RESUMO
INTRODUCTION: Some evidence suggests that cannabis may be a safer substitute for other drugs. Historically, sober living houses (SLHs) have been abstinence-based environments designed for individuals in recovery to live with others in recovery. However, the evolving legal landscape around cannabis use has left SLH operators and managers in a difficult position regarding policies related to cannabis use among residents. The primary aim of this study was to examine how cannabis use relates to alcohol use, other drug use, and related problems among SLH residents. METHODS: Baseline (N = 557), 6-month (n = 462), and 12-month (n = 457) data came from SLH residents living in 48 houses in Los Angeles, CA from 2018 to 2021. Longitudinal generalized estimating equation models tested associations between any past six-month cannabis use and alcohol and non-cannabis drug outcomes: any use, number of days of use, and any alcohol- or drug-related problems. Final models adjusted for baseline age, sex, race-and-ethnicity, inpatient substance use treatment, and alcohol/drug use days, and time-varying 12-step attendance and percent of social network using drugs/alcohol heavily. RESULTS: At baseline, 107 (19.2 %) residents reported cannabis use in the past six months. At 12 months, 80 (17.5 %) residents reported cannabis use in the past six months. Across all timepoints, any vs. no past six-month cannabis use was related to significantly (P < 0.05) higher odds of past-month alcohol use (OR = 3.85, 95 % CI: 2.65, 5.59); more drinking days in the past six months (IRR = 1.76, 95 % CI: 1.40, 2.21); higher odds of alcohol problems (OR = 2.74, 95 % CI: 1.99, 3.76); higher odds of past-month drug use (OR = 10.41, 95 % CI: 6.37, 17.00); more drug use days in the past six months (IRR = 1.86, 95 % CI: 1.40, 2.49); and higher odds of drug problems (OR = 14.99, 95 % CI: 9.91, 22.68). CONCLUSIONS: During each assessment period, almost one-fifth of individuals residing in sample of California sober living houses report using cannabis in the past six months. Cannabis does not appear to work as a substitute for alcohol or other drugs in this population because cannabis use is related to increased risk of alcohol and other drug use and problems. SLH managers and operators should consider potential harm that could result from house policies that fail to address cannabis use.
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Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Masculino , Adulto , Estudos Longitudinais , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Los Angeles/epidemiologia , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/epidemiologia , California/epidemiologia , Casas para Recuperação , Adulto Jovem , Alcoolismo/epidemiologiaRESUMO
Background: Sober living houses are designed for individuals in recovery to live with others in recovery, yet no guidelines exist for the time needed in a sober living house to significantly impact outcomes.Objectives: To examine how the length of stay in sober living houses is related to substance use and related outcomes, focusing on early discontinuation (length of stay less than six months) and stable residence (length of stay six months or longer).Methods: Baseline and 12-month data were collected from 455 sober living house residents (36% female). Longitudinal mixed models tested associations between early discontinuation vs. stable residence and abstinence, recovery capital, psychiatric, and legal outcomes. Final models were adjusted for resident demographics, treatment, 12-step attendance, use in social network, and psychiatric symptoms, with a random effect for house.Results: Both early discontinuers (n = 284) and stable residents (n = 171) improved significantly (Ps ≤ .05) between baseline and 12 months on all outcomes. Compared to early discontinuation, stable residence was related to 7.76% points more percent days abstinent (95% CI: 4.21, 11.31); 0.88 times fewer psychiatric symptoms (95% CI: 0.81, 0.94); 0.84 times fewer depression symptoms (95% CI: 0.76, 0.92); and lower odds of any DSM-SUD (OR = 0.65, 95% CI: 0.47, 0.89) and any legal problems (OR = 0.58, 95% CI: 0.40, 0.86).Conclusion: In this study of sober living houses in California, staying in a sober living house for at least six months was related to better outcomes than leaving before six months. Residents and providers should consider this in long-term recovery planning.
