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PubMed1984

Clinical experience with naltrexone in suburban opioid addicts.

In a study of 160 patients (including 114 active heroin addicts and 42 former heroin addicts maintained on methadone, propoxyphene napsylate, or LAAM), subjects were retained on treatment with naltrexone for a mean of 50.7 days (range, 1-635). Clonidine or guanabenz acetate was used to detoxify subjects who received naltrexone within 10 days of their last dose of opioid. Because of the number of subjects dropping out of treatment after only a few days, it is recommended that there be an opioid-free period of 5 or more days for heroin-dependent subjects and 10 or more days for those on medical maintenance. A naloxone challenge should be administered at a dosage of 0.8 mg. Use of naltrexone combined with psychotherapy appears to promote long periods of opioid abstinence but does not prevent relapse after treatment. Trained clinicians utilizing an appropriate induction protocol can effectively treat volunteer opioid addicts with naltrexone.

Adult↗
PubMed1983

La Crosse encephalitis: occurrence of disease and control in a suburban area.

Fifteen (6.4%) of 233 residents sampled in State Road Coulee (SRC) during 1972-73 had antibodies neutralizing La Crosse (LAC) virus, 9 (3.9%) trivittatus (TVT), 12 (5.2%) Jamestown Canyon (JC) and 2 (0.9%) Bunyamwera serogroup virus. Six of seven youths who had antibodies to LAC virus had been ill: three were serologically confirmed as cases of LAC encephalitis and three had possibly related illnesses. The other reported no illness. Possibly related illnesses were reported by 1 of 10 adults with antibody to LAC; also by 3 of 6 youths who had antibodies to TVT or JC viruses, and by 4 of 39 youths who did not have these antibodies. In prospective studies, 4 of 132 sampled again during 1977 had acquired antibodies, including 2 to LAC and 2 to JC virus. The LAC disease-infection rate was 50%. One of those with antibody to LAC virus was a girl with encephalitis who had a serologically confirmed infection a year after she had moved away from SRC. Her exposure to mosquitoes was not in SRC. The other was a boy who remained a resident but did not have encephalitis or other severe illness. The two who had acquired antibody to JC virus were boys who reported histories of undiagnosed febrile illnesses while attending summer camps in central Wisconsin. Control measures, including closure of treeholes, removing old tires and education, were applied. LAC infections in SRC were reduced from six during 1965 thru 1972, to only one during 1973 thru 1977. No cases have been found in SRC since 1977. Following expansion to a county-wide control program, LAC encephalitis in La Crosse County has been reduced from seven and eight cases during 1978 and 1979 to only one and two during 1980 and 1981. No cases have been found in La Crosse County so far during 1982.

Adolescent↗
PubMed1983

Troubled marriages and divorce: a prospective suburban study.

A longitudinal survey of adjustment to divorce in Cleveland, Ohio, suburbs was conducted with a matched sample of married persons in order to identify some of the common complaints, feelings, concerns, and health hazards among separated and divorced persons. The study findings show that substantial numbers of divorced and married people turn to their physicians for help with personal problems, suggesting that physicians need to be prepared to help them appropriately. Based upon these findings, opportunities are described that are open to the family physician for detecting distress in the troubled marriage and in divorce, as well as for therapeutic intervention. Types of interventions include anticipatory guidance, counseling, and referral for more intensive therapy. In the troubled marriage there is often an extended period of unhappiness and indecision. A physician alerted to the frequency with which marital distress is exhibited in physical or psychological symptoms may be able to provide assistance in sorting out priorities and options. Following a crisis model of adjustment, the heightened physical and psychological distress experienced during the early stages of the divorce process decreases with time. Many divorced parents are not aware of the im pact of marital turmoil and divorce on their children. The family physician plays an important part in helping parents recognize their continuing role in the lives of their children even if the marital relationship ends.

Counseling↗