Screening questionnaires for substance abuse post brain injury: a review.

OBJECTIVE: To assess the psychometric properties of the available assessment questionnaires for substance abuse studied within a brain injury population. METHODS: A literature search was conducted on MEDLINE, PsycINFO, CINAHL, and Embase databases. Articles published in English from inception through March 2018 on the screening questionnaires used to identify substance abuse post brain injury were reviewed. Eligible primary studies had to include: adults (participants ≥18 years old) post brain injury; and report measures of diagnostic accuracy (e.g., sensitivity, specificity, and diagnostic odds ratio). RESULTS: Six screening questionnaires were included: Alcohol Use Disorders Identification Test, Brief Michigan Alcohol Screening Test, CAGE, Drug Abuse Screening Test, Substance Abuse Screening Inventory and the Short Michigan Alcohol Screening Test (SMAST). All questionnaires, except the SMAST, used the Diagnostic and Statistical Manual of Mental Disorders as the criterion measure. While report measures of diagnostic accuracy were reported and summarized, none of the studies provided reliability information or subgroup analysis among those with brain injury. CONCLUSIONS: Concerns of social desirability, population demographics, responsiveness to treatment effects, and administrative burden are important when selecting a questionnaire. Research examining the reliability of substance abuse screening questionnaires in the brain injury population is lacking and future research is warranted.

Targeted social protection in a pastoralist economy: case study from Kenya.

Social protection programmes are designed to help vulnerable populations - including pastoralists - maintain a basic level of well-being, manage risk, and cope with negative shocks. Theory suggests that differential targeting according to poverty status can increase the reach and effectiveness of budgeted social protection programmes. Chronically poor households benefit most from social protection designed to help them meet their basic needs and make vital investments necessary to graduate from poverty. Vulnerable non-destitute households benefit from protection against costly temporary shocks, but do not necessarily need regular assistance. Welfare gains occur when a comprehensive social protection programme considers the needs of both types of households. The authors use evidence-based understanding of poverty dynamics in the pastoralist-based economy of northern Kenya's arid and semi-arid lands as a case study to discuss and compare the observed impacts of two different social protection schemes on heterogeneous pastoralist households: a targeted, unconditional, cash-transfer programme designed to support the poorest, and an index-based livestock insurance programme, which acts as a productive 'safety net' to help stem a descent into poverty and increase resilience. Both types of social protection scheme have been shown to decrease poverty, improve food security and protect child health. However, the behavioural response for asset accumulation varies with the type of protection and the household's unique situation. Poor households that receive cash transfers retain and accumulate assets quickly. Insured households, who are typically vulnerable yet not destitute, protect existing herds and invest more in the livestock they already own. The authors argue that differential targeting increases programme efficiency, and discuss Kenya's current approach to implementing differentially targeted social protection.

Les programmes de protection sociale ont pour but d'aider les populations vulnérables (y compris les pasteurs) à maintenir un niveau acceptable de bienêtre, à gérer le risque et à faire face aux situations de crise. Théoriquement, le traitement différencié en fonction du niveau de pauvreté permet d'accroître la couverture et l'efficacité des programmes de protection sociale budgétisés. Les ménages vivant dans une pauvreté chronique tirent un meilleur bénéfice d'une protection sociale leur permettant de couvrir leurs besoins de base et de réaliser les investissements indispensables pour sortir de la pauvreté. Les ménages vulnérables mais non entièrement démunis tirent un meilleur bénéfice d'une protection leur permettant de couvrir les dépenses liées à des crises ponctuelles, mais n'ont pas nécessairement besoin d'un dispositif d'aide permanent. Des gains de bien-être sont constatés lorsque des programmes de protection sociale complets prennent en compte les besoins de ces deux catégories de foyers. À partir d'éclairages factuels sur la dynamique de la pauvreté dans le système économique à dominante pastorale des régions arides et semi-arides du nord du Kenya, les auteurs réalisent une étude de cas qui leur permet d'examiner et de comparer les impacts avérés de deux dispositifs différents de protection sociale sur un ensemble hétérogène de ménages pastoraux : le premier est un programme ciblé de transfert de liquidités sans conditionnalités, destiné aux foyers les plus pauvres, le deuxième est un programme d'assurance du bétail doté d'une clause d'indexation et faisant office de « filet de sécurité ¼ productif pour aider les pasteurs à ne pas basculer dans la pauvreté en cas de coup dur et à améliorer leur capacité de résilience. Chacun des deux dispositifs de protection sociale permet de contenir la pauvreté, d'améliorer la sécurité alimentaire et de protéger la santé infantile. Néanmoins, les comportements qui en résultent en termes d'accumulation d'actifs varient suivant le type de protection et la situation particulière de chaque foyer. Les foyers les plus pauvres aidés par un apport de liquidités conservent et accumulent rapidement des actifs. Les foyers habituellement vulnérables mais pas entièrement démunis soutenus par un dispositif d'assurance protègent leurs troupeaux et investissent davantage pour le bétail qu'ils possèdent déjà. Après avoir plaidé en faveur du ciblage différencié, qui selon eux améliore l'efficacité des programmes, les auteurs font le point sur la manière dont le Kenya met actuellement en oeuvre une protection sociale ciblée et différentielle.