Assuntos
Casas para Recuperação , Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Masculino , Tempo de Internação , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
OBJECTIVE: Sober living houses (SLHs) are abstinence-based environments designed for individuals in recovery to live with others in recovery. Research shows that SLHs help some individuals maintain recovery and that certain SLH-related factors may be particularly protective. Here we assess how SLH housing and neighborhood characteristics are related to abstinence and psychiatric symptoms over time. METHOD: Baseline, 6-month, and 12-month data were collected from 557 SLH residents. Multilevel mixed models tested associations between house and neighborhood characteristics and individual-level percent days abstinent (PDA) and the number of psychiatric symptoms (measured with the Psychiatric Diagnostic Screening Questionnaire [PDSQ]) as outcomes. Final models adjusted for sex, age, and race/ethnicity; ratings of house characteristics; and objective measurements of neighborhood-level exposures. RESULTS: Both PDA and PDSQ improved significantly (ps ≤ .05) over time in both unadjusted and adjusted models. More self-help groups and fewer alcohol outlets within one mile were significantly protective for PDA, whereas walkability was significantly related to worse PDA and PDSQ (ps ≤ .05). For house-level factors, better ratings of house maintenance were related to significantly fewer psychiatric symptoms, whereas higher scores on SLH's safety measures and personal or residence identity were related to more psychiatric symptoms (ps ≤ .05). No house-level factor was significantly related to PDA. CONCLUSIONS: Neighborhood-level factors such as increased availability of self-help groups and fewer nearby alcohol outlets may increase abstinence among individuals living in SLHs. House-level factors related to better maintenance may also facilitate improved mental health.
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Transtornos Relacionados ao Uso de Substâncias , Humanos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Casas para Recuperação , Grupos de Autoajuda , Saúde Mental , Características de Residência , EtanolRESUMO
Background: The settings where we live shape our daily experiences and interactions. Social environment and physical setting characteristics may be particularly important in communal living services, such as recovery homes for alcohol and drug disorders. Objectives: This paper describes the measurement and mobilization of architectural characteristics in one type of recovery home, sober living houses (SLHs). The Recovery Home Architecture Scale (RHAS) is a 25-item measure comprised of six subscales designed to assess architecture in SLHs. Results: Using a sample of 528 individuals residing in 41 houses, we found the RHAS had good interrater reliability, factor structure, and internal consistency. The measure also showed modest construct validity. The RHAS was not associated with length of stay (LOS) but did interact with a measure of the social environment that predicted LOS, the Recovery Home Environment Scale (RHES). Conclusions: Future studies should include a more diverse sample of SLHs and assess how house management, recovery capital, and other factors work in concert with architecture.
Assuntos
Alcoolismo , Transtornos Relacionados ao Uso de Substâncias , Humanos , Casas para Recuperação , Reprodutibilidade dos Testes , Meio SocialRESUMO
The study aims to investigate the rates of recidivism among prisoners on parole with a substance misuse disorder who participated in the Jerusalem halfway-house, which combines supervision, employment, and a comprehensive therapeutic program. The study population included all participants who have been treated in the halfway-house (N = 125), whereas the comparison group included all prisoners with a substance misuse disorder who were released after serving their full sentences (N = 321). To reduce possible selection biases, the Propensity Score Matching method was used. Findings show that prisoners, who were treated at the Jerusalem halfway-house, are characterized by higher and frequent rates of recidivism. However, when only completers of the halfway-house were evaluated, it was found that they had lower and slower rates of recidivism. Findings suggest that completing treatment contributes to desistance from crime in the critical post-release years among participants and indicates the importance of optimal diagnostic processes before admitting prisoners to a halfway-house.
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Prisioneiros , Reincidência , Transtornos Relacionados ao Uso de Substâncias , Crime , Casas para Recuperação , Humanos , Reincidência/prevenção & controleRESUMO
INTRODUCTION: Linkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group. METHODS: All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment. RESULTS: 351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis. CONCLUSION: PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.
