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Biomedical subjects

N Heather

Publications and source records attributed to N Heather.

At least 37 records · Page 2Linked to original sources
PubMed1997

Acceptability of the controlled-drinking goal among alcohol treatment agencies in New South Wales, Australia.

OBJECTIVE: A survey was conducted to estimate the acceptability of the controlled drinking goal among treatment services in New South Wales (NSW), Australia, and to compare results with similar surveys carried out elsewhere. METHOD: Of all identified alcohol treatment services (N = 295) in NSW, 179 (61%) responded to a mailed questionnaire with useable returns. RESULTS: Nearly three-quarters of respondents endorsed controlled drinking but half of these reported allocating less than 25% of their clients to this goal. Community-based services and alcohol treatment units were significantly more likely to endorse controlled drinking than were residential or private facilities. Community-based services and alcohol treatment units were also more likely to base the appropriateness of controlled drinking on professional experience and research evidence, whereas residential and private facilities relied more on the disease model or agency policy in making this determination. Respondents with tertiary qualifications were more likely to endorse controlled drinking than those without such qualifications, and these respondents were more likely to be found in community-based services and alcohol treatment units. CONCLUSIONS: The results show widespread support for the controlled drinking goal among NSW alcohol treatment services. This is similar to the reported status of controlled drinking in Britain and Norway and stands in marked contrast to the comparative reluctance of treatment services in North America to endorse the controlled drinking goal.

Alcohol Drinking↗
PubMed1997

Where treatment and prevention merge: the need for a broader approach.

Four papers were presented in a Parallel Session chaired by Dr Forge Gleser (Israel) and these are summarized here. The papers were: (1) "Supporting primary health care physicians" by Dr Galina A. Korchagina of the Medical Academy of Postgraduate Studies, St Petersburg, the Russian Federation; (2) "A new role for nurses" by Ms Iveta Kelle, Nursing Consultant, Riga, Latvia; (3) "Broadening the base of treatment" by Dr Nina Kerimi of the Research Institute of Preventive and Clinical Medicine, Ashgabat, Turkmenistan; and (4) "Primary health care and alcohol reduction strategies" by Dr Leo Pas of the Academic Centre of General Practice, Free University Brussels, Belgium. Following a discussion, participants agreed on the wording of a draft Policy for Primary Health Care and Community Action and this is also included here.

Alcohol Drinking↗
PubMed1996

Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection.

Pregnant injecting drug users were randomly assigned to: (i) individually receive a six-session cognitive-behavioural intervention in addition to their usual methadone maintenance treatment (intervention condition (I) (n = 40)); or (ii) their usual methadone maintenance treatment only (control condition (C) (n = 40)). There was no change in drug use per se in either group after the intervention. However, at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours (in particular injecting risk behaviours). The I group reduced the needle risk associated both with "typical" use (drug use in the month before interview) and "binge" use (drug use in the month nominated as the heaviest month of drug use in the previous 6 months). The intervention had no effect on sexual risk behaviours. The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment.

Adult↗
PubMed1996

Effects of brief counselling among male heavy drinkers identified on general hospital wards.

Although the prevalence of heavy alcohol consumption among patients of general hospitals is well documented, no study has yet reported an effect of counselling on the ward in reducing the level of consumption among such patients after discharge. This study was designed to evaluate brief counselling to reduce alcohol consumption among male heavy drinkers identified on general hospital wards. Male patients were screened on wards of four teaching hospitals in Sydney, Australia. Identified heavy drinkers (n = 174) showing predominantly low levels of alcohol dependence were allocated to one of two forms of brief counselling (skills-based counselling or brief motivational interviewing) or to a non-intervention control group. Blind follow-up for 123 patients (71%) was carried out approximately 6 months after discharge from hospital and self-reports of alcohol consumption were compared with collateral sources of information. Patients who received counselling showed a significantly greater mean reduction in a quantity-frequency measure of weekly alcohol consumption than controls but there were no significant differences in reduced consumption between the two intervention groups. However, patients who were deemed "not ready to change" showed greater reductions if they had received brief motivational interviewing than if they had received skills-based counselling. The implications of these findings for counselling male in-patients to reduce alcohol consumption are discussed.

Journal Article↗
PubMed1996

Restrictions on tobacco and alcohol use in Australian work-places.

