<p>Diss. (sammanfattning) Umeå : Umeå universitet, 2003</p> / digitalisering@umu

Thesis (Ph. D.)--University of Toronto, 2007. / Source: Dissertation Abstracts International, Volume: 68-06, Section: A, page: 2670. Includes bibliographical references (leaves 166-206).

This thesis addresses the confluence of the issues of drug use and migration. Using data that explores the needs of new communities, it argues that members of new minority communities who use drugs suffer double discrimination as migrants and as drug users. In failing to address this intersection of need, drug policy and practice compound this discrimination. The data for this submission was drawn from three empirical research projects undertaken for Peterborough Drug Action Team and the National Treatment Agency for Substance Misuse. These research projects addressed previously unreached communities and gathered new data. I published my work among peer-reviewed literature in the form of two journal articles and a book chapter. The research reports and published works inform my thesis. This submission reanalyses the research, using an intersectional lens to understand problems emanating from drug use in the context of migration. Black and minority ethnic people form a small proportion of problem drug users and their needs were under-researched until the late 1990s. A growing body of research has focused on established minority communities, while the drug treatment needs of members of new groups of migrants, whether economic migrants or refugees, remain hidden. My research addresses the impact of policy and practice on new communities. Engaging with members of hard-to-reach groups via community-based researchers, I gathered views about the attitudes and needs of new minority groups and developed a fresh perspective. My work demonstrates that while drug misusers suffer very real discrimination and stigma they also have strengths that could be assets for their recovery. I offer an analysis of the reasons why these strengths are underutilised by a policy agenda that perceives drug misuse as the main feature of the lives of service users in new minority communities. This perception dates back to the first phase of modern drug policy. During the 1980s drug use spread throughout the country, driven by the availability of cheap heroin. The demography of drug users shifted towards white, younger unemployed men and the drugs/crime nexus became the focus of attention. This determined policy development. The context and profile of drug use has changed since 1980; however the decisions of the past affect those taken in the present, and I argue that policy continues to view other issues in individuals' lives as subsidiary to drug use and its treatment. My work has had an impact in practice and in the academic literature and presents significant new knowledge. In order to respond effectively to drug use in new minority communities, policy and practice must employ an intersectional viewpoint, sharing power and developing coalitions of interest.

In this dissertation, I focus on the social response of criminalization and incarceration to the problem of heroin use among women in Massachusetts in the ongoing era of the United States' "War on Drugs." Based on fieldwork conducted between 2010-2014, I argue that the convergence of therapeutic ideals with the prison system creates a means of governing and regulating these women's lives via what I call the "carceral therapeutic state." I examine various facets of treatment programs in the state women's prison, MCI-Framingham, and a local Boston jail, Suffolk County House of Corrections, including drug treatment, trauma treatment and work readiness programs. I consider how and why these programs in prisons and jails have become means to centralize and solidify the criminal justice system as the predominant site of addiction and mental health treatment for poor women on drugs. / Anthropology

Objective: Contingency management (CM) is often criticized for limited long-term impact. This meta-analysis focused on objective indices of drug use (i.e., urine toxicology) to examine the effects of CM on illicit substance use up to 1 year following treatment. Method: Analyses included randomized trials (k = 23) of CM for stimulant, opioid, or polysubstance use disorders that reported outcomes up to 1 year after the incentive delivery had ended. Using random effects models, odds ratios (OR) were calculated for the likelihood of abstinence. Metaregressions and subgroup analyses explored how parameters of CM treatment, namely escalation, frequency, immediacy, and magnitude of reinforcers, moderated outcomes. Results: The overall likelihood of abstinence at the long-term follow-up among participants who received CM versus a comparison treatment (nearly half of which were community-based comprehensive therapies or protocol-based specific therapies) was OR = 1.22, 95% confidence interval [1.01, 1.44], with low to moderate heterogeneity (I² = 36.68). Among 18 moderators, longer length of active treatment was found to significantly improve long-term abstinence. Conclusions: CM showed long-term benefit in reducing objective indices of drug use, above and beyond other active, evidence-based treatments (e.g., cognitive–behavioral therapy, 12-step facilitation) and community-based intensive outpatient treatment. These data suggest that policymakers and insurers should support and cover costs for CM, which is the focus of hundreds of studies demonstrating its short-term efficacy and, now, additional data supporting its long-term efficacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved) What is the public health significance of this article?—This meta-analysis provides a summary of long-term outcomes of contingency management treatment using objective indices of drug use. Contingency management was found to be more efficacious than either standard care or other evidence-based approaches up to 1 year following the discontinuation of incentives. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Women comprise one of the fastest growing populations of the criminal justice system, yet little research exists concerning the success of these women completing a coed pretrial drug court diversion program. Trauma theory was applied to inform the variables in this quantitative correlational study. The predictive nature of age, educational level, marital status, violent criminal history, and mental health problems for women were examined in relation to completion of a coed pretrial drug court diversion program. A convenience sample from secondary, archival data was obtained from a criminal justice agency in Washington, DC. The dataset included women who participated in the program between January 1, 2009 and December 31, 2014. Logistic regression models were used to predict the likelihood of whether these women completed drug court and determine which independent variables were likely to increase or decrease the probability of program completion. Results of the study failed to yield statistically significant relationships between the variables examined. However, the findings indicate possible relationships between marriage and drug court completion, and postsecondary education and drug court completion, which require additional research. Implications for positive social change are drawn for other criminal justice agencies, drug courts, and administrators for enhancing program delivery and reducing women's recidivism.

