Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme

Background: The anti-craving drug, naltrexone, is used as a pharmacotherapeutic adjunct in the treatment of alcohol dependence. In addictive disorders, compliance issues remain central. There are limited data on compliance with naltrexone treatment regimens within formalized rehabilitation programs and even less data that identifies factors that have an impact on this. Objective: To study patient adherence to naltrexone medication regimens and examine whether patients' reported pre-treatment alcohol use, dependence severity and measures of psychological health are predictive of medication compliance. Method: Fifty outpatients meeting DSM IV criteria for alcohol dependence enrolled in 12-week rehabilitation programme. This included cognitive behavioural therapy (CBT) and naltrexone, 50 mg orally daily. Measures included: pharmacy prescription pick-up including number of tablets dispensed, programme attendance and patient pre-treatment alcohol use variables. Measures of psychological health included somatic symptoms, anxiety, social dysfunction and depression as measured by the General Health Questionnaire (GHQ-28). Results: Classifying the sample into compliant (greater than or equal to 90% medication pick-up) and less compliant groups, 66% of subjects were naltrexone-compliant. Pre-treatment alcohol use variables were not predictive of compliance. Although social dysfunction and depression tended towards poorer prescription filling, measures of psychological distress (GHQ-28) did not identify factors predictive of medication non-compliance. One patient withdrew from treatment because of naltrexone-induced dysphoria. Conclusion: Patients with alcohol dependence demonstrated high levels of anti-craving medication compliance, good rehabilitation programme participation and favourable outcomes. Naltrexone was well tolerated. Medication compliance in this study group compared well with those of other hospital populations with chronic disorders. Factors predictive of anti-craving medication compliance in alcohol dependence require further study.

Outpatient cognitive behavioural therapy programme for alcohol dependence impact of naltrexone use on outcome

Objective: Cognitive-behavioural therapy (CBT) has been effectively used in the treatment of alcohol dependence. Clinical studies report that the anticraving drug naltrexone, is a useful adjunct to treatment. Currently, few data are available on the impact of adding this medication to programmes in more typical, outpatient, and rehabilitation settings. The objective of this study was to examine the impact on outcome of adding naltrexone to an established outpatient alcohol rehabilitation program which employed CBT. Method: Fifty patients participated in an established 12-week, outpatient, 'contract'-based alcohol abstinence programme which employed CBT. They also received naltrexone 50 mg orally daily (CBT + naltrexone). Outcomes were compared with 50 historical, matched controls, all of whom participated in the same programme without an anticraving medication (CBT alone). All patients met DSM-IV criteria for alcohol dependence. Results: Programme attendance across the eight treatment sessions was lower in the CBT alone group (p < 0.001). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (p < 0.001). Rehabilitation programme completion at 12 weeks was 88% (CBT + naltrexone) compared with 36% for (CBT alone) (p < 0.001). Alcohol abstinence at 12 weeks was 76% (CBT + naltrexone) compared with 18% (CBT alone) (p < 0.001). Conclusion: When employing the same outpatient rehabilitation programme and comparing outcomes using matched historical controls, the addition of naltrexone substantially improves programme attendance, programme completion and reported alcohol abstinence. In a typical outpatient programme, naltrexone addition was associated with significantly improved programme participation, better outcomes and was well tolerated.

Olfaction in the Queensland fruit fly, Bactrocera tryoni. I: Identification of olfactory receptor neuron types responding to environmental odors

The electroantennogram method was used to investigate the number of distinct olfactory receptor neuron types responding to a range of behaviorally active volatile chemicals in gravid Queensland fruit flies, Bactrocera tryoni. Three receptor neuron types were identified. One type responds to methyl butyrate, 2-butanone, farnesene, and carbon dioxide; a second to ethanol; and a third to n-butyric acid and ammonia. The receptor neuron type responding to methyl butyrate, 2-butanone, farnesene, and carbon dioxide consists of three subtypes. The presence of a limited number of receptor neuron types responding to a diverse set of chemicals and the reception of carbon dioxide by a receptor neuron type that responds to other odorants are novel aspects of the peripheral olfactory discrimination process.

Influence of fungal pathogens and environmental conditions on disease severity, flower fall and desiccation of harvested Geraldton waxflower - 2. Studies with commercial packages

Relationships were examined between environmental conditions mediated by packaging and handling and the deterioration of harvested Geraldton waxflower cv. 'Fortune Cookie'. Disease severity plus flower and leaf drop caused by inoculation with Botrytis cinerea were reduced by lowering handling temperatures to 0, 5 or 5/20 degreesC alternated daily, versus 20 degreesC. They were also reduced by inhibition of ethylene action with a silver thiosulfate pulse pretreatment. Additionally, treatments that enhanced water loss, such as packing dry, keeping forced air-cooling holes open and strategic placement of extra ventilation holes may also reduce disease severity and flower plus leaf fall. Inclusion of KMnO4-based Bloomfresh ethylene scrubbing sachets in packages did not reduce disease severity or lessen flower plus leaf fall. Thus, deterioration of waxflower packaged in commercial cartons can be minimised by keeping temperatures low, packing plant material dry, use of cartons with strategically placed ventilation holes and/or pretreatment with silver thiosulfate.

