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Maintenance Program (maintenance + program)
Kinds of Maintenance Program Selected AbstractsSyringe exchange, injecting and intranasal drug useADDICTION, Issue 1 2010Don C. Des Jarlais ABSTRACT Objective To assess trends in injecting and non-injecting drug use after implementation of large-scale syringe exchange in New York City. The belief that implementation of syringe exchange will lead to increased drug injecting has been a persistent argument against syringe exchange. Methods Administrative data on route of administration for primary drug of abuse among patients entering the Beth Israel methadone maintenance program from 1995 to 2007. Approximately 2000 patients enter the program each year. Results During and after the period of large-scale implementation of syringe exchange, the numbers of methadone program entrants reporting injecting drug use decreased while the numbers of entrants reporting intranasal drug use increased (P < 0.001). Conclusion While assessing the possible effects of syringe exchange on trends in injecting drug use is inherently difficult, these may be the strongest data collected to date showing a lack of increase in drug injecting following implementation of syringe exchange. [source] Periodontal treatment of patients with Papillon,Lefèvre syndrome: a 3-year follow-upJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2004T. Lundgren Abstract Background/aim: Conventional mechanical periodontal treatment of Papillon,Lefèvre syndrome (PLS) has often been reported to fail. This study describes the outcome of a non-surgical periodontal therapy including antimicrobial treatment of nine patients diagnosed with PLS. The patients originate from a total of 15 children and adolescents with PLS for which clinical characteristics are presented. Methods: Clinical examination including conventional periodontal measurements. Initial treatment including oral hygiene instruction, scaling and root planing and systemic amoxicillin,metronidazole therapy for 6 weeks. After that the patients were enrolled in a 3-month recall maintenance program. In addition to this mechanical supportive maintenance treatment, tetracycline was prescribed and used continuously for 1.5 years. Results/Conclusion: On five patients who were showing acceptable standard of oral hygiene and also compliance with the antibiotic medication, development of periodontitis on erupting teeth was prevented and disease activity on the previously periodontally involved teeth controlled during a 3-year period. Poor results of treatment were observed for three patients, all siblings. These patients failed to comply with the medication and also failed to improve their oral hygiene. [source] LC,ESI-MS/MS analysis for the quantification of morphine, codeine, morphine-3-,- D -glucuronide, morphine-6-,- D -glucuronide, and codeine-6-,- D -glucuronide in human urineJOURNAL OF MASS SPECTROMETRY (INCORP BIOLOGICAL MASS SPECTROMETRY), Issue 11 2005Constance M. Murphy Abstract A liquid chromatographic-electrospray ionization-tandem mass spectrometric method for the quantification of the opiates morphine, codeine, and their metabolites morphine-3-,- D -glucuronide (M-3-G), morphine-6-,- D -glucuronide (M-6-G) and codeine-6-,- D -glucuronide (C-6-G) in human urine has been developed and validated. Identification and quantification were based on the following transitions: 286 to 201 and 229 for morphine, 300 to 215 and 243 for codeine, 644 to 468 for M-3-G, 462 to 286 for M-6-G, and 476 to 300 for C-6-G. Calibration by linear regression analysis utilized deuterated internal standards and a weighting factor of 1/X. The method was accurate and precise across a linear dynamic range of 25.0 to 4000.0 ng/ml. Pretreatment of urine specimens using solid phase extraction was sufficient to limit matrix suppression to less than 40% for all five analytes. The method proved to be suitable for the quantification of morphine, codeine, and their metabolites in urine specimens collected from opioid-dependent participants enrolled in a methadone maintenance program. Copyright © 2005 John Wiley & Sons, Ltd. [source] Substance Abuse Treatment and Hospitalization among a Cohort of HIV-Infected Individuals with Alcohol ProblemsALCOHOLISM, Issue 3 2005Anita Palepu Background: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. Methods: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. Results: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7,1.5), whereas homelessness (AOR 2.3; 95% CI 1.5,3.6), injection drug use (AOR 1.7; 95% CI 1.0,2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00,1.05), CD4 cell count (AOR 0.999; 95% CI 0.998,1.00), and HIV RNA (AOR 1.1; 95% CI 1.0,1.2) were independently associated with increased odds of hospitalization over time. Conclusions: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals. [source] Primary care health issues among men who have sex with menJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2006Royal Gee MSN Abstract Purpose: The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. Data source: Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. Conclusions: