A growing body of research is examining effective treatment(s) for individuals with comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). However, treatments for this comorbid population have been inadequately studied in the longer term. This study represents a long-term follow-up assessment of a randomized controlled trial that compared combined therapy (prolonged exposure + naltrexone) with monotherapies (prolonged exposure or naltrexone) for patients with PTSD and AD (see Foa, Yusko, McLean et al., 2013). Attempts were made to contact 120 participants 5-10 years after the original trial to assess the maintenance of treatment gains. Nineteen individuals were located and agreed to participate. A series of mixed ANCOVAs were conducted with PTSD symptom severity and percentage of days drinking and heavy drinking as the dependent variables. Findings revealed that reductions in PTSD symptoms and drinking behaviors generally were maintained 5-10 years after treatment. There was some relapse in heavy drinking days, and combination treatment was most effective for long-term PTSD outcomes. Challenges of conducting follow-up research with this population, implications and limitations of the present findings, and directions for future research are discussed.

MPH, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2010 / INTRODUCTION Although much focus has been placed towards rapid scale-up of antiretroviral treatment programmes and interventions for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV), very little is known about adherence to highly active antiretroviral therapy (HAART) and loss to follow-up of pregnant women in antiretroviral treatment programmes in the developing world. In this retrospective cohort analysis, we described the baseline characteristics of adult women who were pregnant at the time of HAART initiation (pregnant at start) as well as women who became pregnant during follow-up after starting HAART (pregnant after) and women who never had a pregnancy (not pregnant) during the study period. We evaluated the association of pregnancy status with adherence and loss to follow-up in these three groups of women. MATERIALS AND METHODS Themba Lethu Clinic is an urban public-sector antiretroviral rollout facility in Johannesburg, South Africa. A retrospective analysis was conducted of all adult women initiating HAART at this clinic between January 2005 and December 2007. Clinical data from these patients was analysed for differences in rates of loss to follow-up, and measured adherence rates based on CD4 cell count response and virologic suppression. Regression models were performed to determine independent predictors of adherence and loss to follow-up and compared between the three groups. Survival analysis, in the form of Kaplan-Meier plots and log-rank tests, was used to compare the time to becoming lost to follow up. RESULTS Between 1 January 2005 and 31 December 2007, 5129 women initiated HAART at Themba Lethu Clinic, Johannesburg, South Africa. Of these women, 521 (10.0%) were pregnant at the time of HAART initiation (pregnant at start) and 291 (5.6%) became pregnant during follow-up (pregnant after). Women who were pregnant at start (16.6%) of HAART had less-advanced HIV disease than the not pregnant women and pregnant women after HAART initiation 4608 (89.9%). Overall pregnant women were significantly younger than the not pregnant women and fewer pregnant women had a CD4 <100 cells/mm3 and a WHO stage III of HIV disease. There was no significant difference in the CD4 cell count response and virological suppression between the three groups of women based on pregnancy status at 6 months and 12 months (X2=2.1, p=0.347 and X2=4.4, p=0.111 respectively). However, women pregnant at start were more likely to become lost to follow-up (X2=15.8, P=<.0001) during follow up. In the multivariate Cox logistic regression model, independent predictors of loss to follow-up were pregnancy, baseline CD4 cell count and age at initiation. Being pregnant was significantly associated with being loss to follow-up. CONCLUSIONS Pregnancy is significantly associated with defaulting treatment and becoming lost to follow-up from HAART treatment programmes. Together with being pregnant, young age and a low CD4 at baseline are high risk factors for non adherence and loss to follow-up in this sub-group of the population. Early initiation of HAART with adequate pre-treatment counselling and ongoing adherence support could help improve adherence and retention in care for patients in treatment programmes in resource-limited settings. Interventions to trace patients immediately upon missed appointments would help to reduce the number of patients’ loss to follow-up. Moreover, integration of tuberculosis (TB), antenatal care (ANC) and HIV treatment services may maximize the effectiveness of interventions aimed at reducing the loss to follow-up rate. The initiation of HAART in pregnancy requires strengthened antenatal and HIV services that target women with advanced stage disease.

