Older Adults and Substance Abuse: A Program Evaluation

In the year 2011, the first wave of the baby boom generation reached age 65, the age of retirement. Over the next 18 years the U. S. Administration on Aging (2010) reports that these boomers will turn 65 years old at the rate of approximately 8,000 per day. Substance abuse among this cohort has been called an invisible and silent epidemic. Many social service agencies will have to deal with the negative and complicating factors which substance abuse causes. Alcohol and substance misuse among the elderly is associated with many negative consequences, including functional impairment, increase risk of dementia, raised mortality and higher utilization of healthcare services. In addition, it is estimated that 4.4 million adults age 50 and older will be substance dependent and in need of treatment by the year 2020. The focus of this clinical research project was to evaluate the Senior Recovery Program and how effective the program is at meeting its goals through the eyes of its participants. The researcher measured former clients overall satisfaction with the Senior Recovery Program by assessing their perceptions of sobriety maintenance, age appropriate program design, relationship with family, social skills and support and overall program satisfaction. Findings of this program evaluation indicated the Senior Recovery Program is effective in delivering quality chemical health recovery services to older adults through the focus of five areas of service. This program evaluation will add to the research collection and improve understanding and needs of older adults who require substance abuse treatment

Older Adults and Substance Abuse: A Program Evaluation

In the year 2011, the first wave of the baby boom generation reached age 65, the age of retirement. Over the next 18 years the U. S. Administration on Aging (2010) reports that these boomers will turn 65 years old at the rate of approximately 8,000 per day. Substance abuse among this cohort has been called an invisible and silent epidemic. Many social service agencies will have to deal with the negative and complicating factors which substance abuse causes. Alcohol and substance misuse among the elderly is associated with many negative consequences, including functional impairment, increase risk of dementia, raised mortality and higher utilization of healthcare services. In addition, it is estimated that 4.4 million adults age 50 and older will be substance dependent and in need of treatment by the year 2020. The focus of this clinical research project was to evaluate the Senior Recovery Program and how effective the program is at meeting its goals through the eyes of its participants. The researcher measured former clients overall satisfaction with the Senior Recovery Program by assessing their perceptions of sobriety maintenance, age appropriate program design, relationship with family, social skills and support and overall program satisfaction. Findings of this program evaluation indicated the Senior Recovery Program is effective in delivering quality chemical health recovery services to older adults through the focus of five areas of service. This program evaluation will add to the research collection and improve understanding and needs of older adults who require substance abuse treatment

STAGES OF RELATIONSHIP CHANGE AND INDIVIDUAL AND COUPLE ADJUSTMENT

Although Prochaska and DiClemente (1984) considered the Transtheoretical Model of Change (TTM) to be relevant to couples therapy, there is a paucity of research in this area. Understanding how couples initiate change in their relationship still proves difficult due to barriers in the collection of couple level data and the fact that the majority of research on the TTM is individualistic in nature (Fowers, 2001; Schneider, 2003). Schneider (2003) reported that research suggests a relationship between change processes and relationship adjustment in couples. To my knowledge this study is the first test of the reliability and correlates of relationship change, beyond Schneider’s initial work. The purpose of the present study was to examine how individual adjustment and readiness to change affect relationship adjustment. Data were collected from a sample of 389 married and cohabitating individuals using a self-report survey. Readiness to change was found to partially mediate the relationship between individual well-being and relationship adjustment. This link underscores the concept of women as health gatekeepers of the family. The present study validates research on the TTM with individuals but draws further attention to the idea that changing a dyadic relationship is not an individual process

A Content Analysis of Information and Support Needs in Women with Breast Cancer Who Use the Internet

Each year, over 226,870 women in the U.S. will be diagnosed with breast cancer, and 39,510 will die. The five year survival rate for localized cancer is 99%, however this decreases to 84% for regional sites such as the lungs or the abdomen, and 23% for distant sites such as the brain1. The most common treatments include chemotherapy, radiation, lumpectomy and/or mastectomy. Starting with diagnosis, and continuing through treatment and into survivorship, women have information and support needs related to all aspects of the management of their disease. The Breast Cancer Internet and Support Study (BCIIS, N = 429) was a needs assessment of the characteristics of women who were diagnosed with breast cancer and used the Internet. During this time, the women were asked to provide narrative comments related to any aspect of their diagnosis that they would like to discuss. A free form text box of 1000 characters was provided on the BCIIS survey. The contents of the comments were analyzed and a total of nine themes were identified: support, connection and community, trust, interaction with providers, difficult experiences, empowerment, informational competence, attitude and quality of life. The results of this study will enable better understanding of the experiences of women with breast cancer, and help to develop online programming that is based on womens’ needs and preferences. 1. Siegel, R., Naishadham, D. & Jemal, A. (2012). Cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 62, 10-29

How Does Inter-Annual Snowpack Variability Impact Reservoir Storage in the Magic Reservoir?

