In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing 'outcome' data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of 'feminine carer' offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders' stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a 'space' for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the 'other', offenders were able to re-author a more 'moral' and 'worthy' self. Moreover, the ATR has been found to be successful in enabling the offenders' hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

The goal of this study was to determine if a relationship exists between pretreatment facial attractiveness and posttreatment occlusal outcome in orthodontic patients. A randomized sample of forty-seven patients (26 males, 21 females) was selected for inclusion in this study. Orthodontic evaluators rated pretreatment patient photographs (frontal smile, frontal, profile) using a 100 mm visual analog scale (VAS). Occlusal outomes were evaluated using percentage reduction in weighted Peer Assessment Rating (PAR) index scores and the American Board of Orthodontics objective grading system (ABO-OGS). Spearman correlation coefficients were calculated to assess the relationship between pretreatment VAS attractiveness ratings and posttreatment occlusal scores. There was a fair correlation between facial attractiveness and reduction in weighted PAR index scores for all patients (r=.41, p<.01) and for male patients (r=.48, p<.05). The results showed a good correlation between facial attractiveness and the ABO-OGS for females (r=-.55, p<.05).

Recent research has demonstrated that target selection is an important link between phonological assessment and intervention. It is a significant variable in treatment efficacy because, as suggested by Camarata and Nelson (1992), acquisition efficiency is at least predicated on the selection of targets that are addressed in intervention. Typically, speech-language pathologists have relied on phonetic factors that were based on developmental norms and/or stimulability. Specifically, those who adhered to a traditional approach to target selection chose sounds that were stimulable and early developing. This traditional approach to target selection was based on the assumption that earlier, stimulable sounds were easier to produce and followed a developmental sequence of acquisition.

Text in English / Aim: The aims of this study were to investigate the treatment outcomes of patients with MDRTB and its determinants at referral hospitals in Ethiopia. The study also aims to develop a conceptual model for enhancing treatment of patients with MDR-TB in Ethiopia. Design and methods: A concurrent mixed methods design with quantitative dominance was used to investigate treatment outcomes of patients with MDR-TB and its determinants. Results: A total of 136 (n=136) patients with MDR-TB participated in the study, 74 (54%) were male and 62 (46%) were female. Forty-one (31%) of the patients had some co-morbidity with MDR-TB at baseline, and 64% had body mass index less than 18.5kg/m2. Eight (6%) of the patients were diagnosed among household contacts. At 24 months, 76/110 (69%) of the patients had successfully completed treatment, but 30/110 (27%) were died of MDR-TB. Multivariable logistic regression revealed that the odds of unfavourable treatment outcomes were significantly higher among patients with low body mass index (BMI <18.5kg/m2) (AOR=2.734, 95% CI: 1.01-7.395; P<0.048); and those with some co-morbidity with MDR-TB at the baseline (AOR=4.260, 95%CI: 1.607-11.29; p<0.004). The majority of the patients were satisfied with the clinical care they received at hospitals. But as no doctor was exclusively dedicated for the MDR-TB centre, patients could not receive timely medical attention and this was especially the case with those with emergency medical conditions. The caring practice of caregivers at the hospitals was supportive and empathic but it was desperate and alienating at treatment follow up centres. Patients were dissatisfied with the quality and adequacy of the socio-economic support they got from the programme. Despite the high MDR-TB and HIV/AIDS co-infection rate, services for both diseases was not available under one roof. Conclusions: Low body mass index and the presence of any co-morbidity with MDR-TB at the baseline are independent predictors of death among patients with MDR-TB. Poor communication between patients and their caregivers and inadequate socio-economic support were found to determine patients’ perceived quality of care and patients’ satisfaction with care given for MDR-TB. / Health Studies / D. Litt et Phil. (Health Studies)

An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phase-based interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through trauma-focused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any gender-related symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2 X 2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TF-CBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.

