Academic literature on the topic 'Dual diagnosis'

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.

Dual Diagnosis, the co-occurrence of intellectual disability and psychopathology, was evaluated in 31 individuals with 22q13 deletion syndrome. Parents filled out the Reiss Scales for Children's Dual Diagnosis, The Vineland Adaptive Behavior Scales, and the Family Quality of Life Survey in order to describe the mental health, adaptive functioning and family quality of life of the subjects. Six subjects (19.35%) met the criteria for dual diagnosis, three had significant attention problems and another four had significant withdrawn behavior. Dual diagnosis was associated with overall mental health, attention problems, withdrawn behavior, autistic symptoms, anger/self control problems and social skills. Psychotic and attention deficit symptoms were the most frequent symptoms among the Reiss scales. Psychosis was not associated with overall mental health or dual diagnosis; however, it significantly correlated with family interaction, parenting, emotional well-being and quality of life. Maladaptive behavior was marked by a significant increase in externalizing behaviors with age.
Le double diagnostic, la cooccurrence d'une incapacité intellectuelle et psychopathologique, fut évalué avec 31 individus souffrant du syndrome de délétion 22q13. Les parents ont passé le test des échelles de Reiss pour le double diagnostic des enfants, Le Vineland Adaptive Behavior Scales, et le sondage sur la qualité de vie familiale de manière à décrire la santé mentale, le fonctionnement adaptif et la qualité de vie familiale des sujets. Six sujets (19.35%) ont rempli le critère du double diagnostic, trois souffraient de problèmes d'attention significatifs et quatre autres individus souffraient d'un comportement de retrait significatif. Le double diagnostic fut associé avec la santé mentale générale, les problèmes d'attention, le comportement de retrait, des symptômes autistiques, des problèmes de colères ou de contrôle de soi et les habiletés sociales. Les syndromes psychotiques ou de déficits d'attention furent les plus fréquents dans les échelles de Reiss. La psychose ne fut pas associée avec la santé mentale générale ou le double diagnostic; cependant on observa une corrélation significative avec l'interaction familiale, le parentage, le bien-être émotionnel et la qualité de vie. Les comportements mésadaptés furent marqués par une augmentation significative de l'externalisation des comportements avec l'âge.

The dual diagnosis of learning disability and mental illness stigmatises and disenfranchises those subject to it. It silences the structural and material causes of distress, pathologises natural responses to difficult circumstances and legitimises the use of restrictive methods of governance. This study used a Foucauldian genealogical approach to explore the conditions of possibility for the emergence of dual diagnosis in Britain, its attending social practices, and the subjugated discourses that could provide alternative ways of constructing and responding to the distress that people with learning disabilities may experience. Analysis of clinical and social policy documents using Rose’s (1999) six perspectival dimensions suggested that dual diagnosis emerged within a historical context of governmental concerns regarding population control, particularly in relation to economy, productivity and social order. Distal conditions of possibility included the establishment of the state’s legal and political power over insanity; the medicalisation of idiocy and lunacy; and the emergence of disciplinary and biopolitical apparatuses of the state. The developmental (re)construction of idiocy opened up a possibility for its co-occurrence with insanity and presented a conceptual framework that would be taken up following deinstitutionalisation, when dual diagnosis offered an explanation and potential solution for the social problems caused by those who did not settle into the community as desired. Dual diagnosis is neither fixed nor inevitable; it is a ‘truth’ produced by power that has been reified and endorsed through clinical and government policy and practice. Implications for clinical practice, research and policy are discussed. It is proposed that a more helpful approach to alleviating distress, poverty and disability is to address the material and social causes and the power-networks that sustain these.

There is an increase in the number of children who are identified as gifted, and exhibit a learning disorder as well. This condition is known as dual exceptionality. However, there are few empirical studies about this topic. Therefore, the purpose of this article is to pres- ent a case study of a gifted child who was in the process of being diagnosed with Asperger Syndrome. Interviews were conducted with the child, the mother and professionals that served him. Psychological, neurological and phonological evaluations carried out with the boy were analyzed. The mother and professionals raised further explanations for the child’s behavior. The difficulties in the diagnostic process and the need for a multidisciplinary approach are explored.
Se observa un aumento en el número de niños identificados como superdotados que también tienen algún trastorno, condición conocida como doble excepcionalidad. Sin embargo, hay escasez de investigaciones sobre el tema. Luego, el objetivo es presentar un estudio de caso de un niño superdotado que se encontraba en proceso de identificación del síndrome de Asperger. Se realizaron entrevistas con el niño, la madre y los profesionales que lo asistían, y se analizaron evaluaciones psicológica, neurológica y fonoaudiológica llevadas a cabo con el chico. Madre y profesionales hacen ponderaciones acerca del diagnóstico y plantean otras explicaciones para la conducta del niño. Así, darse cuenta de las dificultades en el proceso de identificación y la necesidad del enfoque multidisciplinar para el fenómeno.
Observa-se um aumento no número de crianças identificadas como superdotadas que também apresentam algum transtorno, em uma condição que é denominada dupla excepcionalidade. Porém, há escassez de pesquisas sobre o tema. Nesse sentido, o objetivo deste artigo é apresentar um estudo de caso de uma criança superdotada que estava em processo de diagnóstico da Síndrome de Asperger. Foram realizadas entrevistas com a criança, a mãe e os profissionais que a acompanhavam, e foram analisadas as avaliações psicológica, neurológica e fonoaudiológica, realizadas ao menino. A mãe e os profissionais fazem ponderações enquanto ao diagnóstico e levantam outras possibilidades de explicação para os comportamentos da criança. Percebemse as dificuldades no processo de identificação e a necessidadede um olhar multidisciplinar sobre o fenômeno.

