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Abstract
Within a framework that views alcoholism as a socially acquired, habitual behavior pattern which meets many needs, a three-phase therapeutic plan is used
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Affiliation(s)
- Peter M. Miller
- Clinical psychologist, Psychiatry Service, Veterans Administration Center, Jackson, Mississippi
| | - Ann G. Stanford
- Clinical psychologist, Psychiatry Service, Veterans Administration Center, Jackson, Mississippi
| | - Diana P. Hemphill
- Clinical psychologist, Psychiatry Service, Veterans Administration Center, Jackson, Mississippi
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Jacquot C, Seo A, Miller PM, Lezama N, Criss VR, Colvin C, Luban NLC, Wong ECC. Parental versus non-parental-directed donation: an 11-year experience of infectious disease testing at a pediatric tertiary care blood donor center. Transfusion 2017; 57:2799-2803. [PMID: 28884825 DOI: 10.1111/trf.14312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/24/2017] [Accepted: 06/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Directed donation is associated with a higher prevalence of donations that are positive for infectious disease markers; however, little is known about the positive rates among parental-directed, non-parental-directed, and allogeneic donations. STUDY DESIGN AND METHODS We reviewed blood-collection records from January 1997 through December 2008, including infectious disease results, among parental, non-parental, and community donations. Infectious disease rates were compared by Mann-Whitney U test. RESULTS In total, 1532 parental, 4910 non-parental, and 17,423 community donations were examined. Among parental donors, the median rate of positive infectious disease testing was 8.66% (interquartile range (IQR), 4.49%) for first-time donors and 1.26% (IQR, 5.86%) for repeat donors; among non-parental donors, the rate was 1.09% (IQR, 0.98%) for first-time donors and 0% (IQR, 0.83%) for repeat donors; and, among community donors, the rate was 2.95% (IQR, 1.50%) for first-time donors and 0.45% (IQR, 0.82%) for repeat donors. The mean rate of positive infectious disease testing for first-time parental donors was significantly higher (7.63%), whereas all repeat donors had similar rates. However, the rate of positive infectious disease testing among first-time non-parental donors was significantly lower than that in the other groups, especially for the period from 2001 through 2008. CONCLUSION First-time non-parental and community donors had significantly higher infectious disease risk than the respective repeat donors. First-time parental donors had the highest rates of positive infectious disease testing. We suggest that first-time parental blood donation should be discouraged. Repeat community donors or first-time non-parental donors provide a safer alternative. These findings can foster better patient education, donor selection, and possibly a reduced risk of infectious disease.
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Affiliation(s)
- Cyril Jacquot
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC.,Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrew Seo
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC
| | - Peter M Miller
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC
| | - Niara Lezama
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC
| | - Valli R Criss
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC
| | - Camilla Colvin
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC
| | - Naomi L C Luban
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC.,Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Edward C C Wong
- Divisions of Laboratory Medicine and Hematology, Center for Cancer and Blood Disorders, Sheikh Zayed Campus for Advanced Children's Medicine, Children's National Health System, Washington, DC.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC.,Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Abstract
This study examined anger, depression, and stress as related to alcohol consumption, saturated fat intake, and physical activity. Participants were 23 older adults enrolled in either an outpatient or in-residence executive health program. Participants completed (a) a health-risk appraisal assessing medical history and current health habits, (b) the State-Trait Anger Expression Inventory (STAXI), and (c) the Center for Epidemiological Studies-Depression Questionnaire. Bivariate correlations revealed that anxiety was negatively correlated with alcohol consumption. High levels of depression, trait anger, and outward anger expression style were positively associated with saturated fat intake. Trait anger was also associated with less aerobic exercise. Inward anger expression was positively correlated with regular participation in strength training. Results suggest that anger, anger expression style, and depression interact with healthy and unhealthy behavior patterns and that these interactions may be complex.
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4
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Affiliation(s)
- Peter M Miller
- Department of Pathology, George Washington University, Washington, DC;
| | - D Robert Dufour
- Department of Pathology, George Washington University, Washington, DC; Pathology and Hepatology, Veterans Affairs Medical Center, Washington, DC
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Spada MM, Miller PM. Editorial for the launch of Addictive Behaviors Reports. Addict Behav Rep 2015. [PMID: 29531972 PMCID: PMC5845978 DOI: 10.1016/j.abrep.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Marcantonio M. Spada
- School of Applied Sciences, London South Bank University, London, UK
- Corresponding author at: Division of Psychology, School of Applied Sciences, London South Bank University, UK. Tel.: + 44 20 7815 5760.
| | - Peter M. Miller
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
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Miller PM, Book SW, Thomas S, Smith JP, Randall PK, Randall CL. The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients. J Subst Use 2014; 19:225-228. [PMID: 24982593 DOI: 10.3109/14659891.2013.779756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/13/2022]
Abstract
BACKGROUND Drinking motives are thought to be important mediators of the relationship between social anxiety and alcohol use. This project evaluates whether specific drinking motives accurately reflect alcohol dependence. If so, brief questions about drinking motives could serve as valuable alcohol screening tools with socially anxious patients. METHODS This investigation was a secondary analysis of an existing data set of 83 subjects with social anxiety disorder and at-risk alcohol use. The relationship between Drinking Motives Questionnaire (DMQ-R-5) subscales and alcohol dependence was evaluated. RESULTS Coping-Depression was the only subscale that contributed to the unique prediction of a diagnosis of alcohol dependence. Additionally, two items (i.e. "to cheer up when you're in a bad mood" and "to forget painful memories") predicted a diagnosis of alcohol dependence above and beyond their association with each other. CONCLUSIONS Among patients with social anxiety, two specific questions on the DMQ-R-5 could provide a useful screen for health professionals to predict alcohol dependence. It may be fruitful to specifically target the motives of "to cheer up when you're in a bad mood" and "to forget painful memories" when providing advice during brief interventions.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Sarah W Book
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Suzanne Thomas
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Joshua P Smith
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Patrick K Randall
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Carrie L Randall
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
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Wessell AM, Nemeth LS, Jenkins RG, Ornstein SM, Miller PM. Medications for Alcohol Use Disorders in a Primary Care Practice-Based Research Network Implementation Study. Alcoholism Treatment Quarterly 2014. [DOI: 10.1080/07347324.2014.856224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Peter M. Miller
- Department of Psychiatry and Behavioral Sciences; College of Medicine and Professor of Stomatology and of Craniofacial Biology, College of Dental Medicine, Medical University of South Carolina
| | - Michele C. Ravenel
- Department of Stomatology; College of Dental Medicine, Medical University of South Carolina
| | - Mary P. Mauldin
- Center for Academic Research and Computing; Medical University of South Carolina
| | - Stanley Sulkowski
- Office of Instructional Technology and Faculty Resources; Medical University of South Carolina
| | - Arden Lowndes
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina
| | - Suzanne E. Thomas
- Department of Psychiatry and Behavioral Sciences and Director; Office of Institutional Effectiveness, Medical University of South Carolina
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Miller PM, Ravenel MC, Mauldin MP, Sulkowski S, Lowndes A, Thomas SE. An online alcohol and oral health curriculum for dental students. J Dent Educ 2014; 78:16-23. [PMID: 24385520] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Regular heavy alcohol use can cause or worsen several oral health disorders and is associated with complications during and after dental procedures. Dental student education should provide detailed knowledge of these issues together with skills needed to detect and counsel patients with unhealthy drinking patterns. This project was designed to develop and evaluate a five-module, online program to teach dental students about alcohol and oral health, systemic and oral biological effects of heavy drinking, required changes to treatment protocols for heavy drinkers, reliable methods of alcohol screening, and ways to provide heavy drinkers with brief interventions. Results indicated that the online program resulted in significant changes in knowledge, attitudes, and behavior. This online format could easily be incorporated into an already crowded dental school curriculum, with students learning the material at their own pace and in their own available time.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, P.O. Box 250861, Charleston, SC 29425;.
