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Biomedical subjects

K Humphreys

Publications and source records attributed to K Humphreys.

52 records · Page 3Linked to original sources
PubMed1996

Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous.

OBJECTIVE: This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider. METHODS: Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years. RESULTS: At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group. CONCLUSIONS: Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.

Adult↗
PubMed1993

From the community mental health movement to the war on drugs. A study in the definition of social problems.

In the 1980s, the Reagan and Bush administrations reduced funding for community mental health programs and began instead to support substance abuse treatment agencies. One reason for this shift in policy was that the social problem of mental illness had been captured by progressives in the community mental health movement. Conservatives, therefore, needed a new problem to redefine and use to enact new social control policies. The conservatives' claim that substance abuse is primarily the result of a defect in the character or constitution of the abuser has had profound effects on both social policy and the research community. Greater awareness is needed on the part of researchers as to how social problems have been defined and how government research grants affect our thinking about substance abuse.

Community Mental Health Centers↗
PubMed1991

Factors predicting attendance at self-help groups after substance abuse treatment: preliminary findings.

Some researchers and clinicians believe that only a fairly homogeneous subset of substance abusers are likely to affiliate with self-help groups, whereas others argue that self-help groups appeal to a wide range of persons and that selective referral of clients to self-help may be premature. This study followed 201 treated substance abusers for 6 months and found that contrary to prevailing opinion, Blacks and women were more likely to attend self-help groups and the measures of social stability did not predict attendance. In accord with other investigations, this study found that persons who attended the groups had more severe problems in several domains. Implications for clinical referral policies are discussed.

Adult↗
PubMed1991

Area variations in health outcomes: artefact or ecology.

It is a long-standing belief that the size of the difference between the poor (lower social groups) and the rich (higher social groups) in health outcomes will vary according to the characteristics of the area. However typical approaches to analyses of this kind of question violate standard statistical assumption. The basic problem is how to estimate the size of a 'ward effect' (the disadvantage of living in a 'poor' ward over and above effects associated with individual or household circumstances). This is complicated by the hypothesized existence of intra-ward correlated errors; the only way to avoid this bias is to explicitly model the different variance components using multi-level modelling techniques. The purpose of this paper is to illustrate this technique. Analysis using several of the health outcomes in the Health and Lifestyle Survey data, suggests that the ward effect is quite substantial, and remains after 'controlling for' age, gender and several other socio-demographic variables. This 'ward effect' appears to be best represented by the proportions without access to a car and the preponderance of working class members (RGSC IV and V) in the population. Whilst the verdict on the original hypothesis remains 'not proven', the hypothesis has been shown to be more complex than its simplistic statement suggests. The analyses have shown how to unpack these complexities and, more generally, have illustrated the power of the multi-level modelling technique.

Cluster Analysis↗
PubMedDate not supplied

Two pathways out of drinking problems without professional treatment.

This 3-year longitudinal study examined two recovery pathways among 135 problem drinking individuals who never received professional treatment. Almost half (48.3%) of those individuals for whom outcome could be clearly determined became moderate drinkers or stably abstinent. At baseline, individuals who subsequently became abstinent (n = 28) were of low socioeconomic status, had severe drinking problems, and believed their drinking was a very serious problem. Once they began their recovery, they relied heavily on Alcoholics Anonymous as a maintenance factor. In contrast, individuals who became moderate drinkers (n = 29) had higher socioeconomic status and more social support at baseline than did individuals who became abstinent or continued to have drinking problems. A logistic regression on baseline data showed that it was possible to predict which natural recovery pathway an individual drinker would follow. The implications of these findings for alcoholism treatment and policy are discussed.

Adult↗
PubMedDate not supplied

Recovering substance abuse staff members' beliefs about addiction.

This study of 329 substance abuse treatment staff assessed how recovery status, in combination with other variables, influences beliefs about the causes and treatment of substance abuse. About 15% (n = 47) of participants were "in recovery" from substance abuse problems; these staff members were not significantly different than nonrecovering staff members on education, age, race/ethnicity, years of clinical experience, or amount of client contact. When examined in a multiple regression equation that also included age, education, and treatment program goals and activities, staff members' recovery status was not associated with endorsement of disease and psychosocial models of substance abuse. However, being in recovery was associated with endorsing an eclectic approach to substance abuse treatment. The importance of recognizing the diversity of beliefs about substance abuse among recovering staff and of acknowledging that multiple influences affect all staff members viewpoints on treatment is discussed.

