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Grazioli VS, Graells M, Schmutz E, Cantero O, Sebaï T, Favre V, Richème-Roos J, Morisod K, Jeanneret M, Singy P, Bodenmann P. Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study. BMC Health Serv Res 2024; 24:301. [PMID: 38448935 PMCID: PMC10918938 DOI: 10.1186/s12913-024-10574-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/07/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals' experiences in healthcare and improve their capacity to communicate with these populations. METHODS This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention. RESULTS Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients. CONCLUSIONS Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs' perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.
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Affiliation(s)
- Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland.
| | - Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Odile Cantero
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Tanya Sebaï
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Vanessa Favre
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Jessica Richème-Roos
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Michel Jeanneret
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, Lausanne, 1011, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
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Morisod K, Martin T, Rawlinson C, Grazioli VS, von Plessen C, Durand MA, Selby K, Le Pogam MA, Bühler N, Bodenmann P. Facing the COVID-19 Pandemic: A Mixed-Method Analysis of Asylum Seekers' Experiences and Worries in the Canton of Vaud, Switzerland. Int J Public Health 2023; 68:1606229. [PMID: 37829084 PMCID: PMC10564980 DOI: 10.3389/ijph.2023.1606229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Objectives: The clinical and social burden of the COVID-19 pandemic were high among asylum seekers (ASs). We aimed to understand better ASs' experiences of the pandemic and their sources of worries. Methods: Participants (n = 203) completed a survey about their worries, sleep disorders, and fear of dying. We also conducted semi-structured interviews with ASs living in a community center (n = 15), focusing on how social and living conditions affected their experiences and worries. Results: ASs in community centers experienced more sleep disorders related to the COVID-19 pandemic than those living in private apartments (aOR 2.01, p = 0.045). Similarly, those with lower education had greater fear for their life due to the COVID-19 pandemic (aOR 2.31, p = 0.015). Qualitative findings showed that sharing living spaces was an important source of worries for ASs and that protective measures were perceived to increase social isolation. Conclusion: Our study highlighted the impact of the COVID-19 pandemic for ASs and the importance of tailoring public health measures to their needs and living conditions.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tiffany Martin
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Cloé Rawlinson
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Department of Ambulatory Care, Center for Primary Care and Public Health, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Direction Générale de la Santé (DGS), Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marie-Anne Durand
- UMR1295 Centre d’Epidémiologie et de Recherche en Santé des Populations (CERPOP), Toulouse, France
- University Center of General Medicine and Public Health, Lausanne, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Kevin Selby
- Department of Ambulatory Care, Center for Primary Care and Public Health, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Nolwenn Bühler
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Jackson Y, Bodenmann P, Burton-Jeangros C, Morisod K, Gétaz L, Schmutz E, Baggio S, Grazioli VS. [Research about vulnerable populations: challenges and opportunities]. Rev Med Suisse 2023; 19:1311-1314. [PMID: 37403953 DOI: 10.53738/revmed.2023.19.834.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
There is an important gap in health knowledge about vulnerable and hard-to-reach groups. The development of research projects and the implementation of interventions require strategies adapted to the particularities of these groups. This article reviews some of the main issues through the lens of recent projects conducted in French-speaking Switzerland.
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Affiliation(s)
- Yves Jackson
- Service de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
- Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Patrick Bodenmann
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
- Chaire de médecine des populations vulnérables, Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | - Claudine Burton-Jeangros
- Institut de recherches sociologiques, Faculté des sciences de la société, Université de Genève, 1211 Genève 4
| | - Kevin Morisod
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
| | - Laurent Gétaz
- Faculté de médecine, Université de Genève, 1211 Genève 4
- Service de médecine pénitentiaire, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Elodie Schmutz
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
| | - Stéphanie Baggio
- Faculté de médecine, Université de Genève, 1211 Genève 4
- Service de médecine pénitentiaire, Hôpitaux universitaires de Genève, 1211 Genève 14
- Berner Institut für Hausarztmedizin (BIHAM), Université de Berne, 3012 Berne
| | - Véronique S Grazioli
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
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Morisod K, Nguyen K, Grazioli VS, Marti J, Bodenmann P. [Understanding health equity through artificial intelligence The case of Agent-Based Modelling (ABM)]. Rev Med Suisse 2023; 19:1322-1326. [PMID: 37403955 DOI: 10.53738/revmed.2023.19.834.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Agent-Based Modelling (ABM) is a computer modelling technique that simulates the behaviour and interactions of autonomous agents within a virtual environment. Applied to health equity, this technique allows for a better understanding of the complex social and economic determinants that contribute to health inequities and enables the evaluation of the potential effects of public policies on the latter. Despite some limitations related to the accessibility and quality of health data and the complexity of the models, ABM appears to be a promising tool in the field of health equity, both for researchers in public or community health and for policy makers.
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Affiliation(s)
- Kevin Morisod
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
| | - Khoa Nguyen
- Department Systems Immunology, Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Rebenring 56, 38106 Braunschweig
| | - Véronique S Grazioli
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
| | - Joachim Marti
- Département épidémiologie et systèmes de santé, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
| | - Patrick Bodenmann
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et de santé publique, Unisanté, 1011 Lausanne
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Graells M, Schaad L, Schmutz E, Moullin J, Hugli O, Daeppen JB, Ambrosetti J, Ombelli J, Golay M, Ribordy V, Bodenmann P, Grazioli VS. Experiences of Frequent Users of Emergency Departments in Health Care Setting in French-Speaking Switzerland: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11091228. [PMID: 37174770 PMCID: PMC10178271 DOI: 10.3390/healthcare11091228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
AIMS Frequent users of the emergency department (FUED; five ED visits or more per year) often have negative experiences in health care settings, potentially aggravating their health problems. Scarce research has explored FUED experiences in health care in Europe, none in Switzerland. Thus, this study aimed to conduct an in-depth exploration of FUED experiences in health care settings in Switzerland. METHODS Semi-structured interviews were conducted among 20 FUED (75% female; mean age = 40.6, SD = 12.8). Qualitative data were subject to inductive content analysis. RESULTS Five main themes emerged from the analysis. The main findings documented that FUED experiences in health care were mostly negative, leading to negative emotions, dissatisfaction and a loss of confidence in the system, although some positive experiences were reported as well. The relationship with health care workers was perceived as playing a key role in FUED experiences. CONCLUSION The findings indicate that FUED often have negative experiences in the health care system in Switzerland. The relationship with the health care staff is reported as a decisive ingredient of the experience in health care. Future research is needed to develop awareness-raising interventions for health care staff to improve FUED experiences in health care.
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Affiliation(s)
- Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Luana Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Joanna Moullin
- Faculty Health Sciences, School of Population Health, Curtin University, Perth 6845, Australia
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Julia Ambrosetti
- Emergency Department, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Julien Ombelli
- Emergency Department, North Vaud Hospital Group, 1400 Yverdon-les-Bains, Switzerland
| | - Michel Golay
- Emergency Department, La Broye Hospital, 1530 Payerne, Switzerland
| | - Vincent Ribordy
- Emergency Department, Fribourg Hospital, 1700 Fribourg, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
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Cariello C, Grazioli VS, Nikles J, Schmutz E, Hugli O, Bodenmann P. Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study. BMJ Open 2023; 13:e069272. [PMID: 37094894 PMCID: PMC10151913 DOI: 10.1136/bmjopen-2022-069272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Previous research revealed the vulnerability of frequent users of emergency department (FUED) because of concomitant medical, psychological and social issues. Case management (CM) provides FUED with effective medical and social support, however, the heterogeneity of this population has highlighted the need to explore the specific needs of FUED subpopulations. In response, this study aimed to explore qualitatively the lived experience of migrant and non-migrant FUED in the healthcare system to identify unmet needs. METHODS Adult migrant and non-migrant FUED (≥ 5 visits in the ED in the past 12 months) were recruited in a Swiss university hospital to collect qualitative data on their experience within the Swiss health system. Participants were selected based on predefined quotas for gender and age. Researchers conducted one-on-one semistructured interviews until reaching data saturation. Inductive conventional content analysis was used to analyse qualitative data. RESULTS In total, 23 semistructured interviews were conducted (11 migrant FUED and 12 non-migrant FUED). Four main themes emerged from the qualitative analysis: (1) self-evaluation of the Swiss healthcare system; (2) orientation within the healthcare system; (3) relationship with caregivers and (4) perception of own health. While both groups were overall satisfied with the healthcare system and care provided, migrant FUED reported language and financial barriers to access it. Both groups expressed overall satisfaction over their relationship with healthcare professionals, although migrant FUED reported a feeling of illegitimacy to consult the ED based on social status, whereas non-migrant FUED felt more often the need to justify their use of the ED. Finally, migrant FUED perceived their own health to be affected by their status. CONCLUSION This study highlighted difficulties specific to subpopulations of FUED. For migrant FUED, these included access to care and impact of migrant status on own health. Adapting CM to the specific needs of migrant FUED could help reduce their vulnerability.