Dual diagnosis clients continue to have low treatment completion rates. The purpose of the current study was to understand if motivational interviewing helped to increase completion rates for clients receiving cognitive behavioral therapy (CBT). Studying the problem was necessary for identifying an evidenced-based model for mental health counselors to help clients with dual diagnoses complete CBT treatment. There were no studies available for understanding the effectiveness of motivational interviewing as a tool for improving treatment completion rates for dual diagnoses clients in intensive outpatient programs. The research question examined if motivational interviewing was effective for improving treatment completion rates for the dual diagnosis population. A quantitative methodology with a quasi-experimental design used for this study and included a paired samples t test, a chi-square test, and a logistic regression analysis. The results showed a statistically significant association between receiving the motivational interviewing techniques and completing CBT. Clients who received motivational interviewing were 4 times more likely to complete CBT treatment compared to clients who did not receive the technique. Clients with increased self-efficacy levels were 2 times more likely to complete treatment, thus addressing the problem of dual diagnosis clients having low treatment completion rates. The overall results demonstrated that clients reduced substance use relapse and recidivism improved. Completing treatment helped to reduce crimes related to drug use; it also prepared substance users for return to society as productive citizens, which promoted positive social change.

Dual Diagnosis (DD) is the co-occurrence of a Severe Mental Illness (SMI), commonly a major psychotic or affective disorder, and a Substance Use Dependence Disorder (SUD). It is a highly prevalent disorder with a large impact in clinical and health care systems due to the complications arising from the comorbidity between both conditions. The aim of this work is twofold: the study of the cognitive performance and the Health Related Quality of Life (HRQOL) in patients with DD. The first one, because few studies have examined this question and its assessment is of great interest, since cognitive functioning is related to the clinical course and may even be a predictor of failure or success of the therapeutic interventions. Although major cognitive impairments can be expected in DD due to the additive effects of both psychiatric disorder and SUD, a wide review of published results on the scientific literature suggest that their cognitive functioning depends, among others, on the main substance of choice, the assessed cognitive domain and the age of the participants. Thus, we focus on the assessment of the executive functioning on one hand, and on the domains of attention, memory and speed of processing on the other, in a sample comprised by subjects with schizophrenia and cocaine dependence (SZ+; n = 30) compared to subjects with schizophrenia without SUD history (SZ-; n=30) and to cocaine dependent subjects without psychiatry comorbidity (COC; n=35). Although in the last decades there has been an increased interest in the Quality of Life as an assessment measure as well as an indicator of the effectiveness of interventions in both SMI and SUD, few studies had focused on DD. For this reason, the second objective of this work was to assess HRQOL in a group with DD (n = 35) and compare it to a group with SMI (n=35) and to another one with SUD (N=35) without comorbidity. Regarding the cognitive functioning, the results showed a similar pattern of performance in the SZ+ and COC groups in neuropsychological tasks related to executive functions, being their performance better than the SZ- group. This may suggest that patients with SZ+ have higher cognitive skills than the SZ- ones. Therefore, the SZ+ patients may be a subgroup of SZ with lower biological vulnerability to develop the illness and maybe, a better psychosocial premorbid functioning, making them more able to acquire the illegal substance of abuse. In the domains of attention, memory and speed of processing, the COC group performed better than both SZ+ and SZ- groups, without differences between them. However, the age was negative related to the cognitive performance in the SZ+ group. So, the older SZ+ showed worse cognitive functioning. Otherwise, the SZ- patients showed a stable cognitive functioining regardless of the age. This, in agreement with the idea of an additional cognitive impairment to the psychiatric disorder manifested in older SZ+ patients because of the long term expression of the neurotoxic consequences of consumption. Concerning HRQOL, all the groups showed lower scores compared with the normative Spanish data. The DD group showed the worst scoring in most of assessed scales and in the mental domain, while the SUD group obtained the best, and the SMI obtained intermediate scores. The worse state in the mental domain appeared strongly related to the number of suicide attempts, daily intake of medication and to the caffeine consumption, only in the DD group. The systematic assessment of the HRQOL status could be a useful tool in the detection of specific care areas, helping to improve the treatment goals as well as an assessment measure of the effectiveness of interventions applied to DD patients. Overall, our results suggest particular characteristics in subjects with DD regarding cognitive performance and HRQOL status, which make them different to the subjects with SMI and SUD. This demonstrates the interest to study DD as a specific diagnostic entity. However, further research in this field, incorporating long term measures and biological parameters, could help to a better understanding of the current knowledge in DD and to increase the benefits in the clinical management of these patients.
Se denomina Patología Dual (PD) a la coocurrencia de un Trastorno Mental Severo (TMS), especialmente de la esfera psicótica y/o afectiva y un trastorno por uso de sustancias (TUS). Se trata de un trastorno de elevada prevalencia, con una gran repercusión clínica y asistencial debido a las complicaciones asociadas a la comorbilidad entre ambas patologías. El presente trabajo se propuso dos objetivos, estudiar el rendimiento cognitivo y la calidad de vida Relacionada con la Salud (CVRS) en pacientes con PD. El primero dada la escasez de estudios y la importancia de su evaluación, puesto que el funcionamiento cognitivo se relaciona con el curso clínico de la PD y puede incluso ser un factor predictivo del éxito o fracaso de las intervenciones terapéuticas. Si bien cabrían esperar importantes déficits cognitivos en los pacientes duales, debido a los efectos aditivos del trastorno psiquiátrico y del TUS, una revisión bibliográfica exhaustiva de los principales resultados publicados sugiere que su funcionamiento cognitivo depende, entre otros factores, de la sustancia principal de abuso, del dominio cognitivo evaluado y de la edad de los participantes. Así, nos centramos en evaluar el funcionamiento ejecutivo por una parte y los dominios de atención, memoria y velocidad del procesamiento de la información por otra, en una muestra de pacientes con esquizofrenia y dependencia a la cocaína (SZ+; n=30) comparados con esquizofrénicos sin historia de TUS comórbido (SZ-; n=30) y un grupo con dependencia a la cocaína sin comorbilidad psiquiátrica (COC; n=35). Aunque en las últimas décadas se ha producido un aumento en el interés de la Calidad de Vida como medida de evaluación y como un indicador de la eficacia de las intervenciones en los TMS y en los TUS, los estudios en la PD son pocos. El segundo objetivo de este trabajo fue evaluar la CVRS en pacientes con PD (n=35), con sólo TMS (n=35) y con sólo TUS (n=35). Los resultados del rendimiento cognitivo mostraron un patrón de actuación similar en los grupos SZ+ y COC en tareas neuropsicológicas dependientes del funcionamiento ejecutivo, siendo el rendimiento de ambos grupos mejor que el del grupo SZ-. Esto podría sugerir que los pacientes SZ+ poseen mayores habilidades cognitivas que los SZ-, y por tanto, pudiendo ser un subgrupo de SZ con menor vulnerabilidad biológica a desarrollar la enfermedad, presentando mayores habilidades ejecutivas y quizás, un mejor funcionamiento psicosocial premórbido que les haría más hábiles para adquirir las sustancias ilegales. En los dominios de atención, memoria y velocidad del procesamiento de la información, el grupo COC presentó un mejor rendimiento que los grupos SZ+ y SZ-, los cuáles no presentaron diferencias entre ellos. Sin embargo, la edad mostró una asociación negativa con la ejecución cognitiva en el grupo SZ+, los pacientes de mayor edad mostraban peor rendimiento cognitivo. En cambio, el grupo SZ- presentaba un déficit cognitivo estable independiente de la edad. Esto es coherente con la idea de un déficit cognitivo adicional al del trastorno psiquiátrico manifestado en los pacientes duales de mayor edad, debido a la expresión a largo plazo de las consecuencias neurotóxicas del consumo. En cuanto a la CVRS, todos los grupos aportaron peores puntuaciones de CVRS respecto a los valores normativos españoles. En la mayoría de subescalas y especialmente en el dominio de salud mental, el grupo con PD mostró las peores puntuaciones, el grupo TUS las mejores y el grupo TMS se situó en una posición intermedia. El peor estado en el dominio mental de la CVRS apareció estrechamente relacionado con los intentos de suicidio, el número de medicamentos diarios y el consumo de cafeína en el grupo PD. La evaluación sistemática del estado de la CVRS puede ser útil en la detección de áreas de atención específica para los objetivos del tratamiento, así como medida de la eficacia de las intervenciones aplicadas a la PD. Nuestros resultados sugieren características de rendimiento neuropsicológico y de CVRS particulares de los pacientes con PD, que los diferencian de aquellos con diagnóstico sólo de TMS o TUS. Ello evidencia el interés de estudiar la población dual como una entidad diagnóstica específica. Sin embargo, se requieren investigaciones futuras que progresen en esta línea de trabajo incorporando además, parámetros neurobiológicos y medidas longitudinales, lo que puede ayudar a mejorar el conocimiento actual de la PD y revertir en beneficios para el manejo clínico de los pacientes.