Los programas de protección social están concebidos para ayudar a las poblaciones vulnerables (entre ellas, las pastorales) a mantener un nivel básico de bienestar, gestionar el riesgo y hacer frente a los acontecimientos negativos. Según la teoría, los programas de protección social presupuestados pueden revestir mayor alcance y eficacia cuando distinguen entre los beneficiarios y se adaptan a ellos en función de su nivel de pobreza. Las familias que sufren pobreza crónica son las que más se benefician de los dispositivos de protección social concebidos para ayudarles a cubrir sus necesidades básicas y hacer las inversiones vitales necesarias para salir de la pobreza. Las familias vulnerables, pero no desposeídas, se benefician de la protección contra malas rachas temporales que tienen un costo elevado, pero no necesitan forzosamente ayuda sistemática. Para que un programa integral de protección social depare mayores cotas de bienestar es preciso que en él se tengan en cuenta las necesidades de ambos tipos de familias. Los autores emplean una descripción científicamente contrastada de la dinámica de la pobreza en la economía basada en el pastoreo de las tierras áridas y semiáridas del norte de Kenia como estudio monográfico a partir del cual examinar y comparar los efectos observados de dos dispositivos diferentes de protección social en un conjunto heterogéneo de familias de pastores: un programa selectivo y no condicionado de transferencia de efectivo, destinado a respaldar a los más pobres; y un programa de seguro del ganado basado en un índice, que ofrece una «red de seguridad¼ productiva y ayuda a las familias en cuestión a protegerse de la pobreza y adquirir mayor resiliencia. Se ha demostrado que ambos tipos de programa de protección social reducen la pobreza, mejoran la seguridad alimentaria y protegen la salud infantil. Sin embargo, el comportamiento de respuesta en cuanto a la acumulación de activos difiere según el tipo de protección y la situación propia de cada familia. Los hogares pobres que reciben transferencias de efectivo retienen y acumulan activos rápidamente. Los hogares asegurados, que normalmente son vulnerables pero no están desposeídos, protegen los rebaños existentes e invierten más en el ganado que ya poseen. Los autores postulan que la diferenciación entre beneficiarios confiere mayor eficacia al programa, y examinan el planteamiento adoptado actualmente en Kenia, que consiste en aplicar dispositivos de protección social diferenciados en función del beneficiario.

The Long Term Role of Anxiety Sensitivity and Experiential Avoidance on Pain Intensity, Mood, and Disability among Individuals in a Specialist Pain Clinic.

Background. Anxiety sensitivity (AS) and experiential avoidance (EA) have been shown to have an interactive effect on the response an individual has to chronic pain (CP) potentially resulting in long term negative outcomes. Objective. The current study attempted to (1) identify distinct CP subgroups based on their level of EA and AS and (2) compare the subgroups in terms of mood and disability. Methods. Individuals with CP were recruited from an academic pain clinic. Individuals were assessed for demographic, psychosocial, and personality measures at baseline and 1-year follow-up. A cluster analysis was conducted to identify distinct subgroups of patients based on their level of EA and AS. Differences in clinical outcomes were compared using the Repeated Measures MANOVA. Results. From a total of 229 participants, five clusters were formed. Subgroups with lower levels of AS but similar high levels of EA did not differ in outcomes. Mood impairment was significantly greater among those with high levels of EA compared to lower levels (p < 0.05). Significant improvement in disability (p < 0.05) was only seen among those with lower levels of EA and AS. Conclusions. This cluster analysis demonstrated that EA had a greater influence on mood impairment, while both EA and AS levels affected disability outcomes among individuals with CP.

Mood, Disability, and Quality of Life among a Subgroup of Rheumatoid Arthritis Individuals with Experiential Avoidance and Anxiety Sensitivity.

Objective. The current study aimed to identify and characterize distinct RA subgroups based on their level of EA and AS and compares the difference among the subgroups in mood, disability, and quality of life. Methods. Individuals with chronic pain for at least 3 months were recruited from an academic rheumatoid clinic. Participants were assessed for demographic, psychosocial, and personality measures. A two-step cluster analysis was conducted to identify distinct subgroups of patients. Differences in clinical outcomes were compared using the Multivariate ANOVA based on cluster membership. Results. From a total of 223 participants, three distinct subgroups were formed based on cluster analysis. Cluster 1 (N = 78) included those with low levels of both EA and AS. Cluster 2 (N = 81) consisted of individuals with moderate levels of EA and low levels AS. Cluster 3 (N = 64) included those with moderate levels of EA and high AS. Compared to those in Cluster 1, those in Cluster 3 had significantly higher levels of mood impairment and disability and lower quality of life (p < 0.05). Significantly lower levels of mood impairment were seen in Cluster 1 compared to Cluster 2 (p < 0.05). However, no significant difference in disability or quality of life was seen between the two groups. Conclusions. The three subgroups differed significantly in levels of impairment in mood, disability, and quality of life. However, levels of EA had a greater impact on disability and quality of life than AS.

