Substance Use and Dependency Disorders in Adolescent Girls in Group Living Programs: Prevalence and Associations with Milieu Factors

Fifty-three adolescent girls residing in community-based group-living child welfare programs were administered a standardized measure (SASS-2) in order to assess probability of a substance use/dependency disorder in this highly vulnerable population. Findings revealed that one third of the sample, and one half of the nonpregnant/parenting girls, met the diagnostic criteria for a substance use/dependency disorder. Probability of such a disorder was associated with aspects of the group living milieu including access to peers who also use drugs and lack of perceived pressure from staff to abstain from using drugs and alcohol. Results support the need for broad-based screening of group home youth, intensive interventions to address existing substance use problems, and staff training in prevention and identification of youth who use substances. Findings also suggest that pregnancy and parenthood represent a window of opportunity for changing the trajectory of substance use in adolescent teens in the child welfare system.     

The association between hospital admission and substance use among trauma patients

Background: Alcohol and substance use is prevalent in trauma patients admitted to hospital.

Aim: Investigate the association between hospital admission and substance use for three different injury types among trauma patients according to age and gender.

Method: Prospective cross-sectional emergency department study. The patients were divided into injury groups and compared with respect to gender, age, hospital admission, substance use, and blood alcohol level.

Results: The study included 998 trauma patients, of whom 39% screened positive for substance use. Patients with head injury had a higher prevalence of alcohol use (29%). Patients with head injury and hazardous drug or alcohol use were less likely to stay in hospital for more than 24 hours (adjusted OR: 0.61, 95% CI: 0.41–0.93, p = .02), whereas patients with injuries to neck/thorax/abdomen and hazardous use had the highest risk of staying in hospital more than 24 hours (adjusted OR: 5.22, 95% CI: 1.47–18.76, p = .01). Injuries to pelvis/extremities were more common among women with medicine use.

Conclusion: Patients with head injury and hazardous use were less likely to be admitted to hospital, whereas patients with injuries to the neck/thorax/abdomen and hazardous use were more likely to be admitted.     

COMMENTARY: Metabolic syndrome and its evolving link to diabetes

Abstract

Background: Although attention deficit/hyperactive disorder (ADHD) is a common comorbidity in individuals who are diagnosed with substance use disorder (SUD), little data currently exist on the utility of screening tools in large samples of adults with SUD in inpatient treatment and the prevalence of ADHD in this population. The aims of this study were to assess the screen positive rate on the Adult ADHD Self Report Scale (ASRS) v.1.1 Screener in a large sample of adults being treated for SUD in a residential treatment facility (RTF) and to establish the imputed prevalence of adult ADHD. Methods: Adults with SUD who were either newly admitted (abstinent for < 1 week) or in treatment in the RTF (abstinent < 3 months) were administered the ASRS v.1.1 Screener. Adults who screened positive on the ASRS v1.1 Screener (≥ 4/6 significant items) were then administered the Adult Clinician Diagnostic Scale (ACDS) v.1.2 to establish a diagnosis of ADHD and the positive predictive value (PPV) in this population. The imputed prevalence of adult ADHD was calculated based on the known rate of ADHD in the screened positive cohort and a calculated rate of ADHD in the screened negative sample based on prior studies of the ASRS v1.1 Screener in community-based and managed care samples. Results: 1064 adults were screened via the ASRS v.1.1 Screener, with 92 screening positive (8.6% had ≥ 4 significant items present). Fifty-three of those who screened positive were diagnosed as having adult ADHD (PPV = 57.6%). The imputed prevalence of adult ADHD in this population was 7.5%. Conclusions: The PPV for the ASRS v1.1 Screener for adult ADHD in this sample of adults with SUD was similar to that observed in a prior study of a managed care sample, but was somewhat less than that observed in the community-based sample. The imputed prevalence rate for comorbid ADHD in this study of adults with SUD in a RTF was similar to, but slightly lower than the prevalence rate of ADHD in patients with any SUD observed in the community-based sample.     

Preliminary findings on the links between violence,crime, and HIV risk among young adults with substance use disorders in El Salvador

The links between substance use and violence, crime, and HIV risk behavior have been well-documented among individuals in developed nations. However, it remains uncertain how, and to what degree, such behaviors are related in the severe socio-environmental context of marginalized communities in developing nations like El Salvador. Using data from a sample of young adult men (n?=?177; ages 18–26) residing in marginalized communities in San Salvador, El Salvador (June–November 2011), we conducted Chi-square tests of association and two group mean comparison tests to examine the bivariate associations between substance use disorders (SUDs) and violence, crime, and HIV risk behavior. Results indicate that individuals meeting criteria for SUDs are approximately two to three times more likely than those not meeting criteria to report recent involvement in all violent and criminal outcomes examined in this study. Particularly robust effects were identified in terms of carrying a hidden weapon (χ^2?=?26.98, p?<?0.001, φ?=?0.390) and attacking someone with a weapon or with the idea of seriously hurting/killing them (χ^2?=?17.80, p?<?0.001, φ?=?0.317). Overall, findings suggest that SUDs are strongly associated with violence, crime, and HIV risk behavior within El Salvador’s marginalized communities.     

