The government's decision to upgrade the legal status of cannabis to a Class B drug was welcomed as a victory for common sense by Unite/Mental Health Nurses Association.
Unite/MHNA Chair, Andy Lauder said: "It has been proved time and time again by well-respected medical studies that there are strong links between significant cannabis use and those suffering from mental health problems, or have a disposition to mental illness.
"We, therefore, welcome the Home Secretary, Jacqui Smith's announcement that cannabis should be reclassified from Class C to Class B status."
Andy Lauder warned: "There are now much stronger strains of cannabis, such as skunk, entering the UK in response to so-called market forces."
Last month, Unite/MHNA strongly criticised reports that The Advisory Council on the Misuse of Drugs was recommending that the drug should remain on the Class C list. Unite/MNHA said that such a decision would fly in the face of established medical facts and common sense.
Unite (Amicus section) is the third largest union in the NHS. It has seven professional sections: the Community Practitioners and Health Visitors Association, the Mental Health Nurses Association, the Guild of Healthcare Pharmacists, the Society of Sexual Health Advisers, the Medical Practitioners Union, College of Healthcare Chaplains, and the Hospital Physicists Association.
Unite was formed by an amalgamation of Amicus and the Transport and General Workers Union in May 2007.
Unite/Mental Health Nurses Association
вторник, 21 июня 2011 г.
понедельник, 20 июня 2011 г.
American Indian/Alaska Natives Have Significantly Higher Alcohol-Related Death Percentage Than General Population, CDC Reports
Nearly 12% of American Indian and Alaska Native deaths over a four-year period were alcohol related, according to a CDC report released on Thursday, AP/USA Today reports. Researchers found after examining death certificates from 2001 to 2005 that 11.7% of deaths -- or 1,514 deaths -- among American Indians and Alaska Natives were alcohol-related. During the same time period, 3.3% of all deaths in the U.S. were related to alcohol. The report also found:
Traffic accidents and liver disease are the two leading causes of alcohol-related deaths among American Indians and Alaska Natives;
About one-third of alcohol- related deaths in the American Indian/Alaska Native population occurred in the Northern Plains, where reservations are remote and often destitute;
Alaska had the lowest number of alcohol-related deaths among American Indians/Alaska Natives; and
More than 68% of American Indian/Alaska Native alcohol-related deaths were among men, 66% were among those younger than age 50 and 7% were among those younger than age 20.
The report did not include deaths related to tuberculosis, pneumonia and colon cancer, conditions for which alcohol is thought to be a risk factor, and as a result "[t]here may be many more alcohol-related deaths than the study shows," AP/USA Today, reports. The report recommends "culturally appropriate clinical interventions" to reduce alcohol abuse and improved integration between tribal health care centers and tribal courts, which often handle alcohol-related crimes (Jalonick, AP/USA Today, 8/28).
The report is available online.
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Traffic accidents and liver disease are the two leading causes of alcohol-related deaths among American Indians and Alaska Natives;
About one-third of alcohol- related deaths in the American Indian/Alaska Native population occurred in the Northern Plains, where reservations are remote and often destitute;
Alaska had the lowest number of alcohol-related deaths among American Indians/Alaska Natives; and
More than 68% of American Indian/Alaska Native alcohol-related deaths were among men, 66% were among those younger than age 50 and 7% were among those younger than age 20.
The report did not include deaths related to tuberculosis, pneumonia and colon cancer, conditions for which alcohol is thought to be a risk factor, and as a result "[t]here may be many more alcohol-related deaths than the study shows," AP/USA Today, reports. The report recommends "culturally appropriate clinical interventions" to reduce alcohol abuse and improved integration between tribal health care centers and tribal courts, which often handle alcohol-related crimes (Jalonick, AP/USA Today, 8/28).
The report is available online.
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
воскресенье, 19 июня 2011 г.
Preventing Mental, Emotional And Behavioral Disorders In Young People
Around one in five young people in the U.S. have a current mental, emotional, or behavioral disorder. About half of all adults with mental disorders recalled that their disorders began by their mid-teens and three-quarters by their mid-20s. Early onset of mental health problems have been associated with poor outcomes such as failure to complete high school, increased risk for psychiatric and substance problems, and teen pregnancy.
A new article by Mary E. Evans, RN, PhD, FAAN, published in the Journal of Child and Adolescent Psychiatric Nursing assesses the recently released government report on preventing these disorders among young people. Dr. Evans' paper concludes that using certain interventional programs in schools, communities and health care settings, risk for mental illness can be better identified and treated.
The article highlights the fact that specific risk and protective factors have been identified for many disorders. For example, certain thinking and behavioral patterns are risks for the development of depression. Nonspecific factors that increase risk for developing disorders also include poverty, marital conflict, poor peer relations, and community violence. Also, certain neurobiological factors contribute to the development of disorders in youth, but this is also influenced by environmental factors.
A key risk factor for externalizing disorders is aggressive social behavior that begins in early childhood. A number of interventions have been developed to provide training in parenting skills to prevent the development of aggressive and antisocial behavior. In addition, some preventive interventions have targeted specific disorders such as depression and schizophrenia. Cognitive behavioral treatment for high-risk adolescents has lowered the rate of major depressive symptoms. Also, a number of community-based programs have been shown to be effective in promoting healthy behaviors.
"For all nurses, this report will increase our understanding of risk and protective factors related to the healthy development of children and youth," Evans concludes.
Mary E. Evans, RN, PhD, FAAN, is affiliated with the College of Nursing, University of South Florida & Institute of Medicine.
