The role of significant life events in discriminating help-seeking among illicit drug users.

This paper examines the role of significant life events in distinguishing two samples of illicit drug users: 120 help-seekers (the "agency group") and 120 not seeking help (the "non-agency group"). We examined 10 life areas clustered around the general categories of "substance use," "social functioning," and "emotional and interpersonal functioning." A range of objective and self-reported information was collected regarding each life area covering the 12 months prior to interview. Analysis revealed that the agency group experienced a greater number of negatively perceived drug-related life events than the non-agency group. These life events were also more likely to have occurred in recent months, prompting reported "concern" and "need for help" among the agency group. Additionally, length of use of current primary drug was seen to be a contributory variable in distinguishing between the groups.     

Attrition prevention with individuals awaiting publicly funded drug treatment

Aims . To evaluate the effectiveness of a motivational intervention to reduce attrition from a waiting list for substance abusers seeking publicly funded treatment.
Design . Randomized clinical trial comparing an "attrition prevention" condition to standard care while awaiting treatment admission.
Setting . A centralized substance abuse assessment and referral center in Seattle, Washington.
Participants . Substance abusers (n = 654) eligible for publicly funded drug abuse treatment.
Measurements . Alcohol and drug use, substance-related negative consequences, areas in need of help, perceived need for help, emotional status, readiness to change, reasons for seeking and perceived barriers to entering treatment.
Findings . Overall, approximately 70% of clients entered treatment, and of these approximately 70% completed their assigned treatment. Those who entered treatment showed significant reductions in substance use and improved psychosocial function at a short-term 3-month follow-up. However, the attrition prevention intervention had no differential effect on treatment entry, completion or outcome compared to the standard waiting list. Further, there were no differences across therapists on these outcome measures.
Conclusions . A motivational attrition prevention intervention did not enhance treatment entry, completion or outcome among treatment-seeking substance abusers. It is suggested that alternative strategies, such as contingency management and case management, may help facilitate treatment entry for individuals seeking publicly funded treatment.     

Treatment seeking in populations in urban and rural settings on the border

BACKGROUND: Only a small proportion of persons with alcohol or drug problems seek help in the form of treatment for these problems. To examine service disparities among Hispanics living in urban and rural border areas, an improved understanding of factors associated with service seeking is needed for this population. METHODS: In-person interviews were conducted with a sample of 1,200 colonia residents and urban residents living along the Texas border with Mexico. For the present study, the dataset was limited to Hispanic respondents (85% of the sample) and those who reported any indicator of need for treatment (38% of the sample). There were 380 respondents who met these criteria. Treatment seeking was measured by any past attempt, successful or unsuccessful, to obtain treatment or by their present stated desire for treatment. Factors influencing treatment seeking were compared across 3 sites. RESULTS: Path analyses indicated that, after taking demographics into account, severity of need (the total number of drug-related and alcohol-related problems experienced by an individual) was a strong influence on treatment seeking, but income-related variables were more influential than severity of need in 1 site. Generation of immigration was positively related to treatment seeking in 2 sites, and in colonias, high religiosity was related to treatment seeking. In 2 sites, need severity was related to neighborhood variables. In colonias, need severity was related to low income and low religiosity. CONCLUSIONS: This framework for understanding treatment seeking in border communities suggests that pathways to treatment seeking vary by locality in ways that may reflect variations in local environments and service systems. Design of outreach efforts should be tailored to the unique social and service system challenges of each local community. Although service seeking is low overall, findings are suggestive of an inequitable service access structure in 1 site where need is not the predominant factor for treatment seeking.     

