This dissertation sought to evaluate the efficacy of brief, HIV risk-reduction counseling (versus information only) among subgroups of substance abuse treatment clients by conducting a series of post-hoc analyses of data that were collected from the CTN 0032 trial. It was hypothesized that HIV risk-reduction counseling would be associated with decreased sexual risk behaviors in several subgroups as determined by baseline characteristics. Findings of this dissertation suggest that brief, HIV risk-reduction counseling delivered in conjunction with rapid HIV testing is not efficacious in reducing number of risky sex acts among subgroups of substance abuse treatment clients. Findings suggest that brief, HIV risk-reduction counseling may be efficacious in reducing total number of sex partners among some subgroups. Findings will potentially inform the national HIV prevention agenda by helping to determine whether the current CDC recommendation on HIV testing should be applied broadly versus to specific target groups and, therefore, determine whether monetary resources for risk-reduction counseling should be allocated to specific target groups.

A double-blind comparison was conducted using typical doses of soporific agents from three drug classes and a placebo. Drugs which were used in the study included secobarbital, flurazepam hydrochloride, and thioridazine. Subjects were 40 outpatient volunteers whose primary complaint was difficulty in falling to sleep. Subjects were randomly assigned to one of the three drug groups or the placebo group. One of the drugs or the placebo was administered to each subject for 3 nights. Half of the subjects in each of the four groups were told the drug had caused any observed changes in their sleep behavior and were in this way led to attribute any changed sleep behavior externally to the drug. The other half were told the drugs were not typically used to treat insomnia and changes in their sleep were due to changes made in their own behavior, thus attributing any changes in sleep behavior internally. The implication for clinicians was that a short course of drug therapy using a placebo or one of several soporific drugs might be used equally effectively to treat primary latency insomnia. Additionally, the results demonstrated that clinicians might expect the effectiveness of treatment to be maintained following treatment. Recommendations included a suggestion for future research with soporific drugs in other classes.

Background: The UK has a high prevalence of opioid use; although this population is ageing. The use of opioids is associated with excess mortality and offending and so remains a priority for public health and criminal justice policy. Aims: There are two broad aims for this thesis: firstly, to quantify excess mortality and offending associated with opioid use, and secondly, to assess the effectiveness of drug treatment at reducing these harms. Methods: Cohorts were extracted from the Drug Data Warehouse (DDW); a collection of case-linked drug treatment and criminal justice datasets, linked to mortality and offending records. Excess mortality was quantified by comparing deaths observed in a cohort of opioid users to that expected from the general population, matched on age and gender. The association between opioid use and offending was quantified using a cohort of drug-tested offenders, comparing those who tested positive for opiates and/or cocaine with those who tested negative. The effectiveness of treatment was calculated using two separate measures: the effect of being in treatment, using a time-dependent treatment exposure, and the effect of initiation to treatment. In the latter analysis, the approach was to use observational data to emulate randomised controlled trials, in an attempt to better establish the causal effect of treatment initiation. Confounding bias, when treatment exposure is time-dependent, was discussed, using path diagrams and simulations. Results: The opioid-user cohort extracted from the DDW is the largest assembled to-date (N = 198,247). Controlling for age and gender, opioid use was associated with considerably higher mortality and offending than non-users. Older age was a risk factor for drug related poisoning (DRP) death. The association with offending was considerably higher for females. Compared to periods out of treatment, the risk of a fatal DRP was lower during pharmacological treatment but not during periods where the user received psychological support only. Simulations illustrated that when treatment exposure is time-dependent, analyses may be biased in the presence of confounding by a time-dependent variable. Among opioid-using offenders, there was little support for the hypothesis that initiation to drug treatment was effective at reducing the risk of future acquisitive offending. Conclusion: In England and Wales, there remain considerable excess mortality and offending associated with opioid use. Age and gender have an important influence on these relationships. Treatment (as delivered in England and Wales) appears effective at reducing the risk of a drug-related death, provided there is a pharmacological component, but not at reducing the risk of future offending.

