The Influence of Gender on Perceived Treatment Need among a Community Sample of Substance Users

Purpose: Most individuals do not perceive a need for substance use treatment despite meeting diagnostic criteria for substance use disorders and they are least likely to pursue treatment voluntarily. There are also those who perceive a need for treatment and yet do not pursue it. This study aimed to understand which factors increase the likelihood of perceiving a need for treatment for individuals who meet diagnostic criteria for substance use disorders in the hopes to better assist with more targeted efforts for gender-specific treatment recruitment and retention. Using Andersen and Newman’s (1973/2005) model of individual determinants of healthcare utilization, the central hypothesis of the study was that gender moderates the relationship between substance use problem severity and perceived treatment need, so that women with increasing problems due to their use of substances are more likely than men to perceive a need for treatment. Additional predisposing and enabling factors from Andersen and Newman’s (1973/2005) model were included in the study to understand their impact on perceived need. Method: The study was a secondary data analysis of the 2010 National Survey on Drug Use and Health (NSDUH) using logistic regression. The weighted sample consisted of a total 20,077,235 American household residents (The unweighted sample was 5,484 participants). Results of the logistic regression were verified using Relogit software for rare events logistic regression due to the rare event of perceived treatment need (King & Zeng, 2001a; 2001b). Results: The moderating effect of female gender was not found. Conversely, men were significantly more likely than women to perceive a need for treatment as substance use problem severity increased. The study also found that a number of factors such as race, ethnicity, socioeconomic status, age, marital status, education, co-occurring mental health disorders, and prior treatment history differently impacted the likelihood of perceiving a need for treatment among men and women. Conclusion: Perceived treatment need among individuals who meet criteria for substance use disorders is rare, but identifying factors associated with an increased likelihood of perceiving need for treatment can help the development of gender-appropriate outreach and recruitment for social work treatment, and public health messages.

The ADMIN-ICU survey: A survey on antimicrobial dosing and monitoring in ICUs

Objectives: There is little evidence and few guidelines to inform the most appropriate dosing and monitoring for antimicrobials in the ICU. We aimed to survey current practices around the world. Methods: An online structured questionnaire was developed and sent by e-mail to obtain information on local antimicrobial prescribing practices for glycopeptides, piperacillin/tazobactam, carbapenems, aminoglycosides and colistin. Results: A total of 402 professionals from 328 hospitals in 53 countries responded, of whom 78% were specialists in intensive care medicine (41% intensive care, 30% anaesthesiology, 14% internal medicine) and 12% were pharmacists. Vancomycin was used as a continuous infusion in 31% of units at a median (IQR) daily dose of 25 (25–30) mg/kg. Piperacillin/tazobactam was used as an extended infusion by 22% and as a continuous infusion by 7%. An extended infusion of carbapenem (meropenem or imipenem) was used by 27% and a continuous infusion by 5%. Colistin was used at a daily dose of 7.5 (3.9–9) million IU (MIU)/day, predominantly as a short infusion. The most commonly used aminoglycosides were gentamicin (55%) followed by amikacin (40%), with administration as a single daily dose reported in 94% of the cases. Gentamicin was used at a daily dose of 5 (5–6) mg/day and amikacin at a daily dose of 15 (15–20) mg/day. Therapeutic drug monitoring of vancomycin, piperacillin/tazobactam and meropenem was used by 74%, 1% and 2% of the respondents, respectively. Peak aminoglycoside concentrations were sampled daily by 28% and trough concentrations in all patients by 61% of the respondents. Conclusions: We found wide variability in reported practices for antibiotic dosing and monitoring. Research is required to develop evidence-based guidelines to standardize practices.