Comorbidity between Axis I mental disorders and substance use disorders range from 5%--60% (Farrell, 1998; Fowler, 1998). It has been suggested that dually diagnosed patients are inadequately treated for both disorders and that they are problematic from a diagnostic, clinical management and economic perspective. Dual Diagnosis (DD) maybe associated with a number of issues including increased aggression, increased non-compliance with medication (Swartz, 1998), and exacerbated psychopathology (Tomasson, 1997). However, contradictory evidence has also been found (Leon, 1998), which suggests that patients with DD may be a higher functioning population of mentally ill patients. The objectives of the present study were to determine the prevalence and clinical characteristics of dual diagnosis patients in a chronic psychiatric population. A sample of 217 patients with schizophrenia spectrum disorders was randomly sampled from the psychiatric facilities of the Montreal General Hospital. Almost half of the sample presented with comorbid addictive disorders; the most common drugs abused were alcohol, cannabis and cocaine. Those patients who had a lifetime diagnosis of substance abuse or dependence were more likely to be male, had a more severe course of psychiatric illness, higher rates of psychiatric symptomology, were more likely to be tobacco smokers and had higher rates of non-compliance with psychiatric medications. Further analyses revealed lower levels of social support and more legal problems in patients with DD, all of which may negatively impact on the quality of care for dual diagnosis patients in the clinical setting.