Seeking information about HIV/AIDS: a qualitative study of health literacy among people living with HIV/AIDS in a low prevalence context

People living with HIV/AIDS in rural and low HIV prevalence areas face a number of challenges including stigma, limited access to specialized medical care, lack of an HIV/AIDS specialist and fear which may interfere with their ability to find and use information to manage their health. With a large number of HIV cases located in non-metropolitan and rural areas in the US, more research is needed to better understand the health seeking behaviors of individuals living in this context. This study examined how 16 individuals living with HIV sought out information to meet their health needs. In qualitative semi-structured interviews, we explored participants' primary sources of information, types of information sought, and barriers to accessing information. The sample was comprised of people living with HIV/AIDS (PLWHA) who resided in a predominantly rural area with low HIV prevalence. The majority of participants relied on a combination of sources including their HIV/AIDS physician, the Internet, a Ryan-White caseworker and a staff member of a community-based support organization to meet their informational needs. Information sought focused primarily on drug regimens, drug side effects, or drug research. Participants shared barriers to accessing information including stigma, fear, concern about disclosure, and feelings of futility and anger. Findings point to a need to expand health literacy research and interventions to address broader social and structural barriers to health improvement for PLWHA, especially among those living in rural and low HIV prevalence areas.     

Rural-urban differences in substance use and treatment utilization among prisoners.

Surveys of incarcerated offenders and arrestees consistently report high rates of both alcohol and drug use in this population. This drug-crime connection has highlighted the need to learn more not only about drug treatment effectiveness, but also about drug treatment utilization. While studies have begun to examine drug treatment utilization, most of these studies have been based on urban substance abusers. Little is known about the extent to which urban and rural substance abusers may be different in terms of treatment utilization. This study, therefore, examines differences between urban and rural drug use patterns and treatment utilization among chronic drug abusers to determine whether, and in what ways, rurality may affect substance abuse and treatment seeking. The study examines these issues in a group of chronic drug users who were incarcerated at the time of the study. Findings show significant differences in drug use and treatment utilization of urban and rural offenders. Chronic drug abusers from rural and very rural areas have significantly higher rates of lifetime drug use, as well as higher rates of drug use in the 30 days prior to their current incarceration than chronic drug abusers from urban areas. Nonetheless, being from a very rural area decreased the likelihood of having ever been in treatment after controlling for the number of years using and race. While problem recognition appears to explain much of the effect of very rural residence on treatment utilization for alcohol abuse, the effects of being from a very rural area on seeking treatment for drug abuse remain statistically significant even after controlling for several other variables. The findings point to the importance of providing culturally appropriate education to very rural communities on the benefits of substance abuse treatment and of providing substance abuse treatment within the criminal justice system.     

RURAL-URBAN DIFFERENCES IN SUBSTANCE USE AND TREATMENT UTILIZATION AMONG PRISONERS

Surveys of incarcerated offenders and arrestees consistently report high rates of both alcohol and drug use in this population. This drug-crime connection has highlighted the need to learn more not only about drug treatment effectiveness, but also about drug treatment utilization. While studies have begun to examine drug treatment utilization, most of these studies have been based on urban substance abusers. Little is known about the extent to which urban and rural substance abusers may be different in terms of treatment utilization. This study, therefore, examines differences between urban and rural drug use patterns and treatment utilization among chronic drug abusers to determine whether, and in what ways, rurality may affect substance abuse and treatment seeking. The study examines these issues in a group of chronic drug users who were incarcerated at the time of the study. Findings show significant differences in drug use and treatment utilization of urban and rural offenders. Chronic drug abusers from rural and very rural areas have significantly higher rates of lifetime drug use, as well as higher rates of drug use in the 30 days prior to their current incarceration than chronic drug abusers from urban areas. Nonetheless, being from a very rural area decreased the likelihood of having ever been in treatment after controlling for the number of years using and race. While problem recognition appears to explain much of the effect of very rural residence on treatment utilization for alcohol abuse, the effects of being from a very rural area on seeking treatment for drug abuse remain statistically significant even after controlling for several other variables. The findings point to the importance of providing culturally appropriate education to very rural communities on the benefits of substance abuse treatment and of providing substance abuse treatment within the criminal justice system.     