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Nemeth LS, Miller PM, Nietert PJ, Ornstein SM, Wessell AM, Jenkins RG. Organizational attributes and screening and brief intervention in primary care. Addict Behav 2013; 38:2639-42. [PMID: 23899425 PMCID: PMC3759591 DOI: 10.1016/j.addbeh.2013.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/05/2013] [Revised: 05/02/2013] [Accepted: 05/25/2013] [Indexed: 11/26/2022]
Abstract
Overconsumption of alcohol is well known to lead to numerous health and social problems. Prevalence studies of United States adults found that 20% of patients meet criteria for an alcohol use disorder. Routine screening for alcohol use is recommended in primary care settings, yet little is known about the organizational factors that are related to successful implementation of screening and brief intervention (SBI) and treatment in these settings. The purpose of this study was to evaluate organizational attributes in primary care practices that were included in a practice-based research network trial to implement alcohol SBI. The Survey of Organizational Attributes in Primary Care (SOAPC) has reliably measured four factors: communication, decision-making, stress/chaos and history of change. This 21-item instrument was administered to 178 practice members at the baseline of this trial, to evaluate for relationship of organizational attributes to the implementation of alcohol SBI and treatment. No significant relationships were found correlating alcohol screening, identification of high-risk drinkers and brief intervention, to the factors measured in the SOAPC instrument. These results highlight the challenges related to the use of organizational survey instruments in explaining or predicting variations in clinical improvement. Comprehensive mixed methods approaches may be more effective in evaluations of the implementation of SBI and treatment.
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Affiliation(s)
- Lynne S. Nemeth
- College of Nursing, Department of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St MSC 160, Charleston, SC 29425
| | - Peter M. Miller
- College of Medicine, Department of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC 29425,
| | - Paul J. Nietert
- College of Medicine, Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425,
| | - Steven M. Ornstein
- College of Medicine, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC, , ,
| | - Andrea M. Wessell
- College of Medicine, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC, , ,
| | - Ruth G. Jenkins
- College of Medicine, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC, , ,
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12
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Ornstein SM, Miller PM, Wessell AM, Jenkins RG, Nemeth LS, Nietert PJ. Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings. J Stud Alcohol Drugs 2013; 74:598-604. [PMID: 23739024 PMCID: PMC3711350 DOI: 10.15288/jsad.2013.74.598] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE At-risk drinking and alcohol use disorders are common in primary care and may adversely affect the treatment of patients with diabetes and/or hypertension. The purpose of this article is to report the impact of dissemination of a practice-based quality improvement approach (Practice Partner Research Network-Translating Research into Practice [PPRNet-TRIP]) on alcohol screening, brief intervention for at-risk drinking and alcohol use disorders, and medications for alcohol use disorders in primary care practices. METHOD Nineteen primary care practices from 15 states representing 26,005 patients with diabetes and/or hypertension participated in a group-randomized trial (early intervention vs. delayed intervention). The 12-month intervention consisted of practice site visits for academic detailing and participatory planning and network meetings for "best practice" dissemination. RESULTS At the end of Phase 1, eligible patients in early-intervention practices were significantly more likely than patients in delayed-intervention practices to have been screened (odds ratio [OR] = 3.30, 95% CI [1.15, 9.50]) and more likely to have been provided a brief intervention (OR = 6.58, 95% CI [1.69, 25.7]. At the end of Phase 2, patients in delayed-intervention practices were more likely than at the end of Phase 1 to have been screened (OR = 5.18, 95% CI [4.65, 5.76]) and provided a brief intervention (OR = 1.80, 95% CI [1.31, 2.47]). Early-intervention practices maintained their screening and brief intervention performance during Phase 2. Medication for alcohol use disorders was prescribed infrequently. CONCLUSIONS PPRNet-TRIP is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and/or hypertension in primary care settings.
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Affiliation(s)
- Steven M. Ornstein
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina,Correspondence may be sent to Steven M. Ornstein, Professor of Family Medicine, Medical University of South Carolina, 5 Charleston Center, Suite 263, Charleston, SC 29425, or via email at:
| | - Peter M. Miller
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Andrea M. Wessell
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ruth G. Jenkins
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lynne S. Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Paul J. Nietert
- Department of Medicine, Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
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13
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Book SW, Thomas SE, Smith JP, Miller PM. Severity of anxiety in mental health versus addiction treatment settings when social anxiety and substance abuse are comorbid. Addict Behav 2012; 37:1158-61. [PMID: 22658305 DOI: 10.1016/j.addbeh.2012.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 04/19/2012] [Accepted: 04/30/2012] [Indexed: 11/29/2022]
Abstract
There is increasing interest in the co-occurrence of social anxiety and addiction. Each investigation has a specific vantage point, e.g., the effect social anxiety has in a population with addiction or that of addiction in a population with social anxiety, which could create unique findings. Among comorbid individuals, is social anxiety more severe in people seeking treatment for anxiety, as compared to those seeking treatment for addiction? This report compares social anxiety severity between subjects in two studies--one involving socially anxious individuals (n=38) seeking treatment for addictions; the other (n=41) subjects with social anxiety and an alcohol use disorder, seeking treatment for social anxiety. Baseline severity scores on the Liebowitz Social Anxiety Scale for social anxiety were compared between the groups. No significant differences were found. For both groups, social anxiety was largely in the severe range. The results suggest that clinicians should attend to social anxiety symptom severity in patients with co-occurring social anxiety and addiction, regardless of the condition for which treatment is sought.
