Relationship Between Tridimensional Personality Questionnaire Scores and Clinic Attendance Among Cocaine Abusing,Buprenorphine Maintained Outpatients

With the recent approval of buprenorphine for the treatment of opiate dependence in the United States it has become important to develop an understanding of the factors that influence the likelihood of successful treatment outcomes when using buprenorphine. This study examined, in a convenience sample, the relationship between novelty-seeking behaviors, as determined by Cloninger's Tridimensional Personality Questionnaire (TPQ), and attendance variables during participation in a buprenorphine-based treatment program for 21 heroin-dependent cocaine users that took place in the late 1990s. Approximately two-thirds of the participants were male and primarily African-American. About half of them were employed and had at least a high school education. Approximately one-third of them were married or cohabitating and they all resided in the greater Detroit, Michigan area of the United States. The Tridimensional Personality Questionnaire (TPQ) was administered to the participants prior to entering the treatment program. Demographic variables, psychiatric distress, and substance use severity were also evaluated. Variables with significant bivariate relationships with poor attendance measures were entered into a regression analysis predicting attendance measures. Participants who scored high on the TPQ Novelty Seeking Scale attended significantly fewer regularly scheduled visits, had a greater overall number of missed visits, and shorter treatment retention times. Demographics, substance use severity, and psychiatric distress did not have significant relationships with these attendance measures.     

The Link Between Substance Use and Reproductive Health Service Utilization Among Young US Women

ABSTRACT. Background: The authors sought to investigate associations between young women's use of alcohol and other substances and their sexual and reproductive health (SRH) service utilization. Methods: The authors used data from 4421 young women aged 15–24 years in the nationally representative study, National Survey of Family Growth, 2002–2008. The authors examined associations between frequency of tobacco, alcohol, marijuana, and illicit drug use and SRH service use in the past year using logistic regression. Results: Over half (59%) of the young women used SRH services, including contraception (48%), gynecological examination (47%), and sexually transmitted infection (STI) testing/treatment (17%) services. Proportions of SRH service use increased with higher frequencies of substance use (all P values <.001); service use was particularly common among daily substance users (range: 72% of daily marijuana users to 83% of daily binge drinkers). In multivariable analyses, associations between substance and SRH service use varied by substance and service type: weekly marijuana (odds ratio [OR] = 2.5, 95% confidence interval [95% CI] = 1.4, 4.3, P = .002) and alcohol (OR = 1.7, 95% CI = 1.1, 2.4, P = .01) use were positively associated with gynecological service use. All substances were positively associated with STI service use. However, daily smoking was negatively associated with contraceptive service use (OR = 0.6, 95% CI = 0.4, 0.8, P = .001). Conclusion: SRH service use was common among women reporting frequent substance use. SRH settings provide an opportunity to deliver substance use screening and preventive care to young women.     

The Association Between Stimulant,Opioid, and Multiple Drug Use on Behavioral Health Care Utilization in a Safety-Net Health System

Background: Prior studies show an association between drug use and health care utilization. The relationship between specific drug type and emergent/urgent, inpatient, outpatient, and behavioral health care utilization has not been examined. We aimed to determine if multiple drug use was associated with increased utilization of behavioral health care. Methods: To assess health care utilization, we conducted a retrospective cohort study of patients who accessed health care at a safety-net medical center and affiliated clinics. Using electronic health records, we categorized patients who used stimulants, opioids, or multiple drugs based on urine toxicology screening tests and/or International Classification of Diseases, 9th Revision (ICD-9). Remaining patients were categorized as patients without identified drug use. Health care utilization by drug use group and visit type was determined using a negative binomial regression model. Associations were reported as incidence rate ratios. Utilization was described by rates of health care–related visits for inpatient, emergent/urgent, outpatient, and behavioral health care among patients who used drugs, categorized by drug types, compared with patients without identified drug use. Results: Of 95,198 index visits, 4.6% (n = 4340) were by patients who used drugs. Opioid and multiple drug users had significantly higher rates of behavioral health care visits than patients without identified drug use (opioid incidence rate ratio [IRR] = 7.2; 95% confidence interval [CI]: 3.8–13.8; multiple drug use IRR = 5.6, 95% CI: 3.3–9.7). Patients who used stimulants were less likely to use behavioral health services (IRR = 1.3, 95% CI: 0.9–2.0) when compared with opioid and multiple drug users, but were more likely to use inpatient (IRR = 1.6, 95% CI: 1.4–1.8) and emergent/urgent care (IRR = 1.4, 95% CI: 1.3–1.5) services as compared with patients without identified drug use. Conclusions: Integrated medical and mental health care and drug treatment may reduce utilization of costly health care services and improve patient outcomes. How to capture and deliver primary care and behavioral health care to patients who use stimulants needs further investigation.     