Dual Diagnosis (DD) refers to the co-existence of a Severe Mental Illness (SMI) and a Substance Use Disorder (SUD) in the same individual. The comorbid prevalence of these two diagnoses is very common, with Schizophrenia (SZ), Bipolar Disorder (BD), and Major Depressive Disorder (MDD) as the three most prevalent SMI among patients with SUD. The co-existence of SUD and these SMIs includes several clinical characteristics, related to evolution and prognosis, which may complicate a patient`s recovery from both disorders. However, nowadays there is an evident need to carry out studies that provide both theoretical and practical knowledge transferable to the clinical management of patients with DD. The present study aimed, as the first objective, to study personality characteristics in a sample of patients with SUD taking into account their comorbid SMI. We evaluated a sample of 104 male patients undergoing SUD treatment, considered in three groups according to the comorbid SMI: SZ+ Group (SUD and SZ; N=37), BD+ Group (SUD and BD, N=32), and MDD+ Group (SUD and MDD; N=35). Two instruments were used to measure personality, the Cloninger's Temperament and Character Inventory-Revised (TCI-R) and the Zuckerman-Kuhlman Personality Questionnarie (ZKPQ), both based on psychobiological models. In addition, we explored the influence of the SMI in the relationship among personality and clinical variables related to both SUD and SMI diagnoses. Our second objective was to explore the influence of DD in the coping strategies used in relation to addiction treatment. SUD treatment represents a challenging situation for all patients, but given DD clinical complications, we studied the possible differential profile in the coping strategies used between patients with SZ+ (the most prevalent diagnosis in our sample) and SUD only. To elucidate the influence of comorbidity, a sample of 89 male patients undergoing treatment for addiction was included and distributed in two groups: SZ+ Group (SUD and SZ; N=39) and SUD Group (SUD only; N=43); these patients were assessed using the Coping Strategies Inventory (CS) from Tobin and completed an exhaustive clinical evaluation as well. The main personality results indicate that patients with SZ+ are characterized by an increased anxiety and fear of uncertainty (high Harm Avoidance from the TCI-R), difficulties in persevering when facing frustration and fatigue (lower Persistence from TCI-R), and the preference for solitary activities or small groups (lower Sociability from ZKPQ). Our findings suggest that patients with SZ+ are the ones who would especially need strategies to manage negative expectations and anxiety, motivational strategies, and if possible, a gradual incorporation to the group therapy sessions used during SUD treatment. Regarding personality characteristics for patients with BD+, these are characterized by an exploratory activity in response to novel stimulation, being more impulsive, getting easily bored, and by the willingness to experiment strong emotions for the sake of these types of experiences (high Novelty Seeking from the TCI-R and Impulsivity- Sensation Seeking from the ZKPQ). In addition, BD+ diagnosis is highlighted by a higher level of worries, fears, tension, and general emotional upset (high Neuroticism-Anxiety from the ZKPQ). Therefore, patients with BD+ are the ones who would require a therapeutic approach which emphasizes impulsivity management, as well as, achieving the general activity and stimulation they require. Finally, considering patients with MDD+, these are characterized by being more pragmatic, realistic, having an unstable self-image, and an erratic world-view (lower Self-transcendence from the TCI-R). Taking also into account that in previous studies a lower Self-transcendence is linked to worse general well-being and dropping-out SUD treatment, it may be suggested that interventions with MDD+ patients could benefit from therapeutic strategies that aim to increase creativity and spirituality, which are both associated with a higher Self-transcendence. With regards to the main relationships founded among personality and SUD and SMI clinical variables, we observed that such relationships are also influenced by the type of comorbid SMI. Results from the TCI-R indicate that higher scores in Novelty Seeking for patients with BD+ are related to a higher severity of addiction. Harm Avoidance is only linked to clinical variables for patients with SZ+, with a higher Harm Avoidance in patients having a greater presence of negative symptoms and general psychopathology. While Persistence did not show any clinical implications for none of the groups, Self- transcendence only showed clinical implications for the MDD+ group, in which a later age of SUD onset is associated with a lower Self-transcendence. Regarding results from the ZKPQ, we observed a positive relationship between Neuroticism-Anxiety and manic symptoms for patients with BD+, and the number of suicide attempts for patients with SZ+. Lastly, a higher Sociability is related to a later age of SUD onset for patients with SZ+, and to a later age of SMI onset for patients with MDD+. The study about coping strategies using the CSI in patients with SZ+, revealed that they are less likely to employ Engagement Strategies (Problem Solving and Social Support) and they have a lower self-perceived capacity to cope with treatment, compared with patients with SUD only. Among patients with SZ+, a major use of the Problem Solving strategy is related to a later age of SUD onset, and the self-perceived capacity to cope with treatment is negatively linked to severity of addiction and to positive symptoms. According to normative data, both groups (SUD and SZ+) use the Disengagement Strategy of Self-Criticism frequently; although the use of Self-Criticism was lower for patients with SZ+. Additionally, a higher use of Self-Criticism is related to a higher daily amount of medications for the SZ+ group. Hence, the presence of DD is associated with a lower use of active coping strategies and points to the need of training problem solving strategies, as well as, abilities to seek for social support during SUD treatment of patients with SZ+. Working on these two strategies could potentially improve treatment adherence and therapeutic outcomes. In conclusion, the findings of this thesis showed that patients with DD have different personality characteristics depending on their comorbid SMI diagnosis. Moreover, the relationship among personality and SUD and SMI clinical variables is also influenced by the type of SMI. Our findings extend to the DD field previous data about personality dimensions as potential endophenotypes for SZ (high Harm Avoidance) and BD (high impulsivity). Likewise, we observed the potential endophenotypes for developing an addiction (high Novelty Seeking and Impulsivity-Sensation Seeking, which are suggested especially for alcohol SUD) in polydrug users, regardless of the main SUD´s substance and adding nuances according to the comorbid SMI. On the other hand, a lower use of active coping strategies in relation to addiction treatment for patients with SZ+ extends to the DD field previous observations done in patients with SUD only and with SZ. Our data point to the potential usefulness of working different aspects, related to personality and coping, during DD treatment considering the comorbid SMI. However, future research is needed to advance in those lines of research, as well as, to overcome the limitations of our work. Additional studies should include a clinical, personality, and coping assessment, and longitudinal measures combined with objective data such as genetic polymorphisms and functional neuroimaging.
El concepto de Patología Dual (PD) hace referencia a la concurrencia de un Trastorno Mental (TM) y un Trastorno por Uso de Sustancias (TUS) en una misma persona. La prevalencia conjunta de estos dos diagnósticos es muy frecuente, siendo los tres TM severos comórbidos más prevalentes en pacientes con TUS la Esquizofrenia (SZ), el Trastorno Bipolar (TB) y el Trastorno Depresivo Mayor (TDM). La coexistencia del TUS y estos TMs conlleva una serie de características clínicas, de evolución y pronóstico, que dificultan la recuperación del paciente en ambos trastornos. Sin embargo, en la actualidad existe una necesidad evidente de realizar estudios que aporten tanto conocimiento teórico como trasladable al manejo clínico de los pacientes con PD. El presente trabajo se propuso, como primer objetivo, estudiar las características de personalidad en una muestra de pacientes con TUS atendiendo al diagnóstico de TM severo comórbido. Evaluamos una muestra de 104 pacientes hombres en tratamiento para el TUS, considerados en tres grupos según el diagnóstico de TM severo comórbido: Grupo SZ+ (TUS y SZ; N=37), Grupo TB+ (TUS y TB; N=32) y Grupo TDM+ (TUS y TDM; N=35). Se utilizaron dos instrumentos de medición de la personalidad, el Temperament and Character Inventory-Revised (TCI-R) de Cloninger y el Zuckerman-Kuhlman Personality Questionnarie (ZKPQ), ambos basados en modelos psicobiológicos. Además, se exploró la influencia del TM en la relación entre personalidad y variables clínicas tanto del TUS como del TM. Nuestro segundo objetivo consistió en explorar la influencia de la PD en las estrategias de afrontamiento utilizadas en relación al tratamiento de la adicción. El tratamiento para el TUS representa un desafío para todos los pacientes, pero dadas las complicaciones clínicas de la PD se estudió el posible perfil diferencial de las estrategias de afrontamiento entre pacientes con SZ+ (diagnóstico más prevalente en nuestra muestra) y con sólo TUS. Para elucidar la influencia de la comorbilidad, se incluyó una muestra de 89 pacientes hombres en tratamiento para la adicción considerados en dos grupos: Grupo SZ+ (TUS y SZ; N=39) y Grupo TUS (N=43), a quienes se les aplicó el Coping Strategies Inventory (CSI) de Tobin junto con una exhaustiva evaluación clínica. Los principales resultados sobre personalidad indican que los pacientes con SZ+ destacan por una mayor ansiedad y temor a la incertidumbre (elevada Evitación del Riesgo del TCI-R), dificultad para perseverar ante la frustración y la fatiga (menor Persistencia del TCI-R) y preferencia por actividades en solitario o en grupos pequeños (menor Sociabilidad del ZKPQ). Nuestros hallazgos sugieren que los pacientes con SZ+ son quienes necesitarían especialmente de estrategias de manejo de expectativas negativas y ansiedad, de estrategias motivacionales y, siempre que sea posible, una incorporación paulatina a las sesiones grupales utilizadas durante el tratamiento para el TUS. Respecto a las características de personalidad de los pacientes con TB+, éstos destacan por la excitación frente a estímulos novedosos, ser más impulsivos, aburrirse fácilmente y poseer una necesidad de experimentar sensaciones fuertes por el mero hecho de vivirlas (elevadas Búsqueda de Novedad del TCI- R e Impulsividad-Búsqueda de Sensaciones del ZKPQ). Además, el diagnóstico de TB+ destaca por un mayor nivel de preocupaciones, miedos, tensión y malestar general (elevado Neuroticismo-Ansiedad del ZKPQ). Por tanto, serían especialmente los pacientes con TB+ quienes requieren de un énfasis terapéutico en el manejo de la impulsividad y en la búsqueda de la activación y estimulación que necesitan. Finalmente atendiendo a pacientes con TDM+, éstos se caracterizan por ser más pragmáticos, realistas, poseer una imagen más inestable de sí mismos y una visión más errática del mundo (menor Trascendencia del TCI-R). Considerando además que en estudios previos se ha relacionado una menor Trascendencia con peor bienestar general y con el abandono del tratamiento para el TUS, cabe sugerir que las intervenciones con estos pacientes se podrían beneficiar de incluir estrategias terapéuticas que incrementen la creatividad y la espiritualidad, ambas asociadas a una mayor Trascendencia. Respecto a las principales relaciones encontradas entre personalidad y variables clínicas del TUS y del TM, observamos que éstas también se hallan influenciadas por el tipo de TM severo comórbido. Los resultados del TCI-R indican que las puntuaciones superiores en Búsqueda de Novedad de los pacientes con TB+ se asocian a una mayor gravedad de la adicción. La Evitación del Riesgo sólo se relacionó con variables clínicas en pacientes con SZ+, siendo ésta más elevada cuanto mayor es la presencia de síntomas psicóticos negativos y de psicopatología general. Mientras que la Persistencia no mostró relaciones con variables clínicas en ningún grupo, la Trascendencia sólo mostró implicaciones clínicas en el grupo con TDM+, en el cual, una mayor edad de inicio del TUS se asoció a una menor Trascendencia. Respecto a los datos aportados por el ZKPQ, observamos una relación positiva entre el Neuroticismo-Ansiedad y la presencia de síntomas maníacos en pacientes con TB+, así como con la cantidad de intentos de suicidio en pacientes con SZ+. Finalmente, una mayor Sociabilidad se relaciona con una edad más tardía de inicio del TUS en pacientes con SZ+ y de inicio del TM en pacientes con TDM+. El estudio de estrategias de afrontamiento mediante el CSI en pacientes con SZ+ mostró que éstos utilizan con menor frecuencia estrategias de Manejo Adecuado del problema (Resolución de Problemas y Apoyo Social), y perciben que tienen menor capacidad para afrontar el tratamiento respecto a pacientes con sólo TUS. En pacientes con SZ+ un mayor uso de la estrategia de Resolución de Problemas se relaciona con una edad de inicio de TUS más tardía, y la capacidad para afrontar el tratamiento se asocia negativamente a la gravedad de la adicción y a los síntomas psicóticos positivos. Según baremos normativos ambos grupos (TUS y SZ+) recurrían muy frecuentemente a la estrategia de Manejo Inadecuado de Autocrítica, aunque su uso era menor en pacientes con SZ+. Además, una mayor Autocrítica se relaciona con más cantidad diaria de medicación en SZ+. Por tanto, la presencia de PD se vincula a un afrontamiento del tratamiento para la adicción menos activo y apunta a la necesidad de entrenar a los pacientes con SZ+ en el uso de estrategias de resolución de problemas y búsqueda de apoyo social durante su tratamiento para el TUS, pudiendo ello mejorar tanto la adherencia como la respuesta terapéutica. Como conclusión, los hallazgos de esta tesis muestran que los pacientes con PD difieren en las características de personalidad según su diagnóstico de TM severo comórbido. Además, la relación entre la personalidad y las variables clínicas del TUS y TM también se halla modulada por el tipo de TM. Nuestros resultados extienden al ámbito de la PD los datos previos sobre dimensiones de personalidad como posibles endofenotipos de la SZ (elevada Evitación del Riesgo) y del TB (elevada impulsividad). Así mismo, los posibles endofenotipos de personalidad para el desarrollo de la adicción (elevadas Búsqueda de Novedad e Impulsividad-Búsqueda de Sensaciones, que se sugieren especialmente para el TUS por alcohol) los observamos en pacientes policonsumidores, con independencia del tipo de sustancia principal del TUS, añadiendo matices según el TM severo comórbido. Por otra parte, el menor uso de estrategias de afrontamiento activas en relación al tratamiento de la adicción en pacientes con SZ+ extiende al ámbito de la PD observaciones previas realizadas en pacientes con TUS y con SZ. Los datos apuntan a la posible utilidad de trabajar aspectos diferenciales, relacionados con la personalidad y el afrontamiento, durante el tratamiento de la PD atendiendo al TM severo comórbido. Sin embargo, para poder progresar en esta área y superar las limitaciones de nuestros estudios, se requieren futuras investigaciones que, junto con la evaluación clínica, de personalidad y afrontamiento, incluyan registros longitudinales y medidas objetivas como polimorfismos genéticos y de neuroimagen funcional.