Adult↗
PubMedDate not supplied

Substance abuse prognosis with an additional psychiatric diagnosis: understanding the relationship.

Patients with alcohol and other substance abuse problems have poorer prognoses if there is a concomitant psychiatric diagnosis. However, because severity of psychiatric problems contributes more than the specific psychiatric diagnosis to prognosis, the nature of the interaction between substance abuse treatment outcome and an accompanying psychiatric diagnosis can be questioned. In this article an attempt is made to understand the poor-prognosis-with-psychiatric-diagnosis interaction through a literature review and an analysis of various problem areas that clients bring to substance abuse treatment. Problem areas were measured with a variety of instruments. The results show that groups that vary in severity of psychiatric problems also differ in severity of problems in other areas. As there is no doubt that such dual diagnosis patients pose a considerable treatment challenge, the implications of these findings for theoretical consideration and treatment planning are discussed.

Adult↗
PubMedDate not supplied

Evaluating and improving VA substance abuse patients' care.

The VA has implemented a nationwide evaluation program to monitor process and outcome of care for substance abuse patients. This program focuses on the changing characteristics of VA substance abuse patients and treatment services and involves outcome-based evaluations of major VA substance abuse treatment modalities. Initial findings show that VA substance abuse patients, including patients with concomitant psychiatric disorders, improve substantially from treatment intake to a 1-year follow-up and that community residential facilities are an important part of the continuum of substance abuse care. Moreover, within broad limits, there is a dose-response relationship between the continuity of outpatient mental health care and better 1-year substance use and psychosocial outcomes. These findings are placed into context as part of an evidence-based initiative to improve the quality of VA mental health care.

Adult↗
PubMedDate not supplied

Outcomes for root-fractured permanent incisors: a retrospective study.

PURPOSE: The objective of this study was to assess the outcomes for treated root-fractured permanent incisors with respect to pulp vitality, root tissue union, and tooth survival and to examine the effects of clinical and radiographic parameters and rigid splinting on the outcome. METHODS: Eighty-four teeth were identified and data extracted from case notes prior to transfer to an SPSS data base for analysis. The odds ratios for each factor were calculated and the significance of differences was determined. Tooth loss and relevant risk variables were examined using Cox's regression model and Kaplan-Meyer survival curves. RESULTS: Fourteen (17%) had fractures in the apical third, 47 (56%) in the middle third, and 23 (27%) in the coronal (gingival) third. Twenty-four (29%) also had crown fractures involving enamel and dentine. Crown fractures were identified as significant risk factors for pulp vitality. Loss of pulp vitality, horizontal displacement, and extrusive displacement of the coronal fragment were significant risk factors for hard root tissue union. Survival was poorest with gingival third fractures with 14 (61%) of these teeth being lost. Splinting rigidly had no significant effect on pulp vitality and type of root tissue healing. CONCLUSIONS: Loss of pulp vitality was significantly associated with enamel-dentine crown fracture. Hard root tissue union was significantly affected by pulp necrosis and luxation of the coronal fragment. Survival was poorest for root fractures within the gingival third of the root. Splinting with rigid fixation had no significant effect on pulp vitality and type of root tissue union.

Adolescent↗
PubMedDate not supplied

Factors affecting outcomes of traumatically extruded permanent teeth in children.

PURPOSE: The objectives of the present study were to determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors. METHODS: Seventy-two traumatically extruded permanent incisors were studied at the Departments of Paediatric Dentistry in Belfast, Newcastle upon Tyne, and Glasgow. The mean age of the patients was 10.1 years (range=6 to 18 years). Clinical and radiographic outcomes were analyzed and related to presenting and treatment factors. RESULTS: The initial degree of extrusion was moderate for 46 teeth (64%), and the median delay prior to repositioning was 3 hours (range=1 to 168 hours). Pulp necrosis occurred in 31 teeth (43%), residual extrusion was present in 16 teeth (23%), and inflammatory resorption occurred in 11 teeth (15%). Residual extrusion was significantly associated with a delay in repositioning the tooth, pulpal necrosis was significantly more common in teeth with closed apices and in severely extruded teeth, and inflammatory resorption was more common after pulpal necrosis. CONCLUSIONS: Residual extrusion could be minimized by earlier presentation and repositioning. The risk of pulpal necrosis is greatest for severely extruded teeth and for those with closed apices.

Adolescent↗