The relationship between self-efficacy,coping skill and substance use in adolescent: based on structural equation modeling

Background: This study was aimed to investigate interrelationships between the self-efficacy and coping skill in relation to substance use behavior in adolescent.

Method: A self-administered questionnaire was completed by 720 girls and boys, aged between 14 and 18, involved in the cross-sectional study in Iran. In the first step, first-order measurement models were examined to assess how well the observed measures could reflect the latent constructs and in the second step, the structural component consisting of relationships between the latent factors was examined to determine the theoretical factors of the coping and self-efficacy predicted substance use behavior, as hypothesized.

Result: The results of the first step revealed stable assessment of four confirmed factors in the first-order measurement model. In second step, the structural model of coping and self-efficacy showed an acceptable adequacy in predicting substance use behavior in the second-order model. Direct and indirect path analysis demonstrated that relationship between refusal self-efficacy and substance use would be mediated by the coping skill, and this relationship could significantly predict substance use behavior in our study.

Conclusion: The results of our hypothesized model of coping self-efficacy (CSE) had an acceptable adequacy in predicting substance use behavior in adolescents.     

Addressing Substance Use in Adolescents: Screening,Brief Intervention,and Referral to Treatment

Adolescent substance use is a national public health crisis. The most commonly used substances among adolescents are nicotine, alcohol, and marijuana. Use of these substances during adolescence has serious adverse effects on brain development, with impairments that can endure into adulthood. Advanced practice nurses in primary care can address substance use in the adolescent population with the use of evidence-based interventions, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). This article describes trends in adolescent substance use and use of the SBIRT intervention for low, medium, and high-risk use in this population.     

Psychological stress,smoking, and hazardous drinking behaviors in South Korea: findings from the Korea National Health and Nutrition Examination Survey

ABSTRACT

Introduction: There is growing attention to mental health as a contributor to behavioral health in South Korea. We investigated the prevalence of psychological stress and its associations with cigarette smoking and drinking behaviors among a nationally representative sample of South Korean adults.

Methods: Using data from 14,855 adults aged ≥19 years who participated in the 2013–2016 Korea National Health and Nutrition Examination Survey (KNHANES), we performed weighted logistic regression to examine the associations between stress and three binary outcome variables: cigarette smoking, heavy episodic drinking, and frequent drinking.

Results: 27.2% of the participants reported high stress. Controlling for sociodemographic covariates, high stress was associated with 1.54 times the odds (p < .001) of being a smoker, 1.25 times the odds (p < .001) of being a heavy episodic drinker, and 1.23 times the odds (p < .001) of being a frequent drinker. There was evidence of effect modification by gender and occupation, such that the effects of stress on these behaviors were particularly stronger among women and pink-collar (service industry) workers (compared to men and white-collar workers).

Conclusions: Future policies that aim to address smoking and drinking behaviors in South Korea should consider stress reduction and coping strategies, especially among women and pink-collar workers.     

射频消融术治疗心房颤动患者的领悟社会支持、家庭关怀度与正负情绪的关系:心理弹性的中介作用

目的探讨行射频消融术(RFCA)的心房颤动(AF)患者的心理弹性在领悟社会支持、家庭关怀度对正负情绪影响路径间的中介效应。方法选取2018年11月—2019年3月在天津市某三级甲等医院心内科住院的RFCA术后的207例AF患者,采用一般资料调查表、领悟社会支持量表(PSSS)、家庭关怀指数问卷(FAI)、心理弹性量表(CD-RISC)和正负情绪量表(PANAS)对研究对象进行调查。采用基于结构方程模型的路径分析方法。结果行RFCA术的AF患者PSSS、CD-RISC、FAI、PANAS得分之间具有相关性(P<0.05)。结构方程模型拟合良好,领悟社会支持完全通过心理弹性间接影响行RFCA术的AF患者正负情绪,家庭关怀度通过心理弹性间接影响正性情绪,家庭关怀度对负性情绪的直接效应和间接效应都显著。结论心理弹性是领悟社会支持、家庭关怀度对行RFCA术的AF患者正负情绪影响的中介因素,提高社会支持和家庭关怀度能提升患者心理弹性水平,进而减少其负性情绪并增加正性情绪。     

Alcohol use screening and case finding: screening tools, clinical clues, and making the diagnosis

This article presents an evidence-based approach to screening and case finding for alcohol use disorders in primary care. Problematic alcohol use by both adults and adolescents is considered. For clarity, this evidence-based presentation is divided into 6 sections: (1) epidemiology of alcohol use disorders, (2) associated health problems, (3) US Preventive Services Task Force screening recommendations, (4) screening/case finding instruments, (5) screening/case finding strategies, and (6) summary. This article reviews the state-of-the-art, evidence-based concepts and practices for screening and case finding for alcohol use disorders among adults and adolescents in primary care settings.     