Kumataro Ito, Japanese Artist on Board the U.S. Bureau of Fisheries Steamer Albatross During the Philippine Expedition, 1907–1910

Kumataro Ito produced hundreds of beautiful color paintings of fishes and invertebrates during and after the 1907-10 Philippine Expeditin of the U.S. Bureau of Fisheries Steamer Albatross. The paintings are housed in the files of the Divisions of Fishes and Mollusks, United States National Museum of Natural History, and Smithsonian Institution Archives, Washington, D.C. Few of those paintings have been published in color, but many have been publishes in black and white. Two years after the expedition, Ito came to Washington, D.C., in 1912 for an extended period to render final paintings based on preliminary color sketches made during the expedition. He did not completly render all the sketches during his stay, probably because he was asked to produced a large number of black-and-white illustrations of Philippine fishes, and a few of North American fishes. Most of the black-and-white illustrations have been published. Few publications containing Ito's Philippine and North American illustrations have acknowledged him. The very little that is known about Ito's life is discussed, examples of his black-and-white and colored fish paintings are reproduced, and his previously unacknowledged illustrations in various publications are herein acknowledged. Another Japanese artist, Yasui, about whom almost nothing is known, joined the Albatross during Ito's second tour on board the ship. It appears, with few exceptions, that Yasui produced only preliminary color sketches of fishes, which, if rendered as final paintings, were done by Ito.

An ecological characterization of Salt River Bay National Historical Park and Ecological Preserve, U.S. Virgin Islands

Salt River Bay National Historical Park and Ecological Preserve (hereafter, SARI or the park) was created in 1992 to preserve, protect, and interpret nationally significant natural, historical, and cultural resources (United States Congress 1992). The diverse ecosystem within it includes a large mangrove forest, a submarine canyon, coral reefs, seagrass beds, coastal forests, and many other natural and developed landscape elements. These ecosystem components are, in turn, utilized by a great diversity of flora and fauna. A comprehensive spatial inventory of these ecosystems is required for successful management. To meet this need, the National Oceanic and Atmospheric Administration (NOAA) Biogeography Program, in consultation with the National Park Service (NPS) and the Government of the Virgin Islands Department of Planning and Natural Resources (VIDPNR), conducted an ecological characterization. The characterization consists of three complementary components: a text report, digital habitat maps, and a collection of historical aerial photographs. This ecological characterization provides managers with a suite of tools that, when coupled with the excellent pre-existing body of work on SARI resources, enables improved research and monitoring activities within the park (see Appendix F for a list of data products).

Temporal trends in reef fish assemblages inside Virgin Islands National Park and around St. John, U.S. Virgin Islands, 1988-2006

This report is a result of long-term fish monitoring studies supported by the National Park Service (NPS) at the Virgin Islands National Park since 1988 and is now a joint NPS and NOAA collaboration. Reef fish monitoring data collected from 1988 to 2006 within Virgin Islands National Park (VINP) and adjacent reefs around St. John, U.S. Virgin Islands (USVI) were analyzed to provide information on the status of reef fishes during the monitoring period. Monitoring projects were initiated by the National Park Service (NPS) in the 1980s to provide useful data for evaluation of resources and for development of a long-term monitoring program. Monthly monitoring was conducted at two reef sites (Yawzi Point and Cocoloba Cay) starting in November 1988 for 2.5 years to document the monthly/seasonal variability in reef fish assemblages. Hurricane Hugo (a powerful Category 4 storm) struck the USVI in September 1989 resulting in considerable damage to the reefs around St. John. Abundance of fishes was lower at both sites following the storm, however, a greater effect was observed at Yawzi Point, which experienced a more direct impact from the hurricane. The storm affected species differently, with some showing only small, short-term declines in abundance, and others, such as the numerically abundant blue chromis (Chromis cyanea), a planktivorous damselfish, exhibiting a larger and longer recovery period. This report provides: 1) an evaluation of sampling methods, sample size, and methods used during the sampling period, 2) an evaluation of the spatial and temporal variability in reef fish assemblages at selected reef sites inside and outside of VINP, and 3) an evaluation of trends over 17 years of monitoring at the four reference sites. Comparisons of methods were conducted to standardize assessments among years. Several methods were used to evaluate sample size requirements for reef fish monitoring and the results provided a statistically robust justification for sample allocation.

