This document summarizes the results of a study on the treatment trajectories of drug users from ethnic minority groups in Belgium. The study found that around 12-20% of drug treatment clients in Belgium have non-Belgian origins, mainly Moroccan and Dutch. Some key differences were observed compared to clients of Belgian origin, such as ethnic minority clients being older, more likely to live in cities, and having poorer socioeconomic status. The study also found some indications that ethnic minority clients use different substances like heroin, cocaine and methadone more frequently, while clients of Belgian origin reported more alcohol, XTC and amphetamine use. However, the trajectories of drug use and treatment were found to be highly individual, with diversity within ethnic
Vowles et al (2015) opioid misuse, abuse, and addictionPaul Coelho, MD
This systematic review analyzed 38 studies on rates of problematic opioid use among chronic pain patients. The review sought to provide precise prevalence estimates for misuse, abuse, and addiction by applying explicit definitions and weighting studies by sample size and quality. Rates of misuse averaged between 21-29%, while rates of addiction averaged between 8-12%. Only one study reported rates of abuse. Significant variability remained between studies. Higher quality studies and those where prevalence was a primary objective tended to report lower addiction rates. The review provides guidance on possible average rates but also indicates need for further clarification.
Regional Health Systems and non-conventional medicine: the situation in Italyhome
This document provides an overview of non-conventional medicine (NCM) in Italy. It discusses the growing popularity and use of NCM among citizens and some doctors in Italy and other countries. While NCM is widely used, its legislative status and inclusion in regional health systems varies across Italy. The document examines the levels of NCM recognition and integration in the regional systems of Lombardy, Tuscany, and Campania to determine if organizational models influence inclusion.
This systematic review analyzed data from 38 studies on rates of problematic opioid use among chronic pain patients prescribed opioids. The key findings were:
1. Rates of problematic use varied widely across studies, from 1% to 81%.
2. When weighted averages were calculated, rates of misuse averaged between 21-29% and rates of addiction averaged between 8-12%.
3. Only one study directly reported rates of abuse.
4. Few differences emerged when analyzing rates based on study characteristics, though rates of addiction may be lower in studies where assessing prevalence was the primary aim.
5. Significant variability remains in the literature, but this review provides guidance on possible average rates of different types of problematic
Patient Related Barriers Associated with Under Enrollment in Hospice: A ReviewQUESTJOURNAL
Background: Hospice care provides better quality of life compared with usual care, and focuses on caring, rather than curing. Many factors facing cancer patients at the last days of life prevent them from enrollment in hospice. Purpose:to identify the barriers associated with hospice under enrollment for terminally ill cancer patients. Methodology: an integrative literature review design was utilized, CINAHL, and PubMed were accessed by using key words (hospice, barriers, and cancer patients), and after applying inclusion criteria 8 articles were considered to meet the purpose of this review. Findings: through reviewing literatures,15% of hospice patients dis enrolled from hospice due to long-stay hospitalization, hospital death, & higher medicare expenditure with in sufficient insurance coverage (financial burden), and some other factors may contribute in under enrollment in hospice such as knowledge deficiency with misconception of hospice terminology and scope,mistrust of health care professionals, death timing, and some policies may create a barrier and restrict access to care for hospice. Conclusion:factors that may be associated with under enrollment of terminally ill cancer patients in hospice were lack of knowledge and misperception of hospice scope, emotional, physical and financial burden toward patient and family, death timing and bad quality of care
Tinkering and Tailoring- Use of medicines and rapid diagnostic tests for mala...Mikhael de Souza
1. The document discusses focus group discussions held with 53 private medicine providers in Cambodia to understand how they recognize, test for, and treat malaria.
2. The providers conceptualized their roles as either "selling" drugs to relieve symptoms or "treating" through examinations and testing to achieve a cure. Most saw themselves as sellers rather than treaters.
3. Medicines were often tailored to individual patients by mixing drugs and adjusting dosages to control side effects. Rapid diagnostic tests (RDTs) for malaria were used less and seen as less important than microscopy for confirming illness and guiding treatment.
Masters thesis differential effectiveness of substance abuse treatment by j f...Joyce Fuller
This thesis examines the differential effectiveness of standard substance abuse treatment for those with histories of drug use versus those arrested for drug trafficking. The study analyzed data from 1,348 individuals who completed drug and alcohol treatment. It found that outcomes tended to be poorer for drug traffickers than substance users across 64 of 77 outcome variables. Specifically, drug traffickers had significantly different and poorer outcomes than substance users in the categories of continued drug/alcohol use, reinstitutionalization, environmental issues, high-risk sexual behaviors, and relationship issues. The thesis considers why drug traffickers may receive treatment designed for substance users and potential alternative treatment options.
This document summarizes a study that examines the relationship between direct-to-consumer advertising (DTCA) of prescription drugs and the use of alternative medicines. The study uses survey and advertising expenditure data to estimate the effect of DTCA on alternative medicine prescriptions, both in terms of the number of people obtaining prescriptions and the amount spent. The study finds that while DTCA does not significantly affect total spending on alternative medicines, it does have a positive effect on the number of alternative medicine prescriptions obtained by those who obtain at least one prescription. The study uses a hurdle model approach to account for the fact that some obtain alternative medicine prescriptions while others do not.
This study assessed the knowledge of relatives of burn patients regarding first aid treatment of burns. A survey was conducted of 150 relatives of patients admitted to the burn unit of a hospital in Palestine over one year. The results showed that most relatives had received information about first aid from doctors and nurses or media like TV. However, over half had not received prior first aid training. While two-thirds knew to use cool running water for burns, knowledge regarding timing, duration and other aspects was lower. Females and those informed by healthcare workers had higher overall knowledge scores. The study concluded that greater training is needed for the public, especially on burn first aid, to improve initial management and reduce morbidity from such injuries.
Vowles et al (2015) opioid misuse, abuse, and addictionPaul Coelho, MD
This systematic review analyzed 38 studies on rates of problematic opioid use among chronic pain patients. The review sought to provide precise prevalence estimates for misuse, abuse, and addiction by applying explicit definitions and weighting studies by sample size and quality. Rates of misuse averaged between 21-29%, while rates of addiction averaged between 8-12%. Only one study reported rates of abuse. Significant variability remained between studies. Higher quality studies and those where prevalence was a primary objective tended to report lower addiction rates. The review provides guidance on possible average rates but also indicates need for further clarification.
Regional Health Systems and non-conventional medicine: the situation in Italyhome
This document provides an overview of non-conventional medicine (NCM) in Italy. It discusses the growing popularity and use of NCM among citizens and some doctors in Italy and other countries. While NCM is widely used, its legislative status and inclusion in regional health systems varies across Italy. The document examines the levels of NCM recognition and integration in the regional systems of Lombardy, Tuscany, and Campania to determine if organizational models influence inclusion.
This systematic review analyzed data from 38 studies on rates of problematic opioid use among chronic pain patients prescribed opioids. The key findings were:
1. Rates of problematic use varied widely across studies, from 1% to 81%.
2. When weighted averages were calculated, rates of misuse averaged between 21-29% and rates of addiction averaged between 8-12%.
3. Only one study directly reported rates of abuse.
4. Few differences emerged when analyzing rates based on study characteristics, though rates of addiction may be lower in studies where assessing prevalence was the primary aim.
5. Significant variability remains in the literature, but this review provides guidance on possible average rates of different types of problematic
Patient Related Barriers Associated with Under Enrollment in Hospice: A ReviewQUESTJOURNAL
Background: Hospice care provides better quality of life compared with usual care, and focuses on caring, rather than curing. Many factors facing cancer patients at the last days of life prevent them from enrollment in hospice. Purpose:to identify the barriers associated with hospice under enrollment for terminally ill cancer patients. Methodology: an integrative literature review design was utilized, CINAHL, and PubMed were accessed by using key words (hospice, barriers, and cancer patients), and after applying inclusion criteria 8 articles were considered to meet the purpose of this review. Findings: through reviewing literatures,15% of hospice patients dis enrolled from hospice due to long-stay hospitalization, hospital death, & higher medicare expenditure with in sufficient insurance coverage (financial burden), and some other factors may contribute in under enrollment in hospice such as knowledge deficiency with misconception of hospice terminology and scope,mistrust of health care professionals, death timing, and some policies may create a barrier and restrict access to care for hospice. Conclusion:factors that may be associated with under enrollment of terminally ill cancer patients in hospice were lack of knowledge and misperception of hospice scope, emotional, physical and financial burden toward patient and family, death timing and bad quality of care
Tinkering and Tailoring- Use of medicines and rapid diagnostic tests for mala...Mikhael de Souza
1. The document discusses focus group discussions held with 53 private medicine providers in Cambodia to understand how they recognize, test for, and treat malaria.
2. The providers conceptualized their roles as either "selling" drugs to relieve symptoms or "treating" through examinations and testing to achieve a cure. Most saw themselves as sellers rather than treaters.
3. Medicines were often tailored to individual patients by mixing drugs and adjusting dosages to control side effects. Rapid diagnostic tests (RDTs) for malaria were used less and seen as less important than microscopy for confirming illness and guiding treatment.
Masters thesis differential effectiveness of substance abuse treatment by j f...Joyce Fuller
This thesis examines the differential effectiveness of standard substance abuse treatment for those with histories of drug use versus those arrested for drug trafficking. The study analyzed data from 1,348 individuals who completed drug and alcohol treatment. It found that outcomes tended to be poorer for drug traffickers than substance users across 64 of 77 outcome variables. Specifically, drug traffickers had significantly different and poorer outcomes than substance users in the categories of continued drug/alcohol use, reinstitutionalization, environmental issues, high-risk sexual behaviors, and relationship issues. The thesis considers why drug traffickers may receive treatment designed for substance users and potential alternative treatment options.
This document summarizes a study that examines the relationship between direct-to-consumer advertising (DTCA) of prescription drugs and the use of alternative medicines. The study uses survey and advertising expenditure data to estimate the effect of DTCA on alternative medicine prescriptions, both in terms of the number of people obtaining prescriptions and the amount spent. The study finds that while DTCA does not significantly affect total spending on alternative medicines, it does have a positive effect on the number of alternative medicine prescriptions obtained by those who obtain at least one prescription. The study uses a hurdle model approach to account for the fact that some obtain alternative medicine prescriptions while others do not.
