A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD $491 (buprenorphine-based outpatient); to AUD $605 for conventional outpatient; AUD $1404 for conventional inpatient; AUD $1990 for rapid detoxification under sedation; and to AUD $2689 for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most costeffective inpatient method.

Improvement in measures of psychological distress amongst amphetamine misusers treated with brief cognitive-behavioural therapy (CBT)

This trial of cognitive-behavioural therapy (CBT) based amphetamine abstinence program (n = 507) focused on refusal self-efficacy, improved coping, improved problem solving and planning for relapse prevention. Measures included the Severity of Dependence Scale (SDS), the General Health Questionnaire-28 (GHQ-28) and Amphetamine Refusal Self-Efficacy. Psychiatric case identification (caseness) across the four GHQ-28 sub-scales was compared with Australian normative data. Almost 90% were amphetamine-dependent (SDS 8.15 +/- 3.17). Pretreatment, all GHQ-28 sub-scale measures were below reported Australian population values. Caseness was substantially higher than Australian normative values {Somatic Symptoms (52.3%), Anxiety (68%), Social Dysfunction (46.5%) and Depression (33.7%). One hundred and sixty-eight subjects (33%) completed and reported program abstinence. Program completers reported improvement across all GHQ-28 sub-scales Somatic Symptoms (p < 0.001), Anxiety (p < 0.001), Social Dysfunction (p < 0.001) and Depression (p < 0.001)}. They also reported improvement in amphetamine refusal self-efficacy (p < 0.001). Improvement remained significant following intention-to-treat analyses, imputing baseline data for subjects that withdrew from the program. The GHQ-28 sub-scales, Amphetamine Refusal Self-Efficacy Questionnaire and the SDS successfully predicted treatment compliance through a discriminant analysis function (p

A RELAÇÃO ENTRE RELIGIÃO E SAÚDE NO DISCURSO DE ELLEN G. WHITE (1827-1915)

O objetivo principal da pesquisa encetada foi o de ressaltar a importância do discurso de Ellen White, uma importante líder religiosa do século XIX, nos Estados Unidos da América, para a formação de um estilo e prática de vida, que ainda hoje caracteriza os adventistas do sétimo dia no que se refere a saúde. Outro, não menos importante objetivo, foi o de comparar os principais conceitos de Ellen White sobre saúde e estilo de vida com algumas preocupações científicas e acadêmicas contemporâneas. Para isso, este trabalho mostra como a lista de oito remédios naturais propostos por White sumarizam o ideal de uma vida saudável ainda praticada por milhões de adventistas, 100 anos após a morte de sua Profetiza: ar puro, água, alimentação adequada, luz solar, exercícios físicos, repouso, abstinência, e confiança em Deus. Os conselhos de White foram contrastados com várias práticas culturais que relacionam religião e saúde, levando-nos à conclusão que a cultura adventista tem se mostrado como a mais adequada na salvaguarda da saúde. Isto porque White apresentou uma síntese de elementos da cultura judaica, cristã e ocidental. Nesse sentido, as suas orientações garantem-lhe um lugar privilegiado no movimento de reforma da saúde nos Estados Unidos que ocorreu naquele País na segunda metade do século XIX. Muitos de seus conselhos estão sendo atualmente colocados em prática por todos aqueles que se preocupam com a saúde, longevidade, e a adequação do estilo de vida com as regras inspiradas na natureza e numa espiritualidade sadia.

