BACKGROUND: Guidelines recommend long-term treatment for opioid use disorder including the use of buprenorphine; however, little is known about patients in long-term treatment. OBJECTIVE: Examine the prevalence and patient characteristics associated with long-term treatment retention (≥1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. Study Design: This is a 12-year retrospective cohort study of adults on buprenorphine in OBOT in a large urban safety-net primary care practice. METHODS: The primary outcome was retention in OBOT for ≥1 continuous year. Patients who re-enrolled multiple times in the program contributed repeated observations. Potential predictors of ≥1 year retention assessed were: age, race/ethnicity, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1 year OBOT retention were identified using generalized estimating equation logistic regression models. The different reasons for clinic disengagement by retention status (i.e. ≥1 year vs. <1 year) were also described. RESULTS: OBOT treatment periods (n=1605) among 1237 patients were assessed. Almost half, 44.7% (717/1605), of all treatment periods were ≥1 year and a majority, 53.7% (664/1237), of patients had at least one ≥ 1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05, 1.34]) were associated with greater odds of ≥1 year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]), compared to white, were associated with lower odds of ≥1 year retention. Relapse to substance use appeared to be a less common reason for disengagement for the ≥1 year (23.3%) compared to the <1 year (40.1%) treatment periods. CONCLUSIONS: Over half of patients were successfully retained in Office Based Opioid Treatment with buprenorphine for ≥1 year. However, significant disparities in one-year treatment retention were seen, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C. / 2018-11-09T00:00:00Z

Moisturizers are used in various types of dry skin disorders, but also by people with healthy skin. It is not unusual that use of moisturizers is continued for weeks, months, or even years. A number of moisturizers have been shown to improve the skin barrier function, while others to deteriorate it, but the reason for observed effects remains unknown. Further understanding of the mechanism by which long-term treatment with moisturizers influences the skin barrier would have clinical implications, as barrier-deteriorating creams may enhance penetration of allergens or irritants and predispose to dry skin and eczema, while barrier-improving ones could reduce many problems. The present research combined non-invasive techniques with analyses of skin biopsies, allowing studies of the epidermis at molecular and cellular level. Test moisturizers were examined on healthy human volunteers for their effect on the skin barrier, with regard to such factors as pH, lipid type, and presence of a humectant, as well as complexity of the product. After a 7-week treatment with the moisturizers, changes in transepidermal water loss, skin capacitance, and susceptibility to an irritant indicated a modified skin barrier function. Moreover, the mRNA expression of several genes involved in the assembly, differentiation and desquamation of the stratum corneum, as well as lipid metabolism, was altered in the skin treated with one of the moisturizers, while the other moisturizer induced fewer changes. In conclusion, long-term use of moisturizers may strengthen the barrier function of the skin, but also deteriorate it and induce skin dryness. Moisturizers have also a significant impact on the skin biochemistry, detectable at molecular level. Since the type of influence is determined by the composition of a moisturizer, more careful selection of ingredients could help to design moisturizers generating a desired clinical effect, and to avoid ingredients with a negative impact on the skin.