This study assessed the knowledge of relatives of burn patients regarding first aid treatment of burns. A survey was conducted of 150 relatives of patients admitted to the burn unit of a hospital in Palestine over one year. The results showed that most relatives had received information about first aid from doctors and nurses or media like TV. However, over half had not received prior first aid training. While two-thirds knew to use cool running water for burns, knowledge regarding timing, duration and other aspects was lower. Females and those informed by healthcare workers had higher overall knowledge scores. The study concluded that greater training is needed for the public, especially on burn first aid, to improve initial management and reduce morbidity from such injuries.
Substance use disorders, especially opiate addiction, present significant health and social challenges. In Scotland, approximately 52,000 people experience drug dependence issues. The most common treatment approaches for opiate addiction are pharmacotherapy using methadone or buprenorphine substitution, and participation in 12-step recovery programs. While methadone treatment reduces illicit opiate use and associated harms, it also presents challenges such as stigma and substituting one addiction for another. Twelve-step programs aim to support long-term abstinence through peer support and spiritual principles, but their availability and integration with healthcare services is more limited in the UK compared to other countries. Effective treatment requires addressing both the medical and psychosocial aspects of
Opioid addiction is a growing problem that significantly impacts individuals and society. Social workers are on the front lines addressing this issue through clinical work, education, and intervention programs. Research shows there are many triggers that can lead to opioid use, including use of other drugs like tobacco, avoidance of withdrawal symptoms, exposure to peer groups that use drugs, and conditioning of the brain to see drugs as rewarding despite negative consequences. Understanding these triggers is important for social workers to help prevent and intervene in opioid addiction.
Identikit of the Person Seeking Care at Public Hospital in Italy in the Europ...asclepiuspdfs
The number of frail patients for whom the care of a single acute episode necessarily requires both a global approach and a close interaction with the local health services and social services is progressively growing. The issue of managing frail and complex patients at hospitals still needs to be resolved. Currently, care is fragmented in multiple specialized interventions and patients often find themselves moved from one ward to another, resulting in a perilous loss of information and continuity. The purpose of this paper is to analyze hospitalization modalities, the impact of internal medicine (IM) on the hospital activities, the relationship with emergency room (ER) and general patient characteristics, in order to explore putting the current discussion on the new role of IM in the future hospital into practice.
This study examined self-medication practices among the tribal population in North Maharashtra, India. The researchers found that 100% of the 318 households surveyed practiced self-medication using traditional methods. Additionally, 92.14% (293 households) practiced self-medication using other medical systems like allopathy. The main reasons for self-medication were economic constraints (100%) and past successful use of the same drugs (89.07%). Ancestors were the main source of information for traditional methods (100%), while private practitioners were the primary source for other medical systems (87.03%). The symptoms commonly self-treated included fever, weakness, and pain.
The document summarizes a research report on popular images of addiction problems in contemporary Sweden. The study investigated perceptions of nine different addictions through a population survey of 2,000 adult Swedes. Key findings included:
1) Respondents tended to downplay risks of addictions like tobacco and gambling that are common in mainstream culture, while dramatizing risks of less common addictions like heroin, cocaine, and amphetamines.
2) Tobacco and gambling were seen as relatively harmless "habits" that are not very addictive but easy to quit, while drugs like heroin, cocaine, and amphetamines were seen as major societal problems and their users as "sinners" or "victims
This document discusses approaches to improving emergency department (ED) throughput and addressing overcrowding. It provides background on the problem of ED overcrowding, including factors contributing to increased patient volumes and decreased bed capacity. Common models for improving throughput focus on separating patients by acuity, expediting diagnostics, and using technology. The document also discusses a conceptual model of ED crowding involving input, throughput, and output phases. Key approaches to improving throughput discussed are patient-specific flow models, rapid triage, providers in triage, flow expeditors, and technology. The significance of addressing overcrowding relates to accreditation standards, hospital finances, and patient satisfaction.
Cutting Edge Research in Homeopathy: HRI’s second international research conf...home
Rome, 3rde5th June 2015, was the setting for the Homeopathy Research Institute’s (HRI)
second conference with the theme ‘Cutting Edge Research in Homeopathy’. Attended by
over 250 delegates from 39 countries, this event provided an intense two and a half day
programme of presentations and a forum for the sharing of ideas and the creation of international
scientific collaborations. With 35 oral presentations from leaders in the field,
the scientific calibre of the programme was high and the content diverse. This report
summarises the key themes underpinning the cutting edge data presented by the
speakers, including six key-note presentations, covering advancements in both basic
and clinical research. Given the clear commitment of the global homeopathic community
to high quality research, the resounding success of both Barcelona 2013 and
Rome 2015 HRI conferences, and the dedicated support of colleagues, the HRI moves
confidently forward towards the next biennial conference
Cost profiles of colorectal cancer patients in Italy based on individual patt...Enrique Moreno Gonzalez
Due to changes in cancer-related risk factors, improvements in diagnostic procedures and treatments, and the aging of the population, in most developed countries cancer accounts for an increasing proportion of health care expenditures. The analysis of cancer-related costs is a topic of several economic and epidemiological studies and represents a research area of great interest to public health planners and policy makers. In Italy studies are limited either to some specific types of expenditures or to specific groups of cancer patients. Aim of the paper is to estimate the distribution of cancer survivors and associated health care expenditures according to a disease pathway which identifies three clinically relevant phases: initial (one year following diagnosis), continuing (between initial and final) and final (one year before death).
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
The document discusses the evolving roles of hospital and community pharmacists in managing the COVID-19 pandemic. It outlines how pharmacists have historically transitioned from compounding medications to providing more clinical services and collaborating across healthcare sectors. The COVID-19 crisis has highlighted pharmacists' key roles and propelled changes, with preliminary evidence suggesting a new era where community pharmacists provide more services and are frontline healthcare workers. The pandemic challenged health systems but also presented opportunities for pharmacists to demonstrate their value through interprofessional collaboration addressing this public health crisis.
This document discusses chronic prostatitis and the potential role of clinical pharmacists in improving treatment. It notes that current drug therapies for conditions like chronic prostatitis often have high relapse rates. The document suggests that clinical pharmacists could help develop new drug delivery systems to better target treatment to the prostate and improve outcomes. It argues pharmaceutical companies may underestimate the need for innovative delivery methods to more effectively treat chronic prostatitis and other conditions with current therapies.
A comparison of public perceptions of physicians and veterinarians in the uni...Eduardo J Kwiecien
The document compares public perceptions of physicians and veterinarians in the United States. A survey of 606 participants rated 25 personality characteristics for each profession on a 9-point scale. Statistical analysis found veterinarians were perceived as more approachable, sensitive, sympathetic, patient and understanding, while physicians were seen as more proud and arrogant. Overall, the results indicate the public tends to view veterinarians more favorably than physicians.
El video muestra los créditos de apertura de la película Zodiac en blanco y negro, con el título apareciendo en letras grandes y el logotipo del director David Fincher. Breves clips de noticieros y periódicos de la época resaltan los asesinatos sin resolver del Asesino del Zodiaco y la investigación policial.
Rap emerged in the 1970s when DJ Kool Herc asked his friend Coke La Rock to accompany him while playing music at a party. Coke La Rock spit the first rap verse, helping establish rap as a new genre of music. Early influential rap artists included Run-D.M.C., Whodini, Grandmaster Flash, and Kurtis Blow. Stereotypes that rap artists are often subjected to include being seen as rich, dangerous gang members who only care about money, sex, drugs, and rap. However, some stereotypes emerged from real issues like racial prejudice and unfair policing faced by black rappers in the US. Rivalries between rappers also contributed to perceptions of violence as rap
B Sc. Nurse with Residence Vias & Medical LicenceJacintha Monis
Jacintha Monis is an Indian national who has worked as a nurse in Qatar, UAE, India, and other countries for over 13 years. She has a Bachelor of Science in Nursing and qualifications in midwifery. Her experience includes working in medical, surgical, pediatric, maternity, and ICU wards assisting with various procedures and patient care activities. She is seeking new opportunities as a self-motivated nurse.
Jacintha monis registred nurse with residence vias & medical licenceJacintha Monis
1. The document provides personal and professional details of Jacintha Monis, an Indian nurse seeking a family visa in Qatar.
2. It outlines her educational qualifications and over 15 years of experience working in hospitals in India, Dubai, Abu Dhabi, and Qatar.
3. The document details the medical procedures she has assisted with and her experience in areas like medicine, maternity wards, and community health.
This document summarizes the proceedings of a series of exchanges organized by SMES-B, a Belgian non-profit organization, in 2010 as part of the European Year for Combating Poverty and Social Exclusion. The exchanges focused on making contact with homeless individuals and addressing the complex social and mental vulnerabilities they face. Over four events, participants discussed topics like ethics and responsibility, care for the homeless, mental health reform, and challenges of reintegration. The document outlines SMES-B's work with homeless individuals and efforts to address the multifaceted issues surrounding homelessness.
Jacintha monis Registred Nurse with residence vias & medical licenceJacintha Monis
1. The document provides personal and professional details of Jacintha Monis, an Indian nurse seeking a family visa in Qatar.
2. It outlines her educational qualifications and over 15 years of experience working in hospitals in India, Dubai, Abu Dhabi, and Qatar.
3. The document details the medical procedures she has assisted with and her experience in areas like medicine, maternity wards, and community health.
Running Head SOCIOLOGY IN NURSING 1 SOCIOLOGY IN NURSING .docxtodd521
Running Head: SOCIOLOGY IN NURSING
1
SOCIOLOGY IN NURSING
2
Sociology in nursing: A look from different perspectives
Name
Institution
Introduction
Health literacy is the acquisition and application of knowledge to daily practices for the improvement of the general health of an individual as well as the community. This influences the response to symptoms of illness, approach to treatment and preventive measures. While it may seem like common knowledge, the difference in the cultural and social background comes into play during the stated health literacy skills. Nurses are tasked with the provision of elementary care to culturally diverse communities and thus necessitating cultural competency.