Globalisation and sustainability: environmental Kuznets curve and the WTO

Economic globalisation is seen by many as a driving force for global economic growth. Yet opinion is divided about the benefits of this process, as highlighted by the WTO meeting in Seattle in late 1999. Proponents of economic globalisation view it as a positive force for environmental improvement and as a major factor increasing the likelihood of sustainable development through its likely boost to global investment. These proponents mostly appeal to analysis based on the environmental Kuznets curve (EKC) to support their views about environmental improvement. But EKC-analysis has significant deficiencies. Furthermore, it is impossible to be confident that the process of economic globalisation will result in sustainable development, if 'weak conditions' only are satisfied. 'Strong conditions' probably need to be satisfied to achieve sustainable development, and given current global institutional arrangements, these are likely to be violated by the economic globalisation process. Global political action seems to be needed-to avert a deterioration in the global environment and to prevent unsustainability of development. This exposition demonstrates the limitations of EKC-analysis, identifies positive and negative effects of economic globalisation on pollution levels, and highlights connections between globalisation and the debate about whether strong or weak conditions are required for sustainable development. The article concludes with a short discussion of the position of WTO in relation to trade and the environment and the seemingly de facto endorsement of WTO of weak conditions for sustainable development. It suggests that WTO's relative neglect of environmental concerns is no longer politically tenable and needs to be reassessed in the light of recent developments in economic analysis. The skew of economic growth, e.g. in favour of developing countries, is shown to be extremely important from a global environmental perspective. (C) 2001 Elsevier Science B.V. All rights reserved.

Why farmers continue to use pesticides despite environmental, health and sustainability costs

Use of chemical inputs such as pesticides has increased agricultural production and productivity. However, negative externalities from such use have increased too. These externalities include damage to agricultural land, fisheries, fauna and flora. Another major externality is the unintentional destruction of beneficial predators of pests thereby increasing the virulence of many species of agricultural pests. Furthermore, increased mortality and morbidity of humans due to exposure to pesticides are recorded especially in developing countries. The costs from these externalities are large and affect farmers' returns. However, despite these high costs, farmers continue to use pesticides and in most countries in increasing quantities. In this paper, we examine this paradox and show why farmers continue to use pesticides despite the increasing costs. We also emphasize 'lock-in' aspects of pesticide use. (C) 2001 Elsevier Science B.V. All rights reserved.

Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study

International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.

Environmental regulation of land use and public compensation: principles, and Swiss and Australian examples

The authors discuss the regulation of rural land use and compensation for property-rights restrictions, both of which appear to have become more commonplace in recent years but also more contested. The implications of contemporary theories in relation to this matter are examined, including: the applicability of new welfare economics; the relevance of the neoclassical theory of politics; and the implications of contemporary theories of social conflict resolution and communication. Examination of examples of Swiss and Australian regulation of the use of rural properties, and the ensuing conflicts, reveals that many decisions reflect a mixture of these elements. Rarely, if ever, are social decisions in this area made solely on the basis of welfare economics, for instance social cost-benefit analysis. Only some aspects of such decisions can be explained by the neoclassical theory of politics. Theories of social conflict resolution suggest why, and in what way, approaches of discourse and participation may resolve conflicts regarding regulation and compensation. These theories and their practical application seem to gain in importance as opposition to government decisions increases. The high degree of complexity of most conflicts concerning regulation and compensation cannot be tackled with narrow economic theories. Moreover, the Swiss and Australian examples show that approaches involving conflict resolution may favour environmental standards.

The limits of environmental responsibility - A stormwater case study

The motivation for concern about the environment beyond one's neighborhood is still relatively poorly understood. This article examines the determinants of feelings of responsibility at a regional watershed level. Using demographic, attitudinal, self-reported behavior and neighborhood mapping measures from four cities in Australia, five hypotheses were derived. These were that wider environmental concerns would depend on (a) the physical and social characteristics of the respondents' neighborhoods, (b) the size of their perceived neighborhoods, (c) the length of residence at their localities, (d) educational level and attitudes toward environmental moral responsibility (and the interaction between them), and (e) the level of reported environmentally friendly behavior. Support was gained for all hypotheses except length of residence and the role of general moral attitudes toward the environment. It is concluded that to explain community action at the regional level, it is important to include both spatial and psychological insights and methodologies in research.