Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia

Introduction and Aims. The purpose of this study was to document treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program (STP) in Australia. Design and Methods. Clients attending the STP for methamphetamine use (n = 105) were assessed on entry to the service and at 3 (n = 86) and 6 months (n = 83) after starting treatment. At each interview methamphetamine use (days of use, severity of dependence), other drug use and health and social functioning (HIV risk behaviour, crime, disability, psychotic symptoms and hostility) were assessed for the past month. Results. Participants received a median of six counselling sessions (interquartile range 1–11) over a period of 89 days (interquartile range 41–148 days). Past month methamphetamine use fell from 79% at treatment entry to 53% at the 3‐month follow‐up (P < 0.001) and 55% at the 6‐month follow‐up (P < 0.001). There were statistically significant reductions in psychotic symptoms, hostility and disability associated with poor mental health. There was no change in other drug use, crime or HIV risk behaviour. Reductions in methamphetamine were more common among younger participants, those who had no history of drug treatment and those without concurrent heroin use. Discussion and Conclusions. Methamphetamine users entering the STP showed reductions in methamphetamine use and improvements in their mental health after treatment. Improved treatment responses are needed to address polydrug use and other harms within in this population.[McKetin R, Dunlop AJ, Holland RM, Sutherland RA, Baker AL, Salmon AM, Hudson SL. Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia. Drug Alcohol Rev 2013;32:80–87]     

Spermiogenesis and spermiation in a marsupial, the tammar wallaby (Macropus eugenii)

Fourteen steps of spermatid development in the tammar wallaby (Macropus eugenii), from the newly formed spermatid to the release of the spermatozoon into the lumen of the seminiferous tubules, were recognised at the ultrastructural level using transmission and scanning electron microscopy. This study confirmed that although the main events are generally similar, the process of the differentiation of the spermatid in marsupials is notably different and relatively more complex than that in most studied eutherian mammals and birds. For example, the sperm head rotated twice in the late stage of spermiogenesis: the shape of the spermatid changed from a T-shape at step 10 into a streamlined shape in step 14, and then back to T-shape in the testicular spermatozoa. Some unique figures occurring during the spermiogenesis in other marsupial species, such as the presence of Sertoli cell spurs, the nuclear ring and the subacrosomal space, were also found in the tammar wallaby. However, an important new finding of this study was the development of the postacrosome complex (PAC), a special structure that was first evident as a line of electron dense material on the nuclear membrane of the step 7 spermatid. Subsequently it became a discontinuous line of electron particles, and migrated from the ventral side of the nucleus to the area just behind the posterior end of the acrosome, which was closely located to the sperm–egg fusion site proposed for Monodelphis domestica (Taggart et al. 1993). The PAC and its possible role in both American and Australian marsupials requires detailed examination. Distinct immature features were discovered in the wallaby testicular spermatozoa. A scoop shape of the acrosome was found on the testicular spermatozoa of the tammar wallaby, which was completely different to the compact button shape of acrosome in ejaculated spermatozoa. The fibre network found beneath the cytoplasm membrane of the midpiece of the ejaculated sperm also did not occur in the testicular spermatozoa, although the structure of the principal piece was fully formed and had no obvious morphological difference from that of the epididymal and ejaculated spermatozoa. The time frame of the formation of morphologically mature spermatozoa in the epididymis of the tammar wallaby needs to be determined by further studies.     

Social marketing and communication in health promotion

Communication is a central aspect of health promotion and theopportunity for mass communication makes the ‘media’a popular option amongst health promoters. The media in thiscontext includes any non-personal channels of communication,from leaflets to television commercials to teaching packs. Thesechannels can be employed directly using deliberately designedmedia materials. Alternatively, they may be used indirectlyby stimulating editorial interest and comment on a particularissue. This paper will make some suggestions for improving theuse of the media in health promotion. In seeking guidance about how to make best use of the media,health promoters can turn to a number of disciplines, includingeducation, medicine, social psychology and communication theory.Another obvious source of insights is commercial marketing,where purposeful media communication, most apparent in the formof advertising, is in continuous use. it is this source of advicethat we want to examine here. In recent years much has been written about the applicationof commercial marketing approaches to social issues-so calledsocial marketing. This paper will begin by examining the originsof ‘social marketing’. it will then discuss itskey concepts and consider how these might help health promoterscommunicate more effectively. However, to interest active health promoters, the discussionneeds to progress beyond ideas and concepts, beyond theory anddemonstrate practical benefits that social marketing can providein real life situations. The paper will therefore continue byexamining the case histories of a number of media based healthpromotion campaigns and illustrate how the most basic of socialmarketing insights, consumer orientation, has contributed tothem.     