No período de 2008 a 2010, foi realizado o estudo de Atenção Farmacêutica, prospectivo longitudinal, com a participação de 104 pacientes diagnosticados com hipertensão arterial sistêmica, oriundos de duas unidades de saúde, do Distrito Sanitário Oeste da Cidade de Ribeirão Preto/SP. Após seis meses de estudo houve redução estatística significativa nos valores de Pressão Arterial Sistólica e Diastólica com menor dispersividade dos valores e clínica. A adesão ao tratamento aumentou ao longo do acompanhamento. Apresentou-se reduzido risco cardiovascular, com uma redução estatisticamente significativa do escore de risco Framingham. Discreta redução dos atendimentos de emergência. Apesar do sucesso deste estudo, fica em aberto se os benefícios alcançados são considerados transitórios ou permanentes. Para tanto, os pacientes foram reavaliados quanto aos parâmetros: pressão arterial sistólica e diastólica; valores de colesterol total; HDL; LDL, triglicerídeos, número de consultas em geral realizadas nessas unidades de saúde, e número de princípios ativos utilizados. Comparados os dados no período durante e após a Atenção Farmacêutica observou se que houve um aumento estatisticamente significante nos valores de pressão arterial sistólica e diastólica Com relação aos números de medicamentos prescritos houve também um aumento estatisticamente significativo, mas justificável devido à alteração na relação municipal de medicamentos essenciais entre os anos de 2009 e 2012. Quanto ao número de consultas e os resultados dos exames laboratoriais não houve diferença estatisticamente significante. Diante disso, pode se concluir que a Atenção Farmacêutica foi importante para a manutenção e manejo dos pacientes hipertensos e que o período de 30 meses após a Atenção Farmacêutica apresentou discretas alterações, principalmente nos valores de pressão arterial sistólica e diastólica e número de princípios ativos utilizados. / In the period from 2008 to 2010, a longitudinal and prospective Pharmaceutical Care study was conducted with 104 patients diagnosed with hypertension, from two health units, from the West Sanitary District of the municipality of Ribeirão Preto/SP. In this study, in the first six months of follow-up was observed a statistically and clinically significant reduction in the values of systolic and diastolic blood pressure, and with less dispersivity values. Medication adherece increased during the follow-up, a lower coronary risk was presented, with a statistically significant reduction in the Framingham Risk Score. A slight reduction in the emergency room visits was also observed. Considering the success of this study, was not decide whether the benefits obtained were considered transitory or permanent. Therefore patients were reassessed for the parameters: systolic and diastolic blood pressure; total cholesterol; HDL, LDL, triglycerides, number of consultations in general performed in those health units, and number of active moieties. Comparing data from the period during and after the Pharmaceutical Care, it was observed that there was a statistically significant increase in systolic and diastolic blood pressure. Regarding the number of prescribed medications statistically significant increase was also observed, but justifiable due to changes in the municipal list of essential medicines between the years of 2009 and 2012. Regarding the number of medical appointments and the results of laboratory tests there was no statistically significant difference. Thus, it can be concluded that Pharmaceutical Care was important for the maintenance and management of hypertensive patients and that the period of 30 months after the Pharmaceutical Care showed slight alterations, mainly in systolic and diastolic blood pressure and number of active moieties used.