Background: There are many individuals living with chronic illness and therefore follow one or more prescribed drug therapies. It is shown that over 50 percent of these are not adherent to their prescriptions and that low adherence is a growing problem across the world. Earlier research indicates that low adherence leads to decreased health and reduced quality of life. Aim: The aim was to find factors affecting adherence among individuals with chronic illness. Method: A literature study based on empirical qualitative research. The articles were analysed in accordance with Friberg's five step model. Results: Four categories emerged from the analysis of the articles; personal factors, social factors, health care factors and therapy related factors. Individuals' adherences depend on different internal and external factors. Individuals' own ability to follow routines were the most appearing factor for high adherence. Lack of trust in health professionals was the most appearing factor because of low adherence. Other appearing and affecting factors were social support, trust in healthcare and severe side effects. Conclusion: Adherence is a common and complex issue. There are many facilitators and barriers affecting adherence. Increased awareness of different factors can help health professionals to promote high adherence among individuals with chronic illness. / Många personer i världen lever med en eller flera kroniska sjukdomar och behandlas därför med läkemedel. Definitionen av adherence innebär i vilken utsträckning en person är följsam till sin läkemedelsbehandling. Tidigare forskning påvisar att endast 50 procent är följsamma till förskrivna ordinationer. Låg följsamhet är ett växande problem inom Sverige, men även globalt. I resultatet påvisades att en persons motivation, kunskap och förmåga att kunna ta eget ansvar över sin behandling var viktiga faktorer för långvarig och hög följsamhet. Ett socialt stöd från familj och närstående var betydande för hög följsamhet. Religiösa traditioner och stigmatisering i samhället visade sig ofta ha en negativ påverkan på följsamhet. Vårdrelaterade faktorer som påverkade följsamhet var exempelvis information, kommunikation, förtroende för vårdpersonal och behandling samt vårdtillgänglighet. Läkemedelsrelaterade biverkningar var ett bekymmer för upprätthållandet av följsamhet. I analysen som gjordes enligt Fribergs femstegsmodell framkom att faktorer som påverkar följsamhet inte skiljer sig märkbart över världen. Ökad kunskap hos personer och vårdpersonal om hur följsamhet till läkemedelsbehandling påverkas av olika faktorer kan främja följsamhet. Hög följsamhet bidrar till förbättrad hälsa och ökad livskvalitet hos personer med kronisk sjukdom. Det leder även till färre sjukdomsrelaterade komplikationer och färre vårdtillfällen på sjukhus. I resultatdiskussionen framkom att 'förmåga till följsamhet' och 'tillit till vård och behandling' visade sig vara betydelsefulla faktorer som påverkade följsamhet.

Alzheimer’s disease has been described long ago, yet the illness is yet to be fully understood. Though it is true that research and technological advancements have brought us closer to understanding the disease, a truly effective pharmacological cure has not been discovered. With no permanent cure to rely on, AD patients and their caregivers still go through profound struggles in navigating through life with the disease. In this thesis, current literature on the non-pharmacological interventions is presented and discusses the various options that can provide the greatest relief and reap the most health benefits for patients. In total, four different non-drug treatments come into discussion - exercise, music, diet and cognitive interventions. In terms of exercise, research suggests that anaerobic work may be more beneficial than aerobic exercises in preventing the development or progression of mild cognitive dementia and Alzheimer’s disease. This is mostly due to the fact that anaerobic exercises can shift APP processing away from the non-amyloidogenic pathway and increase BDNF levels to offer improved neural protection. Music therapy intervention is evaluated next. This unique treatment is highly valued due to its beneficial effects on AD patients’ emotional well-being. Music therapy can take the forms of singing in groups or as an individual, and it can also incorporate dancing. Not only does music promote neuroplasticity and neurogenesis, but it also alleviates mood, boosts confidence and strengthens will. Diet is another significant component that can have an incredible impact on the AD patients’ wellbeing. Research reveals that diets high in saturated fatty acid should be avoided. On the other hand, diets mirroring the Mediterranean diet, including polyunsaturated fatty acids along with high amounts of vitamin C and folic acid should be readily consumed. Moreover, spices and herbs such as capsaicin should be used in a limited manner to decrease risk for AD. Finally, cognitive therapy is still a popular method for treating mild cognitive impairment and AD. Though cognitive improvement appears to be more modest, some psychostimulation programs combined with pharmacological treatments can play an influential role in achieving cognitive stability. Further research is needed in upgrading the current non-pharmacological interventions with an emphasis on the four treatments. These are available at an affordable cost and can be easily incorporated into the lifestyles of Alzheimer’s patients.