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Hepatite C , Abuso de Substâncias por Via Intravenosa , Antivirais/uso terapêutico , Casas para Recuperação , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos , Projetos Piloto , Sistemas Automatizados de Assistência Junto ao Leito , RNA , Encaminhamento e Consulta , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
O artigo pretende descrever as percepções do(a)s trabalhadore(a)s quanto ao cotidiano institucional e suas possíveis correlações com os fatores que geram sofrimento mental e crises no público atendido em sete Centros de Socioeducação (Censes) do Paraná. Utilizou-se como instrumentos de coleta de dados grupos focais, entrevistas e observações participantes, sendo os dados interpretados pelos princípios da hermenêutica. Observou-se uma não padronização das estruturas dos Censes e a percepção dos trabalhadores indicou dinâmicas menos institucionalizadas em estruturas menores. A privação ocupacional pareceu sinalizar o aumento do sofrimento mental do(a)s adolescentes, contrariamente ao acesso a um repertório de atividades significativas, as quais pareceram ser promotoras de saúde mental. Conclui-se que a institucionalização pode gerar sofrimento mental tanto ao(a)s adolescentes quanto às equipes que trabalham nos Censes, sendo a estruturação do cotidiano um de seus determinantes. (AU)
El artículo pretende describir las percepciones de los trabajadores y trabajadoras en lo que se refiere al cotidiano institucional y sus posibles correlaciones con los factores que generan sufrimiento mental y crisis en el público atendido en siete Centros de Socioeducación (Censes) de Paraná. Como instrumentos de colecta de datos se utilizaron grupos focales, entrevistas y observaciones participantes, siendo los datos interpretados por los principios de la hermenéutica. Se observó la no estandarización de las estructuras de los Censes y la percepción de los trabajadores indicó dinámicas menos institucionalizadas en estructuras menores. La privación ocupacional pareció señalizar el aumento del sufrimiento mental de los adolescentes, contrariamente al acceso a un repertorio de actividades significativas que parecían ser promotoras de salud mental. Se concluye que la institucionalización puede generar un sufrimiento mental tanto a los adolescentes como a los equipos que trabajan en los Censes, siendo la estructuración del cotidiano uno de sus factores determinantes. (AU)
The article aims to describe the perceptions of the workers about the institutional daily life and its possible correlations with the factors that generate mental suffering and crises in the public assisted in seven Socio-Education Youth Centers (Censes) in Paraná. Instruments of data collection were: focus groups, interviews and participant observations, being the data interpreted by the principles of hermeneutics. We observed a non-standardization of the Censes structures and the workers' perception indicated less institutionalized dynamics in smaller structures. Occupational deprivation seemed to signal the increase of mental suffering of the adolescents, contrary to the access to a repertoire of significant activities, which seemed to promote mental health. It is concluded that institutionalization can generate mental suffering for both the adolescents and the teams working in the Censes, with the structuring of daily life being one of its determinants. (AU)
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Equipe de Assistência ao Paciente , Saúde Mental , Adolescente Institucionalizado/psicologia , Pesquisa Qualitativa , Casas para RecuperaçãoRESUMO
Background. Halfway houses (HwH) may support community reintegration of mental health care users and can be effective in meeting occupational needs of residents. However, they are not optimally used in South Africa. Purpose. This study aimed to improve the functioning of a HwH so that it better meets occupational needs of the resident mental health care users. It draws on Doble & Santha (2008); seven occupational needs. Method. A four-phase Participatory Action Research methodology was used. We conducted thematic analysis to describe met and unmet needs within PAR phases. Findings. Occupational needs of accomplishment, renewal, pleasure and companionship were being met. However, coherence, agency and affirmation needs were not being met. An additional occupational need for interdependence, based on the African ethic of Ubuntu, was identified. Implications. HwH functioning affected residents' experiences of health and wellbeing. Engagement in collective occupations can contribute to meeting the occupational need of interdependence.
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Casas para Recuperação , Terapia Ocupacional , Humanos , Relações Interpessoais , Saúde MentalRESUMO
Background No clinical studies have focused on the factors associated with discharge destination in patients with acute decompensated heart failure. Methods and Results Of 4056 consecutive patients hospitalized for acute decompensated heart failure in the KCHF (Kyoto Congestive Heart Failure) registry, we analyzed 3460 patients hospitalized from their homes and discharged alive. There were 3009 and 451 patients who were discharged to home and nonhome, respectively. We investigated the factors associated with nonhome discharge and compared the outcomes between home discharge and nonhome discharge. Factors independently and positively associated with nonhome discharge were age ≥80 years (odds ratio [OR],1.76; 95% CI,1.28-2.42), body mass index ≤22 kg/m2 (OR,1.49; 95% CI,1.12-1.97), poor medication adherence (OR, 2.08; 95% CI,1.49-2.88), worsening heart failure (OR, 2.02; 95% CI, 1.46-2.82), stroke during hospitalization (OR, 3.74; 95% CI, 1.75-8.00), functional decline (OR, 12.24; 95% CI, 8.74-17.14), and length of hospital stay >16 days (OR, 4.14; 95% CI, 3.01-5.69), while those negatively associated were diabetes mellitus (OR, 0.69; 95% CI, 0.51-0.94), cohabitants (OR, 0.62; 95% CI, 0.46-0.85), and ambulatory state before admission (OR, 0.25; 95% CI, 0.18-0.36). The cumulative 1-year incidence of all-cause death was significantly higher in the nonhome discharge group than in the home discharge group. The nonhome discharge group compared with the nonhome discharge group was associated with a higher adjusted risk for all-cause death (hazard ratio, 1.66; P<0.001). Conclusions The discharge destination of patients with acute decompensated heart failure is influenced by factors such as prehospital social background, age, body mass index, low self-care ability, events during hospitalization (worsening heart failure, stroke, etc), functional decline, and length of hospital stay; moreover, the prognosis of nonhome discharge patients is worse than that of home discharge patients. Registration Information clinicaltrials.gov. Identifier: NCT02334891.