Survey on the quality of Jaadi available [in] Sri Lankan market

A quality of survey was conducted at the fish curing yards in a northwest coast and the southern coast in Sri Lanka. A total of 40 samples different varieties of fishes were collected from the market and jaadi curing yards and all were evaluated for the quality, fungal and insect infestation. Samples were analyzed for proximate composition chemical, microbiological and sensory quality. Thirty percent of the total analyzed samples of fish were found to be unfit for consumption. Samples collected from Negombo were found to the infected with maggots. Only 42% samples had dry matter above 50%. All the samples showed a protein content above 20%. The highest protein content was 27.92% in hurulla. Over 90% of the samples had TVN at acceptable quality limits (>40). The TBC for 33% of the samples were in the range 104-105/g range, while 48% were in the range of 107-108/g due to contamination of maggots and fungi. The Survey showed jaadi had a high level of protein in its composition. But defects of curing process such on imperfect cleaning inadequate salting resulted in low (Chemical and microbiological) quality of the product.

Ethnic variations in the experiences of mental health service users in England: results of a national patient survey programme

Background: Minority ethnic groups in the UK are reported to have a poor experience of mental health services, but comparative information is scarce. Aims: To examine ethnic differences in patients’ experience of community mental health services. Method: Trusts providing mental health services in England conducted surveys in 2004 and 2005 of users of community mental health services. Multiple regression was used to examine ethnic differences in responses. Results: About 27 000 patients responded to each of the surveys, of whom 10% were of minority ethnic origin. In the 2004 survey, age, living alone, the 2004 survey, age, living alone, detention and hospital admissions were stronger predictors of patient experience than ethnicity. Self-reported mental health status had the strongest explanatory effect. In the 2005 survey, the main negative differences relative to the White British were for Asians. Conclusions: Ethnicity had a smaller effect on patient experience than other variables. Relative to the White British, the Black group did not report negative experiences whereas the Asian group were most likely to respond negatively. However, there is a need for improvements in services for minority ethnic groups, including access to talking therapies and better recording of ethnicity.

Exclusion and Marginalisation in Adolescence: The Experience of School Exclusion on Drug Use and Antisocial Behaviour

Young people excluded from school are a group at an increased risk to drug use and antisocial behaviour during adolescence and later marginalisation and exclusion from society in adulthood (Blyth and Milner, 1993). As part of the Belfast Youth Development Study, a longitudinal study of the onset and development of adolescent drug use, young people who entered post primary school in 2000 (aged 11/12 years) were surveyed annually on four occasions. This paper reports on findings from this survey in relation to a supplementary group of young people who were surveyed because they had been excluded from school. The findings show higher levels of drug use and antisocial behaviour among school excludees, lower levels of communication with their parents/guardians, higher levels of contact with the criminal justice system and increased likelihood of living in communities characterised with neighbourhood disorganisation. This lifestyle perhaps suggests these young people are leading a life that is already taking them towards the margins of society.

Stress, Positive Psychology and the National Student Survey

The aim was to explore the predictive ability of sources of stress and a range of dispositional and coping behaviours on student satisfaction and motivation. Most research exploring sources of stress and coping in students construes stress as psychological distress, with little attempt to consider positive experiences of stress. A questionnaire was administered to 120 first-year UK psychology students. Questions were asked which measured sources of stress when rated as likely to contribute to distress (a hassle) and likely to help one achieve (an uplift). The sources of stress were amended from the UK National Student Survey (NSS, 2011). Support, control, self-efficacy, personality and coping style were also measured, along with their potential affect on
course satisfaction, motivation and feeling part of a learning community. The sources of stress likely to lead to distress were more often significant than sources of stress likely to lead to positive, eustress states. Ironically,
factors one would consider would help students, such as the university support facilities, only did so when rated as a hassle, not as an uplift. Published university league tables draw heavily on student course satisfaction but this negatively correlated with intellectual motivation and feeling part of a learning
community. This suggests course satisfaction alone reveals an incomplete picture of the student experience. Course educators need to consider how course experiences contribute not just to potential distress but to
potential eustress. Teaching quality, effective support and work-life balance are key to student satisfaction and motivation. How educators interact with their students and the opportunities they create in and outside the class to promote peer support are likely to enhance satisfaction and motivation.

