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Drug treatment systems and policy frameworks: a comparative social policy perspective.

The article offers a discussion of drug treatment systems from a social policy perspective. Comparative studies of social policy have utilised typologies to aid analysis. These are briefly characterised in this article. Current analysis of social policy points to changes in the shape of policy regimes. How are these changes impacting on drug treatment systems? Key principles around which policy forms are organised are the desire to effect social control, the desire to meet human need, and the need to minimise harm from risks present in the environment. In practice, these principles operate in tension and different outcomes are observable in different societies. The article argues that, in spite of these historical and cultural differences, some convergence is observable in systems as they adapt to global influences. There remains however an urgent need for more detailed empirical research on policy responses in different countries, utilising the case-study approach adopted by the ISDRUTS collaborators.

Attitude to Health↗

Effect of combined oral contraceptives on bone mineral density in pre and postmenopausal women.

A retrospective urban-based cross-sectional study was done in the department of Pharmacology in collaboration with the department of Obs and Gynae of BSSMU, Dhaka, to define any relation between the OCP and BMD in pre and postmenopausal women. A total of 100 closely matched healthy women were selected non-randomly. The age range was 35-55 years. Among them 50 were controls or nonuser and 50 were case or users of OCP. They were further subdivided into pre and postmenopausal groups. Bone density of the 100 women was measured in distal radius and ulna by single photon Absorptiometry Bone Densitometer DTX-100. Statistically significant higher bone mineral density (BMD) was found in oral combined OCP users than non-users, both in pre and postmenopausal women. It can be concluded from this study that the most important non-contraceptive benefit of OCP may be positive effects on bone mass and thus reduced risk of postmenopausal osteoporosis and osteroporotic fracture.

Adult↗

Genetic variations in CC chemokine receptors and hypertension.

BACKGROUND: CC-chemokine receptor 5 (CCR5) is a co-receptor for human immunodeficiency virus type 1 (HIV-1) infection. Homozygosity for a 32-base pair (bp) deletion (Delta32) in the CCR5 gene confers resistance to HIV-1. Previous studies found an increased prevalence of hypertension among CCR5-Delta32 homozygotes and among carriers of a polymorphism (CCR2-64I) found on the gene that codes a closely related chemokine receptor. The present study was carried out to verify these associations. METHODS: Subjects in this cross-sectional study were selected from the Global Repository at Genomics Collaborative, which includes patients and healthy control subjects enrolled at multiple clinical sites in the United States and other nations. The current study includes 2842 subjects with hypertension and 2893 nonhypertensive control subjects from white populations in the United States and Poland. Case and control subjects were frequency matched by age, gender, and birthplace. All subjects were genotyped for CCR5-Delta32 and CCR2-64I polymorphisms by established Taqman assays. RESULTS: The CCR5-Delta32 genotype was not found to be associated with hypertension (CCR5-Delta32 heterozygosity: odds ratio [OR] 0.99, 95% confidence interval [CI] 0.87 to 1.14; CCR5-Delta32 homozygosity: OR 1.07, 95% CI 0.68 to 1.67) among these subjects. There was also no association between CCR2-64I genotype and hypertension (CCR2-64I heterozygosity: OR 0.96, 95% CI 0.83 to 1.10; CCR2-64I homozygosity: OR 1.18, 95% CI 0.73 to 1.92). These results changed little after adjustment for potential confounding variables. CONCLUSION: The results of the present study, which is much larger than previously published studies, provide no evidence that either CCR5-Delta32 or CCR2-64I is associated with hypertension.

Adult↗

A Drosophila homolog of cyclase-associated proteins collaborates with the Abl tyrosine kinase to control midline axon pathfinding.

We demonstrate that Drosophila capulet (capt), a homolog of the adenylyl cyclase-associated protein that binds and regulates actin in yeast, associates with Abl in Drosophila cells, suggesting a functional relationship in vivo. We find a robust and specific genetic interaction between capt and Abl at the midline choice point where the growth cone repellent Slit functions to restrict axon crossing. Genetic interactions between capt and slit support a model where Capt and Abl collaborate as part of the repellent response. Further support for this model is provided by genetic interactions that both capt and Abl display with multiple members of the Roundabout receptor family. These studies identify Capulet as part of an emerging pathway linking guidance signals to regulation of cytoskeletal dynamics and suggest that the Abl pathway mediates signals downstream of multiple Roundabout receptors.