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Affiliation(s)
- Carmen Cariello
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Justin Nikles
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
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Bertholet N, Schmutz E, Cunningham JA, McNeely J, Gmel G, Daeppen JB, Grazioli VS. Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment. JMIR Hum Factors 2023; 10:e41088. [PMID: 36881448 PMCID: PMC10031438 DOI: 10.2196/41088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/28/2022] [Accepted: 01/01/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. OBJECTIVE This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. METHODS The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. RESULTS The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: "General Acceptance of the App," "Importance of the Targeted and Relevant App Content," "Importance of Credibility," "Importance of the App Usability," "Importance of a Simple and Attractive Design," "Importance of Notifications to Ensure App Use over Time." Besides a general acceptance of the app, these themes reflected participants' recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. CONCLUSIONS Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. TRIAL REGISTRATION ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-4145-2.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Elodie Schmutz
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer McNeely
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States
| | - Gerhard Gmel
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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Morisod K, Grazioli VS, Schlüter V, Bochud M, Gonseth Nusslé S, D'Acremont V, Bühler N, Bodenmann P. Prevalence of SARS-CoV-2 infection and associated risk factors among asylum seekers living in asylum centres: A cross-sectional serologic study in Canton of Vaud, Switzerland. J Migr Health 2023; 7:100175. [PMID: 36938329 PMCID: PMC10005972 DOI: 10.1016/j.jmh.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/05/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
Background Understanding the factors influencing SARS-CoV-2 transmission in asylum seekers and refugees living in centres is crucial to determine targeted public health policies protecting these populations fairly and efficiently. In response, this study was designed to explore the pandemic's spread into asylum centres during the first wave of the pandemic in Switzerland. Specifically, it aimed to identify the risk factors associated with a positive anti-SARS-CoV-2 seroprevalence test after the first semi-confinement period (16 March to 27 April 2020) amongst asylum seekers and refugees living in centres. Methods This research is part of SérocoVID, a seroepidemiologic study of SARS-CoV-2 infection conducted in the canton of Vaud, Switzerland. Migrants living in two asylum centres, one known to have had an epidemic outbreak, were invited to participate in this study. Anti-SARS-CoV-2 IgG and IgA antibodies targeting the spike viral protein were measured in all participants using a Luminex immunoassay. Each participant also completed a questionnaire measuring socio-demographic characteristics, medical history (comorbidities, smoking status, BMI, flu-like symptoms), health literacy, public health recommendations (wearing a masque in a public area, social distancing and hands cleaning), behaviours and exposures (daily life activities, number of contacts weekly). The association of these independent variables with the serologic test result were estimated using a multivariable logistic regression model. Findings A total of 124 participants from the two asylum centres took part in the study (Centre 1, n = 82; Centre 2, n = 42). The mean participation rate was 36.7%. The seroprevalence in Centres 1 and 2 were 13% [95% CI 0.03, 0.14] and 50% [0.34, 0.65], respectively. Next, 40.63% of SARS-CoV-2 positive people never developed symptoms (asymptomatic cases), and no one had severe forms of the Covid-19 disease requiring hospitalisation. Participants report high compliance with public health measures, especially hygiene rules (96.3% of positive answers) and social distancing (88.7%). However, only 11.3% said they always wore a masque in public. After adjusting for individual characteristics, infection risk was lower amongst people with high health literacy (aOR 0.16, p = 0.007 [0.04, 0.60]) and smokers (aOR 0.20, p = 0.013 [0.06, 0.69]). Conclusion Despite the lack of severe complications of Covid-19 disease in this study, findings suggest that developing targeted public health measures, especially for the low health literacy population, would be necessary to limit the risk of outbreaks in asylum centres and improve this population's safety. Further investigations and qualitative approach are required to understand more finely how living conditions, risks and behaviours such as tobacco consumption, and the adoption of protective measures impact SARS-CoV-2 infection.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Rue du Bugnon 44, Lausanne, Vaud 1011, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
- Corresponding author at: Chemin de Chantemerle 10, 1010 Lausanne, Vaud, Switzerland.
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Rue du Bugnon 44, Lausanne, Vaud 1011, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
| | - Virginie Schlüter
- Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Route de Berne 113, Lausanne, Vaud 1010 Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
| | - Murielle Bochud
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
- Department of Epidemiology and Health systems, Center for Primary Care and Public Health (Unisanté), Route de la Corniche 10, Lausanne, Vaud 1010, Switzerland
| | - Semira Gonseth Nusslé
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
- Department of Epidemiology and Health systems, Center for Primary Care and Public Health (Unisanté), Route de la Corniche 10, Lausanne, Vaud 1010, Switzerland
| | - Valérie D'Acremont
- Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Route de Berne 113, Lausanne, Vaud 1010 Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
| | - Nolwenn Bühler
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Rue du Bugnon 44, Lausanne, Vaud 1011, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Rue du Bugnon 44, Lausanne, Vaud 1011, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Rue du Bugnon 21, Lausanne, Vaud 1011, Switzerland
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9
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Schaad L, Graells M, Kasztura M, Schmutz E, Moullin J, Hugli O, Daeppen JB, Ambrosetti J, Ombelli J, Golay M, Ribordy V, Grazioli VS, Bodenmann P. Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study. Inquiry 2023; 60:469580231159745. [PMID: 36927138 PMCID: PMC10026145 DOI: 10.1177/00469580231159745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation. OBJECTIVES Explore the FUED's perspectives about CM in Switzerland. DESIGN, SETTING & PARTICIPANTS Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. OUTCOMES MEASURES & ANALYSIS Inductive content analysis. MAIN RESULTS Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM (ie, stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.
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Affiliation(s)
- Luana Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | | | - Olivier Hugli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Jean-Bernard Daeppen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | | | - Julien Ombelli
- North Vaud Hospital Group, Yverdon-les-Bains, Switzerland
| | - Michel Golay
- Broye Intercantonal Hospital, Payerne, Switzerland
| | | | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
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10
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Morisod K, Durand MA, Selby K, Le Pogam MA, Grazioli VS, Sanchis Zozaya J, Bodenmann P, von Plessen C. Asylum Seekers' Responses to Government COVID-19 Recommendations: A Cross-sectional Survey in a Swiss Canton. J Immigr Minor Health 2022; 25:570-579. [PMID: 36508030 PMCID: PMC9743178 DOI: 10.1007/s10903-022-01436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Asylum seekers face multiple language, cultural and administrative barriers that could result in the inappropriate implementation of COVID-19 measures. This study aimed to explore their knowledge and attitudes to recommendations about COVID-19. We conducted a cross-sectional survey among asylum seekers living in the canton of Vaud, Switzerland. We used logistic regressions to analyze associations between knowledge about health recommendations, the experience of the pandemic and belief to rumors, and participant sociodemographic characteristics. In total, 242 people participated in the survey, with 63% of men (n = 150) and a median age of 30 years old (IQR 23-40). Low knowledge was associated with linguistic barriers (aOR 0.36, 95% CI 0.14-0.94, p = 0.028) and living in a community center (aOR 0.43, 95% CI 0.22-0.85, p = 0.014). Rejected asylum seekers were more likely to believe COVID-19 rumors (aOR 2.81, 95% CI 1.24-6.36, p = 0.013). This survey underlines the importance of tailoring health recommendations and interventions to reach asylum seekers, particularly those living in community centers or facing language barriers.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France ,Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Kevin Selby
- Department Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Javier Sanchis Zozaya
- grid.8515.90000 0001 0423 4662Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,Direction Générale de La Santé (DGS), Lausanne, Switzerland ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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11
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Bodenmann P, Singy P, Graells M, Schmutz E, Sebaï T, Favre V, Richème-Roos J, Cantero O, Morisod K, Grazioli VS. Improving communication with hard of hearing and D/deaf patients: a capacity-building intervention. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
D/deaf and hard of hearing (D&HoH) populations are disproportionally affected by physical and mental health problems while facing barriers to accessing health services. These barriers stem from communication challenges with healthcare providers, who are often unprepared to meet their specific needs. This study aimed to develop and evaluate an intervention to improve healthcare providers’ skills to communicate with these patients.
Methods
This study featured a participative action research design. Consistently, the intervention was developed through iterative phases together with the target populations and key stakeholders. The finale version was tested in healthcare workers in Canton of Vaud in Switzerland. Participants completed a questionnaire before (T0) and 6 months after (T1) the intervention, assessing perceived knowledge of deafness and hard of hearing and tools to improve communication, self-efficacy on how to communicate with D&HoH patients and institutional benefits (application frequency of communication rules and tools).
Results
The final intervention aimed to increase participants’ 1) awareness of D&HoH experience and communication needs, 2) knowledge of the tools and basic rules to improve communication. Two D&HoH trainers led one half-day intervention among 28 healthcare providers (e.g., nurses, pharmacists; mean age=43.6). Paired-sample t-tests revealed significant increases in knowledge between T0 and T1, t (23) = -7.81, p < .001 and in self-efficacy, t (24) = -10.23, p < .001, whereas there was no significant difference between institutional benefits at T0 and T1.
Conclusions
Although findings suggest the intervention is a promising means to increase perceived knowledge and self-efficacy on how communicating with D&HoH patients, complementary approaches, such as a resource person within the institutions providing day-to-day support to the teams besides the intervention, may be necessary to induce institutional changes.
Key messages
• Future research should implement the intervention more broadly within inpatient and outpatient settings in Switzerland to increase knowledge on how communicating with D&HoH patients.
• Intervention implementation should be complemented by an additional structural approach to induce sustainable changes in practice and evaluated over 12 months to ensure sustainability.
