, with several chronic diseases per person. This is especially true for St. Petersburg, where 25 % of the populations of over working age. Thus, the demand for specialized medical care, particularly outpatient, will increase. Given that outpatient care is more profitable than hospital care, particular attention should be paid to its organization and expansion (increase in area, number of personnel, logistics, and so on. The article attempts to analyze changes in the volume of specialized outpatient medical care delivered at the outpatient Advisory Department of St. Petersburg state establishment of healthcare Mariinsky hospital in the period from 2008 through 2013.

Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment.

LENUS (Irish Health Repository)

Field, Catherine Anne

2013-01-01

Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients\\' experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care.

Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review.

Science.gov (United States)

Baumeister, Harald; Haschke, Anne; Munzinger, Marie; Hutter, Nico; Tully, Phillip J

2015-01-01

To systematically review in- and outpatient costs in patients with coronary artery disease (CAD) and comorbid mental disorders. A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included which allowed a comparison of in- and outpatient health care costs (assessed either monetarily or in terms of health care utilization) of CAD patients with comorbid mental disorders (mood, anxiety, alcohol, eating, somatoform and personality disorders) and those without. Random effects meta-analyses were conducted and results reported using forest plots. The literature search resulted in 7,275 potentially relevant studies, of which 52 met inclusion criteria. Hospital readmission rates were increased in CAD patients with any mental disorder (pooled standardized mean difference (SMD) = 0.34 [0.17;0.51]). Results for depression, anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from -0.44 to 1.26. Length of hospital stay was not increased in anxiety and any mental disorder, while studies on depression reported heterogeneous SMDs ranging from -0.08 to 0.82. Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders. Results for invasive procedures were non-significant respectively inconclusive. Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs. From a health care point of view, it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs.

Differential response to alcohol in light and moderate female social drinkers.

Science.gov (United States)

Evans, S M; Levin, F R

2004-05-01

Individuals who are moderate drinkers are at increased risk to abuse alcohol. Moreover, women are more vulnerable than men to the adverse consequences of alcohol consumption and recent data indicate that the drinking pattern in women is becoming more similar to that of men. However, few studies have determined whether female moderate drinkers (MD) show a differential response to the subjective and performance effects of alcohol, compared to female light drinkers (LD). Fifteen female MD who consumed an average of 34.7 drinks/month were compared to 15 female LD who consumed an average of 6.7 drinks/month. None of the participants had a first-degree family history of alcoholism or substance abuse. The acute effects of alcohol (0, 0.25, 0.50, 0.75 mg/kg) were evaluated using a double-blind, placebo-controlled outpatient design. Drug effects were assessed using a full range of performance measures, subjective-effects questionnaires and observer ratings. Alcohol impaired performance in a dose-related manner on all performance tasks for both groups of females. However, MD were less impaired than LD on balance and Digit Symbol Substitution Test (DSST). This reduced response was also evident from the observer ratings, with MD being viewed as less impaired by alcohol than LD. While ratings of Drug Liking increased in both groups of women on the ascending limb of the breath alcohol curve, alcohol was disliked by LD on the descending limb and LD reported increased ratings of Bad Drug Effects following the high dose of alcohol. The reduced performance impairment, coupled with the positive subjective effects and relative absence of adverse subjective effects, suggestive of behavioral tolerance, could result in a progression towards increased alcohol consumption among moderate female social drinkers.

EXPERIENCE OF ORNITHINE ASPARTATE (HEPA-MERZ AND PROBIOTICS BIOFLORUM FORTE IN THE TREATMENT OF NON-SEVERE FORMS OF ALCOHOLIC AND NON-ALCOHOLIC FATTY LIVER DISEASE

Directory of Open Access Journals (Sweden)

L. Yu. Ilchenko

2016-01-01

Full Text Available Aim: to evaluate the efficacy and tolerability of ornithine aspartate, probiotic Bioflorum Forte and their combination with steatosis and steatohepatitis in patients  with alcohol and non-alcoholic  fatty  liver disease. Materials and methods.  An open, randomized,  comparative  clinical study, which included 30 outpatients and inpatients with a diagnosis of steatosis, steatohepatitis. We analyzed the clinical symptoms, functional state of the liver. With the help of questionnaires  (Grids LeGo and post intoxication alcohol syndrome have established the presence of chronic alcohol intoxication. Test transmissions of numbers used to characterize the cognitive function, as well as detection  of minimal hepatic encephalopathy. Quality of life was assessed by questionnaire for patients with chronic liver disease — CLDQ (The chronic liver disease questionnaire. The duration of treatment was4 weeks. Results: all three treatment regimens have demonstrated therapeutic  efficacy: clinical improvement, recovery of liver function and results in cognitive function. When combined therapy also produced a significant improvement  in patients’ quality of life. It is shown that  the safety and tolerability of the means employed, adverse events were not reported. Conclusion: the results obtained allow us to recommend the use of ornithine aspartate (Hepa-Merz, both as monotherapy and as part of complex therapy of steatosis,  steatohepatitis with probiotic Bioflorum Forte in patients with alcoholic and non-alcoholic fatty liver disease.