In a telephone survey of 455 of the top 600 companies in Australia, around three-quarters reported the existence of restrictions on both smoking and alcohol in the workplace. Forty-six percent of companies had a total ban on smoking at work, 31% had designated limited areas where employees were permitted to smoke, and 23% had no policy on smoking. Seventy-seven percent of companies encouraged a total alcohol-free work environment. The larger the company, the more likely it was to have restrictions on smoking in the work-place, but there was no relationship between the size of the company and alcohol restrictions. Government organizations were more likely to have restrictions on smoking than non-government organizations, but this difference was not apparent for alcohol restrictions. The major reasons given for smoking restrictions were related to health and comfort, while those for alcohol were related to work productivity and safety.

Journal Article↗
PubMed1996

Programmes for tobacco and alcohol users in Australian work-places.

This article presents findings from a survey of programmes available for tobacco and alcohol users working in 455 of Australia's top 600 companies. Companies were twice as likely to have programmes for smokers (43%) as for problem drinkers (24%) and these programmes were more apparent in large companies. The majority of programmes for smoking were delivered within a health promotion context which included other life-style issues, such as nutrition, exercise, weight management and stress management. Although Employee Assistance Programs (EAPs) were the most commonly available type of work-place programme for excessive drinkers and other drug users, followed by Alcoholics Anonymous and local hospital clinics, only 6% had an EAP for alcohol. Only 21% of programmes for smokers and 12% for excessive alcohol users were evaluated. Around one-quarter of companies knew the costs of smoking programmes, and 9% reported costs of conducting programmes for excessive alcohol consumers.

Journal Article↗
PubMed1996

General practitioners' promotion of healthy life styles: what patients think.

The study examined the prevalence of cigarette smoking, alcohol consumption, exercising to keep fit and dieting to lose weight among general practice patients, and patients' perceptions of the role of the general practitioner in advising about life style. A cross-sectional survey using a self-administered questionnaire was completed by 13,017 patients aged 18 to 70 years who were attending one of 119 general practitioners from 40 group practices in metropolitan Sydney over a six- to eight-week period. More women than men reported dieting to lose weight, just over half of the men and women were exercising regularly to keep fit, 35 per cent of men and 29 per cent of women reported smoking, and 12 per cent of men and 10 per cent of women were drinking alcohol at levels considered hazardous or harmful. More young people were smoking, drinking hazardously or harmfully, dieting to lose weight and exercising than the older age groups, and their smoking rates exceeded those of the general population. Most patients reported that general practitioners should be interested in their life-style behaviours, particularly smoking. Substantially fewer patients (particularly women who drank excessively) reported receiving advice about their habits. General practitioners were more likely to give advice when smoking and drinking levels were very high. There were discrepancies between patients' expectations of the doctor's role in promoting healthy life styles, and their likelihood of receiving advice. Doctors could reduce the diseases associated with unhealthy practices. Developments in medical training in the 1990s may extend the way they engage in advising on issues of life style.

Adolescent↗
PubMed1995

Controlled evaluation of a general practice-based brief intervention for excessive drinking.

In a controlled evaluation of general practitioner (GP)-based brief intervention, 378 excessive drinkers identified opportunistically by screening in 40 group practices in metropolitan Sydney were assigned to groups receiving: (i) a five-session intervention by the GP (the Alcoholscreen Program); (ii) a single session of 5 minutes' advice by the GP plus a self-help manual (minimal intervention); (iii) an alcohol-related assessment but no intervention; (iv) neither intervention nor assessment. Among all patients allocated to receive it, the Alcoholscreen Program did not result in a significantly greater reduction in consumption at follow-up than control conditions but patients offered Alcoholscreen reported a significantly greater reduction in alcohol-related problems in the period to 6 months follow-up. A greater proportion of patients who returned for the second Alcoholscreen visit were drinking below recommended levels at follow-up than in the remainder of the sample. There was no evidence that minimal intervention or alcohol-related assessment were effective in reducing alcohol consumption or problems. Implications for further research into GP-based brief interventions are discussed.

Adolescent↗
PubMed1995

HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment.

This study compares the injecting and sexual risk-taking behaviour among injecting drug users (IDUs) currently, previously and never enrolled in methadone maintenance treatment (MMT). All subjects had injected during the 6 months prior to the day of interview. The current MMT group showed significantly lower injecting risk-taking behaviour subscale scores on the HIV Risk-taking Behaviour Scale (HRBS) of the Opiate Treatment Index than the previous MMT and non-MMT groups together. The current MMT group differed from the other two groups in the frequency of injecting and cleaning of injection equipment with bleach. There was no difference between the current MMT group and the other two groups combined in sexual risk-taking behaviour scores on the HRBS. There were no differences between the previous MMT and non-MMT groups in injecting and sexual risk-taking behaviour. HIV seroprevalence was low and there was no difference in seroprevalence between groups. Thus, IDUs currently enrolled in MMT are at reduced risk for HIV infection when compared with IDUs who have previously or never been enrolled in MMT. However, the absence of a difference between the current MMT and other two groups in frequency of sharing behaviours suggests the need for additional strategies among MMT clients to reduce needle-sharing. Possible strategies include the application of relapse prevention interventions and the availability of sterile injecting equipment in MMT clinics. Further research is needed to identify factors which increase attraction and retention of IDUs to MMT.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Groundwork for a research programme on harm reduction in alcohol and drug treatment.