Different concepts exist with regard to cultural composition and diversity in the community under evaluation. Singleton & Krause (2009) identify these to include: Magico-religious, biomedical and deterministic concepts. These concepts are always evolving with arising situations. Regular training on cultural competence is recommended as it is considered a threat to patients (Kaihlanen, Hietapakka & Heponiemi, 2019). This paper will look at nursing from different sociology perspectives to demonstrate the need for training.
Health literacy from sociological perspectives
Functionalist perspective
Health concepts are shared among a group of people sharing in other aspects of life as well. This is a source of continuity in identity recognized from doing things in a certain way. This is well demonstrated in Mayhew (2018), where an initial visit to a health facility, the nurse provides treatment options, which is met by indecisiveness, which turns around on the second visit following consultation with family members on the best course of action (Mayhew, 2018) for the ailing family member. The consultation gives the young mother confidence and a sense of unity in the family due to their collectivist approach. The institution of marriage is revered as well as nursing, as the mother takes time to understand all that pertains to the provided options.
Conflict perspective
Cultural diversity presents different approaches to decision making on health issues. Despite expert knowledge, a nurse must operate under ethical codes by respecting the patient's autonomy. This means that the decision reached, and failure thereof, must be upheld. For instance, a magico- religious culture may bar ailing members from procuring blood transfusions, even though their condition may only be helped by one. A nurse, while offering this option to them, can only do so much but respect this culture.
Conflict may also arise when actions taken in an emergency situation, maybe in opposition to patient beliefs, such as first aid to the opposite sex.
Symbolic interactionism perspective
This perspective demonstrates the difference in dialects and jargon used by different societies. Nursing uses professional language and jargon, which patients may not decipher. Equally, nurses are fac.
Running Head SOCIOLOGY IN NURSING 1 SOCIOLOGY IN NURSING .docxjeanettehully
Running Head: SOCIOLOGY IN NURSING
1
SOCIOLOGY IN NURSING
2
Sociology in nursing: A look from different perspectives
Name
Institution
Introduction
Health literacy is the acquisition and application of knowledge to daily practices for the improvement of the general health of an individual as well as the community. This influences the response to symptoms of illness, approach to treatment and preventive measures. While it may seem like common knowledge, the difference in the cultural and social background comes into play during the stated health literacy skills. Nurses are tasked with the provision of elementary care to culturally diverse communities and thus necessitating cultural competency.
Different concepts exist with regard to cultural composition and diversity in the community under evaluation. Singleton & Krause (2009) identify these to include: Magico-religious, biomedical and deterministic concepts. These concepts are always evolving with arising situations. Regular training on cultural competence is recommended as it is considered a threat to patients (Kaihlanen, Hietapakka & Heponiemi, 2019). This paper will look at nursing from different sociology perspectives to demonstrate the need for training.
Health literacy from sociological perspectives
Functionalist perspective
Health concepts are shared among a group of people sharing in other aspects of life as well. This is a source of continuity in identity recognized from doing things in a certain way. This is well demonstrated in Mayhew (2018), where an initial visit to a health facility, the nurse provides treatment options, which is met by indecisiveness, which turns around on the second visit following consultation with family members on the best course of action (Mayhew, 2018) for the ailing family member. The consultation gives the young mother confidence and a sense of unity in the family due to their collectivist approach. The institution of marriage is revered as well as nursing, as the mother takes time to understand all that pertains to the provided options.
Conflict perspective
Cultural diversity presents different approaches to decision making on health issues. Despite expert knowledge, a nurse must operate under ethical codes by respecting the patient's autonomy. This means that the decision reached, and failure thereof, must be upheld. For instance, a magico- religious culture may bar ailing members from procuring blood transfusions, even though their condition may only be helped by one. A nurse, while offering this option to them, can only do so much but respect this culture.
Conflict may also arise when actions taken in an emergency situation, maybe in opposition to patient beliefs, such as first aid to the opposite sex.
Symbolic interactionism perspective
This perspective demonstrates the difference in dialects and jargon used by different societies. Nursing uses professional language and jargon, which patients may not decipher. Equally, nurses are fac ...
This document discusses a master's thesis that examines dental care seeking behavior among ethnic minorities in the Netherlands. The thesis conducted ethnographic interviews with Turkish and Moroccan ethnic minorities to understand their perceptions and habits related to dental health care. The research found that most respondents were aware of the importance of visiting a dentist twice a year, but many still considered the cost of dental treatment a significant burden. Communication barriers and lack of cultural sensitivity among healthcare providers also prevented some ethnic minorities from accessing proper dental care. The goal of the research was to gain insights that could help improve the dental health of ethnic minority groups in the Netherlands.
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Substance use disorders, especially opiate addiction, present significant health and social challenges. In Scotland, approximately 52,000 people experience drug dependence issues. The most common treatment approaches for opiate addiction are pharmacotherapy using methadone or buprenorphine substitution, and participation in 12-step recovery programs. While methadone treatment reduces illicit opiate use and associated harms, it also presents challenges such as stigma and substituting one addiction for another. Twelve-step programs aim to support long-term abstinence through peer support and spiritual principles, but their availability and integration with healthcare services is more limited in the UK compared to other countries. Effective treatment requires addressing both the medical and psychosocial aspects of
Opioid addiction is a growing problem that significantly impacts individuals and society. Social workers are on the front lines addressing this issue through clinical work, education, and intervention programs. Research shows there are many triggers that can lead to opioid use, including use of other drugs like tobacco, avoidance of withdrawal symptoms, exposure to peer groups that use drugs, and conditioning of the brain to see drugs as rewarding despite negative consequences. Understanding these triggers is important for social workers to help prevent and intervene in opioid addiction.
Identikit of the Person Seeking Care at Public Hospital in Italy in the Europ...asclepiuspdfs
The number of frail patients for whom the care of a single acute episode necessarily requires both a global approach and a close interaction with the local health services and social services is progressively growing. The issue of managing frail and complex patients at hospitals still needs to be resolved. Currently, care is fragmented in multiple specialized interventions and patients often find themselves moved from one ward to another, resulting in a perilous loss of information and continuity. The purpose of this paper is to analyze hospitalization modalities, the impact of internal medicine (IM) on the hospital activities, the relationship with emergency room (ER) and general patient characteristics, in order to explore putting the current discussion on the new role of IM in the future hospital into practice.
This study examined self-medication practices among the tribal population in North Maharashtra, India. The researchers found that 100% of the 318 households surveyed practiced self-medication using traditional methods. Additionally, 92.14% (293 households) practiced self-medication using other medical systems like allopathy. The main reasons for self-medication were economic constraints (100%) and past successful use of the same drugs (89.07%). Ancestors were the main source of information for traditional methods (100%), while private practitioners were the primary source for other medical systems (87.03%). The symptoms commonly self-treated included fever, weakness, and pain.
The document summarizes a research report on popular images of addiction problems in contemporary Sweden. The study investigated perceptions of nine different addictions through a population survey of 2,000 adult Swedes. Key findings included:
1) Respondents tended to downplay risks of addictions like tobacco and gambling that are common in mainstream culture, while dramatizing risks of less common addictions like heroin, cocaine, and amphetamines.
2) Tobacco and gambling were seen as relatively harmless "habits" that are not very addictive but easy to quit, while drugs like heroin, cocaine, and amphetamines were seen as major societal problems and their users as "sinners" or "victims
This document discusses approaches to improving emergency department (ED) throughput and addressing overcrowding. It provides background on the problem of ED overcrowding, including factors contributing to increased patient volumes and decreased bed capacity. Common models for improving throughput focus on separating patients by acuity, expediting diagnostics, and using technology. The document also discusses a conceptual model of ED crowding involving input, throughput, and output phases. Key approaches to improving throughput discussed are patient-specific flow models, rapid triage, providers in triage, flow expeditors, and technology. The significance of addressing overcrowding relates to accreditation standards, hospital finances, and patient satisfaction.
Cutting Edge Research in Homeopathy: HRI’s second international research conf...home
Rome, 3rde5th June 2015, was the setting for the Homeopathy Research Institute’s (HRI)
second conference with the theme ‘Cutting Edge Research in Homeopathy’. Attended by
over 250 delegates from 39 countries, this event provided an intense two and a half day
programme of presentations and a forum for the sharing of ideas and the creation of international
scientific collaborations. With 35 oral presentations from leaders in the field,
the scientific calibre of the programme was high and the content diverse. This report
summarises the key themes underpinning the cutting edge data presented by the
speakers, including six key-note presentations, covering advancements in both basic
and clinical research. Given the clear commitment of the global homeopathic community
to high quality research, the resounding success of both Barcelona 2013 and
Rome 2015 HRI conferences, and the dedicated support of colleagues, the HRI moves
confidently forward towards the next biennial conference
Cost profiles of colorectal cancer patients in Italy based on individual patt...Enrique Moreno Gonzalez
Due to changes in cancer-related risk factors, improvements in diagnostic procedures and treatments, and the aging of the population, in most developed countries cancer accounts for an increasing proportion of health care expenditures. The analysis of cancer-related costs is a topic of several economic and epidemiological studies and represents a research area of great interest to public health planners and policy makers. In Italy studies are limited either to some specific types of expenditures or to specific groups of cancer patients. Aim of the paper is to estimate the distribution of cancer survivors and associated health care expenditures according to a disease pathway which identifies three clinically relevant phases: initial (one year following diagnosis), continuing (between initial and final) and final (one year before death).
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
The document discusses the evolving roles of hospital and community pharmacists in managing the COVID-19 pandemic. It outlines how pharmacists have historically transitioned from compounding medications to providing more clinical services and collaborating across healthcare sectors. The COVID-19 crisis has highlighted pharmacists' key roles and propelled changes, with preliminary evidence suggesting a new era where community pharmacists provide more services and are frontline healthcare workers. The pandemic challenged health systems but also presented opportunities for pharmacists to demonstrate their value through interprofessional collaboration addressing this public health crisis.
This document discusses chronic prostatitis and the potential role of clinical pharmacists in improving treatment. It notes that current drug therapies for conditions like chronic prostatitis often have high relapse rates. The document suggests that clinical pharmacists could help develop new drug delivery systems to better target treatment to the prostate and improve outcomes. It argues pharmaceutical companies may underestimate the need for innovative delivery methods to more effectively treat chronic prostatitis and other conditions with current therapies.
