scholarly journals Psychosocial difficulties and treatment retention in inpatient detoxification programmes

2021 ◽  
pp. 145507252110212
Author(s):  
Jonna Levola ◽  
Arno Aranko ◽  
Tuuli Pitkänen
Keyword(s):  
Regression Models ◽  
Addiction Treatment ◽  
Real Life ◽  
Treatment Retention ◽  
Logistic Regression Models ◽  
Cognitive Difficulties ◽  
Polysubstance Use ◽  
Real Life Data ◽  
Younger Age ◽  
Psychosocial Difficulties

Aims: Treatment retention is associated with addiction treatment outcomes. Research regarding predictors of retention at inpatient detoxification treatment is limited. The aim of this study was to investigate whether psychosocial difficulties (PSDs) are associated with treatment retention among Finnish inpatients undergoing detoxification treatment. Design: This register-based study included real-life data on detoxification treatment episodes ( n = 2,752) between February of 2016 and May of 2019 from several inpatient treatment units in Finland. The PARADISE24fin instrument was used to assess PSDs. Socio-demographic and substance use related variables, as well as PSDs, were analysed with regard to treatment retention. Multiple logistic regression models were used to identify predictors of treatment incompletion. Results: Of the 2,752 detoxification treatment episodes, 80.3% ( n = 2,209) were completed. Men and women differed with regard to the variables associated with treatment retention. After adjusting for confounders, younger age (≤ 35 years), being less educated (≤ 9 years), being unemployed, using opioids, polysubstance use and more severe dependence were associated with treatment incompletion. Overall severity of PSDs (PARADISE24fin mean score) became non-significant after adjusting for confounders. However, having more severe cognitive difficulties was significantly associated with treatment incompletion, while more severe difficulties in daily activities was associated with treatment completion. Conclusions: Special attention should be paid to younger individuals with opioid and/or polysubstance use, as well as those with cognitive difficulties, in order to retain people in treatment.

scholarly journals Positivity to Cocaine and/or Benzoylecgonine in Confirmation Analyses for On-Road Tests in Spain

2021 ◽  
Vol 18 (10) ◽  
pp. 5371
Author(s):  
Francisco Herrera-Gómez ◽  
Eduardo Gutiérrez-Abejón ◽  
Mercedes García-Mingo ◽  
F. Javier Álvarez
Keyword(s):  
Multivariate Regression ◽  
Real Life ◽  
Multivariate Logistic Regression Analysis ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Life Data ◽  
Polysubstance Use ◽  
Real Life Data ◽  
Other Substances ◽  
Positive Results

We are using real-life data in order to determine the prevalence of driving with the presence of cocaine and/or benzoylecgonine (BZE), their concentrations, and their use in combination with other drugs. This study assessed data on Spanish drivers with confirmed drug-positive results recorded by the Spanish National Traffic Agency from 2011–2016. Frequencies of positivity for cocaine and/or BZE and concentration of such substances were obtained. Comparisons and univariate and multivariate regression analyses were performed. Drivers who tested positive for cocaine and/or BZE accounted for 48.59% of the total positive results for drugs. In positive cases for both cocaine and BZE, other substances were detected in 81.74%: delta-9-tetrahydrocannabinol (THC) (68.19%), opioids (20.78%) and amphetamine-like substances (16.76%). In the multivariate logistic regression analysis, the frequency of cocaine and/or BZE positive cases decreased with age (OR:0.97) and were less likely among women (OR:0.63). Concentrations (ng/mL) of cocaine (249.30) and BZE (137.90) were higher when both substances were detected together than when detected alone. Positivity to cocaine represented an important proportion among Spanish drivers who tested positive for drugs, and polysubstance use was especially observed in more than 8 out of 10 positive cases for cocaine and/or BZE.

Progression of coal workers’ pneumoconiosis absent further exposure

2020 ◽  
Vol 77 (11) ◽  
pp. 748-751
Author(s):  
Kirsten S Almberg ◽  
Lee S Friedman ◽  
Cecile S Rose ◽  
Leonard H T Go ◽  
Robert A Cohen
Keyword(s):  
Disease Progression ◽  
Regression Models ◽  
Medical Surveillance ◽  
Coal Miners ◽  
Radiographic Evidence ◽  
Logistic Regression Models ◽  
Younger Age ◽  
History Of ◽  
Coal Workers Pneumoconiosis ◽  
Coal Workers

ObjectivesThe natural history of coal workers’ pneumoconiosis (CWP) after cessation of exposure remains poorly understood.MethodsWe characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression.ResultsA total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR.ConclusionsThis study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.