Older women and men with urinary symptoms

The aim was to compare urinary symptoms and their influence on daily life among elderly (75+) women and men in a sample that previously had reported difficulties controlling urine (urine incontinence (UI)) and/or other urinary symptoms (OU). A further aim was to find underlying structures of urinary symptoms and to identify symptoms that had an impact on seeking medical help and need of help in daily activities (dependency). In total, 771 persons (352 men and 419 women) over 75 years answered a questionnaire, addressed to those (n=1881) who in a previous population-based study had reported having symptoms of UI and/or OU using the Bristol Female Lower Urinary Tract Symptoms (BF-LUTS) questionnaire and International Continence Society male (ICSmale) questionnaire. The groups with UI, OU, women and men reported similar symptoms of frequency, day and night, as well as influence on social life, and avoidance of places and situations due to the urinary symptoms although they differed in storage and voiding symptoms. Feeling incomplete emptying of bladder differed between the UI, OU, and mixed symptoms (MS) groups but not between genders. Of the whole sample, 43.3% had sought medical help. Factor analysis of similar questions in BF-LUTS and ICSmale questionnaire resulted in the factors labeled voiding, storage, pain, frequency, and daily life. Predictors of the urinary symptoms for needing help in daily activities were frequent micturition day and night (OR 3.2) when aged was controlled for. Influence on daily life (OR 2.5), storage symptoms (OR 2.2), and pain symptoms (OR 2.1) predicted seeking medical help. The results show that urinary symptoms are equally bothersome among men and women. There is a need to encourage elderly to seek medical help and to obtain treatment or alleviations for symptoms that give most bother and indicate dependency, such as frequent micturition day and night and difficulties to reach the toilet in time without leakage.     

Human behavior in relation to selection of malaria treatment.

People in rural areas usually help themselves when malaria attacks by using a drug preparation under the name of "ya-chud" bought from the grocery in the village. The objective of this study was to determine the behavior towards malarial treatment of local inhabitants in two malarious areas in eastern Thailand. Groups of 271 and 131 local inhabitants in villages in Pong Nam Ron and Bo Thong Districts, respectively, aged more than 15 years were interviewed regarding health behavior in seeking care when they became ill with malaria. Forty-two percent of the population at Pong Nam Ron and fifteen percent at Bo Thong went to drug-stores or groceries when they developed minor illness, while 85.2% of the subjects interviewed at Bo Thong went to the local health center. However, when they became severely ill, treatment-seeking patterns were similar in the two study areas. Ninety-four percent of the subjects interviewed at Bo Thong and eighty-seven percent at Pong Nam Ron gave a history of having used ya-chud in the past. On average, a set of ya-chud for malaria infection consists of 3-5 drugs: antimalarial drugs together with others such as analgesic-antipyretics, steroids, anti-histamines, vitamins and antimicrobial agents (tetracycline). The price of one ya-chud varied from 3-9 baht. Such improperly use of antimalarial drugs in malarious areas can result in treatment failure and cause the development of drug resistance, which is a problem in the malaria control program in Thailand.     

Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective

BACKGROUND AND AIMS: The aim of this work was to study feelings of loneliness and fear among elderly people (75+) in a gender perspective, and to explore their causes. METHODS: A cross-sectional study (postal questionnaire) with a randomised and age-stratified sample (n = 4277) was used to study the variables of interest. Because the variables were compared between men and women, weighted values for means, standard deviations, and ratios were used. Multiple logistic regression analysis was used to identify the causes of loneliness and fear. RESULTS: Findings showed that loneliness and fear were both more frequently reported by women than men. Loneliness was significantly associated with gender, marital status, living in special accommodation, fear, and need of help with activities of daily living (IADL). Fear was significantly associated with gender, number of children, having someone to trust, loneliness, and being in need of help with IADL. Those who reported loneliness and/or fear had significantly lower health-related quality of life than those who did not. Many of the elderly feared violence/crime, but only a few had been exposed to violence/crime. CONCLUSIONS: Loneliness and fear are common among elderly people. Both variables seem to be related to each other and were both found to be "threats" to a good life in old age. However, to minimize these "threats" and perhaps improve these people's quality of life, action can be taken in the care for elderly people such as involving the social network and reducing the need of help with IADL.     

