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Aims Alcohol use disorder (AUD) is a common mental disorder characterized by sex-gender differences (SGDs). The present study was aimed at evaluating attitudes displayed by Italian AUD treatment services towards investigating the presence of SGDs in their patients and implementing gender-specific treatments for female AUD patients. Methods Potential SGDs were initially investigated in a sample of AUD outpatients, subsequently followed by a national survey on the adoption of specific interventions for female AUD outpatients. Results The presence of SGDs was confirmed in a sample of 525 (332 men; 193 women) AUD outpatients, including a higher prevalence of anxiety and mood disorders, and episodes of violence and trauma among female AUD outpatients compared to males. Despite the presence of these SGDs, only <20% of a total of 217 Italian AUD treatment services reported the implementation of specific strategies for female AUD outpatients. The majority of services (94%) reported investigating episodes of violence and/or trauma, largely resorting to specific procedures only when these issues were detected. Conclusions Our findings confirm the presence of SGDs among AUD outpatients, including a higher prevalence of anxiety and mood disorders and episodes of violence and trauma among females compared with males. However, only a small number of services have adopted a gender medicine approach in AUD treatment. These results underline the urgency of investigating the specific needs of female, male, and non-binary AUD patients in order to personalize and enhance the effectiveness and appeal of AUD treatment. [ABSTRACT FROM AUTHOR]

Introduction: Persons with substance use disorders (SUD) make up a considerable proportion of mental health care service users worldwide. Since 2010, Belgian mental health care has undergone a nationwide reform ('Title 107') aiming to realize a mental health care system that fosters more intensive collaboration, strengthens the cohesion and integration across and between different services, and is more responsive to the support needs of all service users. Although persons with SUD were named as a prioritized target group, how this reform impacted the lives and recovery journeys of persons with SUD remains understudied. This study aims to investigate how persons with SUD, regardless of whether they have co-occurring mental health issues, experience the accessibility of mental health care in light of the 'Title 107' reform. Methods: Data were collected by means of in-depth interviews with a heterogeneous sample of persons with SUD (n=52), recruited from five regional mental health networks in Belgium. In-depth interviews focused on experiences regarding (history of) substance use, accessibility of services and support needs, and were analyzed thematically. Results: Five dynamic themes came to the fore: fragmentation of care and support, the importance of "really listening", balancing between treatment-driven and person-centered support, the ambivalent role of peers, and the impact of stigma. Discussion: Despite the 'Title 107' reform, persons with SUD still experience mental health care services as 'islands in the stream', pointing to several pressing priorities for future policy and practice development: breaking the vicious cycles of waiting times, organizing relational case management, tackling stigma and centralizing lived experiences, and fostering recovery-promoting collaboration. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Cultural inclusion and competence are understood at the most basic level to be the practice of considering culture so as to provide effective services to people of different cultural backgrounds. In order to work better with clients from diverse backgrounds, alcohol and other drug (AOD) services need to offer a service that is designed to be accessible to all people, where systems in place operate in a way that considers different cultural needs. This research aimed to assess the extent to which non‐government AOD services in New South Wales are positioned to support cultural inclusion as well as to evaluate the acceptability of a cultural inclusion audit across four AOD sites.The research adopted a mixed methods approach comprising of a pre‐audit online survey (n = 85) designed to assess AOD services' attitudes and practices towards cultural inclusion, and in‐depth interviews that were conducted with nine AOD service staff and four cultural auditors to explore the acceptability of a cultural inclusion audit process.Findings from the survey indicate cultural inclusion practices are limited. Interview data highlight that while staff are not fully aware of what appropriate cultural inclusions entails, they are receptive to and want a cultural inclusion program.The study illustrates the benefits of implementing a cultural inclusion audit process aimed at raising awareness of what cultural inclusion entails. Including a cultural inclusion service audit is likely to enhance AOD service provision to culturally and linguistically diverse groups and thereby improve treatment outcomes. [ABSTRACT FROM AUTHOR]

IntroductionPersons with substance use disorders (SUD) make up a considerable proportion of mental health care service users worldwide. Since 2010, Belgian mental health care has undergone a nationwide reform (‘Title 107’) aiming to realize a mental health care system that fosters more intensive collaboration, strengthens the cohesion and integration across and between different services, and is more responsive to the support needs of all service users. Although persons with SUD were named as a prioritized target group, how this reform impacted the lives and recovery journeys of persons with SUD remains understudied. This study aims to investigate how persons with SUD, regardless of whether they have co-occurring mental health issues, experience the accessibility of mental health care in light of the ‘Title 107’ reform.MethodsData were collected by means of in-depth interviews with a heterogeneous sample of persons with SUD (n=52), recruited from five regional mental health networks in Belgium. In-depth interviews focused on experiences regarding (history of) substance use, accessibility of services and support needs, and were analyzed thematically.ResultsFive dynamic themes came to the fore: fragmentation of care and support, the importance of “really listening”, balancing between treatment-driven and person-centered support, the ambivalent role of peers, and the impact of stigma.DiscussionDespite the ‘Title 107’ reform, persons with SUD still experience mental health care services as ‘islands in the stream’, pointing to several pressing priorities for future policy and practice development: breaking the vicious cycles of waiting times, organizing relational case management, tackling stigma and centralizing lived experiences, and fostering recovery-promoting collaboration.

