An institutional ethnography of prevention and treatment services for substance use disorders in the Dominican Republic

ABSTRACT

The Dominican Republic is thought to have significant epidemics of illicit drug use but lacks surveillance and formal analyses of the policy context of drug prevention and treatment services. We conducted an institutional ethnography of 15 drug service organisations in Santo Domingo and Boca Chica, Dominican Republic, to explore barriers and resources for drug abuse prevention and treatment. Here, we present a typology of drug service organisations based on their services, methods, and approach. We then draw on interviews with representatives of drug service institutions to describe the primary barriers to drug treatment and prevention services for drug users. We conclude with a focus on the policy priorities that could improve the conditions of health care for marginalised drug users in the Dominican Republic.     

Commissure Burn Splints: Literature Review and Prefabrication Technique Using a Visible Light–Cured Resin

Commissure burn splints reduce or eliminate the need for reconstructive surgery after injury to the perioral tissues. The literature describes the injury, immediate care, and splint treatment modalities. A technique to construct a prefabricated commissure burn splint from visible light cure resin and orthodontic wire is presented. Passive or dynamic retraction may be obtained by varying the tension of circumcranial orthodontic headgear or adjusting Velcro placed on a Velfoam strap.     

Management of Periodontal Tissues for Restorative Dentistry

Proper management of periodontal tissues is required to achieve predictable long-term success with restorative dental procedures. Forced eruption as well as several surgical techniques may be used to achieve and maintain adequate biologic width during restorative and esthetic dental procedures. The technique that will yield optimal results depends on the relationship between the restoration's margins and the surrounding periodontium. A classification system that describes these interrelationships and provides treatment recommendations is included.     

Porcelain-Fused-to-Metal Pontics for Improved Removable Partial Denture Esthetics

A removable partial denture fabrication technique that uses custom-constructed porcelain fused-to-metal (PFM) pontics is described. PFM pontics enhance the dentist's shade matching effort in esthetically demanding situations.     

Molybdenocene–DNA interaction studies using electrochemical analysis

The binding interactions of molybdenocene dichloride (Cp₂MoCl₂) and [Cp₂Mo(L)_n]Cl₂ (n = 1, L = 6-mercaptopurine, 6-mercaptopurineribose, 2-amine-6-mercaptopurine and 2-amine-6-mercaptopurineribose and n = 2, L = d-penicillamine) complexes with calf-thymus DNA have been investigated by cyclic voltammetry. Cp₂MoCl₂ belongs to a group of metallocene antitumor agents and [Cp₂Mo(L)_n]Cl₂ complexes are structural modifications of molybdenocene dichloride that have also been shown to possess antitumor properties. From the mechanistic point, there is interest in discovering whether molybdenocene dichloride binds DNA or not. To investigate this issue in more detail, we carried out molybdenocene–DNA titrations monitored by cyclic voltammetry. The changes in oxidation potentials (E_pa) allowed us to determine the degree of Mo–DNA interaction. (Cp₂MoCl₂) and [Cp₂Mo(L)_n]Cl₂ (n = 1, L = 2-amine-6-mercaptopurine and 2-amine-6-mercaptopurineribose and n = 2, L = d-penicillamine) complexes showed weak DNA bindings (3.2–10.1%) while the complexes containing the ligands 6-mercaptopurine and 6-mercaptopurineribose showed negligible interactions. ICP-AES was used to corroborate the CV results.     

下颌骨延长术后牵张器拆除时机的实验研究

目的 :研究家兔下颌骨延长术后新生骨回缩情况 ,确定牵张器的拆除时机。方法 :成年家兔 16只 ,体重 2 .4～ 2 .6kg ,随机等分为 4组 ,每组 4只 ;行双侧下颌骨骨切开术 ,采用内置式牵张器对双侧下颌骨同时进行牵引。延迟期 :7d ;牵张期 :10d ;牵引速率 0 .5mm/次 ,2次 /d ;保持期分别为 2周、4周、8周、12周。保持期后行第二次手术取出牵张器 ,并同时植入钛钉为参照 ,判断下颌骨改建后新成骨有无缩短 ,观察期为 8周。结果 :保持期为 2周、4周组的实验动物新生骨在 8周后明显回缩 ,分别为 2 .1± 1.2mm、1.4± 1.3mm ;而保持期 8周、12周组 ,8周后新生骨未见明显回缩。结论 :兔下颌骨牵张延长术后 ,牵张器应在保持期 8周拆除 ;拆除过早 ,新生骨区产生明显回缩。     

