Some Obstacles to Employment for Persons with Chronic Substance Use Disorders

In the U.S., persons with severe and chronic substance use disorders (SUDs) manifest crippling impairments in fulfilling ordinary adult roles, pose serious threats to public health and safety, and constitute one of the costliest populations served by health care systems. Published peerreviewed studies of SUDs and their treatments report problems nearly equal in magnitude to those of persons with severe mental illness (SMI: schizophrenia, manic-depression, major depression), especially extremely poor labor force participation (>80% unemployment), low educational attainment, lack of health care insurance, and earned income below U.S. federal poverty levels. Persons with chronic SUDs rarely receive comprehensive services (especially vocational services) (McLellan et al., 2000) and civil rights protections that promote recovery from illness and facilitate reintegration into their communities (Parikh, 2004). Below, I describe some of the many obstacles to illness recovery and to obtaining and retaining meaningful employment.     

Measurement of quality of life in patients with chronic obstructive pulmonary disease

In measuring quality of life in chronic obstructive pulmonary disease (COPD) we have to make a distinction between using quality-of-life (QOL) instruments for research or for patient care purposes. For research purposes, these instruments have proven their value. However, for healthcare, the value of these instruments has not yet been established. It is clear that quality of life is important to both the patient and the physician. For the patient, experienced health is quite probably the most important aspect of healthcare. For the time being, however, it is difficult to include this aspect of the primary care of patients with COPD in a proper and well balanced way, because we do not know exactly what value we must attach to a changed quality of life and what consequences this has for medical care. Moreover, in COPD it might be possible that only severely obstructed patients have a detectably impaired quality of life as assessed by QOL instruments, which obviously makes these instruments less suitable for healthcare.     

Pharmaceutical care services for asthma patients: a controlled intervention study

As asthma is associated with an enormous social, psychological, and economic burden, various patient education programs have been developed to improve outcomes, including quality of life. The authors evaluated the effectiveness of community pharmacy-based interventions on lung function, health-related quality of life, and self-management in asthma patients in a 12-month controlled intervention study in 26 intervention and 22 control pharmacies. Pharmacies opted whether to take part as intervention or control pharmacies. According to this, patients (ages 18-65) with mild to severe asthma attending the pharmacies were allocated to the intervention (n = 161) or control group (n = 81), respectively. Intervention patients were educated on their disease, pharmacotherapy, and self-management; inhalation technique was assessed and, if necessary, corrected. Pharmaceutical care led to significantly improved inhalation technique. Asthma-specific quality of life and the mental health summary score of the SF-36 improved significantly in the intervention group. At 12 months, the intervention group showed significant improvements with regard to evening peak flow, self-efficacy, and knowledge.     

The Relationships Between Alcohol/Drug Use and Quality of Life Among Adolescents: An International,Cross-Sectional Study

Although a major public health and social concern globally, limited data exist on substance use and their effects among adolescents living in low- and middle-income countries. This study evaluated the relationships between alcohol/drug use and quality of life (QOL) among adolescents in general populations from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria, and Croatia. The sample included 2,393 adolescents. The Pediatric Quality of Life Inventory (PedsQL) was used for QOL assessments, the Strengths and Difficulties Questionnaire (SDQ) was used for mental health problems, and the CRAFFT self-report questionnaire was administered for eliciting alcohol/drug use. Alcohol/drug use was significantly associated with lower levels of QOL. In particular, substance use among older male adolescents, adolescents with overt psychopathology, or adolescents in lower socioeconomic status was associated with greater reductions in levels of QOL.     

Genetic methods and preventive psychiatry.

1. The meaning of the consistently high estimates of heritability of psychiatric disorders such as affective disorders and schizophrenia is that a small proportion of families accounts for a very large proportion of the population diagnostic variance. 2. This implies that the classic community mental health services model of a randomly distributed risk in a geographically defined catchment area population is inappropriate, and that efficient case finding and follow-up would result from tracing illness within pedigrees of known cases. 3. Application to clinical practice of family study methods developed in genetic research enables efficient identification of unrecognized and untreated cases, and early provision of care (secondary prevention). The use of family study methods will also uncover milder and variant ("spectrum") forms of illness in relatives of known patients, which then become accessible to treatment. 4. A family study of affective illness at the United States National Institute of Mental Health, demonstrated how additional ill persons including previously untreated cases could be identified. Starting with 86 Bipolar probands, we interviewed all available first degree relatives, and saw second degree relatives if there was indicated psychopathology by history. 5. Of the 405 living first degree relatives of 86 Bipolar I patients, the study found 1.2% had lifetime diagnosis of untreated Bipolar illness, 2.7% had untreated Unipolar illness, 4% had less severe personality disorders and 2% suffered from behavioral disorders such as drug abuse or alcoholism.     