Background It is of great significance to clarify the characteristics of the main population served by community health service institutions for the precise reform of community health service institutions in the next step. Objective To provide accurate data support for the next reform policy formulation and adjustment by analyzing the characteristics of the beneficiary population in terms of curative care expenditure (CCE) in community health service institutions in Beijing before and after the comprehensive reform. Methods The basic data of this study was obtained from the basic database of total health expenditure accounting in Beijing from 2016 to 2019, and other data was obtained from Beijing Health Statistical Yearbook, Beijing Health Financial Statistics Annual Report, and Beijing Health Expenditure Accounting Report from 2016 to 2019. The multi-stage stratified cluster sampling was adopted to select community health service institutions, and the annual out-patient data and in-patient data were included from HIS system. System of Health Accounts 2011 (SHA 2011) was used to calculate and analyze the situation of the beneficiaries of community health service institutions. Results The CCE of community health service institutions in Beijing increased from 12.181 billion yuan to 22.245 billion yuan with an average annual increase of 19.07% from 2016 to 2019. The CCE of middle-aged and elderly patients over 40 years age accounted for more than 92% over the years, and CCE of patients in the age groups of 60s and 80s increased rapidly, with an average annual growth rate of 24.08% and 25.84%, respectively. Among the CCE, endocrine, nutritional and metabolic diseases, abnormal symptoms, signs and test results, circulatory system diseases accounted for the highest proportion. The CCE of endocrine, nutritional and metabolic diseases, nervous system diseases, abnormal symptoms, signs and test results increased rapidly, with an average annual growth rate of 40.11%, 48.40% and 32.43%, respectively. Conclusion The effectiveness of hierarchical diagnosis and treatment has begun to emerge after the comprehensive reform. Community medical service resources in Beijing are mainly consumed by middle-aged and elderly patients and patients with chronic non-communicable diseases such as endocrine and circulatory diseases. The comprehensive reforms guided more middle-aged and elderly people and patients with chronic diseases to community health service institutions. Community health service institutions should improve their service capacities in many aspects, such as service capacity, human resource, chronic disease management and medical consortium construction, to consolidate and maintain the effectiveness of the reform.

Background: Women experiencing substance use disorders face barriers to treatment, including childcare, stigma and lack of gender/trauma-informed programming. Several non-government organizations in New South Wales run women-only treatment services to address these needs. Objectives: We aim to assess characteristics of women entering treatment in these services. Design: Data on client characteristics from six women-only non-government organization substance use disorder treatment services in New South Wales between 2014 and 2018 were extracted from a database containing demographics, drug use and treatment characteristics and psychological distress (Kessler-10 scale) of women entering the services. Logistic regression models were used to estimate unadjusted odds ratio and adjusted odds ratio for treatment completion and different drugs on entry. Results: Data were available for 1357 women. Most (91%) episodes were for residential treatment. Women's mean age was 35.4 years (standard deviation = 9.8; range = 17–67). Residential clients tended to be younger than non-residential clients (35.1 vs 38.5 years, p < 0.001). Methamphetamine (43%) and alcohol (32%) were the most reported principal drug of concern. Women (89%) reported high levels of psychological distress (median Kessler-10 scale score = 27.5, range = 10–50), highest for women reporting alcohol as their principal drug. Overall, 43% of episodes resulted in treatment completion, most commonly for women entering residential treatment (45% vs 22%, p < 0.001) and for alcohol treatment (adjusted odds ratio = 1.42; confidence interval = 1.07–1.90; p < 0.001). Women with Kessler-10 scale scores indicating anxiety or depression at treatment entry were less likely to complete treatment than those with lower scores (adjusted odds ratio = 0.56; confidence interval = 0.38–0.80; p < 0.001). Conclusion: Women entering women-only residential treatment tend to be younger and report methamphetamine as principal drug of concern. Women enter treatment with high degrees of psychological distress. Women's services need to ensure their programmes can respond to diverse needs of younger women presenting with methamphetamine use disorder and older women with alcohol use disorder experiencing high levels of psychological distress. [ABSTRACT FROM AUTHOR]

The aims of this study were to (a) classify the types of individuals who might be most appropriately served by a mental health court (MHC) and (2) describe the association between class membership on recidivism and MHC completion. Criminal and treatment history data for 350 MHC participants were used. Class memberships were derived using hidden Markov models. Mediation analysis was then used determine the relationship between class, successful MHC completion, and recidivism. Modeling identified a three-class solution and a subsequent path analysis found that those classes associated with lower criminal justice system involvement were more likely to finish MHC successfully and were less likely to recidivate. This study supports research showing patterns of criminal behavior and health/mental health service use is associated with MHC completion and recidivism. The classification of individuals presented here may help court professionals determine to whom MHC should be offered. [ABSTRACT FROM AUTHOR]

An obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women's bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations. This study aimed to uncover North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services. Qualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services. A purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible. Four themes emerged from North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers. The findings from this study highlighted the depth of women's experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women's voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities. Reproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities. [ABSTRACT FROM AUTHOR]

With over 4 million adults under community supervision and an average of 30% that do not fare well, an unanswered question is which strategies reduce the likelihood of technical, absconding, and new arrest violations during the early phase of supervision. Utilizing data on 32,335 moderate to high-supervised individuals on supervision in North Carolina, the study found that success during the first 6 months is due to probation officers' use of incentives to promote positive behavior and swift community-based consequences to address negative behavior, prioritizing treatment services or cognitive programs, increasing monitoring requirements, and using skill-building worksheets to increase engagement and build rapport. Officer actions are more important than individual characteristics, and can promote success for those that are under the age of 31, have more complex needs, and are identified as at-risk for violating supervision. Future studies should explore these concepts more directly regarding their relationship with recidivism. [ABSTRACT FROM AUTHOR]