Multisector Involvement Among Adolescents With Disabilities

2017 ◽  
Vol 39 (6) ◽  
pp. 353-364 ◽  
Author(s):  
Amanda L. Sullivan ◽  
Andrew J. Thayer ◽  
Shanna S. Sadeh
Keyword(s):  
Students With Disabilities ◽  
Regression Models ◽  
School Health ◽  
Logistic Regression Models ◽  
School Based ◽  
Sociodemographic Predictors ◽  
Psychosocial Difficulties ◽  
Nationally Representative ◽  
Transition Study ◽  
National Longitudinal Transition Study

When youth experience psychosocial difficulties, multiple sectors of care may intervene. The present study examined the prevalence and sociodemographic predictors of multisector involvement related to psychosocial difficulties among adolescents with disabilities. Using a nationally representative sample of 9,230 students who participated in the National Longitudinal Transition Study–2, we estimated students’ rates of involvement in school, health, social service, and juvenile justice sectors and used logistic regression models to ascertain the relations to student characteristics. Students with disabilities were frequently involved with a variety of sectors of care, but schools remain the primary provider. Multisector involvement was commonplace, particularly for adolescents with emotional disturbance or autism. Disability and insurance type consistently predicted involvement of each sector, but other sociodemographic characteristics commonly related to disparities in involvement were not significant in most of our models. Communication and collaboration across systems can support the school-based problem solving and individualized planning for students with disabilities.

Nested logistic regression models and ΔAUC applications: Change-point analysis

2021 ◽  
pp. 096228022110223
Author(s):  
Chun Yin Lee
Keyword(s):  
Logistic Regression ◽  
Change Point ◽  
Regression Models ◽  
Real Life ◽  
Change Point Analysis ◽  
Reduced Model ◽  
Finite Sample ◽  
Test Statistic ◽  
Logistic Regression Models ◽  
Nested Models

The area under the receiver operating characteristic curve (AUC) is one of the most popular measures for evaluating the performance of a predictive model. In nested models, the change in AUC (ΔAUC) can be a discriminatory measure of whether the newly added predictors provide significant improvement in terms of predictive accuracy. Recently, several authors have shown rigorously that ΔAUC can be degenerate and its asymptotic distribution is no longer normal when the reduced model is true, but it could be the distribution of a linear combination of some [Formula: see text] random variables [ 1 , 2 ]. Hence, the normality assumption and existing variance estimate cannot be applied directly for developing a statistical test under the nested models. In this paper, we first provide a brief review on the use of ΔAUC for comparing nested logistic models and the difficulty of retrieving the reference distribution behind. Then, we present a special case of the nested logistic regression models that the newly added predictor to the reduced model contains a change-point in its effects. A new test statistic based on ΔAUC is proposed in this setting. A simple resampling scheme is proposed to approximate the critical values for the test statistic. The inference of the change-point parameter is done via m-out-of- n bootstrap. Large-scale simulation is conducted to evaluate the finite-sample performance of the ΔAUC test for the change-point model. The proposed method is applied to two real-life datasets for illustration.

Factors associated with over and underuse of response evaluation in elderly myeloma patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19518-e19518
Author(s):  
Siyang Leng ◽  
Suzanne Lentzsch ◽  
Yizhen Chen ◽  
Divaya Bhutani ◽  
Jason Dennis Wright ◽  
...  
Keyword(s):  
Regression Models ◽  
First Year ◽  
Response Evaluation ◽  
Office Visits ◽  
Central Importance ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Younger Age ◽  
Immunomodulatory Drug ◽  
Medicare Database

