|
| ||
|
|
||
Chronic Nature (chronic + nature)
Selected AbstractsEmployment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: a randomized controlled trialADDICTION, Issue 9 2009Anthony DeFulio ABSTRACT Context Due to the chronic nature of cocaine dependence, long-term maintenance treatments may be required to sustain abstinence. Abstinence reinforcement is among the most effective means of initiating cocaine abstinence. Practical and effective means of maintaining abstinence reinforcement programs over time are needed. Objective To determine whether employment-based abstinence reinforcement can be an effective long-term maintenance intervention for cocaine dependence. Design Participants (n = 128) were enrolled in a 6-month job skills training and abstinence initiation program. Participants who initiated abstinence, attended regularly and developed needed job skills during the first 6 months were hired as operators in a data entry business and assigned randomly to an employment-only (control, n = 24) or abstinence-contingent employment (n = 27) group. Setting A non-profit data entry business. Participants Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Intervention Abstinence-contingent employment participants received 1 year of employment-based contingency management, in which access to employment was contingent upon provision of drug-free urine samples under routine and then random drug testing. If a participant provided drug-positive urine or failed to provide a mandatory sample, then that participant received a temporary reduction in pay and could not work until urinalysis confirmed recent abstinence. Main outcome measure Cocaine-negative urine samples at monthly assessments across 1 year of employment. Results During the 1 year of employment, abstinence-contingent employment participants provided significantly more cocaine-negative urine samples than employment-only participants [79.3% and 50.7%, respectively; P = 0.004, odds ratio (OR) = 3.73, 95% confidence interval (CI) = 1.60,8.69]. Conclusions Employment-based abstinence reinforcement that includes random drug testing is effective as a long-term maintenance intervention, and is among the most promising treatments for drug dependence. Work-places could serve as therapeutic agents in the treatment of drug dependence by arranging long-term employment-based contingency management programs. [source] Oral lichen planus: a condition with more persistence and extra-oral involvement than suspected?JOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 10 2008Marta Bidarra Background:, Lichen planus is a relatively common and often studied chronic mucocutaneous condition. Reports detailing certain aspects relevant to patients affected have been lacking or inconsistent. Methods:, A questionnaire-based survey was employed to assess the duration of oral lesions and the prevalence of self-reported potential extra-oral manifestations associated with oral lichen planus in 87 patients. All patients had recognized clinical features of oral lichen planus, and most had had histopathological confirmation following oral biopsy. Results:, We report the findings of a preliminary survey which assessed the duration of oral lesions and the prevalence of extra-oral lesions consistent with lichen planus in patients presenting with oral lesions. The study confirmed the chronic nature of oral lichen planus and the rarity of spontaneous resolution. Most subjects had experienced symptoms for one to ten years (66 patients; 75.8%). Approximately 40% (36 patients) of the sample reported clinical features suggestive of extra-oral manifestations of lichen planus by the time that their oral lesions were apparent. The most commonly reported extra-oral manifestations involved the nails (27.6%, 24 patients). 25.3% (22 patients) reported a persistently sore throat suggestive of oesophageal or pharyngeal involvement. Skin (17.2%, 11 patients), and genital (10.3%, 9 patients) involvement was relatively infrequently reported. Most patients reported extra-oral lesions at only one site. Conclusions:, The survey results suggest that in patients with oral lichen planus oral lesions persist for a prolonged period, and that extra-oral lesions may be more common than suspected. However, further studies involving specialists to examine extra-oral sites are required. [source] Implementing a Smoking Cessation Program for Pregnant Women Based on Current Clinical Practice GuidelinesJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2002Lynne Buchanan APRN, PhDArticle first published online: 24 MAY 200 Purpose To describe the U.S. Department of Health and Human Services clinical practice guideline for treating tobacco use and dependence and demonstrate how the guideline was utilized in a pilot program for a small sample of pregnant women (n=20) to help them decrease smoking. Data Sources A convenience sample of 20 pregnant women was recruited from a health maintenance organization at their initial prenatal contact either by telephone or in person. A comparison group of pregnant women (n=28) was used for analysis of outcomes. Conclusions Clinical results showed better outcomes for women in the pilot program when compared to a similar group who did not participate in the program. There was a statistically significant difference between the two groups in average number of cigarettes smoked per day at delivery and two weeks after delivery with pilot program participants reporting less smoking (p<.05). Women in both groups showed a pattern of returning to smoking after delivery of the baby. Implications for Practice Although a few tobacco users achieve permanent abstinence in first or second attempts, the majority continue to use tobacco for many years and typically cycle through many lapse and relapses before permanent abstinence. Ambulatory care systems need to be developed and funded to treat tobacco use and dependence over the life span. Recognition of the chronic nature of the problem and development of long term care delivery systems are needed to assist clients to achieve goals of permanent abstinence and better personal and family health. This cycle of lapse and relapse before permanent abstinence is typical and demonstrates the chronic nature of tobacco use and dependence and the need for long term follow-up. [source] Pain management in horses and farm animalsJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2005Alexander Valverde DVM, DACVA Abstract Objective: This review discusses the different analgesic drugs and routes of administration used in large animals for acute pain management. General guidelines and doses are given to assist in choosing techniques that provide effective analgesia. Etiology: Noxious stimuli are perceived, recognized, and localized by specialized sensory systems located at spinal and supraspinal levels. Diagnosis: Localizing the source of the noxious stimulus as