Reducing tobacco use in substance use treatment: The California tobacco free initiative.

BACKGROUND: People in substance use disorder (SUD) treatment have a smoking prevalence that is five times higher than the national average. California funded the Tobacco Free for Recovery Initiative, designed to support programs in implementing tobacco-free grounds and increasing smoking cessation services. In the first cohort of the initiative (2018-2020) client smoking prevalence decreased from 54.2% to 26.6%. The current study examined whether similar findings would be replicated with a later cohort of programs (2020-2022). METHOD: Cross-sectional survey data were collected from clients in 11 residential SUD treatment programs at baseline (n = 185) and at post intervention (n = 227). Multivariate logistic regression assessed change over time in smoking prevalence, tobacco use behaviors, and receipt of cessation services across the two timepoints. RESULTS: Client smoking prevalence decreased from 60.3 % to 40.5 % (Adjusted Odds Ratio [AOR] = 0.46, 95 % CI = 0.27, 0.78; p = 0.004). Current smokers and those who quit while in treatment reported an increase in nicotine replacement therapy (NRT)/pharmacotherapy from baseline to post intervention (31.9 % vs 45.6 %; AOR = 2.22, 95 % CI = 1.08, 4.58; p = 0.031). CONCLUSIONS: Like the first cohort, the Tobacco Free for Recovery initiative was associated with decreased client smoking prevalence and an increase in NRT/pharmacotherapy. These findings strengthen the evidence that similar initiatives may be effective in reducing smoking prevalence among people in SUD treatment.

Associations between smoking and pain in early recovery in residential substance use treatment-seekers.

INTRODUCTION: A growing literature indicates bidirectional associations between pain and tobacco use. Cigarette smokers are at increased risk for chronic pain, and observational and experimental studies indicate that pain increases motivation to smoke. Tobacco use disorder frequently co-occurs with other substance use disorders, which are also associated with chronic pain vulnerability. Despite evidence that pain significantly predicts smoking and relapse, associations between smoking history/trajectory and changes in pain over the course of treatment have not been characterized. The objective of the study was to determine the association between in-treatment smoking trajectory, pack-years (i.e., number of cigarette packs smoked per day multiplied by smoking duration), pain-related interference in daily activities, and pain intensity over the course of residential treatment. METHODS: In this study, 280 adult smokers in a residential SUD treatment center in North Central Florida completed questionnaires assessing cigarette use, pain intensity, and pain interference at treatment entry and discharge (Mean = 80.3 days, SD = 25.6). Most participants were diagnosed with alcohol use disorder (66.1 %). Opioid (27.9 %) and cannabis use disorders (29.6 %) were also common. Participants were grouped by whether their smoking increased (n = 36), decreased (n = 46), or stayed the same (n = 133) from entry to discharge. RESULTS: Analyses indicated a positive association between pack-years and pain intensity at both baseline (r = 0.185, p = 0.018) and discharge (r = 0.184, p = 0.019). Smoking trajectory was associated with pack-years, with those decreasing smoking having greater pack-years than those sustaining or increasing use [F(2,136) = 8.62, p < 0.01, η2p = 0.114]. Mixed general linear models indicated pain intensity [F(1,274) = 44.15, p < 0.0001, η2p = 0.138] and interference in day-to-day activities [F(1,276) = 31.79, p < 0.0001, η2p = 0.103] decreased significantly over time. However, there was no main effect of smoking trajectory on pain intensity [F(2,212) = 2.051, p = 0.131, η2p = 0.019] or of smoking trajectory by time interaction [F(2, 212) = 1.228, p = 0.295, η2p = 0.011]. CONCLUSIONS: Overall, findings provide evidence that smoking behavior influences pain within the context of residential substance use treatment. Given that pain is associated with urge to use substances and risk of return to use, more consistent and rigorous assessment of pain and proactive pain management is likely to enhance substance use treatment outcomes among people who smoke.

Residential Treatment Exclusively for Tobacco Use Disorder: A Narrative Review.