Tardive dyskinesia is an insidious and debilitating extrapyramidal side effect of neuroleptic drug treatment. Recent research has suggested that lecithin has been effective in treating tardive dyskinesia. Lecithin's effects were evaluated under double-blind placebo controlled conditions. Treatment conditions included a placebo control group, a lecithin treatment group, and a no-treatment control group. Subjects in the lecithin group received 60 gms/day of lecithin (33 gms of phosphatidylcholine) . Subjects in the placebo group received a similar mixture which contained no lecithin. Subjects received mixtures for 9-11 days. Treatment effectiveness was determined by subjective, objective, and global evaluations. All subjects were evaluated 3 to 4 days prior to treatment and following 9 to 11 days of treatment.

Bakgrund: Bristande följsamhet till läkemedelsbehandling både på lång och kort sikt är ett problem i behandlingen av patienter som genomgått hjärtinfarkt. Den farmakologiska behandlingen utgör dock en central del i den sekundärpreventiva vården efter hjärtinfarkt med påverkan på både livskvalitet och överlevnad. Brister i följsamhet ses vid all läkemedelsbehandling men tenderar att tillta ju längre behandlingen pågår. Den varierar också med olika typer av läkemedelsterapier där minst följsamhet till läkemedel kan ses vid förebyggande behandling. Följaktligen riskerar den farmakologiskt sekundärpreventiva och delvis livslånga behandlingen efter hjärtinfarkt att fallera. Syfte: Syftet var således att belysa barriärer som påverkar följsamhet till läkemedelsbehandling hos patienter efter hjärtinfarkt. Design: En litteraturöversikt med systematisk sökstrategi användes som design för att svara mot syftet. 16 vetenskapliga artiklar, varav 11 kvantitativa och fem av mixad metod erhölls efter systematiska sökningar i databaserna CINAHL och PubMed och vidare kvalitetsgranskade. Dessa sammanställdes genom integrerad analys utifrån Whittemore och Knalf’s modell. Resultat: Patientens attityd och kunskap, hälsoaspekter, sociodemografiska parametrar samt erhållet stöd och behandling är faktorer som kan utgöra barriärer för följsamhet till läkemedelsbehandling efter hjärtinfarkt. Slutsats: Kunskap och medvetenhet hos sjuksköterskan och övrig vårdpersonal kring barriärer till följsamhet till läkemedelsbehandling efter hjärtinfarkt är central. Utifrån denna kunskap kan adekvata omvårdnadsåtgärder och interventioner vidtas för att främja följsamheten till förskrivna läkemedel. Att överleva hjärtinfarkt innebär förändringar och utmaningar för den drabbade som behöver bearbetas och integreras i det fortsatta livet. De drabbade patienterna behöver få möta sjuksköterskor som har gedigna kunskaper om vanligt förekommande reaktioner, utmaningar och problem som patienten ställs inför. Att förstå detta skeende genom att betrakta det som en transition kan hjälpa sjuksköterskan att identifiera hur patientens behov av stöd ser ut vid den unika tidpunkten. / Background: Lack of medication adherence, both long and short term, is a problem in the treatment of patients after a myocardial infarction. Pharmacological treatment is a central part of the secondary preventive care after myocardial infarction affecting both quality of life and survival. Deficiencies in adherence are seen in all types of drug treatment but tend to increase the longer the treatment lasts. It also varies with different types of drug therapies where the least adherence to drugs can be seen in preventive treatment. Consequently, this puts the pharmacological secondary preventive and partly lifelong treatment after myocardial infarction at risk. Aim: The aim was to highlight barriers affecting medication adherence in patients after myocardial infarction. Design: A literature review with a systematic search strategy was used to answer the aim of this study. Sixteen scientific articles, of which eleven were quantitative and five of mixed method were obtained after systematic searches and quality review in CINAHL and PubMed databases. An integrated analysis based on Whittemore and Knalf's model was used to analys the data. Results: The patient's attitude and knowledge, health aspects, sociodemographic parameters and the support and treatment received are factors that can constitute barriers to medical adherence after myocardial infarction. Conclusion: Nurses and other health personnels´ knowledge and awareness regarding barriers to medication adherence after myocardial infarction is central. Based on this knowledge, adequate nursing measures and interventions can be taken to promote adherence to prescribed medication. Surviving a myocardial infarction means changes and challenges for the person that needs to be processed and integrated into their daily life. Patients impacted need to meet nurses who have good knowledge of common reactions, challenges and problems that they may face. Understanding these course of events by considering it as a transition can help the nurse identify the patient's need for support at this unique time.

Janis is a residential drug treatment program for drug abusers between the ages of twelve and eighteen deigned to rehabilitate the participants. Five homes, each staffed by two trained residential coordinators and one student accommodate a total of thirty patients at a time. The treatment program consists of daily house meetings led by the residential coordinators, one group therapy session per week led by a psychiatric social worker, and individual therapy sessions with a psychiatrist as needed, as well as regular consultation with a psychologist and psychiatrist. The adolescents enrolled in the program are referred from a variety of agencies, including the Multnomah County Juvenile Court and Home, the Psychiatric Crisis Unit operated by the University of Oregon Health Sciences Center, and other out-patient treatment centers in Portland. Only those adolescents who are motivated to change their behavior are accepted into the Janis program.

No description available.