Zielsetzung: Die Gültigkeit des Modells der Stadien der Veränderung von Prochaska und DiClemente für die stationäre Alkoholentwöhnungstherapie empirisch zu prüfen. Methoden: Reliabilität, Faktorstruktur und Konstruktvalidität der Veränderungsstadienskala (VSS) wurden an Alkoholpatienten querschnittlich (N = 265) und längsschnittlich (N = 108) untersucht. Ergebnisse: Die Reliabilität der VSS fiel befriedigend aus mit Ausnahme der Skala «Precontemplation», die sich auf nicht motivierte Patienten bezieht. Die faktorielle Validität war insbesondere für die Skalen «Contemplation» und «Maintenance» unzureichend. Clusteranalysen ergaben eine nicht modellkonforme Drei-Cluster-Lösung einschließlich «uninvolvierter » Patienten. VSS-Werte waren durchgängig mit der Therapiemotivation korreliert. Prädiktive Validität (Behandlungsdauer, Rückfallvorhersage) konnte nicht belegt werden. Schlussfolgerungen: Der Ansatz bestätigt seinen heuristischen Wert, kann aber noch nicht valide für praktische Entscheidungen in der Alkoholentwöhnungsbehandlung herangezogen werden. Spezifische Modelle für verschiedene Behandlungsgruppen und -settings scheinen Erfolg versprechender. / Aim: The validity of the ”Stages of Change” approach was tested in alcohol inpatient long-term treatment. Methods: Reliability, factor structure, and construct validity of the University of Rhode Island Change Assessment Scale (URICA, German version) was examined using cross-sectional (N = 265) and longitudinal data (N = 108). Results: Scale reliability proved to be satisfying, except for the precontemplation scale. Factorial validity was insufficient for the contemplation and the maintenance scale. Cluster analyses revealed a threecluster solution not in accordance with the model and included a cluster of ”uninvolved patients”. URICA-scores were correlated with therapy motivation, but predictive validity with respect to duration of treatment and prediction of relapse was not confirmed. Conclusions: The model proved to be of heuristic value but is not yet a valid basis for practical decisions. Models which are directed more specifically towards a particular treatment group or setting are expected to be more successful. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

<p>Predmet izučavanja ove disertacije obuhvatio je ispitivanje uticaja starenja stabilizovanog/solidifikovanog&nbsp; (S/S)&nbsp; sedimenta&nbsp; zagađenog te&scaron;kim metalima i arsenom, i efikasnost primenjenih imobilizacionih agenasa (Portland cement, kreč, leteći pepeo, zeolit, montmorilonit i kaolinit) nakon dugogodi&scaron;njeg starenja S/S sme&scaron;a. Shodno tome ispitana je dugoročna stabilnost i postojanost dobijenih S/S sme&scaron;a sa aspekta izluživanja pomenutih metala, promene u minerolo&scaron;kim i strukturnim karakteristikama, kao i uticaj su&scaron;enja i zrenja materijala na pomenute parametre. Istraživanja u disertaciji obuhvatila su dve faze. Prva faza imala je za cilj procenu rizika i&nbsp; početnu karakterizaciju netretiranog sedimenta primenom analize pseudo-ukupnog sadržaja metala kojom je utvrđen sadržaj metala u početnom uzorku sedimenta. Druga faza uključivala je primenu tretmana stabilizacije i solidifikacije na kontaminirani sediment dodavanjem različitih imobilizacionih agenasa. Analize su se vr&scaron;ile nakon 7 i 28 dana od primenjenog S/S tretmana, kao i nakon 7 godina sa ciljem da se utvrdi uticaj vi&scaron;egodi&scaron;njeg starenja i zrenja monolitnih sme&scaron;a na mobilnost metala i strukturne karakteristike sme&scaron;a. U&nbsp; okviru&nbsp; druge faze istraživanja ispitana je toksičnost S/S sme&scaron;a primenom DIN i TCLP testova izluživanja, dok je test toksičnosti primenom bakterija Vibrio Fischeri&nbsp; doprineo u&nbsp; sagledavanju&nbsp; procene rizika S/S sme&scaron;a po organizme. Nakon 28 dana i 7 godina kori&scaron;ćena je sekvencijalna ekstrakcija za&nbsp; određivanje mobilnost i biodostupnost metala u monolitnim matriksima. U cilju&nbsp; utvrđivanja mikrostukturnih karakteristika sedimenta primenjena je rendgenska difrakciona analiza (XRD) za ispitivanje kristalnih struktura&nbsp; S/S sme&scaron;a i detekciju mineralnog sastava. Pomoću elektronskog mikroskopa i energodisperzivnog detektora&nbsp; sa X-zrakom (SEM/EDS) određena je kvalitativna i kvantitativna distribucija metala i&nbsp; drugih elemenata od interesa, dok se za identifikaciju formiranih funkcionalnih grupa u monolitnim