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Affiliation(s)
- Sarah W Book
- Charleston Alcohol Research Center, Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street,Charleston, SC 29425, USA.
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Abstract
As a distinguished scholar over the past 45 years, Michel Hersen has left an indelible mark on the field of behavior therapy and clinical psychology. One of his most enduring legacies is his early research work in the area of social skills assessment and training, with special attention to assertiveness training. His basic analogue and clinical outcome studies have served as essential building blocks for current evidence-based treatments. His long and distinguished career has significantly impacted the lives of colleagues, students, and patients alike.
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Affiliation(s)
- Peter M Miller
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, P.O. Box 250861, Charleston, SC 29425, USA.
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15
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Abstract
Because psychiatric illnesses and problematic alcohol use frequently co-occur and heavy alcohol use can exacerbate depression and anxiety, mental health clinicians should perform alcohol-use screenings. The aim of this study was to determine if psychiatric patients would be accepting of their mental health clinician screening them for heavy alcohol use. Using a written survey, patients rated their levels of agreement with 9 statements regarding opinions about alcohol screening by their mental-health providers. They also completed the Alcohol Use Disorders Identification Test-C (AUDIT-C), a screening instrument for heavy alcohol use. One hundred fifty-four patients were surveyed in 2 psychiatric outpatient clinics. Nearly 40% screened positively for heavy alcohol use on the AUDIT-C. Nearly 8 out of 10 psychiatric patients were in favor of being screened for alcohol use by either self-report or biomarkers, independent of AUDIT-C status and gender. Thus, mental health clinicians should not be deterred from alcohol screening by perceived negative attitudes from patients.
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Affiliation(s)
- Sarah W Book
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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16
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Ravenel MC, Salinas CF, Marlow NM, Slate EH, Evans ZP, Miller PM. Methamphetamine abuse and oral health: a pilot study of "meth mouth". Quintessence Int 2012; 43:229-237. [PMID: 22299123] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Abuse of methamphetamine (meth), a potent central nervous system stimulant, has been associated with significant dental disease. Current descriptions of "meth mouth" are limited in their scope and fail to illuminate the potential pathogenic mechanisms of meth for oral disease. The purpose of this pilot study was to characterize the oral health of subjects with a history of meth abuse as compared to nonabusing control subjects. A total of 28 meth abusers and 16 control subjects were enrolled. Interviews and surveys regarding meth abuse, dental history, oral hygiene, and diet were collected. A comprehensive oral cavity examination including salivary characterization was completed. We observed significantly higher rates of decayed surfaces, missing teeth, tooth wear, plaque, and calculus among meth abusers. No significant difference in salivary flow rates were noted, yet results showed significant trends for lower pH and decreased buffering capacity. These findings suggest that salivary quality may play a more important role in meth mouth than previously considered. Salivary analysis may be useful when managing a dental patient with history of methamphetamine abuse.
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Affiliation(s)
- Michele C Ravenel
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Miller PM, Heideman PW, Ravenel MC, Spangler JG, Mauldin MP, Hill EG, Onicescu G. Preliminary development and evaluation of online tobacco and alcohol modules for dental students. J Dent Educ 2011; 75:791-796. [PMID: 21642525] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tobacco use and heavy alcohol consumption are major risk factors for the development of oral and pharyngeal cancer (OPC). Detection and modification of these risks by dentists are keys in preventing OPC. While dentists are encouraged to screen patients for tobacco and alcohol use and educate them about the oral health risks they pose, dental students receive little formalized training in this area. This pilot project was designed to develop and evaluate two online training modules for dental students: one on tobacco and oral health risk factors, and one on methods of alcohol screening. Results indicated that online tobacco/alcohol education for dental students is feasible. The modules resulted in meaningful improvement in dental students' knowledge of tobacco and alcohol use as well as alcohol screening methods. The alcohol module resulted in statistically significant increases in intention to screen patients for alcohol use and in comfort level in performing alcohol screening.
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Affiliation(s)
- Peter M Miller
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Miller PM, Heideman PW, Ravenel MC, Spangler JG, Mauldin MP, Hill EG, Onicescu G. Preliminary Development and Evaluation of Online Tobacco and Alcohol Modules for Dental Students. J Dent Educ 2011. [DOI: 10.1002/j.0022-0337.2011.75.6.tb05107.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Peter M. Miller
- Department of Psychiatry and Behavioral Sciences (Alcohol Research Center and Center for Drug and Alcohol Programs); College of Dental Medicine; Medical University of South Carolina
| | | | - Michele C. Ravenel
- Department of Stomatology; College of Dental Medicine; Medical University of South Carolina
| | - John G. Spangler
- Department of Family Medicine; School of Medicine; Wake Forest University
| | - Mary P. Mauldin
- Center for Academic Research and Computing; Medical University of South Carolina
| | - Elizabeth G. Hill
- Department of Medicine (Biostatistics and Epidemiology); Medical University of South Carolina
| | - Georgiana Onicescu
- Department of Medicine (Biostatistics and Epidemiology); Medical University of South Caro-lina
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Abstract
OBJECTIVE To summarize published data on pharmacologic treatments for alcohol dependence alone and in combination with brief psychosocial therapies that may be feasible for primary care and specialty medical settings. METHODS We conducted electronic searches of published original research articles and reviews in MEDLINE, SCOPUS, CINAHL, Embase, and PsychINFO. In addition, hand searches of reference lists of review articles, supplemental searches of internet references and contacts with experts in the field were conducted. Randomized controlled studies published between January 1960 and August 2010 that met our inclusion/exclusion criteria were included. RESULTS A total of 85 studies, representing 18,937 subjects, met our criteria for inclusion. The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest. Acamprosate shows modest efficacy with recently abstinent patients, with European studies showing better results than U.S. ones. The evidence-base for disulfiram is equivocal. Depot naltrexone shows efficacy (25% greater reduction in rate of heavy drinking vs. placebo, in one of the largest studies) in a limited number of studies. Some studies suggest that patients do better with extensive psychosocial treatments added to medications while others show that brief support can be equally effective. CONCLUSIONS Although treatment effects are modest, medications for alcohol dependence, in conjunction with either brief support or more extensive psychosocial therapy, can be effective in primary and specialty care medical settings.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, SC 29425, USA.