e19518 Background: Most patients with multiple myeloma (MM) have detectable monoclonal protein. While guidelines do not specify the frequency of lab testing for response evaluation, most MM clinical trials perform monthly assessment. We examined the use of 4 serologic tests – protein electrophoresis (SPEP), immunofixation (IFE), quantitative immunoglobulins (QIG), and free light chain (FLC) in newly-diagnosed MM patients. Methods: We identified patients age ≥65 with MM (ICD-O 34000) in the Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2000-2013. Patients were required to have bone marrow biopsy within 6 months of diagnosis, and taken chemotherapy approved for MM. Use of a test was defined as having ≥1 instance of its CPT code within 12 months of diagnosis. Patients with > 12 instances were defined as overusers. Multiple instances of a test on the same date were counted once. Multivariable logistic regression models using covariates including: age and year at MM diagnosis, race, marital status, Charlson comorbidity, chemotherapy use, number of hospitalizations and oncology office visits within 12 months of diagnosis, were developed to examine associations with overuse. Results: Among 6,214 identified patients, users were: SPEP 5,532 (89%), IFE 4,745 (76%), QIG 5,524 (89%), and FLC 3,864 (62%). The median (interquartile range) times each test was used in the first year following diagnosis were: SPEP 6 (3-10), IFE 3 (2-7), QIG 6 (3-10), FLC 5 (2-9). The numbers of overusers were: SPEP 721 (13%), IFE 265 (6%), QIG 498 (9%), FLC 350 (9%). 231 (4%) patients were overusers of 2 tests. Factors associated with overuse common to all 4 tests were: younger age at diagnosis (eg, SPEP: odds ratio (OR) 2.0 for aged 65-74 vs ≥85; P < .001), more oncology office visits (eg, QIG: OR 2.2 for > 15 vs 0-6; P < .001), and use of combination chemotherapy (eg, SPEP: OR 2.2 for proteasome inhibitor + immunomodulatory drug (IMID) vs those on IMID ; P < .001). Conclusions: In our Medicare population, patients on average underwent response evaluation much less often than monthly, but we also found overuse. Further investigation of the use of these tests is warranted given their central importance to MM care and their cumulative financial cost.

Effect of time from onset to endovascular therapy on outcomes: the National Acute Stroke Israeli (NASIS)-REVASC registry

2019 ◽  
Vol 12 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Shlomi Peretz ◽  
Guy Raphaeli ◽  
Natan Borenstein ◽  
Ronen R Leker ◽  
Ran Brauner ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Endovascular Therapy ◽  
Regression Models ◽  
Real Life ◽  
Continuous Variable ◽  
Early Recovery ◽  
Vessel Occlusion ◽  
Logistic Regression Models ◽  
Hospital Transfer ◽  
Transferred Patients

BackgroundEndovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry.MethodsStroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2–4, 4–6, and >6 hours.Results299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours.ConclusionsNationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the ‘two golden hours’ from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.

POLYSUBSTANCE USE IN INFLAMMATORY BOWEL DISEASE

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S54-S55
Author(s):  
Kaleb Bogale ◽  
Kent Vrana ◽  
Wesley Raup-Konsavage ◽  
Vonn Walter ◽  
August Stuart ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Substance Use ◽  
Logistic Regression ◽  
Disease Activity ◽  
Bowel Disease ◽  
Regression Models ◽  
Logistic Regression Models ◽  
Polysubstance Use ◽  
Multivariable Logistic Regression ◽  
Inflammatory Bowel

Abstract Background Polysubstance Use (PSU), the use of two or more substances of abuse, has been associated with increased risk for development of psychiatric conditions and early death compared to both monosubstance use or no substance use. The vast majority of clinical research on prescription or recreational drug consumption in patients with inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), has focused on use of individual substances. We evaluated the incidence and impact of PSU in IBD and assessed potential predisposing factors in this setting. Methods We performed a retrospective analysis using a consented IBD natural history registry from a single tertiary care referral center between 1/1/2015–8/31/2019. Demographics, endoscopic severity (using Mayo endoscopy sub-score for UC and Simple Endoscopic Score for CD), totals and sub-scores of surveys (Harvey-Bradshaw Index, Simple Clinical Colitis Activity Index, Hospital Anxiety and Depression Scale, Short IBD Questionnaire) assessing for symptoms (abdominal pain, fatigue, anxiety/depression, gas, diarrhea, rectal bleeding, and fecal urgency), substance use (tobacco, alcohol, marijuana, cocaine, methamphetamine, heroin, opiates, or benzodiazepine), and antidepressant or anxiolytic medication were abstracted. PSU was defined as concurrent use of two or more non-prescription drugs or substances, and healthcare resource utilization was defined as any IBD-related imaging, emergency room visit, hospitalization, or surgery over the prior 12 months. We computed descriptive statistics and performed contingency table analyses in order to identify associations between PSU and a variety of demographic and clinical characteristics. Multivariable logistic regression models were fit incorporating the clinical factors described above. Results 315 consecutively enrolled IBD patients (166f:149m; 214 CD and 101 UC) were included. Sixty-six patients (21.0%) were polysubstance users. Of these patients, 40.9% had moderate to severe disease activity, 47.0% had extra-intestinal manifestations (EIM), and 36.4% demonstrated an anxious or depressed state. EIM and antidepressant or anxiolytic use were positively associated with PSU on bivariate analysis (Table 1) and multivariable analysis (Table 2). Conclusions PSU is common in IBD, including both CD and UC. Interestingly, disease activity, IBD therapy type, and IBD-related symptoms were not associated with PSU. EIM and antidepressant or anxiolytic use were the only statistically significant predictors of PSU among patients with IBD in the multivariable logistic regression models. Our study represents the first evaluation of PSU within IBD and reinforces the importance of appropriate substance use screening among IBD patients, particularly among those with EIM and antidepressant or anxiolytic use.