Assuntos
Insuficiência Cardíaca , Doença Aguda , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Causalidade , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Casas para Recuperação/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Fatores de RiscoRESUMO
AIMS: Studies have shown persons living in recovery homes for drug and alcohol problems make significant, sustained improvements. However, there is limited information about factors associated with outcomes. This study examined how perceptions of social environment of one type of recovery home, sober living houses (SLHs), were associated with length of stay (LOS). METHODS: SLH residents and their house managers (N = 416) completed the recovery home environment scale (RHES) that assessed social model recovery characteristics and the community-oriented program evaluation scale (CPES) that evaluated perceptions of the program environment. RESULTS: Scales completed by residents predicted LOS, but those completed by house managers did not. Larger discrepancies between the two groups were associated with shorter LOS. The RHES was shown to be a stronger predictor of LOS than the CPES. CONCLUSION: Results highlight the importance of the social environment in SLHs, particularly those most closely aligned with social model recovery principles.
Assuntos
Alcoolismo , Transtornos Relacionados ao Uso de Substâncias , Casas para Recuperação , Humanos , Tempo de Internação , Percepção , Meio SocialRESUMO
Sober living houses (SLHs) are an increasingly common element of the recovery support services landscape, yet little is known about their neighborhood context. This study describes neighborhoods in which SLHs are located and examines differences by house characteristics. SLHs in Los Angeles County (N = 297) were geocoded and linked with U.S. Census, alcohol outlet, recovery resources, and accessibility data. Regression analyses tested differences by house characteristics. Co-ed houses were in neighborhoods that were less ethnically diverse and farther away from recovery resources. Larger house capacity was associated with increased density of off-premise alcohol outlets but also increased proximity to treatment. Higher fees were associated with lower neighborhood disadvantage and off-premise alcohol outlet density but the greater distance from treatment programs and other recovery resources. House characteristics are associated with neighborhood factors that both support recovery and place residents at risk.
Assuntos
Alcoolismo/reabilitação , Casas para Recuperação/organização & administração , Características de Residência/estatística & dados numéricos , Feminino , Casas para Recuperação/economia , Humanos , Los Angeles , MasculinoRESUMO
Effective treatment of opioid use disorder (OUD) must target both the medical and psychosocial aspects of a patient's condition. This, in turn, requires a collaboration between medical providers and social supports. We would like to illustrate a key difficulty in this collaboration for some patients in our country: many post-discharge recovery houses continue to refuse to allow patients to remain on medication treatment for OUD (M-OUD). This barrier to M-OUD access in recovery houses is a significant obstacle to effective OUD treatment.
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Casas para Recuperação/tendências , Cobertura do Seguro/tendências , Colaboração Intersetorial , Transtornos Relacionados com Narcóticos/reabilitação , Alta do Paciente/tendências , Buprenorfina/uso terapêutico , Análise Custo-Benefício/economia , Análise Custo-Benefício/tendências , Casas para Recuperação/economia , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Pessoas Mal Alojadas/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Transtornos Relacionados com Narcóticos/economia , Alta do Paciente/economia , TennesseeRESUMO
Many communities far from treatment centers and large health systems are expanding access to local sober-living homes.
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Casas para Recuperação , Habitação , Recuperação da Saúde Mental , População Rural , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , Estados UnidosRESUMO
OBJETIVO: identificar a percepção das pessoas em situação de rua sobre as barreiras encontradas para garantia do acesso aos serviços de saúde. MÉTODO: pesquisa de natureza qualitativa, descritiva, realizada em um Centro de Referência Especializado de Assistência Social (CREAS) e em uma casa de passagem do município da região norte do estado de Mato Grosso do Sul. Os participantes foram 11 indivíduos em situação de rua. A coleta foi feita por meio de entrevistas utilizando o instrumento semiestruturado, analisadas por meio da análise temática. RESULTADOS: pode-se descrever dois momentos: "o viver na rua" e "o acesso à saúde". No processo de viver na rua, muitos relataram ter se acostumado com a situação de rua. O acesso aos serviços de saúde se deu em pronto-atendimentos devido a situações emergenciais. Experiências positivas e negativas foram relatadas. CONCLUSÃO: acredita-se que, ao se compreender as peculiaridades dessa população e suas demandas, uma assistência de melhor qualidade pode ser oferecida.