Source:
Amy Molnar
Wiley-Blackwell
A new article by Mary E. Evans, RN, PhD, FAAN, published in the Journal of Child and Adolescent Psychiatric Nursing assesses the recently released government report on preventing these disorders among young people. Dr. Evans' paper concludes that using certain interventional programs in schools, communities and health care settings, risk for mental illness can be better identified and treated.
The article highlights the fact that specific risk and protective factors have been identified for many disorders. For example, certain thinking and behavioral patterns are risks for the development of depression. Nonspecific factors that increase risk for developing disorders also include poverty, marital conflict, poor peer relations, and community violence. Also, certain neurobiological factors contribute to the development of disorders in youth, but this is also influenced by environmental factors.
A key risk factor for externalizing disorders is aggressive social behavior that begins in early childhood. A number of interventions have been developed to provide training in parenting skills to prevent the development of aggressive and antisocial behavior. In addition, some preventive interventions have targeted specific disorders such as depression and schizophrenia. Cognitive behavioral treatment for high-risk adolescents has lowered the rate of major depressive symptoms. Also, a number of community-based programs have been shown to be effective in promoting healthy behaviors.
"For all nurses, this report will increase our understanding of risk and protective factors related to the healthy development of children and youth," Evans concludes.
Mary E. Evans, RN, PhD, FAAN, is affiliated with the College of Nursing, University of South Florida & Institute of Medicine.
Source:
Amy Molnar
Wiley-Blackwell
суббота, 18 июня 2011 г.
"UK Teen Binge Drinking Is Serious And Chronic"
The latest findings on teenage drinking, smoking and drug use across Europe are released the 26th of March, 2009. The European School Survey Project on Alcohol and other Drugs (ESPAD) is a study of 15 and 16 year old teenagers in 35 European countries. It is by far the most detailed international study on this subject. ESPAD has been carried out previously in 1995, 1999 and 2003. The latest ESPAD was carried out in 2007. The new international study findings are revealed at a press conference in London. The press conference was chaired by Professor Ray Hodgson, Director of the Alcohol Education and Research Council (AERC). Study findings are presented and discussed by Professor Martin Plant and Dr Patrick Miller of the University of the West of England, Bristol.
The countries that participated in ESPAD 2007 were Armenia, Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, Faroe Islands, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, the Isle of Man, Italy, Latvia, Lithuania, Malta, Monaco, the Netherlands, Norway, Poland, Portugal, Romania, Russia, the Slovak Republic, Slovenia, Sweden, Switzerland, Ukraine and the United Kingdom. The UK sample included 2,179 teenagers (1004 boys and 1175 girls).
The latest ESPAD findings show that:
ALCOHOL
-- Alcohol consumption at least once in the past year amongst European teenagers (including those in the UK) had remained fairly stable since 1995 at about 80% of all students. The 2007 survey indicated a small fall in the UK overall total from 91% to 88% in 2007.
-- Once more UK teenagers reported high levels of binge drinking, intoxication and alcohol-related individual, relationship, sexual and delinquency problems. They ranked third highest (after Bulgaria and the Isle of Man) in relation to such problems.
-- The UK ranked 7th in relation to the percentage of teens who had 'binged' (consumed five or more drinks on at least one occasion) in the past 30 days. A total of 54% of UK teenagers had reportedly done this. The highest levels of 'binge' drinking were in the Isle of Man (61%), Denmark (60%), Malta (57%), Portugal (56%), Estonia and Latvia (54%).
-- In 2003 it was revealed that teen girls in the UK (as well as Ireland and the Isle of Man) were more likely than boys to have binged in the previous 30 days. The 2007 survey shows that girls were more likely than boys to be binge drinkers in the UK, Iceland, Norway and Sweden.
-- UK teenagers ranked third highest (after Denmark and the Isle of Man) in relation to self-reports of having been drunk in the past 30 days. A total of 33% of UK teens reported such recent intoxication.
-- Girls reported higher levels of such recent drunkenness than boys in nine countries. These were the Isle of Man, the UK, Ireland, Spain, Finland, Norway, Sweden, the Faroe Islands and Monaco. The fact that some teenage girls are 'binge' drinking even more than boys suggests that in the UK and elsewhere a profound social change has been taking place. It is clearly no longer socially unacceptable for females to drink heavily or to become intoxicated. This may reflect factors such as greater female social and economic empowerment and changing social roles as well as the marketing practices of the beverage alcohol industry.
-- The percentages of UK teens who had binged at least three times in the past 30 days was almost the same as it had been in 2003. Altogether, 26% of boys and 27% of girls reported having done this.
-- Binge drinking amongst girls had increased across Europe since 1995. It had remained relatively stable amongst boys since 1999.
-- A striking feature of UK teenagers was that they were more likely than those in nearly all other countries to report that they expected positive consequences from drinking. Only Denmark and the Isle of Man scored higher in this respect.
TOBACCO
-- Overall, cigarette use by European teenagers had fallen since 1999. In the UK it had fallen since 1995.
-- Lifetime prevalence of smoking across Europe ranged from 24% and 80%. Smoking in the past 30 days ranged from 7% in Armenia to 45% in Austria. Altogether 22% of UK teens (17% of boys and 25% of girls) had smoked in the past 30 days.
ILLICIT DRUGS
-- Lifetime illicit drug use amongst teenagers across Europe had risen between 1995 and 2003. It had fallen since then. In the UK it had fallen since 1995.
-- The highest lifetime use of any illicit drug was reported by teenagers in the Czech Republic (46%), followed by Spain (38%), the Isle of Man (35%) and Switzerland ( 34%). UK teens ranked 9th in this respect (29%).
