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An overview of the impact of dementia that focuses on underdeveloped countries across the globe, and migrant and minority ethnic communities within the developed world. Increased longevity increases the risk of dementia and brings new challenges in terms of cultural perspectives and cultural obligations in the care of elders. The chapter examines these challenges in detail and their consequences in planning for support and care.

The role of gender in psychiatric disorders is not well understood, but several broad trends are known: while men and women experience psychiatric symptoms at roughly the same rate, women are more likely to experience depressive symptoms (Kessler et al., 1993) and men are more likely to experience substance use disorders (DHHS, 1999). However, women are more likely to use primary care services for mental health care than are men (Wells et al., 1986). Equally controversial and not well understood has been the differential responses to treatment interventions by gender (Kornstein, 1997). One recent study found that a depression intervention was more cost-effective for women than for men (Pyne et al., in press). Indeed, the study found that the intervention was essentially cost and outcome neutral for men, while women were found to have a cost-effectiveness ratio of over $5000 for each QALY saved.

This chapter reports findings on two studies that culminated in the development of a multilevel intervention to improve access to health care among chronic drug users. The first two studies began with an investigation of the health care delivery system serving chronic drug users in Miami-Dade County, Florida from the perspectives of both consumers and providers. These studies documented the health care needs and use patterns of chronic drug users as well as the practices and perspectives of the providers who served them. Findings indicated that (1) chronic drug users demonstrated greater health care needs than nondrug users; (2) chronic drug users were less likely to receive appropriate health care services; and (3) the gap between services needed and services actually provided can be ameliorated. By participating in our multilevel intervention, both health care providers and health care consumers changed attitudes and behaviors resulting in the provision of appropriate, accessible, and acceptable health care.

This study examines the decision process of household members in visiting local health care providers. It also explores the effect of various household level socioeconomic factors on motivating rural people to visit traditional versus modern health care providers in rural Bangladesh. I used the Population, Environment, and Poverty data collected from eight villages of rural Bangladesh in 1998 in addition to self-collected ethnographic survey information. The data suggest that a large majority of rural households attempt to visit locally available untrained health care providers first, and then trained doctors as the sickness worsens. The data also suggest that socio-cultural and economic factors are important in shaping their decision to visit traditional as opposed to modern health care providers. Training the traditional and untrained health care providers will be a wise option to ensure health care to the villagers.

This chapter summarizes findings and conclusions from recent studies exploring the role of motivation-readiness factors in drug abuse treatment. The research focuses on populations entering drug treatment, particularly therapeutic community programs in community- and prison-based settings. However, findings from studies in other modalities and from samples not entering treatment are also discussed. Issues addressed include (1) the nature of the motivational concept in recovery, (2) motivation as a variable affecting treatment retention and outcomes, (3) motivation in the treatment process, (4) differences in motivation across treatment populations and modalities, (5) client correlates of motivation, and (6) motivational enhancement. Conclusions highlight the critical role of motivation-readiness factors in understanding treatment-seeking, retention, and outcomes. Key implications are discussed for research, theory, treatment practice, and health care policy. These implications underscore issues relating to the interaction of motivation and treatment processes, the interaction of motivation and treatment demands, differences in motivation among special populations, client correlates of motivation, and self-selection and study designs.