An Expanded Self‐Medication Hypothesis Based on Cognitive‐Behavioral Determinants for Heroin Abusers in Taiwan: A Cross‐Sectional Study

Background: This study proposed and examined an expanded self‐medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self‐efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self‐efficacy between negative emotional states and heroin use. Methods: A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self‐efficacy. Structural equation modeling was used to examine the eSMH model. Results: Results showed that the eSMH model displayed proper goodness‐of‐fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self‐efficacy was not a significant predictor. Additionally, positive self‐efficacy was a mediator between negative emotional status and heroin use. Conclusion: Results support a reduced eSMH model and suggest a significant role of positive self‐efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states. (Am J Addict 2012;21:S43–S48)     

Syringe Coverage in an Australian Setting: Does a High Level of Syringe Coverage Moderate Syringe Sharing Behaviour?

We examined individual-level syringe coverage among 417 people who inject drugs who were recruited from pharmacies in New South Wales in 2009. There was a U-shaped distribution of syringe coverage with many people having very high (51%) or very low (23%) coverage. Overall, two-thirds of respondents (63%) reported adequate coverage (≥ 100%). Respondents who had not used a needle and syringe program in the previous month were more likely to report inadequate coverage (AOR 2.25, 95% CI 1.25-4.05) as were those who reported daily or more frequent injecting (AOR 3.69, 95% CI 2.00-6.81). Inadequate syringe coverage was not independently associated with receptive needle sharing. The level of syringe coverage was high among this sample, and met targets set out by UNAIDS and other organisations. We found that inadequate syringe coverage was not independently correlated with receptive needle sharing, possibly because coverage is sufficient to diminish the relationship between syringe availability and sharing behaviours.     

Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: Results from the HERCULES trial

Background : Atherosclerotic renal artery stenosis (ARAS) causes hypertension (HTN) and threatens renal function (RF). The HERCULES Trial is a prospective, multicenter trial of renal stenting in patients with uncontrolled HTN and ARAS evaluating the safety and effectiveness of the RX Herculink Elite Renal Stent System (Abbott Vascular, Santa Clara, CA). Results : Mean systolic blood pressure (SBP) at baseline was 162 mm Hg. Nearly 70% of patients were receiving three or more antihypertensive medications (mean 3.4 medications per patient). Baseline serum creatinine was 1.2 ± 0.4 and 61.5% of subjects had estimated glomerular filtration <60. The restenosis rate was 10.5% at 9 months. The study device, procedure, and clinical success rates were 96.0, 99.2, and 98.0%, respectively. Freedom from major adverse events was 94.8%. At 9 months, the mean SBP significantly decreased (mean 145, paired t test P < 0.0001) after stenting with no change in medications. There was no correlation between SBP reduction and baseline BNP or BNP reduction. 相似文献   

Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions

相似文献