共查询到20条相似文献,搜索用时 15 毫秒
1.
The rate of cigarette smoking is greater among persons with mental health and/or substance abuse problems. There are few population-based datasets with which to study tobacco mortality in these vulnerable groups. The Oregon Health Authority identified persons who received publicly-funded mental health or substance abuse services from January 1996 through December 2005. These cases were then matched to Oregon Vital Statistics records for all deaths (N= 148,761) in the period 1999-2005. The rate of tobacco-related death rates was higher among persons with substance abuse problems only (53.6%) and those with both substance abuse and mental health problems (46.8%), as compared to the general population (30.7%). The rate of tobacco-related deaths among persons with mental health problems (30%) was similar to that in the general population. Persons receiving substance abuse treatment alone, or receiving both substance abuse and mental health treatment, were more likely to die and more likely to die prematurely of tobacco-related causes as compared to the general population. Persons receiving mental health services alone were not more likely to die of tobacco-related causes, but tobacco-related deaths occurred earlier in this population. 相似文献
2.
3.
4.
Natalie Durbeej Tom Palmstierna Ingvar Rosendahl Anne H. Berman Marianne Kristiansson Clara Hellner Gumpert 《PloS one》2015,10(9)
Substance abuse is related to offending and substance abuse treatment has been associated with reductions in criminal behavior. This cohort study aimed to explore the relationship between participation in substance abuse interventions and general criminal recidivism among offenders with a combination of mental health problems and substance use problems. In total, 150 Swedish offenders with self-reported mental health and substance use problems were followed for approximately three years with regard to participation in substance abuse interventions and criminal recidivism. Participants with at least three planned visits to specialized outpatient substance abuse clinics had a substantially reduced risk of reoffending as compared to those with fewer than three such visits (HR = 0.47, 95% CI 0.29–0.77). For those with at least three planned visits, general criminal recidivism was reduced by 75% during periods of participation in outpatient visits, as compared to periods of non-participation (HR = 0.25, 95% CI 0.11–0.60). For offenders with mental health problems and substance use problems, outpatient substance abuse interventions could be regarded as important from a clinical risk management perspective, and be encouraged. 相似文献
5.
L M Hellman 《Perspectives in biology and medicine》1973,16(3):357-367
The health aspects and benefits of conception control as a justification for U.S. government support of family planning are reviewed. The Family Planning Services Act of 1970 set a goal of serving 5 million indigent women by 1975. It is predicted that the program will far surpass that goal. 340 million dollars were asked for contraceptive research by the federal government in fiscal year 1973, which is an example of the commitment to family planning by the government. Theoretical and sociopolitical reasons for family planning do not justify expenditure of public tax spending on population control assistance, but public health does justify those expenditures. Health and population control issues include the mental, physical, and social health of the parent and child, and broad demographic effects of age group population differentials, food supply, pollution, and health care services. The personal effects of an unwanted child are the most serious consequences of a lack of population control including economic and psychological hardship and damage. Maternal and infant mortality is related to age, economic status, and parity; e.g., toxemic pregnancy is more frequently found in young nulliparas. A correlation has been found between rapid parity and prematurity, though the research is not yet completely conclusive. Family planning through contraception and abortion can prevent unwanted pregnancies and unnecessary health risks from pregnancy by enabling parents to space and limit their families with safety. This is a highly desirable public health service goal and is emerging as a major concern of the federal government. 相似文献
6.
This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low‐ and middle‐income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long‐term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness. 相似文献
7.
Inhalant use is especially prevalent among antisocial youth and can have serious health consequences. However, the extant literature has not investigated how use of various inhalants may co-occur among incarcerated youth. This study begins to address this gap in the literature by using latent class analyses to form distinct typologies of inhalant use. Study participants were residents (N = 723) of 27 Missouri Division of Youth Services facilities. Interviews assessed psychiatric symptoms, antisocial traits, delinquency, trauma, suicidality, and substance use behaviors. The mean age of the mostly male, ethnically diverse sample was 15.5 (S.D. = 1.2) years old. The study revealed the following classes of inhalant use: (1) severe polyinhalant use; (2) moderate polyinhalant use; (3) gas and permanent marker use; and (4) low-use. Compared to the low-use class, members of the severe polyinhalant use class had experienced more than double the rate of head injuries, the highest rates of traumatic experiences, and the highest rates of mental illness diagnoses. The gas and markers class had the highest rate of reporting hearing voices, followed by the severe polyinhalant use class, and the moderate polyinhalant use class. Results of this study underscore the need to address the high rate of head injuries and mental health diagnoses that contribute to severe polyinhalant use. 相似文献
8.
Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery‐oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person‐centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of person‐centered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence‐based, recovery‐oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person‐centered care. Treatment engagement is complex and multifaceted, but optimizing recovery‐oriented skills and attitudes is essential in delivery of services to those with serious mental illness. 相似文献
9.
10.
Adults with severe mental illness have extraordinarily high rates of co-occurring
substance use disorders, typically around 50% or more, which adversely affect
their current adjustment, course, and outcome. Separate and parallel mental
health and substance abuse treatment systems do not offer interventions that
are accessible, integrated, and tailored for the presence of co-occurrence.
Recent integrated interventions for this population have the specific goal
of ameliorating substance use disorder and the general goal of improving adjustment
and quality of life. The authors overview the current research and offer guidelines
related to mission and philosophy, leadership, comprehensive reorganization,
training, specific programs, and quality improvement. 相似文献
11.
Adolescence methamphetamine use is an issue of considerable concern due to its correlation with later delinquency, divorce, unemployment and health problems. Understanding how adolescents initiate methamphetamine abuse is important in developing effective prevention programs. We formulate a mathematical model for the spread of methamphetamine abuse using nonlinear ordinary differential equations. It is assumed that susceptibles are recruited into methamphetamine use through imitation. An epidemic threshold value, \({\mathcal {R}}_a\), termed the abuse reproduction number, is proposed and defined herein in the drug-using context. The model is shown to exhibit the phenomenon of backward bifurcation. This means that methamphetamine problems may persist in the population even if \({\mathcal {R}}_a\) is less than one. Sensitivity analysis of \({\mathcal {R}}_a\) was performed to determine the relative importance of different parameters in methamphetamine abuse initiation. The model is then fitted to data on methamphetamine users less than 20 years old reporting methamphetamine as their primary substance of abuse in the treatment centres of Cape Town and parameter values that give the best fit are chosen. Results show that the proportion of methamphetamine users less than 20 years old reporting methamphetamine as their primary substance of abuse will continue to decrease in Cape Town of South Africa. The results suggest that intervention programs targeted at reducing adolescence methamphetamine abuse, are positively impacting methamphetamine abuse. 相似文献
12.
Martin Knapp Anita Patel Claire Curran Eric Latimer Jocelyn Catty Thomas Becker Robert E. Drake Angelo Fioritti Reinhold Kilian Christoph Lauber Wulf Rössler Toma Tomov Jooske van Busschbach Adelina Comas‐Herrera Sarah White Durk Wiersma Tom Burns 《World psychiatry》2013,12(1):60-68
A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost‐effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost‐benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost‐effective than standard vocational services. Further analysis demonstrated cost‐benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost‐saving and almost certainly more cost‐effective as a way to help people with severe mental health problems into competitive employment. 相似文献
13.
Rebecca Kershnar Charlene Hooper Marji Gold Errol R. Norwitz Jessica L. Illuzzi 《The Yale journal of biology and medicine》2009,82(4):129-141
Purpose: Several studies have documented a deficiency in the
delivery of preventive services to adolescents during physician visits in the
United States. This study sought to assess and compare pediatric, family
medicine (FM), and obstetrics and gynecology (OB/GYN) resident perceptions of
their responsibility, training, and experience with providing comprehensive
health care services to adolescents.Methods: A 57-item, close-ended survey was designed and administered
to assess resident perceptions of the scope of their practice, training, and
experience with providing adolescent health care across a series of health care
categories.Results: Of the 87 respondents (31 OB/GYN, 29 FM, and 27 pediatric),
most residents from all three fields felt that the full range of adolescent
preventive and clinical services represented in the survey fell under their
scope of practice. Residents from all three fields need more training and
experience with mental health issues, referring teenagers to substance abuse
treatment programs, and addressing physical and sexual abuse. In addition,
OB-GYN residents reported deficiencies in training and experience regarding
several preventive counseling and general health services, while pediatric
residents reported deficiencies in training and experience regarding sexual
health services.Conclusions: Our results indicate that at this time, residents from
these three specialties are not optimally prepared to provide the full range of
recommended preventive and clinical services to adolescents. 相似文献
14.