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Affiliation(s)
- Peter M Miller
- Alcohol Research Center, Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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Stewart SH, Borg KT, Miller PM. Prevalence of Problem Drinking and Characteristics of a Single-Question Screen. J Emerg Med 2010; 39:291-5. [DOI: 10.1016/j.jemermed.2007.11.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/13/2007] [Accepted: 11/05/2007] [Indexed: 10/22/2022]
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Abstract
Immersing the roots of growing strawberry plants in aqúeous solutions of 8-hydroxyquinoline sulfate closes the stomata, reduces water loss, and increases the time before complete wilting under drought conditions. Under such drought conditions plant survival and vigor are increased. Prolonged closing of the stomata seems to be the principal mode of action of the chemical.
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Stewart SH, Reuben A, Brzezinski WA, Koch DG, Basile J, Randall PK, Miller PM. Preliminary evaluation of phosphatidylethanol and alcohol consumption in patients with liver disease and hypertension. Alcohol Alcohol 2009; 44:464-7. [PMID: 19535495 DOI: 10.1093/alcalc/agp039] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS The goal of this preliminary study was to evaluate the relationship between blood phosphatidylethanol (PEth) and recent drinking in patients with liver disease and hypertension. METHODS Twenty-one patients with liver disease and 21 patients with essential hypertension were recruited at an academic medical center. Alcohol consumption was estimated using validated self-report methods, and blood PEth was measured by HPLC-MS/MS at a contracted laboratory. Nonparametric comparisons were made between abstainers/light drinkers, moderate drinkers consuming between 1 and 3 drinks per day, and those drinking above this level. Regression methods were used to estimate the effects of liver disease, gender, and age on the relationship between PEth and alcohol use, and to estimate the strength of the linear relationship between PEth and drinking. RESULTS PEth differed significantly between the three drinking groups (P < 0.001). The relationship between PEth and alcohol did not differ between hypertension and liver disease patients (P = 0.696), nor by gender and age. While there was substantial variability between subjects in the PEth concentration given a similar level of reported drinking, the amount of ethanol consumed was strongly associated with the PEth concentration (P < 0.001). CONCLUSION Results support PEth measurement by HPLC-MS/MS as a promising marker of past 1- to 2-week moderate to heavy alcohol consumption in patients with and without liver disease. PEth appears useful for differentiating abstinence or light drinking from moderate to heavy consumption, but may have limited utility for differentiating moderate from heavy alcohol use.
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Affiliation(s)
- Scott H Stewart
- Medical University of South Carolina, Charleston, 29425, USA.
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Miller PM, Cluver J, Anton RF. A useful test for monitoring alcohol use. Behav Healthc 2009; 29:38-40. [PMID: 19655583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Problems, Medical University of South Carolina, USA.
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Long TAF, Miller PM, Stewart AD, Rice WR. Estimating the heritability of female lifetime fecundity in a locally adapted Drosophila melanogaster population. J Evol Biol 2009; 22:637-43. [PMID: 19210593 DOI: 10.1111/j.1420-9101.2008.01676.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The heritability of genome-wide fitness that is expected in finite populations is poorly understood, both theoretically and empirically, despite its relevance to many fundamental concepts in evolutionary biology. In this study, we used two independent methods of estimating the heritability of lifetime female fecundity (the predominant female fitness component in this population) in a large, outbred population of Drosophila melanogaster that had adapted to the laboratory environment for over 400 generations. Despite strong directional selection on adult female fecundity, we uncovered high heritability for this trait that cannot be explained by antagonistic pleiotropy with juvenile fitness. The evolutionary significance of this high heritability of lifetime fecundity is discussed.
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Affiliation(s)
- T A F Long
- Department of Ecology, Evolution & Marine Biology, University of California Santa Barbara, Santa Barbara, CA 93106-9610, USA.
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Miller PM, Gross RE. Wire Tethering or ‘Bowstringing’ as a Long-Term Hardware-Related Complication of Deep Brain Stimulation. Stereotact Funct Neurosurg 2009; 87:353-9. [DOI: 10.1159/000236369] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 06/13/2009] [Indexed: 11/19/2022]
Abstract
<i>Background:</i> Widely reported long-term complications following implantation of deep brain stimulation (DBS) hardware include breakage of electrode leads, internal pulse generator (IPG) failure, skin erosions and infection. Here we report on a rarely described problem that arises from formation of scar tissue adhesions around the DBS extension wire(s). Over time, this scar tissue can become tight and pronounced, protruding noticeably beneath the skin (‘bowstringing’ in reference to its tight bow-like appearance) and leading to significant limitation of movement and discomfort. We term this ‘wire tethering’. <i>Results:</i>We describe 6 patients with moderate to severe wire tethering. Review of our experience suggests an association of wire tethering with the passage of two extension wires on the same side as is done when using a dual-channel IPG. Five of the patients required surgical revision of the extension wires due to the magnitude of the discomfort, limitation of movement and appearance. Removing the wires was insufficient in the most severe case, necessitating transection of the scar in several places, which was done with the extension wires in situ in 2 patients. Two patients were treated with removal of the wires alone, and 1 patient did not opt for surgery and the tethering has persisted. <i>Conclusion:</i> Wire tethering, or ‘bowstringing’, is an underrecognized complication of DBS hardware implantation often necessitating surgical revision. The possible etiology of wire tethering is discussed as well as suggestions for its avoidance.
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Stewart SH, Latham PK, Miller PM, Randall P, Anton RF. Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction 2008; 103:1622-8. [PMID: 18821872 PMCID: PMC2634596 DOI: 10.1111/j.1360-0443.2008.02317.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [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] [Indexed: 11/26/2022]
Abstract
AIMS Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence. PARTICIPANTS Subjects included 1383 people participating in the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, a large multi-center treatment study for alcohol dependence. MEASUREMENTS Methods appropriate for repeated-measures data were used to assess the relationship of percentage of drinking days (PDD) to systolic and diastolic blood pressure over a 16-week treatment period. Modification of these associations by demographic and other variables was assessed. FINDINGS Blood pressure reduction was evident only in people who were above the median blood pressure at baseline. In this group, systolic blood pressure decreased by an average of 12 mmHg and diastolic blood pressure decreased by an average of 8 mmHg. Blood pressure reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body mass index, reported history of hypertension and use of anti-hypertensive medications. An observed association between blood pressure and PDD in Caucasians was not evident in African Americans due largely to their lower pre-treatment blood pressure. CONCLUSIONS Reduction in alcohol consumption has a potent anti-hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol-dependent people, treatment for alcoholism should be considered a major component of anti-hypertensive therapy.