The aim of this article is to set out the groundwork for a research programme for harm reduction in alcohol and drug treatment. First, attitudes to science of those who work in the harm reduction field are discussed and it is argued that hostility to the introduction of conventional scientific methods to this field is seriously misguided. Harm reduction activity is then defined as an attempt to ameliorate the adverse health, social or economic consequences of mood-altering substances without necessarily requiring a reduction in the consumption of these substances, and this definition is amplified. Finally, issues relevant to the measurement of outcome from harm reduction interventions are discussed by comparing Newcombe's classification of drug-related harms with an existing instrument designed to measure outcomes from interventions in the drugs field (the Opiate Treatment Index).

Journal Article↗
PubMed1995

Interpreting the evidence on brief interventions for excessive drinkers: the need for caution.

Two recent reviews of the evidence on brief interventions in the alcohol field reach highly favourable conclusions regarding their effectiveness and cost-effectiveness. However, both can be criticized on three grounds: (1) they pay insufficient regard to important differences within the family of brief interventions; (2) they do not sufficiently emphasize the crucial distinction between brief interventions among treatment seekers and non-treatment seekers; and (3) they arrive at over-optimistic and uncritical conclusions. While not wishing to dampen enthusiasm for the potential of brief interventions in reducing alcohol-related harm, the present article argues that, if the evidence is not to be misinterpreted by policy makers and purchasers of services, differences between brief interventions must be borne in mind and analyses of effectiveness in the treatment-seeking population must be clearly separated from those in the area of opportunistic interventions in the non-treatment-seeking population. The evidence for the effectiveness of opportunistic brief interventions is much stronger than for brief interventions in specialist settings for those seeking help, where their most prudent application should be restricted to patients with problems of relatively low severity.

Alcoholism↗
PubMed1994

Drug use and HIV risk-taking behaviour among injecting drug users not currently in treatment in Sydney, Australia.

This study investigated the drug use patterns and HIV risk-taking behaviour of 200 injecting drug users (IDU) not currently in treatment in Sydney, Australia. Although there was low HIV seroprevalence, unsafe injecting and sexual practices were common. Variables that were predictive of injecting risk-taking were higher level of heroin use, sexual relationship with an IDU and greater polydrug use. Two variables were predictive of sexual risk-taking: higher level of hallucinogen use and sexual relationship with an IDU. Female subjects were significantly more likely to have an IDU sexual partner. A higher level of cannabis use was associated with greater polydrug use and a higher level of amphetamine use was associated with greater use of opiates other than heroin. The findings are discussed in terms of the need for interventions aimed towards reducing sexual risk-taking among users of hallucinogens and towards reducing injecting and sexual risk-taking among IDU and their sexual partners. The potential difficulty in producing behaviour change among polydrug users is highlighted.

Adolescent↗
PubMed1994

Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment.

This study evaluated the effectiveness of a brief intervention (BI), a one-session motivational interview, in reducing HIV risk-taking behaviour among injecting drug users (IDU) not enrolled in any form of treatment for drug dependence. IDU were randomly assigned to either BI or a non-intervention control condition (NIC). One hundred and twenty-one subjects were successfully contacted for a 3-month follow-up and 88 subjects were followed up at 6 months. There were significant reductions for the sample as a whole for injecting risk-taking subscale scores on the HIV Risk-taking Behaviour Scale between pre-treatment and follow-up. There was no significant change in sexual risk-taking behaviour. There were no significant differences between groups on any measure at 3- and 6-month follow-up. There are a number of possible reasons why the sample as a whole showed significant improvements from initial to follow-up assessments. It is possible that, having had their attention directed to their risk-taking behaviour, subjects attempted to reduce their injecting risk-taking behaviour. If this is the case and subjects in the NIC condition can be considered as having received a BI, this suggests that BIs involving a personal risk assessment are effective in reducing risk behaviours associated with injecting. However, this suggestion could only be confirmed by comparison with a non-assessment control group.

Adolescent↗