A Bayesian multinomial logistic exposure model for estimating probabilities of competing sources of nest failure 下载免费PDF全文
Understanding causes of nest loss is critical for the management of endangered bird populations. Available methods for estimating nest loss probabilities to competing sources do not allow for random effects and covariation among sources, and there are few data simulation methods or goodness‐of‐fit (GOF) tests for such models. We developed a Bayesian multinomial extension of the widely used logistic exposure (LE) nest survival model which can incorporate multiple random effects and fixed‐effect covariates for each nest loss category. We investigated the performance of this model and the accompanying GOF test by analysing simulated nest fate datasets with and without age‐biased discovery probability, and by comparing the estimates with those of traditional fixed‐effects estimators. We then exemplify the use of the multinomial LE model and GOF test by analysing Piping Plover Charadrius melodus nest fate data (n = 443) to explore the effects of wire cages (exclosures) constructed around nests, which are used to protect nests from predation but can lead to increased nest abandonment rates. Mean parameter estimates of the random‐effects multinomial LE model were all within 1 sd of the true values used to simulate the datasets. Age‐biased discovery probability did not result in biased parameter estimates. Traditional fixed‐effects models provided estimates with a high bias of up to 43% with a mean of 71% smaller standard deviations. The GOF test identified models that were a poor fit to the simulated data. For the Piping Plover dataset, the fixed‐effects model was less well‐supported than the random‐effects model and underestimated the risk of exclosure use by 16%. The random‐effects model estimated a range of 1–6% probability of abandonment for nests not protected by exclosures across sites and 5–41% probability of abandonment for nests with exclosures, suggesting that the magnitude of exclosure‐related abandonment is site‐specific. Our results demonstrate that unmodelled heterogeneity can result in biased estimates potentially leading to incorrect management recommendations. The Bayesian multinomial LE model offers a flexible method of incorporating random effects into an analysis of nest failure and is robust to age‐biased nest discovery probability. This model can be generalized to other staggered‐entry, time‐to‐hazard situations. 相似文献
15.
Relationships between substance abuse/dependence and psychiatric disorders based on polygenic scores
Xaquín Gurriarn Julio Rodríguez‐Lpez Gerardo Flrez Csar Pereiro Jos M. Fernndez Emilio Farias Valentín Estvez Manuel Arrojo Javier Costas 《Genes, Brain & Behavior》2019,18(3)
Genetic susceptibility to substance use disorders (SUDs) is partially shared between substances. Heritability of any substance dependence, estimated as 54%, is partly explained by additive effects of common variants. Comorbidity between SUDs and other psychiatric disorders is frequent. The present study aims to analyze the additive role of common variants in this comorbidity using polygenic scores (PGSs) based on genome‐wide association study discovery samples of schizophrenia (SCZ), bipolar disorder, attention‐deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder and anxiety disorders, available from large consortia. PGSs were calculated for 534 patients meeting DSM‐IV criteria for dependence of a substance and abuse/dependence of another substance between alcohol, tobacco, cannabis, cocaine, opiates, hypnotics, stimulants, hallucinogens and solvents; and 587 blood donors from the same population, Iberians from Galicia, as controls. Significance of the PGS and percentage of variance explained were calculated by logistic regression. Using discovery samples of similar size, significant associations with SUDs were detected for SCZ PGS. SCZ PGS explained more variance in SUDs than in most psychiatric disorders. Cross‐disorder PGS based on five psychiatric disorders was significant after adjustment for the effect of SCZ PGS. SCZ PGS was significantly higher in women than in men abusing alcohol. Our findings indicate that SUDs share genetic susceptibility with SCZ to a greater extent than with other psychiatric disorders, including externalizing disorders such as attention‐deficit/hyperactivity disorder. Women have lower probability to develop substance abuse/dependence than men at similar PGS probably because of a higher social pressure against excessive drug use in women. 相似文献
16.