Associations between perceived proximity to neighborhood resources, disability, and social participation among community-dwelling older adults: results from the VoisiNuAge study

Levasseur M, Gauvin L, Richard L, Kestens Y, Daniel M, Payette H, for the NuAge Study. Associations between perceived proximity to neighborhood resources, disability, and social participation among community-dwelling older adults: results from the VoisiNuAge Study.

Objective

To examine the associations between perceived proximity to neighborhood resources, disability, and social participation and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation in community-dwelling older women and men.

Design

Cross-sectional.

Setting

Community.

Participants

Older adults (296 women, 258 men).

Interventions

Not applicable.

Main Outcome Measures

Data for age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services, amenities), and functional autonomy in daily activities (disability) were collected by means of interviewer-administered questionnaire.

Results

Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women (R²=.10; P<.001) and men (R²=.05; P<.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources in women (no moderating effect; P=.15). However, in men, greater perceived proximity to neighborhood resources enhanced social participation (P=.01), but only in those with minor or no disability.

Conclusions

Future studies should investigate why perceived proximity to services and amenities is associated with social participation in older men with minor or no disabilities and with women overall, but has no association in men with moderate disabilities.     

Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial

Objective: To compare the effectiveness of three corticosteroid regimens in children with mild to moderate croup. Methods: Double‐blinded, randomized comparative trial with parallel design, conducted in the ED of a paediatric tertiary care hospital. Children aged 6 months to 6 years presenting to the ED with croup were eligible for inclusion if their Westley croup score was 2 or more. They were randomized to receive a single oral dose of either prednisolone 1 mg/kg, dexamethasone 0.15 mg/kg or dexamethasone 0.6 mg/kg. Primary outcome measures were the magnitude and rate of reduction in Westley croup score, rate of return for medical care with ongoing croup, and further treatment with steroids in the week following index presentation. Secondary outcome measures were the proportion of subjects requiring admission or salvage therapy, such as nebulized adrenaline, during index presentation. Results: A total of 99 children, aged 6–79 months, were enrolled (mean age: 1.7 years). Thirty‐four patients were randomized to receive prednisolone 1 mg/kg, 34 to receive dexamethasone 0.15 mg/kg, and 31 to receive dexamethasone 0.6 mg/kg. Baseline characteristics of the three groups were similar. The parents of 86 patients (87%) were available for follow‐up telephone interview at 1 week. There were no significant differences in primary or secondary outcome measures between the three treatment groups. Conclusions: Both prednisolone 1 mg/kg and low‐dose dexamethasone (0.15 mg/kg) were found not to differ in efficacy from the currently recommended 0.6 mg/kg dexamethasone. The use of these corticosteroid regimens in treating patients with mild to moderate croup is thus supported.     

Relationship between osteopathic manipulative treatment of the temporomandibular joint,molar shim and the orthostatic position: A randomized,controlled and double blinded study

This randomized, controlled, double-blinded study related the effect of osteopathic manipulative treatment (OMT) of the temporomandibular joint (TMJ) and the orthostatic posture using the molar shim (MS) as a postural adjustment factor. Twenty individuals classified with temporomandibular disorder (TMD) were randomly assigned to a treated group (TG, n = 10) and placebo (PG, n = 10). The independent variables were: MS and OMT of the TMJ. The dependent variables were: DC-TMD data; local pressure pain using algometry; and orthostatic posture assessed by the distribution of plantar pressures (baropodometry), in the evaluation periods before and immediately after the interventions. Results: pain did not show a statistically significant difference after the interventions. However, when comparing the Effect Size (ES) between the groups in the post-intervention moment, a moderate relationship was observed for the left trapezius muscle (0.51) and right and left TMJ (0.41 and 0.54 respectively). When correlating the pain and percentage of anteroposterior postural dislocation variables, a significant moderate inverse correlation was observed in the post-intervention moment. The results of the MS pointed to a significant decrease (p ≤ 0.05) of the average peak pressure (Medium P) during the use of the MS (503.4 ± 44.1 kgf/cm2) and after performing the OMT (516.5 ± 49.6 kgf/cm2), both for the TG compared to the pre intervention moment (519.3 ± 42.9 kgf/cm2). There is a correlation between TMJ and orthostatic posture. OMT of the TMJ influences orthostatic posture. The MS can be added to the evaluative context of TMD.