A comparison of public perceptions of physicians and veterinarians in the uni...Eduardo J Kwiecien
The document compares public perceptions of physicians and veterinarians in the United States. A survey of 606 participants rated 25 personality characteristics for each profession on a 9-point scale. Statistical analysis found veterinarians were perceived as more approachable, sensitive, sympathetic, patient and understanding, while physicians were seen as more proud and arrogant. Overall, the results indicate the public tends to view veterinarians more favorably than physicians.
El video muestra los créditos de apertura de la película Zodiac en blanco y negro, con el título apareciendo en letras grandes y el logotipo del director David Fincher. Breves clips de noticieros y periódicos de la época resaltan los asesinatos sin resolver del Asesino del Zodiaco y la investigación policial.
Rap emerged in the 1970s when DJ Kool Herc asked his friend Coke La Rock to accompany him while playing music at a party. Coke La Rock spit the first rap verse, helping establish rap as a new genre of music. Early influential rap artists included Run-D.M.C., Whodini, Grandmaster Flash, and Kurtis Blow. Stereotypes that rap artists are often subjected to include being seen as rich, dangerous gang members who only care about money, sex, drugs, and rap. However, some stereotypes emerged from real issues like racial prejudice and unfair policing faced by black rappers in the US. Rivalries between rappers also contributed to perceptions of violence as rap
B Sc. Nurse with Residence Vias & Medical LicenceJacintha Monis
Jacintha Monis is an Indian national who has worked as a nurse in Qatar, UAE, India, and other countries for over 13 years. She has a Bachelor of Science in Nursing and qualifications in midwifery. Her experience includes working in medical, surgical, pediatric, maternity, and ICU wards assisting with various procedures and patient care activities. She is seeking new opportunities as a self-motivated nurse.
Jacintha monis registred nurse with residence vias & medical licenceJacintha Monis
1. The document provides personal and professional details of Jacintha Monis, an Indian nurse seeking a family visa in Qatar.
2. It outlines her educational qualifications and over 15 years of experience working in hospitals in India, Dubai, Abu Dhabi, and Qatar.
3. The document details the medical procedures she has assisted with and her experience in areas like medicine, maternity wards, and community health.
This document summarizes the proceedings of a series of exchanges organized by SMES-B, a Belgian non-profit organization, in 2010 as part of the European Year for Combating Poverty and Social Exclusion. The exchanges focused on making contact with homeless individuals and addressing the complex social and mental vulnerabilities they face. Over four events, participants discussed topics like ethics and responsibility, care for the homeless, mental health reform, and challenges of reintegration. The document outlines SMES-B's work with homeless individuals and efforts to address the multifaceted issues surrounding homelessness.
Jacintha monis Registred Nurse with residence vias & medical licenceJacintha Monis
1. The document provides personal and professional details of Jacintha Monis, an Indian nurse seeking a family visa in Qatar.
2. It outlines her educational qualifications and over 15 years of experience working in hospitals in India, Dubai, Abu Dhabi, and Qatar.
3. The document details the medical procedures she has assisted with and her experience in areas like medicine, maternity wards, and community health.
Running Head SOCIOLOGY IN NURSING 1 SOCIOLOGY IN NURSING .docxtodd521
Running Head: SOCIOLOGY IN NURSING
1
SOCIOLOGY IN NURSING
2
Sociology in nursing: A look from different perspectives
Name
Institution
Introduction
Health literacy is the acquisition and application of knowledge to daily practices for the improvement of the general health of an individual as well as the community. This influences the response to symptoms of illness, approach to treatment and preventive measures. While it may seem like common knowledge, the difference in the cultural and social background comes into play during the stated health literacy skills. Nurses are tasked with the provision of elementary care to culturally diverse communities and thus necessitating cultural competency.
Different concepts exist with regard to cultural composition and diversity in the community under evaluation. Singleton & Krause (2009) identify these to include: Magico-religious, biomedical and deterministic concepts. These concepts are always evolving with arising situations. Regular training on cultural competence is recommended as it is considered a threat to patients (Kaihlanen, Hietapakka & Heponiemi, 2019). This paper will look at nursing from different sociology perspectives to demonstrate the need for training.
Health literacy from sociological perspectives
Functionalist perspective
Health concepts are shared among a group of people sharing in other aspects of life as well. This is a source of continuity in identity recognized from doing things in a certain way. This is well demonstrated in Mayhew (2018), where an initial visit to a health facility, the nurse provides treatment options, which is met by indecisiveness, which turns around on the second visit following consultation with family members on the best course of action (Mayhew, 2018) for the ailing family member. The consultation gives the young mother confidence and a sense of unity in the family due to their collectivist approach. The institution of marriage is revered as well as nursing, as the mother takes time to understand all that pertains to the provided options.
Conflict perspective
Cultural diversity presents different approaches to decision making on health issues. Despite expert knowledge, a nurse must operate under ethical codes by respecting the patient's autonomy. This means that the decision reached, and failure thereof, must be upheld. For instance, a magico- religious culture may bar ailing members from procuring blood transfusions, even though their condition may only be helped by one. A nurse, while offering this option to them, can only do so much but respect this culture.
Conflict may also arise when actions taken in an emergency situation, maybe in opposition to patient beliefs, such as first aid to the opposite sex.
Symbolic interactionism perspective
This perspective demonstrates the difference in dialects and jargon used by different societies. Nursing uses professional language and jargon, which patients may not decipher. Equally, nurses are fac.
Running Head SOCIOLOGY IN NURSING 1 SOCIOLOGY IN NURSING .docxjeanettehully
Running Head: SOCIOLOGY IN NURSING
1
SOCIOLOGY IN NURSING
2
Sociology in nursing: A look from different perspectives
Name
Institution
Introduction
Health literacy is the acquisition and application of knowledge to daily practices for the improvement of the general health of an individual as well as the community. This influences the response to symptoms of illness, approach to treatment and preventive measures. While it may seem like common knowledge, the difference in the cultural and social background comes into play during the stated health literacy skills. Nurses are tasked with the provision of elementary care to culturally diverse communities and thus necessitating cultural competency.
Different concepts exist with regard to cultural composition and diversity in the community under evaluation. Singleton & Krause (2009) identify these to include: Magico-religious, biomedical and deterministic concepts. These concepts are always evolving with arising situations. Regular training on cultural competence is recommended as it is considered a threat to patients (Kaihlanen, Hietapakka & Heponiemi, 2019). This paper will look at nursing from different sociology perspectives to demonstrate the need for training.
Health literacy from sociological perspectives
Functionalist perspective
Health concepts are shared among a group of people sharing in other aspects of life as well. This is a source of continuity in identity recognized from doing things in a certain way. This is well demonstrated in Mayhew (2018), where an initial visit to a health facility, the nurse provides treatment options, which is met by indecisiveness, which turns around on the second visit following consultation with family members on the best course of action (Mayhew, 2018) for the ailing family member. The consultation gives the young mother confidence and a sense of unity in the family due to their collectivist approach. The institution of marriage is revered as well as nursing, as the mother takes time to understand all that pertains to the provided options.
Conflict perspective
Cultural diversity presents different approaches to decision making on health issues. Despite expert knowledge, a nurse must operate under ethical codes by respecting the patient's autonomy. This means that the decision reached, and failure thereof, must be upheld. For instance, a magico- religious culture may bar ailing members from procuring blood transfusions, even though their condition may only be helped by one. A nurse, while offering this option to them, can only do so much but respect this culture.
Conflict may also arise when actions taken in an emergency situation, maybe in opposition to patient beliefs, such as first aid to the opposite sex.
Symbolic interactionism perspective
This perspective demonstrates the difference in dialects and jargon used by different societies. Nursing uses professional language and jargon, which patients may not decipher. Equally, nurses are fac ...
This document discusses a master's thesis that examines dental care seeking behavior among ethnic minorities in the Netherlands. The thesis conducted ethnographic interviews with Turkish and Moroccan ethnic minorities to understand their perceptions and habits related to dental health care. The research found that most respondents were aware of the importance of visiting a dentist twice a year, but many still considered the cost of dental treatment a significant burden. Communication barriers and lack of cultural sensitivity among healthcare providers also prevented some ethnic minorities from accessing proper dental care. The goal of the research was to gain insights that could help improve the dental health of ethnic minority groups in the Netherlands.
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
(1) The document examines why patients in Palestine use traditional medicine to treat burns. It conducted a cross-sectional study of 290 burn patients admitted to a hospital in Hebron, Palestine in 2020.
(2) The study found that 29% of admissions used traditional medicine after their burns. The most common reasons for using traditional medicine were believing it does not leave scars after healing (70%), rapid healing (70%), and thinking traditional medicine is better than conventional treatments (57%).
(3) Sources of information about traditional burn treatments included friends (22%), the internet (53.3%), media (16.8%), and family (15%). The study found no significant differences in reasons for using traditional medicine based on
Read Individuals with Serious Mental Illness in the Criminal Just.docxdanas19
Read "Individuals with Serious Mental Illness in the Criminal Justice System: The Case of Richard P." located in this week's Electronic Reserve Readings.
Review UOP's Sample PowerPoint Presentation to guide you in creating an effective presentation.
As a Team, create a visually engaging 10- to 12-slide Microsoft® PowerPoint® presentation to describe the role of communication skills in handling the case.
Include speaker notes with each slide of your presentation that provides information on the topics below. Each topic should have at least two corresponding slides.
· Describe how you could use different communication models to assist in communicating with this offender.
· Describe how interpersonal communication skills and motivational interviewing could be used with this offender.
· Describe how you would take this offender's culture and mental capacity into consideration when communicating with him.
· Describe how the use of jargon may affect communicating with this offender.
Include a minimum of three reputable sources.
Format any citations in your presentation consistent with APA guidelines.
Click the Assignment Files tab to submit your assignment.