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Affiliation(s)
- P Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - P Singy
- Psychiatric Liason Service, Lausanne University Hospital , Lausanne, Switzerland
| | - M Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - E Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - T Sebaï
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - V Favre
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - J Richème-Roos
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - O Cantero
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - K Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
| | - VS Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne , Lausanne, Switzerland
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12
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Grazioli VS, Tzartzas K, Blaser J, Graells M, Schmutz E, Petitgenet I, Favrat B, Zozaya JS, Kokkinakis I, Marion-Veyron R, Bodenmann P. Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study. Int J Public Health 2022; 67:1604517. [PMID: 36119446 PMCID: PMC9478025 DOI: 10.3389/ijph.2022.1604517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs. Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses. Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions. Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.
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13
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Morisod K, Malebranche M, Marti J, Spycher J, Grazioli VS, Bodenmann P. Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review. Eur J Public Health 2022; 32:548-556. [PMID: 35640159 PMCID: PMC9341675 DOI: 10.1093/eurpub/ckac056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background d/Deaf people suffer from inequitable access to healthcare and health information. This results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people have been documented but not systematically analyzed. The purpose of this systematic review is to obtain a global overview of what we know about interventions aimed at improving health equity for d/Deaf people. Methods Medline Ovid SP, Embase, CINAHL EBSCO, PsycINFO Ovid SP, Central—Cochrane Library Wiley and Web of Science were searched for relevant studies on access to healthcare and health-related interventions for d/Deaf people following the PRISMA-equity guidelines. We focused on interventions aimed at achieving equitable care and equitable access to health information for d/Deaf people. Results Forty-six studies were identified and analyzed. Seven categories of interventions facing healthcare or health education inequities emerged: use of Sign Language (1), translation, validation and identification of clinical tools and scales (2), healthcare provider training program (3), development of adapted healthcare facilities (4), online interventions (5), education programs (6) and videos (7). Despite some methodological limitations or lack of data, these interventions seem relevant to improve equity of care and health education for d/Deaf people. Conclusion Interventions that promote healthcare equity, health education amongst d/Deaf patients and healthcare provider awareness of communication barriers and cultural sensitivity show promise in achieving more equitable care for d/Deaf patients. Meaningful engagement of d/Deaf individuals in the conceptualization, implementation and evaluation of health-related interventions is imperative.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Mary Malebranche
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Joachim Marti
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Jacques Spycher
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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14
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Morisod K, Bühler N, Grazioli VS, Moschetti K, Marti J, Pralong M, Rawlinson C, Sanchis Zozaya J, Michaud L, Brovelli S, Schaad L, Hugli O, Bodenmann P. [The health equity issues of an emergency department fee]. Rev Med Suisse 2022; 18:675-679. [PMID: 35385619 DOI: 10.53738/revmed.2022.18.776.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In June 2021, the Swiss parliament accepted a legislative proposal calling for the introduction of a fee to fight emergency department (ED) overcrowding. Although this issue remains a major challenge for health policies, the introduction of such a fee raises many questions, notably regarding health equity. However, other more equitable solutions exist: improving the case management of ED frequent users and improving coordination between ED and primary care.
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Affiliation(s)
- Kevin Morisod
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
- Chaire de médecine des populations vulnérables, Université de Lausanne, 1005 Lausanne
| | - Nolwenn Bühler
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Véronique S Grazioli
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
- Chaire de médecine des populations vulnérables, Université de Lausanne, 1005 Lausanne
| | - Karine Moschetti
- Département épidémiologie et systèmes de santé, Unisanté, 1011 Lausanne
| | - Joachim Marti
- Département épidémiologie et systèmes de santé, Unisanté, 1011 Lausanne
| | - Melody Pralong
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Cloé Rawlinson
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
| | - Javier Sanchis Zozaya
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
- Chaire de médecine des populations vulnérables, Université de Lausanne, 1005 Lausanne
| | - Laurent Michaud
- Service de psychiatrie de liaison, Département de psychiatrie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Sebastien Brovelli
- Service de psychiatrie de liaison, Département de psychiatrie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Luana Schaad
- Faculté de biologie et médecine, Université de Lausanne, 1005 Lausanne
| | - Olivier Hugli
- Service des urgences, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Patrick Bodenmann
- Département vulnérabilités et médecine sociale, Unisanté, 1011 Lausanne
- Chaire de médecine des populations vulnérables, Université de Lausanne, 1005 Lausanne
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15
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von Allmen M, Grazioli VS, Kasztura M, Chastonay O, Moullin JC, Hugli O, Daeppen JB, Bodenmann P. Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception. BMC Emerg Med 2021; 21:92. [PMID: 34348645 PMCID: PMC8336392 DOI: 10.1186/s12873-021-00481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Frequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs’ legitimacy to use ED. Method Mixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10). Results Both quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs’ legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings. Conclusion Despite promising results on FUEDs’ QoL and frequency of ED visits, these preliminary findings suggest that CM may provide limited support to ED staff in its current form. Given the high burden of FUED-related challenges encountered by ED staff, improved communication and FUED-related knowledge transfer between ED staff and the CM team should be prioritized to increase the value of a FUED CM intervention for ED staff. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00481-9.
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Affiliation(s)
- Michael von Allmen
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland.
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Oriane Chastonay
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | | | - Olivier Hugli
- Emergency Department, University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
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16
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Bodenmann P, Kasztura M, Graells M, Schmutz E, Chastonay O, Canepa-Allen M, Moullin J, von Allmen M, Lemoine M, Hugli O, Daeppen JB, Grazioli VS. Healthcare Providers' Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study. Inquiry 2021; 58:469580211028173. [PMID: 34328025 PMCID: PMC8326990 DOI: 10.1177/00469580211028173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly
cumulate medical, social, and substance use problems requiring complex and
sustained care coordination often unavailable in ED. This study aimed to explore
ED healthcare providers’ challenges related to FUED care to gain insight into
the support and resources required to address FUED complex needs. An online
survey was sent to all general adult emergency services within Switzerland
(N = 106). Participants were asked to indicate the extent to which they
perceived that FUED represented a problem and to describe the main challenges
encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed
the survey. Among the 208 participants, 134 (64%) reported that FUED represented
a challenge and 133 described 1 to 5 challenges encountered. A conventional
content analysis yielded 4 main categories of perceived challenges. Negative
consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff
helplessness, and fatigue) was the most frequently reported challenge, followed
by challenges related to FUEDs’ characteristics (eg, mental health and social
problems) leading to healthcare complexity. The third most frequently
encountered challenge was related to the ED inappropriateness and inefficiency
to address FUEDs’ needs. Finally, challenges related to the lack of FUED
healthcare network were the least often mentioned. ED healthcare providers
experience a wide range of challenges related to FUED care. These findings
suggest that currently EDs nor their staff are equipped to address FUEDs’
complex needs.
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Affiliation(s)
- Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Oriane Chastonay
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Marina Canepa-Allen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Joanna Moullin
- Faculty Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Western Australia
| | - Michael von Allmen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Melissa Lemoine
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, University of Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Switzerland
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17
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Bodenmann P, Singy P, Kasztura M, Graells M, Cantero O, Morisod K, Malebranche M, Smith P, Beyeler S, Sebaï T, Grazioli VS. Developing and Evaluating a Capacity-Building Intervention for Healthcare Providers to Improve Communication Skills and Awareness of Hard of Hearing and D/deaf Populations: Protocol for a Participative Action Research-Based Study. Front Public Health 2021; 9:615474. [PMID: 33996710 PMCID: PMC8113414 DOI: 10.3389/fpubh.2021.615474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population. Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up. Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.
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Affiliation(s)
- Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Odile Cantero
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Mary Malebranche
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pascal Smith
- Schweizerischer Gehörlosenbund-Fédération Suisse des Sourds (SGB-FSS), Lausanne, Switzerland
| | - Stéphane Beyeler
- Schweizerischer Gehörlosenbund-Fédération Suisse des Sourds (SGB-FSS), Lausanne, Switzerland
| | - Tanya Sebaï
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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Larimer ME, Witkiewitz K, Schwebel FJ, Lee CM, Lewis MA, Kilmer JR, Andersson C, Johnsson K, Dillworth T, Fossos-Wong N, Pace T, Grazioli VS, Berglund M. An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden. Prev Sci 2021; 22:670-682. [PMID: 33817755 DOI: 10.1007/s11121-021-01231-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 01/13/2023]
Abstract
Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.
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Affiliation(s)
- Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA, 98105, USA
| | - Katie Witkiewitz
- Department of Psychology and Center On Alcohol, Substance Use, And Addictions, University of New Mexico, MSC03 2220 Logan Hall 118, Albuquerque, NM, 87131, USA
| | - Frank J Schwebel
- Department of Psychology and Center On Alcohol, Substance Use, And Addictions, University of New Mexico, MSC03 2220 Logan Hall 118, Albuquerque, NM, 87131, USA.