Overview of Health-Related Quality-of-Life Measures for Pediatric Patients: Application in the Assessment of Pharmacotherapeutic and Pharmacoeconomic Outcomes

Health-related quality of life (HRQOL) is an important dimension in assessing health care. Several methodologic considerations are related to the manner in which these data are obtained in children. Few multidimensional generic measures of quality of life (QOL) have been developed for children and adolescents. Most published research concerns the development of tools to be used in a disease-specific manner for clinical trials. Although several authors point out numerous advantages in assessing HRQOL in clinical practice, several barriers must be overcome for this to occur. In the current era of economic restraint, HRQOL measures must be integrated into pharmacoeconomic analyses to assess fully the impact of a drug on health care resources and outcomes.     

Assessing quality of life in patients with epilepsy

The importance of quality-of-life (QOL) assessments in providing quantified information about the impact of chronic illness and its treatment is now generally accepted. For epilepsy, QOL assessment is a relatively recent development, but it is increasingly included within clinical trial protocols. Clinical trials in epilepsy that have included a comprehensive QOL assessment, although still relatively few in number, have examined the effectiveness both of broad management policies and of individual drug therapies. There are a number of important conceptual, methodological and practical issues behind the measurement of quality of life as an outcome of care in epilepsy that are being addressed through current efforts to develop standardised QOL instruments. In trying to assess quality of life in epilepsy, as in any other condition, it is important to satisfy the universal requirements of a scientific instrument-that it be valid, reliable, sensitive in change and practical. To date, the main 'formal' approaches to QOL assessment in epilepsy have involved the development of a novel QOL measure from first principles, customising of a previously developed generic measure, identification of a battery of generic and disease-specific scales addressing specific QOL domains, and adoption of an individual patient-generated approach. These various efforts have produced a battery of potentially valuable tools and approaches. Although QOL assessment is now mainly on the epilepsy research agenda, some important challenges remain to be met. These include the development of comprehensive, age-related measures for children with epilepsy, further investigation of the psychometric properties of the available measures for adults, issues of cross-cultural application and use with proxy informants, and the development of utility-based measures.     

Long Acting Injectables and their Correlation with Subjectivity in Schizophrenia Spectrum Disorder

Nowadays, mental illness can no longer be considered as a mere list of symptoms corresponding to localized brain dysfunctions but rather as a disturbance of the patient’s subjectivity. Thus, a solid, qualitative study of patients’ subjectivity could represent a useful tool in the complex evaluation of efficacy of pharmacotherapy in schizophrenic persons. In this perspective, authors performed a phenomenological oriented investigation on 49 patients, diagnosed with schizophrenia spectrum disorder, who were receiving long-acting injectable (LAI) antipsychotic therapy. From data analysis, authors found a positive correlation between general psychopathology and the use of LAI antipsychotic therapies. The present study highlighted the necessity of a careful investigation of patients’ subjectivity in a phenomenological way as an irreducible part of both psychopathological and psychopharmacological matters.     

光明社区医养结合服务模式实践的探索

目的：通过医养结合服务模式的实施,评价医养结合服务模式对促进老年人身心健康的效果。方法：2013年6月光明社区卫生服务中心与辖区内3家社会养老机构结对,签订服务协议,由家庭医生每周1次到养老机构提供查房、医疗咨询、老年预防保健等医疗服务。每月提供1次健康讲座和慢性病随访。采用SF-36生活质量评定表对实施前后老年人生活质量进行评分和比较。结果：通过2年来医养结合服务模式的实践,养老机构中老年人的生活质量、慢性病的随访率及控制率得到明显提高。结论：医养结合服务模式是一种新型的养老服务模式,能有效促进老年人的身心健康和生活质量,应积极推广应用。     

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

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.     

乳腺癌患者围手术期护理满意度与术后生存质量关系的探讨

目的调查乳腺癌患者围手术期对临床护理的满意度与康复效果的相关性,评估乳腺癌患者围手术期临床护理干预的效果。方法应用问卷形式向44位乳腺癌患者对围手术期护士的护理质量、工作能力、关爱与沟通、健康教育四个方面进行满意度的评价,同时对患者的康复情况进行跟踪调查,并进行统计分析。结果当患者护理的总体满意度高,对护理认同感强时,患者出现的心理问题较少,手术后的康复效果较好,并发症也相对较少。结论乳腺癌患者围手术期的护理质量直接影响患者的康复状况和生存质量。在围手术期实施优质的临床护理工作,能明显提高临床的治疗效果,有利于患者顺利渡过围手术期,提高患者的生存质量,促进患者的身心健康。     