Stress, eustress and the National Student Survey

The aim was to explore the relationship between sources of stress and a range of coping behaviours on student
satisfaction and motivation. Most research exploring sources of stress construes stress as distress, with little
attempt to consider positive, good stress or ‘eustress’ experiences. A cohort of first-year psychology students (N=88)
were surveyed on a range of stressors. These were amended from the UK National Student Survey (NSS, 2011).
Published university league tables draw heavily on student course satisfaction but study results suggest there was
also merit in measuring students’ intellectual motivation and the extent to which they felt part of a learning
community. Using multiple regression analyses, it was found that even the attributes that normally help one to adjust to change, such as self-efficacy, do little to help the new student adjust to university life, such was the acuteness of perceived stress in the first year. Social opportunities within the university were important to help new students integrate into university life and to help them network and build support. Educators need to consider how course experiences contribute, not just to potential distress but to potential eustress.

Coping with an HIV infection. A multicenter qualitative survey on HIV positive adolescents' perceptions of their disease, therapeutic adherence and treatment.

HIV-positive adolescents face a number of challenges in dealing with their disease and its treatment. In this qualitative study, twenty-nine HIV-positive adolescents aged 13 to 20 years (22 girls), who live in Switzerland, were asked, in a semi-structured interview (duration of 40-110 minutes), to describe their perceptions and experiences with the disease itself and with therapeutic adherence. While younger adolescents most often thought of their disease as fate, older adolescents usually knew that they had received it through vertical transmission, although the topic appeared to be particularly difficult to discuss for those living with their HIV-positive mothers. Based on their attending physician's assessment, 18 subjects were judged highly adherent, 4 fairly and 7 poorly adherent. High adherence appeared linked with adequate psychological adjustment and effective coping mechanisms, as well as with the discussion and adoption of explicit medication-taking strategies. The setting and organisation of health care teams should allow for ongoing discussions with HIV-positive adolescents that focus on their perceptions of their disease, how they cope with it and with the treatment, and how they could improve their adherence.

Survey on current practices for neurological prognostication after cardiac arrest.

PURPOSE: To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. METHODS: An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. RESULTS: A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. CONCLUSION: National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial.

Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes.

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

Epidemiología de pacientes atendidos por uso de sustancias psicoactivas en el servicio de Toxicología de Colsubsidio 2011-2012

Introducción: Es una necesidad para los países del mundo, tener información epidemiológica mucho más precisa y oportuna sobre las sustancias psicoactivas (SPA), partiendo del conocimiento científico de porqué unas personas abusan de las sustancias y otras no. El objetivo de investigación es establecer el perfil epidemiológico y evolución de los pacientes consumidores de SPA que acuden al servicio de toxicología de Colsubsidio durante el 2011 y 2012. Caracterizar la población, identificar su patrón de consumo y explorar las tendencias, para poder generar estrategias dirigidas de atención y prevención. Metodología: Estudio descriptivo observacional exploratorio retrospectivo. 610 historias clínicas fueron analizadas para variables epidemiológicas y clínicas, por medio de análisis univariados acorde al tipo de variable y análisis bivariados exploratorios en los cuales se compararon proporciones. Resultados: Se evaluaron un total de 610 pacientes, 475 hombres y 135 mujeres. El promedio de edad, la mediana y la moda fue de 24,9, 17 y 16 años respectivamente; la mayoría solteros y cursando bachillerato; la mayoría menores de 18 años fueron remitidos por ICBF y psiquiatría. Los patrones de abuso y dependencia representaron los porcentajes más elevados. Las sustancias más consumidas fueron marihuana, etanol y tabaco. El tratamiento para el 44,3% de los pacientes fue valoración por especialidades, seguido de básico (33,1%), y sólo 1,1% asistieron para prevención en el consumo de SPA. Discusión: Es necesario dirigir los esfuerzos y recursos a la generación de campañas de diagnóstico temprano y prevención en el consumo de SPA principalmente para la población adolescente.