A trial of relapse prevention with severely dependent male problem drinkers

Over the last two decades, relapse prevention has emerged as a major focus of the treatment of drug problems. Few studies have demonstrated any impact on generally high relapse rates. In this paper the outcome of a controlled trial of a relapse prevention programme with male problem drinkers (n=60) attending an Alcohol Treatment Unit is reported. Subjects who met the inclusion criteria were allocated to a relapse prevention (n=20) procedure or a discussion (n=20) or no-additional treatment (n=20) control procedure. Subjects were followed-up at 6 and 12 months by the first author. The relapse prevention programme was associated with significantly greater increases in pre- and post-treatment self-efficacy compared to the discussion control group and significantly greater probability of total abstinence than all controls over the first 6-month follow up. In addition, the relapse prevention programme was associated with significantly longer survival time to an initial lapse and relapse than the controls. At 12-month follow-up, treatment effects had been eroded. It was concluded that the relapse prevention programme was an effective treatment in the short term and that longer-term impact may require greater focus on maintenance factors, such as the individual's environment.     

EFFECT OF STIMULATION OF THE P6 ANTIEMETIC POINT ON POSTOPERATIVE NAUSEA AND VOMITING

The antiemetic action of stimulation of the P6 (Neiguan) acupuncture(ACP) point has been studied in women, premedicated with nalbuphine10 mg, undergoing minor gynaecological operations under methohexitonenitrousoxide-oxygen anaesthesia. Invasive ACP—manual or electricalat 10 Hz—applied for 5 min at the time of administrationof the premedication markedly reduced the incidence of vomitingand nausea in the first 6 h after operation, compared with untreatedcontrols. This did not occur with stimulation of a "dummy" ACPpoint outside the recognized ACP meridians. Non-invasive methods(stimulation via a conducting stud or by pressure) were equallyas effective as invasive ACP during the early postoperativeperiod. However, both these non-invasive approaches were lesseffective than invasive ACP in the 1–6 h postoperativeperiod, although each was as effective as two standard antiemetics(cyclizine 50 mg, metoclopramide 10 mg). In view of the totalabsence of any side effects in more than 500 ACP procedures,the clinical applications of this finding are worthy of furtherstudy.     

Effects of indomethacin on regional blood flow in conscious rabbits—a microsphere study

In an attempt to reveal the importance of prostaglandins in the control of regional blood flow 20 mg/kg b.wt. indomethacin was given i.v. in conscious resting rabbits. Regional blood flow determinations were made before and 20 min after the injection using the labelled microsphere technique. The blood flow in the stomach wall was reduced by 0.75 ± 0.17 g·min^-1·g^-1 from a level of 1.64 ± 0.24 g·min^-1·g^-1. In jejunum the corresponding figures were 0.44 ± 0.12 and 1.26 ± 0.17 and in the brain 0.29 ± 0.10 and 1.24 ± 0.10. The blood flow in the liver via the hepatic artery increased by 0.20 ± 0.02 g·min^-1·g^-1 from a level of 0.13 ± 0.02 g·min^-1·g^-1. In the retina there was a reduction in blood flow by 2.75 ± 1.03 mg·min^-1 from a starting level of 15.1 ± 2.3 mg·min^-1. In a number of other tissues investigated there were no significant effects of the drug. The results suggest that under resting conditions prostaglandins play a role in the control of blood flow in the gastrointestinal tract, the brain and the retina—tissues which are likely to be rather active under such conditions.     