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA, 98105, USA
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Jason R Kilmer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA, 98105, USA
| | - Claes Andersson
- Department of Criminology, Malmö University, 205 06, Malmö, Sweden
| | - Kent Johnsson
- Department of Social Work, Malmö University, 205 06, Malmö, Sweden
| | - Tiara Dillworth
- Department of Rehabilitation Medicine, University of Washington, Box 359740, Seattle, WA, 98195, USA
| | - Nicole Fossos-Wong
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA, 98105, USA
| | - Timothy Pace
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA, 98105, USA
| | - Véronique S Grazioli
- Department of Community Medicine and Health, Department of Psychiatry and Behavioral Sciences, Lausanne University Hospital, Switzerland, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA, 98105, USA
| | - Mats Berglund
- Department of Criminology, Malmö University, 205 06, Malmö, Sweden
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Gaume J, Grazioli VS, Paroz S, Fortini C, Bertholet N, Daeppen JB. Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department - Results from an iterative qualitative design. PLoS One 2021; 16:e0246652. [PMID: 33556153 PMCID: PMC7869998 DOI: 10.1371/journal.pone.0246652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. METHODS Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. RESULTS Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions. DISCUSSION This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Véronique S. Grazioli
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Sophie Paroz
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Cristiana Fortini
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
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20
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Chastonay OJ, Lemoine M, Grazioli VS, Canepa Allen M, Kasztura M, Moullin JC, Daeppen JB, Hugli O, Bodenmann P. Health care providers' perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland. BMC Emerg Med 2021; 21:4. [PMID: 33413163 PMCID: PMC7792123 DOI: 10.1186/s12873-020-00397-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Frequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce. Objectives The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service. Methods Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds. Results The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization. Conclusions The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00397-w.
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Affiliation(s)
- Oriane J Chastonay
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland.
| | - Melissa Lemoine
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Marina Canepa Allen
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | | | | | - Olivier Hugli
- Emergency Department, University Hospital, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
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21
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Grazioli VS, Studer J, Larimer ME, Lewis MA, Bertholet N, Marmet S, Daeppen JB, Gmel G. Protective behavioral strategies and alcohol outcomes: Impact of mood and personality disorders. Addict Behav 2021; 112:106615. [PMID: 32889443 DOI: 10.1016/j.addbeh.2020.106615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
Although young men or young adults with mental health disorders are at higher risk to engage in problematic drinking, they typically evince stronger associations between protective behavioral strategies (PBS) and fewer alcohol outcomes. This study aimed to contribute to this line of research by examining the moderating effect of depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder on the association between PBS and alcohol outcomes. Participants (N = 4,960; mean age = 25.43) were young men participating in the Cohort Study on Substance Use Risk Factors. Measures of PBS use, typical drinks per week, alcohol-related consequences, depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder were used from the second follow-up assessment. Main results indicated that the negative association between PBS and alcohol use was stronger in participants with borderline personality disorder than among those without this disorder. Unexpectedly, in participants with depression, PBS were not significantly associated with alcohol use, whereas they were related to fewer drinks among those without the disorder. Similarly, in participants with bipolar spectrum disorder, the association between PBS and alcohol-related consequences was not significant, whereas PBS were associated with fewer consequences in those without the disorder. Finally, findings indicated that social anxiety disorder did not significantly moderate the associations between PBS and alcohol outcomes. If replicated by future research, these findings imply that PBS-intervention may not equally impact young adults with diverse mental health disorders.
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22
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Mackelprang JL, Clifasefi SL, Grazioli VS, Collins SE. Content Analysis of Health Concerns among Housing First Residents with a History of Alcohol Use Disorder. J Health Care Poor Underserved 2021; 32:463-486. [PMID: 33678708 PMCID: PMC9940994 DOI: 10.1353/hpu.2021.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Previous research has utilized survey and administrative data to document health problems among Housing First (HF) residents; however, little is known about residents' personal perspectives on their health. The purpose of this study was to utilize conventional content analysis to analyze health-related concerns among HF residents with histories of alcohol use disorder. Between June and December 2013, we interviewed 44 adults who had histories of chronic homelessness and alcohol use disorder and were residing in single-site HF in Seattle, Washington. Responses centered on five primary topics: alcohol-related harm, perceived health vulnerability, concern for fellow residents' health, end of life, and health and safety promotion. HF residents experience complex alcohol-exacerbated health difficulties and existing health services may not meet the needs of those whose health is particularly compromised. Considering that HF facilitates aging in place, end-of-life care and grief counseling should be integrated into HF services.
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Affiliation(s)
- Jessica L. Mackelprang
- Department of Psychological Sciences, School of Health Sciences at Swinburne University of Technology
| | - Seema L. Clifasefi
- Harm Reduction Research and Treatment Center, Psychiatry & Behavioral Sciences at the University of Washington-Harborview Medical Center
| | - Véronique S. Grazioli
- Department of Vulnerabilities & Social Medicine, Center for Primary Care & Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University
| | - Susan E. Collins
- Harm Reduction Research and Treatment Center, Psychiatry & Behavioral Sciences at the University of Washington-Harborview Medical Center and with Washington State University
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Malebranche M, Grazioli VS, Kasztura M, Hudon C, Bodenmann P. Case management for frequent emergency department users: no longer a question of if but when, where and how. CAN J EMERG MED 2020; 23:12-14. [PMID: 33683597 PMCID: PMC7726608 DOI: 10.1007/s43678-020-00024-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Mary Malebranche
- Department of Medicine, Cumming School of Medicine, University of Calgary, HSC 1410, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada.
- Department of Vulnerabilities and Social Medicine, Center for General Medicine and Public Health (Unisanté), University of Lausanne, Canton of Vaud, Lausanne, Switzerland.
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for General Medicine and Public Health (Unisanté), University of Lausanne, Canton of Vaud, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, Center for General Medicine and Public Health (Unisanté), University of Lausanne, Canton of Vaud, Lausanne, Switzerland
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for General Medicine and Public Health (Unisanté), University of Lausanne, Canton of Vaud, Lausanne, Switzerland
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Clifasefi SL, Collins SE, Torres NI, Grazioli VS, Mackelprang JL. The life-enhancing alcohol-management program: Results from a 6-month nonrandomized controlled pilot study assessing a community based participatory research program in housing first. J Community Psychol 2020; 48:763-776. [PMID: 31778585 PMCID: PMC9970685 DOI: 10.1002/jcop.22291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
A 2-arm, 6-month, nonrandomized controlled pilot trial was conducted to test the initial effectiveness of the Life Enhancing Alcohol-management Program (LEAP) as an adjunct to Housing First (HF; e.g., permanent supportive housing) on alcohol and quality-of-life (QoL) outcomes. The LEAP entails resident-driven leadership opportunities, meaningful activities, and pathways to recovery aimed at reducing alcohol-related harm and improving QoL. Data analyses were conducted to test between- and within-subjects effects of the LEAP on self-reported alcohol and QoL outcomes among HF residents. At the 6-month follow up, between groups analysis revealed nonsignificant findings for alcohol quantity or alcohol-related harm (ps > 0.06); however, LEAP participants reported significantly more engagement in meaningful activities than control participants (p < .001), and within-subjects analyses indicated that high levels of LEAP programming engagement predicted significant reductions in alcohol quantity and alcohol-related harm (ps < 0.01). The LEAP was associated with increased engagement in meaningful activities, and greater involvement in the LEAP programming was associated with reduced alcohol use and alcohol-related harm. Planning is underway for a future, large-scale randomized controlled trial to establish the efficacy of this approach, its generalizability across HF programs, and potential mechanisms of action.
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Affiliation(s)
| | - Susan E. Collins
- University of Washington – Harborview Medical Center, Seattle, Washington, USA
| | - Nicole I. Torres
- University of Washington – Harborview Medical Center, Seattle, Washington, USA
| | | | - Jessica L. Mackelprang
- University of Washington-Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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Bertholet N, Schmutz E, Grazioli VS, Faouzi M, McNeely J, Gmel G, Daeppen JB, Cunningham JA. Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial. Trials 2020; 21:191. [PMID: 32066490 PMCID: PMC7027100 DOI: 10.1186/s13063-020-4145-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use. METHODS This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance. DISCUSSION The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet. TRIAL REGISTRATION ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Elodie Schmutz
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jennifer McNeely
- Department of Population Health, Section on Tobacco, Alcohol and Drug Use, New York University (NYU) Grossman School of Medicine, New York, NY, 10016, USA
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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26
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Marmet S, Studer J, Lemoine M, Grazioli VS, Bertholet N, Gmel G. Reconsidering the associations between self-reported alcohol use disorder and mental health problems in the light of co-occurring addictions in young Swiss men. PLoS One 2019; 14:e0222806. [PMID: 31568530 PMCID: PMC6768466 DOI: 10.1371/journal.pone.0222806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems. METHOD Participants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction. RESULTS Overall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR's ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder. CONCLUSIONS AUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders.