Objectives: Substance use disorders (SUD) among older adults have become a serious public health concern. The purpose of this study was to assess which states in the Southern U.S. are more responsive to SUD treatment needs of older adults.Methods: This study is a secondary data analysis of the N-SSATS-2019 dataset.Results: There were 1,215 substance treatment facilities in the five states. Kentucky had the highest number of substance use treatment facilities (n = 449, 37%), followed by Georgia (357, 29%), Alabama (153, 13%), Louisiana (146, 12%) and then Mississippi (110, 9%). Out of the 1,215 facilities, only 20% (n = 244) indicated that they had programs specifically tailored for older adults. Kentucky had the largest number of facilities per 1 million older adults while Mississippi had the highest number of facilities per 1 million older adults offering detoxification services. Alabama had the lowest number of services per 1 million adults in all categories examined.Conclusion: Across the U.S., most adults with SUD do not have access to substance use treatment; in the southeastern region of the country, higher rates of poverty, rural geography and stigma, and lack of treatment availability may further complicate individuals' ability to access substance use-related medical care. [ABSTRACT FROM AUTHOR]

Introduction: The satisfaction of diabetic patients with the treatment and their cooperation in obtaining therapeutic results and increasing quality of life is very decisive. This study aimed to investigate the relationship between type II diabetes patients' satisfaction with medical services and their quality of life. Methods: This cross-sectional study was conducted on 198 type II diabetic patients referred to Hamadan Diabetes Clinic in 2021. The convenience sampling method was used to select the samples. The data were collected using a checklist of demographic characteristics and the quality of care, patient behavior, and quality of life researcher-made questionnaire. The obtained data were then analyzed in SPSS software at a significant level of 0.05. Results: According to the results, the majority of the participants were female (70.71%), and the mean age of the respondents was obtained at 59.65 ± 9.26 years. In addition, the mean score of quality of life was estimated at 84.7±12.6. The quality of life score showed a significant relationship with education level, marital status, employment status, and body mass index. The mean score of satisfaction with services was 92.78±19.8. The high level of education and lack of health insurance revealed a correlation with lower satisfaction with services. Finally, there was a direct and significant relationship between quality of life and satisfaction with the received services. Conclusion: A significant relationship was found between the quality of life and the level of satisfaction with the services received. Therefore, improving the quality of medical services for these patients in order to increase their satisfaction level with treatment can be effective in enhancing their quality of life. [ABSTRACT FROM AUTHOR]

Background: The ongoing and evolving overdose epidemic highlights the need to translate research results into routine clinical practice to address urgent service delivery needs. Implementation science is a relatively new discipline intended to develop systematic, replicable, scalable strategies to accelerate this translation. This article presents a comprehensive review of implementation research funded by the National Institute on Drug Abuse (NIDA)., Methods: The study identified all NIDA-funded research grants awarded in fiscal years 2007 through 2023 in treatment services or prevention research (n = 1111) and screened them to find those with a pre-specified implementation science component (n = 248). Using the text of the grant application, two reviewers independently coded the key characteristics of each study., Results: The characteristics of these grants, and trends over time, are described, and priority gap areas are identified. NIDA's implementation research grants have demonstrated increasing rigor in design and measurement., Conclusions: Growth in the portfolio has been driven in part by NIDA's investments in research-practice partnerships in the criminal-legal system, and by recent efforts to address the overdose epidemic., Competing Interests: Declaration of competing interest Nothing to declare., (Published by Elsevier Inc.)

Introduction: Internationally, clinical/practice supervision is considered essential in the development and maintenance of professional proficiency across health disciplines. Among alcohol and other drug (AOD) workers, however, access to effective clinical supervision is limited. This study examined perceived barriers and facilitators to: (i) AOD workers accessing effective clinical supervision; and (ii) effective implementation of a clinical supervision exchange model in the AOD sector. Methods: Qualitative interviews with frontline workers (n = 10) and managers (n = 11) employed by eight government and non‐government AOD treatment services in Brisbane, Australia were undertaken. Interviews were audio recorded, transcribed and data were thematically analysed. Results: Frontline workers and managers shared similar views. Reported barriers and facilitators to accessing effective clinical supervision included limited time, the high cost of providers, availability of skilled clinical supervisors, supervisor–supervisee matching and supervision modality. Participants considered the implementation of a clinical supervision exchange model to be a resource‐effective strategy to increase access to external, individual clinical supervision while also exposing workers to a greater diversity of perspectives, increasing sector collaboration and improving the perceived value of clinical supervision among the workforce. Discussion and Conclusions: The findings of this study suggest that limited time, cost and availability of skilled supervisors are primary barriers to AOD workers accessing high‐quality clinical supervision. Implementation of a clinical supervision exchange model is perceived by frontline workers and service delivery managers to be a resource‐effective strategy for increasing access to high‐quality clinical supervision among workers. [ABSTRACT FROM AUTHOR]