There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. Implications for practice: Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM. [source] MISSOURI RIVER FLOOD OF 1993: ROLE OF WOODY CORRIDOR WIDTH IN LEVEE PROTECTION,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 4 2003Stephen B. Allen ABSTRACT. We investigated the relationships between levee damage and woody corridor along a 353-mile segment of the Missouri River in Missouri during the flood of 1993. Results indicated that woody corridors between riverbanks and primary levees played a significant role in the reduction or prevention of flood related damage to levees. Forty-one percent of levee failures in this segment occurred in areas with no woody corridor, while 74 percent and 83 percent of failures occurred where woody corridor widths were less than 300 feet and less than 500 feet, respectively. Median failure lengths with a woody corridor present were 50.3 percent shorter than median failure lengths with no woody corridor present. Levees without failures had significantly wider median woody corridor widths than levees that failed. Eligibility for the Corps of Engineers levee maintenance program was not a significant factor in the reduction of levee damage. Discontinuities in woody corridors played a role in 27.5 percent of the levee failures in the study segment. Smaller segments of the river valley were studied to determine if geomorphic differences influenced variations in the protective value of woody corridors. [source] The Effects of Obesity on Functional Work Capacity and Quality of Life in Phase II Cardiac RehabilitationPREVENTIVE CARDIOLOGY, Issue 2 2007John Gunstad PhD Many patients referred to cardiac rehabilitation (CR) programs are obese. It is unknown, however, whether obese patients derive reduced benefit from CR. A total of 388 CR patients were categorized into normal-weight, overweight, class I obese, and class II/III obese groups. Functional work capacity and quality of life were examined at baseline and after 12-week completion of the CR program. After adjusting for demographic and medical conditions, class II/III obese persons showed lower work capacity and physical quality of life at both baseline and follow-up. Class II/III obese individuals also showed smaller gains in work capacity from baseline to follow-up than all other groups. Further work is needed to identify strategies for improving outcome in obese patients, including incorporating structured weight loss into CR or post-CR referral to an exercise maintenance program. [source] Need for Medical and Psychosocial Services Among Injection Drug Users: A Comparative Study of Needle Exchange and Methadone MaintenanceTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2002Michael D. Stein M.D. This study compares the prevalence of perceived and unmet needs of HIV-negative injection drug users (IDUs) not receiving drug treatment (n = 251) and those recruited from a methadone maintenance program (n = 312) in 1998. We studied self-reported needs for six community services: medical, mental health, housing, income assistance, alcohol treatment, and drug treatment. Respondents reported the highest levels of need for mental health and housing services. Ninety-four percent of out-of-treatment IDUs reported having at least one need compared to 62% of methadone clients (p < .001). Across all reported service needs, at least 69% of respondents in both cohorts reported their needs were unmet. While HIV-infected drug users receive assistance through the Ryan White CARE Act, these findings suggest that seronegative drug users may benefit from similar community service programs. [source] Modified Directly Observed Therapy (MDOT) for Injection Drug Users with HIV DiseaseTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2002Elinore F. McCance-Katz M.D., Ph.D. Injection drug use is an important factor in the spread of HIV infection, and strategies to enhance adherence to HIV therapeutics are critically important to controlling viral transmission and improving clinical outcomes. To this end, the authors sought (1) to enhance adherence to highly active antiretroviral therapy (HAART) among methadone-maintained injection drug users (IDUs) using modified directly observed therapy (MDOT), and (2) to define interactions between methadone and HAART and the potential contribution of drug interactions to adherence and HIV outcomes in this population. Adherence was explored here through a pilot, unblinded, 24-week study in a methadone maintenance program in which simplified HAART (efavirenz and didanosine [once daily] and a second nucleoside [twice daily]) was administered 6 days/week by clinic staff to HIV-infected IDUs (n = 5) with their methadone. Evening doses of riboflavin-tagged nucleoside and one full day of medication weekly were given as take home doses. As a result of HAART administration, four of five participants with mean viral load at baseline of 105 copies/ml had undetectable viral load by 8 weeks of treatment (p = 043). Methadone area under the curve (AUC) decreased by 55% (p = 007) within 2 weeks of initiating this HAART regimen, and a mean methadone dose increase of 52%o was required. The authors conclude that MDOT is a promising