INTRODUCTION: Tobacco use disorder is a major public health issue, and novel smoking cessation approaches are urgently needed. Residential treatment programs have been suggested as a potentially effective treatment for tobacco use disorder. However, there is limited literature on residential treatment programs for patients who are exclusively dependent on nicotine. AIM: The aim of this study is to review the literature on residential treatment programs for patients admitted exclusively for tobacco use disorder. METHODS: A literature search was conducted in PubMed with the aim of identifying relevant articles on residential treatment exclusively for tobacco use disorder from inception until February 2023. References in retrieved articles were screened for additional relevant articles. RESULTS: Fourteen studies on residential treatment programs for tobacco use disorder were identified. The duration of the residential cessation programs ranged from 3 days to 3 weeks. Individualized or group cognitive behavioral therapy and tailored pharmacotherapy were the key components of the programs. Eligibility criteria for the programs included moderate to severe tobacco use disorder as measured by Fagerström or Diagnostic and Statistical Manual of Mental Disorders (DSM), consistent relapses, smoking-related comorbidities (eg, cardiovascular or pulmonary diseases), and daily use of (smokeless) tobacco. The 6- and 12-month 7-day point prevalence rate ranged from 58% to 26%, whereas the 6- and 12-month continuous abstinence rate ranged from 52% to 29%. CONCLUSIONS: Based on the literature we reviewed, residential smoking cessation programs targeted exclusively at individuals with tobacco use disorder have shown effectiveness, particularly for those who are highly dependent on tobacco and have a history of relapse. However, more research is needed to further explore the effectiveness of these programs and to determine the optimal program components and duration.

The health of people attending residential treatment for alcohol and other drug use: Prevalence of and risks for major lifestyle diseases.

INTRODUCTION: Cardiovascular disease and cancers are the leading cause of mortality amongst people accessing treatment for alcohol and other drug use. The current study aimed to examine risk factors for chronic disease amongst people attending residential alcohol and other drug treatment services. METHODS: Participants (N = 325) were attending residential alcohol and other drug treatment services across Australia. Diabetes and cardiovascular disease risk scores were calculated using established risk estimation algorithms. Differences in existing health conditions, risk factors for chronic diseases and risk algorithms were calculated for males and females. RESULTS: In addition to alcohol and other drug use (including tobacco use), 95% of the sample had at least one other risk factor for chronic disease. Of participants not already diagnosed, 36% were at a high risk of developing type 2 diabetes and 11% had a high risk of developing cardiovascular disease. The heart age of participants was 11 years older than actual age (Mage = 40.63, Mheart age = 52.41). Males had a higher cardiovascular disease risk than females. DISCUSSION AND CONCLUSIONS: A large proportion of people accessing residential alcohol and other drug treatment were at risk of chronic disease. Future research is needed that uses objective indicators of physical health. Such research will help to develop our understanding of prevention and intervention initiatives that could be adopted by treatment providers to improve the physical health of their consumers.

Reliability of online self-report versions of the Australian Treatment Outcome Profile (ATOP) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) among people in residential treatment for substance use problems.

BACKGROUND: Online self-report measures are resource-efficient and widely used for monitoring substance use, yet few studies have assessed their reliability. This study assessed the reliability of online self-report versions of the Australian Treatment Outcomes Profile (ATOP) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) among people seeking treatment for substance use problems. PROCEDURES: One-hundred and five clients entering residential treatment for substance use problems (Mage = 33.34, 65% male) were recruited from two facilities in Queensland, Australia. Using a repeated-measures design, we compared online self-report with the original interview versions of the ASSIST, which measured (i) lifetime substance use and (ii) past 3-month substance-use and related harms, and the ATOP, which measured (i) past month frequency of substance use and (ii) the typical quantity used per day. Assessments were administered 1-7 days apart. FINDINGS: The ATOP demonstrated moderate-excellent inter-rater reliability for the past month use (yes/no) for all substance types, but had poor reliability for alcohol and cannabis. ATOP reliability was high-excellent for the total number of days used in the past month for all substances. The ASSIST demonstrated moderate-excellent inter-rater reliability for substance-use and related harms for all substances except tobacco, however was poor for lifetime use for most substances due to greater reporting in the interview assessment. CONCLUSIONS: Reliable responding was observed for the frequency of substance use in the past month on the ATOP, and past 3-month substance-use and related harms on the ASSIST. These findings support use of online-self report measures a resource-efficient method to monitor substance use. Underreporting of lifetime use was found in self-report online version of the ASSIST, highlighting the need for improved instruction or interviewer/clinician assistance for lifetime use.

Service user perceptions of smoking cessation in residential substance use treatment.

