Injection Drug User Quality of Life Scale (IDUQOL): findings from a content validation study

Psychological distress and quality of life among Opioid Agonist Treatment service users with a history of injecting and non-injecting drug use: A cross-sectional study in Kathmandu, Nepal

BACKGROUND

Opioid use disorder is a serious public health problem in Nepal. People who use opioids often experience psychological distress and poor quality of life. Opioid agonist Treatment (OAT) is central in managing opioid dependence. This study aimed to examine factors associated with quality of life and serious psychological distress among OAT service users in the Kathmandu Valley, Nepal and compare those who had injected opioids prior to OAT and those who had not.

METHODS

A cross-sectional study with 231 was conducted using a semi-structured questionnaire, the Nepalese versions of the Kessler 6 psychological distress scale and World Health Organization Quality of Life scale (WHOQOL-BREF). Bivariate and multivariate analyses were undertaken to examine factors associated with quality of life and serious psychological distress.

RESULTS

Most participants were males (92%) and about half had injected opioids before initiating OAT. Serious psychological distress in the past four weeks was significantly more prevalent among participants with a history of injecting (32.2%) than those who did not inject (15.9%). In the adjusted linear regression model, those who had history of injecting were likely to have lower physical quality of life compared to non-injectors. Those self-reporting a past history of mental illness were more than seven times and those with medical comorbidity twice more likely to have serious psychological distress over last four weeks. Lower socioeconomic status and a history of self-reported mental illness in the past were found to be significantly associated with lower quality of life on all four domains.

CONCLUSION

Those who had history of injecting were younger, had frequent quit attempts, higher medical comorbidity, lower socioeconomic status and remained longer in OAT services. Alongside OAT, the complex and entangled needs of service users, especially those with a history of injecting drugs, need to be addressed to improve quality of life and lessen psychological distress.

The role of unsustainable HR practices as illegitimate tasks in escalating the sense of workplace ostracism

Unsustainable HR practices impose illegitimate tasks on employees due to a shortage of resources. These illegitimate tasks bring counterproductive work behavior in terms of workplace incivility that creates a sense of ostracism in employees. To address these issues, the study examined the relationship among unsustainable HR practices in terms of illegitimate tasks and workplace ostracism. Whereas workplace incivility is defined as an underlying reason through which this association exists. Adopting a theoretical framework from earlier research, the study used cross-sectional data and subsequently a method of quantitative research, and the sample comprised permanent faculty members of private universities in Pakistan working in different departments with different role titles. Smart PLS was applied to run multiple statistics analyzed on the obtained data. The results from the study supported the hypothesis by depicting a positive and significant association between illegitimate tasks and workplace ostracism. Further, workplace incivility was playing the mediating role between illegitimate tasks and workplace ostracism. The results from the study carry significant implications for managers and researchers. Recommendations and future research directions are also discussed in the paper.

Quality of life during a randomized trial of a therapeutic-workplace intervention for opioid use disorder: Web-based mobile assessments reveal effects of drug abstinence and access to paid work

Background

Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder.

Methods

For 12 weeks, participants (n = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones. At enrollment, participants were randomized to work in the Therapeutic Workplace immediately (immediate work group, IWG) or after a 3-week waitlist delay (delayed work group, DWG). Once both groups could work, wage-resetting contingencies were introduced for their opiate- and cocaine-urinalysis. Data were analyzed by (1) access to work with and without contingencies and (2) overall urinalysis-verified opiate- and cocaine-abstinence.

Results

DWG and/or IWG reported improvements in several QOL areas (sleep, transportation, recreation); however, they also reported increased money-related difficulties and less time spent with friends/family. These changes did not coincide with DWG's work access, but some (more sleep, money-related difficulties) coincided with the urinalysis contingencies. Greater opiate- and/or cocaine-abstinence was also associated with several improvements: sleep, paying bills, time spent with friends/family, and exercising. Surprisingly, intermediate cocaine abstinence was associated with reductions in work-capacity satisfaction and recreation.

Conclusions

Participants reported complex QOL differences during their experimental employment and associated with drug abstinence. Future work should help participants address issues that may be relevant to employment generally (e.g., time with friends/family) or contingency management specifically (e.g., money-related issues for non-abstinent participants).

