Behavior change is a critical part of effective health care. The final decision to become healthier, however, is that of the patient and not the practitioner. Anyone who has treated patients knows ...

Motivational Interviewing in Health Care: Helping Patients Change Behavior

Wechsler Individual Achievement Test.

The objective of this work is to determine and study, analyze and elaborate, classify and categorize the main risk analysis and risk-assessment methods and techniques by reviewing the scientific literature. The paper consists of two parts: a) the investigation, presentation and elaboration of the main risk-assessment methodologies and b) the statistical analysis, classification, and comparative study of the corresponding scientific papers published by six representative scientific journals of Elsevier B.V. covering the decade 2000–2009. The scientific literature reviewing showed that the risk analysis and assessment techniques are classified into three main categories: (a) the qualitative, (b) the quantitative, and (c) the hybrid techniques (qualitative–quantitative, semi-quantitative). The qualitative techniques are based both on analytical estimation processes, and on the safety managers–engineers ability. According to quantitative techniques, the risk can be considered as a quantity, which can be estimated and expressed by a mathematical relation, under the help of real accidents’ data recorded in a work site. The hybrid techniques, present a great complexity due to their ad hoc character that prevents a wide spreading. The statistical analysis shows that the quantitative methods present the highest relative frequency (65.63%) while the qualitative a lower one (27.68%). Furthermore the hybrid methods remain constantly at a very low level (6.70%) during the entire processing period.

http://risktr.com/dokumanlar/risk%20analysis%20and%20assessment%20methodologies%20in%20th%20work%20sites.pdf

Risk analysis and assessment methodologies in the work sites: On a review, classification and comparative study of the scientific literature of the period 2000–2009

OBJECTIVE\nThe authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management.\n\n\nMETHOD\nPrimary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks after the initial prescription. Those with persistent major depression or significant subthreshold depressive symptoms were randomly assigned to continued usual care or collaborative care. The collaborative care included systematic patient education, an initial visit with a consulting psychiatrist, 2-4 months of shared care by the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Clinical outcomes were assessed through blinded telephone assessments at 1, 3, and 6 months. Health services utilization and costs were assessed through health plan claims and accounting data.\n\n\nRESULTS\nPatients receiving collaborative care experienced a mean of 16.7 additional depression-free days over 6 months. The mean incremental cost of depression treatment in this program was $357. The additional cost was attributable to greater expenditures for antidepressant prescriptions and outpatient visits. No offsetting decrease in use of other health services was observed. The incremental cost-effectiveness was $21.44 per depression-free day.\n\n\nCONCLUSIONS\nA stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs. These findings are consistent with those of other randomized trials. Improving outcomes of depression treatment in primary care requires investment of additional resources, but the return on this investment is comparable to that of many other widely accepted medical interventions.

Cost-effectiveness of a collaborative care program for primary care patients with persistent depression

Purpose. Offender motivation is one specific responsivity variable in offender treatment and motivational interviewing (MI) is commonly used by corrections personnel. Although evidence for the effectiveness of motivational interviewing is accruing overall, a review of MI specifically with offender populations is required.

Method. Relevant databases and websites were searched using terms relating to MI with offenders.

Results. In total, 13 published studies and 6 dissertation abstracts were identified. MI is most evaluated in relation to substance misusing offenders (N=10). Other applications are with domestic violence offenders (N=3), drink-drivers (N=5), and general offending (N=1). In these populations, MI is used to enhance retention and engagement in treatment, improve motivation for change, and change behaviour.

Conclusions. MI can lead to improved retention in treatment, enhanced motivation to change, and reduced offending, although there are variations across studies. To advance the study of MI with offenders, a theory of change needs to be articulated on which testable hypotheses may be based. The integrity of treatment in its application needs to be assured. Based on these foundations, more outcome research is needed to examine who responds to what type of MI in relation to treatment retention, readiness to change, and reconviction.

/pdf/motivational-interviewing-with-offenders-a-systematic-review-3awjbxklem.pdf

Motivational interviewing with offenders: A systematic review

Aims. This study was designed to determine the efficacy of alcohol safety interlocks in reducing recidivism among first and second driving-under-the-influence (DUI) offenders. It also evaluates the overall effectiveness of interlock programs where typically only a small portion of DUI offenders elect to install interlocks. Design. The driving records of DUI offenders participating in interlock programs for 6 months for first offenders and 2 years for second offenders were compared with similar offenders who chose not to participate. Setting. A province-wide program in Alberta, Canada. Participants. Records of 35 132 drivers convicted of DUI between 1 July 1998 and 30 September 1996 were analyzed. Measurements. Repeat DUI offenses during and after the interlock period. Findings. While the offenders had interlocks on their vehicles, DUI recidivism was substantially reduced. Once the interlock had been removed and the participants had been reinstated, their DUI rate was the same as other offenders indicating that the interlock reduced recidivism while in place. Because only 8.9% of eligible drivers elected to participate in the interlock program, the program did not significantly increase the overall effectiveness of the province's management of DUI offenders. Conclusions. Interlocks are associated with a major reduction in DUI recidivism while on the vehicle of the offender. However, because few offenders elect to participate, the program produces only a small (5.9%) overall reduction in the recidivism rate of all DUI offenders.