INTRODUCTION: Prevalence of tobacco smoking among adults in substance misuse treatment is much higher than the wider population, yet limited research is available, and residential treatment services have been overlooked as a potential setting for cessation interventions. Exploring the perceptions of service users about smoking cessation in residential rehabilitation is important to gain better understanding of this issue and identify ways to inform future intervention development. METHODS: Ten semi-structured interviews were conducted in the Northwest of England in 2017 with adults (7 male, 3 female) who were currently or had previously been in residential treatment for substance misuse. Five participants were current smokers, three had never smoked, and two were former smokers. Participants were asked about their smoking behaviours, factors relating to smoking and smoking cessation and the relationship between smoking and substance use. All interviews were transcribed and data was analysed thematically. RESULTS: Study findings highlighted a general consensus amongst participants that residential treatment services offered an ideal opportunity for cessation but there were concerns that doing so might jeopardise recovery. Smoking in substance use treatment services is still the norm and factors such as perceived social and psychological benefits, normative behaviours and lack of perceived risk or prioritisation pose challenges for implementing smoking cessation within this setting, although facilitators such as motivation to change and appropriateness of the setting were also identified. CONCLUSIONS: This study suggests that service users perceive residential treatment services as suitable environments to introduce smoking cessation. To address the needs of adults who smoke and are in recovery from substance use, further research and cooperation from treatment organisations is needed to integrate substance misuse and smoking cessation services. More conclusive evidence on the effectiveness of tackling both issues at the same time is also required.

Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California.

BACKGROUND: Across the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs. METHODS: We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. FINDINGS: Themes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors' strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services. CONCLUSION: To support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.

Diagnosing obstructive sleep apnea in a residential treatment program for veterans with substance use disorder and PTSD.

BACKGROUND: Obstructive sleep apnea (OSA) is often comorbid with both substance use disorders (SUD) and posttraumatic stress disorder (PTSD), yet frequently goes undiagnosed and untreated. We present data on the feasibility and acceptability of objective OSA diagnosis procedures, findings on OSA prevalence, and the relationship between OSA and baseline SUD/PTSD symptoms among veterans in residential treatment for comorbid PTSD/SUD. METHODS: Participants were 47 veterans admitted to residential PTSD/SUD treatment. Participants completed questionnaires assessing PTSD and sleep symptoms, and filled out a sleep diary for seven days. Apnea-hypopnea index (AHI) was recorded using the overnight Home Sleep Apnea test (HSAT; OSA was diagnosed with AHI ≥ 5). RESULTS: Objective OSA diagnostic testing was successfully completed in 95.7% of participants. Of the 45 veterans who went through HSAT, 46.7% had no OSA, 35.6% received a new OSA diagnosis, and 8.9% were previously diagnosed with OSA and were using positive airway pressure treatment (PAP); an additional 8.9% were previously diagnosed with OSA, reconfirmed with the HSAT, but were not using PAP. One hundred percent of respondents during follow-up deemed the testing protocol's usefulness as "Good" or "Excellent." CONCLUSION: OSA diagnostic testing on the residential unit was feasible and acceptable by participants and was effective in diagnosing OSA. OSA testing should be considered for everyone entering a SUD and PTSD residential unit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Crianças com condições crônicas complexas de saúde moradoras de uma pediatria: por que é tão difícil desospitalizar? / Children with complex chronic health conditions living in a pediatric ward: why is it so difficult to dehospitalize?