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Affiliation(s)
- Simon Marmet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joseph Studer
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mélissa Lemoine
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique S. Grazioli
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bertholet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Canada
- University of the West of England, Frenchay Campus, Bristol, United Kingdom
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Gmel G, Clair C, Rougemont-Bücking A, Grazioli VS, Daeppen JB, Mohler-Kuo M, Studer J. Snus and Snuff Use in Switzerland Among Young Men: Are There Beneficial Effects on Smoking? Nicotine Tob Res 2019; 20:1301-1309. [PMID: 29059425 DOI: 10.1093/ntr/ntx224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/25/2017] [Indexed: 12/26/2022]
Abstract
Introduction There are few recent longitudinal studies on smokeless tobacco (SLT) products and smoking outside the United States or European Nordic countries. The present longitudinal study tests whether Swedish-type snus and nasal snuff use decreases smoking incidence and prevalence in a central European country. Methods The sample consisted of 5198 Swiss men (around 20 years of age). Retention rate was 91.5% over 15 months. Regression models, adjusting for a variety of psychosocial, smoking-related, and other risk factors, assessed whether no, low (less than weekly), and high (weekly or more) use baseline groups showed changes or maintenance in snus and snuff use related to smoking initiation, cessation, and reduction. Results Among baseline nonsmokers, snus initiators (OR = 1.90, p = .003) and low baseline maintainers (OR = 4.51, p < .001) were more likely to start smoking (reference: persistent nonusers of snus). Among baseline smokers, initiators (OR = 2.79, p < .001) and low baseline maintainers (OR = 2.71, p = .005) more often continued smoking, whereas snus quitters less frequently continued smoking (OR = 0.57, p = .009). High baseline maintainers were non-significantly less likely to continue smoking (OR = 0.71, p = .315). Among continuing smokers, only snus quitters significantly reduced the number of cigarettes smoked per day (b = -1.61, p = .002) compared with persistent nonusers of snus. Results were similar for snuff. Conclusions SLT use did not have any significant beneficial effects on young men in Switzerland but significantly increased the likelihood of smoking initiation and continuation, independent of whether the substance is legally sold (snuff) or not (snus). This does not exclude that there may be beneficial effects at older ages. Implications Our research provides evidence that SLT use has no benefits for cigarette smoking initiation, cessation, or reduction among young men in a central European country, where SLT is not highly promoted or receives tax incentives. This is true for both legally sold nasal snuff and Swedish-type snus that cannot be legally sold. Results indicate that without incentives for using it, among young people shifts from smoking to SLT use are questionable and confirms the need for country-specific studies before the global public health community engages in promoting SLT.
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Affiliation(s)
- Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland.,Addiction Switzerland, Research Department, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,University of the West of England, Faculty of Health and Applied Science, Bristol, United Kingdom
| | - Carole Clair
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Véronique S Grazioli
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Meichun Mohler-Kuo
- Institute of Social and Preventive Medicine, and Epidemiology, Biostatistics and Preventive Institute, University of Zurich, Zurich, Switzerland
| | - Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Grazioli VS, Studer J, Larimer ME, Lewis MA, Marmet S, Lemoine M, Daeppen JB, Gmel G. Protective Behavioral Strategies Scale-20: Psychometric properties of a French and German version among young males in Switzerland. Int J Methods Psychiatr Res 2019; 28:e1777. [PMID: 30848002 PMCID: PMC6877153 DOI: 10.1002/mpr.1777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The Protective Behavioral Strategies Scale (PBSS-20) is one of the most commonly used measures of engagement in protective behavioral strategies (PBS). This research aimed to examine the psychometric properties of a French and German version of the PBSS-20 in a large sample of young males in Switzerland. METHOD The sample included 5,017 young males (mean age = 25.44) participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Measures of PBS use, total drinks per week, and alcohol-related consequences were used from a second follow-up assessment. RESULTS Confirmatory factor analysis testing different models previously documented in the literature provided initial support for a four-factor model. Fit statistics indicated that this model adequately reflects the structure of data. Further findings also provided support for adequate internal consistency and for convergent validity of this four-factor model, whereas metric-but not scalar-measurement invariance across linguistic regions was demonstrated. CONCLUSION Although further research testing measurement invariance across linguistic regions and gender is warranted, results of the current study suggest that the French and German PBSS-20 is reliable and that it may represent a promising research and clinical tool that can be used in both French- and German-speaking countries.
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Affiliation(s)
- Véronique S Grazioli
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Simon Marmet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Mélissa Lemoine
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of the West of England, Bristol, UK
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Grazioli VS, Gmel G, Rougemont-Bücking A, Baggio S, Daeppen JB, Studer J. Attention deficit hyperactivity disorder and future alcohol outcomes: Examining the roles of coping and enhancement drinking motives among young men. PLoS One 2019; 14:e0218469. [PMID: 31216319 PMCID: PMC6584013 DOI: 10.1371/journal.pone.0218469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Although there is evidence that Attention Deficit Hyperactivity Disorder (ADHD) symptoms are positively related to alcohol use and related problems among young adults, little research has examined the mechanisms that might explain this association. In response, this study examined the mediating effects of coping and enhancement drinking motives on the prospective associations between ADHD symptoms and alcohol outcomes. Method Participants (N = 4,536) were young men from the Cohort Study on Substance Use Risk Factors. Measures of ADHD symptoms and those of drinking motives, heavy episodic drinking (HED) and alcohol use disorder symptoms were used from the baseline and 15-month follow-up assessments. Results Findings indicated that the associations of ADHD-inattention symptoms with alcohol use disorder (AUD) symptoms and with HED were partially and completely mediated through drinking motives, respectively, whereas drinking motives did not mediate the ADHD-hyperactivity/impulsivity-symptoms-alcohol outcomes associations. Conclusion Results indicated that coping and enhancement motives partially explained the ADHD-inattention symptoms—subsequent alcohol outcomes association. These findings suggest that interventions targeting enhancement and coping motives may help prevent problematic drinking among young men with elevated ADHD-inattention symptoms.
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Affiliation(s)
- Véronique S. Grazioli
- Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland
- * E-mail:
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Canada
- University of the West of England, Bristol, United Kingdom
| | | | - Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
| | | | - Joseph Studer
- Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Vu F, Hugli O, Daeppen JB, Kasztura M, Grazioli VS, Bodenmann P. [Management of emergency department frequent users]. Rev Med Suisse 2019; 15:490-493. [PMID: 30811120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
For decades, emergency departments of hospitals in industrialized countries have been dealing with the challenges of a group of patients responsible for a disproportionate number of emergency room visits : the emergency department frequent users. Although they represent only a minority of all emergency department patients, their healthcare can often be complex if not difficult due to their health vulnerability (e. g., psychiatric disorders associated with substance addictions), often aggravated by a precarious psycho-social context (e. g., homelessness, illegal status, poverty, etc.). Taking care of these patients by using a case management approach can promote the development of an interprofessional and coordinated healthcare plan that includes their empowerment.
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Affiliation(s)
- Francis Vu
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | | | | | - Miriam Kasztura
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | - Véronique S Grazioli
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | - Patrick Bodenmann
- Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
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Grazioli VS, Moullin JC, Kasztura M, Canepa-Allen M, Hugli O, Griffin J, Vu F, Hudon C, Jackson Y, Wolff H, Burnand B, Daeppen JB, Bodenmann P. Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol. BMC Health Serv Res 2019; 19:28. [PMID: 30634955 PMCID: PMC6330435 DOI: 10.1186/s12913-018-3852-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/20/2018] [Indexed: 12/01/2022] Open
Abstract
Background ED overcrowding represents a significant public health problem in developed countries. Frequent users of the emergency departments (FUEDs; reporting 5 or more ED visits in the past year) are often affected by medical, psychological, social, and substance use problems and account for a disproportionately high number of ED visits. Past research indicates that case management (CM) interventions are a promising way to reduce ED overcrowding and improve FUEDs’ quality of life. There is, however, very limited knowledge about how to disseminate and implement this intervention on a large scale to diverse clinical settings, including community hospitals and non-academic centers. This paper describes the protocol of a research project aiming to implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland and evaluate both the implementation process and effectiveness of the CM intervention. Methods This research project uses a hybrid study design assessing both implementation and clinical outcomes. The implementation part of the study uses mixed methods a) to describe quantitatively and qualitatively factors that influence the implementation process, and b) to examine implementation effectiveness. The clinical part of the study uses a within-subject design (pre-post intervention) to evaluate participants’ trajectories on clinical variables (e.g., quality of life, ED use) after receiving the CM intervention. We designed the study based on two implementation science frameworks. The Generic Implementation Framework guided the overall research protocol design, whereas the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework guided the implementation and effectiveness evaluations. Discussion This research project will contribute to implementation science by providing key insights into the processes of implementing CM into broader practice. This research project is also likely to have both clinical and public health implications. Trial registration NCT03641274, Registered 20 August 2018.
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Affiliation(s)
- Véronique S Grazioli
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
| | | | - Miriam Kasztura
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Marina Canepa-Allen
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Judy Griffin
- Department of Medicine, Well Cornell College Of Medicine, New York, USA
| | - Francis Vu
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Catherine Hudon
- Department of Family and Emergency Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Yves Jackson
- Division of primary care medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Grazioli VS, Lewis MA, Fossos-Wong N, Larimer ME. Attitudes toward protective behavioral strategies: Do they predict use of strategies and alcohol outcomes over time? Addict Behav 2018; 87:190-195. [PMID: 30053704 DOI: 10.1016/j.addbeh.2018.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
Whereas past research among young adults has established that the use of protective behavioral strategies (PBS) is negatively related to alcohol outcomes, fewer studies have examined constructs related to PBS use. This study aimed to examine longitudinally the associations of attitudes toward PBS with PBS use and alcohol outcomes, as well as between PBS use and attitudes toward PBS. It also aimed to examine biological sex as a moderator of these associations. Participants (N = 248) were young adults participating in a longitudinal study in the US. Measures of attitudes toward PBS, PBS use, alcohol use and related consequences at 18, 24 and 30-months were included in the analyses. Results indicated that attitudes toward PBS were positively related to subsequent PBS use when prior PBS use was not controlled for; similarly, PBS use was positively related to attitudes toward PBS when prior attitudes were not taken into account. Both associations did not remain significant after controlling for prior PBS use and attitudes. These associations were not significantly moderated by biological sex. There was, however, a significant interaction between attitudes toward PBS and biological sex in predicting alcohol use, such that positive attitudes toward PBS were significantly related to fewer drinks over time among males but not among females, even after controlling for prior PBS use and alcohol use. Finally, after controlling for prior PBS use and consequences, attitudes toward PBS were not significantly related to consequences over time. Implications of these findings for prevention among young adults are discussed.