Subgroup Variations in Bone Mineral Density Response to Zoledronic Acid After Hip Fracture

Minimizing post‐fracture bone loss is an important aspect of recovery from hip fracture, and determination of factors that affect bone mineral density (BMD) response to treatment after hip fracture may assist in the development of targeted therapeutic interventions. A post hoc analysis of the HORIZON Recurrent Fracture Trial was done to determine the effect of zoledronic acid (ZOL) on total hip (TH) and femoral neck (FN) BMD in subgroups with low‐trauma hip fracture. A total of 2127 patients were randomized (1:1) to yearly infusions of ZOL 5 mg (n = 1065) or placebo (n = 1062) within 90 days of operation for low‐trauma hip fracture. The 1486 patients with a baseline and at least one post‐baseline BMD assessment at TH or FN (ZOL = 745, placebo = 741) were included in the analyses. Percentage change from baseline in TH and FN BMD was assessed at months 12 and 24 and compared across subgroups of hip fracture patients. Percentage change from baseline in TH and FN BMD at months 12 and 24 was greater (p < 0.05) in ZOL‐treated patients compared with placebo in most subgroups. Treatment‐by‐subgroup interactions (p < 0.05) indicated that a greater effect on BMD was observed for TH BMD at month 12 in females, in patients in the lower tertile body mass index at baseline (≤22.6 kg/m²), and in patients with baseline FN BMD T‐score of ≤ –2.5; for FN BMD in patients who received ZOL for >6 weeks post‐surgery; and for TH and FN BMD in patients with a history of one or more prior fractures. All interactions were limited to the first 12 months after treatment with none observed for the 24‐month comparisons. (Clinical trial registration number NCT00046254.) © 2014 American Society for Bone and Mineral Research.     

NF1 optic pathway glioma: analyzing risk factors for visual outcome and indications to treat

BackgroundThe aim of the project was to identify risk factors associated with visual progression and treatment indications in pediatric patients with neurofibromatosis type 1 associated optic pathway glioma (NF1-OPG).MethodsA multidisciplinary expert group consisting of ophthalmologists, pediatric neuro-oncologists, neurofibromatosis specialists, and neuro-radiologists involved in therapy trials assembled a cohort of children with NF1-OPG from 6 European countries with complete clinical, imaging, and visual outcome datasets. Using methods developed during a consensus workshop, visual and imaging data were reviewed by the expert team and analyzed to identify associations between factors at diagnosis with visual and imaging outcomes.ResultsEighty-three patients (37 males, 46 females, mean age 5.1 ± 2.6 y; 1–13.1 y) registered in the European treatment trial SIOP LGG-2004 (recruited 2004–2012) were included. They were either observed or treated (at diagnosis/after follow-up).In multivariable analysis, factors present at diagnosis associated with adverse visual outcomes included: multiple visual signs and symptoms (adjusted odds ratio [adjOR]: 8.33; 95% CI: 1.9–36.45), abnormal visual behavior (adjOR: 4.15; 95% CI: 1.20–14.34), new onset of visual symptoms (adjOR: 4.04; 95% CI: 1.26–12.95), and optic atrophy (adjOR: 3.73; 95% CI: 1.13–12.53). Squint, posterior visual pathway tumor involvement, and bilateral pathway tumor involvement showed borderline significance. Treatment appeared to reduce tumor size but improved vision in only 10/45 treated patients. Children with visual deterioration after primary observation are more likely to improve with treatment than children treated at diagnosis.ConclusionsThe analysis identified the importance of symptomatology, optic atrophy, and history of vision loss as predictive factors for poor visual outcomes in children with NF1-OPG.     

The donating capacity of the elderly: A case report of vascular dementia

Seniors may be more vulnerable to the influence of others, being less able to make judicious decisions. The legal legitimacy of donating capacity is based on the clinical assumption that, at the time of the event, the donor is able to understand the nature of the transaction, weigh its consequences and determine his/her actions according to it. From the point of view of forensic psychiatry, the evaluation of such premises is a challenge, reflecting the difficulty in assessing, retrospectively, the subject's cognitive functions at the time of the event. In cases where the cross-sectional evaluation favours the diagnosis of dementia it is crucial to objectify the onset and course of the illness. The authors report and discuss the case of a donation from father to sons, involving a great deal of money, made by an 85-year-old man, who had suffered an ischaemic cerebrovascular accident 5 years before.