"Now here come the pills that are going to save your life": pharmacists' discussions of antiretroviral drugs in a context of life and death

HIV/AIDS has associated cultural and social meanings which shape communication. The disease is closely linked to the concepts of life and death. Antiretroviral therapy (ART) has brought hope and life, but its success is heavily dependent on strict adherence. Research has shown that patients and health professionals often find it difficult to talk about these topics. However, there is little research available which focuses on health professionals' and patients' discussion of ART. This paper thus presents some exploratory discussion of extracts from pharmacy interactions in an HIV context which illustrate how pharmacists talk about antiretrovirals (ARVs) with patients with particular reference to the concepts of life and death. Data are taken from 26 video pharmacist-patient interactions recorded in a South African HIV/AIDS pharmacy. A hybrid qualitative analytic approach enabled identification of three types of references to ART, including the need to take ART "for the rest of your life", ART as "saving your life" and ART as "making you better". Explicit references to death were infrequent. These references were often emphatic and there are several potential reasons for this. The pharmacists' communication appears to be influenced by the urgency of the disease, a desire to give patients hope and a need to "normalise" discussions of death and HIV. The importance of ensuring understanding of ARV dosage instructions and discouraging patients from seeking traditional healing also appears to affect communication. The disease, societal and cultural contexts are thus shown to be significant influences which shape discussions of ART. This study has a number of practical implications, which are discussed.     

Drug-resistant tuberculosis: worldwide trends, problems specific to Eastern Europe and other hotspots, and the threat to developing countries

Although it had been appreciated that high levels of antituberculous drug resistance existed in some regions of the world, the full extent of the problem was not known. A combined initiative by the World Health Organization and the International Union Against Tuberculosis and Lung Disease was launched in 1994 to address this. A second report was issued in March 2000, in which surveillance of drug resistance had been extended to 72 countries and regions. A number of drug resistant "hotspots," where there are high levels of combined multidrug-resistant tuberculosis (> 3% prevalence), have been identified. Particular areas of concern are countries of the former Soviet Union, India, and China, because these countries have the highest burden of multidrug-resistant tuberculosis. For the first time, information on trends in global drug resistance is available.     

OMERACT 10 Patient Perspective Virtual Campus: valuing health; measuring outcomes in rheumatoid arthritis fatigue, RA sleep, arthroplasty, and systemic sclerosis; and clinical significance of changes in health

This workshop reviewed progress in a number of areas related to patient perspective outcomes that were not specifically included within other areas of the program. A substantial review of the work of the valuing health outcomes group (the "QALY" working group) with participation and feedback from the plenary audience resulted in guidance to refocus on the use of patient preferences in the elaboration of more robust outcome measures for patient-reported outcomes and life impact measures. Progress and developments in the areas of fatigue and sleep in rheumatoid arthritis, outcome measures in hip and knee arthroplasty clinical trials, and scleroderma were outlined, and the challenge of truly understanding the nature of clinically important improvement was reviewed.     

New cohorts of urban elders: are they in trouble?

Recent social and economic trends suggest that the health and welfare of elderly persons living in urban areas may have deteriorated during the past two decades. Two representative samples of noninstitutionalized urban persons aged 65 and over were interviewed, one in 1975 (n = 1598) and the other in 1987 (n = 1491). Cohorts of "young-old" (ages 65-76), "old-old" (ages 77-88), and "oldest-old" (ages 89-100) urban residents were compared at the two time points by multivariate analysis. Over the 12 years studied, the proportion of Blacks and poor persons rose, while the educational level improved. The young-old cohort of 1987, in particular, reported more chronic illness, more psychological distress, more need for help with activities of daily living, more visits to physicians, and more need for additional medical care. We conclude that, between 1975 and 1987, a new cohort of urban residents who were more impaired, disabled, and disadvantaged than their predecessors entered the young-old age group.     