Marketing is a process where companies are able to promote their product or service and create a demand for it. One of the instruments to perform a good promotion is an exhibition. Exhibitions go back hundreds of years ago, where they were markets of exchange for home made products. In today’s modern society, exhibitions are an effective marketing tool where people gather for a short period of time to present their products and services. Clients, competitors, visitors and all involved in the particular business visit the exhibition to get an update of the market.The research in this essay will concentrate on trade fair exhibitions, while consumer exhibitions are a slightly different topic. While exhibitions are an effective marketing tool they are also very expensive to participate at. Exhibitions organizers charge companies great sums of money to be part of an exhibition, where during the few days of the event more people visit a company’s booth than perhaps during a 6 month period. The amount of exhibitions has also increased due to bigger and new markets. Which exhibitions to participate at are where many companies have a dilemma.As this essay is a research paper, it is also a project for SKF Service Division Europe that I have the privilege to write. SKF is a global company that manufactures and offers bearings, seals, mechatronics, services and lubrication systems. SKF is represented in 140 countries and is divided in three divisions: Industrial, Automotive and Service. The magnitude of this company gives an idea of how challenging it is to decide which exhibition to participate at. An exhibition is an investment after all.Of all the marketing tools exhibitions are the ones that have the personal touch. Meeting with possible future clients in this way establishes a trust through the personal meeting. The fact is though that attendance numbers at exhibitions has decreased in the past few years. The research in this essay is to look at new trends surrounding exhibitions. What is the exhibition media moving towards? Is the marketing tool of trade fairs less popular due to for example other cheaper marketing? Another issue in the essay is concerning the developing market of exhibitions between big international fairs and small local fairs.The results of a trade fair can perhaps be more effective than all the other marketing tools combined. Another purpose to the essay is to find possible ways to do a fair follow-up on a trade fair. The research will hopefully give alternative suggestions that are useful to achieve a fair follow-up on a trade fair, and in that way justify the investment by showing what results it provided.The method used in this essay is of a qualitative type. Through interviews with people who are experts in the subject of exhibition media, the purpose of this essay will be accomplished. Assisting to that task are also SKF employees, especially my tutor Åsa Nordström, who has helped me with information needed to shine light on the essays problem. In addition to interviews, literature has been used to strengthen the empirical research and come to an analysis of the problem presented in the essay.In the discussion I am talking about future trends that could occur and how they can be predicted through situational analysis. A part of the discussion is devoted to the relationship between big and small exhibitions. Perhaps the most interesting part of the discussion, and the one of most importance to companies, is a follow-up and evaluation of a trade fair. I recommend using a model where ROI (Return On Investment) is a key number to examine the success of a trade fair, and in that way justify the investment made by a company. The essay in concluded with suggestions for future research to develop the knowledge on the topic that is trade fairs. / Uppsatsnivå: D

Patients who are unable to comply with their health care regimen are almost 3 times more likely to have an adverse health outcome and are more likely to suffer irreversible progression of a chronic disease process. Increasing patient return clinic visits is essential, not only to curtail rapidly rising costs of health care but also to improve patient outcomes. This project focused on an uninsured patient population of a clinic in a rural community in the southeastern United States. The purpose of the project was to conduct a systematic review of the literature and identify the barriers and motivating factors for chronic care return primary care visits among uninsured patients. The theoretical models supporting the project were the health belief model and the chronic care model. A search of scholarly databases resulted in 366 articles meeting the inclusion criteria of peer-reviewed English-language literature published since 2014 that focused on outpatient care among uninsured populations. All identified articles were reviewed, and several interventions emerged as options to increase patient return rates: care transition and coordination services, patient education, patient follow up, pharmacy assistance programs, food assistance programs, and integration of computer-based literacy interventions. The clinic administrators determined that the best option for the site would be implementation of an on-site food program. The findings of this project have potential to create social change in clinics for uninsured in the community by addressing food insecurity and providing patients an incentive to return for care every 6 months.

This study explored and expanded a model of community intervention that proposes researcher, practitioner, and community member unification to produce communitywide programs used to improve society. The data were obtained from the community members of Hyrum, Utah, who participated in a needs assessment and then a follow-up survey, which began an examination and refinement process of the city's community programs. Research questions addressed the impact of the community programs in the areas of community safety, cultural relations, and family involvement. The data suggested that after one year of program implementation, the follow-up study participants perceived a general trend of lowered concern and increased strength within the three areas of study. The results also indicated that although certain programs were utilized by more participants, those programs did not necessarily have the most positive impact on those in the follow-up sample. This study added components of refinement and sensitivity differences to the community intervention model explored.