sme&scaron;ama primenio spektrometar sa infracrvenom Furijeovom transformacijom (FTIR). Na osnovu dobijenih rezultata zaključeno je da se mobilnost te&scaron;kih metala i arsena značajno smanjila nakon 7 godina za sme&scaron;e tretirane cementom (C5), krečom (L10), letećim pepelom (F30) i kaolinitom&nbsp; (K20), a efekat stabilizacije je pokazan transformacijom metala iz direktne toksične frakcije u&nbsp; stabilnije oblike. Sme&scaron;e C5 i K20 ispoljavaju&nbsp; najmanje toksične efekate od svih sme&scaron;a, jer je procenat inhibicije&nbsp; na&nbsp; bioluminiscentnim&nbsp; bakterijama manji od 13%, dok je u pogledu izdržljivosti monolitna sme&scaron;a C5 pokazala najveću pritisnu čvrstoću od svih sme&scaron;a. Dobijeni podaci su neprocenjivi za dobijanje stvarnog uvida u dugoročnu efikasnost&nbsp; primenjenog&nbsp; tretmana i mogućnost bezbedne upotrebe ili odlaganja dobijenih S/S sme&scaron;a sa aspekta za&scaron;tite životne sredine, kao i ekonomski i ekolo&scaron;ki prihvatljivog upravljanja opasnim otpadom.</p> / <p>The subject of study in this dissertation included to investigate the&nbsp; effect&nbsp; of&nbsp; aging&nbsp; of&nbsp; stabilized/solidified&nbsp; (S/S)&nbsp; sediment&nbsp; contaminated with&nbsp; heavy&nbsp; metals&nbsp; and&nbsp; arsenic,&nbsp; and&nbsp; the&nbsp; efficacy&nbsp; of&nbsp; the&nbsp; applied immobilization&nbsp; agent&nbsp; (Portland&nbsp; cement,&nbsp; lime,&nbsp; fly&nbsp; ash,&nbsp; zeolite, montmorillonite and kaolinite) after long-term aging of S/S mixtures. The<br />long&nbsp; -&nbsp; term stability and stability of the obtained S/S mixtures from the aspect of leaching of the mentioned metals, changes in mineralogical and structural characteristics,&nbsp; as&nbsp; well&nbsp; as&nbsp; the&nbsp; influence&nbsp; of&nbsp; drying&nbsp; and maturation of the material on the mentioned parameters were examined. The&nbsp; research&nbsp; in&nbsp; the&nbsp; dissertation&nbsp; included&nbsp; two&nbsp; phases.&nbsp; The&nbsp; first&nbsp; phase aimed&nbsp; at&nbsp; risk&nbsp; assessment&nbsp; and&nbsp; initial characterization&nbsp; of&nbsp; untreated sediment using pseudo-total metal content analysis which determined the<br />metal content in the initial sediment sample.&nbsp; The second phase involved applying&nbsp; stabilization&nbsp; and&nbsp; solidification&nbsp; treatments&nbsp; to&nbsp; the&nbsp; contaminated sediment&nbsp; by&nbsp; adding&nbsp; various&nbsp; immobilizing&nbsp; agents.&nbsp; The&nbsp; analyzes&nbsp; were performed after 7 and 28&nbsp; days from the applied S/S treatment, as well as after 7 years in order to determine the influence of perennial aging and maturation&nbsp; of&nbsp; monolithic&nbsp; mixtures&nbsp; on&nbsp; metal&nbsp; mobility&nbsp; and&nbsp; structural characteristics&nbsp; of&nbsp; the&nbsp; mixtures.&nbsp; In&nbsp; the&nbsp; second&nbsp; phase&nbsp; of&nbsp; the&nbsp; study,&nbsp; the toxicity&nbsp; of&nbsp; S/S&nbsp; mixtures&nbsp; using&nbsp; DIN&nbsp; and&nbsp; TCLP&nbsp; leaching&nbsp; tests&nbsp; was examined, while&nbsp; the&nbsp; toxicity&nbsp; test&nbsp; using&nbsp; bacteria&nbsp; Vibrio&nbsp; Fischeri contributed&nbsp; to&nbsp; the assessment&nbsp; of&nbsp; the&nbsp; risk&nbsp; of&nbsp; S/S&nbsp; mixtures&nbsp; to&nbsp; organisms. After&nbsp; 28 days&nbsp; and&nbsp; 7 years,&nbsp; sequential extraction was&nbsp; used to&nbsp; determine the mobility and bioavailability of metals in monolithic matrices. In order to&nbsp; determine&nbsp; the&nbsp; microstructural&nbsp; characteristics&nbsp; of&nbsp; the&nbsp; sediment,&nbsp; x-ray diffraction analysis (XRD) was used to examine the crystal structures of&nbsp; S/S mixtures and&nbsp; to detect the mineral composition.