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This study extends the limited research on predictors of completion of adolescent residential drug and alcohol program. A Queensland, Australia, five-bed state-wide voluntary adolescent drug and alcohol withdrawal service collected routine clinical pre-entry data over a period of 9 years (2000–2009) on 524 subjects. Potential predictors of program completion included socio-demographic, family functioning, past mental health history, mental health problems on admission, and patterns of drug use variables. The chi-square analysis identified significant predictors with subsequent multivariate logistic regression modeling. Given the loss of data, additional multiple imputation logistic regression analysis was utilized. Initial predictors were aged 17 and over; a past history of psychiatric treatment or violence or assault; mental health problems identified on entry; absence of current alcohol use or ecstasy use. After regression and multiple imputation modeling, predictors were a history of psychiatric treatment and of violence/assault. A history of co-morbidity rather than traditional markers of good outcomes such as sex, ethnic background, income support, and housing support predicted program retention. The study reinforces the important role of non-substance psychiatry co-morbidity in the treatment of substance use disorder. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is a group of health conditions affecting the heart and vascular system with very high prevalence and mortality rates. The presence of CVD is characterised by high levels of inflammation which have previously been associated with increased plasma concentrations of N-acetyl neuraminic acid (Neu5Ac). While Neu5Ac has been studied in the context of CVD, Neu5,9Ac2 has not, despite being the second most abundant sialic acid in human plasma. A small-scale pilot study of thirty plasma samples from patients with diagnosed CVD, and thirty age and sex-matched healthy controls, was designed to gain insight into sialic acids as biomarkers for CVD and potential future areas of study. Each sample was assayed for Neu5Ac and Neu5,9Ac2 concentrations. Mean Neu5Ac and Neu5,9Ac2 concentrations were significantly elevated in patients with CVD compared to healthy controls (Neu5Ac: P < 0.001; Neu5,9Ac2: P < 0.04). Receiver operator curve (ROC) analysis indicated that both Neu5Ac and Neu5,9Ac2 have reasonable predictive power for the presence of CVD (Neu5Ac AUC: 0.86; Neu5,9Ac2 AUC: 0.71). However, while Neu5Ac had both good sensitivity (0.82) and specificity (0.81), Neu5,9Ac2 had equivalent specificity (0.81) but very poor sensitivity (0.44). A combination marker of Neu5Ac + Neu5,9Ac2 showed improvement over Neu5Ac alone in terms of predictive power (AUC: 0.93), sensitivity (0.87), and specificity (0.90). Comparison to a known inflammatory marker, high sensitivity c-reactive protein (hs-CRP: P-value: NS, ROC:0.50) was carried out, showing that both Neu5Ac and Neu5,9Ac2 outperformed this marker. Further to this, hs-CRP values were combined with the three different sialic acid markers to determine any effect on the AUC values. A slight improvement in AUC was noted for each of the combinations, with Neu5Ac + Neu5,9Ac2 + hs-CRP giving the best AUC of 0.97 overall. Thus, Neu5Ac would appear to offer good potential as a predictive marker for the presence of CVD, which the addition of Neu5,9Ac2 predictive power improves, with further improvement seen by the addition of hs-CRP. [ABSTRACT FROM AUTHOR]

Domestic and family violence (DFV) is a serious, worldwide public health concern and the literature suggests that women who have experienced violence identify health care providers as the professionals they would most trust with disclosure of abuse. Social work is well positioned to respond to women presenting in hospitals after experiencing DFV and in advocating for systems and policy initiatives to support health staff in becoming adequately trained and supported to detect and respond appropriately. This paper reports on research that surveyed health staff in two hospitals in Queensland, Australia, to identify what DFV training they had received, whether this training increased their knowledge, skills and confidence to address DFV and what services they would access to support women presenting with DFV. The results showed that the respondents were an experienced staff group who had worked in the health sector for 10–20 years but despite having access to State-based training, the majority of them had not completed any in-house training and only 12% had received face-to-face training, and when they did undertake training, it was usually only a two-hour session. Seventy-five per cent of respondents would refer to their hospital-based social worker and 40% would make referrals to other support services, primarily social work. IMPLICATIONS Hospitals need to prioritise, commit to, and resource appropriate and regular training to better equip health staff to identify and respond to DFV. Training needs to build the knowledge and skills of staff members to address their confidence to intervene and offer support. Social work can provide an important role in advocating and developing training and procedures to sustain health staff members' capacity to respond appropriately to DFV. [ABSTRACT FROM AUTHOR]

Objective: To work collaboratively with women accessing an integrated program for women with substance use in pregnancy to learn how services can be improved., Design: Qualitative design using focus groups within a participatory action framework., Setting: Sheway, a program located in the Downtown Eastside of Vancouver, BC., Participants: A total of 21 co-researchers who were women who had accessed Sheway services., Methods: Semistructured focus groups were recorded and transcribed. Data analysis was iterative and reviewed weekly with focus group members. Themes were member checked and reviewed with co-researchers. The action phase of the project involved the co-researchers presenting their main findings to the Sheway staff members. The staff and women worked collaboratively to implement client-directed changes to the program., Main Findings: Co-researchers described Sheway as family. They expressed concern about transitioning from the program to other community services and identified stereotypes and negative treatment by health care providers as barriers to their transition out of the program. One action project developed by the co-researchers was a "transition group" where women could connect to current and former Sheway clients. The women could retain the social support they gained through Sheway while learning about other resources. The co-researchers also prioritized developing peer-to-peer mentorship to support new clients. The findings of the research were disseminated to Sheway staff, the Department of Family Practice at the University of British Columbia, and local family medicine maternity care providers with the hope of improving care for women with substance use in pregnancy., Conclusion: A participatory action framework allowed women to engage as co-researchers. The co-researchers emphasized the importance of relationships and a sense of family with other women as well as providers as positive aspects of their care. Women involved in this project identified negative attitudes of health care providers toward substance use in pregnancy as barriers. Co-researchers proposed transition support and peer-to-peer networking as action projects to improve their care., (Copyright© the College of Family Physicians of Canada.)