-- The highest lifetime use of cannabis was reported by teens in the Czech Republic (45%), Spain (36%), the Isle of Man (34%) and Switzerland (33%). UK teenagers ranked 7th in this respect (29%). A total of 11% of UK teenagers reported having used cannabis in the past 30 days.
COMMENT
Professor Martin Plant commented: "ESPAD shows that the use of alcohol, tobacco and illicit drugs is widespread amongst 15 and 16 year olds across Europe. Even so, there has been a fall in both smoking and illicit drug use. This is good news for the health of young adults. Alcohol consumption has remained fairly stable, although a small reduction has recently been evident amongst boys. The UK retains its unenviable position in relation to both binge drinking, intoxication and alcohol-related problems amongst teenagers. This problem is both serious and chronic. I hope that the Government will prioritise policies that are effective to reduce heavy drinking and alcohol-related disorder and health problems amongst young people. Increasing numbers of young people are developing serious health problems related to drinking. More and more younger people also are dying prematurely due to their alcohol use.
"There is a clear scientific consensus that alcohol education and mass media campaigns have a very poor track record in influencing drinking habits. Far more effective (and cost effective) policies include using taxation to make alcohol less affordable. Alcohol problems do not only affect a tiny minority of very heavy drinkers. Everyone has a stake in public health and safety. Moreover, many people whose alcohol consumption is generally moderate also experience some adverse effects from their drinking. It is therefore recommended that a minimum price of 50 pence per unit of alcohol should be introduced. This would save over 3,000 lives per year. It would also reduce problems such as absenteeism, public disorder and hospital admissions. This measure would particularly affect harmful and hazardous drinkers. It could save ??1 billion per year in the cost of alcohol-related harm. In addition, serious consideration must be given to raising the minimum age at which young people may consume or purchase alcoholic beverages, perhaps to eighteen years of age."
West of England University
uwe.ac
The countries that participated in ESPAD 2007 were Armenia, Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, Faroe Islands, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, the Isle of Man, Italy, Latvia, Lithuania, Malta, Monaco, the Netherlands, Norway, Poland, Portugal, Romania, Russia, the Slovak Republic, Slovenia, Sweden, Switzerland, Ukraine and the United Kingdom. The UK sample included 2,179 teenagers (1004 boys and 1175 girls).
The latest ESPAD findings show that:
ALCOHOL
-- Alcohol consumption at least once in the past year amongst European teenagers (including those in the UK) had remained fairly stable since 1995 at about 80% of all students. The 2007 survey indicated a small fall in the UK overall total from 91% to 88% in 2007.
-- Once more UK teenagers reported high levels of binge drinking, intoxication and alcohol-related individual, relationship, sexual and delinquency problems. They ranked third highest (after Bulgaria and the Isle of Man) in relation to such problems.
-- The UK ranked 7th in relation to the percentage of teens who had 'binged' (consumed five or more drinks on at least one occasion) in the past 30 days. A total of 54% of UK teenagers had reportedly done this. The highest levels of 'binge' drinking were in the Isle of Man (61%), Denmark (60%), Malta (57%), Portugal (56%), Estonia and Latvia (54%).
-- In 2003 it was revealed that teen girls in the UK (as well as Ireland and the Isle of Man) were more likely than boys to have binged in the previous 30 days. The 2007 survey shows that girls were more likely than boys to be binge drinkers in the UK, Iceland, Norway and Sweden.
-- UK teenagers ranked third highest (after Denmark and the Isle of Man) in relation to self-reports of having been drunk in the past 30 days. A total of 33% of UK teens reported such recent intoxication.
-- Girls reported higher levels of such recent drunkenness than boys in nine countries. These were the Isle of Man, the UK, Ireland, Spain, Finland, Norway, Sweden, the Faroe Islands and Monaco. The fact that some teenage girls are 'binge' drinking even more than boys suggests that in the UK and elsewhere a profound social change has been taking place. It is clearly no longer socially unacceptable for females to drink heavily or to become intoxicated. This may reflect factors such as greater female social and economic empowerment and changing social roles as well as the marketing practices of the beverage alcohol industry.
-- The percentages of UK teens who had binged at least three times in the past 30 days was almost the same as it had been in 2003. Altogether, 26% of boys and 27% of girls reported having done this.
-- Binge drinking amongst girls had increased across Europe since 1995. It had remained relatively stable amongst boys since 1999.
-- A striking feature of UK teenagers was that they were more likely than those in nearly all other countries to report that they expected positive consequences from drinking. Only Denmark and the Isle of Man scored higher in this respect.
TOBACCO
-- Overall, cigarette use by European teenagers had fallen since 1999. In the UK it had fallen since 1995.
-- Lifetime prevalence of smoking across Europe ranged from 24% and 80%. Smoking in the past 30 days ranged from 7% in Armenia to 45% in Austria. Altogether 22% of UK teens (17% of boys and 25% of girls) had smoked in the past 30 days.
ILLICIT DRUGS
-- Lifetime illicit drug use amongst teenagers across Europe had risen between 1995 and 2003. It had fallen since then. In the UK it had fallen since 1995.
-- The highest lifetime use of any illicit drug was reported by teenagers in the Czech Republic (46%), followed by Spain (38%), the Isle of Man (35%) and Switzerland ( 34%). UK teens ranked 9th in this respect (29%).
-- The highest lifetime use of cannabis was reported by teens in the Czech Republic (45%), Spain (36%), the Isle of Man (34%) and Switzerland (33%). UK teenagers ranked 7th in this respect (29%). A total of 11% of UK teenagers reported having used cannabis in the past 30 days.