Validation and psychometric properties of the drug users' quality of life scale in Iranian population

INTRODUCTION

Drug dependence and the resultant problems notably decrease the quality of life (QOL). Measuring the QOL in persons who use drugs (PWUD_s) and planning to improve it can be helpful for rehabilitation programs. Given the absence of a standard tool to measure the quality of life of PWUD, the present study is an attempt to validate psychometric and cultural characteristics of non-injection drug users' QOL scale.

METHOD

The study was carried out as a validation and methodological work. The study population consisted of 273 PWUDs in Kermanshah-based drug clinics including outgoing and hospitalized patients. The participants were selected through convenient-quota sampling. After securing the required permission from the copyright owner of the tool, it was forward/backward translated. Face validity and content validity were determined quantitatively and qualitatively. To examine construct validity of the tool, explorative factor analysis and confirmatory factor analysis were used. Internal consistency was measured using Cronbach's alpha and statistical analyses were performed using SPSS (v.25) and LISREL (v.8).

RESULTS

Explorative factor analysis (EFA) and confirmatory factor analysis (CFA) results supported the tool with one factor and 22 items. The R2 index in the model was equal to 0.99, which means that 99% of the variation of dependent variable (total score of QOL) is attributed to independent variable (22 statements). In other words, 99% of the variation of dependent variable is due to the independent variables in the model. The main indices of the model based on CFA all were higher than 0.9, which indicates goodness of fit of the model (χ2/DF = 2.18, CFI, NFI, TLI = 0.93 GF = 0.84, REMSEA = 0.066, R2 = 0.99). The correlative coefficient was significant (p < 0.05). The reliability of the tool based on internal consistency (Cronbach's alpha) for the subscales ranged from 0.84 to 0.85 and equal to 0.84 for the whole tool.

CONCLUSION

The Farsi version of non-injection drug users' QOL scale had acceptable indices and it was applicable to assess QOL in the target population. The tool can be used in different fields of drug addiction.

Developing the Co-Worker Acceptance of Disabled Employees (CADE) Scale

There are a number of scales intended to measure workplace attitudes toward people with disabilities. However, there is limited demonstration of validity evidence, especially theoretical validity. This article reports on the development of the Co-Worker Acceptance of Disabled Employees (CADE) Scale, including an examination of theoretical and empirical validity evidences. Theoretical validity is supported by screening each scale item through the difference model of disability. Empirical validity evidence is generated through a content validity study and an initial validity study. Exploratory factor analysis reveals that workplace attitudes toward employees with disabilities are based on perceived differences between those with disabilities and others. The CADE Scale will support workplace training and provide evidence of attitude change subsequent to workplace disability-related interventions.

Performance of the WHOQOL-BREF among Norwegian substance use disorder patients

BACKGROUND

Quality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables.

METHODS

107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL.

RESULTS

Three out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL.

CONCLUSIONS

After one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.

Patient experiences with interdisciplinary treatment for substance dependence: an assessment of quality indicators based on two national surveys in Norway

Purpose: The quality of health care is often measured using quality indicators, which can be utilized to compare the performance of health-care providers. Conducting comparisons in a meaningful and fair way requires the quality indicators to be adjusted for patient characteristics and other individual-level factors. The aims of the study were to develop and test a case-mix adjustment model for quality indicators based on patient-experience surveys among inpatients receiving interdisciplinary treatment for substance dependence, and to establish whether the quality indicators discriminate between health care providers. Patients and methods: Data were collected through two national surveys involving inpatients receiving residential treatment in Norway in 2013 and 2014. The same questionnaire was used in both surveys, and comprised three patient-experience scales. The scales are reported as national quality indicators, and associations between the scales and patient characteristics were tested through multilevel modeling to establish a case-mix model. The intraclass correlation coefficient was computed to assess the amount of variation at the hospital-trust level. Results: The intraclass correlation coefficient for the patient-reported experience scales varied from 2.3% for "treatment and personnel" to 8.1% for "milieu". Multivariate multilevel regression analyses showed that alcohol reported as the most frequently used substance, gender and age were significantly associated with two of the three scales. The length of stay at the institution, pressure to be admitted for treatment, and self-perceived health were significantly related to all three scales. Explained variance at the individual level was approximately 7% for all three scales. Conclusion: This study identified several important case-mix variables for the patient-based quality indicators and systematic variations at the hospital-trust level. Future research should assess the association between patient-based quality indicators and other quality indicators, and the predictive validity of patient-experience indicators based on on-site measurements.