Developmental Toxicity of L-Selenomethionine in Macaca fascicularis

Forty pregnant long-tailed macaques were dosed via nasogastricintubation with 0, 25, 150, or 300 µg/kg of L-selenomethionine(Se) daily during organogenesis [Gestational Day (GD) 20–50].Clinical examination of the dams, maternal body weights, sonographicevaluations, clinical chemistry screens, and measures of serumprogesterone and urinary estrone conjugates were used as indicatorsof maternal and fetal status in all animals. The pregnanciesof two to three dams from each dose group were followed untilterm ({small tilde}GD 165); the remainder (N = 7/dose group)were scheduled for hysterotomy on GD 100 ± 2. A standardteratologic evaluation was performed including visceral andskeletal examinations. Fetal liver, kidney, skin, and smooth,cardiac, and skeletal muscles were examined by light microscopy;heart muscle was also evaluated by transmission electron microscopy.Neonates delivered at term remained with the dams and were removedperiodically for morphometric, neurologic, behavorial, and ophthalmologicassessments on Days 1, 8, 15, 22, and 30 of age. Dose-dependentmaternal toxicity as evidenced by anorexia, vomiting, and asignificant reduction in body weight increased with increasingduration of Se exposure. One growth-retarded fetus was recoveredon GD 131 from a compromised dam exposed to 25 /ig/kg-day; oneearly embryonic death (GD 35) and two fetal deaths [GD 68 (followedby maternal death) and GD 123] occurred among animals dosedwith 300 µg/kg-day. Pregnancy loss among treated animalswas not significantly different from concurrent or historicalcontrols. No statistically significant treatment-related effectswere observed at necropsy on GD 100 ± 2. One infant exposedto 150 Mg/kg-day prenatally exhibited a unilateral corticalcataract, which may have been a spontaneous occurrence. Thelimited developmental effects observed and reported teratogenesisin nonmammalian species suggest that comparative pharmacokineticstudies are required before the full public health significanceof elevated Se is understood.     

The Process of Transforming Mental Health Services in Australia

Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country.     

The Role of Stigma in Access to Health Care for the Poor

Context

The Affordable Care Act provides new Medicaid coverage to an estimated 12 million low-income adults. Barriers to access or quality could hamper the program''s success. One of these barriers might be the stigma associated with Medicaid or poverty.

Methods

Our mixed-methods study involved 574 low-income adults and included data from an in-person survey and follow-up interviews. Our analysis of the interviews showed that many participants who were on Medicaid or uninsured described a perception or fear of being treated poorly in the health care setting. We defined this experience as stigma and merged our qualitative interviews coded for stigma with our quantitative survey data to see whether stigma was related to other sociodemographic characteristics. We also examined whether stigma was associated with access to care, quality of care, and self-reported health.

Findings

We were unable to identify other sociodemographic characteristics associated with stigma in this low-income sample. The qualitative interviews suggested that stigma was most often the result of a provider-patient interaction that felt demeaning, rather than an internalized sense of shame related to receiving public insurance or charity care. An experience of stigma was associated with unmet health needs, poorer perceptions of quality of care, and worse health across several self-reported measures.

Conclusions

Because a stigmatizing experience in the health system might interfere with the delivery of high-quality care to new Medicaid enrollees, further research and policy interventions that target stigma are warranted.     

Early family predictors of child and adolescent antisocial behaviour: who are the mothers of delinquents?

This study tested the utility of 29 maternal and familial characteristics for the purpose of prospectively identifying children who are at high risk for antisocial and delinquent outcomes. The family data were drawn from the archives of the Dunedin Multidisciplinary Health and Development Study. The study's design offers certain methodological advantages: the sample is a representative unselected birth cohort; the family measures were taken very early in childhood; information about the child's antisocial behaviour was collected from many different sources and at many different ages; a comparison group of children with other behaviour disorders was included, and it was possible to examine the influence of possible ‘confounding variables'. Three groups of 11-year-old children (antisocial (n = 50), other disorders (n = 37), and non-disordered (n = 220)) were compared on family variables. Nine family variables differentiated the antisocial children from the nondisordered children, the most important of which were parental disagreement about how to discipline the 5-year-old child, and many changes of the child's primary caretaker during childhood. In addition, among the children who were known to police by age 15, prospective family variables accounted for significant amounts of the variance in number of police contacts and age at first police contact.     

The Extracellular Portion of HLA-DR α Chain is Composed of Two Compactly Folded Domains

A truncated form of the class II antigen DR alpha chain of the human major histocompatibility complex was produced in bacteria. A cDNA clone encoding the intact chain was modified so that the segment encoding the signal sequence was replaced by an ATG codon and the 3' region downstream to the part corresponding to the third exon was replaced by a stop codon. The new construct was put under the control of the Tac promoter in a bacterial expression vector. The distance between the Shine-Delgarno sequence and the initiation codon was randomized so that clones with optimal expression of the truncated DR alpha chain could be obtained after induced expression and immunoscreening. The truncated DR alpha chain was subjected to limited proteolysis with chymotrypsin, and the resulting cleavage products were analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Two fragments were visualized by western blotting. Electrophoresis in the absence and presence of reducing agents suggested that one of the proteolytic fragments contained a disulphide bridge. It is concluded that the extracellular portion of the DR alpha chain is composed of two compactly folded domains connected by an extended stretch of the polypeptide chain.