Search

Objective: This work focuses on understanding quality of life and evaluating a brief quality of life measure in an outpatient emerging adult (17-25 years of age) substance use program. Method: Mixed methods were used including: (a) psychometric evaluation of the adapted MyLifeTracker (MLT) based on assessments completed four times throughout treatment (n = 100) and (b) qualitative interviews with 12 emerging adults in the program. The study was codesigned, cofacilitated, and cointerpreted with emerging adults with lived experience. Results: At intake, emerging adults reported quality of life scores of 3.7/10 on average and significantly improved (change M = 2.1 points, d = 0.86, p < .001) at the ∼12-week follow-up demonstrating program effects and sensitivity to change. Factor analysis suggested unidimensionality of the measure and internal consistency was high (ω = 0.81). MLT scores correlated in expected directions with other measures of quality of life, functioning, and mental health symptoms and demonstrated incremental validity in explaining variability in these measures over and above World Health Organization quality of life items. Emerging adults thought the five items (i.e., general well-being, day-to-day activities, relationships with friends, relationships with family, coping) generally captured the most important aspects of quality of life to them and had positive impressions regarding the use of this measure for measurement-based care. Other important aspects of quality of life included feeling a sense of meaning, purpose, motivation, and independence. Conclusion: Overall, the MLT demonstrated evidence of psychometric and content validity among emerging adults in substance use treatment. Public Health Significance Statement This study demonstrates the relevance and validity of the MyLifeTracker (MLT) as a brief measure of quality of life among emerging adults who use substances. This study also highlights the clinical utility of the MLT and the importance of including measures of quality of life as part of measurement-based care for emerging adults with substance use concerns. [ABSTRACT FROM AUTHOR]

Previous research has identified illicit substance use on hospital property as an ongoing concern, particularly in inpatient mental health units. This research, combined with concerns raised by healthcare providers, patients, and patients' families, resulted in one hospital in a medium‐sized city in Canada enacting two internal strategies for the management of illicit substances on hospital property. The unit‐based Green‐Yellow‐Red procedure employs environmental scanning and regular risk assessment to report the incidence rate of illicit substances suspected and/or found in the unit, to inform staff of the extent of necessary interventions which should ensue. The hospital‐wide Management of Illicit Substances protocol includes ten steps which can be followed by any staff member who suspects they have found an illicit substance or related paraphernalia on hospital grounds. This paper discusses the creation and implementation of these two strategies, as well as associated challenges and outcomes of each. Overall, these strategies have effectively functioned to mitigate the potential dangers of exposure to illicit substances for staff and patients alike. These results stand to encourage other institutions to implement similar strategies in order to better manage situations in which illicit substances are suspected or discovered on hospital property. [ABSTRACT FROM AUTHOR]

Abstract Background The immune mechanisms associated with infection-induced disease exacerbations in asthma and COPD are not fully understood. Toll-like receptor (TLR) 3 has an important role in recognition of double-stranded viral RNA, which leads to the production of various inflammatory mediators. Thus, an understanding of TLR3 activation should provide insight into the mechanisms underlying virus-induced exacerbations of pulmonary diseases. Methods TLR3 knock-out (KO) mice and C57B6 (WT) mice were intranasally administered repeated doses of the synthetic double stranded RNA analog poly(I:C). Results There was a significant increase in total cells, especially neutrophils, in BALF samples from poly(I:C)-treated mice. In addition, IL-6, CXCL10, JE, KC, mGCSF, CCL3, CCL5, and TNFα were up regulated. Histological analyses of the lungs revealed a cellular infiltrate in the interstitium and epithelial cell hypertrophy in small bronchioles. Associated with the pro-inflammatory effects of poly(I:C), the mice exhibited significant impairment of lung function both at baseline and in response to methacholine challenge as measured by whole body plethysmography and an invasive measure of airway resistance. Importantly, TLR3 KO mice were protected from poly(I:C)-induced changes in lung function at baseline, which correlated with milder inflammation in the lung, and significantly reduced epithelial cell hypertrophy. Conclusion These findings demonstrate that TLR3 activation by poly(I:C) modulates the local inflammatory response in the lung and suggest a critical role of TLR3 activation in driving lung function impairment. Thus, TLR3 activation may be one mechanism through which viral infections contribute toward exacerbation of respiratory disease.

High rates of substance misuse during emerging adulthood (~17-25 years of age, also referred to as young adulthood) require developmentally appropriate clinical programs. This article outlines: 1) the development of an evidence-informed young adult outpatient substance use program that takes a biopsychosocial patient-centred approach to care; 2) a quality improvement process and protocol; and 3) the patient characteristics of an initial cohort. Literature reviews, program reviews, environmental scans, and consultations with interested parties (including individuals with lived expertise) were used to develop the program. A 12-week measurement-based care program was developed comprising: 1) individual measurement-based care and motivational enhancement therapy sessions; 2) group programming focused on cognitive behavioural therapy, mindfulness, distress tolerance, and emotional regulation; 3) clinical consultations for diagnostic clarification and/or medication review; and 4) an independent Community Reinforcement Approach Family Training (CRAFT) group for loved ones. A measurement system was concurrently created to collect clinical and program evaluation data at six time points. In the first 21 months of the program, 152 young adults enrolled in the program (mean age = 21 years old, 47% female gender) primarily reporting treatment targets of cannabis (68%) and alcohol (63%) and almost all presenting with co-occurring mental health concerns (95%). The initial cohort who completed the program showed symptom improvements. Collectively, the program demonstrates the feasibility of developing an evidence-informed young adult substance use program using measurement-based care, but also the need for flexibility and ongoing monitoring to meet local needs. [ABSTRACT FROM AUTHOR]