O estudo pretende promover uma discussão sobre a desospitalização de crianças com condições crônicas complexas de saúde que vivem uma internação prolongada e poderiam se beneficiar com o tratamento em casa. Almeja-se também, dar maior visibilidade à situação das crianças que aguardam a efetivação da transição do cuidado seguro para o ambiente familiar. Tem-se como principal objetivo conhecer e analisar a situação de hospitalização por tempo prolongado e a proposta de desospitalização do Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) vinculado a Universidade Federal do Rio de Janeiro, visando a contribuir com propostas de adequação desse processo. O trabalho consiste num estudo exploratório de cunho qualitativo, que busca responder às seguintes questões: estratégias utilizadas pela equipe de saúde e pela gestão do hospital para propiciar a redução do tempo da internação e viabilizar a desospitalização; organização do processo de desospitalização nessa instituição de saúde; fatores que interferem direta e indiretamente no processo de desospitalização e impedem a ida dessas crianças para casa; os obstáculos existentes para as famílias receberem a criança, como elas se organizam e suas percepções sobre sua situação; e o que poderia ser feito para melhorar esse processo. Entre os meses de dezembro de 2021 e janeiro de 2022 foram entrevistados 31 profissionais de saúde, 2 gestores e 5 familiares. O estudo foi aprovado pelo comitê de ética em pesquisa do IPPMG. Os resultados da pesquisa mostraram que o conceito de desospitalização está claro para a maioria dos profissionais e para a gestão, no entanto, as ações são ainda incipientes. São necessárias condições externas (familiares, de acesso a insumos, equipamentos, medicamentos, de apoio dos serviços locais de saúde, da comunidade, das condições das moradias) e internas (uma liderança do processo e uma equipe multiprofissional em dedicação de tempo necessário) para promover a desospitalização prevista pelo Ministério da Saúde. Observa-se a falta de prioridade por parte da gestão de se institucionalizar o processo de desospitalização na unidade sob a escusa de que faltam pessoal e condições objetivas. Nenhuma das crianças citadas realmente conseguiu ainda ir para casa com o devido acompanhamento. Em geral, os familiares têm muitas dúvidas e passam por muitos caminhos tortuosos e sofrimentos para promover o retorno da criança ao lar, entretanto, querem os filhos de volta em casa. Há obstáculos estruturais que contradizem o que propugnam as políticas de proteção: o desamparo por parte do Estado que deixa de prover pessoal, transporte, medicamentos, insumos, alimentação especial, equipamentos e serviços de atendimento domiciliar, além dos longos processos judiciais para a aquisição destes itens. A desospitalização traz um benefício inequívoco para a criança, colocando-a de forma assistida no ambiente familiar, o que significa teoricamente mais qualidade de vida para ela e seus familiares e, para a unidade hospitalar, a redução de custos de internação, diminuição de gastos e maior rotatividade de pacientes, liberando vagas para outras crianças No entanto, tudo isso só pode ser devidamente tratado e equacionado quando há um programa que focalize todas as dimensões e interfaces de um processo de desospitalização adequado.

The study aims to promote a discussion about the dehospitalization of children with complex chronic health conditions who experience a prolonged hospitalization and could benefit from treatment at home. It is also intended to give greater visibility to the situation of children who are waiting for the effective transition from safe care to the family environment. The main objective is to know and analyze the situation of hospitalization for a long time and the proposal of dehospitalization of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) linked to the Federal University of Rio de Janeiro (UFRJ), aiming to contribute with proposals for the adequacy of this process. The work consists of an exploratory study of a qualitative nature, which seeks to answer the following questions: strategies used by the health team and hospital management to reduce the length of hospital stay and enable dehospitalization; organization of the dehospitalization process in this health institution; factors that interfere directly and indirectly in the dehospitalization process and prevent these children from going home; the existing obstacles for families to receive the child, how they organize themselves and their perceptions of their situation; and what could be done to improve this process. Between December 2021 and January 2022, 31 health professionals, 2 managers and 5 family members were interviewed. The study was approved by the Research Ethics Committee (CEP/IPPMG). The survey results showed that the concept of dehospitalization is clear to most professionals and management, however, the actions are still incipient. External conditions (family members, access to supplies, equipment, medicines, support from local health services, the community, housing conditions) and internal conditions (a process leader and a multiprofessional team dedicating the necessary time) are needed to promote the dehospitalization provided by the Ministry of Health. There is a lack of priority on the part of the management to institutionalize the process of dehospitalization in the unit under the excuse that there is a lack of personnel and objective conditions. None of the children mentioned actually managed to go home with the proper follow-up. In general, family members have many doubts and go through many tortuous paths and suffering to promote the child's return home, however, they want their children back home. There are structural obstacles that contradict what protection policies advocate: the helplessness on the part of the State that fails to provide professionals, transport, medicines, supplies, special food, equipment and home care services, in addition to the long legal processes for the acquisition of these items. Dehospitalization brings an unequivocal benefit to the child, placing him in an assisted way in the family environment, which theoretically means better quality of life for him and his family and for the hospital unit, the reduction of hospitalization costs, reduction of expenses and greater patient turnover, freeing up spaces for other children. However, all of this can only be properly addressed and equated when there is a program that focuses on all dimensions and interfaces of an adequate dehospitalization process.