intervention for the treatment of IDUs with HIV disease, though significant drug interactions must be monitored for carefully and rapidly addressed. [source] Early Functional Loading of Brånemark Dental Implants: 5-Year Clinical Follow-up StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2000Ingvar Ericsson DDS ABSTRACT Background: Short-term clinical studies have indicated the possibility of one-stage surgery and early loading of machined titanium implants. However, long-term data comparing the outcome to the conventional two-stage technique are missing. Purpose: A clinical and radiographic study was performed to compare the outcome of oral rehabilitation of the endentulous mandible by fixed suprastructures connected to implants installed according to either (1) a one-stage surgical procedure and early loading (experimental group - EG) or (2) the original two-stage concept (reference group - RG). The EG and RG comprised 16 and 11 subjects, respectively. Materials and Methods: The following specific inclusion criterion were adopted: (1) all patients had to consider themselves to be in good general health, (2) the amount of bone had to enable the installation of five to six, at least 10-mm long fixtures (Mk II fixtures; Nobel Biocare AB, Göteborg, Sweden) between the mental foramina, and (3) the patients had to be available for the follow-up and maintenance program. A total of 88 implants were placed in the EG compared to 30 in the RG. In the EG, fixed appliances were connected to the implants within 20 days following implant installation while the fixed appliances in the RG were connected about 4 months following fixture installation. At delivery of the suprastructures, all patients were radiographically examined, an examination that was repeated at the 18- and 60-month follow-ups. Results: The analysis of the radiographs from the EG disclosed that during the observation period, between 18 and 60 months, the mean loss of bone support amounted to 0.2 mm (SD = 0.4). The corresponding value observed in the RG was 0.0 mm (SD = 0.5). During the 60-month observation period, no fixture was lost in any of the two groups examined. The implants under study as well as those in the reference material were at all observation intervals found to be clinically stable. Conclusions: This clinical study demonstrated that it is, at least based on a 5-year observation period, possible to successfully load via a permanent fixed rigid cross-arch suprastructure titanium dental implants soon after installation. However, such a treatment approach has to be strictly limited to the interforamina area of the endentulous mandible. Furthermore, the bone resorption was found to be within the same range around such implants as around implants installed and loaded according to the original two-stage protocal. [source] Early colonization of non-submerged dental implants in patients with a history of advanced aggressive periodontitisCLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2006Annemarie L. De Boever Abstract: The aim of the study was to evaluate the early colonization of non-submerged implants over a 6-month period in partially edentulous patients treated for advanced aggressive periodontal disease. In 22 patients treated for advanced aggressive periodontitis and in a supportive maintenance program for a period between 12 and 240 months at implant surgery, a total of 68 non-submerged dental implants were installed. Patients had a plaque score below 20%, and less than 20% of the pockets around the teeth were bleeding on probing (BOP). Using DNA-probes (micro-IDent®), the presence and concentration of five periodontal pathogens (Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf) and Treponema denticola (Td)) were determined in the five deepest pockets of the rest dentition pre-operatively and after 6 months as well as five places around each implant 10 days, 1 month, 3 months and 6 months after surgery. In each patient, a test to determine the genotype interleukin-1 (IL-1) was performed (PST , micro-IDent®). After 6 months, no difference in microbial composition as compared with baseline was found around the teeth in five patients, in 12 minute differences and in five patients important differences were observed. Ten days after surgery, three patients had a complete similar bacterial composition between teeth and implants. In 14 patients, the composition was fairly similar, while large differences in composition and concentration occurred in five patients. This microbiota around the implants remained almost unchanged over a 6-month period and did not hamper the clinical and radiographic osseointegration and did not lead to peri-implantitis, mucositis or initiation of bone destruction. [source] Effect of cumulative seismic damage and corrosion on the life-cycle cost of reinforced concrete bridgesEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 7 2009R. Kumar Abstract Bridge design should take into account not only safety and functionality, but also the cost effectiveness of investments throughout a bridge life-cycle. This paper presents a probabilistic approach to compute the life-cycle cost (LCC) of corroding reinforced concrete (RC) bridges in