1. Objectives: To assess the impact of the pregnancy on dual-diagnosed women. 2. Material and methods: Non-systematic review of the literature, through research on PubMed database with the keywords “dual diagnosis”, “pregnancy” and “mental illness”. 3. Results and conclusions: Dual diagnosis refers to the co-occurrence of a mental illness and substance abuse. The mean age of diagnosis for both mental illnesses and substance abuse on women is between 25 and 34 years old, which coincides with the period when women are most likely to be pregnant. One of the existent barriers on this topic is the lack of knowledge on the part of care providers as to the difficulties and treatment needs of the dual diagnosis client, with resultant anxiety and confusion about how to intervene, the efficacy of treatments, and especially how to balance the needs of the mother and fetus. The studies on this area show that patients with a substance abuse disorder or dual diagnosis had a high-risk pregnancy and less prenatal care than those with a mental illness alone, being schizophrenia the most frequent psychiatric diagnosis. For women who are dually diagnosed, the risks inherent in each disorder are combined with the potential for greater negative impact on pregnancy and the newborn.The risks of poor prenatal care, obstetric complications, and psychosocial difficulties increase and each disorder may exacerbate the other. Early identification and treatment of psychiatric disorders in pregnancy can prevent morbidity in pregnancy and postpartum with the concomitant risks to mother and baby.