A RENÚNCIA SEXUAL PELO REINO: A IMPORTÂNCIA DA RENÚNCIA SEXUAL PARA A LIDERANÇA DA MULHER EM ATOS DE PAULO E TECLA

O propósito desta pesquisa é analisar a obra os Atos de Paulo e Tecla, focando na importância da renúncia sexual para a liderança da mulher. Tema este que se tornou fundamental para que as mulheres conseguissem conquistar seu espaço e poder diante da sociedade e assim conseguir fazer com que sua voz fosse ouvida, mesmo que de forma não tão considerável. Ao examinar os Apócrifos Atos de Paulo e Tecla, pôde-se observar suas principais características e composição, apresentando sua origem e interpretação pelas comunidades e pelos líderes do início do cristianismo. Buscou-se nesta pesquisa retratar e fundamentar o romance grego, apresentando suas similaridades com os Atos de Paulo e Tecla, e desta maneira destacar a influência do escrito grego sobre o texto apócrifo em sua forma de estruturação. Apresentamos as definições sobre a renúncia sexual, liderança e martírio sempre destacando os temas com a figura da mulher, abordando a questão do corpo e a sociedade e demonstrando como estes temas inspiraram os discursos no início do cristianismo. Referente aos escritos dos Atos Apócrifos, apresentamos a origem das comunidades de mulheres celibatárias, que influenciaram a escrita dos textos, relatando o motivo pelo qual os Atos foram escritos e como foram disseminados nas outras comunidades. Sobre o martírio, descrevemos suas origens e como os cristãos viam nessa ação uma aproximação com Deus, e como o martírio preparou a vida de Tecla para que ela se tornasse uma anunciante da palavra de Deus.

INSTITUIÇÕES DE ATENDIMENTO A TOXICODEPENDENTES: EXPERIÊNCIAS NO VALE DO PARAÍBA

Atualmente, verifica-se um aumento de oferta e de procura de substâncias psicoativas, e observa-se um aumento de instituições de assistência a essa demanda. A presente pesquisa aborda as instituições de atendimento a toxicodependentes no Vale do Paraíba, São Paulo, Brasil e tem como objetivo descrever e discutir o método de atendimento adotado pelas instituições, a partir do enfoque dos dirigentes. Utiliza-se a entrevista semi-dirigida, o método usado é análise de conteúdo e são pesquisadas dez instituições. Predomina a presença de exdependentes na equipe e o regime de internação. É marcante a carência de profissionais da área de saúde e de profissionais com formação em dependência química e 60% das instituições são comunidades terapêuticas. Prevalece, como método de atendimento, o trabalho, a disciplina e a espiritualidade. Não há avaliação de resultados e a meta é a abstinência. Há pouco controle sistemático por meio dos órgãos competentes e as instituições não cumprem requisitos indicados para o seu funcionamento. Contudo, mesmo com as dificuldades financeiras, falta de recursos bem como de profissionais qualificados, essas instituições promovem cuidados asilares, alimentação, higiene e adaptação a uma rotina. Dada a complexidade no campo da drogadependência, sugere-se a diversidade de opções de intervenção e de tratamento

BEM-ESTAR SUBJETIVO E AUTOEFICÁCIA EM DEPENDENTES DE COCAÍNA/CRACK

Este estudo teve por objetivo identificar e descrever associações entre bem-estar subjetivo, construto formado por satisfação geral com a vida e afetos positivos e negativos,e autoeficáciapara abstinência de drogas em dependentes de cocaína/crack em processo de abstinência. Utilizou, para avaliar as variáveis, as Escalas de Afetos Positivos e Negativos, de Satisfação Geral com a Vida, de Autoeficácia para Abstinência de Drogas, de Avaliação para Mudança da Universidade de Rhode Island e um questionário de dados sócio-demográficos e socioculturais. Participaram 70 homens, dependentes de cocaína/crack, jovens e de baixa escolaridade.Eram pessoas de rendimentos de até três salários mínimos (63%), que foram internadas mais de uma vez (65%), autodeclaradas abstinentes no momento da coleta dos dados. Os participantes possuíam níveis médiosde autoeficácia para abstinência de drogas, níveis baixos de bem-estar subjetivo, e estavam satisfeitos com suas vidas. Cálculos de correlação de Pearson revelaram que não há associação entre bem-estar subjetivoe autoeficácia para abstinência de drogas, entre prontidão para mudança no consumo de drogas e bem-estar subjetivo, nem entre prontidão para mudança no consumo de drogas eautoeficácia para abstinência de drogas. Resultados de análise de variância revelaram que não houve diferençasnos níveis de bem-estar subjetivo entreos diferentes os agrupamentos de prontidão para mudanças nem entre as médias de autoeficácia para abstinência de drogas entre os diferentes agrupamentos de prontidão para mudanças no consumo de drogas. A discussão abordou os resultados diante do fato de a internação dos participantes ter sido involuntária ou voluntária, do tempo de internação, do seu estágio de prontidão para mudar seu comportamento de consumo de drogas e das características de seu grupo de abstinência diante da literatura da área. Finalmente, apontou, em conclusão, limitações e agenda de pesquisa futura.