Since it was first articulated, the Risk-Need-Responsivity model (RNR; Andrews, Bonta, & Hoge, 1990) has been extensively researched and is regarded as an empirically supported model for providing effective correctional treatment. It is comprised of three core principles: the risk principle, which provides direction for who should receive treatment; the need principle, which identifies intermediate treatment targets; and the responsivity principle, which states how treatment programs should be structured. The RNR model is purported to be relevant for all offender populations, including female offenders (Dowden & Andrews, 1999a), juvenile offenders (Dowden & Andrews, 1999b), violent offenders (Dowden & Andrews, 2000), and sexual offenders (Hanson, Bourgon, Helmus, & Hogdson, 2009). Yet, the majority of RNR research has examined the risk and need principles, and the responsivity principle remains understudied. The responsivity principle includes two sub-principles: general and specific (Andrews, & Bonta, 2010). The current research explored the general responsivity principle, which states that programs should use theoretically relevant models for individual change, specifically cognitive-behavioral and cognitive-social learning models (Andrews & Bonta, 2010). The following techniques are consistent with these models: "role-playing, modeling, repeated practice of alternative behaviors, cognitive restructuring to modify thoughts/emotions, skills building, or reinforcement" (Andrews & Bonta, 2010, p. 50). Despite empirical support, the RNR model has received minimal application to juveniles, and it has not been widely tested in the substance abuse treatment context. Additionally, it is not clear whether adherence to the RNR model is relevant for reducing substance use outcomes in youth. Adolescent substance abuse treatment programs were designed to address substance use among juveniles, and have been widely researched to determine their effectiveness; yet their effectiveness remains understudied among juvenile offenders. These studies include examinations of specific treatment interventions used, such as Multisystemic Therapy. Many of these interventions are considered to be "evidence-based treatment" (EBT), but there is a wide variety of repositories that classify interventions as "evidence-based" with varying criteria used to classify them. The juvenile drug treatment court model (JDTC) was specifically developed to address substance use and crime among juvenile offenders; however, findings from empirical studies have not demonstrated a strong treatment effect. To address these gaps in the literature, secondary analyses were conducted on data collected from 132 adolescent outpatient substance abuse treatment programs (AOPs) and 10 juvenile drug treatment courts nationwide. This research was an application of the general responsivity principle in the AOP and JDTC context to determine the impact of responsivity adherence on the odds of rearrest and substance use severity. The analyses also included an examination of evidence-based treatment (EBT) in both samples to determine the influence of EBT use scores on the odds of rearrests and substance use severity scores. To examine the AOP sample, multilevel models were used to examine the individual- and program-level impact of responsivity adherence and EBT use. To examine the JDTC sample, multivariate analyses were used to examine the individual-level impact of responsivity adherence and EBT use. Overall, responsivity adherence was not significantly associated with rearrests among AOP participants, nor was it significantly associated with substance use severity scores. Additionally, the odds of rearrest were significantly greater among individuals who received interventions with a higher EBT use score; though, there was no association between the average EBT use scores across programs and the odds of rearrest. There was no significant association between individual- and program-level EBT use scores and substance use severity. Among JDTC participants, an increase in responsivity adherence was associated with an increase in the odds of rearrest and substance use severity. A similar association emerged between EBT use scores and both outcomes, wherein increases in EBT use scores were significantly associated with an increase in the odds of rearrest and substance use severity. The results of the analyses suggest the need for further specification of both general responsivity adherence and "evidence-based" treatment for use in future research and theory; specifically, further elaboration of the general responsivity-adherent techniques and clear criteria for classifying interventions as "evidence-based treatment." The findings also imply that certain types of treatment interventions are more compatible with the JDTC model than other interventions. Additional analyses suggest the possibility that general responsivity adherence and evidence-based treatment may not be unique constructs. Future research may benefit through exploring evidence-based treatment as a criterion for adherence to the general responsivity principle. / Criminal Justice

No description available.

Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment. Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework. Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent. Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes. Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes. / On the day of the public defence of the doctoral thesis the status of article V was Submitted.