Young, isolated migrants (YIMs) represent some particularly vulnerable populations that have arrived unaccompanied on the national territory and are particularly exposed to mafia networks, delinquency, and prostitution. YIMs thus cumulate social (e.g., precarity, or isolation), psychiatric (e.g., post-traumatic stress disorder, mood, or anxiety disorders), and addiction (e.g., prescription drug dependence) disorders. This addition of vulnerabilities makes the social and medical support difficult to operationalize as it requires multidisciplinary and coordinated programs. In Lyon, the 2nd-largest urban agglomeration in France, the "Dispositif d'accompagnement en Réseau pour l'accès aux soins psychiatriques et addictologiques des jeunes migrants en errance à Lyon" (DARJELY), ("Network System for supporting psychiatric and addiction care to YIMs in Lyon") has been implemented since early 2023 and gathers the following components: (i) a coordinating pair of professionals (i.e., a street worker and an addiction nurse) who ensure a case management of individual situations and articulate the medical and social support with external partners, (ii) an addiction medicine team, (iii) a psychiatric team working at the same place as the addiction medicine team, and (iv) a socio-educational team that can meet YIMs "in situ" and refer them into care, in particular toward teams (ii) and (iii). Overall, DARJELY is thus an innovative system which offers multidisciplinary and coordinated missions toward YIMs including: (i) meeting YIMs on the ground and referring them to specialized care units through the coordination team; (ii) orchestrating the follow-up with other social or medical stakeholders on the local territory; (iii) collecting and synthetizing data for local decision-makers and partners; and (iv) producing research data for improving the understanding of these hard-to-reach populations. All these missions meet current needs of public health regarding these complex populations whose number has been constantly increasing over the recent years., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Although most people gamble safely, national prevalence rates indicate that approximately 0.2 to 1% of the Australian population experience problems with gambling. An issue that has not been extensively researched in Australia is whether the nature of gambling, and the associated harms is consistently observed across the nation. In particular, are there are differences between metropolitan and rural areas in people's experiences with gambling and the associated impacts? A qualitative study involving interviews with 10 help-seekers affected by problem gambling examined the nature of gambling in rural and remote areas and the potential barriers and challenges associated with help-seeking. Particular issues relevant to rural gamblers that set them apart from metropolitan gamblers were: limitations in leisure choices in rural areas; the problem of social familiarity in relation to anonymous help-seeking; and the dearth of specialized services. This study highlights the need to consider the role of rural-specific barriers, motivating and protective factors in developing service delivery models and specialized interventions for problem gambling in rural and remote communities. [ABSTRACT FROM AUTHOR]

BackgroundThe treatment of alcohol and other drugs is now more commonly framed in terms of a chronic condition which requires ongoing monitoring. A model which includes continuing access to health care may optimize outcomes. Most studies of chronic care models have not included health care and have only examined short term effects.MethodsThe sample (n = 783) included consecutive admissions in ten public and private alcohol and other drug (AOD) treatment programs followed over seven years. The outcome was remission which was defined as alcohol and drug abstinence or non-problem use.ResultsIn the private sample, receiving health care services predicted remission across the seven years; however this did not occur in the public sample. More patients in the public treatment sample received AOD treatment readmissions each year, while more of those in the private sector received psychiatric and general health visits. Except for drug problem severity, there were no other clinical differences between the samples. There were no differences in the proportions of patients in the two sectors who received the full spectrum of chronic care services. In the final models, 12-step participation was markedly significant for both samples.ConclusionsModels of chronic care for substance use need to consider differences between private and public treatment and should take into account that individuals may not always have access, or avail themselves of services that may optimize long-term outcomes.

Survivors of sexual trauma face barriers following any incident of sexual violence, and all survivors have a right to accessible treatment. However, this literature review highlights the experiences of male survivors as an underserved population in terms of available research and treatment. Many barriers exist for male survivors, including gender socialization, feminist ideology, victim-to-offender ideology, and treatment programs based on the female experience. Coping experiences remain largely undistinguished among the male survivor subpopulations, including men of color and men who identify as LGBTQ+. This lack of understanding further isolates survivors from support they desperately need. Researchers must investigate prevalence and incidence rates, document individual experiences, record demographic variables in experience, and test treatment theories so professionals can effectively support this silently suffering population. [ABSTRACT FROM AUTHOR]

This article addresses the following research question: How important is the portrayal of culture in its many manifestations in the assessment and analyses of Mexican immigrants and Mexican American families as these two groups grapple with life's challenges and other urban stressors in American society, followed by seeking out assistance in mainstream health, mental health, criminal justice and other social service agencies? Cultural knowledge and the subsequent application of cultural concepts as methods for use by the aforementioned helping and healing programs are presented, as considerations when providing culturally responsive prevention, intervention and treatment services to Mexican immigrants and Mexican Americans. My intention is to offer culturally competent perspectives that can be incorporated into human services fields that often operate from a mainstream model without taking into consideration the importance of diverse cultural influences. Salient information on Mexican and Mexican American histories and cultures is presented in order to provide analysts with information critical to shaping alternative perspectives. Readers are introduced to ongoing issues such as inter-generational and historical trauma, grief associated with loss, cultural and identity conflict, and acculturation, with citations from the historical and contemporary research extrapolated from state-of-theart research coupled with my three decades of experience in community mental health and consulting with students and parents at a charter school, whose enrollment was predominantly Mexican and Mexican American children. [ABSTRACT FROM AUTHOR]

Youth enter the juvenile justice system with a variety of service needs, particularly for mental health problems. Research has examined the extent to which youth have mental health disorders, primarily among detained youth, and factors associated with treatment referrals, but little research has examined youth on probation and the actual use of services. Using data obtained from the Maricopa County Juvenile Probation Department from July 2012 through August 2014 (N = 3,779), the current study examines (1) the factors associated with receiving treatment services while on probation and (2) the factors associated with receiving treatment services through different funding streams. Findings reveal that only about 25% of the sample of youth on probation received treatment services, suggesting the underservicing of youth. Consistent with prior research, there were also racial and ethnic disparities concerning treatment use, with Blacks and Latinos less likely to receive services. Additionally, certain characteristics of youth and their background influenced the funding source for treatment services. Implications for policy and research are discussed in light of these findings. [ABSTRACT FROM AUTHOR]

