Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities

Objective: Access to substance abuse treatment among historically disadvantaged communities (HDCs) in Cape Town, South Africa is limited, despite a growing demand for services. Although research has reported on structural barriers to treatment access, nonstructural factors remain largely unexplored. The aim of this paper is to describe two nonstructural influences on the use of substance abuse treatment services for people from HDCs: stigma and negative beliefs about treatment. Method: Findings from the qualitative component of a multi-method study are reported. In-depth interviews were conducted with 20 key informants, all of whom worked or lived in HDCs in the greater Cape Town area. Content and thematic techniques were used to analyse data. Results: According to key informants (i) stigma towards individuals with substance use disorders was prevalent in HDCs and negatively impacted on attempts to access services; (ii) negative beliefs about the quality and effectiveness of treatment were commonplace and acted as barriers to the use of existing services; and (iii) several factors contributed to these nonstructural barriers including media representations of both individuals with substance use disorders and treatment facilities for these disorders. Conclusion: This paper moves beyond the description of structural barriers to treatment to describe how two nonstructural factors, stigma and negative beliefs about treatment, hinder treatment seeking for substance use disorders. Recommendations for addressing these barriers include efforts to (i) shift discourses about substance abuse treatment, (ii) improve service quality, and (iii) address myths and misconceptions about treatment

Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa

Objective: The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework. Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants. Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men. Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided.Keywords: Health care quality; Access and evaluation; Gender; Substance abuse treatment centres; South Afric

Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities

Objective: Access to substance abuse treatment among historically disadvantaged communities (HDCs) in Cape Town, South Africa is limited, despite a growing demand for services. Although research has reported on structural barriers to treatment access, nonstructural factors remain largely unexplored. The aim of this paper is to describe two nonstructural influences on the use of substance abuse treatment services for people from HDCs: stigma and negative beliefs about treatment. Method: Findings from the qualitative component of a multi-method study are reported. In-depth interviews were conducted with 20 key informants, all of whom worked or lived in HDCs in the greater Cape Town area. Content and thematic techniques were used to analyse data. Results: According to key informants (i) stigma towards individuals with  substance use disorders was prevalent in HDCs and negatively impacted on attempts to access services; (ii) negative beliefs about the quality and effectiveness of treatment were commonplace and acted as barriers to the use of existing services; and (iii) several factors contributed to these nonstructural barriers including media representations of both individuals with substance use disorders and treatment facilities for these disorders. Conclusion: This paper moves beyond the description of structural barriers to treatment to describe how two nonstructural factors, stigma and negative beliefs about treatment, hinder treatment seeking for substance use disorders. Recommendations for addressing these barriers include efforts to (i) shift discourses about substance abuse treatment, (ii) improve service quality, and (iii) address myths and misconceptions about treatment

Gender differences in barriers to alcohol and other drug treatment in Cape Town South Africa

The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework. Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants. Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men. Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided

Academic Preparation in Cleft Palate for Speech-Language Pathologists: Is the ICF-CY (Who, 2007) Alive and Well?

The purpose of this project is to determine inclusion of the ICF-CY in CLP training curricula for SLPs. Survey research was conducted with course instructors across the nation. Results describe the application of the ICF-CY in CLP courses at the graduate level. Recommendations for including the ICF-CY framework are made

The use of VTE prophylaxis in relation to patient risk profiling(TUNE-IN) Wave 2 Study

KMBackground: The TUNE-IN (The Use of VTE prophylaxis in relatioN to patiEnt risk profiling) study evaluated venous thromboembolism (VTE) risk assessment and prophylaxis in private medical and surgical inpatients in Gauteng Province, South Africa. The study concluded that of the 608 patients enrolled, 54.1% were clinically evaluated to be at risk for VTE. A VTE risk assessment model (RAM), the Caprini score, increased the rate to 74.6%. Objectives: TUNE-IN Wave 2, an extension of TUNE-IN, was conducted on a national level including the public sector, focusing on surgical inpatients. Methods. The study was a national, prospective, non-interventional, multisite, epidemiological disease registry enrolling 453 surgical inpatients. The perceived clinical VTE risk, VTE risk score on Caprini RAM, VTE prophylaxis and clinical details were documented during a baseline visit. A bleeding risk score was provided. Results: Of the cohort, 269 patients (59.4%) were assessed to be at risk for VTE before applying the RAM. All patients (100%), however, were at risk on the RAM score. Early mobilisation and assessment of the VTE risk as low were the most frequent reasons for non-prescription of prophylaxis. Only 15 patients in the private and 2 in the public sector were assessed as having a bleeding risk. Chemoprophylaxis differed between the healthcare sectors, with low-molecular-weight heparin predominating in the private sector and unfractionated heparin being prescribed only in the public sector. Conclusion: VTE risk assessment and prophylaxis need to improve in both the public and the private sectors. A formal RAM will improve identification of patients at risk of VTE

Thrombotic disorders (part 1)

Thromboembolic conditions are the leading cause of mortality, estimated to account for 1 in 4 deaths worldwide in 2010. Over time, the incidence and mortality rates of these conditions have improved in developed countries, but are increasing in developing countries. The haemostatic system comprises 6 main components, i.e. (i) platelets; (ii) vascular endothelium; (iii) coagulation proteins; (iv) natural anticoagulants; (v) the fibrinolytic system; and (vi) natural antifibrinolytic factors. A delicate balance exists between procoagulant and anticoagulant factors within the vascular system. Numerous acquired or inherited conditions may tip the balance either way, i.e. towards a prothrombotic or prohaemorrhagic state. In this issue of CME, the first of a 2-part series on thrombophilic disorders, the subject of discussion is on inherited varieties that the general practitioner is likely to encounter. This review is primarily based on venous thrombosis

Lizard epidermal gland secretions II : chemical characterization of the generation gland secretion of the sungazer, Cordylus giganteus

The original publication is available at http://pubs.acs.org/doi/full/10.1021/np1008366In lizards, the epidermal glands of the femoral and precloacal regions are involved in the production of semiochemicals. In addition to its femoral glands, the giant girdled lizard, or sungazer, Cordylus giganteus, which is endemic to South Africa, has generation glands as an additional potential source of semiochemicals. These epidermal glands are described as glandular scales that overlay the femoral glands and are included in the normal epidermal profile located in the femoral (thigh) and anterior antebrachial (fore-leg) regions of the male sungazer. GC-MS analysis of the generation gland secretions and the trimethylsilyl derivatives of some of the steroidal constituents was employed to identify 59 constituents, including alkenes, carboxylic acids, alcohols, ketones, aldehydes, esters, amides, nitriles, and steroids. The quantitative differences of the volatile constituents of the fore- and hind-leg generation glands were compared between individuals. This is the first report on the chemical composition of generation glandular material of lizards. © 2011 The American Chemical Society and American Society of Pharmacognosy.Post-prin