东莞市哮喘儿童用药合理性及影响因素调查分析

目的调查分析哮喘儿童用药的合理性及影响因素。方法对我市6家医院就诊的哮喘患儿及家属和负责诊治的医师进行调查,事先拟定问卷调查表,请他们回答。将患儿分为用药合理组和用药不合理组,观察在性别、年龄、监护人对疾病了解程度以及学历水平、药物不良反应发生率、过去1年哮喘发作次数以及过去1年用于哮喘的治疗费用方面的差别。同时对患儿用药不合理的原因以及医师可能影响患儿用药合理性的因素进行汇总分析。结果用药合理组115例(53.49%),不合理组100例(46.51%)。两组患儿性别无明显差别(P0.05),而用药合理组患儿年龄、主要监护人对疾病了解程度以及学历水平明显高于不合理组(P0.05),同时药物不良反应发生率、过去1年哮喘发作次数以及过去1年用于哮喘的治疗费用均显著低于用药不合理组(P0.05)。导致患儿其用药不合理的原因,排在第一位的为无医务人员进行用药和健康宣教,或宣教过于简单(30.37%)。而在医师可能影响患儿用药合理性的因素中,没有为患儿进行详细用药指导的比例最高(55.56%)。结论影响我市哮喘患儿用药最主要的原因为无医务人员进行用药指导和健康宣教,我们临床药师今后还需针对这些因素,协助医师做好哮喘患儿的管理。     

Old farmers,invisible farmers: Age and agriculture in Jamaica

Increases in both the percentage and absolute numbers of elders, originally observed in industrialized countries, are now a concern for a growing number of developing countries. At present, most elders are found in rural areas where many remain active in agriculture to very advanced years. There is concern that the rural concentration of elders may have negative consequences for agricultural production. This paper presents ethnographic material from Jamaica, where agriculture occupies an important place in the life course of many elders. Contrary to popular perceptions, farming is not exclusively the domain of elderly Jamaicans, but rather occurs at various stages in the life course in ways which make such activity invibible to farm surveys and agricultural development policy. Such policies fail to account for the special abilities and needs of elder farmers.     

Linking Surveillance with Action against Drug-Resistant Tuberculosis

The speed at which most countries with high burdens of multidrug-resistant tuberculosis (MDRTB) have scaled up their capacity to diagnose and treat individuals with these forms of TB has failed to keep pace with the problem. Limited availability of drug susceptibility testing, high costs and inefficiencies in the supply of second-line drugs, and inadequate capacity for the management of patients with MDRTB have contributed to the wide gap between the estimated need for and the delivery of MDRTB treatment. The most recent global estimates indicate that only about 1 in 20 individuals with incident MDRTB will be properly diagnosed; fewer still receive quality-assured treatment. As policy makers confront the threat of growing levels of drug-resistant TB, there is a clear role for improved surveillance methods that can facilitate more effective public health responses. In countries that cannot yet test all incident cases for drug resistance, analysis of programmatic data and use of periodic, efficient surveys can provide information to help prioritize the use of limited resources to geographic areas or population subgroups of greatest concern. We describe methods for the analysis of routinely collected data and alternative surveys that can help tighten the link between surveillance activities and interventions.     

Sensation Seeking in Long‐Term Abstinent Alcoholics,Treatment‐Naïve Active Alcoholics,and Nonalcoholic Controls

Background: Elevated sensation seeking is associated with the development of alcohol dependence; however, it has not been studied in long‐term abstinent alcoholics. In the current study, we examine sensation seeking in middle‐aged long‐term abstinent alcoholics (LTAA) and in younger actively drinking treatment‐naïve alcoholics (TxN). Methods: A modified version of the Sensation Seeking Scale (SSS) was administered to 52 middle‐aged LTAA (average age = 46.6 years) and 86 younger TxN (average age = 31.2 years), each study with its own age and gender comparable nonalcoholic controls (NAC). The SSS was modified to remove items specifically associated with alcohol or drug use. The associations between the SSS and alcohol use and deviance proneness were examined. Results: The 2 NAC samples did not differ on the SSS, allowing the 2 NAC samples to be combined into a single control group (NAC = 118), and the LTAA and TxN samples to be directly compared without concern for cohort effects. LTAA did not differ from NAC on the SSS; however, the TxN group had higher SSS scores compared with NAC on all subscales except Boredom Susceptibility. Sensation seeking was comparably associated with lower socialization in each group. Conclusions: The results suggest that either sensation seeking normalizes with long‐term abstinence or that relatively normal levels of sensation seeking predict the ability to achieve long‐term abstinence. In either case, the results have important implications for our understanding of long‐term abstinence.     