Introduction: Today, access to healthcare is considered a major indicator of community health. Telemedicine technology is an opportunity to increase access and improve the quality of healthcare in a country's development of a healthcare system. The establishment of a telemedicine system and the provision of healthcare in this way require a proper infrastructure, and multiple factors must be considered. This study investigated the areas of establishing telemedicine and the factors affecting its success in the Health Department of Iran’s oil industry. Methods: This study is objective and analytical (non-experimental) and used the research-applied method to collect information. The statistic community included all professionals and personnel of the Health Department of Iran’s oil industry in 2014-2015. The establishment background and success factors of telemedicine provision were explored based on the study of 341 health experts and professionals. Data was analyzed by SPSS16 and Lisral Software. Results: The results show that both variables, i.e. establishment background (0.63) and organizational effectiveness factors (0.52), had a significant positive effect on the successful implementation of a telemedicine provision system. Furthermore, the factors of successful establishment of a telemedicine system (0.67) had a significant effect. Among the establishment background factors, financial structure (0.87) had the most significant effect on the successful establishment of a telemedicine system. Among the factors influencing success, organizational regulations and rules (0.83) were the most significant. Conclusion: Based on the results of the current study, it is clear that giving the same attention to the establishment background and organizational effectiveness factors will lead to the successful implementation of telemedicine. It is recommended that the managers and policy makers of the country's health sector use and implement telemedicine in other areas as well. With proper planning, this could lead to increased community access to health services, savings in human and financial resources in the healthcare system, and reduced healthcare costs.

Purpose: Although extensive screening services for breast and cervical cancers are available in the Caribbean, these cancers continue to be the leading causes of cancer death among women in this region. The purpose of this study was to determine the quality and availability of breast and cervical cancer treatment care and support services from the perspective of the gatekeepers who provide care for the patients in the Windward Islands of Dominica, Grenada, St Lucia, and St. Vincent.Methods: A qualitative research design using semi-structured, in-depth interviews was used to gather data from gatekeepers who provided oncology prevention and care services to patients for at least one year. Data were collected on availability and quality of cancer care and treatment services and coded using the themes obtained via thematic analysis of the data.Results: Twenty-three current providers participated in the study (Dominica, 5; Grenada, 7; St. Lucia, 5; St. Vincent and the Grenadines, 6). The participants' years of work experience ranged from 2 to 45 years. The codes encompassed a range of social ecological factors that influence breast and cervical cancer screening and treatment in the Windward Islands. The emergent themes were availability of resources, cost of care, and social support.Conclusion: The findings of this study emphasize the varying social determinants of health that affect breast and cervical cancer prevention and treatment. It also highlights the disparities in availability of treatment within the wider Caribbean. It is necessary to broaden the perspective on health from a purely biomedical paradigm to a social perspective. [ABSTRACT FROM AUTHOR]

Objective: When planning severe acute malnutrition (SAM) treatment services, estimates of the number of children requiring treatment are needed. Prevalence surveys, used with population estimates, can directly estimate the number of prevalent cases but not the number of subsequent incident cases. Health managers often use a prevalence-to-incidence conversion factor (J) derived from two African cohort studies to estimate incidence and add the expected number of incident cases to prevalent cases to estimate expected SAM caseload for a given period. The present study aimed to estimate J empirically in different contexts.Design: Observational study, with J estimated by correlating expected numbers of children to be treated, based on prevalence surveys, population estimates and assumed coverage, with the observed numbers of SAM patients treated.Setting: Survey and programme data from six African and Asian countries.Subjects: Twenty-four data sets including prevalence surveys and programme admissions data for 5 months following the survey.Results: A statistically significant relationship between the number of SAM cases admitted to SAM treatment services and the estimated burden of SAM from prevalence surveys was found. Estimate for the slope (intercept forced to be zero) was 2·17 (95 % CI 1·33, 3·79). Estimates for the prevalence-to-incidence conversion factor J varied from 2·81 to 11·21, assuming programme coverage of 100 % and 38 %, respectively.Conclusions: Estimation of expected caseload from prevalence may require revision of the currently used prevalence-to-incidence conversion factor J of 1·6. Appropriate values for J may vary between different locations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To map treatment trajectories in a sample of male and female crack users through their narratives about the course of treatment seeking and their attempts to access health care services in Brazil. METHODS: Qualitative study of a purposive sample (five female and nine male hospitalized crack users) using semi-structured interviews. The interviews were transcribed and data explored using content analysis. RESULTS: Respondents reported difficulties getting access to hospitalization, relapse after discharge, and abandonment of treatment. There seems to be a peculiar model of behavior for women and men while dealing with craving for crack: while women got involved with prostitution and consequently became infected with HIV, every men of the sample reported criminal involvement. CONCLUSIONS: The relationship between relapse and a social environment conducive to consumption, associated with belief or disbelief in spiritual support, prostitution, and the legal complications arising from the use of crack, are relevant issues and should be taken into consideration in the development of preventive actions aimed at this specific population.OBJETIVO: Mapear as trajetórias de tratamento em uma amostra de homens e mulheres usuários de crack, através de suas narrativas acerca do percurso de busca por tratamento e suas tentativas de ter acesso ao sistema de saúde brasileiro. MÉTODO: Estudo qualitativo de uma amostra intencional (cinco mulheres e nove homens usuários de crack internados) utilizando entrevistas semiestruturadas. As entrevistas foram transcritas e os dados explorados utilizando-se a técnica de análise de conteúdo. RESULTADOS: Os entrevistados referiram dificuldades em obter acesso à internação, recaídas após a alta e abandono do tratamento. Parece existir um modelo de comportamento peculiar às mulheres e aos homens para lidar com a fissura pelo crack: enquanto as mulheres se prostituíram e, consequentemente, infectaram-se pelo HIV, todos os homens da amostra referiram envolvimento com o crime. CONCLUSÕES: As relações entre recaída e um ambiente social propício ao consumo, associadas a crença ou descrença em um auxílio espiritual, prostituição e às complicações legais decorrentes do uso de crack, são pontos relevantes e devem ser levados em consideração no desenvolvimento de ações preventivas voltadas a essa população específica.