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Studer J, Bertholet N, Baggio S, Gaume J, Grazioli VS, Rougemont-Bücking A, Daeppen JB, Gmel G. Cigarette and Cannabis Use in Young Swiss Men: Examination of the Bidirectional, Longitudinal Associations Between Frequency of Use and Descriptive Norms. J Stud Alcohol Drugs 2018. [DOI: 10.15288/jsad.2018.79.585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Bertholet
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland
| | - Jacques Gaume
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | | | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Center for Addiction and Mental Health, Toronto, Ontario, Canada
- Alcohol and Health Research Unit, University of the West of England, Bristol, United Kingdom
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Studer J, Bertholet N, Baggio S, Gaume J, Grazioli VS, Rougemont-Bücking A, Daeppen JB, Gmel G. Cigarette and Cannabis Use in Young Swiss Men: Examination of the Bidirectional, Longitudinal Associations Between Frequency of Use and Descriptive Norms. J Stud Alcohol Drugs 2018; 79:585-590. [PMID: 30079874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Although several studies have investigated longitudinal associations between social norms and alcohol use behaviors, less is known about associations between social norms and use of other substances, such as cigarettes and cannabis. The present study aimed to examine the temporal ordering of descriptive norms and cigarette and cannabis use over time. METHOD A sample of 5,158 young Swiss men from the Cohort Study on Substance Use Risk Factors (C-SURF) completed baseline and 15-month follow-up questionnaires assessing frequency of use and descriptive norms of cigarette and cannabis use. Bidirectional, longitudinal associations between descriptive norms and cigarette and cannabis use were examined using cross-lagged panel models. RESULTS Descriptive norms for cigarette use at baseline predicted increased frequency of use at follow-up, whereas the opposite association, from frequency of cigarette use at baseline to descriptive norms at follow-up, was not significant. For cannabis, associations between descriptive norms and frequency of use were reciprocal. Descriptive norms at baseline predicted an increased frequency of cannabis use at follow-up, and frequency of cannabis use at baseline predicted a later increase in descriptive norms. CONCLUSIONS For cigarette use, findings suggest that descriptive norms shape later cigarette use behaviors. For cannabis use, findings suggest that descriptive norms shape cannabis use, but cannabis use also shapes later descriptive norms.
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Affiliation(s)
- Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Bertholet
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
- Division of Prison Health, Geneva University Hospitals & University of Geneva, 1225 Geneva, Switzerland
| | - Jacques Gaume
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Véronique S Grazioli
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Center for Addiction and Mental Health, Toronto, Ontario, Canada
- Alcohol and Health Research Unit, University of the West of England, Bristol, United Kingdom
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Collins SE, Taylor E, Jones C, Haelsig L, Grazioli VS, Mackelprang JL, Holttum J, Koker M, Hatsukami A, Baker M, Clifasefi SL. Content Analysis of Advantages and Disadvantages of Drinking Among Individuals With the Lived Experience of Homelessness and Alcohol Use Disorders. Subst Use Misuse 2018; 53:16-25. [PMID: 28742410 PMCID: PMC6079115 DOI: 10.1080/10826084.2017.1322406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) are more prevalent among people who are homeless than in the general population. Thus, homeless individuals experience disproportionately high levels of alcohol-related problems and associated publicly funded criminal justice and healthcare system utilization. Available treatment services, however, are not effective at engaging and treating this population. To better tailor treatment services to their needs, it is imperative we understand this population's perceptions of their alcohol use. OBJECTIVES The aim of this study was to provide description and relative rankings of the advantages and disadvantages of alcohol use from this population's perspectives. METHODS Participants were 44 individuals with lived experiences of AUDs and homelessness who received services at community-based agencies in Seattle, Washington. Open-ended prompts were used in interviews conducted in 2013-2014 to assess the perceived role of alcohol in participants' lives, including participants' perceptions of the advantages and disadvantages of their current drinking, and a conventional content analysis was conducted. RESULTS The most frequently mentioned advantages of drinking included positively and negatively reinforcing psychological reasons, perceived control over drinking, and social benefits. Physical effects, concerns about dependence on alcohol, and health problems were the most commonly mentioned disadvantages. Conclusions/importance: By documenting the perceived advantages and disadvantages of drinking among people with the lived experience of homelessness and AUDs, this study supplies information providers may use to better tailor treatment services to this multimorbid, high service-utilizing population's needs and interests.
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Affiliation(s)
- Susan E Collins
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Emily Taylor
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Connor Jones
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Laura Haelsig
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Véronique S Grazioli
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Jessica L Mackelprang
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Jessica Holttum
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Molly Koker
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Alyssa Hatsukami
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Madeline Baker
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
| | - Seema L Clifasefi
- a Department of Psychiatry and Behavioral Sciences , University of Washington - Harborview Medical Center , Seattle , Washington , USA
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Rougemont-Bücking A, Grazioli VS, Marmet S, Daeppen JB, Lemoine M, Gmel G, Studer J. Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors. Eur J Psychotraumatol 2018; 9:1468706. [PMID: 29760868 PMCID: PMC5944370 DOI: 10.1080/20008198.2018.1468706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/03/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Non-medical use of prescription drugs (NMUPD) is an increasing phenomenon associated with physical and psychological consequences. This study investigated the effects of distinct forms of stress on NMUPD. Methods: Data from 5308 young adult men from the Swiss cohort study on substance use risk factors (C-SURF) were analysed regarding NMUPD of sleeping pills, tranquilizers, opioid analgesics, psychostimulants, and antidepressants. Various forms of stress (discrete, potentially traumatic events, recent and long-lasting social-environmental stressors) during the period preceding the NMUPD assessment were measured. Backward log-binomial regression was performed and risk ratios (RR) were calculated. Results: NMUPD was significantly associated with the cumulative number of potentially traumatic events (e.g. for opioid analgesics, RR = 1.92, p < .001), with problems within the family (e.g. for sleeping pills, RR = 2.45, p < .001), and the peer group (e.g. for tranquilizer use, RR = 2.34, p < .01). Factors describing family functioning in childhood showed very few significant associations. Sexual assault by acquaintances was associated only with use of sleeping pills (RR = 2.91, p p <.01); physical assault by acquaintances was not associated with NMUPD. Physical (e.g. for psychostimulants, RR = 2.01, p < .001) or sexual assaults (e.g. for antidepressants, RR = 4.64, p < .001) perpetrated outside the family context did show associations with several drug categories. Conclusion: NMUPD appears to be more consistently associated with discrete and potentially traumatic events and with recent social-environmental stressors than with long-lasting stressors due to family functioning during childhood and youth. Physical and sexual assaults perpetrated by strangers showed more associations with NMUPD than those perpetrated by a family member.
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Affiliation(s)
- Ansgar Rougemont-Bücking
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland.,Chair of Psychiatry and Psychotherapy, University of Fribourg, Department of Neurosciences and Movement Science (NMS), Psychiatry and Psychotherapy, Fribourg, Switzerland
| | - Véronique S Grazioli
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Simon Marmet
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Mélissa Lemoine
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland.,Addiction Suisse, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, Canada.,Frenchay Campus, University of the West of England, Bristol, UK
| | - Joseph Studer
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
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Marmet S, Studer J, Grazioli VS, Gmel G. Bidirectional Associations Between Self-Reported Gaming Disorder and Adult Attention Deficit Hyperactivity Disorder: Evidence From a Sample of Young Swiss Men. Front Psychiatry 2018; 9:649. [PMID: 30618855 PMCID: PMC6297670 DOI: 10.3389/fpsyt.2018.00649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/16/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Gaming disorder (GD) has been shown to co-occur with attention deficit hyperactivity disorder (ADHD), yet few studies to date have investigated their longitudinal associations. Method: The sample included 5,067 young Swiss men (mean age was 20 years at wave 1 and 25 years at wave 3). Measures were the Game Addiction Scale and the Adult ADHD Self-Report Scale (6-item screener). Longitudinal associations were tested using autoregressive cross-lagged models for binary measures of GD and ADHD, as well as continuous measures for GD score and ADHD subscales of inattention and hyperactivity. Results: ADHD at age 20 increased the risk for GD at age 25 (probit = 0.066 [0.023, 0.109]; p = 0.003). GD at age 20 also increased the risk for ADHD at wave 3 (probit = 0.058 [0.013, 0.102]; p = 0.011). Only the ADHD inattention subscale showed a bidirectional longitudinal relationship with the GD score (standardized Beta from inattention at age 20 to GD score at age 25: 0.090 [0.056, 0.124]; p < 0.001; from GD score at age 20 to inattention at age 25: 0.044 [0.016, 0.071]; p = 0.002), whereas associations between the hyperactivity subscale and GD were not significant. Discussion: GD had bidirectional longitudinal associations with ADHD, in that ADHD increased the risk for GD and GD increased the risk for ADHD, and they may reinforce each other. These associations may be linked more to the inattention ADHD component than to the hyperactivity ADHD component. Individuals with ADHD or GD should be screened for the other disorder, and preventive measures for GD should be evaluated in individuals with ADHD.