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Affiliation(s)
- SH Stewart
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - PK Latham
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - PM Miller
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - P Randall
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - RF Anton
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Rose HL, Miller PM, Nemeth LS, Jenkins RG, Nietert PJ, Wessell AM, Ornstein S. Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention. Addiction 2008; 103:1271-80. [PMID: 18422825 DOI: 10.1111/j.1360-0443.2008.02199.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS To determine the effect of an intervention to improve alcohol screening and brief counseling for hypertensive patients in primary care. DESIGN Two-year randomized, controlled trial. SETTING/PARTICIPANTS Twenty-one primary care practices across the United States with a common electronic medical record. INTERVENTION To promote alcohol screening and brief counseling. Intervention practices received site visits from study personnel and were invited to annual network meetings to review the progress of the project and share improvement strategies. MEASUREMENTS Main outcome measures included rates of documented alcohol screening in hypertensive patients and brief counseling administered in those diagnosed with high-risk drinking, alcohol abuse or alcohol dependence. Secondary outcomes included change in blood pressure among patients with these diagnoses. FINDINGS Hypertensive patients in intervention practices were significantly more likely to have been screened after 2 years than hypertensive patients in control practices [64.5% versus 23.5%; adjusted odds ratio (OR) = 8.1; 95% confidence interval (CI) 1.7-38.2; P < 0.0087]. Patients in intervention practices diagnosed with high-risk drinking, alcohol abuse or alcohol dependence were more likely than those in control practices to have had alcohol counseling documented (50.5% versus 29.6%; adjusted OR = 5.5, 95% CI 1.3-23.3). Systolic (adjusted mean decline = 4.2 mmHg, P = 0.036) and diastolic (adjusted mean decline = 3.3 mmHg, P = 0.006) blood pressure decreased significantly among hypertensive patients receiving alcohol counseling. CONCLUSIONS Primary care practices receiving an alcohol-focused intervention over 2 years improved rates of alcohol screening for their hypertensive population. Implementation of alcohol counseling for high-risk drinking, alcohol abuse or alcohol dependence also improved and led to changes in patient blood pressures.
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Affiliation(s)
- Heather Liszka Rose
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Thomas SE, Miller PM, Randall PK, Book SW. Improving acceptance of naltrexone in community addiction treatment centers: a pilot study. J Subst Abuse Treat 2008; 35:260-8. [PMID: 18329227 DOI: 10.1016/j.jsat.2007.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 11/13/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
Alcoholism pharmacotherapies are underused in community addiction treatment settings, in part because individuals who practice in these settings--nonmedical addiction counselors and administrators--lack knowledge about and confidence in the value of adjunctive alcohol pharmacotherapies. We developed and tested an intervention to improve knowledge and attitudes about naltrexone. A team of researchers, physicians, addiction treatment counselors, and administrators collaborated to develop a naltrexone educational intervention designed for nonmedical addiction professionals. The intervention was compared with a control condition in a pilot study with 6 addiction treatment agencies (3 agencies per group). Participants (counselors and administrators, N = 84) were assessed before and 6 months after the intervention. Results revealed that the intervention significantly improved naltrexone knowledge, and participants who received the intervention reported greater satisfaction with the education they received, as well as greater use of the information. The effect of the intervention on attitudes about naltrexone was encouraging but did not to reach statistical significance. This study is the first reported attempt to develop and test an intervention specifically to improve acceptance of adjunctive medications for alcoholism among nonmedical addiction professionals.
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Affiliation(s)
- Suzanne E Thomas
- Center for Drug and Alcohol Programs, Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Baros AM, Wright TM, Latham PK, Miller PM, Anton RF. Alcohol consumption, %CDT, GGT and blood pressure change during alcohol treatment. Alcohol Alcohol 2007; 43:192-7. [PMID: 18039674 DOI: 10.1093/alcalc/agm156] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Blood pressure (BP) changes in alcohol-dependent individuals during a 12-week alcohol relapse prevention study were examined in light of drinking status and biomarkers of alcohol consumption [carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl transpeptidase (GGT)]. METHODS Of 160 randomized alcoholic individuals, 120 who had hypertension and in whom daily drinking data was available, at 6 and 12 weeks of treatment were included. The impact of alcohol consumption on change in systolic BP (SBP) and diastolic BP (DBP) was examined. Further analysis determined the relationship between BP and alcohol-use biomarkers. RESULTS A significant effect of complete abstinence on both SBP (-10 mmHg; P = 0.003) and DBP (-7 mmHg; P = 0.001) when compared to any drinking (SBP and DBP = -1 mmHg) was observed. At week 12, participants with a positive %CDT (> or =2.6) had 7 mmHg greater SBP (P = 0.01) and DBP (P < 0.001) than those with negative %CDT. Participants with positive GGT (> or =50 IU) had 10 mmHg greater SBP (P = 0.12) and 9 mmHg greater DBP (P = 0.03) than those with negative GGT. The percent change in SBP was correlated with percent change in %CDT (P = 0.003) but not GGT (P = ns). The percent change in DBP was correlated with both percent change in %CDT (P < 0.0001) and GGT (P = 0.03). CONCLUSIONS Abstinence from alcohol significantly decreased the BP and a positive relationship between BP and both alcohol-use biomarkers was illustrated. Since %CDT is more specific than GGT for heavy alcohol consumption, clinicians may monitor the role of alcohol in hypertension using %CDT as a supplemental aid, providing an objective assessment of drinking to influence BP treatment decisions.
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Affiliation(s)
- A M Baros
- Charleston Alcohol Research Center, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425, USA.
