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51.
The Institute of Medicine distinguishes between programs based on who is targeted: the entire population (universal), those
at risk (selective), or persons exhibiting the early stages of use or related problem behavior (indicated). Evaluations suggest
that although universal programs can be effective in reducing and preventing substance use, selective and indicated programs
are both more effective and have greater cost-benefit ratios. This paper tests these assumptions by comparing the impact of
these program types in reducing and preventing substance use at the individual level (i.e., those exposed to intervention
services) and in the population (i.e., those exposed and not exposed to intervention services). A meta-analysis was performed
on 43 studies of 25 programs to examine program comparability across IOM categories. When examining unadjusted effect sizes
at the individual level, universal programs were modestly more successful in reducing tobacco use, but selective and indicated
programs were modestly more successful in reducing alcohol and marijuana use. When adjusted to the population level, the average
effect sizes for selective and indicated programs were reduced by approximately half. At the population level, universal programs
were more successful in reducing tobacco and marijuana use and selective and indicated programs were more successful in reducing
alcohol use. Editors’ Strategic Implications: The authors’ focus on the public health value of a prevention strategy is compelling and provides a model for analyses of
other strategies and content areas. 相似文献
52.
Central Sensitization Theory of Migraine: Clinical Implications 总被引:4,自引:2,他引:2
The clinical science of migraine headache continues to evolve. Theories of the pathophysiology of migraine have progressed from the early vascular basis of migraine to more complex current theories that emphasize the centrality of neuronal dysfunction. The most recently articulated theory of migraine is the central sensitization hypothesis, which proposes that altered processing of sensory input in the brainstem, principally the trigeminal nucleus caudalis, could account for many of the temporal and symptomatic features of migraine, as well as its poor response to triptan therapy when such treatment is initiated hours after the onset of pain. Both preclinical and clinical data support the central sensitization theory. A critical clinical implication of this theory is that drugs that are capable of either aborting or arresting the process of central sensitization, most prominently dihydroergotamine, may have a unique role in the treatment of migraine. An additional, and highly practical, implication is based upon the finding that cutaneous allodynia—pain arising from innocuous stimulation of the skin, as in hair brushing or the application of cosmetics—is an easily identifiable marker of central sensitization. Thus, the presence or absence of cutaneous allodynia can be integrated into the routine clinical assessment of migraine and utilized as a determinant of treatment. Future basic and clinical research on central sensitization is likely to be of ongoing importance to the field. 相似文献
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The myxozoan parasite Ceratomyxa shasta is a virulent pathogen of salmonid fish in the Klamath River, Oregon/California, USA. We previously defined four principal genotypes of the parasite (O, I, II, III) based on a trinucleotide repeat (ATC)0–3 in Internal Transcribed Spacer region 1 sequences. Genotypes occur in sympatry and show marked host preference: I in Chinook salmon (Oncorhynchus tschawytscha) and II in non-native rainbow trout (O. mykiss). In the present study, we sequenced the parasite from river water samples collected in May, June and September at three localities below, above and between the Klamath's five dams. We also sampled adult and juvenile coho salmon (O. kisutch), steelhead trout (O. mykiss, anadromous form) and native redband rainbow trout (O. mykiss, freshwater form) and additional Chinook salmon and non-native rainbow trout. We found that the C. shasta population was highly structured spatially, temporally and with respect to fish host species. Genotype O was present in water throughout the basin but detected almost exclusively in steelhead and native rainbow trout. Genotype I was in water only below the dams and detected only in Chinook salmon. Genotype II was detected in coho salmon below the dams, and in non-native rainbow trout exposed both above and below the dams. The same genotypes were detected in adult and juvenile fish of the same species. These findings have major implications for the design of effective surveillance and control programs for this economically and ecologically important fish parasite. 相似文献
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Scalp electrical recording during paralysis: quantitative evidence that EEG frequencies above 20 Hz are contaminated by EMG. 总被引:2,自引:0,他引:2
Emma M Whitham Kenneth J Pope Sean P Fitzgibbon Trent Lewis C Richard Clark Stephen Loveless Marita Broberg Angus Wallace Dylan DeLosAngeles Peter Lillie Andrew Hardy Rik Fronsko Alyson Pulbrook John O Willoughby 《Clinical neurophysiology》2007,118(8):1877-1888
OBJECTIVE: To identify the possible contribution of electromyogram (EMG) to scalp electroencephalogram (EEG) rhythms at rest and induced or evoked by cognitive tasks. METHODS: Scalp EEG recordings were made on two subjects in presence and absence of complete neuromuscular blockade, sparing the dominant arm. The subjects undertook cognitive tasks in both states to allow direct comparison of electrical recordings. RESULTS: EEG rhythms in the paralysed state differed significantly compared with the unparalysed state, with 10- to 200-fold differences in the power of frequencies above 20 Hz during paralysis. CONCLUSIONS: Most of the scalp EEG recording above 20 Hz is of EMG origin. Previous studies measuring gamma EEG need to be re-evaluated. SIGNIFICANCE: This has a significant impact on measurements of gamma rhythms from the scalp EEG in unparalysed humans. It is to be hoped that signal separation methods will be able to rectify this situation. 相似文献
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