Introduction: According to the studies, a quarter of people who drink alcohol suffer at least one depressive episode in their lifetime. It has also been found that one-third of people who suffer from depression, abusively consume psychoactive substances, such as alcohol, as a form of self-healing. Aim: In this retrospective study, we propose to statistically quantify the relationship between alcohol-related mental and behavioural illnesses and depression spectrum disorders. Method: The retrospective study was conducted on a group of hospitalized patients, between January 1st and June 30th, 2018, at "Elisabeta Doamna" Psychiatric Hospital, in Galati, Romania. For diagnosis we used the ICD-10 (The ICD-10 Classification of Mental and Behavioral Disorders. (Clinical description, diagnostic guidelines and psychometric tests, such as HAM-D (Hamilton Depression Rating Scale)), AUDIT (Alcohol Use Disorders Identification Test). Patients were selected among those who had a combination of mental and behavioural disorders due to alcohol and depressive spectrum disorders. Results: Between January 1st and June 30th, 2018, a quarter of total 6316 hospitalized patients, or 24.79% (1566 patients) were diagnosed with alcohol-related disorders, and 5.4% (341 cases) had a dual diagnosis, with alcohol-related disorders associated with depressive elements. During this 6-month period, of all cases of alcohol-related disorders, it was found that approximately 22% had a dual diagnosis, respectively, the combination of alcohol-related disorders with depressive spectrum disorders or depressive elements. Conclusions: Unfortunately, it is estimated that depression will become a secondary cause of disability worldwide after cardiovascular disease. According to the WHO (World Health Organization), this disease affects more than 320 million people worldwide, and its combination with alcohol abuse is alarming. Therefore, patients with dual diagnosis require a multidisciplinary therapeutic approach to reduce or even neutralize the adverse consequences that may occur in the psycho-social, medical, family, economic, or behavioural context.

1.Objective: Dual diagnosis patients perpetrate crime more often than healthy individuals and is of great importance for forensic mental health services. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. This work aims to summarize the epidemiological and clinical approach of dual diagnosis patients, focusing on the Iberian Peninsula scope. Aditionaly, it aims to analyse the state of the art regarding associations between demographic and clinical factors and perpetration of crime in dual disorder patients. 2. Method: A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE and Google Scholar. 3. Results and conclusions: Perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. The three drugs most commonly associated with the drugs–crime connection are heroin, crack and cocaine. A study conducted in penitentiary centers of the Interior in Spain found a high percentage of dual pathology (81.4%) In the portuguese largest security ward, in Coimbra, 40.5% of the sample had dual diagnosis disorders. Forensic units must take an integrated approach to addressing substance-use disorders. It is needed to consider not only the complexities of the substance misuse and the mental disorder, but also the offending behaviour that brought them into the forensic services. Also, social skills can effectively be improved in dual diagnosis patients. Further research is required to identify additional risk factors, such as individual substances of abuse, and establish a causal model leading to criminal perpetration.

Objectives: Wernicke's encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of confusion, ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, whereby recognition of nutritional deficiency or any portion of the triad should prompt treatment. We present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient's alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. Starting from this case report, we pretend to discuss the differential diagnosis of seizures in dual pathology. Materials and methods: Clinical records and Pubmed search using the keywords: Wernicke’s Encephalopathy, Seizures, Alcohol, Benzodiazepines. Results and conclusions: Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments. At discharge the diagnostic discussion prevailed and the patient was medicated for seizures with clinical stabilization. The complexity of psychiatric diagnoses in dual pathology requires a longitudinal assessment for a better understanding of clinical conditions as illustrated here.

Abstract Well operators often face various technical challenges when intervening and repairing older, mature field wells. The most common problem associated with aging wells are tubing and casing integrity. Uncertain sources of downhole leaks and data ambiguity often lead to incorrect diagnostics that can hinder repair work or even contribute to additional or worsened integrity issues. Operators continuously challenge service companies and technology providers to drive innovation. One such challenge is in finding efficient and comprehensive integrity diagnostics for dual-string wells. A basic and general diagnostic method to verify well integrity in dual-string wells involves setting plugs in the long and short strings and pressure testing the tubings. These operations are generally time consuming, and the test data does not usually pinpoint the location of the leak, if any. Since 2016 a new diagnostic solution for this challenge has been implemented using a slickline-deployed passive acoustic logging technique. Carefully designed intervention planning, combined with efficient data acquisition, led to significant time saving and improved data quality. A more complete assessment of the integrity of both strings is now more frequent and often necessary, while challenging the conventional thinking of having to assess the lower string only while assuming the upper string is in good condition. However, investigating dual-string integrity with uncertainty on the source of leak, restrictions on facilities and limitations on surveillance time will often waste more time and money if not approached carefully. This paper discusses two case studies, including a dual-string oil producer in the South China Sea that had sustained pressure in production casing annulus. The well operator initially considered that the long string had an integrity issue, while the short string did not, based on their surface-based annulus pressure diagnostics. Consequently, the operator decided to diagnose only the long string. The passive acoustic memory tool. combined with a fast-response temperature and spinner used for the diagnosis, identified a possible short string leak while logging through the long string. This result clearly demonstrated that surface analyses can be misleading, and a comprehensive downhole diagnostic should be the recommended method to identify leaks, especially in dual-string completions. This well operator has completed more than 100 integrity diagnostic runs in the last five years. The passive acoustic diagnostic interventions have resulted in an average 50-percent time saving compared to legacy methods, and data analysis results have led to significant improvements in well productivity.