Strategies to Improve Access to and Utilization of Health Care Services and Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users

We review five innovative strategies to improve access, utilization, and adherence for HIV-infected drug users and suggest areas that need further attention. In addition, we highlight two innovative programs. The first increases access and utilization through integrated HIV and opioid addiction treatment with buprenorphine in a community health center, and the second incorporates adherence counseling for antiretroviral therapy in methadone programs. Preliminary evaluations demonstrated that these strategies may improve both HIV and opioid addiction outcomes and may be appropriate for wider dissemination. Further refinement and expansion of strategies to improve outcomes of HIV-infected drug users is warranted.     

社区老年高血压患者家庭功能和主观幸福感的相关性研究

目的：探讨社区老年高血压患者家庭功能与主观幸福感之间的关系,为社区老年高血压患者的家庭访视提供依据。方法采用便利抽样入户调查法,对满足纳入标准的社区老年高血压患者,采用家庭功能评估量表及纽芬兰主观幸福感量表进行调查。结果社区老年高血压患者家庭功能总分为（5.12±2.30）分,家庭功能障碍者486人（73.0%）,家庭功能良好者180人（27.0%）。社区老年高血压患者主观幸福感总分（24.24±2.15）分,总体幸福感处于中、高水平者占73.0%,处于低水平者占27.0%。社区老年高血压患者家庭功能总分及各维度得分与主观幸福感呈正相关（P<0.05）。结论社区老年高血压患者家庭功能与主观幸福感密切相关,可通过提高社区老年高血压患者的家庭功能来提高患者的主观幸福感。     

The Impact of Human Rights Violations and Perceptions of Discrimination on Health Service Utilization Among Injection Drug Users in Delhi,India

The study was conducted from August to December , in two urban, poor neighborhoods in Delhi. A respondent-driven sampling was used to recruit 343 injection drug users who were interviewed with a survey questionnaire that included items of human rights abuses, health service utilization, and sociodemographic characteristics. Multivariate logistic regression with backward selection of variables was conducted with the three outcome variables—service utilization in general care sector, harm reduction, and drug user treatment. Findings suggest advocating for human rights and securing standards of care in improving health care use and future research on documenting human rights abuses occur in health care settings. The study's limitations are noted.     

The Relationship Between Vulnerable Attachment Style,Psychopathology, Drug Abuse,and Retention in Treatment Among Methadone Maintenance Treatment Patients

The relationship between vulnerable attachment style, psychopathology, drug abuse, and retention in treatment among patients in methadone maintenance treatment (MMT) was examined by the Vulnerable Attachment Style Questionnaire (VASQ), the Symptom Checklist-90 (SCL-90), and drug abuse urine tests. After six years, retention in treatment and repeated urine test results were studied. Patients with vulnerable attachment style (a high VASQ score) had higher rates of drug abuse and higher psychopathology levels compared to patients with secure attachment style, especially on the interpersonal sensitivity, anxiety, hostility, phobic anxiety, and paranoid ideation scales. Drug abstinence at baseline was related to retention in treatment and to higher rates of drug abstinence after six years in MMT, whereas a vulnerable attachment style could not predict drug abstinence and retention in treatment. Clinical Implications concerning treatment of drug abusing populations and methodological issues concerning the VASQ’s subscales are also discussed.     

The Roles of Spirituality in the Relationship Between Traumatic Life Events,Mental Health,and Drug Use Among African American Women from One Southern State

This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.