Multidrug-resistant tuberculosis (MDR-TB) is a public health problem in several countries such as Angola, India, China, Kenya, and Nigeria. Due to the increasing high burden of MDR-TB, most of these countries do not have adequate capacities to manage MDR-TB patients effectively. This study investigated the effect of model of care; human immunodeficiency virus comorbidity; and demographic factors such as age, gender, and marital status on the treatment outcomes of MDR-TB patients in Nigeria. The study was based on the analysis of secondary data of 402 MDR-TB patients accessed from the data systems of the National Tuberculosis, Buruli Ulcer, and Leprosy Control Program. The theoretical framework for this study was the health belief model. The results of the study showed that treatment outcomes were similar for hospital and community-based models of care. Age was the only factor found to be significantly associated with treatment outcomes; age > than 40 years was a predictor of unsuccessful treatment outcomes among MDR-TB patients at a p-value of 0.026. In the multivariate logistics regression analysis, age and model of care were found to be significantly associated with treatment outcomes at p-values of 0.043 and 0.048, respectively. Marital status, gender, and HIV comorbidity were not significantly associated with treatment outcomes. Implications of the findings of this study for social change in a health care program include opportunities to help reduce the number of patients on waiting lists for MDR-TB treatment. These strategies may ultimately help to reduce the spread of MDR-TB infection as well as the mortality associated with late treatment.

This study aimed to examine end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical or non-surgical approaches. This study tests the hypotheses that occlusal outcomes (ABO-OGS) at end of treatment will be similar while cephalometric outcomes will differ between these groups. A total of 60 patients were included: 20 of which underwent surgical correction and 40 of which did not. The end of treatment ABO-OGS and cephalometric outcomes were compared by Mann-Whitney U tests and multivariable linear regression models. Following adjustment for multiple confounders (age, gender, complexity of case, and skeletal patterns), the final deband score (ABO-OGS) was similar for both groups (23.8 for surgical group versus 22.5 for non-surgical group). Those treated surgically had a significantly larger reduction in ANB angle, 3.4 degrees reduction versus 1.5 degrees reduction in the non-surgical group (p=0.002). The surgical group also showed increased maxillary incisor proclination (p=0.001) compared to candidates treated non-surgically. This might be attributed to retroclination of incisors during treatment selection in the non-surgical group – namely, extraction of premolars to mask the discrepancy. Studies such as this are necessary because they begin to give practitioners view of not only the outcomes of a single treatment plan, but a comprehensive approach by providing evidence of the over-arching treatment used for successful treatment in both groups.

The accurate evaluation of substance use is a critical component of forensic assessment due to the well-established link between drug use sentencing issues and risk of recidivism. Due to limited resources and chronic time constraints, practitioners typically rely only on self-report measures to assess substance use (SU) patterns. As these measures directly inquire about SU patterns, they remain vulnerable to response distortion. This can lead to ineffective treatment recommendations made to the Court and misuse of resources. The present study investigated the utility of the PAI and SASSI-3 in identifying SU patterns in offenders mandated to a long-term treatment facility. As a second major component, offenders were examined post-release to identify predictors for poor treatment outcomes. Results found the direct questioning approach best identified SU patterns in the present sample. In addition, while statistically significant differences in treatment outcomes were not observed between offenders who endorsed a more severe course of their SU problem versus those who endorsed a much less problematic pattern of use, they were trending in the expected direction. Specifically, offenders who used "hard" drugs regularly (e.g., cocaine, heroin), had more negative consequences directly related to their use (e.g., more arrests, prior treatment), and had a more complex clinical presentation (e.g., endorsing more personality pathology) did have worse outcomes by follow up. Methodological and statistical limitations are discussed in depth, and future directions to improve on this study and clarify these relationships are emphasized.