Background: Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need.Aims: In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need.Discussion: Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need. [Brett J, Lee K, Gray D, Wilson S, Freeburn B, Harrison K, Conigrave K. Mind the gap: what is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians? Drug Alcohol Rev 2016;35:456-460]. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to describe the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. This paper describes (a) the study background and rationale, including the juvenile justice context and best practices for substance use disorders, (b) the selection and use of an implementation science framework to guide study design and inform selection of implementation components, and (c) the specific study design elements, including research questions, implementation interventions, measurement, and analytic plan.Methods/design: The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in seven states. A Core strategy for promoting change is compared to an Enhanced strategy that incorporates all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment.Discussion: Contributions to implementation science are discussed as well as challenges associated with designing and deploying a complex, collaborative project.Trial Registration: NCT02672150 . [ABSTRACT FROM AUTHOR]

Introduction Evidence shows a lag in adoption of evidence-based practices (EBPs) for substance abuse treatment and supports the need for studying the factors involved in this worldwide problem. Objective This study aimed to assess the readiness and barriers to adopt EBPs for substance abuse in a sample of outpatient treatment centers of a newly created Mexican Clinical Trials Network. Method An online survey was administered to directors (n = 8) and clinicians (n = 40) from seven outpatient treatment centers in Mexico. Questions were obtained from two surveys that had been implemented in the US to assess the same objectives. Results Respondents reported being more ready to adopt Cognitive Behavioral Therapy (CBT, 83.3%) and Motivational Enhancement Therapy (MET, 79.1%), compared to 12 step facilitation (58.3%), couples therapy (56.2%), Brief Strategic Family Therapy (BSFT, 66.6%), and motivational incentives (60.4%). Directors had lower mean resistance to EBPs (11.8 vs. 17.4; p = 0.01) than clinicians. The biggest barriers identified by directors to EBP adoption were not having enough clinical staff, being unable to afford well-trained staff, not enough psychiatric and medical support. Discussion and conclusion CBT and MET emerged as the most frequently used evidence based practices in the sites that are part of the Mexican Clinical Trials Network. Staff positive attitudes towards EBPs are critical for adoption. [ABSTRACT FROM AUTHOR]

Background: Best practice models are calling for a holistic, needsled, and sex-informed treatment approach to substance misuse treatment. To date, research into the impact of sex on needs and quality of life within methadone-treatment populations using validated research tools is limited. Objectives: The aim of the study was to evaluate the impact of sex upon self-rated unmet need and quality of life among people on methadone treatment. Methods: Cross-sectional survey of adults attending a specialist methadone treatment clinic, in Dublin, Ireland. Participants completed the Camberwell Assessment of Need Short Appraisal Schedule, Patient Version and the WHO Quality of Life—Brief Version. Ongoing drug use was determined using the Maudsley Addiction Profile and weekly supervised urine toxicology screens. A linear regression analysis was conducted. Results: One hundred eight of 190 eligible service-users (57%) participated. No significant differences existed between the participants and the nonparticipants on demographic variables or measures of drug use. Among them, 33%were women.Women demonstrated lower levels of ongoing opiate use. Linear regression analysis indicated that women had a greater number of unmet needs (P¼0.02) and lower quality of life in the domains of physical health (P¼0.003), psychological well being (P<0.001), environmental well being (P¼0.03), and social relationships (P¼0.007). When the Bonferroni adjustment was applied to account for multiple testing, the relationship between psychological well being and female sex remained statistically significant. Conclusions: Our study suggests that female sex may be associated with greater self-rated needs and poorer quality of life within a methadone-treated population, in particular, in the domain of psychological well being. Further research in this area is warranted to discover if these findings can be replicated and confirmed in larger samples. [ABSTRACT FROM AUTHOR]

Background: Substance misuse is a significant global health concern. In the UK, the prevalence of substance misuse has increased over the past decade and the number of alcohol and drug related deaths are increasing. Individuals with substance dependency issues are entitled to access treatment services. However, the COVID-19 pandemic created significant challenges for public services, including drug and alcohol treatment, and resulted in significant service reconfiguration and a shift from in-person to remote delivery. This study aims to evaluate the delivery of drug and alcohol services in a large metropolitan area in Northern England during the COVID-19 pandemic. It aims to understand the impact of service reconfiguration for services, staff and service users, and to use this understanding to inform the future optimised design of services., Design and Methods: The study has five workstreams within a mixed methods framework: (1) Systematic review of literature; (2) Qualitative process evaluation with service providers (digital timelines, focus groups and interviews); (3) Qualitative process evaluation with service users (interviews, focus groups, text based conversations and case studies); (4) Quantitative outcomes and health economic analysis; and (5) Data synthesis and dissemination., Expected Impact of the Study for Public Health: The breadth of the study, its novel nature, and the importance of substance misuse as a public health issue, mean that this study will provide valuable findings for those who commission, deliver and use drug and alcohol treatment services nationally and internationally. There will also be important learning for the effective remote delivery of services in sectors beyond drug and alcohol treatment., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: To map treatment trajectories in a sample of male and female crack users through their narratives about the course of treatment seeking and their attempts to access health care services in Brazil. Methods: Qualitative study of a purposive sample (five female and nine male hospitalized crack users) using semi-structured interviews. The interviews were transcribed and data explored using content analysis. Results: Respondents reported difficulties getting access to hospitalization, relapse after discharge, and abandonment of treatment. There seems to be a peculiar model of behavior for women and men while dealing with craving for crack: while women got involved with prostitution and consequently became infected with HIV, every men of the sample reported criminal involvement. Conclusions: The relationship between relapse and a social environment conducive to consumption, associated with belief or disbelief in spiritual support, prostitution, and the legal complications arising from the use of crack, are relevant issues and should betaken into consideration in the development of preventive actions aimed at this specific population. [ABSTRACT FROM AUTHOR]