Individuals With Serious Mental Illness in the Criminal Justice System The Case of Richard P. Arthur J. Lurigio Loyola University Chicago, Illinois John Fallon Thresholds This paper presents a case study that illuminates the clinical and practical challenges that accompany the treatment of people with serious mental illness (SMI) and criminal involvement. We discuss the historical conditions that led to the influx of a large number of people with SMI into the criminal justice system. We discuss the case history of Richard P., which illustrates the use of Assertive Community Treatment (ACT) to care for criminally involved people with SMI. We focus on the ACT model that was employed by Thresholds to treat Richard P. It was known as the Thresholds Jail Program. We track his progress in the program and explicate the case management considerations that are most salient in treating offenders with SMI. Keywords: criminalization, mental illness, crime, deinstitutionalization, mental health services, probation, ACT 1 Theoretical and Research Basis Fundamental changes in mental health policies and laws have brought criminal justice professionals into contact with the seriously mentally ill at every stage of the justice process: police arrest people with serious mental illness (SMI) because few other options are readily available to handle their disruptive public behaviors; jail and prison administrators strain to attend to the care and safety of the mentally ill; judges grapple with limited sentencing alternatives for individuals with SMI who fall outside of specific forensic categories (e.g., guilty but mentally ill); and probation and parole officers scramble to obtain scarce community services and treatments for people with SMI and attempt to fit them into standard correctional programs or monito.
Racial and Socioeconomic Disparities in Substance Abuse TreatmentAlexandraPerkins5
This document provides an overview of racial and socioeconomic disparities in substance abuse treatment in the United States. It discusses how factors like insurance coverage, treatment availability, and social determinants can influence disparities in treatment completion and outcomes. Specifically, it notes that Black and Hispanic youth are less likely to complete substance abuse treatment than white youth. While Medicaid expands coverage for treatment, not all providers accept it, creating availability issues. The document also explores historical models of addiction and how they impacted disparities, and examines various treatment approaches including medication-assisted treatment, peer-based support, and harm reduction strategies.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
Defining a Culturally Competent Organization Culturally competent .docxvickeryr87
Defining a Culturally Competent Organization Culturally competent health care, broadly defined as services that are respectful of and responsive to the cultural and linguistic needs of patients, is increasingly viewed as essential in reducing racial and ethnic disparities, improving health care quality, and controlling costs. The U.S. government considers cultural competence as a method of increasing access to quality care for all patients. The aim should be to develop systems more responsive to diverse populations. Managed care organizations view cultural competence as driving both quality and business. By embedding cultural competence strategies into quality improvement initiatives to make care more efficient and effective, clinical outcomes are improved while costs are controlled. Those in academic settings agree that cultural competency education is crucial for preparing future health care workers, although appropriate education on the topic is provided in only half of the medical schools in the United States (Betancourt, Green, Carrillo, & Park, 2005). According to the Office of Minority Health, cultural competence refers to the ability of health care providers and organizations to understand and respond effectively to the cultural and linguistic needs of patients (Office of Minority Health, 2001). Cultural competence encompasses a wide range of activities and considerations. It includes providing respectful care that is consistent with cultural health beliefs of the clients and family members. Competent interpreter services and programs to promote staff diversity are other ways in which health care organizations can increase cultural competence (Clancy & Stryer, 2001). Because communication is a cornerstone of patient safety and quality care, every patient has the right to receive information in a manner he or she understands. Effective communication allows patients to participate more fully in their care. Communicating effectively with patients is also critical to the informed consent process and helps practitioners and hospitals give the best possible care. For communication to be effective, the information provided must be complete, accurate, timely, unambiguous, and understood by the patient. Many patients of varying circumstances require alternative communication methods: patients who speak and/or read languages other than English; patients who have limited literacy in any language; patients who have visual or hearing impairments; patients on ventilators; patients with cognitive impairments; and children. The hospital has many options available to assist in communication with these individuals, such as interpreters, translated written materials, pen and paper, communication boards, and speech therapy. It is up to the hospital to determine which method is the best for each patient. Various laws, regulations, and guidelines are relevant to the use of interpreters. These include Title VI of the Civil Rights Act, 1964; Executive Order .
Exploring Intercultural Competence DiversityAs a college we have .docxelbanglis
Exploring Intercultural Competence/ Diversity
As a college we have been asked to use the rubric that is attached to this assignment to reflect on issues of Global and Social Diversity. The list of questions is an attempt to have you think and write about your thoughts on personal culture/bias/social diversity/your world view etc. (Your answers will not be shared with anyone)
1. We all grow up experiencing the culture of our families and communities. List and explain 4 rules/customs that you, your family and/or your community follows. (Awareness)
2. On a scale of 1 to 5 (1 being not very aware to 5 being very aware) how aware would you say you are of your own culture? (Awareness)
3. When making new friends, do you find that you seek out people that are similar or different than you? (Awareness)
4. What other cultures are you familiar with? What have you learned about these cultures (for example their history, values, politics, communication styles, economy, beliefs and practices. (World View)
5. When you think about the world and different cultures/religions do you find yourself judging other views/lifestyles or beliefs? Or are you more likely to read, research and questions things you don’t know? (Empathy)
6. Has someone ever been biased toward you because of your beliefs? How did that make you feel? Did you find that you could still empathize with someone who was biased against you? (Empathy)
7. Communication is not limited to just words. We communicate through personal space, hand gestures and voice tone and body language. Have you experienced miscommunications with someone of another culture due to any of these factors? Or have you been misunderstood due to any of these factors? Give an example that describes what happened. (Verbal and Non-verbal Communication)
8. Are you curious about the world and people that act and believe differently than you do? What are five experiences (Cultural Bucket List) you would like to have to increase your cultural awareness? (Curiosity)
9. On a scale of 1-5 (1 indicates you are rather closed and 5 indicating that you are very open), how would you rate your attitude/openness to other cultures? (Openness)
Are you eager to learn about new cultures or are you more cautious when it comes to being around people who appear different? (Openness)
10. When you find yourself in a new situation where you are out of your comfort zone do you find that you make judgements or can you suspend your judgments at least until you have learned more about the new experience? (Openness)
Lyons et al. Substance Abuse Treatment, Prevention, and Policy (2015) 10:17
DOI 10.1186/s13011-015-0015-4
RESEARCH Open Access
A qualitative study of transgender individuals’
experiences in residential addiction treatment
settings: stigma and inclusivity
Tara Lyons1,2, Kate Shannon1,2,3, Leslie Pierre4, Will Small1,5, Andrea Krüsi1,2 and Thomas Kerr1,2*
Abstract
Background: While considerable research has been undertaken ...
First model of one stop service for drug users in drug dependent centers in s...Alexander Decker
This study developed and evaluated a "one stop service" model providing integrated care for drug users at a drug dependence treatment center in southern Thailand. Fifty-six intravenous and other drug users received services including methadone maintenance, HIV/AIDS testing and counseling, health education, tuberculosis screening, antiretroviral therapy, and harm reduction. Most participants were satisfied with the integrated services. The model helped address barriers to care by providing comprehensive services in a single location and establishing a self-help support group. The study concluded the one stop service model should be expanded to improve care for drug users and reduce HIV transmission in Thailand.
Health policy plan. 2007-lönnroth-156-66Reaksmey Pe
This study assessed the impact of a social franchise model for tuberculosis (TB) care delivered through private general practitioners (GPs) in Myanmar. The key findings were:
1) The franchisees contributed around 20% of newly diagnosed smear-positive TB cases notified to the national TB program, helping to improve case detection.
2) Lower socioeconomic groups represented 68% of TB patients accessing care through the franchise, indicating it helped reach the poor.
3) The treatment success rate for new smear-positive cases through the franchise was 84%, close to the WHO target of 85% and similar to the national program rate.
4) While overall costs of TB care were high for poor patients, comprising on
Dual diagnosis occurs when a person has both a substance abuse disorder and a mental health disorder. Treating both conditions is necessary for recovery, which typically involves detoxification followed by rehabilitation for substance abuse and treatment for the mental health disorder. Over half of those with substance abuse or dependence have also experienced a mental health disorder at some point. Integrated treatment programs that address substance abuse, psychiatric symptoms, and other issues like housing, employment, legal concerns, and family/medical problems are recommended for those with dual diagnoses.
Art as therapy: An effective way of promoting positive mental health?Peachy Essay
The document discusses an art therapy program delivered by a community mental health organization in Northern Ireland. Interviews with participants found that the program improved their self-esteem and self-confidence. It provided a safe space for reflection on mental health issues. Participants described the program as cathartic and empowering, helping them engage in further projects. The study concluded that creative programs in supportive, non-clinical environments can encourage recovery and empowerment for those with mental health issues. However, such programs are currently small-scale and not integrated into mainstream service provision.
To Follow Dermatological Treatment Regimens – Patients' and Providers' Vi...ricklock78
Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to derma- tological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence.
AN OUTSIDER S VIEW OF THE DUTCH EUTHANASIA POLICY AND PRACTICEChristine Williams
This summary provides an overview of a research article that analyzes the Dutch policy and practice of euthanasia through interviews with 28 leading experts in the Netherlands. Key findings from the interviews include that while the Dutch guidelines aim to prevent abuse of euthanasia, the guidelines are insufficient and do not provide adequate control over practice. Some interviewees were also troubled by low levels of reporting of euthanasia cases. However, many interviewees were still content with the guidelines despite their flaws. The researcher observed defensiveness from some interviewees who seemed to identify strongly with the government's policy.
The document provides guidance on including strong human rights programming in Global Fund concept notes and grant applications. It recommends that applicants:
1. Identify key populations most affected by HIV, TB, and malaria who face human rights-related barriers to health services.
2. Design disease programs using a human rights-based approach to address these barriers through specific activities.
3. Invest in services to remove human rights barriers, such as legal aid for criminalized groups, sensitization of healthcare workers, and community outreach.
Including such human rights programming will help improve health outcomes by overcoming discrimination and marginalization that worsen the diseases. The Global Fund encourages consulting rights experts and affected communities to fully understand barriers
The document provides guidance on integrating human rights considerations into Global Fund grants. It recommends that applicants:
1) Identify key populations most affected by HIV, TB, and malaria and human rights barriers they face in accessing health services.
2) Design disease programs using a human rights-based approach to remove these barriers.
