Drug treatment program ownership, Medicaid acceptance, and service provision

The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002-2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.     

Reproductive health services utilization and its associated factors among adolescents in Debre Berhan town,Central Ethiopia: a community-based cross-sectional study

Background

Utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. As a result, the extent of their service utilization should be determined before implementing any kind of interventions. Therefore, this study was aimed at assessing the level of reproductive health services utilization and its associated factors among adolescents who live in Debre Berhan town.

Methods

A community-based cross-sectional method was employed in this study from April 5–May 1, 2016. A multi-stage systematic sampling technique was applied to select a total of 648 adolescents living in 5 randomly selected kebeles of Debre Berhan town. Moreover, a logistic regression was done to identify independent predictors of reproductive health service utilization.

Results

Accordingly, the major findings of this study reveals that about one-third (33.8%) of adolescents utilized at least one of reproductive health services. Adolescents who had discussed sexual and reproductive health issues with their sexual partner and peers were two times more likely to use reproductive health services than their counter parts (AOR?=?2.368, 95% CI: 1.168–4.802 and AOR?=?2.360, 95% CI: 1.155–4.820 respectively). Adolescents who weren’t co-resided with both their parents were also about two times more likely to utilize reproductive health service than those who were living together (AOR?=?2.570, 95% CI?=?1.155–4.820). Positive perception of oneself towards acquisition of Human Immunodeficiency Virus urged the adolescents to use RH services twice than those who didn’t perceive themselves as risky (AOR?=?2.231, 95%CI: 1.001–4.975).

Conclusion

Succinctly speaking, the analysis of the major finding suggests that the utilization of reproductive health services among adolescents in the study area was low. Discussion with sexual partner and peers, risk perception of oneself towards the acquisition of human immune-deficiency virus was among the predictors of reproductive health services usage.

     

Compartment syndrome in patients with massive venous thrombosis after inferior vena cava filter placement

Massive venous thrombosis, which can occur acutely after inferior vena cava filter placement, has 2 forms: phlegmasia cerulea dolens and phlegmasia alba dolens. In phlegmasia cerulea dolens, complete occlusion of venous outflow occurs. In the milder phlegmasia alba dolens version, collateral venous flow out of the limb remains despite the venous thrombosis. This article presents, to our knowledge, the first 2 cases of massive venous thrombosis (1 phlegmasia cerulea dolens, 1 phlegmasia alba dolens) below inferior vena cava filters occurring after the acute period. Phlegmasia cerulea dolens and phlegmasia alba dolens can present as compartment syndrome. Prompt fasciotomies were performed, but the underlying massive venous thrombosis was not addressed surgically. Phlegmasia cerulea dolens and phlegmasia alba dolens have high morbidity and mortality. The patient with phlegmasia alba dolens required leg and thigh fasciotomies and eventually required an above-knee amputation. The patient with phlegmasia cerulea dolens developed compartment syndrome in the left leg, right leg, and right thigh. Although he underwent decompression of all of these compartments, he died from multiple organ failure. A multidisciplinary approach with the vascular service and the intensivists is required in the treatment of patients with massive venous thrombosis. Treatment goals include preventing additional propagation of the thrombus via anticoagulation, with strong consideration for catheter-directed thrombolysis or thrombectomy and fasciotomies for compartment syndrome. The orthopedic surgeon should keep phlegmasia cerulea dolens and phlegmasia alba dolens in the differential for compartment syndrome, especially in patients who have had a history of acute or chronic inferior vena cava filter placement.     

Mechanism of anestrus in rats treated with an antihypertensive agent, losulazine hydrochloride

The mechanism of anestrus in rats treated with losulazine, a peripheral sympatholytic antihypertensive agent, was investigated by determining its effect on hypothalamic catecholamines and serum sex hormones and by evaluating the influence of bromocriptine on the reproductive functions of rats treated with losulazine. Groups of six female Upjohn Sprague-Dawley rats were treated orally with 10 mg/kg/day of losulazine and/or 18.75 mg/kg/day of bromocriptine for 15 or 27 days. Six rats were treated with losulazine plus 6.25 mg/kg/day of bromocriptine for 16 days followed by losulazine alone for 11 days. Rats treated with losulazine only were depleted of hypothalamic catecholamines, were hyperprolactinemic, and had interrupted estrous cycles and attenuated vaginal mucosa. Treatment with bromocriptine, a dopamine receptor agonist, resulted in suppression of serum prolactin and normal estrous cycles. Rats reverted back to hyperprolactinemia and anestrus shortly after bromocriptine withdrawal. These results suggest that hyperprolactinemia mediated through hypothalamic dopamine depletion is the mechanism of anestrus in rats treated with losulazine.     