Abstract: The question of why and under what circumstances family reunification takes place in the context of the child welfare system is complex and the presence of substance abuse only further complicates the picture. Past studies have explored a multitude of factors that are associated with family reunification among caregivers and children engaged with the child welfare system. Yet there is limited understanding of how families with substance abuse problems experience family reunification. This study attempts to fill this gap by investigating to what extent treatment completion is related to the likelihood of family reunification, using a sample of 858 mothers with substance abuse problems and their 1548 children in public child welfare. We utilized descriptive analysis and hierarchal nonlinear models (HNLM) to understand the effects of treatment completion on reunification. This current study provided important empirical evidence for the link between family reunification and treatment completion. Based on these findings, improvements in the way that treatment services are provided to mothers in child welfare are discussed. [Copyright &y& Elsevier]

Abstract: The effect of mothers'' participation in substance abuse treatment on reunification with their children who are in out-of-home care is an important policy issue. This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1,115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a “high” level of family-related or education/employment services were approximately twice as likely to reunify with their children as those who were treated in programs with “low” levels of these services. [Copyright &y& Elsevier]

Personality disorders (PD) and substance use disorders (SUD) are highly comorbid conditions. However, their treatment services are often separated. The aims of this study was to investigate how extensive this separation was prior to a Norwegian health reform (2004) that promoted integration, and to discuss clinical challenges for an integrated treatment of PD and SUD. All patients with a diagnosis of PD (n=1783) admitted to 10 day hospital treatment programs (1993-2003) were examined. Diagnoses were assessed by Mini International Neuropsychiatric Interview and Structured Clinical Interview for DSM-IV interviews. Socio-demographic data, psychosocial functioning (Global Assessment of Functioning Scale), symptom distress (Symptom Check List-90-Revised), interpersonal problems (Circumplex of Interpersonal Problems) and treatment course were recorded. The majority of patients were females (72%) and the prevalence of SUD was low (14%). SUD occurred among all PD categories. Patients with borderline PD were over-represented and patients with cluster C disorders were under-represented in the SUD sample. The SUD sample contained more men and it was associated with more previous violence against self and others. The reported violence was partly explained by gender (males) and diagnoses (borderline and SUD). PD patients with SUD also displayed more aggression during treatment and dropped out more frequently. The findings demonstrate that the female dominated specialized psychiatric treatment services for PD to a large extent had excluded PD patients who also had SUD. The reasons are probably related to the surplus problems that characterized the SUD sample and gender issues. Implications for the development of the PD and SUD services with respect to an integrated treatment for these comorbid conditions are discussed. [ABSTRACT FROM AUTHOR]

Abstract: This study examined relationships between state policy requirements governing outpatient substance abuse treatment services and reported outpatient treatment program practices. State policies effective as of February 1, 2003, and February 1, 2004, were collected and analyzed via primary legal research; data were validated by state officials (88% response rate; > 90% validation rate). Treatment practice data were obtained from the National Survey of Substance Abuse Treatment Services for the years 2003 and 2004. Multivariate analyses clustered by state were conducted, controlling for state, program, and state-aggregated client admission characteristics. Results indicated that treatment programs located in states with requirements for comprehensive substance abuse assessment, family counseling, substance abuse and infectious disease/sexually transmitted disease testing services, HIV/AIDS education, and aftercare services had significantly higher odds of offering such services (p values ranging from < .05 to < .001). This study presents new information regarding the potential role that state policy context may play in understanding treatment program practices. [Copyright &y& Elsevier]