Perceived need for depression treatment among persons entering inpatient opioid detoxification

BACKGROUND AND OBJECTIVES

Depression is common among persons with opioid use disorder. We examined the perceived need for depression treatment (PNDT) among opioid-dependent patients and the relationship of PNDT to depression screening result.

METHODS

Between May and December 2015, we surveyed consecutive persons (n = 440) seeking inpatient opioid detoxification. We used the Patient Health Questionnaire-2 (PHQ-2) to screen for depression. To assess perceived need for depression services, participants were asked, "Do you believe you should be treated for depression?" Response options were recorded into four categories: "Not Depressed (ND)," "Perceive Need for Depression Treatment (PNDT)," "Depressed/Don't Want Treatment," and "Currently Treated."

RESULTS

Participants' mean age was 32.3 (±8.7) years; 70.7% were male. Nearly two out of three persons screened positive for depression yet only 8.2% were being treated for depression prior to admission. Screening positive for depression was associated with a 2.95 (95%CI 1.82-4.81, p < .005) fold increase in the expected odds of PNDT. But nearly half of those depressed (48%) did not perceive the need for treatment. Approximately 40% of the participants (n = 177) perceived that they were not depressed; of these persons, 52% screened positive for depression.

DISCUSSION AND CONCLUSIONS

Detoxification program staff should screen patients for depression, and if a clinical diagnosis is confirmed, discuss treatment options, exploring the level of interest in mental health treatment for depression.

SCIENTIFIC SIGNIFICANCE

Screening for and addressing depression, including patients' interest in treatment, should be central to post-detoxification aftercare planning. (Am J Addict 2017;26:395-399).

Patient experiences questionnaire for interdisciplinary treatment for substance dependence (PEQ-ITSD): reliability and validity following a national survey in Norway

BACKGROUND

Patient experiences are an important aspect of health care quality, but there is a lack of validated instruments for their measurement in the substance dependence literature. A new questionnaire to measure inpatients' experiences of interdisciplinary treatment for substance dependence has been developed in Norway. The aim of this study was to psychometrically test the new questionnaire, using data from a national survey in 2013.

METHODS

The questionnaire was developed based on a literature review, qualitative interviews with patients, expert group discussions and pretesting. Data were collected in a national survey covering all residential facilities with inpatients in treatment for substance dependence in 2013. Data quality and psychometric properties were assessed, including ceiling effects, item missing, exploratory factor analysis, and tests of internal consistency reliability, test-retest reliability and construct validity.

RESULTS

The sample included 978 inpatients present at 98 residential institutions. After correcting for excluded patients (n = 175), the response rate was 91.4%. 28 out of 33 items had less than 20.5% of missing data or replies in the "not applicable" category. All but one item met the ceiling effect criterion of less than 50.0% of the responses in the most favorable category. Exploratory factor analysis resulted in three scales: "treatment and personnel", "milieu" and "outcome". All scales showed satisfactory internal consistency reliability (Cronbach's alpha ranged from 0.75-0.91) and test-retest reliability (ICC ranged from 0.82-0.85). 17 of 18 significant associations between single variables and the scales supported construct validity of the PEQ-ITSD.

CONCLUSION

The content validity of the PEQ-ITSD was secured by a literature review, consultations with an expert group and qualitative interviews with patients. The PEQ-ITSD was used in a national survey in Norway in 2013 and psychometric testing showed that the instrument had satisfactory internal consistency reliability and construct validity.