PERCEPÇÃO DE SUPORTE SOCIAL E CONSUMO DE ÁLCOOL EM DESEMPREGADOS

O desemprego tem sido objeto de preocupação no contexto político, econômico e social, uma vez que a população de trabalhadores desempregados enfrenta dificuldades diárias para a obtenção de trabalho/ou emprego, situação que gera intenso sofrimento psíquico e pode repercutir de modo negativo na saúde do trabalhador. Este estudo teve por objetivo investigar a percepção de suporte social e o consumo de álcool em desempregados. Por meio de estudo epidemiológico, quantitativo e transversal constituímos uma amostra de 300 indivíduos, recrutados em uma agência pública em São Bernardo do Campo SP, que capta vagas no mercado e encaminha trabalhadores para recolocação profissional. A amostra resultou em 54,3% pessoas do gênero masculino, com idade média de 29,30, com mínimo de 18 anos e máximo de 56 anos; 67% tinham ensino médio, sendo 50% solteiros, 52% encontravam-se desempregados de um a seis meses, 37% residiam em imóvel próprio, e 37% possuíam renda familiar de um a dois salários mínimos. Foram utilizados três instrumentos auto-aplicáveis para coleta dos dados: a) Questionário de características sócio-demográficas; b) Escala de Percepção de Suporte Social (EPSS); c) Teste para Identificação de Problemas Relacionados ao Uso de Álcool (AUDIT). Os dados coletados foram submetidos ao programa estatístico SPSS, versão 15.0 para Windows que permitiu fazer as correlações entre as variáveis. Os resultados indicaram correlações significativas entre as variáveis: suporte prático e renda; suporte prático e suporte emocional, com idade. Estas correlações sugeriram que os sujeitos apresentavam melhor percepção de suporte prático na medida em que aumentava a renda familiar, e que quanto maior a idade, menor é a percepção do suporte prático e emocional recebido pela rede social. O AUDIT não apontou correlações significativas entre as variáveis estudadas, e 76% da amostra se situou na zona 1 consumo de baixo risco ou abstinência. Não verificamos correlação entre consumo de álcool e desemprego.(AU)

A specific and rapid neural signature for parental instinct

Darwin originally pointed out that there is something about infants which prompts adults to respond to and care for them, in order to increase individual fitness, i.e. reproductive success, via increased survivorship of one's own offspring. Lorenz proposed that it is the specific structure of the infant face that serves to elicit these parental responses, but the biological basis for this remains elusive. Here, we investigated whether adults show specific brain responses to unfamiliar infant faces compared to adult faces, where the infant and adult faces had been carefully matched across the two groups for emotional valence and arousal, as well as size and luminosity. The faces also matched closely in terms of attractiveness. Using magnetoencephalography (MEG) in adults, we found that highly specific brain activity occurred within a seventh of a second in response to unfamiliar infant faces but not to adult faces. This activity occurred in the medial orbitofrontal cortex (mOFC), an area implicated in reward behaviour, suggesting for the first time a neural basis for this vital evolutionary process. We found a peak in activity first in mOFC and then in the right fusiform face area (FFA). In mOFC the first significant peak (p<0.001) in differences in power between infant and adult faces was found at around 130 ms in the 10-15 Hz band. These early differences were not found in the FFA. In contrast, differences in power were found later, at around 165 ms, in a different band (20-25 Hz) in the right FFA, suggesting a feedback effect from mOFC. These findings provide evidence in humans of a potential brain basis for the "innate releasing mechanisms" described by Lorenz for affection and nurturing of young infants. This has potentially important clinical applications in relation to postnatal depression, and could provide opportunities for early identification of families at risk.