Clinical and Demographic Characteristics of Erosion-free and Erosion-present Status in Psoriatic Arthritis in a Cohort Study

2016 ◽  
Vol 43 (6) ◽  
pp. 1057-1062 ◽  
Author(s):  
Zahi Touma ◽  
Arane Thavaneswaran ◽  
Vinod Chandran ◽  
Fawnda Pellett ◽  
Richard J. Cook ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Regression Models ◽  
Cox Regression ◽  
Erosive Disease ◽  
Radiographic Findings ◽  
Logistic Regression Models ◽  
Younger Age ◽  
The Mean ◽  
Time Varying Covariates ◽  
Mean Time

Objective.Psoriatic arthritis (PsA) has been recognized as a severe erosive disease. However, some patients do not develop erosions. We aimed to determine the prevalence, characteristics, and predictors of erosion-free patients (EFP) as compared with erosion-present patients (EPP) among patients with PsA followed prospectively.Methods.This is a retrospective analysis conducted on patients from the Toronto PsA cohort. Patients with at least 10 years of followup and radiographs were analyzed. Radiographs were scored with the modified Steinbrocker method. Baseline (first visit to clinic) characteristics were used to predict the development of erosions with logistic regression models. To examine the effect of time-varying covariates, Cox regression models were fit for the time to development of erosions from baseline.Results.Among 290 patients, 12.4% were EFP and 87.6% were EPP over the study period. The mean time to development of erosion in the EPP over the course of followup was 6.8 ± 6.1 years. EFP were diagnosed with psoriasis at a younger age compared with EPP. In both models, actively inflamed joints and clinically damaged joints were predictive of the development of erosion, whereas a longer duration of psoriasis at baseline decreased the odds of developing erosion. EPP had a higher percentage of unemployment as compared with EFP at baseline and followup visits.Conclusion.Among patients with PsA followed for at least 10 years, 12.4% never develop erosions. The clinical and radiographic findings can ultimately assist in the stratification of a patient’s prognosis regarding the development of erosions.

A Randomized Trial of the Effectiveness of Using Incentives to Reinforce Parolee Attendance in Community Addiction Treatment

2016 ◽  
Vol 47 (2) ◽  
pp. 148-163 ◽  
Author(s):  
Elizabeth A. Hall ◽  
Michael L. Prendergast ◽  
Umme Warda
Keyword(s):  
Drug Use ◽  
Treatment Outcomes ◽  
Addiction Treatment ◽  
Psychological Symptoms ◽  
Post Treatment ◽  
Treatment Retention ◽  
Community Treatment ◽  
Younger Age ◽  
Secondary Analyses ◽  
Drug Use Outcomes

This study was a randomized effectiveness trial of the use of incentives to improve treatment retention and post-treatment outcomes among parolees in community treatment. Parolees entering community treatment were randomized to incentives ( N = 104) or brief education ( N = 98). It was hypothesized that the use of incentives to increase treatment retention would result in improved post-treatment outcomes (i.e., arrest, employment, and drug use), but at 18 months post-intake, there were no group differences for any outcome. In secondary analyses, rearrest by 18 months post-intake was predicted by substance use, greater number or severity of psychological symptoms, treatment non-completion, unemployment, and younger age. Contrary to expectations, results indicated that participants who received incentives for attendance had arrest, employment, and drug use outcomes similar to those who received a brief education session. Our findings, in concert with those of several other researchers, suggest that there may be certain populations or settings where incentives may not be effective.

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