COVID-19 vaccine trust among clients in a sample of California residential substance use treatment programs.

BACKGROUND: Individuals with a substance use disorder (SUD) are at a significantly higher risk for coronavirus disease-19 (COVID-19) and have higher rates of COVID-19 related hospitalization and death than those without SUD. This study assessed COVID-19 vaccine trust, transmission awareness, risk and protective behaviors, and effects of COVID-19 on mental health and smoking among a sample of clients in California residential SUD treatment programs and identified factors associated with vaccine trust. METHODS: A multi-site sample of SUD treatment clients (n = 265) completed a cross-sectional survey. Multivariable logistic regression was used to identify factors associated with COVID-19 vaccine trust. RESULTS: Participants were predominantly male (82.3 %) and racially/ethnically diverse (33.3 % Non-Hispanic White). Most participants were aware of COVID-19 modes of transmission, however, only 39.5 % trusted a COVID-19 vaccine would be safe and effective. Factors independently associated with trust in a COVID-19 vaccine included age (AOR = 1.03, 95 % CI = 1.02, 1.05, p = 0.0001) and wearing a mask all the time (AOR = 2.48, 95 % CI = 1.86, 3.31, p = 0.0001). African Americans were less likely than White participants to trust that a COVID-19 vaccine is safe and effective (AOR = 0.41, 95 % CI = 0.23, 0.70, p = 0.001). CONCLUSION: SUD treatment clients were aware of COVID-19 modes of transmission; however, fewer than half trusted that a COVID-19 vaccine would be safe and effective. Health communication about COVID-19 for people with SUD should use a multipronged approach to address COVID-19 vaccine mistrust and transmission risk behaviors.

Healthy recovery: A stepped wedge cluster randomised controlled trial of a healthy lifestyle intervention for people attending residential alcohol and other drug treatment.

BACKGROUND: Unhealthy lifestyle behaviours contribute to the poor health of people attending alcohol and other drug (AOD) treatment. Healthy Recovery is an 8-session group-based intervention that targets smoking, diet and physical inactivity as part of an integrated healthy lifestyle approach. The current study aimed to examine the effectiveness of Healthy Recovery when delivered within residential AOD treatment settings. METHODS: The study design was a stepped-wedge cluster randomised trial. Participants were 151 current smokers attending residential AOD programs provided by the Australian Salvation Army (n = 71, Control condition; n = 80, Intervention condition). The primary outcome was number of cigarettes smoked per day. Secondary outcomes examined other smoking behaviours (7-day point prevalence, use of nicotine replacement therapy [NRT]), diet (servings and variety of fruit and vegetables), and physical activity. RESULTS: The mean number of cigarettes smoked per day was significantly lower in the Intervention condition at 2-, 5-, and 8-month follow-up. There were also significant differences in favour of the Intervention condition for number of quit attempts, use of NRT and variety of fruit. There were no other significant differences for other dietary or physical activity variables. CONCLUSIONS: Healthy Recovery had a positive impact on smoking behaviours. Future research should consider strategies to further promote smoking cessation (e.g. promoting longer-term use of NRT), as well as addressing physical activity and dietary behaviours. The introduction of broader organisational approaches (e.g. smoke free policies, organised group exercise and cooking activities) might help to enhance healthy lifestyle approaches within AOD treatment settings.

Catatonia in a 10-year-old boy with early childhood neglect and disruptive behaviours in psychiatric residential treatment.

Catatonia is a rare medical condition that can be fatal in paediatric patients if left untreated. It is often misdiagnosed or underdiagnosed. There are no published cases of catatonia in traumatised children living in long-term psychiatric care. However, there is some evidence that childhood maltreatment in its variant forms may be a risk for the development of catatonia in children and adolescents. In this case, a 10-year-old boy with intrauterine exposure to alcohol and multiple drugs and early childhood deprivation, developed neuroleptic-induced catatonia in an intensive psychiatric residential treatment centre approximately 24 hours after receiving a first-time intramuscular injection of haloperidol 5 mg for acute agitation. He had no known predisposing factors for catatonia such as psychosis, autism, neurological or general medical problems. This 10-year-old child's early childhood trauma should be considered as a predisposing factor for catatonia.

Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy ('START-Study'): study protocol of a randomized controlled trial.