Treatment of ocular allergies:nonpharmacologic, pharmacologic and immunotherapy

Ocular allergy is a significant and growing issue worldwide but for many patients, it is often not differentiated from systemic conditions, such as hay fever. Management of seasonal and perennial allergic conjunctivitis is often poor. Management is principally through avoidance measures (blocking or hygiene), nonpharmaceutical (such as artificial tears and cold compresses) and pharmaceutical (such as topical antihistamines and prophylactic mast cell stabilizers). Vernal and atopic keratoconjunctivitis are more severe and generally need treatment with NSAIDs, steroids and immunomodulators. Giant papillary conjunctivitis can be related to allergy but also is often contact lens related and in such cases can be managed by a period of abstinence and replacement of the lens or a change in lens material and/or design. Immunotherapy can be efficacious in severe, persistent cases of contact lens or allergic conjunctivitis.

Under the influence? The construction of foetal alcohol syndrome in UK newspapers

Today, alongside many other proscriptions, women are expected to abstain or at least limit their alcohol consumption during pregnancy. This advice is reinforced through warning labels on bottles and cans of alcoholic drinks. In most (but not all) official policies, this is linked to a risk of Foetal Alcohol Syndrome (FAS) or one of its associated conditions. However, given that there is little medical evidence that low levels of alcohol consumption have an adverse impact on the foetus, we need to examine broader societal ideas to explain why this has now become a policy concern. This paper presents a quantitative and qualitative assessment of analysis of the media in this context. By analysing the frames over time, this paper will trace the emergence of concerns about alcohol consumption during pregnancy. It will argue that contemporary concerns about FAS are framed around a number of pre-existing discourses including alcohol consumption as a social problem, heightened concerns about children at risk and shifts in ideas about the responsibility of motherhood including during the pre-conception and pregnancy periods. Whilst the newspapers regularly carried critiques of the abstinence position now advocated, these challenges focused did little to refute current parenting cultures.

Crack-growth of medical-grade silicone using pure shear tests

Silicone elastomers are commonly used in the manufacture of single-piece joint replacement implants for the finger joints. However, the survivorship of these implants can be poor, with failure typically occurring from fracture of the stems. The aim of this paper was to investigate the crack growth of medical-grade silicone using pure shear tests. Two medical-grade silicones (C6-180 and Med82-5010-80) were tested. Each sample had a 20 mm crack introduced and was subjected to a sinusoidally varying tensile strain, with a minimum of 0 per cent and a maximum in the range 10 to 77 per cent. Testing was undertaken at a frequency of 10 Hz. At various times during testing, the testing machine was stopped, the number of cycles completed was noted, and the crack length measured. Graphs of crack length against number of cycles were plotted, as well as the crack growth rate against tearing energy. The results show that Med82-5010-80 is more crack resistant than C6-180. Graphs of crack growth rate against tearing energy can be used to predict the failure of these medical-grade elastomers.

The relative influence of social support, rehabilitation program participation, and inmate preincarceration characteristics on incarcerated substance abusers' perceptions of adjustment to community reintegration

This dissertation identifies, examines, and assesses the relative influence of identified empirically and conceptually relevant variables on incarcerated substance abusers' expectations of postrelease adjustment. A purposive sampling procedure was used to recruit 101 male and female substance-abusing offenders participating in prison- and jail-based drug treatment programs in south Florida. A 92-item survey questionnaire was used to collect basic demographic data; measure inmate preincarceration characteristics, social support, and rehabilitation program participation; and record archival data. Regression equations were developed utilizing ten different measures of the participants' expectations of their postrelease adjustment. Two equations yielded statistically significant F ratios; maintaining a stable living and maintaining abstinence. Twenty-two percent of the variance in respondents' expectations of maintaining a stable living was explained by preincarceration characteristics, social support, and rehabilitation program participation (F = 1.89; df = 13,87; p $<$.05). The only significant predictor variable was perception of social support (b = $-$.05; t = $-$3.6; p $<$.001). Twenty-three percent of the variance in respondents' expectations of maintaining abstinence from substances was explained by preincarceration characteristics, social support, and rehabilitation program participation (F = 2; df = 13,87; p $<$.05). Once again, the only significant predictor variable was perception of social support. The results of the analyses indicate that social support was the only important variable for understanding these respondents' efficacy expectations of postrelease abstinence and stable living. The results of this investigation demonstrate the complexity of the social support variable for prisoners, and identify social support as a potential rehabilitative resource for substance-abusing inmates. The results of this investigation underscore the importance of continued, detailed empirical study in order to understand and clarify how social support, efficacy expectations, and actual postrelease performance interrelate for this population of offenders.