Animals↗

Consanguinity and apnea of prematurity.

Consanguinity, marriage between relatives, has been associated with perinatal mortality and morbidity. Apnea of prematurity is defined as the cessation of breathing for longer than 20 seconds or that of any duration if accompanied by cyanosis and sinus bradycardia, for infants born before 37 weeks of gestation. The objective of the study was to examine the association between consanguinity and apnea of prematurity in Greater Beirut, an area having a relatively high prevalence rate of consanguineous marriages. The study was cross-sectional. Between September 1, 1998, and March 31, 2001, 21723 newborn infants were admitted to the National Collaborative Perinatal Neonatal Network in Greater Beirut, Lebanon. The inclusion criteria were infants less than 37 weeks of gestation who were admitted to the intensive care unit, with no congenital malformations, sepsis, or neurologic disorders. Analysis was based on 597 infants of whom 66 had apnea of prematurity. With adjustment for weeks and type of gestation, pregnancy complications, and Apgar score, the odds ratio of apnea of prematurity for first-degree consanguineous parents as compared with other marriages was 2.9 (95% confidence interval: 1.3, 6.4). In addition to the recognized etiologic factors for apnea of prematurity, this study suggests a role played by genetic factors.

Adult↗

Risk factors for Kaposi's sarcoma among HHV-8 seropositive homosexual men with AIDS.

Kaposi's sarcoma (KS) is a frequent complication of the acquired immunodeficiency syndrome (AIDS) in homosexual men. Risk factors for developing this malignancy are uncertain, other than immunosuppression and coinfection with human herpesvirus 8 (HHV-8). We therefore examined factors associated with KS in a cross-sectional analysis of 99 cases among 503 HHV-8 seropositive homosexual men with AIDS. Data were collected by computer-assisted personal interviews and medical chart reviews. HHV-8 seroreactivity was determined by enzyme-linked immunosorbent assay for antibodies against HHV-8 K8.1 glycoprotein. KS was significantly less common in blacks compared to whites [risk ratio (RR) = 0.4; 95% CI = 0.2 =0.8] and more common in subjects who had completed college (RR = 1.7; 95% CI = 1.1-2.7) or had annual income greater than dollar 30,000 (RR = 1.5; 95% CI = 1.1-2.2). KS was less common in cigarette smokers (RR = 0.6; 95% CI = 0.5-0.9) and users of crack cocaine (RR = 0.4; 95% CI = 0.1-0.8). KS was less common in bisexual men compared to men who were exclusively homosexual (estimated RR = 0.6; 95% CI = 0.4-0.9) and inversely associated with number of female partners. KS was also less common in men who had received pay for sex (RR = 0.6; 95% CI = 0.4-1.0). These cross-sectional associations could be biased by potential differences in relative timing of HHV-8 and HIV infection, a postulated determinant of KS risk. Alternatively, our findings may reflect factors protective against KS in individuals infected with HHV-8. Future research should focus on identifying practical measures for countering KS that do not increase the risk of other diseases.

Acquired Immunodeficiency Syndrome↗

Community solutions to violence: a Minnesota managed care action plan.

Reducing violence is a critical health and economic priority. In Minnesota, as in other parts of the United States, violence is increasingly viewed as a public health problem. Helping people work together to prevent violence is one way that managed care organizations are collaborating with public health to improve the health of communities. In 1994, Blue Cross and Blue Shield of Minnesota worked with community organizations to develop The Minnesota Action Plan to End Gun Violence, a broad-based solution to a community problem: violence in Minnesota. The goal of this initiative was to develop grassroots solutions to violence and to inspire community members to take action. Outcomes of the initiative included: participation by over 1,000 Minnesotans in 12 community violence prevention forums; a widely distributed action plan; Students Stop Guns, a school-based intervention to keep Minnesota schools gun-free; the Governor's Task Force on Violence as a Public Health Problem, which led to a commitment of resources to prevent violence and respond to the victims and consequences of violence, and the Health Care Coalition on Violence, to institutionalize strategies within the Minnesota health care environment. The project's qualitative evaluation resulted in lessons and advice on how to execute a collaborative health improvement initiative. These lessons have been widely shared with Minnesota community health advocates.