BACKGROUND: In Germany, evidence-based outpatient smoking cessation therapies are widely available. Long-term abstinence rates, however, are limited. Studies suggest that short-term residential therapy enables a higher level of environmental control, more intense contact and greater support among patients and from therapists, which could result in higher abstinence rates. The aim of the current START-study is to investigate the long-term efficacy of a short-term residential therapy exclusively for smoking cessation, conducted by a mobile team of expert therapists. METHODS: A randomized controlled trial (RCT) is conducted to examine the efficacy of residential behavior therapeutic smoking cessation therapy compared to standard outpatient behavior therapeutic smoking cessation group therapy. Adult smokers consuming 10 or more cigarettes per day, who are willing to stop smoking, are randomized in a ratio of 1:1 between therapy groups. The primary endpoint is sustained abstinence for 6-month and 12-month periods. Secondary endpoints include smoking status after therapy, 7-day point abstinence after the 6-month and 12-month follow-ups, level of physical dependence, cost-effectiveness, use of nicotine replacement products, health-related quality of life, self-efficacy expectation for tobacco abstinence, motivational and volitional determinants of behavior change, self-reported depressive symptom severity, adverse events and possible side effects. Assessments will take place at baseline, post-therapy, and at 6-month and 12-month intervals after smoking cessation. DISCUSSION: There is a high demand for long-term effective smoking cessation therapies. This study represents the first prospective RCT to examine the long-term efficacy of a residential smoking cessation therapy program compared to standard outpatient group therapy as an active control condition. The residential therapeutic concept may serve as a new model to substantially enhance future cessation therapies and improve the understanding of therapeutic impact factors on tobacco abstinence. Utilizing a mobile team, the model could be applied efficiently to medical centers that do not have permanent and trained personnel for smoking cessation at their disposal. TRIAL REGISTRATION: German Register for Clinical Trials (Deutsches Register für Klinische Studien), DRKS00013466. Retrospectively registered on 1 April 2019. https://www.drks.de/drks_web/navigate.do?navigationId=start.

Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial).

BACKGROUND: Eating problems frequently affect quality of life and physical, psychological and social function in patients treated for head and neck cancer (HNC). Residential rehabilitation programmes may ameliorate these adverse effects but are not indicated for all individuals. Systematic assessment of rehabilitation needs may optimise the use of resources while ensuring referral to rehabilitation for those in need. Yet, evidence lacks on which nutrition screening and assessment tools to use. The trial objectives are: 1) To test the effect of a multidisciplinary residential nutritional rehabilitation programme compared to standard care on the primary outcome body weight and secondary outcomes health-related quality of life, physical function and symptoms of anxiety and depression in patients curatively treated for HNC and 2) To test for correlations between participants' development in outcome scores during their participation in the programme and their baseline scores in Nutritional Risk Screening 2002 (NRS 2002), the Scored Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and M. D. Anderson Dysphagia Inventory (MDADI) and to assess sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores. METHODS: In a randomised controlled trial, 72 patients treated for HNC recruited through a nationwide survey will be randomised to a multidisciplinary residential nutritional rehabilitation programme or to a wait-list control group. Data are collected at baseline, three and six months. Primary outcome is change in body weight, and secondary outcomes include changes in quality of life, physical function and symptoms of anxiety and depression. Potential correlations between intervention effect and baseline scores in NRS 2002, PG-SGA-SF and MDADI will be tested, and sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores will be assessed. DISCUSSION: This is the first randomised controlled trial to test the effect of a multidisciplinary residential nutritional rehabilitation programme in patients treated for HNC. Recruitment through a nationwide survey gives a unique possibility to describe the trial population and to identify potential selection bias. As the trial will explore the potential of different nutrition screening and assessment tools in the assessment of rehabilitation needs in patients treated for HNC, the trial will create knowledge about how selection and prioritisation of nutritional rehabilitation aimed at patients treated for HNC should be offered. The results may contribute to a better organisation and use of existing resources in benefit of patients treated for HNC. TRIAL REGISTRATION: The trial is registered by The Danish Data Protection Agency (registration 2012-58-0018, approval number 18/14847) and the Regional Committees on Health Research Ethics for Southern Denmark (journal number 20182000-165). ClinicalTrials.gov Identifier: NCT03909256. Registered April 9, 2019.

