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1.
Aust N Z J Public Health ; 43(6): 532-537, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31577862

RESUMO

OBJECTIVE: This paper provides a case study of the responses to alcohol of an Aboriginal Community Controlled Health Service (The Service), and investigates the implementation of comprehensive primary health care and how it challenges the logic of colonial approaches. METHODS: Data were drawn from a larger comprehensive primary health care study. Data on actions on alcohol were collected from: a) six-monthly service reports of activities; b) 29 interviews with staff and board members; c) six interviews with advocacy partners; and d) community assessment workshops with 13 service users. RESULTS: The Service engaged in rehabilitative, curative, preventive and promotive work targeting alcohol, including advocacy and collaborative action on social determinants of health. It challenged other government approaches by increasing Aboriginal people's control, providing culturally safe services, addressing racism, and advocating to government and industry. CONCLUSIONS: This case study provides an example of implementation of the full continuum of comprehensive primary health care activities. It shows how community control can challenge colonialism and ongoing power imbalances to promote evidence-based policy and practice that support self-determination as a positive determinant for health. Implications for public health: Aboriginal Community Controlled Health Services are a good model for comprehensive primary health care approaches to alcohol control.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde do Indígena/organização & administração , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Álcool/etnologia , Colonialismo , Humanos , Grupo com Ancestrais Oceânicos , Racismo , Determinantes Sociais da Saúde
2.
Lancet Psychiatry ; 6(12): 1054-1067, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31630982

RESUMO

Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.


Assuntos
Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Programas de Rastreamento , Saúde Pública , Encaminhamento e Consulta , Comorbidade , Saúde Global , Humanos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
3.
Epidemiol Health ; 41: e2019041, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31623424

RESUMO

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits. METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model. RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate. CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Renda/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Adulto Jovem
4.
Psychiatr Danub ; 31(Suppl 3): 418-420, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488764

RESUMO

BACKGROUND: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. SUBJECTS AND METHODS: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. RESULTS: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. CONCLUSION: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.


Assuntos
Intervenção na Crise/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/provisão & distribução , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Psiquiatria/métodos , Psiquiatria/organização & administração , Transtornos Relacionados ao Uso de Álcool/terapia , Bélgica/epidemiologia , Depressão/epidemiologia , Depressão/terapia , Humanos , Estudos Retrospectivos , Ideação Suicida
5.
Psychol Addict Behav ; 33(7): 637-643, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31486660

RESUMO

Research has shown links between interpersonal conflict and problematic drinking behaviors as a way to cope. The present research examined the effects of a brief interpersonal conflict cognitive reappraisal intervention on short-term reductions in alcohol-related problems in a sample of college student drinkers. Undergraduates who were regular drinkers (N = 190) participated in a randomized control online study, completing self-reported measures of alcohol consumption and alcohol-related problems at baseline and 2 weeks later. After completing the baseline survey, participants completed a brief writing intervention during which they were asked to reflect on a recent interpersonal conflict and write about it from 1 of 3 possible perspectives, 2 of which were targeting cognitive reappraisal (i.e., a neutral, third-party perspective and the other party's perspective), their own perspective, or to reflect on their activities that day (control). Results from negative binomial regression models supported both reappraisal conditions: Compared with control, those who thought about the conflict from a neutral third-party perspective and those who thought about the conflict from the other party's perspective reported significantly fewer drinking problems at follow-up. Results from this study suggest preliminary efficacy of a single-session writing intervention aimed at reappraising interpersonal conflict. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/terapia , Transtornos Relacionados ao Uso de Álcool/terapia , Relações Interpessoais , Psicoterapia Breve/métodos , Teoria da Mente , Adolescente , Adulto , Consumo de Álcool na Faculdade/psicologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
6.
BMC Public Health ; 19(1): 1010, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357967

RESUMO

BACKGROUND: Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. METHODS: A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. RESULTS: After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. CONCLUSIONS: Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.