Comprehension of Written Grammar Test: Reliability and Known-Groups Validity Study With Hearing and Deaf and Hard-of-Hearing Students

The aim of the current study was to gather validation evidence for the Comprehension of Written Grammar (CWG; Easterbrooks, 2010) receptive test of 26 grammatical structures of English print for use with children who are deaf and hard of hearing (DHH). Reliability and validity data were collected for 98 participants (49 DHH and 49 hearing) in Grades 2-6. The objectives were to: (a) examine 4-week test-retest reliability data; and (b) provide evidence of known-groups validity by examining expected differences between the groups on the CWG vocabulary pretest and main test, as well as selected structures. Results indicated excellent test-retest reliability estimates for CWG test scores. DHH participants performed statistically significantly lower on the CWG vocabulary pretest and main test than the hearing participants. Significantly lower performance by DHH participants on most expected grammatical structures (e.g., basic sentence patterns, auxiliary "be" singular/plural forms, tense, comparatives, and complementation) also provided known groups evidence. Overall, the findings of this study showed strong evidence of the reliability of scores and known group-based validity of inferences made from the CWG.

The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons

BACKGROUND

The aim of this cross-sectional study was to evaluate the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of alcohol and drug addicted persons, receiving care at outpatient treatment facilities in Brazil.

METHODS

A random sample of 262 participants, mean age 37 years, from Psychosocial Care Centers for Alcohol and Drugs (CAPS AD) located in three cities in the state of São Paulo, Brazil, were clinically examined for caries experience (DMFT index) by a calibrated examiner. They were asked to complete a series of questionnaires, including the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), socioeconomic characteristics, and the World Health Organization Quality of Life assessment (WHOQOL), which were considered the outcome variables of the study. Associations between oral health status, socioeconomic characteristics, substance involvement with WHOQOL were investigated by means of the chi-square test and multiple logistic regression analysis with a level of significance α < 0.05.

RESULTS

The mean DMF index of the group was 13.0. Subjects with DMFT >14 (OR = 2.25; CI 95% = 1.30-3.89); low-income (OR = 2.41; CI 95% = 1.22-4.77) and users of cocaine/crack (OR = 2.02; CI 95% = 1.15-3.59) were more likely to have poor general quality of life.

CONCLUSION

This study demonstrated that the general quality of life of addicted persons was associated with caries experience, low income and cocaine/crack use.

Cognitive-behavioral therapy in depressed primary care patients with co-occurring problematic alcohol use: effect of telephone-administered vs. face-to-face treatment-a secondary analysis

This secondary analysis of a larger study compared adherence to telephone-administered cognitive-behavioral therapy (T-CBT) vs. face-to-face CBT and depression outcomes in depressed primary care patients with co-occurring problematic alcohol use. To our knowledge, T-CBT has never been directly compared to face-to-face CBT in such a sample of primary care patients. Participants were randomized in a 1:1 ratio to face-to-face CBT or T-CBT for depression. Participants receiving T-CBT (n = 50) and face-to-face CBT (n = 53) were compared at baseline, end of treatment (week 18), and three-month and six-month follow-ups. Face-to-face CBT and T-CBT groups did not significantly differ in age, sex, ethnicity, marital status, educational level, severity of depression, antidepressant use, and total score on the Alcohol Use Disorders Identification Test. Face-to-face CBT and T-CBT groups were similar on all treatment adherence outcomes and depression outcomes at all time points. T-CBT and face-to-face CBT had similar treatment adherence and efficacy for the treatment of depression in depressed primary care patients with co-occurring problematic alcohol use. When targeting patients who might have difficulties in accessing care, primary care clinicians may consider both types of CBT delivery when treating depression in patients with co-occurring problematic alcohol use.

Comparing the life concerns of prescription opioid and heroin users

This study explored life concerns of prescription opioid (PO) and heroin users. Persons entering opioid detoxification rated their level of concern about 43 health and welfare items. Using exploratory factor analysis and conceptual rationale, we identified ten areas of concern. Participants (N=529) were 69.9% male, 87.5% non-Hispanic Caucasian, and 24.2% PO users. Concern about drug problems was perceived as the most serious concern, followed by money problems, relationship problems, mental health, and cigarette smoking. PO users expressed significantly lower concern about drug problems (p=.017) and transmissible diseases (p<.001), but were more concerned about alcohol use (p<.001) than heroin users. There were no significant differences with regard to the other 7 areas of concern. Recognition of the daily worries of opioid dependent persons could allow providers to better tailor their services to the context of their patients' lives.