Peripartum mental health and the role of the pharmacist: A scoping review

BackgroundThe global prevalence of peripartum mental illness is 20%, though estimates have increased since the start of the COVID-19 pandemic. Chronic illnesses affect one in five pregnancies and may be associated with higher rates of peripartum mental illness. Though pharmacists are well-positioned to facilitate appropriate and timely care of co-occurring mental and physical health conditions during this period, little is understood regarding their potential roles.ObjectivesTo understand the current evidence examining the role of pharmacists to improve the outcomes of women with peripartum mental illness, with and without chronic illness.MethodsA scoping review was performed with assistance from an interdisciplinary team following the Joanna Briggs Institute framework. MEDLINE, Embase, PsychNet and International Pharmaceutical Abstracts databases were searched. English-language articles (published up to May 30, 2022) were screened and assessed for eligibility, and data were charted to collate results, by dual independent reviewers.ResultsThe search strategy produced 922 articles. After screening, 12 articles were included (5 narrative reviews, 7 primary research). There was limited discussion or empirical data regarding specific interventions (screening, counseling), opportunities (accessibility, managing stigma, forming trusting relationships and building rapport with patients) or barriers (lack of privacy, time constraints, adequate remuneration, training) associated with an expanded role of pharmacists in peripartum mental health care. The clinical complexity arising from co-occurring mental health and chronic illnesses was not explored, other than a small pilot study involving pharmacists screening for depression among pregnant women with diabetes.ConclusionsThis review highlights the limited evidence available on the explicit role of pharmacists in supporting women with peripartum mental illness, including those with comorbidity. More research, including pharmacists as study participants, is required to fully understand the potential roles, barriers, and facilitators of integrating pharmacists into peripartum mental healthcare to improve the outcomes of women in the peripartum period.     

家庭关怀度对老年慢性病患者幸福感的影响研究

目的探讨老年慢性病患者家庭关怀度对幸福感的影响及其二者之间的关系。方法采用家庭关怀度指数量表(APGAR)和总体幸福感量表(GWB)对200例老年慢性病患者进行调查,分析APGAR和GWB之间的关系。结果老年慢性病患者APGAR和GWB总分分别为(6.75±1.38)分和(72.38±16.46)分,二者水平均较低。相关分析显示,APGAR与GWB呈高度正相关性(r=0.462,P<0.01)。结论老年慢性病患者家庭关怀度较低,是影响其幸福感的重要因素。社会工作者应给予老年慢性病患者更多的家庭关怀,以提高其心理幸福感,改善生活质量。     

Quality of life measurements in oncology.

Quality of life (QOL) has transcended from an implicit concern to an explicit measurement in oncology. In contemporary clinical research, QOL can now often be identified and objectively measured in health as well as in illness. The major domains which comprise QOL in patients with cancer include symptoms and side effects, social function, physical function, and psychological status. One of the preferred methods for measuring QOL consists of self-administered questionnaires. A number of instruments have been developed which vary in features such as type of domains included, number of items, response options, specificity for disease type, and psychometric assessments. The role of QOL assessment is becoming increasingly important in clinical oncology.     

The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review of Qualitative Research From a First-Person Perspective

Objectives: In recent years, the concept of recovery has gained ground in the treatment of persons with dual diagnosis. Recovery refers to living a meaningful life despite limitations caused by mental illness and substance use disorders. It also implies that support for persons with dual diagnosis should be organized according to the personal needs and wishes of its users. Therefore, it is important to gain insight into the aspects that persons with dual diagnosis deem important for their recovery process. This systematic review aims to summarize existing qualitative research on the meaning of recovery from the perspective of persons with dual diagnosis. Methods: A literature search was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews in the following databases: Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Embase, and Web of Science. Results: Sixteen studies using a qualitative research design were retained in which four overarching themes could be identified. The first theme focused on feeling supported by family and peers and being able to participate in the community. The second theme focuses on the need for a holistic and individualized treatment approach, seeing the persons “behind the symptoms.” The third theme that emerged was having personal beliefs, such as fostering feelings of hope, building a new sense of identity, gaining ownership over one's life, and finding support in spirituality. The last theme identified was the importance of meaningful activities that structure one's life and give one motivation to carry on. Conclusions: In this review, the participants pleaded for “flexibility” in mental health care, i.e., an approach that allows for both successes and failures. However, in order to come to a more comprehensive theoretical model of recovery in persons with dual diagnosis, future research is necessary to gain insight into the underlying mechanisms of recovery processes.     

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

Objectives

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

惊恐障碍的病因及治疗进展

惊恐障碍是一种临床常见的精神障碍,严重影响患者的生活质量。其发病机制目前尚未有定论,治疗方案也不十分成熟。本文综述了惊恐障碍的发病机制及治疗的研究进展,其发病与生物、心理、社会等因素密切相关,治疗主要采用药物治疗、认知行为治疗以及综合治疗。     

A multiple-domain framework of clinical, economic, and patient-reported outcomes for evaluating benefits of intervention in atopic dermatitis

Atopic dermatitis (AD) increases health care utilization, affects patient quality of life, places a burden on caregivers, decreases patient/parent productivity, and adds to health care costs. Few studies have examined the effect of specific treatment modalities across a variety of AD-related outcomes. This prospective, multicenter, open-label longitudinal study of adult and pediatric patients with moderate to severe AD was conducted to evaluate the effect of a specific therapeutic intervention on AD-related outcomes over a period of 6 months. Surveys collected physician clinical assessments and patient- and caregiver-reported data across the following domains: clinical outcome, health care utilization/costs, quality of life, physical appearance, productivity/absenteeism, and medication compliance. This study is intended to help guide future research efforts on the net costs and benefits of different interventions across a diverse set of domains and in larger populations.