Fertility and pregnancy after operation for a prolactinoma

Summary. Pituitary exploration was performed in 40 women with hyperprolactinaemic infertility and a prolactinoma was found in 37. After operation 26 (65%) of the 40 patients had a normal serum prolactin concentration; 31 women have so far had 49 pregnancies; in seven of these patients bromocriptine therapy was used after surgery. Eight of the remaining nine women were shown to be ovulating, but four of these subsequently decided not to attempt a pregnancy. The course and outcome of the 49 pregnancies were similar to those in normal women and no visual or endocrine complications occurred. Surgical removal of a prolactinoma often restores fertility, and may secure a safer pregnancy.     

Lamp light on leadership: clinical leadership and Florence Nightingale

stanley d. & sherratt a. (2010) Journal of Nursing Management  18, 115–121
Lamp light on leadership: clinical leadership and Florence Nightingale Aims The purpose of the present study was to use the example of Florence Nightingales’ nursing experience to highlight the differences between nursing leadership and clinical leadership with a focus on Miss Nightingales’ clinical leadership attributes. Background 2010 marks the centenary of the death of Florence Nightingale. As this significant date approaches this paper reflects on her contribution to nursing in relation to more recent insights into clinical leadership. Evaluation Literature has been used to explore issues related to nursing leadership, clinical leadership and the life and characteristics of Florence Nightingale. Key issues There are a few parts of Florence’s character which fit the profile of a clinical leader. However, Miss Nightingale was not a clinical leader she was a powerful and successful role model for the academic, political and managerial domains of nursing. Conclusion There are other ways to lead and other types of leaders and leadership that nursing and the health service needs to foster, discover and recognize. Implications for nursing management Clinical leaders should be celebrated and recognized in their own right. Both clinical leaders and nursing leaders are important and need to work collaboratively to enhance patient care and to positively enhance the profession of nursing.     

Alcohol consumption and unemployment among men: the Scottish Heart Health Study

There is growing concern about the relationship between health-related behaviour and employment status. Data from the Scottish Mean Health Study included information on the self-reported drinking habits of 4170 full-time employed and 479 unemployed men. This enabled the patterns of alcohol consumption in the unemployed to be compared to those of the full-time workers. There were appreciable differences in both frequency and quantity of reported alcohol consumption between the two groups and a higher percentage of the unemployed reported being non-drinkers. Nevertheless, the unemployed drinkers drank more alcohol than those in employment, even after standardization for both age and social class (27.9 units vs 20.7 units per week). Binge drinking was common in both groups, but the proportion was higher among the unemployed (58.8% of the unemployed reported drinking more than eight units in any day in the previous week compared to 33.5% among the full-time workers). In an attempt to validate these findings and to assess the possible health consequences of heavy drinking, serum gamma-glutamyl transferase levels were analysed. Overall, the unemployed were found to have higher levels, this finding being largely influenced by the excess of heavy drinkers. The reasons behind these differences in drinking behaviour between the employed and unemployed need to be identified before any cause and effect hypotheses can be generated, and counselling given where needed.     

REVIEW: Present and future directions in the treatment of chronic hepatitis B infection

The last decade has witnessed substantial progress in the development of chemotherapeutic agents for chronic hepatitis B. However, the only currently licensed treatment in Australia, interferonalpha, has low initial response rates and the adverse effects are often unacceptable. Of the newer agents in the class of nucleoside analogues, famciclovir and lamivudine are in phase III clinical trials with encouraging preliminary results, while other agents, such as bis-POM PMEA (Adefovir), are at phase I/II development. Future approaches to therapy will be governed by an understanding of the effects of nucleoside analogues on the natural history of the disease as well as on the hepatitis B virus-hepatocyte interaction. Combination antiviral therapy should theoretically offer improved response rates, decrease the development of viral resistance, and provide the greatest reduction in viral load, but it has not yet been widely examined in the clinical setting. In this article, we review the currently available strategies, discuss potential problem areas, and speculate on promising approaches with combination chemotherapy and the features of agents soon to be trialed.