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Affiliation(s)
- Simon Marmet
- Alcohol Treatment Centre, Lausanne University Hospital/CHUV, Lausanne, Switzerland
| | - Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital/CHUV, Lausanne, Switzerland
| | - Véronique S Grazioli
- Alcohol Treatment Centre, Lausanne University Hospital/CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital/CHUV, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Health and Social Sciences, University of the West of England, Frenchay, Bristol, United Kingdom
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Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB. Six-month outcomes among socially marginalized alcohol and drug users attending a drop-in center allowing alcohol consumption. Int J Drug Policy 2017; 41:65-73. [PMID: 28104548 DOI: 10.1016/j.drugpo.2016.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite their experience of substance-related harm, few socially marginalized alcohol and other drug (AOD) users access substance use treatment. Thus, identifying alternative approaches for this population is important. This program evaluation documented substance use and health-related quality of life (QoL) following exposure to such an alternative approach: a harm-reduction drop-in center allowing alcohol consumption onsite. METHODS Participants (N=85) were socially marginalized AOD users (e.g., alcohol, heroin) attending a harm-reduction drop-in center in the French-speaking part of Switzerland. Time and drop-in center attendance were predictors of substance-use outcomes and mental and physical health-related QoL, which were measured at baseline, 1- and 6-month follow-ups. RESULTS Findings indicated that, for each month of the evaluation, participants' alcohol use and related problems decreased by 5% and 7%, respectively. Drop-in center attendance predicted additional decreases in drug-related problem severity and improvements in mental health-related QoL. CONCLUSION Participants' alcohol use and related problems decreased over time. Additionally, participants evinced improved mental health-related QoL and decreased drug-related problem severity with greater drop-in center attendance. Harm-reduction drop-in centers allowing alcohol consumption onsite are promising interventions for socially marginalized AOD users.
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Affiliation(s)
- Véronique S Grazioli
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland; University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Susan E Collins
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Sophie Paroz
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Caroline Graap
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Studer J, Baggio S, Grazioli VS, Mohler-Kuo M, Daeppen JB, Gmel G. Risky substance use and peer pressure in Swiss young men: Test of moderation effects. Drug Alcohol Depend 2016; 168:89-98. [PMID: 27632359 DOI: 10.1016/j.drugalcdep.2016.08.633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Peer pressure (PP) toward misconduct is a well-known risk factor for substance use. However, the way it interacts with social factors and the associations of the aspects of PP other than PP toward misconduct have been understudied. This study examined the associations of three aspects of PP with risky substance use and tested whether the associations of PP toward misconduct were moderated by social factors. METHOD A representative sample of 5,680 young Swiss males completed a questionnaire assessing risky alcohol, cigarette, and cannabis use, PP toward misconduct, toward peer involvement, and toward peer conformity, as well as social support (SS) and neighbourhood cohesion. Multinomial logistic regression models were used. RESULTS PP toward misconduct was positively associated with all substance use outcomes. The PP toward misconduct-risky alcohol use association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement, SS, and neighbourhood cohesion. The PP toward misconduct-risky cannabis use association was stronger in individuals reporting high than in those reporting low levels of SS and neighbourhood cohesion. The PP toward misconduct-smoking association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement. CONCLUSIONS The risk for substance use associated with PP toward misconduct varies as a function of social factors. Being well connected with others (high level of PP toward peer involvement and SS), and living in a cohesive neighbourhood may amplify the risk for risky substance use associated with PP toward misconduct.
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Affiliation(s)
- Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland.
| | - Stéphanie Baggio
- Life course and social inequality research centre, University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Meichun Mohler-Kuo
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland; Addiction Switzerland, Lausanne, Switzerland; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of the West of England, Bristol, United Kingdom
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Clifasefi SL, Collins SE, Torres NI, Grazioli VS, Mackelprang JL. Housing First, but What Comes Second? A Qualitative Study of Resident, Staff and Management Perspectives on Single-Site Housing First Program Enhancement. J Community Psychol 2016; 44:845-855. [PMID: 28579653 PMCID: PMC5451125 DOI: 10.1002/jcop.21812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Single-site Housing First (HF) is associated with reduced publicly funded service utilization and costs and alcohol-related harm for chronically homeless individuals with severe alcohol problems. Many residents, however, continue to experience alcohol-related problems after their move into single-site HF. Thus, it is necessary to explore areas for program enhancement after individuals move into single-site HF. To this end, we collected qualitative data via 30 hours of naturalistic observation, staff focus groups (n = 3), and one-on-one interviews with single-site HF residents (n = 44), program staff (n = 7), and agency management (n = 4). Qualitative analyses were used to construct a conceptual or thematic description of residents', staff's, and management's suggestions for program enhancement, which comprised 3 areas: (a) enhancing training and support for staff, (b) increasing residents' access to meaningful activities, and (c) exploring alternate pathways to recovery. Development of programming addressing these areas may help residents continue to reduce alcohol-related harm and improve health and quality of life after their move into single-site HF.
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Watson R, Morris J, Isitt J, Barrio P, Ortega L, Gual A, Conner K, Stecker T, Maisto S, Paroz S, Graap C, Grazioli VS, Daeppen JB, Collins SE, Bertholet N, McNeely J, Kushnir V, Cunningham JA, Crombie IK, Cunningham KB, Irvine L, Williams B, Sniehotta FF, Norrie J, Melson A, Jones C, Briggs A, Rice P, Achison M, McKenzie A, Dimova E, Slane PW, Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB, Baggio S, Dupuis M, Studer J, Gmel G, Magill M, Grazioli VS, Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK, Renko E, Mitchell SG, Lounsbury D, Li Z, Schwartz RP, Gryczynski J, Kirk AS, Oros M, Hosler C, Dusek K, Brown BS, Finnell DS, Holloway A, Wu LT, Subramaniam G, Sharma G, Wallhed Finn S, Andreasson S, Dvorak RD, Kramer MP, Stevenson BL, Sargent EM, Kilwein TM, Harris SK, Sherritt L, Copelas S, Knight JR, Mdege ND, McCambridge J, Bischof G, Bischof A, Freyer-Adam J, Rumpf HJ, Fitzgerald N, Schölin L, Toner P, Böhnke JR, Veach LJ, Currin O, Dongre LZ, Miller PR, White E, Williams EC, Lapham GT, Bobb JJ, Rubinsky AD, Catz SL, Shortreed S, Bensley KM, Bradley KA, Milward J, Deluca P, Khadjesari Z, Watson R, Fincham-Campbell S, Drummond C, Angus K, Bauld L, Baumann S, Haberecht K, Schnuerer I, Meyer C, Rumpf HJ, John U, Gaertner B, Barrault-Couchouron M, Béracochéa M, Allafort V, Barthélémy V, Bonnefoi H, Bussières E, Garguil V, Auriacombe M, Saint-Jacques M, Dorval M, M’Bailara K, Segura-Garcia L, Ibañez-Martinez N, Mendive-Arbeloa JM, Anoro-Perminger M, Diaz-Gallego P, Piñar-Mateos MA, Colom-Farran J, Deligianni M, Yersin B, Adam A, Weisner C, Chi F, Lu W, Sterling S, Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Korthuis PT, Edelman EJ, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O’Connor PG, Maisto SA, Bedimo R, Gilbert C, Marconi VC, Rimland D, Rodriguez-Barradas M, Simberkoff M, Justice AC, Bryant KJ, Berman AH, Shorter GW, Bray JW, Barbosa C, Johansson M, Hester R, Campbell W, Souza Formigoni MLO, Andrade ALM, Sartes LMA, Sundström C, Eék N, Kraepelien M, Kaldo V, Fahlke C, Hernandez L, Becker SJ, Jones RN, Graves HR, Spirito A, Diestelkamp S, Wartberg L, Arnaud N, Thomasius R, Gaume J, Grazioli V, Fortini C, Malan Z, Mash B, Everett-Murphy K, Grazioli VS, Studer J, Mohler-Kuo M, Bertholet N, Gmel G, Doi L, Cheyne H, Jepson R, Luna V, Echeverria L, Morales S, Barroso T, Abreu Â, Aguiar C, Stewart D, Abreu A, Brites RM, Jomar R, Marinho G, Parreira P, Seale JP, Johnson JA, Henry D, Chalmers S, Payne F, Tuck L, Morris A, Gonçalves C, Besser B, Casajuana C, López-Pelayo H, Balcells MM, Teixidó L, Miquel L, Colom J, Hepner KA, Hoggatt KJ, Bogart A, Paddock SM, Hardoon SL, Petersen I, Hamilton FL, Nazareth I, White IR, Marston L, Wallace P, Godfrey C, Murray E, Sovinová H, Csémy L. Proceedings of the 13th annual conference of INEBRIA. Addict Sci Clin Pract 2016; 11:13. [PMID: 27654147 PMCID: PMC5032602 DOI: 10.1186/s13722-016-0062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Grazioli VS, Lewis MA, Garberson LA, Fossos-Wong N, Lee CM, Larimer ME. Alcohol expectancies and alcohol outcomes: effects of the use of protective behavioral strategies. J Stud Alcohol Drugs 2016; 76:452-8. [PMID: 25978832 DOI: 10.15288/jsad.2015.76.452] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol expectancies (AEs) are positively associated with drinking behaviors, whereas the use of protective behavioural strategies (PBS) is negatively related to alcohol outcomes among young adults. PBS have been shown to weaken relationships between some alcohol risk factors and alcohol outcomes. This study aimed to examine longitudinally the moderating effect of PBS on the relationships between AEs and alcohol outcomes among young adults. METHOD Participants (N = 188; 61.7% female) were U.S. young adults participating in a larger longitudinal study. Measures of PBS, AEs, alcohol use, and related consequences were used from the baseline and 12-month follow-up assessments. RESULTS Negative binomial hurdle models found that PBS (total score) significantly moderated the relationship between positive AEs and consequences, such that among high school seniors endorsing higher positive AEs, those using more PBS in high school reported fewer negative consequences 1 year later. PBS (Manner of Drinking) also moderated the relationship between negative AEs and alcohol use, revealing the use of PBS in high school as having a protective function against later drinking among participants with high positive AEs. Last, PBS (Serious Harm Reduction) significantly moderated the associations between positive AEs and alcohol use and between negative AEs and consequences, such that participants with higher AEs and higher PBS use in high school were at greatest risk for drinking and experiencing negative consequences later. CONCLUSIONS Overall, these findings suggest that PBS use may be protective by weakening relationships between positive AEs and alcohol outcomes. Limitations and future directions are discussed.