COMMENT
Professor Martin Plant commented: "ESPAD shows that the use of alcohol, tobacco and illicit drugs is widespread amongst 15 and 16 year olds across Europe. Even so, there has been a fall in both smoking and illicit drug use. This is good news for the health of young adults. Alcohol consumption has remained fairly stable, although a small reduction has recently been evident amongst boys. The UK retains its unenviable position in relation to both binge drinking, intoxication and alcohol-related problems amongst teenagers. This problem is both serious and chronic. I hope that the Government will prioritise policies that are effective to reduce heavy drinking and alcohol-related disorder and health problems amongst young people. Increasing numbers of young people are developing serious health problems related to drinking. More and more younger people also are dying prematurely due to their alcohol use.
"There is a clear scientific consensus that alcohol education and mass media campaigns have a very poor track record in influencing drinking habits. Far more effective (and cost effective) policies include using taxation to make alcohol less affordable. Alcohol problems do not only affect a tiny minority of very heavy drinkers. Everyone has a stake in public health and safety. Moreover, many people whose alcohol consumption is generally moderate also experience some adverse effects from their drinking. It is therefore recommended that a minimum price of 50 pence per unit of alcohol should be introduced. This would save over 3,000 lives per year. It would also reduce problems such as absenteeism, public disorder and hospital admissions. This measure would particularly affect harmful and hazardous drinkers. It could save ??1 billion per year in the cost of alcohol-related harm. In addition, serious consideration must be given to raising the minimum age at which young people may consume or purchase alcoholic beverages, perhaps to eighteen years of age."
West of England University
uwe.ac
пятница, 17 июня 2011 г.
More Drug Users Are Being Provided With Effective Treatment Services But These Are Still Key Areas For Improvement, UK
Healthcare watchdogs are calling for a continued drive to improve drug addiction treatment, to ensure services are delivered consistently across the country.
A report released today by the Healthcare Commission and the National Treatment Agency (NTA), shows results from the second of three annual reviews to assess the performance of substance misuse treatment services.
Focusing specifically on how services are commissioned and harm reduction service provision, the findings reveal the majority of services are performing well within acceptable levels across these categories.
The number of people receiving specialist drug treatment has increased dramatically, with 195,400 in treatment during 2006/07 - up from 85,000 in 1998/99. Estimates for 2007/8 show 210,800 people will receive treatment. This means that more drug users than ever before are getting the treatment they need.
The review showed that there had been considerable improvement in the commissioning and performance management of drug treatment services, resulting in more service users receiving better treatment.
However, there were significant deficits, particularly in the provision of vaccination for hepatitis B and testing and treatment for hepatitis C. As 90% of all hepatitis C diagnoses are associated with injecting drug use, this is a key area of concern.
The review covered 149 'local drug partnerships' in England. Drug treatment is provided by a network of services, commissioned by local partnerships of statutory agencies within a particular locality, rather than being provided by individual organisations. These networks or 'local drug partnerships' are aligned to local authority boundaries. They bring together representatives of local organisations involved in the delivery of the drug strategy, including primary care trusts, local authorities, the police and the probation service.
Partnerships were asked 45 questions across 10 criteria. Each area was then scored on a scale; "weak", "fair", "good" and "excellent". Thirty four percent of local drug partnerships had an overall score of "excellent", 45% were "good" and 21% were "fair". No partnerships had an overall score of "weak", however the review revealed the majority of partnerships had deficits in key areas.
The review confirmed widespread good practice in relation to commissioning performance management but also showed that many areas did not have an adequate understanding of local need through systematic assessments. Since the review the Commission and the NTA have issued guidance and supported action plans to address this issue.
Partnerships also made significant progress in relation to care planning and treatment discharge systems, with nearly all (99%) achieving or exceeding 70% of their local target.
A good standard of financial management was found across the sector, with 60% of partnerships achieving the maximum score for this area.
Anna Walker, Chief Executive of the Commission, says: "Substance misuse affects not only the individual concerned but their families, friends, and the communities they live in.
"As the UK has one of the highest recorded drug-related death rates in Europe, it is a clear national priority to minimise the impact of substance misuse.
"It's very encouraging that thousands more people are now getting the treatment they need, and this review shows there is much to celebrate about the progress that has been made.
"However, it is worrying that the majority of hepatitis C cases are associated with injecting drugs, yet we know access to testing and treatment for the disease is patchy across the country. Similarly, access to clean needles provided by out of hours exchanges varies considerably. These are the areas that need to improve if the health of those who inject drugs is to be tackled effectively, and drug-related deaths reduced.
"Partnerships must now concentrate on driving improvements in the key areas highlighted by the review, in order to provide an equal service to all patients across the country. It is also important that partnerships really understand the needs in their area for these services and provides them accordingly."
Paul Hayes, the Chief Executive of the National Treatment Agency for substance misuse, said: "Effective commissioning underpins effective drug treatment delivery.
The improvements in commissioning shown by this review are very welcome.
However the review also highlights inconsistent practice across the country in key areas of delivery such as testing for and treatment of hepatitis B and C. The NTA will be working with all partnerships to spread best practice more consistently and has agreed action plans for improvement with the poorest performing areas."
Following the results of this review, work has been carried out by the Commission and the NTA with the 25 lowest performing partnerships. Action plans were to developed to improve performance and good progress has already been made implementing this.
The Commission and the NTA will follow up this report with a third and final review into this sector. This will look at diversity and residential services and will complete what has been a comprehensive review of the provision of substance misuse treatment.
The National treatment agency is engaging the sector in a range of initiatives and programmes to address the deficits identified by the review. The joint NTA/Department of Health action plan, Reducing drug-related harm was published in May 2007, and includes a national campaign aiming to tackle these and other harm reduction issues to begin in October this year.