There has been increasing concern in England regarding the neglect of alcohol treatment in favour of treatment for illicit drug users (especially offenders). The project sought to obtain the views of addiction professionals in specialist NHS services in England regarding recent changes to service provision. Postal survey questionnaires were sent to the duty worker at 120 Community Drug and Alcohol Teams in the England. Responses were received from 180 participants representing at least one clinician at 87 of the teams. Respondents had 1660 years of experience in substance misuse treatment. Only 11% felt that alcohol treatment services had improved over the last few years and 53% agreed that 'Government targets for treatment of illicit drug users has had a disastrous effect on the provision of alcohol treatment services'. The enhanced treatment for offenders was widely regarded as unfair to other service users. Half of respondents considered that the recent Government Alcohol Strategy was either 'pathetic' or 'a recipe for ineffectiveness.' Despite the limited number of self-selecting participants, the opinions are clearly cause for concern. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Substance misuse among Aboriginal Australians is both a symptom of disadvantage and suffering but also a cause of health and social problems. Few data are available on how mainstream drug and alcohol services meet the needs of Aboriginal Australians. We assessed acceptability and accessibility of mainstream services for Aboriginal Australians with alcohol or drug use disorders in an urban Area Health Service (AHS). We identified priorities for improvement and an implementation plan. Methods. We collected feedback via consultation with client groups, with the Aboriginal community and community organisations, with staff of the AHS and of the local Aboriginal Medical Service (AMS) and through direct observation. We examined attendance data. Results. Aboriginal people were well represented in this mainstream service, partly because of existing collaboration with the AMS. Good points in the service were reported to be priority appointments for new Aboriginal clients, professional and caring service and collaboration with the AMS. Suggested improvements included increased cultural sensitivity of communication, more appropriate physical surrounds and printed materials, having Aboriginal staff available, peer support groups and integration of health care for individual, family and community. The action plan included increased recruitment and career opportunities for Aboriginal staff, strengthened partnerships with the Aboriginal community, including ongoing collaboration with the AMS in improving and monitoring mainstream service quality. Discussion and Conclusions. Given the adverse impact of substance use disorders, there is a pressing need for services to work with Aboriginal communities to optimise the quality of mainstream treatment services. [Teasdale KE, Conigrave KM, Kiel KA, Freeburn B, Long G, Becker K. Improving services for prevention and treatment of substance misuse for Aboriginal communities in a Sydney Area Health Service. Drug Alcohol Rev 2008; 27:152-159] [ABSTRACT FROM AUTHOR]

Using the 1992-1995 National Treatment Improvement Evaluation Study data, we employ principal components analysis to create treatment service factors based on both patient self-reports and treatment record extracts. We included these factors in multivariate models for 1,136 outpatient drug-free treatment patients to estimate the relationship between services and post-treatment employment and crime. Although our models indicated some significant predictors of employment and crime, the overall effects of services were generally insignificant. We conclude that either services are unrelated to outcomes or if they are related then we are not measuring the key aspects of service provision that may be important. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Abstract: Although substance abuse is one of the primary reasons that parents become involved with the child welfare system, there is surprisingly little empirical research that examines the relationship of substance abuse treatment to child welfare outcomes. In this statewide longitudinal study of 1911 women who had children placed in substitute care, we examined the influence of three key factors in the treatment process on child welfare outcomes. Results indicated that when these women entered treatment more quickly, spent more time in treatment, or completed at least one treatment episode, their children spent fewer days in foster care and were more likely to be reunified with their parents. These findings were significant even controlling for families'' levels of risk including treatment and child welfare history, substance abuse frequency and chronicity, and demographic risks. Implications of these findings for improvements in the way that treatment services are provided to women in the child welfare system are discussed. [Copyright &y& Elsevier]

Abstract: Despite growing interest in closing the “research to practice gap”, there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of “technology clusters”, where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and for-profit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts. [Copyright &y& Elsevier]

Findings from the National Criminal Justice Drug Abuse Treatment Studies (CJDATS) National Criminal Justice Treatment Practices survey are examined to describe types of services provided by three types of prisons: those that serve a cross-section of offenders, those that specialize in serving offenders with special psychosocial and medical needs, and those that specialize in serving legal status or gender specific populations. Information is presented on the prevalence and type of specialized prisons and services provided to offenders as reported by wardens and other facility directors drawn from a nationally representative sample of prisons. Additional analyses explore organizational factors that differentiate prisons that serve specialized populations including staffing, training, other resources, leadership, and climate for change and innovation. Implications for expanding and improving services for special populations in correctional settings and the values of specialized prisons are discussed. [ABSTRACT FROM AUTHOR]

Abstract: This study examines whether the mechanism through which a methadone maintenance treatment site offers seven treatment-related and support services is related to whether a patient receives such services. Mechanisms include the provision of services on-site, at another program site, or through formal or informal linkage arrangements. Analysis was conducted on a nationally representative sample of methadone treatment sites. Providing services on-site was found to be positively related to patient access to a majority of services, whereas, in general, offering services at another program site or through formal or informal linkages was not found to be effective. Not-for-profit or public ownership of treatment sites was also found to be positively related to patient access. [Copyright &y& Elsevier]

The goal of this article is to examine whether profit status affects the provision of seven ‘core’ drug treatment services and nine ‘auxiliary’ treatment services. Data on the type of services provided by 8,606 treatment providers obtained from the National Survey of Substance Abuse Treatment Services (N-SSATS) collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2000 were used for this study. The types of services offered by the providers were modeled to be a function of the drug treatment providers' (DTP) profit status, DTP organizational and financial characteristics, staff's characteristics, clients' characteristics, and regional variables. A total of 16 logistic regressions were estimated. For-profit DTPs were found to be more likely to offer only two core services and were less likely to offer eight auxiliary services. However, after correcting for sample selection bias many differences in the supply of services between for- profit and nonprofit providers disappeared. [ABSTRACT FROM AUTHOR]

Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Abstract: This study examines the impact of comprehensive services on treatment outcomes for women and men. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3,142 clients (1,123 women and 2,019 men) from 59 treatment facilities. The results show that substance abuse treatment benefits both women and men. Further, both women and men benefit from comprehensive services provided as part of substance abuse treatment: specifically, the receipt of educational, housing and income support services is related to reduced post-treatment substance abuse for both women and men. Gender differences are revealed by the fact that, overall, greater proportions of women receive services and, when individual, service, and treatment organizational characteristics are controlled, women show greater reductions in post-treatment substance use. Further, women and men differ in their responsiveness to organizational characteristics: the availability of on-site services and the frequency of counseling significantly predict reduced post-treatment substance use for men but not for women. [Copyright &y& Elsevier]