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Thomas SE, Miller PM. Knowledge and attitudes about pharmacotherapy for alcoholism: a survey of counselors and administrators in community-based addiction treatment centres. Alcohol Alcohol 2006; 42:113-8. [PMID: 17172258 DOI: 10.1093/alcalc/agl100] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Medications, when combined with psychosocial therapy, can improve treatment outcomes in alcoholics; however, medications are not widely utilized in community-based addiction treatment centres. Of interest is how non-medical addiction treatment professionals in these facilities view adjunctive pharmacotherapies for alcoholism. The present report focuses on baseline data collected during the course of an educational intervention project and explores predictors of positive attitudes about adjunctive pharmacotherapies among community addiction counselors and administrators. METHODS Questionnaires were administered to 84 counselors and administrators at six community-based addiction treatment centres in South Carolina. Demographic data were collected, and knowledge and attitudes regarding the value of pharmacotherapies in the treatment of alcoholism were assessed. Correlation coefficients were explored, and follow-up multiple regression analyses were conducted to examine variables that predict scores reflecting the degree to which one values adjunctive pharmacotherapies for alcoholism. RESULTS Respondents had little knowledge of naltrexone, with average test scores reflecting no better than chance performance. In addition, most participants believed that adjunctive pharmacotherapy is ineffectual. Higher valuation of adjunctive pharmacotherapy was related to knowledge about naltrexone, having a post-baccalaureate degree, and years of experience in the addictions treatment field. CONCLUSIONS These data support that more widespread use of adjunctive pharmacotherapy for alcoholism may be impeded by the fact that addictions counselors, who are often the first contact for treatment-seeking individuals, have a lack of knowledge and a lack of confidence in the effectiveness of such treatments. Directed educational interventions are warranted for this population.
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Affiliation(s)
- Suzanne E Thomas
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina Charleston, SC 29425, USA.
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Abstract
BACKGROUND Because heavy drinking is a risk factor for oral cancer, dentists should screen patients for alcohol use. The authors investigated heavy drinking in dental patients and patients' attitudes about alcohol screening. METHODS A convenience sample of 408 patients attending an emergency walk-in dental clinic served as subjects. Patients completed the Alcohol Use Disorders Identification Test-C (AUDIT-C), a three-item alcohol screening test, and an opinion survey regarding attitudes about the acceptability of alcohol screening and counseling by dentists. RESULTS One in four patients had positive screening results for heavy alcohol use. The majority of subjects (> 75 percent) were in support of dentists' inquiries and advice about alcohol use. Age, sex and drinking status were not predictive of patients' opinions about alcohol screening. CONCLUSIONS One hundred three of the dental patients exhibited evidence of hazardous alcohol consumption, a risk factor for oropharyngeal cancer. The majority of patients reported that they would readily accept alcohol screening and alcohol counseling by dentists. CLINICAL IMPLICATIONS Because studies have shown that some dentists hesitate to screen for alcohol use because of a belief that screening is unacceptable to patients, these results may encourage a change in practice.
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Affiliation(s)
- Peter M Miller
- Medical University of South Carolina, Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Charleston, SC 29425, USA.
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Miller PM, Stockdell R, Nemeth L, Feifer C, Jenkins RG, Nietert PJ, Wessell A, Liszka H, Ornstein S. Initial Steps Taken by Nine Primary Care Practices to Implement Alcohol Screening Guidelines with Hypertensive Patients. Subst Abus 2006; 27:61-70. [PMID: 17062546 DOI: 10.1300/j465v27n01_08] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many medical conditions are caused or exacerbated by heavy drinking, necessitating alcohol screening and discussion in primary care practices. This is particularly true of hypertension, the most common primary diagnosis in the United States, which has been linked to the regular consumption of 3 or more standard alcoholic beverages a day. The Accelerating Alcohol Screening-Translating Research into Practice (AA-TRIP) project was designed to improve detection and management of alcohol problems in primary care patients with hypertension. Medical providers are being trained using the Practice Partner Research Network's- Translating Research into Practice (PPRNet-TRIP) quality improvement model. This includes a multi-method intervention (electronic medical records, on-site academic detailing, practice feedback reports and annual network meetings) to help practices increase adherence to clinical guidelines. Qualitative analyses of initial steps taken by nine primary care practices toward the routine implementation of alcohol screening guidelines are presented. Organizational factors and provider and patient characteristics all influenced the method and consistency of alcohol screening and intervention. Perceived time constraints, patient sensitivity to questions about alcohol, and possible stigma associated with a diagnosis of alcoholism were also relevant barriers requiring problem solving.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Medical University of South Carolina, 67 President St, PO Box 250861, Charleston, SC 29425, USA.
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Abstract
AIMS One of the many barriers to more frequent alcohol screening by primary care physicians is a reported concern that patients may be offended by questions about drinking. However, evidence suggests that patients do not object to alcohol screening and actually expect physicians to ask about lifestyle factors that influence their health. The aim of this study was to provide more detailed information on patient attitudes toward self-report and biomarker alcohol screening and to explore whether demographic variables were related to these attitudes. METHODS We administered (i) a survey about attitudes towards alcohol screening, and (ii) the Alcohol Use Disorders Identification Test-C (AUDIT-C) to primary care outpatients at the time of their medical appointments. The survey contained 10 items on patient opinions about being screened for at-risk drinking by physicians. Participants rated their levels of agreement with each statement using a 5-point Likert scale. Participants also provided demographic information. RESULTS The majority of patients reported that they were supportive of physician screening about alcohol use. Responses on 3 of the 10 statements were related to patient race, age, and/or AUDIT-C results. CONCLUSIONS In general, results support the fact that patients are in favour of being screened for at-risk drinking by their physicians whether the screening instrument was a self-report measure or an alcohol biomarker laboratory test. In addition, the majority of patients are open to advice from physicians about their alcohol use.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Miller PM, Spies C, Neumann T, Javors MA, Hoyumpa AM, Roache J, Webb A, Kashi M, Sharkey FE, Anton RF, Egan BM, Basile J, Nguyen S, Fleming MF, Dillie KS. Alcohol Biomarker Screening in Medical and Surgical Settings. Alcohol Clin Exp Res 2006; 30:185-93. [PMID: 16441267 DOI: 10.1111/j.1530-0277.2006.00029.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article highlights the proceedings of a symposium presented at the 28th Annual Meeting of the Research Society on Alcoholism in Santa Barbara, CA, on June 28, 2005, organized and chaired by Peter Miller. The presentations included (1) Screening for Alcohol Use Disorders in Surgical and Trauma Patients, presented by Claudia Spies; (2) Are Serum Levels of %CDT and GGT Related to Severity of Liver Biopsy Inflammation, Fibrosis, and Steatohepatitis in Patients with Hepatitis C? by Martin Javors; (3) Biochemical Alcohol Screening in the Treatment of Hypertension, presented by Peter Miller; and (4) The Cost-Effectiveness of a New Biomarker, CDT, in a Primary Care Sample, by Michael Fleming. Presentations were discussed by Raymond Anton.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Charleston, South Carolina 29425, USA.