In relation to commissioning the NTA continues to support the work of local areas in relation to treatment planning and needs assessment. 2008 will also see the publication of new guidance initiatives to enhance commissioning practice.
More information on the Improvement review of substance misuse 2006/2007
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
Information on the NTA
The National Treatment Agency for Substance Misuse (NTA) is a special health authority, created by the Government in 2001 to improve the availability, capacity and effectiveness of treatment for drug misuse in England. The NTA's purpose is to work with local partnerships and health commissioners to deliver high-quality, effective drug misuse treatment that improves individuals' physical and mental health and wellbeing. In turn, this improves public health, reduces crime and helps make communities safer.
The Government set the NTA a target of doubling the number of people in structured treatment programmes between 1998 and 2008. This has been exceeded two years ahead of schedule. The NTA is now concentrating on the quality agenda, improving services for people in treatment and improving outcomes for those who leave.
Briefing note:
Effective commissioning is key to the delivery of effective drug treatment, ensuring it meets local need and is planned, integrated and strategic.
Key areas of improvement for commissioning include:
- Needs assessment
Over a quarter (26%) of local drug partnerships were rated as "weak" for the quality of their needs assessment. The effective commissioning of a drug treatment system is dependent on having a clear profile of the diversity of local need. When asked whether the partnership carried out or updated a local needs assessment during 2005/06 to inform the commissioning for 2006/07, 21% of partnerships were rated "weak" and 79% "fair" - a poor result considering the impact this will have on the delivery of effective treatment.
- Strategic leadership
The review highlighted deficits in the seniority and frequency of attendance of senior representatives from statutory partners at local drug partnerships' strategic board meetings. In 15% of local drug partnerships there were board members below assistant director level.
Blood-borne virus (BBV) infections and drug overdoses account for a significant number of drug-related deaths and poor health among drug misusers and particularly drug injectors.
Recent concerns about the rates of BBV infections and overdoses led the Government to launch a new Reducing Harm Action Plan in May 2007. Recorded drug-related deaths due to overdose in the UK are among the highest recorded levels in Europe. Although a steep increase in the 1990s was halted by the implementation of Government targets in 2001, the target to reduce the number of deaths by 20% by 2004 was not met.
The review showed there are key improvements that need to be made in harm reduction:
- Strategic planning for reducing number of deaths
While strategic planning for harm reduction services was generally good, the scale of both preventable and treatable blood-borne virus infections and the high rates of overdose deaths, call for additional action by local drug partnerships. Only 68% of local drug partnerships had a multi-agency strategic plan for reducing the number of drug related deaths.
Harm reduction interventions were not provided broadly enough across the treatment system or sufficiently integrated into it. Just over a third (37%) of local drug partnerships did not have access to HIV testing with access to pre and post-test counselling integrated with their inpatient drug treatment services.
- Testing for hepatitis B and C
Ninety five percent of partnerships reported that less than half of service users had a recorded test date for hepatitis C. This is a clear national priority for improvement due to the scale of infection amongst injecting drug users.
Vaccination for hepatitis B and testing and treatment for hepatitis C was not provided widely enough via local drug treatment systems. Ninety five percent of local drug partnerships offered a hepatitis B vaccination to less than 75% of their service users and 29% did not have a protocol relating to hepatitis B.
- Out of hours needle exchange
There is a clear deficit nationally in the provision of out-of-hours needle exchange, with just under half (44%) of local drug partnerships scoring "weak". Forty four percent scored "fair" and 12% scored "good".
Healthcare Commission
A report released today by the Healthcare Commission and the National Treatment Agency (NTA), shows results from the second of three annual reviews to assess the performance of substance misuse treatment services.
Focusing specifically on how services are commissioned and harm reduction service provision, the findings reveal the majority of services are performing well within acceptable levels across these categories.
The number of people receiving specialist drug treatment has increased dramatically, with 195,400 in treatment during 2006/07 - up from 85,000 in 1998/99. Estimates for 2007/8 show 210,800 people will receive treatment. This means that more drug users than ever before are getting the treatment they need.
The review showed that there had been considerable improvement in the commissioning and performance management of drug treatment services, resulting in more service users receiving better treatment.
However, there were significant deficits, particularly in the provision of vaccination for hepatitis B and testing and treatment for hepatitis C. As 90% of all hepatitis C diagnoses are associated with injecting drug use, this is a key area of concern.
The review covered 149 'local drug partnerships' in England. Drug treatment is provided by a network of services, commissioned by local partnerships of statutory agencies within a particular locality, rather than being provided by individual organisations. These networks or 'local drug partnerships' are aligned to local authority boundaries. They bring together representatives of local organisations involved in the delivery of the drug strategy, including primary care trusts, local authorities, the police and the probation service.
Partnerships were asked 45 questions across 10 criteria. Each area was then scored on a scale; "weak", "fair", "good" and "excellent". Thirty four percent of local drug partnerships had an overall score of "excellent", 45% were "good" and 21% were "fair". No partnerships had an overall score of "weak", however the review revealed the majority of partnerships had deficits in key areas.
The review confirmed widespread good practice in relation to commissioning performance management but also showed that many areas did not have an adequate understanding of local need through systematic assessments. Since the review the Commission and the NTA have issued guidance and supported action plans to address this issue.
Partnerships also made significant progress in relation to care planning and treatment discharge systems, with nearly all (99%) achieving or exceeding 70% of their local target.
A good standard of financial management was found across the sector, with 60% of partnerships achieving the maximum score for this area.
Anna Walker, Chief Executive of the Commission, says: "Substance misuse affects not only the individual concerned but their families, friends, and the communities they live in.