well as understanding the behavioral aspects and physiological changes that result from such insult is important to adequately diagnose and treat pain. Pain assessment is far from being definite and objective; not only are there species differences, but also individual variation. In addition, the behavioral and physiological manifestations vary with the acute or chronic nature of pain. Therapy: Pain management should include (1) selecting drugs that better control the type of pain elicited by the insult; (2) selecting techniques of analgesic drug administration that act on pathways or anatomical locations where the nociceptive information is being processed or originating from; (3) combining analgesic drugs that act on different pain pathways; and (4) provide the best possible comfort for the animal. Prognosis: Providing pain relief improves the animal's well being and outcome; however, interpreting and diagnosing pain remains difficult. Continuing research in pain management will contribute to the evaluation of the pathophysiology of pain, pain assessment, and newer analgesic drugs and techniques. [source] Health economics of asthma: assessing the value of asthma interventionsALLERGY, Issue 12 2008J. D. Campbell The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0,100). Six studies (15%) had quality category 2, 26 studies (65%) achieved quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. [source] ANTHROPOLOGICAL APPROACHES TO THE GLOBAL FOOD CRISIS: UNDERSTANDING AND ADDRESSING THE "SILENT TSUNAMI"ANNALS OF ANTHROPOLOGICAL PRACTICE, Issue 1 2009David Himmelgreen The food riots and demonstrations that occurred in more than 50 countries in 2008 signaled the oncoming global economic recession. Skyrocketing food and fuel prices spurred on violence in poorer countries where there is no social safety net and in places impacted by food insecurity and malnutrition. Today, while the prices for some food staples have retracted a little, the deepening economic recession poses a threat in wealthier nations including the United States and members of the European Union. For example, the shuttering fall in the U.S. stock market in October 2008 resulted in the loss of billions of dollars not only to individual investors but also to states and local municipalities. In this environment, there is a potentially grave threat to the social safety net in the United States including food assistance programs. The World Food Program (WFP) has cited the increase in world food prices as the biggest challenge in its 45-year history, calling the impact a "silent tsunami" that threatened to plunge millions into hunger. In this volume, practicing and applied anthropologists examine the current global food crisis in a variety of settings including Belize, Cuba, the Dominican Republic, Ethiopia, Lesotho, Mozambique, Tanzania, and the United States. Further, they use a variety of theoretical orientations and methodological approaches to understand the chronic nature of food insecurity and the ways in which global food policies and economic restructuring have resulted in increasing food inequities across the globe. Throughout this volume, the authors make suggestions for combating the global food crisis through the application of anthropological principles and practices. [source] Proapoptotic and antiapoptotic markers in cutaneous T-cell lymphoma skin infiltrates and lymphomatoid papulosisBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2001H. Nevala Background In cutaneous T-cell lymphoma (CTCL) lesions, both reactive T cells and malignant T cells intermingle. The disease progression is mostly slow. Recent evidence suggests that even if clinical remission is reached, malignant cells persist and a relapse follows sooner or later. To what extent tumour cell apoptosis occurs in the skin lesions either due to the reactive T cells or to therapeutic efforts is not known. Objectives To determine the extent of tumour cell apoptosis and the expression of proapoptotic and antiapoptotic markers in serial skin lesion samples from patients with CTCL, and to compare the findings with those in patients with lymphomatoid papulosis (LyP). Methods Thirty-four skin samples were obtained from 12 patients with CTCL at the time of diagnosis and at a mean of 1·6, 3 and 6 years later. The patients received psoralen plus ultraviolet A (PUVA), electron beam or cytostatic treatments. In addition, fresh post-treatment samples from three patients with CTCL undergoing PUVA therapy were obtained. For comparison, skin biopsies of five patients with LyP were studied. Immunohistochemical demonstration of the expression of the following markers was performed on formalin-fixed skin sections: Fas (CD95), Fas ligand (FasL), bcl-2, granzyme B, the tumour-suppressor protein PTEN and the effector caspase, caspase-3. The malignant cells were identified morphologically, and apoptotic cells were identified with the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling method on parallel sections. Results In untreated CTCL lesions, apoptotic lymphocytes were extremely rare, and no increase in the number of apoptotic cells was observed after any of the treatments used. In LyP, apoptotic cells were more frequent, comprising on average 5% of the infiltrate. The apoptosis-associated markers Fas, FasL, caspase-3 and granzyme B were expressed by morphologically neoplastic cells in CTCL and by large atypical cells in LyP, with no significant differences. However, only a few reactive cells in CTCL infiltrates expressed granzyme B while about 10% of the corresponding cells were positive in LyP. The expression of antiapoptotic bcl-2 was more frequent in CTCL than in LyP, while PTEN expression was high in both instances. The number of bcl-2+ cells tended to decrease after therapy. When comparing the findings between the first and the last samples, a decrease in the number of bcl-2+ cells and an increase in Fas+ cells was associated with disease progression, despite therapy, while the opposite was true for remissions. Conclusions Apoptosis was found to be a rare event in CTCL lesions irrespective of preceding therapy. During patient follow-up, no significant differences in the expression of apoptotic markers was observed while in most cases a lower level of antiapoptotic bcl-2 expression was observed after all types of therapies and in association with disease progression when compared with high expression in the untreated lesions. The absence of apoptosis and high expression of bcl-2 together with a low expression of apoptosis-inducing granzyme B in the reactive lymphocytes in CTCL could explain the chronic nature of the disease and the poor response to therapy, while the more frequent occurrence of granzyme B and apoptosis together with a lower level of expression of bcl-2 by the large atypical cells in LyP could contribute to the favourable outcome of the latter. [source] | ||||||||||