Qualidade de vida de hipertensos acompanhados por uma equipe da estratégia saúde da família / Quality of life of hypertensive patients accompanied by a family health strategy team

Objetivo: Avaliar a qualidade de vida de pacientes hipertensos acompanhados por uma equipe da Estratégia Saúde da Família. Metodologia: Estudo descritivo, quantitativo realizado com 150 hipertensos de uma Unidade Básica de Saúde de Caxias-MA. Utilizou-se dois instrumentos: um questionário estruturado e o instrumento Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36) de qualidade de vida. Os dados obtidos, foram analisados no software Statistical Package for the Social Sciences. O estudo foi aprovado pelo Comitê de Ética com número 1.872.621. Resultados: 77,3% eram mulheres, com idade de 60 anos ou mais (74,7%), casadas (37,4%), da cor parda (42,0%), com renda média igual a 1 salário mínimo (60,0%) e ensino fundamental incompleto (33,5%). 79,3% não consomem bebidas alcoólicas, 48,0% não fumam, 54,0% praticam atividade física e 50,0% não seguiam dieta. 36,0% foram diagnosticados no período entre 6 a 10 anos, 92,0% faziam tratamento, 52,2% do tipo medicamentoso exclusivo. Os sujeitos apresentaram maiores escores de qualidade de vida para os domínios Aspectos Sociais, Saúde Mental, Capacidade Funcional e Aspectos Emocionais. Conclusão: A hipertensão arterial provoca impacto negativo na qualidade de vida, sendo importante tratá-la e colocar em prática um estilo de vida saudável, evitando assim o comprometimento da mesma.

Objective: To evaluate the quality of life of hypertensive patients accompanied by a Family Health Strategy team. Methodology: it is a descriptive, quantitative study carried out on 150 hypertensive patients from a Basic Health Unit of Caxias - MA. Two instruments were used: structured questionnaire, and the instrument Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36). The obtained data, were analyzed in the software Statistical Package for the Social Sciences. The study was approved by the Ethics Committee with number 1.872.621. Results: 77.3% were women, aged 60 years or more (74.7%), married (37.4%), brown (42.0%), with average income equal to 1 minimum wage (60.0%) and incomplete elementary school (33.5%). 79.3% do not consume alcoholic beverages, 48.0% do not smoke, 54.0% practice physical activity and 50.0% did not follow a diet. 36.0% were diagnosed in the period between 6 and 10 years, 92.0% did treatment, 52.2% of the exclusive drug type. The subjects presented higher quality of life scores for the domains Social Aspects, Mental Health, Functional Capacity and Emotional Aspects. Conclusion: Hypertension has a negative impact on quality of life, and it is important to treat it and put into practice a healthy lifestyle, thus avoiding its prejudice.

Predictors of Dropout in Disordered Gamblers in UK Residential Treatment.

Within the cohort of individuals who seek treatment for disordered gambling, over half fail to complete treatment. The current study sought to identify predictors of treatment dropout in a sample of gamblers attending a residential treatment facility for disordered gamblers in the UK and to report differences in voluntary and enforced dropout. Data on 658 gamblers seeking residential treatment with the Gordon Moody Association (GMA) was analysed, collected between 2000 and 2015. Measurements included demographic data, self-reported gambling behavior, (including the Problem Gambling Severity Index), mental and physical health status, and a risk assessment. Binary logistic regression models were used to examine predictors of treatment termination. Results confirm a high percentage of treatment dropout among disordered gamblers (51.3%). Significant predictors of treatment dropout included older age of the client, higher levels of education, higher levels of debt, online gambling, gambling on poker, shorter duration of treatment, higher depression, experience of previous treatment programmes and medication, and adverse childhood experiences. Within non-completers, significant predictors of enforced dropout included lifetime homelessness, less debt, sports gambling, depression and lifetime smoking. Those who were on a longer treatment programme and had previously received gambling treatment or support were less likely to be asked to leave. Clinicians working in inpatient support need to be aware of the increased psychopathogical and psychosocial problems in those who are at risk of termination and make attempts to retain them in treatment and increase patient compliance.

Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program.

BACKGROUND: Recent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu. OBJECTIVE: In the fall of 2015, a SUD treatment program at a large midwestern Veteran. Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented. PARTICIPANTS & PROCEDURES: This study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use. RESULTS: Veterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled. CONCLUSIONS: Our data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications.

Evaluating the short-term impact of a tobacco-free policy in an inpatient addiction treatment setting.