HIV/AIDS Communication Inequalities and Associated Cognitive and Affective Outcomes: A Call for a Socioecological Approach to AIDS Communication in Sub-Saharan Africa

Three-and-a-half decades on, no cure or vaccine is yet on the horizon for HIV, making effective behavior change communication (BCC) the key preventive strategy. Despite considerable success, HIV/AIDS BCC efforts have long been criticized for their primary focus on the individual-level field of influence, drawing on the more reductionist view of causation at the individual level. In view of this, we conducted a series of studies that employed a household survey, field experiment, and textual content analysis, and explored the macro-social-level effects of HIV/AIDS-related media and messages on HIV/AIDS cognitive and affective outcomes in Ethiopia. Against a backdrop of epidemiological and socioecological differences, urban versus rural residence has emerged as an important community-level factor that impacts HIV/AIDS-related media and message consumption processes and associated outcomes. The central thread crossing through the six studies included in this paper demonstrates that urban and rural people in high HIV prevalence contexts differ in their concern about and information needs on HIV/AIDS, HIV/AIDS-related media use, and HIV/AIDS-related cognitive and affective outcomes, as well as in their reaction to differently designed/framed HIV prevention messages. This paper proposes that HIV prevention media and message effects in high epidemic situations should be considered from a larger community-level perspective and calls for a socioecological approach to AIDS communication in the hard-hit sub-Saharan Africa. With a number of concrete recommendations to current and future HIV/AIDS BCC efforts in the region, the study joins an emerging body of health communication literature and theorizing that suggests the need to consider media and message effects from a macro-social perspective.     

Relationship between Serum Concentrations, Hemodynamic Effects, and Cardiovascular Lesions in Dogs Treated with Minoxidil

The threshold hemodynamic changes associated with the cardiovascular (CV) toxicity of minoxidil (MNX) in the dog, characterized by subendocardial necrosis, right atrial hemorrhagic lesions, and coronary vascular medial hemorrhage and necrosis, have not been defined. To determine the relationship between serum concentration, hemodynamic effects [heart rate (HR) and mean arterial pressure (MAP)] and CV toxicity, groups of female Beagle dogs were treated with a continuous iv infusion of dextrose (control) or 0.05, 0.14, 0.43, 1.44, or 4.32 mg/kg/day of MNX for 3 days. Serum concentration of free MNX increased in a dose-related manner and reached steady state within 4 hr after the initiation of infusion. There was a time-dependent, apparently dose-related increase in HR at all doses. MAP was decreased at ≥0.14 mg/kg/day in a time- and dose-related manner. The doses or steady-state serum concentrations of MNX that showed no significant hemodynamic effects and CV toxicity were approximately 0.05 mg/kg or 3.0 ± 0.6 ng/ml and 0.14 mg/kg or 7.3 ± 2.0 ng/ml, respectively. CV toxicity occurred at a serum concentration of 16.6 ± 1.9 ng/ml where HR was increased by 65 ± 11 beats/min and MAP was decreased by 34 ± 2 mmHg. A serum concentration of 7.3 ± 2 ng/ml of MNX that increased HR by 47 ± 14 beats/min and decreased MAP by 17 ± 8 mmHg was not associated with CV toxicity. This study suggests that the threshold hemodynamic effects associated with the CV toxicity of MNX in the dog are a function of an increase in HR by at least 55 beats/min and a decrease in MAP by at least 30 mmHg. In conclusion, the safety margin of drugs like MNX, where the mechanisms of toxicity are known to be related to their pharmacologic effects, should be based on the ratio of the pharmacokinetically and metabolically adjusted dose/serum concentration of the drug that evokes comparable pharmacologic effects in the animal model and humans rather than on the ratio of the nontoxic dose/serum concentration in animals to the efficacious dose in humans.     

Mental distress in medical students of Addis Ababa University

Life in medical schools is said to be stressful leading to emotional distress. A study was conducted to estimate the prevalence of mental distress among medical students of Addis Ababa University using a Self Report Questionnaire (SRQ) in 2001. The SRQ was distributed to the entire student population through class representatives. A total of 273 (80%) students returned completed questionnaires. Of these, 83.2% were males and over 85% were above the age of 20 years. About 70% were Orthodox Christians and nearly half of the study population was from Addis Ababa. The one month prevalence of mental distress was found to be 32.6%. Over 6.0% reported that they had suicidal ideation in the last one month. Females reported symptoms of mental distress more often than males, but the difference was not statistically significant (X2 =2.97, df= 1, P=0.08). Age and level of training were shown to have significant association with mental distress (Age, X2=20.88, df=2, p<0.001 and year of study, X2 = 32.04, df=4, p<0.001). Those who were 20 years of age or below and those who were in the preclinical years of training were likely to report symptoms of mental distress more often than those who were older and above preclinical years of training, respectively. Students who use substances reported symptoms of mental distress more often than non users, but the difference was not statistically significant. The study showed that the risk of mental distress decreases as year of study advances in the medical school. However, this trend showed deflection in the year of internship. This study showed that mental distress is a common problem among medical students of Addis Ababa University. Further studies and support services for the students are recommended.