Made available in DSpace on 2017-07-21T19:59:55Z (GMT). No. of bitstreams: 1 Katia Alonso.pdf: 2466313 bytes, checksum: 4c119b2a40368dd791db57672106bd65 (MD5) Previous issue date: 2012-03-09 / The arterial hypertension is characterized as a multifactorial disorder, influenced by genetic and environmental factors. Environmental factors are most responsible for the accelerated growth of this disease. The physical exercise is considered a very important non pharmacological model of treatment for the hypertension. Actually, how much genes are studying for better clarified the real relationship between the genetic and blood pressure (BP) control. The insertion/deletion (I/D) The arterial hypertension is characterized as a multifactorial disorder, influenced by genetic and environmental factors. Environmental factors are most responsible for the accelerated growth of this disease. The physical exercise is considered a very important non pharmacological model of treatment for the hypertension. Actually, how much genes are studying for better clarified the real relationship between the genetic and blood pressure (BP) control. The insertion/deletion (I/D) polymorphism, with 287 base pairs at the intron 16, of the angiotensin-converting enzyme (ACE) gene has recently been related with HBP in different populations. Therefore, the aim of the present study was to investigate possible association of the polymorphism of the ACE forward clinical diagnosis of hypertension in a sample population from southern Brazil, submitted to physical training and / or drug treatment. Thus, it was possible to evaluate and verify a positive effect on BP control, under the influence of aerobic exercise short-term (two months) in 10 hypertensive individuals heterozygous for ACE (genotype ID). Furthermore, we evaluated the possible relationship between the polymorphism insertion/deletion (I/D) with hypertension in a group consisting of 78 hypertensive individuals, and these showed no direct relationship with the disease. The groups were not showed genetic structure and the genotypic classes presented out of equilibrium of Hardy-Weinberg. The D allele was minor frequent, and new alleles was descript. It is suggest that other mechanisms post-transcriptions are linked in the gene regulation and ECA function.polymorphism, with 287 base pairs at the intron 16, of the angiotensin-converting enzyme (ACE) gene has recently been related with HBP in different populations. Therefore, the aim of the present study was to investigate possible association of the polymorphism of the ACE forward clinical diagnosis of hypertension in a sample population from southern Brazil, submitted to physical training and / or drug treatment. Thus, it was possible to evaluate and verify a positive effect on BP control, under the influence of aerobic exercise short-term (two months) in 10 hypertensive individuals heterozygous for ACE (genotype ID). Furthermore, we evaluated the possible relationship between the polymorphism insertion/deletion (I/D) with hypertension in a group consisting of 78 hypertensive individuals, and these showed no direct relationship with the disease. The groups were not showed genetic structure and the genotypic classes presented out of equilibrium of Hardy-Weinberg. The D allele was minor frequent, and new alleles was descript. It is suggest that other mechanisms post-transcriptions are linked in the gene regulation and ECA function. / A hipertensão arterial sistêmica (HAS) é caracterizada como sendo um distúrbio multifatorial, influenciada por fatores genéticos e ambientais. Os fatores ambientais são os maiores responsáveis pelo crescimento acelerado da doença. O exercício físico é considerado um modelo muito importante não farmacológico de tratamento para a hipertensão. Na verdade, vários genes estão sendo estudados para melhor esclarecer o papel da genética no controle da pressão arterial (PA). Um polimorfismo de inserção/deleção (I/D) de aproximadamente 287 pares de base no íntron 16, do gene da enzima conversora de angiotensina (ECA) foi recentemente relacionado com a HAS em diferentes populações. Portanto, o objetivo do presente estudo foi investigar a possível associação do polimorfismo da ECA frente ao diagnóstico clínico de hipertensão em uma amostra da população do sul do Brasil, submetidos ao treinamento físico e/ou tratamento medicamentoso. Assim, foi possível avaliar e verificar um efeito positivo sobre o controle da PA, sob a influência de exercício aeróbio de curto prazo (dois meses), em 10 indivíduos hipertensos heterozigotos para ECA (genótipo ID). Além disso, foi avaliada a possível relação entre o polimorfismo inserção/deleção (I/D) com a HAS em um grupo constituído de 78 indivíduos hipertensos, e esses não mostraram relação direta com a doença. Os grupos não apresentaram estruturação genética e as classes genotípicas apresentaram fora do equilíbrio de Hardy-Weinberg. O alelo D foi menos frequentes e novos alelos foram descritos. É sugestivo que outros mecanismos pós-transcricionais estejam envolvidos na regulação do gene e função da ECA.

In my senior year at ETSU I produced a documentary about opioid abuse in East Tennessee. In 2016, two local health care providers and a university collaborated on a project that would bring an opioid treatment center to Gray, Tennessee. The center includes a methadone clinic, an addition that piqued the concern of many citizens living in Gray. The film evaluates the concerns citizens had about the clinic and explores the issue of opioid abuse in East Tennessee.