Assuntos
Acidentes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/terapia , Comércio/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Menores de Idade/legislação & jurisprudência , Consumo de Álcool por Menores/legislação & jurisprudência , Ferimentos e Lesões/terapia , Adolescente , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Concentração Alcoólica no Sangue , Criança , Feminino , Humanos , Illinois/epidemiologia , Masculino , Menores de Idade/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
7.
Int J Behav Med ; 26(4): 401-414, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161592

RESUMO

BACKGROUND: Smartphone-based interventions are a potentially effective way to minimize alcohol-related harm in young adult, non-dependent drinkers. This pilot study is the first to evaluate the benefits and feasibility of a personalized alcohol harm-minimization intervention delivered via smartphones. METHODS: Within a single-blind, randomized controlled design, 45 young adults were randomly assigned to either the intervention app (n = 25; 18 females; Mage = 21.36 years, SDage = 4.15 years) or the control app (n = 20; 18 females; Mage = 22.75; SDage = 4.41). The two primary outcomes were frequency of risky drinking and drinking-related harms, and the secondary outcome was frequency of protective behavioral strategies (PBS) use. All outcomes were measured at baseline and immediately post-intervention. Using the Enlight framework [1], usability was evaluated via structured one-on-one phone interviews with a subgroup of six participants from the intervention group (3 females; Mage = 19.5 years, SDage = 1.64). RESULTS: There was no significant reduction in the primary outcomes from baseline to post-intervention across the groups. For the secondary outcome, the application of PBS within drinking contexts increased at follow-up for those in the intervention group but not for control participants. End-users rated the app as highly usable but had some concerns with repetition of the app-recommended strategies. CONCLUSIONS: This intervention, designed to reduce risky drinking behaviors among young adults, was rated as highly usable and was shown to increase the application of harm minimization strategies within drinking contexts. While the intervention and its delivery show promise, it did not appear to mitigate risky drinking behaviors. Implications of this research and future directions are discussed. TRIAL REGISTRATION: This trial is registered at the Australian New Zealand Clinical Trials Registry: BLINDED.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Terapia Comportamental/métodos , Smartphone , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/psicologia , Austrália , Feminino , Humanos , Masculino , Projetos Piloto , Método Simples-Cego , Adulto Jovem
8.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235608

RESUMO

Alcohol use continues to be a major concern from preadolescence through young adulthood in the United States. Results of recent neuroscience research have helped to elucidate neurobiological models of addiction, substantiated the deleterious effects of alcohol on adolescent brain development, and added additional evidence to support the call to prevent and reduce underage drinking. This technical report reviews the relevant literature and supports the accompanying policy statement in this issue of Pediatrics.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Consumo de Álcool por Menores , Adolescente , Desenvolvimento do Adolescente/efeitos dos fármacos , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Bebidas Alcoólicas/efeitos adversos , Encéfalo/efeitos dos fármacos , Humanos , Fatores de Risco , Consumo de Álcool por Menores/prevenção & controle , Consumo de Álcool por Menores/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , Estados Unidos/epidemiologia
9.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235610
10.
Eur Addict Res ; 25(5): 213-223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112984

RESUMO

BACKGROUND: Abstinence-related self-efficacy and action-oriented motivation to change addictive behaviours have been demonstrated to be important predictors of post-treatment drinking. However, there are only a few studies that assess drinking outcomes through a long-term follow-up interval. OBJECTIVES: The purpose of this longitudinal observational study is to evaluate whether self-efficacy and motivation at a 1-year follow-up mediate the relationship of self-efficacy at discharge from residential treatment with drinking outcomes at 5-year follow-up. METHOD: Simple and serial multiple mediation analyses were conducted on data collected from 263 patients (174 men, 89 women) with severe alcohol use disorder (AUD). Self-efficacy was measured at discharge and 1-year follow-up, and motivation was also measured at 1-year follow-up. Abstinence, percent days of abstinence (PDA), and drinks per drinking day (DDD) were used as drinking outcomes at 5-year follow-up. Exploring the indirect paths provided details about the interrelationship between self-efficacy and motivation. RESULTS: Self-efficacy at discharge predicted abstinence and PDA. The mediation models suggest that self-efficacy at discharge was associated with self-efficacy and motivation at 1-year follow-up, which in turn was related to better long-term drinking outcomes, in particular for abstinence and PDA at 5-year follow-up. No such effects were found for DDD. CONCLUSIONS: The results indicate that self-efficacy and motivation are interrelated in improving long-term abstinence and PDA following residential treatments and may play a substantial role in recovery from AUD.