Psychometrics of the Short Form 36 Health Survey version 2 (SF-36v2) and the Quality of Life Scale for Drug Addicts (QOL-DAv2.0) in Chinese mainland patients with methadone maintenance treatment

OBJECTIVE

To test psychometrics of the Short Form 36 Health Survey version 2 (SF-36v2) and the Quality of Life Scale for Drug Addicts (QOL-DAv2.0) in Chinese mainland patients with methadone maintenance treatment (MMT).

METHODS

A total of 1,212 patients were recruited from two MMT clinics in Xi'an, China. Reliability was estimated with Cronbach's α and intra-class correlation (ICC). Convergent and discriminant validity was assessed using multitrait-multimethod correlation matrix. Sensitivity was measured with ANOVA and relative efficiency. Responsiveness was evaluated by pre-post paired-samples t-test and standardized response mean based on the patients' health status changes following 6-month period.

RESULTS

Cronbach's α of the SF-36v2 physical and mental summary components were 0.80 and 0.86 (eight scales range 0.73-0.92) and the QOL-DAv2.0 was 0.96 (four scales range: 0.80-0.93). ICC of the SF-36v2 two components were 0.86 and 0.85 (eight scales range: 0.72-0.87) and the QOL-DAv2.0 was 0.94 (four scales range: 0.88-0.92). Convergent validity was lower between the two instruments (γ <0.70) while discriminant validity was acceptable within each instrument. Sensitivity was satisfied in self-evaluated health status (both instruments) and average daily methadone dose (SF-36v2 physical functioning and vitality scales; QOL-DAv2.0 except psychology scale). Responsiveness was acceptable in the improved health status change (SF-36v2 except vitality scale; QOL-DAv2.0 except psychology and symptoms scales) and deteriorated health status change (SF-36v2 except vitality, social functioning and mental health scales; QOL-DAv2.0 except society scale).

CONCLUSIONS

The SF-36v2 and the QOL-DAv2.0 are valid tools and can be used independently or complementary according to different emphases of health-related quality of life evaluation in patients with MMT.

Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India

BACKGROUND

Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi.

METHODS

Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months.

RESULTS

The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves.

CONCLUSIONS

Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for programmes seeking to engage, treat and rehabilitate PWID in India.

Development and validation of a quality of life instrument for patients with drug dependence: comparisons with SF-36 and WHOQOL-100

AIM

Our goal was to develop a self-administered quality of life scale for patients with drug addiction/dependence (QOL-DA) and compare it with the SF-36 and the WHOQOL-100.

METHODS

Employing theory and methodology of rating scale construction, a self-administered quality of life instrument for individuals with drug dependence QOL-DA was developed and evaluated utilizing responses from 212 drug-dependent subjects at the Kunming Municipal Mandatory Detoxification and Rehabilitation Center in China. Quality of life was measured using the SF-36, WHOQOL-100 and QOL-DA three times during the detoxification.

RESULTS

Test-retest reliability in the domains of physical function, psychological function, social function and toxicity were 0.82, 0.64, 0.78, and 0.76, respectively. Cronbach's coefficient α for the 4 domains was 0.87, 0.89, 0.93 and 0.86, respectively. Correlations and factor analysis showed good construct validity. Criterion-related and convergent validity was confirmed by using the SF-36 and the WHOQOL-100 simultaneously. The instrument does show the change in QOL after two weeks of detoxification with higher standardized response mean higher than that of SF-36 and WHOQOL-100.

CONCLUSION

The instrument developed has good validity, reliability and better responsiveness than instruments currently used, and can be employed effectively to measure the quality of life of individuals with drug dependence.

The self-reported personal wellbeing of a sample of Australian injecting drug users

AIMS

To examine the self-reported personal wellbeing of a sample of Australian injecting drug users (IDU) using a standardized instrument and determine the key correlates of variations in self-reported personal wellbeing.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional survey of 881 Australian IDU.

MEASUREMENTS

Self-reported personal wellbeing collected using the Personal Wellbeing Index (PWI).

FINDINGS

IDU scored significantly lower than the general Australian population on the PWI and all subscales. Lower PWI scores were associated with a range of socio-demographic, drug use and other health and social characteristics. Across all PWI subscales, lower personal wellbeing scores were associated with unemployment, past 6-month mental health problems and more frequent injecting (all P < 0.05).