Attitude to Health↗

Does integration really make a difference? A comparison of old age psychiatry services in England and Northern Ireland.

OBJECTIVE: This paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements. DESIGN: The study employed a cross-sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information. MEASURES: A self-administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people's services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter-professional team working. RESULTS: The integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked. CONCLUSIONS: Health and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice-related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services.

Aged↗

Reconciling open-charm production at the Fermilab Tevatron with QCD.

We study the inclusive hadroproduction of D0, D+, D*+, and D(s)+ mesons at next-to-leading order in the parton model of quantum chromodynamics endowed with universal nonperturbative fragmentation functions fitted to e+e- annihilation data from CERN LEP1. Working in the general-mass variable-flavor-number scheme, we resum the large logarithms through the evolution of the fragmentation functions and, at the same time, retain the full dependence on the charm-quark mass without additional theoretical assumptions. In this way, the cross section distributions in transverse momentum recently measured by the CDF Collaboration in run II at the Fermilab Tevatron are described within errors.

Journal Article↗

Integrating Escherichia coli antimicrobial susceptibility data from multiple surveillance programs.

Collaboration between networks presents opportunities to increase analytical power and cross-validate findings. Multivariate analyses of 2 large, international datasets (MYSTIC and SENTRY) from the Global Advisory on Antibiotic Resistance Data program explored temporal, geographic, and demographic trends in Escherichia coli resistance from 1997 to 2001. Elevated rates of nonsusceptibility were seen in Latin America, southern Europe, and the western Pacific, and lower rates were seen in North America. For most antimicrobial drugs considered, nonsusceptibility was higher in isolates from men, older patients, and intensive care unit patients. Nonsusceptibility to ciprofloxacin was higher in younger patients, rose with time, and was not associated with intensive care unit status. In univariate analyses, estimates of nonsusceptibility from MYSTIC were consistently higher than those from SENTRY, but these differences disappeared in multivariate analyses, which supports the epidemiologic relevance of findings from the 2 programs, despite differences in surveillance strategies.

Anti-Bacterial Agents↗

Distance education: strategies for maintaining relationships.

Experience with Australian Aboriginal and Torres Strait Islander students in the Bachelor of Applied Health Science (BAppHSc) course suggests that one of the key elements for students is the sense of relationship built up through Problem Based Learning (PBL). Failure to retain students is more likely to be related to personal than academic concerns. The low attrition rate is largely attributed to the sense of community and support the course generates. In 1997, the Centre for Indigenous Health, Education and Research offered the BAppHSc to rural Queensland. Campuses were opened in the Torres Strait and Cairns, with 9 and 5 students respectively. The course consisted of PBL sessions, fixed resource sessions provided by local staff or guest lecturers, video-conferencing and the use of videos, or text. Face-to-face contact hours were concentrated into two blocks of one and two weeks respectively, plus one day per week. Course materials such as journal articles and texts were provided. The nine Torres students and three Cairns students completed the first semester. This paper discusses the differences between the centres and examines strategies for maintaining the sense of relationship in distance education settings. In 1999 applications from other remote areas are challenging the model further. Multiple technologies are envisaged and discussed. In addition, similar methods are being applied to post graduate courses and collaboration with other institutions in the Pacific suggested. This would allow cross crediting of such course-work into a range of courses and institutions, reducing duplication and increasing options.

Australia↗

[General practitioners' views on the cooperation with nursing homes].