Assuntos
Abstinência de Álcool/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/terapia , Motivação , Tratamento Domiciliar , Autoeficácia , Comportamento Aditivo/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
11.
Australas Psychiatry ; 27(4): 374-377, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107103

RESUMO

OBJECTIVES: There is emerging interest in models of care that focus on assessment and brief inpatient treatment (two to three days) including psychiatric emergency care centre units and short-stay units in Australia. We present the development of a functionally integrated Missenden Assessment Unit and six-bed short-stay unit in the new Professor Marie Bashir Centre at Royal Prince Alfred Hospital in inner-city Sydney. The focus was on collaboration between emergency, drug and alcohol and mental-health services in developing the short-stay unit and Missenden Assessment Unit with joint admission and resource use. We outline the models of care and findings from the 2016 evaluation following the initial two years of operation and consider ongoing challenges. CONCLUSION: The Missenden Assessment Unit provides an alternative point of presentation for mental-health drug and alcohol patients. The short-stay unit provides coordinated, therapeutic interventions. The Missenden Assessment Unit/short-stay unit reduced the burden of presentations to the emergency department while providing the opportunity for training and collaboration. Further refinement of the models of care should occur with policy development and via research.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Emergência Psiquiátrica/organização & administração , Unidades Hospitalares , Tempo de Internação , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Austrália , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia
12.
Arch Psychiatr Nurs ; 33(2): 189-195, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927989

RESUMO

The purpose of this study was to examine the effects of a drinking-reduction program on drinking behavior, stages of change, drinking refusal self-efficacy, and resilience in Koreans with moderate alcohol use disorder. This study used a quasi-experimental nonequivalent control design. This study was performed from March 2015 to July 2015. The drinking-reduction program was conducted once per week for 11 weeks. This program improved drinking behavior, stages of change, drinking refusal self-efficacy, and resilience in the experimental group compared to the control group (p < .05, n = 34). The drinking-reduction program can be used as a nursing intervention for people with moderate alcohol use disorder.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos Relacionados ao Uso de Álcool/terapia , Resiliência Psicológica , Autoeficácia , Adulto , Feminino , Humanos , Masculino , República da Coreia , Inquéritos e Questionários
13.
Psychol Addict Behav ; 33(2): 128-138, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30640505

RESUMO

This study tested technical and relational processes hypothesized to explain the therapeutic benefit of an efficacious brief motivational interview (BMI). A randomized controlled trial compared the efficacy of a BMI to an attention-matched control (i.e., relaxation training [REL]) for reducing heavy alcohol consumption and associated negative consequences. Participants were underage, past-month heavy drinkers recruited from community settings (N = 167; ages 17-20; 62% female; 59% White). Data were collected on session recordings, using established motivational interviewing process measures. Statistical analyses followed 3 steps. First, a latent class model determined the optimal class solution for characterizing proportion change talk means within BMI and REL. Next, the probability of proportion change talk class membership was examined as a mediator and then as a moderated mediator of BMI efficacy. The latent class model yielded a 3-class solution, including a low-increasing proportion change talk class (n = 61), a moderate-increasing proportion change talk class (n = 97), and a nonlinear proportion change talk class (n = 7). Across the outcomes examined, membership in the moderate-increasing class rather than the low-increasing class mediated BMI effects on alcohol-related consequences at 6 weeks. Mediation tests for consequences at 3 months and heavy drinking were nonsignificant. Moderated mediation results for therapist empathy and MI Spirit were nonsignificant. Findings suggest that moderate increases in prochange statements, relative to anti- or neutral-change statements, help explain BMI effects on reducing alcohol-related negative consequences soon after intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Entrevista Motivacional/métodos , Consumo de Álcool por Menores , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
14.
PLoS One ; 14(1): e0209210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30601850

RESUMO

OBJECTIVES: To estimate the impacts and social value relative to the cost of the Integrated Management of Alcohol Intervention Program in the Health Care System (i-MAP) on direct beneficiaries, using a Social Return on Investment (SROI) analysis. METHOD: A mixed-method approach was conducted among stakeholders and 113 drinkers (29 low-risk, 43 high-risk, and 41 dependent drinkers) who consecutively received i-MAP at four community hospitals in Songkhla province of Thailand. Resources for program implementation as well as drinking and a list of psychosocial outcomes, selected through stakeholder interviews, were measured among participants during and at the sixth month after participation, respectively. SROI (societal benefit-to-cost) ratio of i-MAP was estimated over a 5-year time horizon and shown in 2017 Thai baht, where US$1.00 = 33.1 baht. One-way and probabilistic sensitivity analyses of key parameters were performed among treatment subgroups. RESULTS: Baseline estimates of the annual cost and 5-year social value of i-MAP were 25.5 and 51.0 million baht, respectively, yielding an estimated SROI ratio of 2.0, with a possible range of 1.3 to 2.4. Value created by the program was mostly attributed to broader gains to society (productivity gains and averted crime costs) and drinkers. Subgroup analyses suggested that the SROI ratio for high-risk drinkers was twice that for dependent drinkers (2.8 vs. 1.5). The probabilistic sensitivity analysis showed that more than 99% of the simulated treatments for both high-risk and dependent groups yielded benefits beyond the corresponding costs. CONCLUSIONS: By considering societal perspective, the i-MAP program has demonstrated its social value is twice its investment cost and potential for the program to be implemented nationwide.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Adulto , Idoso , Transtornos Relacionados ao Uso de Álcool/economia , Análise Custo-Benefício , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/economia , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Determinantes Sociais da Saúde/economia , Valores Sociais , Inquéritos e Questionários , Tailândia , Adulto Jovem
15.
Artigo em Alemão | MEDLINE | ID: mdl-30617556