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Affiliation(s)
- Véronique S Grazioli
- Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland.,Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Melissa A Lewis
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Lisa A Garberson
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Nicole Fossos-Wong
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Christine M Lee
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Mary E Larimer
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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Collins SE, Jones CB, Hoffmann G, Nelson LA, Hawes SM, Grazioli VS, Mackelprang JL, Holttum J, Kaese G, Lenert J, Herndon P, Clifasefi SL. In their own words: Content analysis of pathways to recovery among individuals with the lived experience of homelessness and alcohol use disorders. Int J Drug Policy 2016; 27:89-96. [PMID: 26364078 PMCID: PMC4715940 DOI: 10.1016/j.drugpo.2015.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/19/2015] [Accepted: 08/04/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) are more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by alcohol-related morbidity and mortality. Unfortunately, abstinence-based approaches are neither desirable to nor highly effective for most members of this population. Recent research has indicated that homeless people aspire to clinically significant recovery goals beyond alcohol abstinence, including alcohol harm reduction and quality-of-life improvement. However, no research has documented this population's preferred pathways toward self-defined recovery. Considering principles of patient-centred care, a richer understanding of this population's desired pathways to recovery may help providers better engage and support them. METHODS Participants (N=50) had lived experience of homelessness and AUDs and participated in semi-structured interviews regarding histories of homelessness, alcohol use, and abstinence-based treatment as well as suggestions for improving alcohol treatment. Conventional content analysis was used to ascertain participants' perceptions of abstinence-based treatment and mutual-help modalities, while it additionally revealed alternative pathways to recovery. RESULTS Most participants reported involvement in abstinence-based modalities for reasons other than the goal of achieving long-term abstinence from alcohol (e.g., having shelter in winter months, "taking a break" from alcohol use, being among "like-minded people"). In contrast, most participants preferred alternative pathways to recovery, including fulfilling basic needs (e.g., obtaining housing), using harm reduction approaches (e.g., switching from higher to lower alcohol content beverages), engaging in meaningful activities (e.g., art, outings, spiritual/cultural activities), and making positive social connections. CONCLUSIONS Most people with the lived experience of homelessness and AUDs we interviewed were uninterested in abstinence-based modalities as a means of attaining long-term alcohol abstinence. These individuals do, however, have creative ideas about alternative pathways to recovery that treatment providers may support to reduce alcohol-related harm and enhance quality of life.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Connor B Jones
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Gail Hoffmann
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Lonnie A Nelson
- Department of Health Services, University of Washington School of Public Health, 1100 Olive Way, Suite 1200, Seattle, WA 98101, USA.
| | - Starlyn M Hawes
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Véronique S Grazioli
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Jessica L Mackelprang
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Jessica Holttum
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Greta Kaese
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - James Lenert
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Patrick Herndon
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
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Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB. Harm-reduction goals and safer-drinking strategies among individuals attending a new drop-in center. Addict Sci Clin Pract 2015. [PMCID: PMC4597417 DOI: 10.1186/1940-0640-10-s2-o19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Collins SE, Grazioli VS, Torres NI, Taylor EM, Jones CB, Hoffman GE, Haelsig L, Zhu MD, Hatsukami AS, Koker MJ, Herndon P, Greenleaf SM, Dean PE. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addict Behav 2015; 45:184-90. [PMID: 25697724 DOI: 10.1016/j.addbeh.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 01/26/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Most treatment programs for alcohol dependence have prioritized alcohol abstinence as the primary treatment goal. However, abstinence-based goals are not always considered desirable or attainable by more severely affected populations, such as chronically homeless people with alcohol dependence. Because these individuals comprise a multimorbid and high-utilizing population, they are in need of more focused research attention that elucidates their preferred treatment goals. The aim of this secondary study was therefore to qualitatively and quantitatively document participant-generated treatment goals METHODS Participants were currently or formerly chronically homeless individuals (N=31) with alcohol dependence who participated in a pilot of extended-release naltrexone and harm-reduction counseling. Throughout the treatment period, study interventionists elicited participants' goals and recorded them on an open-ended grid. In subsequent weeks, progress towards and achievement of goals was obtained via self-report and recorded by study interventionists. Conventional content analysis was performed to classify participant-generated treatment goals RESULTS Representation of the three top categories remained stable over the course of treatment. In the order of their frequency, they included drinking-related goals, quality-of-life goals and health-related goals. Within the category of drinking-related goals, participants consistently endorsed reducing drinking and alcohol-related consequences ahead of abstinence-based goals. Quantitative analyses indicated participants generated an increasing number of goals over the course of treatment. Proportions of goals achieved and progressed towards kept pace with this increase CONCLUSIONS Findings confirmed hypotheses that chronically homeless people with alcohol dependence can independently generate and achieve treatment goals towards alcohol harm reduction and quality-of-life improvement.
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Grazioli VS, Dillworth T, Witkiewitz K, Andersson C, Kilmer JR, Pace T, Fossos-Wong N, Carroll H, Berglund M, Daeppen JB, Larimer ME. Protective behavioral strategies and future drinking behaviors: Effect of drinking intentions. Psychology of Addictive Behaviors 2015; 29:355-64. [DOI: 10.1037/adb0000041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Grazioli VS, Hicks J, Kaese G, Lenert J, Collins SE. Safer-drinking strategies used by chronically homeless individuals with alcohol dependence. J Subst Abuse Treat 2015; 54:63-8. [PMID: 25690515 DOI: 10.1016/j.jsat.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/16/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
Chronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N=31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80-90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population.
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Affiliation(s)
- Véronique S Grazioli
- Lausanne University Hospital, Alcohol Treatment Center, Av. de Beaumont 21 bis, 1011 Lausanne, Switzerland; University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Jennifer Hicks
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Greta Kaese
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - James Lenert
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Susan E Collins
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
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Grazioli VS, Collins SE, Daeppen JB, Larimer ME. Perceptions of twelve-step mutual-help groups and their associations with motivation, treatment attendance and alcohol outcomes among chronically homeless individuals with alcohol problems. Int J Drug Policy 2014; 26:468-74. [PMID: 25477286 DOI: 10.1016/j.drugpo.2014.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/22/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Twelve-step mutual-help groups (TMGs) are among the most available forms of support for homeless individuals with alcohol problems. Qualitative research, however, has suggested that this population often has negative perceptions of these groups, which has been shown to be associated with low TMG attendance. It is important to understand this population's perceptions of TMGs and their association with alcohol outcomes to provide more appropriate and better tailored programming for this multiply affected population. The aims of this cross-sectional study were to (a) qualitatively examine perception of TMGs in this population and (b) quantitatively evaluate its association with motivation, treatment attendance and alcohol outcomes. METHODS Participants (N=62) were chronically homeless individuals with alcohol problems who received single-site Housing First within a larger evaluation study. Perceptions of TMGs were captured using an open-ended item. Quantitative outcome variables were created from assessments of motivation, treatment attendance and alcohol outcomes. RESULTS Findings indicated that perceptions of TMGs were primarily negative followed by positive and neutral perceptions, respectively. There were significant, positive associations between perceptions of TMGs and motivation and treatment attendance, whereas no association was found for alcohol outcomes. CONCLUSIONS Although some individuals view TMGs positively, alternative forms of help are needed to engage the majority of chronically homeless individuals with alcohol problems.
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Affiliation(s)
- Véronique S Grazioli
- Department of Community Medicine and Health, Lausanne University Hospital, Switzerland; University of Washington, Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors (CSHRB), 1100 NE 45th, Suite 300, Box 354944, Seattle, WA 98105, United States
| | - Susan E Collins
- University of Washington-Harborview Medical Center, 325 Ninth Avenue, Box 359911, Seattle, WA 98195, United States.
| | - Jean-Bernard Daeppen
- Department of Community Medicine and Health, Lausanne University Hospital, Switzerland
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors (CSHRB), 1100 NE 45th, Suite 300, Box 354944, Seattle, WA 98105, United States
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