OBJECTIVE: to identify the perception of homeless people about the barriers to guarantee access to health services. METHOD: qualitative, descriptive research carried out in a Specialized Reference Center for Social Care (CREAS) and a halfway house of a municipality in the northern region of the state of Mato Grosso do Sul. The participants were 11 homeless individuals. Data were collected through semi-structured interviews and analyzed through thematic analysis. RESULTS: two moments were described: "living on the street" and "access to health". In the process of living on the street, many people reported having become accustomed to the homeless situation. Access to health care occurred in emergency services due to situations of emergency. Positive and negative experiences were reported. CONCLUSION: it is believed that, by understanding the peculiarities of this population and its demands, better quality care can be offered.
OBJETIVO: identificar la percepcíon de las pensonas que viven en la calle sobre las adversidades encontradas para garantizar un acceso a los servicios de salud. METODO: investigación de naturaleza cualitativa, descritiva, realizada en el Centro de Referencia Especializado en Asistencia Social (CREAS) y una estancia de um município en la regíon norte del Estado de Mato Grosso del Sur. Los participantes fueron 11 personas que vivian en la calle. La colecta de datos fue hecha por medio de entrevistas utilizando un instrumento semiestructurado, y por medio de un análisis temático. RESULTADOS: se puede describir dos situciónes: "el vivir en la calle" y "el acceso a la salud". Em la situacion de vivir em la calle muchos testimoniaron que tuvieron que adaptarse a sus condiciones. El acceso a los servicios de salud fue se dio en atencion inmediata a situaciones de emergencia. Las experiencias positivas y negativas fuero reportadas. CONCLUSIÓN: se cree que, al comprenderse las peculiaridades de esa poblacíon y sus demandas, una asistencia de mejor calidad puede ser ofrecida.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Percepção , Encaminhamento e Consulta , Sistema Único de Saúde , Pessoas Mal Alojadas , Casas para Recuperação , Serviços de Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
A failure to maintain improvement achieved during acute treatment, followed by a "revolving door syndrome," is a common phenomenon in eating disorders (EDs). As a result, many patients develop a chronic course that is difficult to treat. To target these difficulties, we established a novel rehabilitation treatment model in Israel for patients with severe and enduring EDs, based on the "recovery theory" in mental health treatment. This paper describes the process of conceiving this model and specifies the components of this rehabilitation house, "Zeida Laderech" (Provisions for the Journey), that aims to provide a home-like environment, while assisting in developing a healthy and balanced lifestyle. Finally, the model is discussed in light of other residential programs established in the world. With the hope to improve the overall prognosis of individuals with EDs, it is suggested that the similar programs and ongoing innovation will continue to emerge internationally.
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Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Casas para Recuperação , Tratamento Domiciliar/métodos , Adulto , Humanos , Israel , Adulto JovemRESUMO
Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aORâ¯=â¯3.98, pâ¯<â¯0.001) and drug abstinence (aORâ¯=â¯3.19, pâ¯<â¯0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aORâ¯=â¯2.92, pâ¯=â¯0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30â¯days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.
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Casas para Recuperação , Habitação , Avaliação de Processos e Resultados em Cuidados de Saúde , Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Feminino , Seguimentos , Casas para Recuperação/estatística & dados numéricos , Habitação/estatística & dados numéricos , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Análise Multinível , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Tratamento Domiciliar/estatística & dados numéricosRESUMO
People who use illicit drugs face significant physical risks in the acquisition, use, and aftermath of their use. This is particularly the case among those who use heroin in view of recent spikes in heroin-associated overdoses, injuries, and deaths. Using a restrictive deterrence framework, we identify the risks that women associate with chronic heroin use and the ways they seek to manage those risks. We also examine psychological and physiological disinhibitors that contribute to women reducing use of risk reduction strategies. We find from the narratives that nearly all of the women initially engaged in specific strategies to manage risk; however, as they continued using the drug, they began to abandon even the simplest of measures. Our findings shed light on the limitations of harm reduction strategies and inform the theoretical tradition of restrictive deterrence and the importance of disinhibitors.