3) Invest in services like community strengthening to promote access for all populations in a non-discriminatory way. Applicants are encouraged to consult with affected communities and human rights experts to comprehensively assess barriers and design appropriate rights-respecting programs and interventions. Protecting human rights is crucial to effectively respond to the three diseases.
The Socioeconomic Consequences and Costs of Mental IllnessMika Truly
The document summarizes several socioeconomic consequences and costs of mental illness. It discusses how approximately half of adults with severe mental illnesses also have a substance abuse disorder, but only a small percentage receive treatment for both. It also examines how substance abuse and lack of medication adherence in the mentally ill have been associated with increased violence. Additionally, the document outlines how treating the mentally ill with co-occurring substance abuse disorders results in significantly higher psychiatric care costs. Lastly, it explores the high rates of incarceration and homelessness among the mentally ill population and the financial costs these issues impose on society.
The Socioeconomic Consequences and Costs of Mental Illness
rDR28sum_en
1. TREATMENT TRAJECTORIES OF DRUG USERS
FROM ETHNIC MINORITY GROUPS
Ilse Derluyn
Wouter Vanderplasschen
Sébastien Alexandre
Ilona Stoffels
Veerle Scheirs
Sofie Vindevogel
Tom Decorte
Abraham Franssen
Dan Kaminski
Yves Cartuyvels
Eric Broekaert
For further information or ordering of the publication:
Ilse Derluyn
Department of Orthopedagogics
Ghent University
H. Dunantlaan 2
9000 Gent
Belgium
Tel: +32 (0) 9 264 63 63
Fax: +32 (0) 9 264 64 91
E-mail: Ilse.Derluyn@UGent.be
The research is part of the "Research programme in support of the federal drugs policy
document", commissioned and financed by the Belgian Science Policy Office
2. 1. PROBLEM SITUATION AND HYPOTHESES
1.1. Problem situation
International research has shown that drug abusers from ethnic minority groups experience various
difficulties when contacting (specialised) treatment services (Ashruf & van der Eijnden, 1996; Longshore
et al., 1997; Verdurmen et al., 2004; Curtis et al., 2006). Moreover, as compared with the distribution in
the general population, a disproportionate (low) number of substance abusers from ethnic minority
groups utilizes substance abuse treatment services. This is particularly true for high threshold, residential
facilities (Braam et al., 1998; De Leon et al., 1993; Vandevelde et al., 2000; Haasen et al., 2001).
Still, epidemiological research has demonstrated that ethnic minority groups are more vulnerable to
(ab)use substances due to, among others, higher unemployment rates, limited language skills, less
educational opportunities, intergenerational conflicts, acculturation difficulties and higher peer pressure
(Reid et al., 2001). Also, various ‘institutional’ barriers may influence accessibility of drug treatment
services for ethnic minorities, such as language and communication problems (Fountain et al., 2002;
Schneider, 2001) and lack of ‘cultural responsiveness’ (Castro & Alarcon, 2002; Ja & Aoki, 1993). In
addition, drug users from ethnic minority groups often hardly know about the wide range of existing
treatment facilities (Reid et al., 2001; Salman, 1998) and are suspicious towards the western-oriented
treatment offer (Broers & Eland, 2000; Eland & Rigter, 2001). Moreover, the stigma on substance abuse
among (some) ethnic minority groups leads to numerous attempts to hide the problems for the
surrounding social network (Vandevelde et al., 2003).
Except the accessibility of services, also other elements of the treatment trajectory of substance abusers
from ethnic minority groups seem to be problematic. Research has shown that clients from ethnic
minority groups are more eager to drop-out and are less likely to complete treatment successfully (Finn,
1994, 1996; Verdurmen et al., 2004; Vrieling et al., 2000), since specialized substance abuse treatment
services do not adequately meet the needs of (problem) substance abusers from ethnic minorities (Yildiz
& Keersmaeckers, 2001). This observation includes an unfavourable prognosis for successful outcomes
after treatment (Verdurmen et al., 2004).
In Belgium, few information is available on the prevalence and type of drugs used by ethnic minority
groups on the one hand, and on the representation of drug users from ethnic minorities in substance
abuse treatment and the treatment trajectories they follow on the other hand. From two small-scale
studies, indications can be found that ethnic minorities experience various barriers (language, religious,
cultural, social, …) towards treatment, and that drug users from ethnic minority groups rather contact
low-threshold medical services (e.g. methadone maintenance treatment) than long-term residential
treatment (Vanderplasschen et al., 2003; Vandevelde et al., 2003). In addition, drug addicts from ethnic
minorities are overrepresented in prison populations (Vandevelde et al., 2005).
1.2. Hypotheses of the study
The central research question we want to address in this study is whether drug abusers from ethnic
minority groups do use the existing services less and/or differently, and – related to this – to what extent
they make use of ‘alternative’ treatment methods that are not part of the regular treatment system. We
assume that this population utilizes relatively less often specialised (residential) treatment services, but
rather contacts medical services or specific programs for ethnic minorities and is more often incarcerated.
In order to understand these difficulties concerning the accessibility of services and clients’ treatment
trajectories, we put forward the following hypotheses that will be tested during this study.
A first hypothesis concerns the ‘dual exclusion’ or ‘dual isolation’ of (some) ethnic minority groups with
substance abuse problems. Persons from ethnic minority groups that are closely incorporated in the
network of the own community (sometimes based on close family bonds) are at risk of dropping out of
this protecting network or of being expelled in case of substance abuse problems, due to the stigma that is
2
3. associated with substance abuse in some ethnic communities. Moreover, they often do not access existing
services or supportive organisations, since they do not know these initiatives or these appear to be
inaccessible or irrelevant to them.
A second hypothesis is the following: “Competition between preventive and supportive efforts concerning
substance abuse problems by (self-)organisations and mosques on the hand, and by ‘regular’ treatment
services on the other hand”. Various North African and Turkish clubs and (self-)organisations report in
their regulations about activities and initiatives concerning drug prevention and treatment (Jacobs, 2005).
Also, several mosques state explicitly that they are involved in dissuading substance use and helping
persons with substance abuse problems. It is extremely difficult to estimate the real extent and impact of
this kind of (self-)organisations, but it might be that these initiatives interfere with initiatives taken by
‘regular’ treatment agencies or that they reach – in a complementary way – other target groups which are
underrepresented in ‘traditional’ in- and outpatient treatment facilities.
A third hypothesis is the one of ‘cultural blindness’ of existing treatment and prevention programs, resulting
in a lack of attention for cultural influences (Castro & Alarcon, 2002). It seems in any case important to
integrate cultural variables, in order to establish ‘culturally-sensitive’ treatment programs that address
specific treatment needs of ethnic minority groups (Castro & Garfinkle, 2003).
This research assumes three aims.
A first aim of this research proposal is to compare the treatment trajectories of substance abusers from
ethnic minority groups and substance abusers from the ‘Belgian’ population, and to look for differences
concerning treatment access, participation and retention in medical and specialized substance abuse
agencies.
Once these differences concerning the treatment trajectories have been studied quantitatively, these will be
analysed – as the study’s second aim – more thoroughly based on qualitative research. Thus, we want to
identify which factors and mechanisms (may) hinder or stimulate the treatment trajectory of ethnic
minority groups, and to which extent.
The third objective of this study consists of the formulation of concrete recommendations, pathways and
solutions for countering the difficulties concerning the accessibility of services and (treatment) trajectories
of ethnic minority groups.
1.3. Study design
First, a literature study has been performed to make an overview of already existing studies about the
central research theme and the theoretical frameworks concerned. For this purpose, we chose to analyse
both Dutch and English literature on the one hand, and French and Spanish literature on the other hand,
since we suggested the hypothesis that the research theme is approached differently in both language
communities. This might be reflected in a potentially diverse approach of this theme in the two Belgian
language communities. The literature study was complemented with explorative interviews with key
figures from various agencies, both in the Flemish- and French-speaking part of Belgium.
Secondly, a large quantitative study was set up, consisting of three parts, in which existing data sets were
analysed to gain more insight concerning the central research questions described above. As each of the
data set has its limitations, we have chosen to combine three different data sets in order to have a reliable
view on the representation of ethnic minority groups in mainstream and specialised health care.
The first data set was gathered during a research project executed by the Department of Orthopedagogics
of the Ghent University and the University Scientific Institute for Drug problems of the University of
Antwerp concerning the characteristics of alcohol and drug users with a treatment demand in the province of Antwerp.
A second chapter analyses the data of 1,880 clients registered in one of the treatment facilities of vzw De
Sleutel, a large organisation providing substance abuse treatment and prevention in Flanders. In this
chapter, we focus on the problem severity concerning different life-domains, based on data from the
European version of the Addiction Severity Index.
3
4. The third chapter of the quantitative research part involves a secondary analysis of data from the three
biggest health insurances companies in Belgium. We assessed the health care consumption of a randomised
sample of 2,000 persons who have been in substance abuse treatment between January and June 2004..
In all three secondary analyses, a comparison was made between clients from ethnic minority groups and
the rest of the study population.
Despite the large quantitative part of this study, this perspective also includes some limitations. Therefore,
we chose to complement and deepen the quantitative research with a qualitative study. This qualitative
study was executed simultaneously in the French- and Flemish-speaking part of Belgium in four large
cities (Antwerp, Brussels, Charleroi and Ghent). Given the parallel study in both language communities, it
was necessary to attune the research methodology optimally. Therefore, much time has been spent on the
development of a common research methodology, especially for making up the interview scheme for the
qualitative interviews and the guidelines and statements of the focus groups, and for the data-analysis of
the interviews and focus groups.
The qualitative research part consists of semi-structured interviews with drug users from ethnic minority
groups. In total, 45 persons have been interviewed. Because of the heterogeneity of the research
population, we have chosen to limit these interviews to respondents from Turkish and Moroccan origin,
since these are the two biggest groups of non-European ethnic minorities in Belgium. During the
interviews, we focused on the diverse ‘trajectories’ of these persons, their trajectory into drug use, their
trajectory within the treatment system, and their own life trajectory, with special attention for aspects
related to the participant’s migration process.
In addition, the interview findings have been discussed with several key persons and experts from the
health care, social welfare and judicial system during focus groups in the four above-mentioned cities.