earthquake-prone regions. The approach is developed by combining cumulative seismic damage and damage associated with corrosion due to environmental conditions. Cumulative seismic damage is obtained from a low-cycle fatigue analysis. Chloride-induced corrosion of steel reinforcement is computed based on Fick's second law of diffusion. The proposed methodology accounts for the uncertainties in the ground motion parameters, the distance from the source, the seismic demand on the bridge, and the corrosion initiation time. The statistics of the accumulated damage and the cost of repairs throughout the bridge life-cycle are obtained by Monte-Carlo simulation. As an illustration of the proposed approach, the effects of design parameters on the LCC of an example RC bridge are studied. The results are valuable in better estimating the condition of existing bridges and, therefore, can help to schedule inspection and maintenance programs. In addition, by taking into consideration the two deterioration processes over a bridge life-cycle, it is possible to estimate the optimal design parameters by minimizing, for example, the expected cost throughout the life of the structure. A comparison between the effects of the two deterioration processes shows that, in seismic regions, the cumulative seismic damage affects the reliability of bridges over time more than the corrosion even for corrosive environments. Copyright © 2008 John Wiley & Sons, Ltd. [source] Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patientsADDICTION, Issue 6 2008David M. Novick ABSTRACT Aims Hepatitis C virus (HCV) infection is a common chronic complication of injection drug use. Methadone maintenance programs contain large numbers of patients infected with HCV. This paper reviews HCV infection with emphasis on the medical care of HCV-infected, or HCV and human immunodeficiency virus co-infected, patients on methadone or buprenorphine maintenance. Methods Literature searches using PubMed, PsycINFO and SocINDEX were used to identify papers from 1990,present on antiviral therapy for HCV in methadone maintenance patients and on liver transplantation in methadone maintenance patients. Results Injection drug use is the most significant risk factor for HCV infection in most western countries. The prevalence of HCV antibody is high in injection drug users (53,96%) and in patients enrolled in methadone maintenance programs (67,96%). Studies of antiviral therapy for HCV in methadone maintenance patients show rates of sustained virological response (SVR), defined as negative HCV-RNA 24 weeks after the end of treatment, of 28,94%. In studies with contrast groups, no significant differences in SVR between methadone and contrast groups were found. Excellent completion rates of antiviral therapy (72,100%) were found in five of six studies. There are many barriers to methadone maintenance patients' receiving antiviral therapy, and research on overcoming barriers is discussed. Liver transplantation has been successful in methadone maintenance patients but has not been utilized widely. Conclusion High quality medical care for all aspects of HCV infection can be provided to methadone maintenance patients. The literature supports the effectiveness of such services, but the reality is that most patients do not receive them. [source] Accessibility of Addiction Treatment: Results from a National Survey of Outpatient Substance Abuse Treatment OrganizationsHEALTH SERVICES RESEARCH, Issue 3 2003Peter D. Friedmann Objectives This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment. Methods Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients. Results In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR, .65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3). Conclusions Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs. [source] Cancer incidence and mortality in aircraft maintenance workers,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2008Catherine D'Este PhD Abstract Background A cancer incidence and mortality study was conducted in response to health concerns raised by workers from F-111 aircraft deseal/reseal fuel tank maintenance programs, to determine whether personnel exposed to deseal/reseal had an excess of cancers and mortality. Methods Number of deaths and cancers for individuals involved in F-111 DSRS activities were matched against two Air Force comparison groups. Analyses were weighted to adjust for differences in age, exposure period and rank. Results Eight hundred seventy-three exposed, 7,577 comparison group one, and 9,408 comparison group two individuals were matched against death and cancer data, with 431 cancers and 431 deaths. Cancer incidence was higher in the exposed group, with marginally significant increases of 40,50% (cancer incidence rate ratio range 1.45,1.62). Exposed group mortality was significantly lower than both comparison groups, likely due to survivor bias in the exposed group (mortality rate ratio range 0.33,0.44). Conclusions On the balance of probabilities, there is an increased risk of cancer associated with participation in F-111 deseal/reseal activities. Am. J. Ind. Med. 51:16,23, 2008. © 2007 Wiley-Liss, Inc. [source] | |||||||||||||