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Redução do Dano , Dependência de Heroína , Comportamento de Redução do Risco , Assunção de Riscos , Adulto , Feminino , Casas para Recuperação , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Adulto JovemRESUMO
Halfway houses are a form of community supervision and correctional programming that have become a staple intervention in recent years. Despite the ingrained belief in their benefits with respect to successful reintegration, this assumption may not be justified based on the existing literature. The current study provides a systematic review and meta-analysis of nine studies examining the effects of halfway houses on recidivism. Overall, the findings suggest that halfway houses are an effective correctional strategy for successful reentry (log odds ratio [LOR] = 0.236, z = 9.27, p < .001). Further work is needed to determine best practices for programming and meeting the needs of different participants.
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Estudos de Avaliação como Assunto , Casas para Recuperação , Reincidência/prevenção & controle , Adulto , Criminosos/estatística & dados numéricos , Humanos , Ajustamento Social , Meio Social , Estados UnidosRESUMO
INTRODUCTION: Hospitals are dealing with patients who may have clinical discharge but cannot return to their home due to non-medical issues. MATERIAL AND METHODS: Cross-sectional analysis of all the cases referred to the Integrated Care Network during the year 2016. Evaluation of waiting times, typology, reason for referral and clinical parameters. IBM SPSS 24.0 software was used for all statisticalanalyses. RESULTS: In the evaluated period, 2294 patients were discharged from our department. Of these, 55 were referred to Integrated Care Network. The mean length of hospitalization of the patients referred to the network was 20.6 ± 11.4 days, and the mean overall length of hospital stay in the period analyzed was 4.8 ± 0.9 days. The mean time between hospitalization and referral for continuing care was 10.7 ± 7.2 days. The time between referral and discharge of the hospital was 10.0 ± 8.7 days. Thirty-nine (70.9%) patients were hospitalized for oncological diseases. The most common referral was to Palliative Care units (n = 16; 29.1%). Patients referred to Palliative Care units showed the largest waiting times between the referral for the network and the hospital discharge, 12.2 ± 10.51 days. We observed 289 hospitalization days with patients who had no need of specialized urological care. DISCUSSION: In order to reduce time between referral to the network and hospital discharge, there is a need for enhanced cooperation and coordination among doctors, nurses and social workers. CONCLUSION: Early identification by physicians and nurses of patients who will require care after discharge will provide a better response from social workers and increased hospital performance.
Introdução: Os hospitais deparam-se cada vez mais com doentes que, tendo alta clínica, não têm condições de ordem não clínica para regressar imediatamente ao domicílio. Material e Métodos: Estudo transversal dos casos referenciados para a Rede Nacional de Cuidados Continuados Integrados durante o ano de 2016 no nosso Serviço de Urologia. Foram avaliados os tempos de espera, tipologia, motivo de referenciação e os parâmetros clínicos. Análise estatística realizada com recurso ao software IBM SPSS 24.0. Resultados: No período analisado, 2294 pacientes tiveram alta hospitalar no nosso serviço. Destes, 55 foram referenciados para a Rede Nacional de Cuidados Continuados Integrados. O tempo médio de internamento dos pacientes referenciados foi de 20,6 ± 11,4 dias enquanto o tempo médio global de internamento foi de 4,8 ± 0,9 dias. O tempo médio entre o internamento e a referenciação para a Rede Nacional de Cuidados Continuados Integrados foi de 10,7 ± 7,2 dias. O tempo entre a referenciação e a alta hospitalar foi de 10,0 ± 8,7 dias. Trinta e nove (70,9%) pacientes foram internados por patologias oncológicas. A referenciação mais frequente foi para unidades de cuidados paliativos (n = 16; 29,1%). Os pacientes referenciados para cuidados paliativos foram os que apresentaram os maiores tempos de espera entre a referenciação e a alta hospitalar efetiva, 12,2 ± 10,51 dias. Foram despendidos 289 dias de hospitalização com pacientes que não precisavam de cuidados urológicos especializados. Discussão: Para que o tempo entre a referenciação para a Rede Nacional de Cuidados Continuados Integrados e a alta hospitalar sejam diminuídos, é necessário que haja uma otimização da cooperação e coordenação entre médicos, enfermeiros e assistentes sociais. Conclusão: A identificação precoce dos doentes que necessitarão de apoio após a alta clínica permitirá uma resposta mais atempada por parte dos assistentes sociais e uma consequente melhoria do desempenho dos serviços hospitalares e satisfação dos doentes.