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Neuner B, Miller PM, Felsmann B, Weiss-Gerlach E, Neumann T, Wernecke KD, Spies C. Health-related quality of life in urban surgical emergency department patients: comparison with a representative German population sample. Health Qual Life Outcomes 2005; 3:77. [PMID: 16321144 PMCID: PMC1327693 DOI: 10.1186/1477-7525-3-77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 12/01/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients in emergency departments show a high prevalence of substance use. Quality of life is associated with substance use as well as socioeconomic status. Little is known about quality of life in substance-abusing young patients with minor trauma. METHODS An investigation in an Emergency Department in an inner city university hospital was conducted during 8 months. Overall, 1,596 patients completed the SF-36 and an established SES-questionnaire and were screened for substance use (harmful alcohol consumption (>or= 8 points in men and >or= 5 points in women on the Alcohol Use Disorders Identification Test (AUDIT), smoking and illicit drug use). Results were compared with a representative German population sample (German Federal Health Survey 1998). RESULTS Median age of participants was 32 years and 61.8% were male. Mean physical component summary score (PCS) of the Short Form-36 Health Survey (SF-36) was 53.4 +/- 8.3 points and significantly higher than the age and gender-stratified German Federal Health Survey-data. Mean mental component summary score (MCS) was 47.9 +/- 10.0 points and significantly lower than the age and gender-stratified German Federal Health Survey-data. In Emergency Department patients, prevalence of substance use was high and harmful alcohol consumption and illicit drug use were strongly associated with impaired mental health. Education and occupational status were strongly positively associated with physical health. CONCLUSION We conclude that there is a high prevalence of substance use in young patients with minor trauma and mental quality of life is impaired. Screening and brief intervention strategies to reduce substance-use associated disorders should consider these findings.
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Affiliation(s)
- Bruno Neuner
- Dept. of Anaesthesiology, Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany
| | - Peter M Miller
- Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Bodo Felsmann
- Dept. of Anaesthesiology, Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany
| | - Edith Weiss-Gerlach
- Dept. of Anaesthesiology, Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany
| | - Tim Neumann
- Dept. of Anaesthesiology, Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany
| | - Klaus Dieter Wernecke
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany
| | - Claudia Spies
- Dept. of Anaesthesiology, Charité-Universitätsmedizin Berlin, Campus Charité-Mitte, Berlin, Germany
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Miller PM, Day TA, Ravenel MC. Clinical implications of continued alcohol consumption after diagnosis of upper aerodigestive tract cancer. Alcohol Alcohol 2005; 41:140-2. [PMID: 16308354 DOI: 10.1093/alcalc/agh245] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To examine clinical implications of findings on the relationship between continued alcohol consumption in patients after diagnosis and treatment of upper aerodigestive tract cancer. METHODS Clinical research literature on the prevalence and effects of alcohol consumption after oral cancer diagnosis was reviewed. Since limited research is currently available on this important clinical topic, all published studies were considered regardless of size and methodology. RESULTS Between 34 and 57% of oral cancer patients continue to drink alcohol after cancer diagnosis. Continued drinking increases complications from surgery, increases the likelihood of recurrent cancer, and reduces disease-specific survival. Older patients and those with a longer and heavier drinking pattern prior to diagnosis are more likely to continue drinking after diagnosis. CONCLUSIONS Findings indicate that routine alcohol screening of newly diagnosed oral cancer patients as well as brief intervention and/or treatment referral is warranted. Monitoring of alcohol consumption for the first year after diagnosis and treatment is recommended.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, P.O. Box 250861, Charleston, SC 29425, USA.
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Abstract
Substantial evidence demonstrates that: 1) heavy alcohol consumption (three or more standard drinks per day) is associated with and predictive of hypertension; 2) reduction in alcohol consumption is associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure; and 3) physician advice can reduce heavy drinking in hypertensive patients. These findings suggest that the routine evaluation of alcohol consumption in hypertensive patients is warranted. The Alcohol Use Disorders Identification Test-C (AUDIT-C), a brief, three-question screening test, is useful in this regard. Alcohol biomarkers can also play a role in detecting and monitoring heavy drinking in hypertensive patients whose self-reports on the AUDIT-C are suspect. Carbohydrate-deficient transferrin, a new alcohol biomarker with high specificity, can provide objective data for feedback and counseling. A routine search for excessive use of alcohol, along with brief interventions and monitoring, can have a major impact on reducing the prevalence of hypertension in the general population.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 25086, USA.
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Murray V, McKee I, Miller PM, Young D, Muir WJ, Pelosi AJ, Blackwood DHR. Dimensions and classes of psychosis in a population cohort: a four-class, four-dimension model of schizophrenia and affective psychoses. Psychol Med 2005; 35:499-510. [PMID: 15856720 DOI: 10.1017/s0033291704003745] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. METHOD OPCRIT (operational criteria) analysis was performed on 387 adults aged 18-65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. RESULTS Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled 'depression', 'reality distortion', 'mania' and 'disorganization'. Latent classes identified were 'depression', 'bipolar', 'reality distortion/depression' and 'disorganization'. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. CONCLUSIONS Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.
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Affiliation(s)
- V Murray
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK.
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Abstract
Alcohol biomarkers such as carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) have significant potential for enhancing the quality of medical treatment in primary health care settings. Recent studies demonstrate that these laboratory tests can help the general practitioner in several ways. First, CDT and GGT can detect current heavy drinking in primary care patients with a fair degree of sensitivity (approximately 60% to 70%), with CDT being more specific (approximately 90%). When combined with self-report tests, they can provide a clinically useful alcohol screening battery. Second, elevated CDT and GGT levels have been correlated with specific alcohol-sensitive diseases (e.g., hypertension) and, as such, can serve as risk indicators for those diseases. Third, alcohol biomarkers have proven to be useful in monitoring the effectiveness of brief alcohol interventions with medical patients. Unfortunately, preliminary findings indicate that physicians have little knowledge of current biomarker research as applied to primary health care. Translational studies are needed on methods to facilitate knowledge and use of alcohol biomarkers by general practitioners.
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Affiliation(s)
- Peter M Miller
- Medical University of South Carolina, 67 President Street, P.O. Box 250861, Charleston, SC 29425, USA.