&nbsp; The qualitative and quantitative&nbsp; distribution&nbsp; of&nbsp; metals&nbsp; and&nbsp; other&nbsp; elements&nbsp; of&nbsp; interest&nbsp; was determined using an electron microscope and an energy-dispersive X-ray detector&nbsp; (SEM&nbsp; /&nbsp; EDS),&nbsp; while&nbsp; an&nbsp; infrared&nbsp; Fourier&nbsp; transform spectrometer(FTIR) was used to identify the formed functional groups in monolithic mixtures. Based on the obtained results, it was concluded that the mobility of heavy metals and arsenic decreased significantly after 7 years&nbsp; for&nbsp; mixtures&nbsp; treated&nbsp; with&nbsp; cement&nbsp; (C5),&nbsp; lime&nbsp; (L10),&nbsp; fly ash&nbsp; (F30) and&nbsp; kaolinite&nbsp; (K20),&nbsp; and&nbsp; the&nbsp; stabilization&nbsp; effect&nbsp; was&nbsp; shown&nbsp; by transformation&nbsp; of&nbsp; metals&nbsp; from&nbsp; direct&nbsp; toxic&nbsp; fractions&nbsp; into&nbsp; more&nbsp; stable forms. Mixtures&nbsp; C5&nbsp; and&nbsp; K20&nbsp; exhibit&nbsp; the&nbsp; least&nbsp; toxic&nbsp; effects&nbsp; of&nbsp; all mixtures, because the percentage of inhibition on bioluminescent bacteria is less than 13%, while in terms of durability, the monolithic mixture C5 showed&nbsp; the&nbsp; highest&nbsp; compressive&nbsp; strength&nbsp; of&nbsp; all&nbsp; mixtures.&nbsp; The&nbsp; obtained data are invaluable for gaining real insight into the long-term efficiency of the applied treatment and the possibility of safe use&nbsp; or disposal of the obtained&nbsp; S/S&nbsp; mixtures&nbsp; from&nbsp; the&nbsp; aspect&nbsp; of&nbsp; environmental&nbsp; protection,&nbsp; as well&nbsp; as&nbsp; economically&nbsp; and&nbsp; ecologically&nbsp; acceptable&nbsp; hazardous&nbsp; waste management.</p>

Disertacijoje tiriant ligonių, ilgai gydytų intensyviosios terapijos skyriuje, su sveikata susijusios gyvenimo kokybės skirtumus iki gydymo ir praėjus 6 mėnesiams po gydymo vertinamos gyvenimo kokybės pablogėjimo priežastys bei gyvenimo kokybės ir mirštamumo po iškėlimo iš intensyviosios terapijos skyriaus ryšys. Jau anksčiau nustatyta, kad gyvenimo kokybė po gydymo intensyviosios terapijos skyriuje pablogėja. Tačiau neaišku, kokie veiksniai turi didžiausios įtakos intensyviosios terapijos skyriaus ligonių gyvenimo kokybei. Ypač mažai duomenų apie ligonių, ilgai gydytų intensyviosios terapijos skyriuje, gyvenimo kokybę po iškėlimo iš intensyviosios terapijos skyriaus. Tyrimo rezultatai patvirtino, kad ilgas gydymas intensyviosios terapijos skyriuje turi didžiausios įtakos fizinėms su sveikata susijusioms gyvenimo kokybės sritims. Tyrimo rezultatai įrodo, kad būklės sunkumas pirmą gydymo intensyviosios terapijos skyriuje parą, terapinių intervencijų skaičius iškėlimo iš intensyviosios terapijos skyriaus metu ir sunkus kritinių būklių neuroraumeninis pažeidimas susiję su pablogėjusia gyvenimo kokybe, o dirbtinės plaučių ventiliacijos trukmė – veiksnys turintis didžiausią įtaką gyvenimo kokybės blogėjimui. Taip pat nustatyta, kad įprastos sistemos būklės sunkumui įvertinti netinka numatyti ligonių mirštamumui po gydymo intensyviosios terapijos skyriuje, o nustačius fizinį aktyvumą iki gydymo intensyviosios terapijos skyriuje tai galima atlikti. / The doctoral dissertation investigates changes in health-related quality of life for long-term intensive care patients prior to ICU admission and 6 months after ICU discharge, exploring into the causes of impaired quality of life and the relationship between the quality of life and post-ICU mortality. It has already been established that the quality of life decreases after treatment in the intensive care unit. However, factors that have the strongest effect on the quality of life in ICU patients have not been identified. Information on post-ICU quality of life in long-term intensive care patients is particularly scarce. The findings of our research confirmed that long term treatment in the intensive care unit has major implications for the physical domains of health-related quality of life. The findings evidence that severity of illness on the first day in the ICU, number of therapeutic interventions upon ICU discharge and severe critical illness neuromuscular abnormalities are associated with impaired quality of life, while duration of mechanical ventilation is the factor with the strongest effect on reduced quality of life. Likewise, the findings demonstrate that usual systems for identification of severity of illness are not useful for predicting mortality in patients after discharge from the intensive care unit. Yet, identification of pre-ICU physical activity allows predicting post-ICU mortality.