Depression, suicidality and substance abuse disorders are examined with special emphasis on the role of stressful life events in predicting severity and patterns of comorbidity among American Indian and Alaska Native adolescents in boarding school environments. Both amount and severity of comorbidity increase with age and specific patterns of comorbidity are associated with gender. Different types and amounts of stressful life events predict specific combinations of comorbidity. These outcomes are interpretable with respect to associated cultural dynamics and the ecology of mental health services delivery for Indian and Native adolescents. Theoretical and methodological issues are discussed in relation to the use of stressful life events in examining cultural factors related to comorbidity among culturally different populations. 相似文献
17.
We consider a compelling research question raised by the growing prevalence of overweight among adolescents: do overweight adolescents incur greater health care expenditures than adolescents of normal weight? To address this question, we use data from the Medical Expenditure Panel Survey (MEPS) and estimate a two-part, generalized linear model (GLM) of health spending. Considering separate models by gender, we find that overweight females incur $790 more in annual expenditures than those of normal weight but we find no expenditure differences by bodyweight for males. We find that mental health spending is associated with part of the disparity in expenditures for adolescent females but establishing causality between mental health problems and weight-related health expenditure differences is challenging. 相似文献
18.
Jim van Os Sinan Guloksuz Thomas Willem Vijn Anton Hafkenscheid Philippe Delespaul 《World psychiatry》2019,18(1):88-96
The content and organization of mental health care have been heavily influenced by the view that mental difficulties come as diagnosable disorders that can be treated by specialist practitioners who apply evidence‐based practice (EBP) guidelines of symptom reduction at the group level. However, the EBP symptom‐reduction model is under pressure, as it may be disconnected from what patients need, ignores evidence of the trans‐syndromal nature of mental difficulties, overestimates the contribution of the technical aspects of treatment compared to the relational and ritual components of care, and underestimates the lack of EBP group‐to‐individual generalizability. A growing body of knowledge indicates that mental illnesses are seldom “cured” and are better framed as vulnerabilities. Important gains in well‐being can be achieved when individuals learn to live with mental vulnerabilities through a slow process of strengthening resilience in the social and existential domains. In this paper, we examine what a mental health service would look like if the above factors were taken into account. The mental health service of the 21st century may be best conceived of as a small‐scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability, complemented by a limited number of regional facilities. Peer support, organized at the level of a recovery college, may form the backbone of the community. Treatments should be aimed at trans‐syndromal symptom reduction, tailored to serve the higher‐order process of existential recovery and social participation, and applied by professionals who have been trained to collaborate, embrace idiography and maximize effects mediated by therapeutic relationship and the healing effects of ritualized care interactions. Finally, integration with a public mental health system of e‐communities providing information, peer and citizen support and a range of user‐rated self‐management tools may help bridge the gap between the high prevalence of common mental disorder and the relatively low capacity of any mental health service. 相似文献
19.
Anna Chiumento Muhammad Naseem Khan Atif Rahman Lucy Frith 《Developing world bioethics》2016,16(1):15-28
Recently the World Health Organization (WHO) has highlighted the need to strengthen mental health systems following emergencies, including natural and manmade disasters. Mental health services need to be informed by culturally attuned evidence that is developed through research. Therefore, there is an urgent need to establish rigorous ethical research practice to underpin the evidence‐base for mental health services delivered during and following emergencies. 相似文献
20.
Matthew K. Vendlinski Kristin N. Javaras Carol A. Van Hulle Kathryn Lemery-Chalfant Rose Maier Richard J. Davidson H. Hill Goldsmith 《PloS one》2014,9(7)