Risk factors and prevalence of HIV infection in people seeking health care in an STI clinic in Brazil

Comprehensive care for people seeking assistance in sexually transmitted infections (STI) clinics provides access to a group of patients in need of HIV prevention interventions and represents appropriate locations for the implementation of these activities. The goal of this study was to determine the risk factors for HIV infection. A profile of patients seeking care in an STI clinic in Vitória, Brazil; including the motives for this, the risk factors and the prevalence for HIV was carried out. Patients were systematically interviewed regarding demographic information, motivation for seeking assistance, risk exposures, and clinical data. Blood samples were collected to test HIV infection in 562 people enrolled in the study. Prevalence of HIV infection was 6.8 per cent (95 per cent CI 4.7-8.9). Prevention and STI symptoms were the main reasons for seeking care. Variables found to be independently associated with HIV infection were: age (> = 30 years) [OR = 3.24 (95 per cent CI 1.40-7.52)]; seeking medical assistance [OR = 3.88 (95 per cent CI 6.22-40.95)]; and illicit drug use [OR = 14.58 (95 per cent CI 6.11-34.72)]. These results found high prevalence of HIV infection in this population and reinforce the need for ongoing STI prevention activities to further decrease HIV and other STI.     

Motivation for Change and Barriers to Treatment among Young Cannabis Users

Background/Aims: Despite cannabis use among adolescents has shown to be related to psychosocial and mental health problems, the demand from adolescents for professional help is very low, and determinants of motivation for change among nonclinical populations remain unknown. The purpose of this study was to assess motivation for change among young cannabis users and to identify determinants of intention to change and self-change, as well as perceived barriers to seeking professional help. Methods: 261 cannabis users aged 16-21 participated in a computerized survey in Spain. Results: Data from this cross-sectional study indicated that few users intend to stop taking the drug. Determining factors of intention to change were the following: having more drug-related problems, paranoid symptomatology and greater concern about the consequences of use. Self-change was facilitated by lower use of cannabis, and could be hindered by tobacco smoking and cannabis dependence. Lack of awareness of the problems and the desire to solve one's problems alone constitute the main barriers to seeking professional help. Conclusions: Adolescent cannabis users show low motivation for change though experiencing more problems associated with its use emerges as a determinant of increased motivation. Several barriers impede this motivation from turning into treatment demand.     

Urban lymphatic filariasis in central Nigeria

Wuchereria bancrofti and the other mosquito-borne parasites that cause human lymphatic filariasis (LF) infect over 120 million people world-wide. Global efforts are underway to stop transmission of the parasites, using annual, single-dose mass drug administrations (MDA) to all at-risk populations. Although most MDA to date have been in rural settings, they are also recommended in urban areas of transmission. It remains unclear whether there is significant urban transmission in West Africa, however, and the need for urban MDA in this region therefore remains a matter of debate.Clinic-based surveillance, for the clinical manifestations of LF, has now been used to identify areas of urban transmission of W. bancrofti in Jos, the major urban population centre of Plateau state, Nigeria. The eight clinics investigated were all located in slum areas, close to vector breeding sites, and were therefore considered to serve at-risk populations. Over a 1-month period, selected providers in these clinics sought hydrocele, lymphoedema, elephantiasis, or acute adenolymphangitis among the patients seeking treatment. The consenting patients who were suspected clinical cases of LF, and a cohort of patients suspected to be cases of onchocerciasis, were tested for W. bancrofti antigenaemia. All the patients were asked a series of questions in an attempt to determine if those found antigenaemic could only have been infected in an urban area. During the study, 30 suspected clinical cases of LF were detected and 18 of these (including two patients who were found to be antigenaemic) lived in urban areas. Of the 98 patients with exclusively urban exposure who were tested for filarial antigenaemia, six (6.1%) were found antigenaemic. Clinic-based surveillance appears to be a useful tool for determining if there is W. bancrofti transmission in an urban setting.