The Alberta Interlock Program: the evaluation of a province-wide program on DUI recidivism.

Background: Two types of transdermal electrochemical sensors that detect alcohol at the skin surface were evaluated. One, the AMS SCRAM TM device, is locked onto the ankle and is based on a fuel cell sensor; the other, a Giner WrisTAS TM device, worn on the wrist, is based on a proton exchange membrane. SCRAM is used by several court systems in the United States to monitor alcohol offenders, WrisTAS, a research prototype, is not commercially available. Methods: The 2 devices were worn concurrently by 22 paid research subjects (15 men, 7 women), for a combined total of 96 weeks. Subjects participated in both laboratory-dosed drinking to a target of 0.08 g ⁄ dl blood alcohol concentration (BAC), and normal drinking on their own; all subjects were trained to use and carry a portable fuel-cell breath tester for BAC determinations. Overall 271 drinking episodes with BAC ‡ 0.02 g ⁄ dl formed the signal for detection—60 from laboratory dosing, and 211 from self-dosed drinking, with BAC ranging from 0.02 to 0.230 g ⁄ dl (mean 0.077 g ⁄ dl). Results: False negatives were defined as a transdermal alcohol concentration response equivalent <0.02 g ⁄ dl when BAC ‡ 0.02 g ⁄ dl. The overall true-positive hit rate detected by WrisTAS was 24%. The low detection rate was due to erratic output and not recording during nearly 67% of all episodes; reportedly a chipset, not a sensor problem. SCRAM correctly detected 57% across all BAC events, with another 22% (total 79%) detected, but as <0.02 g ⁄ dl. When subjects dosed themselves to BAC ‡ 0.08 g ⁄ dl, SCRAM correctly detected 88% of these events. SCRAM devices lost accuracy over time likely due to water accumulation in the sensor housing. Neither unit had false-positive problems when true BAC was <0.02 g ⁄ dl. Conclusions: Each device had peculiarities that reduced performance, but both types are able to detect alcohol at the skin surface. With product improvements, transdermal sensing may become a valuable way to monitor the alcohol consumption of those who should be abstaining.

http://home.trafficresourcecenter.org/~/media/Microsites/Files/traffic-safety/tms/Field%20and%20Laboratory%20Alcohol%20Detection%20With%202%20Types%20of%20Transdermal%20Devices%20Marques%202009.ashx

Field and Laboratory Alcohol Detection With 2 Types of Transdermal Devices

Aim To identify alcohol biomarker and psychometric measures that relate to drivers' blood alcohol concentration (BAC) patterns from ignition interlock devices (IIDs). Design, setting, participants, measurements In Alberta, Canada, 534 drivers, convicted of driving under the influence of alcohol (DUI), installed IIDs and agreed to participate in a research study. IID BAC tests are an established proxy for predicting future DUI convictions. Three risk groups were defined by rates of failed BAC tests. Program entry and follow-up blood samples (n = 302, 171) were used to measure phosphatidyl ethanol (PETH), carbohydrate deficient transferrin (%CDT), gamma glutamyltransferase (GGT) and other biomarkers. Program entry urine (n = 130) was analyzed for ethyl glucuronide (ETG) and ethyl sulphate (ETS). Entry hair samples were tested for fatty acid ethyl esters (FAEE) (n = 92) and ETG (n = 146). Psychometric measures included the DSM-4 Diagnostic Interview Schedule Alcohol Module, Alcohol Use Disorders Identification Test (AUDIT), the time-line follow-back (TLFB), the Drinker Inventory of Consequences (DRINC) and the Temptation and Restraint Inventory (TRI). Findings Except for FAEE, all alcohol biomarkers were related significantly to the interlock BAC test profiles; higher marker levels predicted higher rates of interlock BAC test failures. PETH, the strongest with an overall analysis of variance F ratio of 35.5, had significant correlations with all nine of the other alcohol biomarkers and with 16 of 19 psychometric variables. Urine ETG and ETS were correlated strongly with the IID BAC tests. Conclusions The findings suggest that several alcohol biomarkers and assessments could play an important role in the prediction and control of driver alcohol risk when re-licensing.

/pdf/estimating-driver-risk-using-alcohol-biomarkers-interlock-g2svr0343v.pdf

Paul R. Marques

Papers

The Alberta Interlock Program: the evaluation of a province-wide program on DUI recidivism.

Field and Laboratory Alcohol Detection With 2 Types of Transdermal Devices

Estimating driver risk using alcohol biomarkers, interlock blood alcohol concentration tests and psychometric assessments: initial descriptives

Predicting repeat DUI offenses with the alcohol interlock recorder

Evaluation of a program to motivate impaired driving offenders to install ignition interlocks.