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Miller PM, Ornstein SM, Nietert PJ, Anton RF. SELF-REPORT AND BIOMARKER ALCOHOL SCREENING BY PRIMARY CARE PHYSICIANS: THE NEED TO TRANSLATE RESEARCH INTO GUIDELINES AND PRACTICE. Alcohol Alcohol 2004; 39:325-8. [PMID: 15208165 DOI: 10.1093/alcalc/agh070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess knowledge and use of alcohol self-report and biomarker screening by physicians. METHODS Forty-eight primary care physicians were surveyed. RESULTS Knowledge of MCV and GGT was as good as that for non-biomarker screening tools (CAGE, AUDIT) although use was significantly less. Knowledge and use of carbohydrate-deficient transferrin (CDT) was extremely low. CONCLUSIONS Little translation of alcohol biomarker research into guidelines for primary care medicine has occurred. Most physicians report they would utilize these tests more frequently with additional knowledge about availability and use.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs, Medical University of South Carolina, 67 President Street, P.O. Box 250861, Charleston 29425, USA.
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Abstract
Cardiac behavioral medicine is the application of behavioral and psychosocial principles to the prevention and treatment of heart disease. Most biomedical cardiovascular risk factors (e.g., high blood lipids, high blood pressure, diabetes) require behavioral and medical interventions. Other risks, including obesity, high-fat eating pattern, smoking, and inactivity, clearly require lifestyle change. Behavioral medicine screening and intervention have been applied to psychosocial risk factors such as depression, hostility, and social isolation. Appropriate assessment of risk factors is essential because research has demonstrated successful prevention of heart disease and reduction of morbidity and mortality in patients with existing disease. Behavioral interventions have been beneficial in improving cardiac outcomes by enhancing compliance with medication taking and dietary/exercise recommendations. Future needs include the study of psychosocial factors in women and ethnic minorities with heart disease and the integration of behavioral medicine with newer medical technologies designed to detect subclinical biomarkers of heart disease.
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Miller PM, Byrne M, Hodges A, Lawrie SM, Johnstone EC. Childhood behaviour, psychotic symptoms and psychosis onset in young people at high risk of schizophrenia: early findings from the edinburgh high risk study. Psychol Med 2002; 32:173-179. [PMID: 11883726 DOI: 10.1017/s0033291701004779] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several studies suggest that many patients with schizophrenia have pre-morbid neurodevelopmental abnormalities. This study examines how behavioural abnormalities are associated with mild psychotic symptoms and later schizophrenic illness. METHODS Maternal ratings on the Child Behavior Checklist (CBCL) of the early behaviour of 155 subjects were obtained at entry to the Edinburgh study of people at high risk of schizophrenia. These maternal ratings were compared in those with and without psychotic symptoms and used to predict the later onset of psychosis. RESULTS The CBCL syndrome scores for the children prior to age 13 did not distinguish any of the study groups at entry to the study. In the ratings made for the subjects when aged from 13 to 16, delinquent behaviour and 'other problems' were weakly associated with these symptoms. However, with the exception of somatic symptoms and thought problems, the age 13-16 scales were significant predictors of later schizophrenic illness. This was true also for some of the ratings prior to age 13. CONCLUSIONS Various behaviours, in particular, withdrawn and delinquent-aggressive behaviour in adolescents at risk of schizophrenia may predict later onset of the illness. These behaviours, however, are far less predictive of isolated psychotic symptoms prior to psychosis onset.
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Affiliation(s)
- P M Miller
- Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital
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Watkins JA, Sargent RG, Miller PM, Ureda JR, Drane WJ, Richler DL. A study of the attribution style, self-efficacy, and dietary restraint in female binge and non-binge eaters. Eat Weight Disord 2001; 6:188-96. [PMID: 11808814 DOI: 10.1007/bf03339742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to identify the role that attribution style and self-efficacy expectations have in overweight binge and non-binge eaters. The subjects were women (n=210) enrolled for weight control treatment, who completed a questionnaire to assess attribution style and self efficacy expectations. They were categorized into three binge eating disorder (BED) groups: non-BED, borderline BED and BED. The results of the ANOVA analysis indicated that the borderline and BED groups were significantly similar in terms of all measures of attribution and self-efficacy; and logistic regression analysis that the odds of being borderline BED or BED were greater if an individual had internal attributions, and more likely in the presence of diminished self-efficacy expectations. The subjects with low levels of eating self-efficacy and internal, global, and uncontrollable attributions were also more likely to have borderline BED and BED. The implications of the borderline BED category are discussed in relationship to the DSM-IV BED diagnosis.
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Affiliation(s)
- J A Watkins
- School of Public Health, University of South Carolina, Columbia 29208, USA
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Elberson KL, Daniels KK, Miller PM. Structured and nonstructured exercise in a corporate wellness program. A comparison of physiological outcomes. Outcomes Manag Nurs Pract 2001; 5:82-6. [PMID: 11898332] [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: 02/24/2023]
Abstract
The devastating effects from cardiovascular disease are the largest contributors to employers' health care costs, insurance premiums, disability insurance, and worker's compensation. The purpose of this study was to establish baseline data regarding physiological outcomes comparing two participant groups in a corporate wellness program. Results suggest that a corporate wellness program can be beneficial in assisting employees to improve their health behaviors and outcomes.
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Affiliation(s)
- K L Elberson
- Instructional Technology Systems, East Carolina University School of Nursing, Greenville, NC 27858-4353, USA.
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Gutheil TG, Commons ML, Miller PM. Personal questions on cross-examination: a pilot study of expert witness attitudes. J Am Acad Psychiatry Law 2001; 29:85-88. [PMID: 11302392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- T G Gutheil
- Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
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Gutheil TG, Commons M, Miller PM. Withholding, seducing, and threatening: a pilot study of further attorney pressures on expert witnesses. J Am Acad Psychiatry Law 2001; 29:336-339. [PMID: 11592463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- T G Gutheil
- Harvard Medical School, Boston, Massachusetts, USA
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Gutheil TG, Commons ML, Miller PM. Expert witness billing practices revisited: a pilot study of further data. J Am Acad Psychiatry Law 2001; 29:202-206. [PMID: 11471787] [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: 05/23/2023]
Abstract
This pilot study follows up an earlier study of the strategies and rationales by which psychiatric expert witnesses bill for their time on a case. Questionnaires were answered by participants at a workshop at the Annual Meeting of the American Academy of Psychiatry and Law (AAPL). In this follow-up, additional novel billing issues were addressed, some subtler than in the original study. In addition, responses to one question supported the previous finding that experts billed more reasonably when a case was simple. Additional issues included use of fee agreements and returning an unpaid-for case. The implications of these findings are discussed.
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Affiliation(s)
- T G Gutheil
- Program in Psychiatry and the Law, Masschusetts Mental Health Center, Harvard Medical School, Boston, USA
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