The doctoral dissertation investigates changes in health-related quality of life for long-term intensive care patients prior to ICU admission and 6 months after ICU discharge, exploring into the causes of impaired quality of life and the relationship between the quality of life and post-ICU mortality. It has already been established that the quality of life decreases after treatment in the intensive care unit. However, factors that have the strongest effect on the quality of life in ICU patients have not been identified. Information on post-ICU quality of life in long-term intensive care patients is particularly scarce. The findings of our research confirmed that long term treatment in the intensive care unit has major implications for the physical domains of health-related quality of life. The findings evidence that severity of illness on the first day in the ICU, number of therapeutic interventions upon ICU discharge and severe critical illness neuromuscular abnormalities are associated with impaired quality of life, while duration of mechanical ventilation is the factor with the strongest effect on reduced quality of life. Likewise, the findings demonstrate that usual systems for identification of severity of illness are not useful for predicting mortality in patients after discharge from the intensive care unit. Yet, identification of pre-ICU physical activity allows predicting post-ICU mortality. / Disertacijoje tiriant ligonių, ilgai gydytų intensyviosios terapijos skyriuje, su sveikata susijusios gyvenimo kokybės skirtumus iki gydymo ir praėjus 6 mėnesiams po gydymo vertinamos gyvenimo kokybės pablogėjimo priežastys bei gyvenimo kokybės ir mirštamumo po iškėlimo iš intensyviosios terapijos skyriaus ryšys. Jau anksčiau nustatyta, kad gyvenimo kokybė po gydymo intensyviosios terapijos skyriuje pablogėja. Tačiau neaišku, kokie veiksniai turi didžiausios įtakos intensyviosios terapijos skyriaus ligonių gyvenimo kokybei. Ypač mažai duomenų apie ligonių, ilgai gydytų intensyviosios terapijos skyriuje, gyvenimo kokybę po iškėlimo iš intensyviosios terapijos skyriaus. Tyrimo rezultatai patvirtino, kad ilgas gydymas intensyviosios terapijos skyriuje turi didžiausios įtakos fizinėms su sveikata susijusioms gyvenimo kokybės sritims. Tyrimo rezultatai įrodo, kad būklės sunkumas pirmą gydymo intensyviosios terapijos skyriuje parą, terapinių intervencijų skaičius iškėlimo iš intensyviosios terapijos skyriaus metu ir sunkus kritinių būklių neuroraumeninis pažeidimas susiję su pablogėjusia gyvenimo kokybe, o dirbtinės plaučių ventiliacijos trukmė – veiksnys turintis didžiausią įtaką gyvenimo kokybės blogėjimui. Taip pat nustatyta, kad įprastos sistemos būklės sunkumui įvertinti netinka numatyti ligonių mirštamumui po gydymo intensyviosios terapijos skyriuje, o nustačius fizinį aktyvumą iki gydymo intensyviosios terapijos skyriuje tai galima atlikti.