RESUMO

Reducing alcohol consumption is one of the central health goals in Germany because the negative health consequences of excessive alcohol consumption are among the country's most serious and avoidable health risks. The care system for people with alcohol-related disorders comprises a large number of services, but due to the historically developed structures and respective responsibilities, it also includes many interfaces. Alcohol addicts often seek professional help only after many years of dependence. Especially in the areas of early detection and early intervention, there is a significant undersupply for people with alcohol-related disorders (see S3 guideline on alcohol-related disorders). Therefore, efforts should be made to promote the competence of the various actors (e. g. general practitioners, hospital and nursing staff, psychotherapists, case managers in job centers/employment agencies) to recognize alcohol-related disorders in their respective field of activity, to deal with them in a target-oriented manner, to identify risk groups, and to convey them according to their respective needs (e. g. in offers for qualified withdrawal, medical rehabilitation facilities (alcohol addiction treatment)). Accordingly, development potentials for promoting early and seamless access are presented using selected fields of action as an example. It is also emphasized that the implementation of case management is necessary to build bridges between the utility sectors. Finally, central aspects for the future development of the care system for people with alcohol-related problems are described.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Alcoolismo , Clínicos Gerais , Alemanha , Humanos , Fatores de Risco
16.
Transl Behav Med ; 9(2): 296-307, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29733406

RESUMO

Excessive alcohol consumption poses a serious problem for public health. Digital behavior change interventions have the potential to help users reduce their drinking. In accordance with Open Science principles, this paper describes the development of a smartphone app to help individuals who drink excessively to reduce their alcohol consumption. Following the UK Medical Research Council's guidance and the Multiphase Optimization Strategy, development consisted of two phases: (i) selection of intervention components and (ii) design and development work to implement the chosen components into modules to be evaluated further for inclusion in the app. Phase 1 involved a scoping literature review, expert consensus study and content analysis of existing alcohol apps. Findings were integrated within a broad model of behavior change (Capability, Opportunity, Motivation-Behavior). Phase 2 involved a highly iterative process and used the "Person-Based" approach to promote engagement. From Phase 1, five intervention components were selected: (i) Normative Feedback, (ii) Cognitive Bias Re-training, (iii) Self-monitoring and Feedback, (iv) Action Planning, and (v) Identity Change. Phase 2 indicated that each of these components presented different challenges for implementation as app modules; all required multiple iterations and design changes to arrive at versions that would be suitable for inclusion in a subsequent evaluation study. The development of the Drink Less app involved a thorough process of component identification with a scoping literature review, expert consensus, and review of other apps. Translation of the components into app modules required a highly iterative process involving user testing and design modification.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos Relacionados ao Uso de Álcool/terapia , Aplicativos Móveis , Smartphone , Telemedicina , Transtornos Relacionados ao Uso de Álcool/psicologia , Terapia Cognitivo-Comportamental , Retroalimentação Psicológica , Humanos , Modelos Teóricos , Terapia Assistida por Computador
17.
Psychol Trauma ; 11(4): 459-465, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29939060