Health-related lifestyle factors and mammography screening attendance in a Swedish cohort study.

Science.gov (United States)

Lagerlund, Magdalena; Drake, Isabel; Wirfält, Elisabet; Sontrop, Jessica M; Zackrisson, Sophia

2015-01-01

To determine whether health-related lifestyle factors are associated with attendance at a population-based invitational mammography screening program in southern Sweden, data on health-related lifestyle factors (smoking, alcohol use, physical activity, BMI, diet, self-rated health, and stress) were obtained from the Malmö Diet and Cancer Study and linked to the Malmö mammography register (Sweden, 1992-2009). Women (n=11 409) who were free from breast cancer at study entry were included in the cohort, and mammography attendance was followed from cohort entry to 31 December 2009. Generalized estimating equations were used to account for repeated measures within patients. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported. Nonattendance occurred in 8% of the 69 746 screening opportunities that were observed. Nonattendance was more common among women who were current or former smokers [OR=1.60 (1.45-1.76) and OR=1.15 (1.05-1.28)], had not used alcohol in the past year [OR=1.55 (1.32-1.83)], were less physically active outside of work [OR=1.10 (1.00-1.20)], had high physical activity at work (OR=1.13, 95% CI: 1.00-1.28), were vegetarians or vegans [OR=1.49 (1.11-1.99)], had not used dietary supplements [OR=1.11 (1.01-1.21)], had poor self-rated health [OR=1.24 (1.14-1.36)], and were experiencing greater stress [OR=1.25 (1.14-1.36)]. In this cohort, nonattendance was associated with smoking, alcohol abstinence, physical activity, poor self-rated health, stress, and following a vegetarian/vegan diet. These findings generally support the notion that women with less healthy lifestyles are less likely to engage in mammography screening.

Attendance Policies, Student Attendance, and Instructor Verbal Aggressiveness

Science.gov (United States)

Snyder, Jason; Forbus, Robert; Cistulli, Mark

2012-01-01

The authors utilized an experimental design across six sections of a managerial communications course (N = 173) to test the impact of instructor verbal aggressiveness and class attendance policies on student class attendance. The experimental group received a policy based on the principle of social proof (R. B. Cialdini, 2001), which indicated…

Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders.

Science.gov (United States)

Karlsson, Linnea; Pelkonen, Mirjami; Ruuttu, Titta; Kiviruusu, Olli; Heilä, Hannele; Holi, Matti; Kettunen, Kirsi; Tuisku, Virpi; Tuulio-Henriksson, Annamari; Törrönen, Johanna; Marttunen, Mauri

2006-06-01

To compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression. A sample of 218 consecutive adolescent (13-19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses. Current comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF

[Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study].

Science.gov (United States)

Osuna-Pozo, Carmen María; Serra-Rexach, José Antonio; Viña, José; Gómez-Cabrera, María del Carmen; Salvá, Antoni; Ruiz, Domingo; Masanes, Ferrán; Lopez-Soto, Alfonso; Formiga, Francesc; Cuesta, Federico; Cruz-Jentoft, Alfonso

2014-01-01

There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

Peripheral arterial disease among adult diabetic patients attending a large outpatient diabetic clinic at a national referral hospital in Uganda: a descriptive cross sectional study.

Directory of Open Access Journals (Sweden)

Raymond Mbayo Mwebaze

Full Text Available BACKGROUND: Peripheral arterial disease (PAD is one of the recognised diabetic macro vascular complications. It is a marker of generalised systemic atherosclerosis and is closely associated with symptomatic coronary and cerebrovascular disease, hence significant morbidity and mortality. Among African adult diabetic populations, screening and diagnosis of PAD is frequently suboptimal. The aim of this study was to determine the prevalence and associated clinical factors of PAD in adult ambulatory diabetic patients attending the outpatient diabetic clinic of Mulago national referral and teaching hospital, Kampala Uganda. METHODS: In this descriptive cross sectional study, 146 ambulatory adult diabetic patients were studied. Information about their socio-demographic and clinical characteristics, fasting lipid profile status, blood pressure, glycated haemoglobin (HbA1c levels and presence of albuminuria was collected using a pre tested questionnaire. Measurement of ankle brachial index (ABI to assess for PAD, defined as a ratio less than 0.9 was performed using a portable 5-10 MHz Doppler device. Clinical factors associated with PAD were determined by comparing specific selected characteristics in patients with PAD and those without. RESULTS: The mean age/standard deviation of the study participants was 53.9/12.4 years with a male predominance (75, 51.4%. PAD was prevalent in 57 (39% study participants. Of these, 34 (59.6% had symptomatic PAD. The noted clinical factors associated with PAD in this study population were presence of symptoms of intermittent claudication and microalbuminuria. CONCLUSIONS: This study documents a high prevalence of PAD among adult ambulatory Ugandan diabetic patients. Aggressive screening for PAD using ABI measurement in adult diabetic patients should be emphasised in Uganda especially in the presence of symptoms of intermittent claudication and microalbuminuria.