CONCLUSIONS

The PWI is sufficiently sensitive to distinguish between IDU and the general population, and to identify key correlates of PWI among IDU. Some domains canvassed within the scale, such as health, standard of living and life achievements, are well within the scope of current intervention strategies, such as pharmacotherapy maintenance treatment and housing and employment support services. This suggests that the PWI could be useful in clinical settings by allowing structured identification of the areas of a person's life to be addressed as a part of a treatment regimen. In order to inform targeted prevention and intervention efforts, longitudinal studies of PWI and its correlates among IDU are required.

Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence

BACKGROUND

There is increasing evidence that health-related quality of life (HRQOL) is associated with a successful treatment and better outcome in opioid addiction. The aim of the present study was the longitudinal investigation of HRQOL in patients with severe opioid dependence, who were randomly assigned to four groups of medical and psychosocial treatment: heroin (diacetylmorphine) versus methadone and case management (CM) versus psychoeducation (PSE) respectively.

METHODS

HRQOL (MSQoL) and physical health (OTI) were investigated in 938 subjects, who participated in the German multi-centre study examining the effects of heroin-assisted treatment in patients with severe opioid dependence. Data for the present analysis were taken from baseline and 12-month follow up.

RESULTS

Under both forms of maintenance and psychosocial treatment HRQOL improved significantly during the observation period. HRQOL improvement under maintenance with heroin exceeded improvement under methadone, especially with regard to subjective physical health. HRQOL improvement was significantly associated with better expert-rated physical health. Further analyses showed significant better improvement of HRQOL in subjects treated with PSE compared with CM.

CONCLUSIONS

The advantage of heroin with regard to the improvement of HRQOL may be partially explained by a better improvement of physical health under maintenance with heroin compared with methadone, which highlights the importance of a comprehensive model of health care for patients with severe opioid dependence. Future studies need to investigate the benefits of PSE for patients in maintenance therapy.

Quality of life and substance use: concepts and recent tendencies

PURPOSE OF REVIEW

Quality of life (QoL) has become an important clinical and research outcome in clinical drug and alcohol studies. Yet, further advancement in this field is hindered by the lack of a consensual definition of QoL in that often investigators use the constructs of health status and QoL interchangeably. This article reviews the conceptual definitions of QoL as a researchable construct. It also presents the most commonly used questionnaires to evaluate QoL in the context of substance use.

RECENT FINDINGS

In the area of substance use research, the evaluation of QoL has been conducted mainly via generic instruments. Most of the studies reporting results of QoL measurements have obtained their data from opiate users receiving different treatment modalities at various healthcare agencies. Recent studies have used the Injection Drug User QoL Scale as a specific assessment tool. Specific QoL instruments have also been developed in the area of alcohol and nicotine dependence.

SUMMARY

QoL is an important clinical and research outcome in the context of substance use. However, the indiscriminate use of nonspecific measurement tools may produce questionable results. A new generation of specific tools takes into particular consideration the life areas that have a greater influence on the QoL of substance users. It is hoped that the new impetus toward a specific QoL assessment in the context of substance use will promote further scientific advancement in this area.

Adaptação cultural de instrumento que avalia atividades do trabalho e sua relação com sintomas osteomusculares

OBJETIVO: Traduzir e adaptar culturalmente o questionário Work-related activities that may contribute to job-related pain and/or injury para o português falado no Brasil e verificar a validade de conteúdo desta nova versão. MÉTODOS: A adaptação cultural seguiu normas internacionalmente aceitas com as etapas de tradução, síntese, retro-tradução, avaliação por um comitê de especialistas e pré-teste. Esta versão do instrumento foi aplicada em 40 trabalhadores. RESULTADOS: O procedimento de adaptação cultural foi realizado com sucesso. O comitê de especialistas verificou a validade de conteúdo e realizou algumas modificações. No pré-teste, 7,5% dos indivíduos indicaram sugestões para um item do questionário e 17,5% demonstraram dificuldades no entendimento da instrução. Informações adicionais foram incluídas para tornar o instrumento final mais compreensível. CONCLUSÕES: A versão brasileira deste instrumento foi obtida com sucesso.