RESUMO

OBJECTIVE: Although brief alcohol interventions (BAIs) that incorporate personalized feedback demonstrate efficacy for reducing the frequency and quantity of alcohol consumption in veteran samples, little research has explored the influence of BAIs in reducing symptoms of posttraumatic stress disorder (PTSD). The goal of this investigation was to understand whether PTSD symptom severity and diagnostic status changed after exposure to an intervention that targeted alcohol misuse and integrated feedback on PTSD. METHOD: Sixty-eight combat veterans (8.8% female; 27.9% African American) who screened positive for hazardous drinking were recruited from a Veterans Affairs Medical Center. Participants received a 1-session brief intervention that primarily targeted alcohol misuse but also included personalized feedback and psychoeducation on PTSD symptoms and coping. Participants were randomized to receive personalized written feedback either with or without a motivational interview. RESULTS: A mixed-model repeated measures analysis revealed that PTSD symptom severity was significantly lower at the 6-week (M = 41.47, SD = 28.94) and 6-month (M = 35.56 SD = 26.99) follow-up appointments relative to baseline (M = 51.22, SD = 26.67), F(2, 127.24) = 38.32, p < .001. Regression analyses demonstrate that the percent change in alcohol use was related to the change in PTSD severity. Further, results indicated that a motivational-interviewing-style counseling session accompanying the feedback was not significantly more efficacious than receiving feedback only. CONCLUSION: A brief alcohol intervention that integrates information on PTSD has the potential to reduce PTSD severity. Personalized alcohol and PTSD feedback may be useful as an opportunistic intervention for OEF/OIF veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Transtornos Relacionados ao Uso de Álcool/complicações , Aconselhamento , Retroalimentação , Feminino , Seguimentos , Humanos , Guerra do Iraque 2003-2011 , Masculino , Educação de Pacientes como Assunto , Medicina de Precisão , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/complicações , Resultado do Tratamento
18.
In Vivo ; 33(1): 145-154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30587615

RESUMO

BACKGROUND/AIM: The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing. But there is no proper management based on age stratification in elderly patients. Therefore, we evaluated the clinical characteristics and outcomes of elderly HCC patients more than 75 years old in South Korea. PATIENTS AND METHODS: Five hundred and fifty elderly patients with HCC were enrolled and divided into the oldest-old (age ≥85 years), middle-old (age between 80 and 85 years), and young-old groups (age between 75 and 80 years). RESULTS: Fifty-one, 153, and 346 patients were included in the oldest-old (mean age: 87 years), middle-old (mean age: 82 years), and young-old groups (mean age: 77 years), respectively. There was a significantly lower rate of alcohol-related and hepatitis B virus-related diseases in the oldest-old group than in the other groups, whereas there was no significant difference in other characteristics. With increasing age, conservative treatment was predominantly performed. Transarterial chemoembolization was the main modality of active treatment in all groups. In multivariate analysis, the performance score, model for end-stage liver disease score, modified Union for International Cancer Control staging, Barcelona Clinic Liver Cancer staging, presence of portal vein tumor thrombosis, ruptured HCC, and active treatment were risk factors of overall survival. CONCLUSION: When the therapeutic approach is used in elderly patients with HCC, the patient's performance status, liver function, and stage of cancer should be considered, and its use should not be restricted to those of advanced age.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Carcinoma Hepatocelular/epidemiologia , Neoplasias Hepáticas/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/patologia , Transtornos Relacionados ao Uso de Álcool/terapia , Transtornos Relacionados ao Uso de Álcool/virologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/virologia , Quimioembolização Terapêutica , Feminino , Vírus da Hepatite B/patogenicidade , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/virologia , Masculino , Estadiamento de Neoplasias , República da Coreia , Fatores de Risco , Resultado do Tratamento
19.
Dig Surg ; 36(1): 41-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29339657

RESUMO

AIM: This study is about a questionnaire survey of delegates attending the chronic pancreatitis symposium at the 2016 meeting of the Pancreatic Society of Great Britain and Ireland and seeks a multidisciplinary "snapshot" overview of practice. METHODS: A questionnaire was developed with multidisciplinary input. Questions on access to specialist care, methods of diagnosis and treatment including specific scenarios were incorporated. Eighty-three (66%) of 125 delegates effectively participated in this survey. RESULTS: Twenty-four (29%) had neither a chronic pancreatitis MDT in their hospital nor a chronic pancreatitis referral MDT. Most frequently utilised diagnostic modalities were CT, MR and EUS with no respondents utilising duodenal intubation tests. Initial treatment was provided through non-opiate analgesia by 69 (93%), through the use of opiates by 56 (76%) and through the use of co-analgesics by 49 (66%). Fifty two (68%) routinely referred patients with alcohol-related disease for counselling. Preferred treatment for large duct disease without mass was endoscopic therapy. In older patients with a mass, pancreaticoduodenectomy was preferred. CONCLUSION: This is a small study likely to be skewed by sampling bias but is thought to be the first multidisciplinary survey of the management of chronic pancreatitis in the United Kingdom and Ireland. The results show a need for comprehensive access to specialist pancreatitis MDT care and there remains substantial variation in management.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Neoplasias Pancreáticas/cirurgia , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/terapia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Transtornos Relacionados ao Uso de Álcool/complicações , Transtornos Relacionados ao Uso de Álcool/terapia , Colangiopancreatografia Retrógrada Endoscópica , Endossonografia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Pancreaticoduodenectomia , Pancreatite Crônica/complicações , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
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