Water users in the state of Idaho are dependent on reservoir storage for irrigation during the dry season. By knowing the reservoir storage early water users can decide on how much water to use and when to use it. We want to predict reservoir storage so that water users can then have early access to the upcoming storage levels and can then decide the action needed in using the predicted reservoir storage. To predict reservoir storage, we used a linear regression automated model selection that highlighted the important variables of Spring temperatures, Winter temperature at Soldier R.S. SNOTEL site, and Snow Water Equivalence (SWE) at Camas Creek Divide SNOTEL site. The model found that these variables are the major drivers of predicting maximum reservoir storage at Magic Reservoir in Idaho. The implication of this finding is that spring temperatures play a larger role in prediction reservoir maximum storage than Snow Water Equivalence. This is impactful as spring temperatures are not thought of as a major driver in predicting reservoir maximum storage, when in accordance with the results shown from this study spring temperatures are a major driver in predicting reservoir maximum storage

Walking in a maze : community providers\u27 difficulties coordinating health care for homeless patients

BACKGROUND: While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. METHODS: Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. RESULTS: HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. CONCLUSIONS: Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons

Quantifying relative fish abundance with eDNA : a promising tool for fisheries management

1. Assessment and monitoring of exploited fish populations are challenged by costs, logistics and negative impacts on target populations. These factors therefore limit large-scale effective management strategies. 2. Evidence is growing that the quantity of eDNA may be related not only to species presence/absence, but also to species abundance. In this study, the concentrations of environmental DNA (eDNA) from a highly prized sport fish species, Lake Trout Salvelinus namaycush (Walbaum 1792), were estimated in water samples from 12 natural lakes and compared to abundance and biomass data obtained from standardized gillnet catches as performed routinely for fisheries management purposes. To reduce environmental variability among lakes, all lakes were sampled in spring, between ice melt and water stratification. 3. The eDNA concentration did not vary significantly with water temperature, dissolved oxygen, pH and turbidity, but was significantly positively correlated with relative fish abundance estimated as catch per unit effort (CPUE), whereas the relationship with biomass per unit effort (BPUE) was less pronounced. 4. The value of eDNA to inform about local aquatic species distribution was further supported by the similarity between the spatial heterogeneity of eDNA distribution and spatial variation in CPUE measured by the gillnet method. 5. Synthesis and applications. Large-scale empirical evidence of the relationship between the eDNA concentration and species abundance allows for the assessment of the potential to integrate eDNA within fisheries management plans. As such, the eDNA quantitative method represents a promising population abundance assessment tool that could significantly reduce the costs associated with sampling and increase the power of detection, the spatial coverage and the frequency of sampling, without any negative impacts on fish populations

P-225: Effective blood-pressure control with valsartan/HCTZ combination therapy in patients with moderate to severe systolic hypertension: The valor trial

Increasing evidence shows that combination therapy with at least two antihypertensive agents is needed to achieve appropriate blood-pressure (BP) control in a large part of the hypertensive population. One of the most appealing combinations is that of adding a diuretic to an angiotensin-receptor blocker (ARB). We studied the effects on sitting systolic BP of the combinations valsartan (V; an ARB) 160 mg + HCTZ 12.5 mg and V160 mg + HCTZ 25 mg od, compared with monotherapy V160 mg od. Treatment-naive and previously treated patients (N=767) with moderate to severe systolic hypertension (SBP ≥160 mm Hg and ≤200 mmHg) and with or without co-morbidities, were randomised (after a 2-week washout if previously treated and a 2 week placebo run-in period) to either V80 od (monotherapy group) or V160 od (combination groups) for 4 weeks, with force-tration to V160 mg, V160/HCTZ 12.5 od or V160/HCTZ 25 od for an additional 4 weeks. Endpoints were change in SBP between V160 and V160/HCTZ 25 and between V160/HCTZ 12.5 and V160; changes in DBP between groups, response rates and tolerability. As shown in the Table, all treatments were highly effective and there were additional SBP and DBP reductions in the combination groups. Responder rates were above 50% in all groups and reached 75% in the V160/HCTZ 25 group. Rates of adverse events did not differ significantly between monotherapy and combination therapies. Table 1 V160 V160/HCTZ12.5 V160/HCTZ25 N 261 254 252 Male/female 130/131 141/113 140/112 Mean age 60.4 (10.6) 60.8 (11.5) 60.7 (11.6) Baseline mean SBP/DBP 167.9 (8.0)/93.2 (8.9) 167.4 (8.3)/93.4 (9.6) 167.2 (7.9)/93.7 (8.8) Mean change SBP/DBP −20.7 (15.7)/−6.6 (8.9) −27.9 (13.8) *−10.2 (7.7)* −28.3 (13.1) *−10.1 (7.8)* Response rate¥ 56.9% 74.4% * 75% * Any AE (monotherapy phase/combination phase) 37.3%/27.5% 32.1%/28.6% 32.8%/34.0% Values in brackets are ± SD. *P < 0.05 vs V160; ¥SBP < 140 or decrease in SBP ≥20 mmHg and/or DBP<90 mmHg. V160 mg od is safe and effective in patients with moderate to severe systolic hypertension. Adding HCTZ 12.5 or 25 mg provides significant additional reductions in systolic and diastolic BP and increases responder rates compared with V160 mg monotherapy, with maintained excellent tolerabilit