Finally, some ‘interesting practices’ have been visited in neighboring countries, in order to gain insight into
some specific and successful initiatives for drug users from ethnic minority groups. In total, three
interesting practices were visited in various European countries.
Since this study project included the analysis of private and sensitive data (such as data concerning
participants’ health status and ethnic origin), we asked the Ethical Committee of the Faculty of Psychology
and Educational Sciences of the Ghent University for advice (permission dd. 10.10.2006). Further, for the
secondary analysis of the data from the health insurance companies, we needed the permission of the
Committee for Social Security and Health which is part of the National Commission for the Protection of
Persons’ Privacy (permission dd. 08.05.07, authorization n° 07/020; for the entire order, see:
http://www.privacycommission.be/nl/docs/SZ-SS/2007/beraadslaging_ SZ_ 020_2007.pdf).
2. MAIN RESEARCH RESULTS
2.1 The system of trajectories of ethnic minority groups
During this study, it became clear that the treatment trajectory of drug users from ethnic minority groups
cannot be separated from their drug use trajectory or from their individual life trajectory, background and
history. Therefore, we suggest to use the term ‘system of trajectories’. If we want to gain more insight
into the similarities and differences between the treatment trajectories of drug users from ethnic minority
groups and from Belgian origin, we have to take into account this entire system of trajectories.
All separate parts of this study have shown that the system of trajectories of ethnic minorities cannot be
interpreted univocally. Consequently, no consistent findings were retrieved concerning the prevalence and
type of substance use and service utilisation by ethnic minority groups. Therefore, one of the main
conclusions of this study is that mainly individual factors determine the differentiated course of persons’
trajectories, both concerning drug use and concerning service utilisation. Scheppers and colleagues (2006)
came to similar conclusions in their study. However, this conclusion is strongly influenced by the central
idea that the group of ‘ethnic minorities’ is a very difficult group to define, leading to various criteria that
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5. can be applied (such as nationality, country of birth, country of birth of the parents, name, …). Moreover,
we want to emphasize that this population is very heterogeneous group. For example, a lot of differences
concerning nationality, country of birth, background, migration history, current socio-economical status,
et cetera can be observed. Further, we want to stress that the use of criteria such as ‘nationality’ and/or
‘country of birth’ does not imply homogeneous groups, since also within these groups, there are important
intra-group differences (e.g., educational degree, urban or rural background). Consequently, it is not at all
easy and certainly not desirable to define a univocal trajectory for drug users from ethnic minority groups.
At any time, we have to be aware that this group encloses an enormous diversity.
If we compare the trajectories of drug use and of treatment utilisation of ethnic minorities with those of
persons of Belgian origin, we find as well many differences as many similarities. Therefore, the question
whether the system of trajectories of ethnic minorities differs importantly from the system of trajectories
of clients from Belgian origin cannot be answered univocally. Moreover, the answer to this question seems
to depend largely from whether one chooses to stress similarities or dissimilarities. Despite the prudence
needed when discussing and interpreting the study results, we will present some striking findings and
conclusions. We will primarily focus on differences between drug users from ethnic minorities and from
Belgian ethnic origin concerning their system of trajectories. Ultimately, we want to provide some
recommendations in order to better meet the specific needs of drug users from ethnic minorities.
2.1.1 Treatment demand and demographic and social characteristics of drug users of non-
Belgian origin
The quantitative research part gives us an idea of the number of clients of non-Belgian ethnic origin in
substance abuse treatment. Despite methodological differences and the use of different criteria to define
the group of ‘persons from ethnic minority groups’ throughout the three quantitative analyses, we found
that approximately 12 to 20% (depending on the criteria that were used) of all clients in drug treatment
have non-Belgian origins, mainly Moroccan and Dutch. This percentage is comparable with the total
number of persons of non-Belgian origin in Belgium (cf. NPDATA, 2007).
Some striking differences could be observed concerning social and demographic characteristics. We
found a significantly lower number of female clients in the group of clients of non-Belgian origin, as
compared to the group of clients of Belgian origin. Drug users from ethnic minorities also seem to be
older when they come into contact with the specialized (residential) drug treatment system. Given these
age differences, it is not surprising that clients of non-Belgian origin live more often together with their
partner (and children), while clients from Belgian origin live more frequently with their parents or with
their partner alone. Drug users from ethnic minority groups also live more often in big cities as compared
with clients of Belgian origin.
Another striking difference concerning clients’ socio-economical status is that drug users of non-Belgian
origin are often in a less favourable and more precarious situation as compared to clients of Belgian origin,
since significantly more persons from the former group receive social security benefits, are unemployed,
have an unsteady employment status and have debts. This less favourable socio-economic situation of
drug users from ethnic minority groups has also been confirmed in other studies (see e.g., Haasen, 2007;
Jackson et al., 1996; Schneider, 2001).
2.1.2 Patterns and trajectories of drug use
Our literature study concerning the prevalence and type of drug use among ethnic minorities revealed
rather conflicting results: some studies stress some big differences (Argeriou & Daley, 1997), while other
publications did find few or no differences at all (Adrian, 2002).
Based on our study, we found some indications that drug users’ of non-Belgian origin treatment demand
is related to other substances as compared to clients of Belgian origin. The quantitative research part
shows that clients of Belgian origin use and misuse more often alcohol, as is the case with misuse of XTC
and amphetamines. On the other hand, clients from ethnic minority groups report more frequently
heroin, cocaine and methadone use and are usually older when they contact treatment. Also, some
important within-group differences were observed concerning substances of abuse (cf. Haasen, 2007): the
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6. use of alcohol is less common among persons of Moroccan origin, while the prevalence of alcohol use in
clients of Dutch and Eastern-European origin is comparable to that of persons of Belgian origin. Still, it is
impossible to report univocal results concerning differences in patterns of drug use among various ethnic
minority groups based on this study, due to – amongst other reasons – the exclusive focus on persons in
treatment and the small number of persons from some specific ethnic minorities.
Rather conflicting findings are reported concerning the way drugs are administered (e.g. intravenous drug
use), since one analysis (treatment demand-study in the province of Antwerp) revealed that intravenous
drug use was more common among clients from non-Belgian origin, while a second analysis (EuropASI-
data De Sleutel) could not confirm this observation. This may be explained by the fact that some ethnic
minority groups with high prevalence of intravenous drug use (e.g. drug users of Eastern-European origin)
are underrepresented in the database of De Sleutel.
Given the limited number of Belgian studies concerning patterns and trajectories of drug use and given
the fact that results from foreign studies can hardly be generalised to the Belgian context, we cannot
formulate firm conclusions concerning differences in substances use and the way these are administered.
Consequently, these findings should be interpreted cautiously.
2.1.3 Service utilisation and treatment trajectories
Based on our findings, we cannot confirm the hypothesis that drug users from ethnic minority groups are
underrepresented in drug treatment and also leave drug treatment more quickly, as is often stated in the
literature. Although this study cannot provide definitive answers about the prevalence of ethnic minorities
in residential drug treatment, we found some clear indications that drug users from ethnic minority groups
contact drug treatment services to a similar extent as drug users from Belgian origin, although some
qualitative differences can be observed. Furthermore, it is clear that certain subgroups, such as women,
adolescents and persons originating from Eastern-Europe and Africa are represented to a limited extent in
the study samples. This might indicate that these – and maybe also other – subgroups within the
population of drug users from ethnic minority groups make less use of residential (drug) treatment.
However, our observation may be an indication that the population of drug users from some ethnic
minority groups is composed differently as compared to other ethnic groups.
The study in the province of Antwerp shows that drug users of non-Belgian origin contact treatment
services – on average - at an older age, and they also tend to stay in treatment longer. This may have to do
with the fact that drug users from ethnic minorities are rather registered in outpatient programmes, such
as methadone programmes, individual support services, medical assistance and low threshold agencies.
Another striking finding is that clients of Belgian origin consult more frequently a psychiatrist as
compared to other ethnic minority groups. In addition, they receive more often a prescription for anti-
depressant medication, although the prevalence of psychological problems (e.g. depression) does not
seem to be different between the ethnic groups studied. Utilisation of residential treatment was lower
among some ethnic groups (e.g. drug users from Eastern European and Turkish origin), but this finding
was not applicable to persons of Moroccan origin.
It appears that the referring agent to treatment is more often the informal network (e.g. partner, family)
and the criminal justice system among drug users from ethnic minority groups. The findings of the
treatment demand study in Antwerp indicate that intake interviews with persons of non-Belgian ethnic
origin result less often in the start of a treatment episode, as they drop out themselves. This finding has
also been shown in a Dutch study (Verdurmen et al., 2004). On the other hand, we found several
indications that drug users from ethnic minority groups are more frequently directly referred to another
agency by caregivers, which could indicate that these persons do not address the treatment services that
are most appropriate to answer their treatment demand. The focus groups further revealed that the
referral policy of some drug treatment agencies may be due to caregivers’ inability to cope with another
concept of addiction and/or another culture and not with the presence of psychiatric disorders among
these clients.
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7. The qualitative research part has highlighted the importance of so-called ‘alternative coping
mechanisms’ of persons from ethnic minority groups to deal with drug problems. It concerns, among
other mechanisms, a short- or long-term stay in the country of origin, religious devotion, the use of
alternative medication or healing methods and marriage as a last resort to control substance abuse. The
application of such ‘alternative coping mechanisms’ is often done in consultation with or even by force of
the family of the drug user. These coping mechanisms can replace or complement institutionalised or
mainstream drug treatment services; both types of ‘treatment’ utilisation can appear around the same time
or at different moments in someone’s treatment trajectory. This will vary greatly from individual to
individual.
2.2 Influencing factors
Differences concerning drug use and treatment utilisation between drug users of Belgian ethnic origin and
from ethnic minority groups can be attributed to various factors. Mainly the qualitative research part has
illustrated that the latter group experiences various barriers that may hinder the access to and retention in
treatment. It is very important to stress that these barriers are very individual. Moreover, these barriers are
time-limited and may vary during the course of the treatment trajectory. Also, Scheppers and colleagues
(2006) have demonstrated the relative nature of obstacles to treatment. Consequently, the reported
barriers cannot be generalised, but they are illustrative for the existing bottlenecks concerning the
treatment trajectories of ethnic minority groups in drug treatment.
