Alcohol and drug problems among diverse health and social service populations.

OBJECTIVES. This study responds to clinical and research interest in identifying alcohol- and drug-related problems in health and social service agency populations. These problems are associated with a variety of illnesses and social problems, and community agencies serve important screening functions. METHODS. Indicators of problematic alcohol and drug use are compared across representative samples of clients within a county's alcohol, mental health, and drug treatment systems; hospital emergency rooms; primary health clinics; criminal justice and welfare systems; and general population. RESULTS. Agencies followed a consistent rank ordering in the prevalence of substance abuse indicators. Highest prevalences were found in the populations of behavioral health agencies, including alcohol, drug, and mental health treatment facilities and criminal justice, followed by welfare agencies. General medical agencies served populations with the lowest prevalence and problem severity. CONCLUSION. Health and social service agencies provide significant opportunities for the screening and referral of individuals with problematic alcohol and drug use. Although behavioral agencies have higher potential for referral and intervention, general medical services may be more effective in conducting prevention and early case-finding activities.     

Exploring the influence of service user involvement on health and social care services for cancer

Background Service user involvement in health and social care is a key policy driver in the UK. In cancer care it is central to developing services which are effective, responsive and accessible to patients. Cancer network partnership groups are set up to enable joint working between service users and health care professionals and to drive service improvements. Aims and objectives The aim of this study was to explore the influence of the cancer network partnership groups’ service user involvement activities on cancer care. Design This was a qualitative study involving documentary analysis and in‐depth case studies of a sample of partnership groups. Setting and participants Five partnership groups were purposively selected as case studies from Macmillan regions across the UK; documents were collated from a further five groups. Forty people, including core group members and key stakeholders in cancer services, were interviewed. Results and conclusions The evidence from this study suggests that cancer network partnership groups are at their most influential at ‘grass roots’ level – contributing to patient information resources, enhancing access to services, and improving care environments. While such improvements are undoubtedly important to patients, the groups’ aim is to influence strategic changes, for example in cancer care commissioning or macro‐level policy decision‐making. The evolution of open, participatory relationships between service users and professionals, and recognition of the value of experiential knowledge are seen as key factors in influencing cancer care. The provision of dedicated resources to strengthen service user involvement activities is also vital.     

Criminal exposure to HIV: evolving laws and court cases

Legislatures in many States have passed or are considering statutes that impose tougher penalties on those who knowingly expose others to HIV infection. Florida, New Jersey, Missouri, Iowa, and Washington created tougher penalties for people who knowingly expose others to HIV. Pennsylvania and Rhode Island reviewed their current HIV-specific offenses and changed these offenses to include other activities that could be subject to criminal prosecution.     

Methodological advances in the use of recidivism rates to assess mental health treatment programs

This study of recidivism rates within a state psychiatric system identifies and controls for a number of flaws in other recidivism studies and provides one of the few direct comparisons between different mental health programs using recidivism rates as a dependent variable. It is not an attempt to predict the likelihood of an individual patient’s recidivism or to improve the treatment provided the individual patient. Instead, it is an endeavor to address the issue of using recidivism rates to assess a treatment program’s effectiveness and to examine such treatment at the macro-or system-wide level.     

The social network of alcohol users undergoing treatment in a mental health service

The treatment of alcohol and drug users requires an extended reflection on the influence of the family and other social network groups of these individuals. Thus, this study, results of a qualitative study, aimed at investigating the presence of drug users in the social network of individuals undergoing treatment and the possible interventions of the mental health services in the social network of four users of alcohol in the municipality of Alegrete/RS. Interviews with users and families, genograms and eco-maps were used. The results indicated the presence of drug users in the family and in the other social network groups, and that the group for chemical dependants was the main intervention in these social networks. These results demonstrate the need for directing the actions of mental health to develop healthy bonds, to expand the social network and structure of the group in order to provide benefits which favor effective psychosocial rehabilitation.     

Beyond tokenistic participation: Using representational artefacts to enable meaningful public participation in health service design

A number of recent policies promote public participation in health service design. Yet, a growing literature has articulated a gap between policy aims and actual practice resulting in public participation becoming tokenistic. Drawing on theory from participatory design, we argue that choosing appropriate artefacts to act as representations can structure discussions between public participants and health professionals in ways that both groups find meaningful and valid. Through a case study of a service improvement project in outpatient services for older people, we describe three representational artefacts: emotion maps, stories, and tracing paper, and explain how they helped to mediate interactions between public participants and health professionals. We suggest that using such representational artefacts can provide an alternative approach to participation that stands in contrast to the current focus on the professionalisation of public participants. We conclude that including participatory designers in projects, to chose or design appropriate representational artefacts, can help to address the policy–practice gap of including public participants in health service design.     

Accessibility to tuberculosis treatment: assessment of health service performance

The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeir?o Preto, countryside of S?o Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.     