"As the UK has one of the highest recorded drug-related death rates in Europe, it is a clear national priority to minimise the impact of substance misuse.
"It's very encouraging that thousands more people are now getting the treatment they need, and this review shows there is much to celebrate about the progress that has been made.
"However, it is worrying that the majority of hepatitis C cases are associated with injecting drugs, yet we know access to testing and treatment for the disease is patchy across the country. Similarly, access to clean needles provided by out of hours exchanges varies considerably. These are the areas that need to improve if the health of those who inject drugs is to be tackled effectively, and drug-related deaths reduced.
"Partnerships must now concentrate on driving improvements in the key areas highlighted by the review, in order to provide an equal service to all patients across the country. It is also important that partnerships really understand the needs in their area for these services and provides them accordingly."
Paul Hayes, the Chief Executive of the National Treatment Agency for substance misuse, said: "Effective commissioning underpins effective drug treatment delivery.
The improvements in commissioning shown by this review are very welcome.
However the review also highlights inconsistent practice across the country in key areas of delivery such as testing for and treatment of hepatitis B and C. The NTA will be working with all partnerships to spread best practice more consistently and has agreed action plans for improvement with the poorest performing areas."
Following the results of this review, work has been carried out by the Commission and the NTA with the 25 lowest performing partnerships. Action plans were to developed to improve performance and good progress has already been made implementing this.
The Commission and the NTA will follow up this report with a third and final review into this sector. This will look at diversity and residential services and will complete what has been a comprehensive review of the provision of substance misuse treatment.
The National treatment agency is engaging the sector in a range of initiatives and programmes to address the deficits identified by the review. The joint NTA/Department of Health action plan, Reducing drug-related harm was published in May 2007, and includes a national campaign aiming to tackle these and other harm reduction issues to begin in October this year.
In relation to commissioning the NTA continues to support the work of local areas in relation to treatment planning and needs assessment. 2008 will also see the publication of new guidance initiatives to enhance commissioning practice.
More information on the Improvement review of substance misuse 2006/2007
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
Information on the NTA
The National Treatment Agency for Substance Misuse (NTA) is a special health authority, created by the Government in 2001 to improve the availability, capacity and effectiveness of treatment for drug misuse in England. The NTA's purpose is to work with local partnerships and health commissioners to deliver high-quality, effective drug misuse treatment that improves individuals' physical and mental health and wellbeing. In turn, this improves public health, reduces crime and helps make communities safer.
The Government set the NTA a target of doubling the number of people in structured treatment programmes between 1998 and 2008. This has been exceeded two years ahead of schedule. The NTA is now concentrating on the quality agenda, improving services for people in treatment and improving outcomes for those who leave.
Briefing note:
Effective commissioning is key to the delivery of effective drug treatment, ensuring it meets local need and is planned, integrated and strategic.
Key areas of improvement for commissioning include:
- Needs assessment
Over a quarter (26%) of local drug partnerships were rated as "weak" for the quality of their needs assessment. The effective commissioning of a drug treatment system is dependent on having a clear profile of the diversity of local need. When asked whether the partnership carried out or updated a local needs assessment during 2005/06 to inform the commissioning for 2006/07, 21% of partnerships were rated "weak" and 79% "fair" - a poor result considering the impact this will have on the delivery of effective treatment.
- Strategic leadership
The review highlighted deficits in the seniority and frequency of attendance of senior representatives from statutory partners at local drug partnerships' strategic board meetings. In 15% of local drug partnerships there were board members below assistant director level.
Blood-borne virus (BBV) infections and drug overdoses account for a significant number of drug-related deaths and poor health among drug misusers and particularly drug injectors.
Recent concerns about the rates of BBV infections and overdoses led the Government to launch a new Reducing Harm Action Plan in May 2007. Recorded drug-related deaths due to overdose in the UK are among the highest recorded levels in Europe. Although a steep increase in the 1990s was halted by the implementation of Government targets in 2001, the target to reduce the number of deaths by 20% by 2004 was not met.
The review showed there are key improvements that need to be made in harm reduction:
- Strategic planning for reducing number of deaths
While strategic planning for harm reduction services was generally good, the scale of both preventable and treatable blood-borne virus infections and the high rates of overdose deaths, call for additional action by local drug partnerships. Only 68% of local drug partnerships had a multi-agency strategic plan for reducing the number of drug related deaths.
Harm reduction interventions were not provided broadly enough across the treatment system or sufficiently integrated into it. Just over a third (37%) of local drug partnerships did not have access to HIV testing with access to pre and post-test counselling integrated with their inpatient drug treatment services.
- Testing for hepatitis B and C
Ninety five percent of partnerships reported that less than half of service users had a recorded test date for hepatitis C. This is a clear national priority for improvement due to the scale of infection amongst injecting drug users.
Vaccination for hepatitis B and testing and treatment for hepatitis C was not provided widely enough via local drug treatment systems. Ninety five percent of local drug partnerships offered a hepatitis B vaccination to less than 75% of their service users and 29% did not have a protocol relating to hepatitis B.
- Out of hours needle exchange
There is a clear deficit nationally in the provision of out-of-hours needle exchange, with just under half (44%) of local drug partnerships scoring "weak". Forty four percent scored "fair" and 12% scored "good".
Healthcare Commission
четверг, 16 июня 2011 г.
Spouse May 'DriveYou To Drink' But Also Can Protect You From Alcohol
Men and women at risk for alcohol dependence are more likely to choose a mate who also is at risk, say investigators at Washington University School of Medicine in St. Louis. That doesn't necessarily mean, however, that both spouses will end up as problem drinkers.
