David Ryder

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

BackgroundIn developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh.MethodsA total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at womens home.ResultsOverall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = < 0.001). Depression status were significantly associated with women reporting negative life changes such as worse relationships with their husband (adjusted OR = 3.89, 95% CI: 1.37-11.04) and feeling guilty (adjusted OR = 2.61, 95% CI: 1.22-5.63) following the results of their last pregnancy outcome after 6 months of childbirth.ConclusionsThis study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

Effectiveness of Interventions for Grandparent Caregivers: A Systematic Review

ABSTRACT Grandparent caregivers face a myriad of challenges that require intervention at various levels. Programs are now available to enhance the lives of grandparent caregivers, and there is evidence, although largely from methodologically inadequate studies, that such interventions are beneficial. This review critically appraised the research on the effectiveness of different interventions for these grandparents. A total of 21 studies were included in the review. Studies were assessed according to research design, methodological quality, and intervention outcomes. Best available evidence suggests that interventions within the cognitive-behavioral spectrum have the most empirical support. Promising approaches that require further research include interdisciplinary case management, support groups, and psychoeducational interventions. To establish an evidence base for interventions designed to promote the well-being of grandparents and alleviate the stress associated with raising grandchildren, there is a need for high quality intervention studies. Future trials need to be rigorous in design and include high quality descriptions of all aspects of methodology to enable appraisal and interpretation of results.

Political and legal institutions and their influence on drug policy: an Australian perspective

ISSUES Under a federal system of government, political power is separated and distributed between different institutions of government. The distribution of power to enact policies that influence alcohol and other drug use can impact on the associated harm. APPROACH A description of the separation of powers under a federal system of government is followed by three case studies of alcohol and other drug policies which have been influenced by the use of power by different institutions of government. KEY FINDINGS Whether or not a policy is enacted depends upon who has the power to bring such a policy into being, who has the power to prevent its enactment and whether those with such power choose to use them. CONCLUSION The enactment of policy is a political act, needing to be understood by those wishing to see evidence-based policies brought into being. An understanding of the separation of powers under a federal system of government is one aspect of the political process that those who work in the alcohol and other drug field need to understand.

The western Australian court diversion service: Client profile and predictors of program completion, sentencing and re‐offending

The Western Australian Court Diversion Service (CDS) is a post‐conviction / pre‐sentence program that aims to divert substance‐using offenders from the prison system and into treatment programs. It has been in operation since 1988, though a formal evaluation has not been conducted. The present study evaluated the outcomes for offenders referred to the program in relation to program completion, sentencing and re‐offending. It utilised a quasi‐experimental within groups design using data from client files from January 1998 to June 1999. Offenders who had higher motivation, attended treatment regularly and had less than 20 prior convictions were more likely to complete the program. A custodial sentence was more likely if the offender was male, had committed a serious offence, had more than 30 prior convictions, had lower motivation and had not completed the CDS program. Predictors of re‐offending included lower motivation and a previous custodial sentence. The offenders level of motivation to change and number of prior convictions were significant predictors of all three outcomes: program completion, sentencing and re‐offending. The findings highlight the importance of considering offender characteristics when assessing eligibility for diversion programs, addressing offender motivation within diversion programs and considering issues of which offenders are most likely to benefit from which programs.

Observations of the role of science in the United States medical cannabis state policies: Lessons learnt

BACKGROUND Clinical trials have shown cannabis to be effective in the treatment of some medical conditions and there is mounting public and political pressure to enact laws enabling the use of cannabis for medicinal purposes. To date, 28 United States (U.S.) states and the District of Columbia have enacted medical cannabis laws. This study sought to identify the main issues pertaining to the development of medical cannabis laws in the U.S, including the role of scientific evidence. METHODS Data were collected from three groups of participants: government officials, lobbyists and medical professionals involved in the medical cannabis debate in five selected states in the U.S.; researchers from the same five states conducting funded research in the alcohol and other drugs field; and members of the International Society for the Study of Drug Policy. The data were analysed using thematic analysis. RESULTS Six major themes emerged in relation to the factors influencing policy: scientific evidence plays a limited role in the development of policy; the available research is limited and mixed; there is a need for clearer communication and active dissemination of evidence to policy makers; researchers need to consider what research is likely to impact on policy; scientific evidence is not a major factor in policy development; and there is a need to consider evidence within a political context. CONCLUSION Researchers need to be aware of the political context in which medical cannabis laws are or are not enacted and consider ways in which research findings can achieve a higher profile within this context.

Secondary Prevention of Alcohol Related Problems

It is argued that the secondary prevention of alcohol related problems cannot be undertaken within the methods currently employed to deal with a chronic drinking population. It is argued that fresh initiatives are required, involving seeking out the target population in venues other than treatment units. The interventions can be less intensive than those generally adopted and will preferably be conducted by non-specialists. The treatment goal will in all likelihood be for a moderating of consumption and a non-confrontational style of counselling is required. A broader model of what constitutes an alcohol related problem is discussed, as are the implications of such initiatives for the specialist alcohol worker.

Alcohol, casemix and hospitals: an opportunity?

The number of patients in hospitals who experience alcohol-related problems is high, and the provision of intervention for these patients is a significant public health measure. The current move towards casemix funding of acute hospital services provides an opportunity for the development of such programmes. Modifications to the Diagnosis Related Groups categorization of alcohol-related problems that would allow for appropriate funding are discussed.

Current understanding and future direction of the Trans-Theoretical model: The role of adolescent cognitive egocentrism

Abstract Despite being the cornerstone of behaviour change interventions, a review of the Transtheoretical Model (TTM) highlights that younger populations have been excluded in the development of this model. It is not surprising then that interventions underpinned by the TTM have not been shown to be effective when applied to younger populations. Cognitive development was proposed to account for this age discrepancy. One such construct, adolescent egocentrism comprising of the imaginary audience and the personal fable was explored in relation to both unhealthy behaviour participation and behavioural change. It appeared plausible that the cognitive distortions associated with this construct could affect individuals’ utilisation of those cognitive processes of change proposed by the TTM as being necessary for successful behaviour change. This may provide a fertile avenue for future behaviour change research, extending the interventional scope of the TTM.

Surviving as a Controlled Drinking Therapist

In essence, conducting a controlled drinking programme is no different from conducting an abstinence programme, in that the therapeutic skills and structure of the treatment are the same. Only the drinking goal itself is different. The controversy regarding controlled drinking, however, has led to a greater degree of pressure being applied to those therapists who conduct controlled drinking programmes, particularly by colleagues. The factors required for the therapist to cope with this are detailed.It is also argued that, as controlled drinking appears to be most efficacious with drinkers other than those who attend traditional alcohol problem clinics, therapists need to seek out such clientele in other venues.

What is controlled drinking

Different terms have been utilized to define the drinking dispositions of problem drinkers which are neither total abstinence nor overtly harmful. The main terms that have been used are “normal drinking”, “controlled drinking”, “non-problem drinking” and “attenuated drinking”. Each concept is considered and criticized and it is concluded that clinicians and researchers need to be very aware of the overlap that exists between the different definitions. It is concluded that the greatest value that has been achieved from the advent of controlled drinking treatment and the ensuing debate is not that another treatment option has been developed, but that the perception of alcohol related problems has been changed to encompass the drinking of the population as a whole.