Managing the basic health unit in tuberculosis control: a field of challenges

In this study we analyzed the management of Basic Health Units in terms of Tuberculosis (TB) control in a city in the interior of S?o Paulo state. Fourteen managers participated in the study. A closed questionnaire was administered and an open question was also applied. The interview was carried out after obtaining free and informed consent. Data analysis was performed using the Statsoft software Statistica 8.0 and thematic content analysis was used for the qualitative data. It was found there is a clear technical-bureaucratic management, deficient in the activity planning and organization dimensions at the BHU. Hence, health care managers in this study should include management aspects of planning and organization as ways to make TB control feasible.     

Tuberculosis treatment drop out and relations of bonding to the family health team

This study aimed to analyze the relation between the singularities of the sick subject with the history of dropping out of the tuberculosis treatment and the care given by the family health team in light of the bonding concept. The empirical material was built through recorded interviews, in the period from July to September of 2008, using the Thematic Oral History methodology. Interviews were taken with nine users whose drop out was the criteria for closing the treatment to tuberculosis in two municipalities of the metropolitan region of Jo?o Pessoa, Paraíba, Brazil. The analysis was performed according to the discourse analysis technique. The study identified that a therapeutic relation, sharing commitments and the user's valuation, strengthens the bonding and produces the care management democratization. On the other hand, a vertical relation, with fragile bonding, is opposed to the purpose of an intersubjective practice in the perspective of the care co-management.     

The Complexity of Treatment Adherence in Adults with Asthma: Challenges and Opportunities

The therapeutic program for persons with asthma includes recommendations for altering the environment and a drug regimen designed to alleviate symptoms, minimize exacerbations, and improve quality of life. Unfortunately, patients can have difficulty adhering to these recommendations, which contributes to treatment failure and increased costs. This paper provides a comprehensive review of the challenge of adherence in adults with asthma, including the costs and benefits, optimal adherence levels, assessment methods commonly used in research and practice, factors believed to predict poor adherence, and tested and untested strategies for improving adherence. Opportunities for further research are discussed throughout the paper.     

Epigenome‐wide Association of DNA Methylation in Whole Blood With Bone Mineral Density

Genetic and environmental determinants of skeletal phenotypes such as bone mineral density (BMD) may converge through the epigenome, providing a tool to better understand osteoporosis pathophysiology. Because the epigenetics of BMD have been largely unexplored in humans, we performed an epigenome‐wide association study (EWAS) of BMD. We undertook a large‐scale BMD EWAS using the Infinium HumanMethylation450 array to measure site‐specific DNA methylation in up to 5515 European‐descent individuals (N_Discovery = 4614, N_Validation = 901). We associated methylation at multiple cytosine‐phosphate‐guanine (CpG) sites with dual‐energy X‐ray absorptiometry (DXA)‐derived femoral neck and lumbar spine BMD. We performed sex‐combined and stratified analyses, controlling for age, weight, smoking status, estimated white blood cell proportions, and random effects for relatedness and batch effects. A 5% false‐discovery rate was used to identify CpGs associated with BMD. We identified one CpG site, cg23196985, significantly associated with femoral neck BMD in 3232 females (p = 7.9 × 10^?11) and 4614 females and males (p = 3.0 × 10^?8). cg23196985 was not associated with femoral neck BMD in an additional sample of 474 females (p = 0.64) and 901 males and females (p = 0.60). Lack of strong consistent association signal indicates that among the tested probes, no large‐effect epigenetic changes in whole blood associated with BMD, suggesting future epigenomic studies of musculoskeletal traits measure DNA methylation in a different tissue with extended genome coverage. © 2017 American Society for Bone and Mineral Research.     

The Emerging Buprenorphine Epidemic in the United States

The authors sampled for expanded drug testing of 1,061 urine specimens collected by Maryland Division of Parole and Probation staff. They found an increase in the percentage of individuals testing positive for buprenorphine and found that these specimens often contained other drugs, suggesting misuse. Subsequent interviews with 15 probationers and parolees in Baltimore, Maryland, showed wide-scale availability of buprenorphine on the street and in prisons. Medical examiners and drug testing programs should immediately initiate routine testing for buprenorphine to track a possible outbreak of buprenorphine diversion and misuse. Physician education programs should redouble their efforts to teach strategies to deter diversion and misuse of the drug.     

Randomized Trial of Web-Based Training to Promote Counselor Use of Cognitive Behavioral Therapy Skills in Client Sessions

ABSTRACT

Background and Methods: The authors designed and delivered an innovative Web course on cognitive behavioral therapy (CBT), a specific empirically based treatment, to a diverse group of addiction counselors and supervisors in 54 addiction units across the country, and conducted a randomized controlled trial of its effectiveness with 127 counselors. The primary focus of the trial was to assess “adequate adherence to CBT practice” after training as judged by raters blinded to training condition who listened to audiotapes of actual client sessions. Counselors who passed were judged to satisfy 2 criteria: (a) low pass or greater on at least 1 of 3 “CBT-generic skills” assessing session structure; and (b) low pass or greater on at least 1 of 3 “CBT-specific skills” related to use of functional analysis, cognitive skills practice, or behavioral skills practice. Results: Although the counselors’ use of CBT skills in sessions increased after Web course training, it was not statistically significant and not larger than the gain of control-group counselors trained with a written CBT manual.     

Local Adaptations to Implement the Strengthening Families Program in Northeastern Brazil

International Journal of Mental Health and Addiction - Local adaptations can promote user engagement and sustainability in the preventive program. The objective of this study is to evaluate local...