Alcoholism is more common among partners of alcoholics than among partners of non-alcoholics, but it isn't as common as it might be. The researchers found that in some cases, one spouse's excesses with alcohol actually could help protect the other from alcohol dependence.
A team of researchers from Washington University and from the Queensland Institute of Medical Research in Brisbane, Australia, studied 5,974 twins born between 1902 and 1964 who were part of the Australian Twin Register. They also spoke with 3,814 of those twins' spouses for the study, published in the May issue of the journal Alcoholism: Clinical & Experimental Research.
"As they say, 'like marries like,'" says first author Julia D. Grant, Ph.D., research assistant professor of psychiatry at Washington University. "Spouse selection is not a random process, and we call this non-random mating. People tend to choose mates who are similar to them, not only from the same neighborhood or socio-economic background but also alike in personality and other behaviors. We found that people at risk for alcohol dependence tend to marry others who are at risk."
Alcohol dependence is influenced by both genetic and environmental factors. Genetic influences explain about half of the variance in a person's total risk for alcohol dependence. The other half of an individual's risk for alcohol dependence comes from environmental factors - such things as employment, interests, friends and family.
"There's lots of room for different factors to influence the behavior of two people who are married," Grant says. "One spouse could work at a place where the co-workers go out for a drink after work. Or one spouse could be a regular churchgoer, while the other prefers to sleep."
Another aspect of the environment is the drinking behavior of one's partner. The researchers found that the impact of the partner's drinking depends on whether it's examined along with non-random mating. Once the researchers accounted statistically for the fact that "like marries like," they saw that the additional influence of the partner's behavior tended to reduce the likelihood of problem drinking. Grant says that although non-random mating means that a person with genetic risks for alcohol problems will tend to marry another with a propensity toward alcohol dependence, it appears that when one spouse begins to abuse alcohol, the other might actually reduce alcohol intake.
"We don't really know how this works," she explains. "It is possible that an individual decreases his or her alcohol consumption in reaction to the other's excessive alcohol use. Maybe one person is responsible for getting the kids up and out for school in the morning, for example."
Grant says she hopes soon to study how spouses might influence not only each other's risk of alcohol dependence but also other psychiatric disorders, such as depression and how those factors interact. And she says as more is learned about these risks, it's important to let people know what they're up against.
"Education is a key to reducing risk for alcohol dependence," she says. "Regardless of genetic risks, there are other detrimental environmental factors associated with alcohol, including reduced educational attainment and income, fewer social and neighborhood support networks, higher rates of divorce and single parenthood and exposure to other psychiatric problems. We need to make people aware of all of their risks, so they can take steps to protect themselves."
Grant JD, Heath AC, Bucholz KK, Madden PAF, Agrawal A, Stratham DJ, Martin NG. Spousal concordance for alcohol dependence: evidence for assortative mating or spousal interaction effects? Alcoholism: Clinical & Experimental Research, vol. 31 (5), pp. 717-728, May 2007.
DOI: 10.1111/j/1530-0277.2007.00356.x
This research was supported by was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Contact: Jim Dryden
Washington University School of Medicine
Alcoholism is more common among partners of alcoholics than among partners of non-alcoholics, but it isn't as common as it might be. The researchers found that in some cases, one spouse's excesses with alcohol actually could help protect the other from alcohol dependence.
A team of researchers from Washington University and from the Queensland Institute of Medical Research in Brisbane, Australia, studied 5,974 twins born between 1902 and 1964 who were part of the Australian Twin Register. They also spoke with 3,814 of those twins' spouses for the study, published in the May issue of the journal Alcoholism: Clinical & Experimental Research.
"As they say, 'like marries like,'" says first author Julia D. Grant, Ph.D., research assistant professor of psychiatry at Washington University. "Spouse selection is not a random process, and we call this non-random mating. People tend to choose mates who are similar to them, not only from the same neighborhood or socio-economic background but also alike in personality and other behaviors. We found that people at risk for alcohol dependence tend to marry others who are at risk."
Alcohol dependence is influenced by both genetic and environmental factors. Genetic influences explain about half of the variance in a person's total risk for alcohol dependence. The other half of an individual's risk for alcohol dependence comes from environmental factors - such things as employment, interests, friends and family.
"There's lots of room for different factors to influence the behavior of two people who are married," Grant says. "One spouse could work at a place where the co-workers go out for a drink after work. Or one spouse could be a regular churchgoer, while the other prefers to sleep."
Another aspect of the environment is the drinking behavior of one's partner. The researchers found that the impact of the partner's drinking depends on whether it's examined along with non-random mating. Once the researchers accounted statistically for the fact that "like marries like," they saw that the additional influence of the partner's behavior tended to reduce the likelihood of problem drinking. Grant says that although non-random mating means that a person with genetic risks for alcohol problems will tend to marry another with a propensity toward alcohol dependence, it appears that when one spouse begins to abuse alcohol, the other might actually reduce alcohol intake.
"We don't really know how this works," she explains. "It is possible that an individual decreases his or her alcohol consumption in reaction to the other's excessive alcohol use. Maybe one person is responsible for getting the kids up and out for school in the morning, for example."
Grant says she hopes soon to study how spouses might influence not only each other's risk of alcohol dependence but also other psychiatric disorders, such as depression and how those factors interact. And she says as more is learned about these risks, it's important to let people know what they're up against.
"Education is a key to reducing risk for alcohol dependence," she says. "Regardless of genetic risks, there are other detrimental environmental factors associated with alcohol, including reduced educational attainment and income, fewer social and neighborhood support networks, higher rates of divorce and single parenthood and exposure to other psychiatric problems. We need to make people aware of all of their risks, so they can take steps to protect themselves."