Lack of cultural sensitiveness among caregivers, language and communication problems, a medical and
religion-oriented perspective on drug use and its treatment and the fact that people do not feel attracted
and supported by the western-oriented treatment programme, … . These are only some of the potential
obstacles that drug users from ethnic minority groups may experience when contacting health care and
drug treatment services. These hindering factors can be of practical, cultural or institutional nature. We try
to fit these observed obstacles in a comprehensive framework by referring to the overview made by
Scheppers et al. (2006), in which they describe the potential barriers that may be encountered by ethnic
minority groups when contacting health care services. They distinguish three kinds of barriers: barriers on
client-level; barriers on the level of caregivers or treatment agencies; and system-barriers. We highlight
some of the observed barriers that drug users from ethnic minority groups may experience.
2.2.1 Client-level
According to Scheppers et al. (2006) various demographic variables can be a barrier to look for help,
such as age, gender, not having a family, having children, …. Based on our study, there is clear support for
this cluster of variables: women, youngsters and unmarried persons are relatively underrepresented in the
sample of drug users from ethnic minority groups.
Another cluster of barriers concerns social-structural variables, such as ethnicity, education, social and
economic status, living situation, way of living, family and social support, culture, length of stay,
acculturation, language skills, communication and translation. Our research has shown that the precarious
social status (education and employment) and the frequent involvement with the criminal justice system of
drug users of Moroccan origin is an important potential barrier. Also, language competence appears to be
of utmost importance.
Conceptions about and attitudes towards (drug) treatment may be other barriers according to Scheppers
et al. (2006). They refer to factors such as time in treatment, conceptions about goals and values
concerning health and disease, perceptions about and attitudes towards health care services and caregivers,
knowledge about physiology and disease. This research has further shown that limited identification with
other drug users, negative perception of the quality of care, viewing methadone treatment as drug use, not
understanding or appreciating psychology and a lack of belief and trust in treatment are other potential
barriers for drug users from ethnic minority groups.
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8. Also, personal variables may cause problems when contacting institutionalised treatment services.
Scheppers and colleagues (2006) refer to factors such as migration laws, income and financial means,
access to health insurance, sources of advice and support, time available and stress. Our study supports
the existence of barriers concerning the knowledge about the treatment offer, accessibility of treatment,
entitlement to health insurance and also some other factors such as motivation for change, identification
as a drug user, perception of the different cultural background of treatment services, psychiatric
comorbidity and the belief in someone’s potential to change drug use.
Moreover, the fact that someone has helping resources in his/her immediate surroundings or in the
community may influence how people experience the afore-mentioned barriers. Scheppers and colleagues
(2006) mention the availability and the offer of services, the price of health care services, transportation
and travel time to these services. Based on our research, we further add the availability of support, the
stigmatisation by the own community and the pressure to keep their drug use hidden.
What is defined by Scheppers and colleagues as ‘perception of disease’, referring to the perception by
ethnic minority groups of the causes of addiction, rather appears to be – based on this study – the
perception of drug use. It concerns factors such as having information about the substance and its effects,
the fact that drug use is taboo, having a medical and spiritual view on drug use and treatment, and having
insight in one’s problems.
A final cluster of client variables is described by Scheppers and colleagues as personal health habits.
They refer to self-care and some specific health care practices that are applied in specific cultural groups,
as a means of treating drug use. The qualitative study in particular has shown that drug users from ethnic
minority groups make use of such alternative coping mechanisms (e.g. return to the country of origin,
military service) and self-help in order to deal with their drug problems.
2.2.2 Level of caregivers and treatment services
First, we distinguish characteristics of the treatment services that may interfere with treatment access and
retention, such as the medical procedures and practices applied, the orientation towards urgent
complaints, the programme-orientation and its adaptation to specific cultural/ethnic habits. Concerning
barriers at the level of caregivers, Scheppers et al. (2006) point at cultural sensitivity and cultural skills, the
communication style, the way of providing information, the approach of clients, the presence of
multilingualism and the availability of translators and interpreters, the cultural knowledge, involvement of
family members in the programme, the possibility to profess their religion and spirituality and the
presence of parallel sets of convictions and practices. Many of these factors have also been illustrated by
our research. Following aspects are further deemed important: the relation with the caregiver and the
degree of identification with them, language as a means to express emotions, communication, group
therapy, side-effects of medication, experiencing a negative perception of methadone treatment by
caregivers, knowledge about and trust in the approach of a psychologist, cultural differences, match
between expectations and the actual offer, having the feeling to be taken seriously, appraisal of the
competences of the caregiver and the cultural knowledge in the treatment service.
2.2.3 System-level
A third cluster of barriers that may be experienced by drug users from ethnic minority groups when they
contact treatment services are situated at the system-level (Scheppers et al., 2006). They state that the
medical model, that often inspires substance abuse treatment, is a potential barrier for clients with a
rather cultural and religion-oriented perception of addiction. Our research supports this finding to a
certain extent, but it should be clear that the psychotherapeutic model may also be a barrier, as persons
from ethnic minority groups are less familiar with this kind of approach of drug use and treatment.
8
9. A second group of system variables concerns the approach of clients by the treatment system, which is
often rather formal, impersonal and distant. Our research indicates that drug users from ethnic minority
groups often feel not attracted by the selective approach (only oriented at some target-groups) in
specialised treatment agencies.
Also, organisational variables play a role, such as the referral system, intake procedures and opening
hours, procedure for making an appointment, waiting lists and waiting times, duration of a consultation
and length of treatment, available education and information materials and the possibilities of translation.
This research has shown that especially institutionalised rules in treatment services, the referral system, the
standardised approach, waiting lists and waiting times and the intensity of after-care and follow-up conflict
with the expectations of drug users from ethnic minority groups.
Another dimension can be added to the system level, namely the political climate concerning ethnic
minority groups and concerning migration, xenophobia, … (Fassin, 2002). This research has shown that
drug users from ethnic minority groups, particularly persons from Turkish and Moroccan origin, state that
they have ever experienced racism in treatment. Whether caregivers take position concerning
discrimination and racism or not can be a stimulus or a barrier to further contact treatment services.
Existing good practices concerning this topic are appreciated a lot by persons from ethnic minority
groups. In the literature, it is suggested that especially the migration trajectory of persons from ethnic
minority groups may complicate persons drug use and treatment trajectory. However, we found few
indications for such a link in this study.
These insights concerning potential barriers to treatment for drug users from ethnic minority groups can
help us to answer the hypotheses we put forward at the beginning of this study.
2.3 Answers to the hypotheses of the study
2.3.1 ‘Dual exclusion’
The first hypothesis that was suggested concerned the ‘dual exclusion’ or ‘dual isolation’ of drug users
from ethnic minority groups (cf. supra). This hypothesis is partially supported by our study to a large
extent. It appears that some drug users from ethnic minority groups have a limited knowledge about
drugs, their effects and potential consequences. If persons have insight into their problems, this may
conflict with taboos concerning drug use in some ethnic communities. This often results in ignoring and
hiding substance abuse and not seeking help. If the persons’ substance use and need for treatment come
to light, they are at risk of losing the support of their family and social network. This may escalate and lead
to a situation in which they have few or no contacts at all with the own community. For many of them,
the step towards treatment is a bridge too far, given their limited knowledge about the treatment offer
and/or their biased view of it. This may explain why caregivers often experience that drug users from
ethnic minority groups are often in a further stage of dependence and marginalisation when they decide to
contact treatment. Many clients of non-Belgian origin appear to be supported by their network and
community, who stimulate them to change their drug abuse and inform them about and/or refer them to
some kind of treatment, either an alternative or institutionalised form of treatment. Consequently,
situations of ‘dual exclusion’ exist and need to be taken into consideration, but will – according to this
study – not always be the case.
2.3.2 Competition between self-organisations and mosques and mainstream treatment
The second hypothesis concerns “the competition between preventive and supportive efforts concerning
substance abuse problems by (self-)organisations and mosques on the hand, and by ‘regular’ treatment
services on the other hand”. Based on this study, it is not possible to answer this hypothesis, since we
have found insufficient indications to support this hypothesis. It is not easy to estimate the range and
impact of these alternative practices. Still, it is apparent that many drug users from Turkish and Moroccan
origin make use of such alternatives and that such approaches can be effective to a certain extent. On the
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10. 10
other hand, the results seem to indicate that drug users from ethnic minority groups are not
underrepresented in mainstream drug treatment (as compared with the percentage of persons from ethnic
minorities in the total population). Our findings show that making use of alternative coping mechanisms
can complement service utilisation in general health care or specialised drug treatment services.
Consequently, we cannot conclude that there is competition between activities by (self-)organisations and
mosques and institutionalised treatment services. Moreover, we found some indications that both parties
are interested to combine forces and to collaborate more closely in the near future to help drug users from
ethnic minority groups more adequately.
2.3.3 ‘Cultural blindness’
The hypothesis of ‘cultural blindness’ implies that existing treatment and prevention programs do not take
cultural influences into account sufficiently (Castro & Alarcon, 2002). Based on this study, we can confirm
the hypothesis of ‘cultural blindness’. Several inadequacies have been reported concerning this topic.
Although serious efforts have been made by caregivers to improve the cultural sensitivity of treatment
programs, several elements still exist that interfere with this cultural sensitivity. It mainly concerns
discrepancies about the perception of drug use and drug treatment and implies that clients’ perceptions
are insufficiently listened to and integrated in the programme. Caregivers seem to show insufficient
openness and flexibility towards other conceptions, individualities, needs, values and follow the postulated
programs and procedures too rigidly. Drug users of non-Belgian ethnic origin often feel less supported by
a treatment program that stresses the importance of introspection, communication of feelings, … As a
consequence, caregivers are often perceived as incompetent and are not trusted by clients from ethnic
minority groups.
Institutionalised practices that demonstrate some degree of cultural sensitivity are better evaluated and
appreciated by drug users from ethnic minority groups. Such concessions make that these persons feel
more attracted to the programme and are recognised in their cultural identity. Consequently, such efforts
that are already made or that are planned by caregivers should be further stimulated and supported in
order to move towards a culturally sensitive substance abuse treatment.