BACKGROUND: In addition to the coordination between primary and secondary health care, the collaboration between the general practitioner (GP) and the community-based nursing services is a challenge. While the GPs are responsible for his or her list patients' needs, the organisational structure and resource allocation of nursing home services is a community-based responsibility. MATERIAL AND METHODS: Data on GPs' view on collaborative aspects of nursing home services was collected in a cross-sectional questionnaire survey among all Norwegian list-patient GPs in 2004 (N=1633). RESULTS: Out of the 1637/3338 (48%) responding GPs, 1180 (72%) performed community-based services; 462 (37%) of the latter as nursing home physicians. Four out of five GPs found physician-based services for their list patients satisfactory. The GPs had an influence on the provision of nursing and care services in approximately 50% of cases. The less satisfied GPs were less frequently informed when their list patients received nursing home beds and less frequently asked to contribute patient information when the need for nursing home facilities was assessed. These latter GPs were more often of the opinion that GPs should play a major role in the decision for home-based versus nursing home services. INTERPRETATION: Although there is a potential for improvement in the exchange of information between nursing homes and GPs, 80% of the GPs were satisfied with physician-based services in nursing homes.

Attitude of Health Personnel↗

The foundations of effective management of bipolar disorder.

OBJECTIVES: To understand the epidemiology and course of bipolar disorder; to outline the importance of accurate and reliable diagnosis of bipolar disorder both on a cross-sectional and longitudinal basis; and to emphasize the value of a collaborative therapeutic relationship, psychoeducation, and psychotherapy. METHODS: A brief review of relevant literature to deal with the issues of diagnosis and laying the foundations for effective treatment. RESULTS: Bipolar disorder may well be a heterogeneous group of conditions with varying forms of biphasic mood dysregulation and a changing course across a lifetime. A collaborative therapeutic relationship, psychoeducation, and psychotherapy can be the basis for effective management. CONCLUSIONS: As the concept of bipolar disorder has broadened, the condition is being identified with increasing frequency in many clinical settings. It is a relapsing and recurring condition. It is now recognized that in addition to rational pharmacotherapy, there is a need to encourage a high level of treatment adherence while providing a holistic package of interventions.

Bipolar Disorder↗

The Spanish National Institutes of Health-Chronic Prostatitis Symptom Index: translation and linguistic validation.

PURPOSE: The prominence of health related quality of life end points in international clinical research underscores the importance of well validated and translated measures to enable cross-cultural comparison. The National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) assesses symptoms and health related quality of life in men with chronic nonbacterial, NIH type III prostatitis. To expand its use to Spanish speaking patients we performed a translation and linguistic validation. MATERIALS AND METHODS: The 9-item NIH-CPSI was translated into Spanish according to a standard methodology of 2 forward translations, 1 reconciled version, back translation of the reconciled version and 3 independent reviews by bilingual experts. The purpose of this methodology was to create a single universal Spanish version that would be acceptable to native Spanish speakers inside and outside of the United States. After the translation process the Spanish version was pre-tested in Argentina, Mexico, Spain and the United States. Patient responses were analyzed to identify necessary modifications. The internal consistency of the CPSI was evaluated using Cronbach's alpha. Pearson's product moment correlations were used to evaluate construct validity. RESULTS: Data were collected from chronic prostatitis patients, including 15 in Argentina, 15 in Mexico, 4 in the United States and 3 in Spain. The translation had high reliability overall and in all subscales (Cronbach's coefficient alpha = 0.81 to 0.94), and the subscales correlated well with each other (r = 0.76 to 0.97). However, patients expressed difficulty in distinguishing the response categories "a menudo" ("often") from "normalmente" ("usually") in question 3. We revised "a menudo" to "muchas veces" ("much of the time") and "normalmente" to "casi siempre" ("almost always") to improve the distinctiveness of response categories. CONCLUSIONS: The Spanish NIH-CPSI has high reliability as well as face and construct validity in Spanish speaking men from various countries. The Spanish NIH-CPSI permits cross-cultural comparisons of men with chronic nonbacterial prostatitis.

Adult↗

The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA Field Trial.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-III-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.

Alcoholism↗