Degenerative changes in the neonatal kidney following in-utero exposure to methylmercury

Pregnant Sprague—Dawley rats were injected with 4.0 mg Hg/kg body weight of methylmercuric chloride on the 8th day of pregnancy. Tissue samples from the kidneys of the offspring were obtained for electron microscopic examination. Degenerative changes in the epithelial cells of the proximal convoluted tubules (PCT) including accumulation of lysosomes, enlargement of the apical vacuoles, cytoplasmic vacuolation, and extrusion of large cellular casts into the tubular lumen were observed. Flattening of the basal infolding was found in some PCT epithelial cells. Deposition of basal filaments in these cells were also observed. Extrusion and embedding the spherical microparticles into the basement membranes of the PCT was also a prominent finding. No degenerative changes were seen in the distal tubules. However, degeneration of the Bowman's capsule of the glomeruli, fusion of the epithelial foot-processes, and detachment of the glomerular epithelial cells from their basement membranes could be observed occasionally.     

The health of restaurant work: A historical and social context to the occupational health of food service

The United States currently has over one million restaurants, making food service one of the largest workforces and industry sectors in the nation's economy. Historically, concern for the health of early restaurant workers was tied largely to the hygiene of the food and thus the wellbeing of the customer rather than the individuals preparing the food. The landscape of occupational illness and injury that resulted is fraught with some of the starkest health disparities in wages, discrimination, benefits, injuries, and illness seen among US laborers. These disparities have consistently been associated with social class and economic position. Conditions identified during the early years of restaurant work, before the introduction of occupational safety and health protections, persist today largely due to tipped wages, dependence on customer discretion, and the management structure. Research and intervention efforts to control occupational health hazards should be directed toward the socioeconomic and structural roots of health problems among food service workers in the United States. Such efforts have important implications for enhancing worker protections, improving wages, and restructuring working conditions for restaurant and food service workers. They also suggest opportunities for occupational health practitioners and researchers to contribute to system-level change analysis to address centuries-old occupational health challenges still facing one of the largest sectors of workers in the country.     

Partners in projects: Preparing for public involvement in health and social care research

In recent years, several UK and, international funders of health and social care related research have adopted the policy of requiring explicit evidence of the ‘public’ voice in all aspects of project design. For many academic researchers engaged within research, evaluations or audit projects, this formal requirement to actively engage members of the public will present them with both benefits and challenges to securing knowledgeable, skilled, and confident lay representation onto project teams. This could potentially lead to the exploitation of those individuals who are available, appropriately informed, and adequately prepared for such activities. Currently, much of the preparation of patients or members of the public for research involvement tends to be aligned to specific projects; however, with the call for greater active and meaningful involvement of lay representatives in future national and international funding applications, there is clearly a growing need to ‘train’ sufficient numbers of confident and competent representatives to meet this growing demand. This paper describes the development of a specifically designed research awareness training programme and underpinning theoretical model, which has been specifically designed to support active and meaningful lay involvement in research, evaluations and audit projects. Developed over a four year period, the course is a culmination of learning extracted from a series of four completed research projects, which have incorporated an element of public and patient involvement (PPI) training in their overall design.     

Mental health policies and changes in emergency service demand

OBJECTIVE: To verify the modifications observed in a school hospital psychiatric emergency unit in Ribeir?o Preto - SP, Brazil (EP-RP), due to alterations in the mental health policies implemented in this region. METHODS: Data about attendances was collected from university hospital files of the EP-RP, from 1988 to 1997. The following variables were studied: sex, age, origin and main diagnosis. Data about changes in mental health policies of the region was obtained from documents of the city and state departments of health. RESULTS: The yearly increase in the number of attendances followed the progressive involvement of EP-RP with the mental health service network, as the number of patients who looked for the service in 1995 was 2.3 times greater than in 1988. During this period, attendance at the EP-RP gave support to the modifications in the mental health policies in this region, resulting in a reduction of 654 psychiatry beds. In 1996 and 1997, a reduction of about 20% was observed in the total of attendance, as compared to 1995, result from an increase in the attendance capacity and number of the extra-hospital services. Since 1990, the EP-RP started to attend a higher proportion of older, male patients, with drug dependency and psychotic disorders and a lower proportion of non-psychotic patients. CONCLUSIONS: The changes observed in the EP-RP are related to modifications in the Ribeir?o Preto region mental health policies, like the psychiatric beds control, installed in 1990, the reduction of psychiatric beds after 1993, and the creation and/or amplification of extra-hospital services, in 1995.     

Public health, not social warfare: a public health approach to illegal drug policy.

This article makes three major arguments: (I) the current War on Drugs undercuts public health values and premises, resulting in a war on the poor, disenfranchised, people of color, the homeless, and the unemployed; (2) drug problems should be addressed primarily within the realm of public health policy rather than criminal justice policy; and (3) to achieve a viable public health drug policy, the public health community needs to build grassroots support and become effective activists. The article reviews the history of past drug wars, analyzes recent trends in illegal drug use and problems, and critiques current policy initiatives and their consequences. It then outlines a comprehensive, public health approach to addressing illegal drug problems, and concludes with an analysis of what steps are needed to become effective in the public policy arena.