Grant JD, Heath AC, Bucholz KK, Madden PAF, Agrawal A, Stratham DJ, Martin NG. Spousal concordance for alcohol dependence: evidence for assortative mating or spousal interaction effects? Alcoholism: Clinical & Experimental Research, vol. 31 (5), pp. 717-728, May 2007.
DOI: 10.1111/j/1530-0277.2007.00356.x
This research was supported by was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Contact: Jim Dryden
Washington University School of Medicine
среда, 15 июня 2011 г.
Preventing Risk-Taking And Self-Destructive Behavior In Young People
At the beginning of 2010, the Child and Adolescent Psychiatry Department at the Center for Psychosocial Medicine at Heidelberg University Hospital will conduct a study named "Saving and Empowering Young Lives in Europe (SEYLE) - promoting the health of young people through the prevention of risk-taking and self-destructive behavior" in cooperation with twelve centers in other EU countries and Israel. The 12-month study, which will receive some 3 million euros in funding from the European Union, was presented in Heidelberg on November 24, 2009. The Karolinska Institute in Stockholm will assume the Europe-wide direction of the study.
Promote health, reduce injurious behavior
Risk-taking and self-destructive behavior is understood to mean alcohol and drug consumption, self-injury and suicidal actions, aggression, anxiety, depression, and various dangerous situations that youth in particular expose themselves to.
The primary objective of the study is to promote the psychological health of youth at schools. To do this, over 1,000 pupils per country will be surveyed by means of questionnaires. In the Rhein-Neckar region, several types of secondary schools will participate. Information will be gathered on factors such as eating behavior, Internet and media use, depression, and social situation. "This information will indicate the extent of the problems and which pupils are at risk," explains the head of the study Professor Dr. Romuald Brunner, consultant at the Child and Adolescent Psychiatry Department at Heidelberg University Hospital.
"The SEYLE study builds on the experience of the "Heidelberg school study" that has been examining the psychological health of 15-year-olds for many years," reported Professor Dr. Franz Resch, Medical Director of the Department of Child and Adolescent Psychiatry at Heidelberg University Hospital. Among other things, this study determined that some 5 percent of female pupils and 2 percent of male pupils frequently inflicted injuries on themselves.
Four different preventive measures to be tested
In the SEYLE study, following the initial survey, one of a total of four different preventive measures will be conducted at every participating school and then examined as to effectiveness.
"Gatekeeper Training" for teachers and school staff to recognize and help at-risk pupils.
"Awareness Program", in which pupils learn to deal with the risks by engaging in role-play.
"Professional Screening": after evaluation of the questionnaires, at-risk pupils are identified and interviewed.
Minimal intervention with posters and contact information for pupils.
Use regional help centers and treatment systems
All preventive measures are conducted in close cooperation with regional outpatient treatment systems and therapists and should introduce youth who exhibit risk-taking and self-injurious behavior to these regional help centers and treatment systems. In the longer term, the goal is to establish effective preventive measures for all schools.
The results of the study should help develop a comprehensive, country-specific concept for youth that takes the needs and wishes of all involved into consideration and can be integrated as a fixed component of preventive healthcare in Germany and other countries.
This project is under the patronage of Dr. Eckart W??rzner, Lord Mayor of the City of Heidelberg.
Source: Professor Dr. Franz Resch
University Hospital Heidelberg
Promote health, reduce injurious behavior
Risk-taking and self-destructive behavior is understood to mean alcohol and drug consumption, self-injury and suicidal actions, aggression, anxiety, depression, and various dangerous situations that youth in particular expose themselves to.
The primary objective of the study is to promote the psychological health of youth at schools. To do this, over 1,000 pupils per country will be surveyed by means of questionnaires. In the Rhein-Neckar region, several types of secondary schools will participate. Information will be gathered on factors such as eating behavior, Internet and media use, depression, and social situation. "This information will indicate the extent of the problems and which pupils are at risk," explains the head of the study Professor Dr. Romuald Brunner, consultant at the Child and Adolescent Psychiatry Department at Heidelberg University Hospital.
"The SEYLE study builds on the experience of the "Heidelberg school study" that has been examining the psychological health of 15-year-olds for many years," reported Professor Dr. Franz Resch, Medical Director of the Department of Child and Adolescent Psychiatry at Heidelberg University Hospital. Among other things, this study determined that some 5 percent of female pupils and 2 percent of male pupils frequently inflicted injuries on themselves.
Four different preventive measures to be tested
In the SEYLE study, following the initial survey, one of a total of four different preventive measures will be conducted at every participating school and then examined as to effectiveness.
"Gatekeeper Training" for teachers and school staff to recognize and help at-risk pupils.
"Awareness Program", in which pupils learn to deal with the risks by engaging in role-play.
"Professional Screening": after evaluation of the questionnaires, at-risk pupils are identified and interviewed.
Minimal intervention with posters and contact information for pupils.
Use regional help centers and treatment systems
All preventive measures are conducted in close cooperation with regional outpatient treatment systems and therapists and should introduce youth who exhibit risk-taking and self-injurious behavior to these regional help centers and treatment systems. In the longer term, the goal is to establish effective preventive measures for all schools.
The results of the study should help develop a comprehensive, country-specific concept for youth that takes the needs and wishes of all involved into consideration and can be integrated as a fixed component of preventive healthcare in Germany and other countries.
This project is under the patronage of Dr. Eckart W??rzner, Lord Mayor of the City of Heidelberg.
Source: Professor Dr. Franz Resch
University Hospital Heidelberg
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