Zielsetzung: Die Gültigkeit des Modells der Stadien der Veränderung von Prochaska und DiClemente für die stationäre Alkoholentwöhnungstherapie empirisch zu prüfen. Methoden: Reliabilität, Faktorstruktur und Konstruktvalidität der Veränderungsstadienskala (VSS) wurden an Alkoholpatienten querschnittlich (N = 265) und längsschnittlich (N = 108) untersucht. Ergebnisse: Die Reliabilität der VSS fiel befriedigend aus mit Ausnahme der Skala «Precontemplation», die sich auf nicht motivierte Patienten bezieht. Die faktorielle Validität war insbesondere für die Skalen «Contemplation» und «Maintenance» unzureichend. Clusteranalysen ergaben eine nicht modellkonforme Drei-Cluster-Lösung einschließlich «uninvolvierter » Patienten. VSS-Werte waren durchgängig mit der Therapiemotivation korreliert. Prädiktive Validität (Behandlungsdauer, Rückfallvorhersage) konnte nicht belegt werden. Schlussfolgerungen: Der Ansatz bestätigt seinen heuristischen Wert, kann aber noch nicht valide für praktische Entscheidungen in der Alkoholentwöhnungsbehandlung herangezogen werden. Spezifische Modelle für verschiedene Behandlungsgruppen und -settings scheinen Erfolg versprechender. / Aim: The validity of the ”Stages of Change” approach was tested in alcohol inpatient long-term treatment. Methods: Reliability, factor structure, and construct validity of the University of Rhode Island Change Assessment Scale (URICA, German version) was examined using cross-sectional (N = 265) and longitudinal data (N = 108). Results: Scale reliability proved to be satisfying, except for the precontemplation scale. Factorial validity was insufficient for the contemplation and the maintenance scale. Cluster analyses revealed a threecluster solution not in accordance with the model and included a cluster of ”uninvolved patients”. URICA-scores were correlated with therapy motivation, but predictive validity with respect to duration of treatment and prediction of relapse was not confirmed. Conclusions: The model proved to be of heuristic value but is not yet a valid basis for practical decisions. Models which are directed more specifically towards a particular treatment group or setting are expected to be more successful. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thrombosis and restenosis are two major complications associated with current commercial vascular stents. In situ regeneration of a healthy endothelium has been recognized as a promising strategy to address these issues. Numerous strategies have been explored for this goal. However, in most of the cases, they only focused on enhancing endothelial cell growth, ignoring antithrombotic requirements and the competition between smooth muscle cells (SMCs) and endothelial cells (ECs) for their growth. This resulted in non-satisfying clinical results. In this study, we created a multifunctional surface that meets the need of antithrombosis and re-endothelialization. A nanotubular titanium oxide (TiO₂) system has been developed, which elutes the direct thrombin inhibitor, bivalirudin (BVLD); moreover, polydopamine (PDAM) is used to tailor the surface functionality of TiO₂ nanotubes (NTs) for controlling the elution of BVLD. PDAM-functionalized TiO₂ NTs controls the BVLD for more than two months. BVLD eluted from NTs was bioactive and showed a substantial inhibitory effect on thrombin bioactivity, platelet adhesion and activation. In addition, the BVLD-eluting nanotubular TiO₂ system has high selectivity to enhance human umbilical vein endothelial cell (HUVEC) growth, while it inhibits human umbilical artery smooth muscle cell (HUASMC) proliferation. Our design strategy for the BVLD-eluting nanotubular TiO₂ system creates a favorable microenvironment for durable thromboresistance and the promotion of reendothelialization, and thus it is suitable for the long-term treatment of cardiovascular diseases.

This study is an exploration, through ethnographic and auto-ethnographic inquiry, of the personal world, gambling experiences and underlying biopsychosocial vulnerabilities of three individual case studies - one male and two females - each representing a different sub-type of pathological gambler. It comprises the integration and implementation of a psycho-structural stage matching model to explore comorbidity and identify certain biopsychosocial manifestations in the respective stages of pathological gambling. Long term treatment strategies were identified and patient treatment matching was explored. Further, it comprises my personal relationship and therapeutic treatment of these sub-types of gamblers over a period of one year and longer. In this study it is hypothesized that formulating appropriate matching long term treatment strategies should be based on the stage of change, the phase in the psycho-structural model, as well as the gambler's underlying vulnerability. From this a comprehensive gambling disposition profile can be completed with proper intervention matching approaches. A number of other hypotheses emerged from this study that could provide valuable information and serve as a guideline to those working with pathological gamblers. / Psychology / D.Phil.

This study is an exploration, through ethnographic and auto-ethnographic inquiry, of the personal world, gambling experiences and underlying biopsychosocial vulnerabilities of three individual case studies - one male and two females - each representing a different sub-type of pathological gambler. It comprises the integration and implementation of a psycho-structural stage matching model to explore comorbidity and identify certain biopsychosocial manifestations in the respective stages of pathological gambling. Long term treatment strategies were identified and patient treatment matching was explored. Further, it comprises my personal relationship and therapeutic treatment of these sub-types of gamblers over a period of one year and longer. In this study it is hypothesized that formulating appropriate matching long term treatment strategies should be based on the stage of change, the phase in the psycho-structural model, as well as the gambler's underlying vulnerability. From this a comprehensive gambling disposition profile can be completed with proper intervention matching approaches. A number of other hypotheses emerged from this study that could provide valuable information and serve as a guideline to those working with pathological gamblers. / Psychology / D.Phil.