Methods and Material: All patients admitted for inpatient treatment at Alcohol and New Addiction’s Treatment Unit from Lisbon’s Psychiatric Hospital Center, between 1st November 2021 and 30th April 2022, were selected and screened for sociodemographic and clinical characteristics (age, gender, education level, professional situation, and activity sector at admission as well as main admission diagnosis and other psychiatric comorbidities). Comparative analysis focused on patient’s work capacity was conducted between patients who had been diagnosed with an addiction disorder (AD) and patients with DD. Results and Conclusions: Our sample had 78 patients (59 male; 19 female) and an average age of 50.7 years. From those 78 patients, 31 had diagnosis of AD and 47 had DD. Most studied until the 9th grade (55%), 26% completed 12th grade and 19% had a degree. Only 27% patients were still active at admission, with 15% being with temporary incapacity certificate and most of them being unemployed (41%) or retired (17%). Most patients worked in accommodation, transportation, and food services activities (29%), construction sector (19%) and in healthcare, education, and social work activities (17%). In our sample, more than half patients (60%) had DD. The unemployment rates between patients with (40%) and without (42%) DD were similar. However, 39% of patients without DD were active while only 19% with DD were active. Also of interest was that 34% of those with DD worked in accommodation, transportation, and food services activities and 26% of those without DD worked in the construction sector. These results show that DD has a significant impact in the working capacity and suggest that there are important differences between professional activity sectors.

Introduction. Dual diagnosis (DD) refers to the simultaneous diagnosis of a psychiatric disorder and a substance use disorder (SUD). The prevalence rate is considerably high in patients with schizophrenia and affective disorders; it predicts a more severe illness course, with decreased adherence to treatment and higher rates of hospitalization. As such, there is a growing demand for clinical guidelines and treatment consensus for these patients. In this retrospective analysis, we aimed to examine if and how prescription patterns in DD differ regarding psychiatric diagnosis and type of substance used. Methods. Data from patients with a DD diagnosis admitted at Lisbon’s Psychiatric Hospital Center from June to September 2021 was collected (n=94). Chi-square or Fisher tests were used to analyze associations between substance use and specific psychiatric disorders, along with number and class of medications prescribed. Results. Schizophrenia was the most frequent diagnosis (n=47). The most abused substances were alcohol (n=62) and cannabinoids (n=57). We found a statistically significant association between schizophrenia and cannabis misuse (p=0,006). A personality disorder diagnosis was also found to be associated to the misuse of cannabinoids (p=0,04) and cocaine (p=0,003). Finally, there was a statistically significant association between prescription of 2 or more drugs from different classes and a diagnosis of schizophrenia. No association was found between number/class of drugs, other psychiatric conditions or the type of substance misuse. Conclusion. Our study confirms well established associations between specific substance use and psychiatric conditions. However, no evidence of a specific drug prescription pattern of use in DD patient was apparent, which suggests the need for more studies on DD population and treatment outcomes.

Objectives: to analyze prescription pattern of clozapine in dual diagnosis (DD) inpatients' and to find out if there was any association with acute relapses either from psychiatric symptoms or from substance use disorder. Material and Methods: a retrospective study was conducted with all patients admitted at Lisbon's Psychiatric Hospital Center for psychiatric inpatient treatment during a 4 months' period. Patients with a dual diagnosis at discharge were selected and their clinical files were screened to assess sociodemographic and clinical information. Results and conclusions: from a total of 536 inpatients, 17,5% had a dual diagnosis at discharge. Most frequent substance of abuse was alcohol, followed by cannabinoids, nicotine, cocaine, and opiates. Most frequent psychiatric diagnosis associated with substance use disorder was schizophrenia (50%), depressive disorder (17%) and bipolar disorder (10,6%). Clozapine was prescribed to 22,3% patients and a statistically significant association was found between clozapine prescription and prevention of acute relapses of psychiatric symptoms in DD patients. Although there was no significant association between prescription of clozapine versus other antipsychotic drugs in preventing relapses of substance use, there was found a larger than expected number of patients in clozapine that didn't have a relapse of substance use.

Review question / Objective: This meta-analysis investigated the value of rsDECT -based non-invasive assessment of the severity of esophagus varices and the risk of hemorrhage in patients with cirrhotic portal hypertension. Eligibility criteria: Studies meeting the following criteria were included: Studies evaluating the effect of rsDECT on EV in patients with hepatic cirrhosis, and published in Chinese or English; The diagnosis was based on acknowledged gold standard. Containing complete four-grid table data of diagnostic tests, which can be extracted directly or indirectly. Review, case-report, conference summary, animal study, and repeatedly published study were excluded.Based on the severity of EV shown in the endoscopy, patients in the study group were classified into the mild EV (EV1), medium EV (EV2), or severe EV (EV3) groups according to the General Rules for Recording Endoscopic Findings of Esophagogastric varices (The Japan Society for Portal Hypertension) : EV1, slightly linear expansions; EV2, moderately beaded expansions; EV3, significantly nodular or neoplastic expansions.