PURPOSE: Tobacco use is highly prevalent within addiction treatment settings, despite the potential benefits that cessation may provide to patients' psychosocial functioning and overall sobriety. Moreover, tobacco cessation is often insufficiently addressed in addiction treatment programs, although evidence suggests that tobacco control policies, such as access to evidence-based treatment or tobacco-free policies, may be effective. The objective of our study was to evaluate the impact of the implementation of these two tobacco control policies in an inpatient addiction treatment centre. METHODS: Using a 3-group quasi-experimental design, we examined how the implementation of the Ottawa Model for Smoking Cessation (OMSC) and a subsequent campus-wide tobacco ban influenced patients' overall smoking status, frequency, amount used per day, and quit attempts during treatment, compared to usual care. Participants (N = 397) responded to a comprehensive questionnaire upon admission and discharge from an addiction treatment program. We used generalized linear mixed modelling to measure changes over time while accounting for relevant sociodemographic covariates. RESULTS: Patients exposed to a more comprehensive tobacco control environment (i.e., the OMSC, plus complete tobacco ban) were over 80% less likely to report having used tobacco during treatment, compared to patients exposed to usual care (AOR = 0.17, 95% CI [0.05-0.63]). Receiving treatment in this setting also contributed to a 35% decrease in the average number of days patients used tobacco compared to usual care (AOR = 0.65, 95% CI [0.53-0.98]), and a 27% decrease in the average number of cigarettes used per day compared to usual care (AOR = 0.73, 95% CI [0.58-0.93]). CONCLUSION: Comprehensive tobacco control policy interventions within inpatient addiction treatment hospitals promote tobacco cessation. Such interventions should include a combination of evidence-based treatment for patients and environmental restrictions to discourage tobacco use. The results of our study suggest that, within inpatient addiction treatment settings, use of the OMSC in combination with a campus-wide tobacco ban may be more effective than usual care or the OMSC alone.

Residential eating disorder outcomes associated with screening positive for substance use disorder and borderline personality disorder.

OBJECTIVE: We examined whether eating disorder (ED) outcome trajectories during residential treatment differed for patients screening positive for comorbid borderline personality disorder (BPD) and/or substance use disorders (SUDs) than those who do not. METHOD: We examined data from patients in a residential ED treatment program. Patients completed validated self-report surveys to screen for SUDs and BPD on admission, and the ED Examination-Questionnaire (EDE-Q) on admission and every 2 weeks until discharge (N = 479 females). RESULTS: Fifty-four percent screened positive for at least one co-occurring condition. At admission, patients screening positive for SUD and/or BPD had significantly greater eating pathology than patients screening negative for both (t[477] = 8.23, p < .001). Patients screening positive for SUD (independent of BPD screening status) had a significantly faster rate of symptom improvement during the initial 4 weeks than patients screening positive for BPD only and those with no comorbidities. DISCUSSION: Screening positive for SUD and/or BPD was common in residential ED treatment, and associated with more severe ED symptoms. Screening positive for SUD was associated with faster ED symptom improvement than screening positive for BPD. These findings suggest that intensive ED treatment, even in the absence of intensive SUD treatment, may enhance patient outcomes for those with SUDs.

Barriers and facilitators to implementing playlists as a novel personalised music intervention in public healthcare settings in New South Wales, Australia.

Listening to personalised music is a simple and low-cost intervention with expected therapeutic benefits, including reduced agitation, stress responses and anxiety. While there is growing evidence for the use of personalised music as a therapeutic intervention, there has been little investigation into processes and strategies that would support the implementation of playlists. The aim of this study was to identify the perceived barriers and facilitators to implementing personalised playlists on a large scale in public healthcare settings. A mixed-methods approach was used to evaluate the feasibility of the intervention in 21 different acute, sub-acute and primary healthcare settings in New South Wales (NSW), Australia, between June 2016 and June 2017. Data collection included 153 survey responses (staff n=35, patients n=49 and family members n=69), six focus groups (staff n=21) and an analysis of 37 documents. Data sources were systematically categorised using a Policy Analysis Framework. Facilitators included the use of implementation leads and volunteers, a high level of staff engagement and the integration of music selection and playlist development into routine clinical practice. Barriers included ongoing and unexpected funding, time to prepare playlists and staff turnover. The results from this study support the feasibility and acceptability of implementing playlists in different healthcare settings.