Bakgrund: Personer med psykisk ohälsa, och däribland depression, är ett ökande folkhälsoproblem som vanligtvis behandlas med antidepressiva läkemedel och olika former av terapi inom primärvården. Fysisk aktivitet kan erbjudas som behandling vid depression och distriktssköterskan behöver kunskap om fysisk aktivitet och dess användning som sjukdomsprevention och behandling. Detta för att kunna erbjuda individanpassad, evidensbaserad vård till personer med depressionssymtom. Syfte: Syftet med denna litteraturstudie var att beskriva effekten av fysisk aktivitet vid primär depression hos vuxna, samt att undersöka om typen, intensiteten, dosen (frekvensen) eller durationen av den fysiska aktiviteten hade någon betydelse för effekten. Metod: Systematisk litteraturstudie med narrativ syntes, som inkluderar experimentella, randomiserade kontrollerade studier (RCT). Huvudresultat: De flesta av studiernas interventioner utfördes i instruktörsledda grupper och resultatet visade signifikant minskad grad av depression hos majoriteten av deltagarna i interventionerna. Detta samtidigt som all fysisk aktivitet oavsett typ, intensitet och dos (frekvens) gav effekt på depressionssymtom. Dock sågs durationen ha betydelse för effekten av fysisk aktivitet på primär depression och interventioner som pågick under längre tid gav i större utsträckning fördelaktiga signifikanta resultat. Slutsats: All fysisk aktivitet, oavsett typ, intensitet och dos (frekvens) gav effekt vid depression. Interventionernas duration hade betydelse för effekten, och interventioner som pågick under längre tid gav i högre grad signifikanta effekter på depression. Dessa resultat kan vara användbara i distriktssköterskans kliniska arbete och ett stöd när den fysiska aktiviteten ska individanpassas vid behandling av depression, exempelvis vid utbildning och förskrivning av fysisk aktivitet på recept (FaR®). / Background: People with mental illness, including depression, are an increasing public health problem that is usually treated with antidepressants and various forms of therapy in primary care. Physical activity can be offered as a treatment for depression and district nurses need knowledge of physical activity and its use as disease prevention and treatment in order to offer personalised, evidence-based care to people with depressive symptoms. Aim: The aim of this literature review was to describe the effect of physical activity on primary depression in adults, as well as to investigate whether the type, intensity, dose (frequency) or duration of physical activity had any impact on the effect. Method: Systematic literature review with narrative synthesis, including experimental, randomized controlled trials (RCT). Main results: Most of the studies’ interventions were performed in instructor-led groups and the results showed significantly reduced rates of depression in the majority of participants who participated in the interventions. All physical activity, regardless of type, intensity and dose (frequency), had an effect on depressive symptoms. However, the duration was seen to have an impact on the effect of physical activity on primary depression and interventions that lasted for a longer period of time gave more beneficial significant results. Coclusion: All physical activity, regardless of type, intensity and dose (frequency) had an effect on depression. The duration of the interventions had an impact on the effect, and interventions that lasted for a longer period of time had a greater effect on depression. These results can be useful in the district nurse’s clinical work when personalizing physical activity in the treatment of depression, for example in the education of patients and when prescribing physical activity on prescription (FaR®).

Evaluace výsledků léčby v terapeutické komunitě pro drogově závislé Martin Šefránek Abstrakt: Východiska: Výzkumem podložené závěry prokazující efektivitu léčby v terapeutických komunitách pro léčbu závislostí a umožňující mezinárodní srovnání jsou v ČR ojedinělé. "Evaluace výsledků léčby v terapeutické komunitě pro drogově závislé" je v ČR první prospektivní výzkumná studie hodnoticí efektivitu léčby uživatelů drog v terapeutických komunitách. Cil: Cílem studie je vyhodnotit, jak se změnilo užívání drog, kriminalita, osobní a sociální fungování a kvalita života uživatelů drog 1 rok po ukončení léčby. Metody: Data byly sbírány prostřednictvím strukturovaných interview s klienty terapeutických komunit. Studie porovnává změny v problémovém chování klientů ve 30 dnech před začátkem léčby a ve 30 dnech po 1 roce od jejího ukončení. Základním výzkumným nástrojem je the Maudsley Addiction Profile, který jsme doplnili o další měření. Soubor: Výzkumný soubor tvoří 176 uživatelů drog, kteří v letech 2007 a 2008 zahájili léčbu v rezidenční terapeutické komunitě. 1 rok po ukončení léčby byly data získány od 77.8% (N=137) klientů. Na studii participovaly 4 terapeutické komunity. Výsledky: Po 1 roce od ukončení léčby došlo k signifikantnímu nárůstu abstinence od metamfetaminu, opiátových drog a benzodiazepinů. Před...