Similar to most metering technologies, turbine meters are known to be affected by abnormal flow or abnormal mechanical conditions which can cause bias in flow measurement. These types of flow conditions include blockage at the flow meter or straightening vanes, grime or liquid contamination on the internal meter components, damage to the internal meter components, and pulsation in the flow. With the introduction of ultrasonic and Coriolis meters for gas applications, the natural gas industry has embraced the concept of meters with embedded diagnostic capabilities. These capabilities allow the detection of potential problems with the flow behavior or meter condition that may lead to measurement error. Diagnostic measurements also exist for turbine meters. Some turbine meter manufacturers provide techniques for diagnosing proper meter performance through approaches that include unique design attributes (e.g., dual-rotors) or by monitoring the characteristics (shape, timing, etc.) of the pulses produced as blades pass a sensor. Various analog and digital signal analysis methods exist to interpret the output pulse characteristics to determine meter condition attributes such as bent blades and bearing wear. The objective of this research was to assess, through flow testing, the ability of various diagnostic methods to detect abnormal flow and abnormal mechanical conditions for both single and dual-rotor turbine meters. A secondary objective was to determine the amount of flow measurement error that could be present for the various flow conditions that were tested. The approach was to test three different diagnostic methods on a single-rotor and dual-rotor turbine meter at the Metering Research Facility at Southwest Research Institute. The selected diagnostic methods were the Smith MeterTM AccuLERT II from FMC Technologies, TurbinScope from Elster-Instromet, and The Turbo Corrector from Mercury Instruments. Tests were performed under controlled conditions and were designed to determine the ability of the selected diagnostics to detect various levels of flow meter or tube bundle blockage, grime buildup on the rotor or rotor bearings, damage to the rotor, or flow pulsations.

Limited information exists about enrollment in Part D prescription coverage by Medicare beneficiaries with cancer. Part D coverage may increase access to medicines. This study evaluated patterns of Part D uptake and costs and assessed the effects of coverage on hospitalizations and emergency department (ED) use among people with colorectal cancer (CRC). We analyzed Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data on fee-for-service (FFS) Medicare beneficiaries with at least 36 months of follow-up who were diagnosed with CRC at any point from January 2007 through December 2010, and a matched cohort of beneficiaries without cancer. Dual (Medicare/Medicaid) enrollees were excluded because they are automatically enrolled in Part D. Among beneficiaries with CRC (n=12,774), 39 percent had complete Part D coverage, defined as coverage in the diagnosis year and 2 subsequent years; the rate was 38 percent in the matched comparison cohort (P=.119). Among those with complete Part D coverage, there was no significant difference in annual prescription drug costs between people with CRC ($3,157, 95% confidence interval [CI]: $3,098–$3,216) and without ($3,113, 95% CI: $3,054–$3,172). Among people with CRC, odds of ED use ranged from unchanged to marginally higher for those with no or partial Part D coverage, (adjusted odds ratio: 1.09, 95% CI: 1.00–1.18), compared with those with complete Part D coverage. Lack of continuous Part D coverage was associated with more ED use among Medicare FFS beneficiaries with CRC in 2007–2013. Among people with Part D coverage, prescription drug costs varied little between those with CRC and matched beneficiaries without cancer.

Objectives. To review the association between malnutrition and clinical outcomes among hospitalized patients, evaluate effectiveness of measurement tools for malnutrition on clinical outcomes, and assess effectiveness of hospital-initiated interventions for patients diagnosed with malnutrition. Data sources. We searched electronic databases (Embase®, MEDLINE®, PubMed®, and the Cochrane Library) from January 1, 2000, to June 3, 2021. We hand-searched reference lists of relevant studies and searched for unpublished studies in ClinicalTrials.gov. Review methods. Using predefined criteria and dual review, we selected (1) existing systematic reviews (SRs) to assess the association between malnutrition and clinical outcomes, (2) randomized and non-randomized studies to evaluate the effectiveness of malnutrition tools on clinical outcomes, and (3) randomized controlled trials (RCTs) to assess effectiveness of hospital-initiated treatments for malnutrition. Clinical outcomes of interest included mortality, length of stay, 30-day readmission, quality of life, functional status, activities of daily living, hospital acquired conditions, wound healing, and discharge disposition. When appropriate, we conducted meta-analysis to quantitatively summarize study findings; otherwise, data were narratively synthesized. When available, we used pooled estimates from existing SRs to determine the association between malnutrition and clinical outcomes, and assessed the strength of evidence. Results. Six existing SRs (including 43 unique studies) provided evidence on the association between malnutrition and clinical outcomes. Low to moderate strength of evidence (SOE) showed an association between malnutrition and increased hospital mortality and prolonged hospital length of stay. This association was observed across patients hospitalized for an acute medical event requiring intensive care unit care, heart failure, and cirrhosis. Literature searches found no studies that met inclusion criteria and assessed effectiveness of measurement tools. The primary reason studies did not meet inclusion criteria is because they lacked an appropriate control group. Moderate SOE from 11 RCTs found that hospital-initiated malnutrition interventions likely reduce mortality compared with usual care among hospitalized patients diagnosed with malnutrition. Low SOE indicated that hospital-initiated malnutrition interventions may also improve quality of life compared to usual care. Conclusions. Evidence shows an association between malnutrition and increased mortality and prolonged length of hospital stay among hospitalized patients identified as malnourished. However, the strength of this association varied depending on patient population and tool used to identify malnutrition. Evidence indicates malnutrition-focused hospital-initiated interventions likely reduce mortality and may improve quality of life compared to usual care among patients diagnosed with malnutrition. Research is needed to assess the clinical utility of measurement tools for malnutrition.

One of the most pressing challenges for health programs in most sub-Saharan African countries is effectively addressing the increasing prevalence of HIV/AIDS. Recent evidence suggests that controlling sexually transmitted diseases (STDs) through undertaking preventive measures, early diagnosis, and treatment significantly slows the spread of HIV/AIDS. In regard to STI/HIV, Maternal and Child Health (MCH) and Family Planning (FP) clients are described as “low risk” groups. However, in a number of sub-Saharan African countries, the reported levels of STDs are significantly high enough to justify use of limited resources to target this group for STD services. MCH/FP programs have begun to get more involved in prevention of STDs/HIV among MCH and FP clients through providing integrated programs and integrated services. This move toward integration is gaining momentum, however it presents immense challenges for reproductive health (RH) programs in the region. The issue of the best cost-effective strategy to provide quality integrated MCH/FP/STD/HIV services in the context of scarce financial, laboratory, and technical resources is still unsettled, according to this report, including the technical challenge of altering existing MCH/FP services to simultaneously meet contraceptive and disease-control goals.