<p>The aim of this study is to analyse conditions that either promote or hamper the implementation of methods for systematic documentation, follow-up and evaluation in social-work services with individuals and families. The theoretical framework consists of organization theories. Human Service Organizations (HSO) theory is complemented with concepts from the new institutionalism, domain theory, implementation theory, and theory about interventions.</p><p>A concrete case, a project has been studied. The purpose of project was to implement methods for systematic documentation in public social services. With the notation “integrated” is meant that the methods should be built in and adjusted to the social-work practice. The methods were ASI (Addiction Severity Index) and IUS (a locally based model for integrated evaluation by inspiration from Göran Sandell).</p><p>Data has been captured in a pretest/ posttest design (Marlow 2000). This means that “state of things” has been described before the intervention and after. The methods used were surveys and interviews (individual and group). The process has been documented through research notes proceeding records, protocols and some diaries written by social workers. Four municipalities from the middle of Sweden took part with five working groups. Two groups contained social workers acting with children and families and three groups were working with drug abusers. The population consisted of the social workers, the managers responsible for the individual and family entities, the politicians and the clients who were affected during the time of the project.</p><p>The implementation of ASI and IUS has not occurred in the extent that was stated in the intervention theory. This means that ASI and IUS were not used in all new cases that occurred during the time of the project. The interviews supposed to be done in the beginning of the clients contact with the agency tended to be done more often than the follow-up interviews. After the project ended, three of five working groups decided to continue to use ASI (one group) and IUS (two groups). The overall impression is that the respondents comprehend, they have the willingness but they do not have the capability of using ASI and IUS. The organization does not seem to have the capacity of imposing requirements and giving resources. The outcomes do not seem to be the most important issue for the social services. These conditions are discussed in the study by means of the theoretical concepts. In the end, there is an effort to adjust the implementation theory to human service organizations.</p>

Thesis (Ed. D.)--Illinois State University, 2006. / Title from title page screen, viewed on April 27, 2007. Dissertation Committee: Thomas P. Crumpler, Thomas S. Haynes (co-chairs), Aimee D. Adkins, Barbara B. Meyer. Includes bibliographical references (leaves 173-180) and abstract. Also available in print.

Longitudinal substance abuse research has often been compromised by high rates of attrition, thought to be the result of the lifestyle that often accompanies addiction. Several studies have used a standardized follow-up protocol to minimize attrition, however it is unclear whether this protocol is equally effective for participants struggling with varying levels of housing stability, support for sobriety, and substance abuse severity. The current study extends research supporting the effectiveness of this protocol by demonstrating the importance of two central aspects of the follow-up protocol: locator form completion and continual verification contacts. Results indicated that each additional piece of locator form information and verification contact significantly and independently increased the odds for completing a follow-up interview, and that these effects were not moderated by participant characteristics. Practical and theoretical implications for longitudinal substance abuse research are discussed.

Data from longitudinal surveys give rise to many statistical challenges. They often come from a vast, heterogeneous population and from a complex sampling design. Further, they are usually collected retrospectively at intermittent interviews spaced over a long period of time, which gives rise to missing information and loss to follow-up. As a result, duration data from this kind of surveys are subject to dependent censoring, which needs to be taken into account to prevent biased analysis. Methods for point and variance estimation are developed using Inverse Probability of Censoring (IPC) weights. These methods account for the random nature of the IPC weights and can be applied in the analysis of duration data in survey and non-survey settings. The IPC estimation techniques are based on parametric estimating function theory and involve the estimation of dropout models. Survival distributions without covariates are estimated via a weighted Kaplan-Meier method and regression modeling through the Cox Proportional Hazards model and other models is based on weighted estimating functions. The observational frameworks from Statistics Canada's Survey of Labour and Income Dynamics (SLID) and the UK Millenium Cohort Study are used as motivation, and durations of jobless spells from SLID are analyzed as an illustration of the methodology. Issues regarding missing information from longitudinal surveys are also discussed.