Oral care post stroke: a scoping review.

Health concerns post stroke may be the result of, or exacerbated by, neglected oral health care (OHC). However, OHC may be challenging post stroke due to hemiparesis, hemiplegia, a lack of coordination, and/or cognitive deficits. The objective of this study was to conduct a scoping review and summarise the current state of knowledge pertaining to OHC post stroke. A literature search was conducted using the multiple databases (MEDLINE, CINAHL, EMBASE, etc.). Combinations of multiple keywords were searched: oral, dental, health, care, hygiene, teeth, dentures, tooth brushing, stroke, cardiovascular health and cardiovascular disease. A grey literature search was also conducted. Articles included were those published in English between 1970 and July 2013, which focused on at least one aspect of OHC among a stroke population. For clinical trials, ≥50% of the sample must have sustained a stroke. In total, 60 articles met inclusion and focused on three primary area: (i) OHC Importance/Stroke Implications; (ii) Current Research; and (iii) Current Practice. It was found that OHC concerns are mainly related to mastication, dysphagia/nutrition, hygiene, prostheses and quality of life. Research indicates that there is limited specialised and individual care provided, and there are few assessment tools, guidelines and established protocols for oral health that are specific to the stroke population. Further, dental professionals' and nurses' knowledge of OHC is generally inadequate; hence, proper education for health professionals in acute and rehabilitation settings, patients, and caregivers has been discussed.

Community stroke rehabilitation teams: providing home-based stroke rehabilitation in Ontario, Canada.

BACKGROUND: Community stroke rehabilitation teams (CSRTs) provide a community-based, interdisciplinary approach to stroke rehabilitation. Our objective was to assess the effectiveness of these teams with respect to client outcomes. METHODS: Functional, psychosocial, and caregiver outcome data. were available at intake, discharge from the program, and six-month follow-up. Repeated measures analysis of covariance was performed to assess patient changes between time points for each outcome measure. RESULTS: A total of 794 clients met the inclusion criteria for analysis (54.4% male, mean age 68.5±13.0 years). Significant changes were found between intake and discharge on the Hospital Anxiety and Depression Scale total score (p=0.017), Hospital Anxiety and Depression Scale Anxiety subscale (p<0.001), Functional Independence Measure (p<0.001), Reintegration to Normal Living Index (p=0.01), Bakas Caregiver Outcomes Scale (p<0.001), and Caregiver Assistance and Confidence Scale assistance subscale (p=0.005). Significant gains were observed on the strength, communication, activities of daily living, social participation, memory, and physical domains of the Stroke Impact Scale (all p<0.001). These improvements were maintained at the 6-month follow-up. No significant improvements were observed upon discharge on the memory and thinking domain of the Stroke Impact Scale; however, there was a significant improvement between admission and follow-up (p=0.002). All significant improvements were maintained at the 6-month follow-up. CONCLUSIONS: Results indicate that the community stroke rehabilitation teams were effective at improving the functional and psychosocial recovery of patients after stroke. Importantly, these gains were maintained at 6 months postdischarge from the program. A home-based, stroke-specific multidisciplinary rehabilitation program should be considered when accessibility to outpatient services is limited.

Telemedicine: application of telepathology-remote microscopy for intraoperative diagnoses on frozen sections.

Due to the time delay, intraoperative consultations result in an extension of operation times, leading to prolonged anesthesia and idle time during surgery. Using a remote controlled microscope for telepathology, transfer times between hospital and pathologist can be eliminated and pathological expertise obtained independently of the geographic location of the hospital. In cooperation with a community hospital located 100 km apart from the Institute of Pathology of the Justus Liebig University Giessen, telepathological intraoperative consultations have been performed since 1999. After preparation and staining of the cryosection in the hospital, the slide was examined in our institute using a remote-controlled microscope (Leica DMRXA) and a special telepathological software (Leica TPS1). Data were transferred via two ISDN connections in parallel. The telepathology system contains an additional macroscopic examination equipment. Up to now more than 40 telepathological consultations have been done. Time required for the microscopic diagnosis ranged between 4 and 25 minutes. The amount of time saved, compared to the transfer to the next available pathologist, was approximately 45 minutes. In our experience, telepathological diagnoses were fully in accordance with conventional diagnoses routinely performed afterwards. The application of telepathology can lead to a significant shortening of surgery time if a pathologist is locally not available. In the study presented, no diagnostic errors occurred. The additional application of a macroscopic equipment allows inspection and interactive guidance for sampling, thus preventing sampling errors.