Ecological genetics of Melaleuca quinquenervia (Myrtaceae): Population variation in Florida and its influence on performance of the biological control agent Oxyops vitiosa (Coleoptera: Curculionidae)

Melaleuca quinquenervia (Cav.) Blake (Myrtaceae) was imported into Florida from Australia over a century ago as a landscape plant. A favorable climate and periodic wildfires helped M. quinquenervia thrive; it now occupies about 200,000 hectares in southern Florida. A biological control (i.e., biocontrol) program against M. quinquenervia has been initiated, but not all biocontrol releases are successful. Some scientists have argued that poor biocontrol agent success may relate to genetic differences among populations of invasive weeds. I tested this premise by determining (1) the number and origins of M. quinquenervia introductions into Florida, (2) whether multiple introduction events resulted in the partitioning of Florida's M. quinquenervia populations into discrete biotypes, and (3) whether Oxyops vitiosa, an Australia snout beetle imported to control this weed, might discriminate among putative M. quinquenervia biotypes. Careful scrutiny of early horticultural catalogs and USDA plant introduction records suggested at least six distinct introduction events. Allozyme analyses indicated that the pattern of these introductions, and the subsequent redistribution of progeny, has resulted in geographic structuring of the populations in southern Florida. For example, trees on Florida's Gulf Coast had a greater effective number of alleles and exhibited greater heterozygosity than trees on the Atlantic Coast. Essential oil yields from M. quinquenervia leaves followed a similar trend; Gulf Coast trees yielded nearly twice as much oil as Atlantic Coast trees when both were grown in a common garden. These differences were partially explained by the predominance of a chemical phenotype (chemotype) very rich in the sesquiterpene (E)-nerolidol in M. quinquenervia trees from the Gulf Coast, but rich in a mixture of the monoterpene 1,8-cineole and the sesquiterpene viridiflorol in trees from the Atlantic Coast. Performance of O. vitiosa differed dramatically in laboratory studies depending on the chemotype of the foliage they were fed. Larval survivorship was four-fold greater on the (E)-nerolidol chemotype. Growth was also greater, with adult O. vitiosa gaining nearly 50% more biomass on the (E)-nerolidol plants than on the second chemotype. The results of this study thus confirmed the premise that plant genotype can affect the population dynamics of insects released as weed biocontrols. ^

Eastern Orthodox Christian fasting in northeastern Pennsylvania

The purpose of this research was to examine the fasting practices of Eastern Orthodox Christians (EOCs) in northeastern Pennsylvania. Fasting, according to Eastern Orthodox Church doctrine, is primarily abstinence from meat, dairy products, fish and certain other foods during Easter Lent and other periods, for approximately 180 days annually. Goals were to discern what EOCs consider their fasting rules to be, their actual fasting practices, what factors influence this practice and the relationship of fasting to nutrition. Methodology included 29 months of ethnographic fieldwork at local parishes, content analysis of local written materials and semi-structured interviews of 58 core church members. A pile sort was conducted whereby subjects classified various foods according to fasting or non-fasting status and then sorted the fasting foods into a hierarchy of avoidance. Data were analyzed using ANTHROPAC and NVivo software. Results included identification of a cognitive hierarchy of avoidance, with meat the most important to avoid, followed by dairy and alcoholic beverages. An important finding was the differences in subjects' knowledge of Church doctrine and a wide variation in their actual fasting practices. Contrary to Church doctrine, fish was not usually perceived as a food to abstain from. A historic Byzantine Catholic presence in the area (with a different fasting doctrine), family members who did not fast, and health concerns were some factors that affected fasting practices. A conclusion is that while meat, dairy and alcoholic beverages were usually categorized as foods to avoid during fasts, it is not possible to generalize with regard to actual practices or the impact of fasting on nutrition, due to individual variation. It was demonstrated that qualitative data could provide information that can be crucial to know prior to conducting quantitative nutrition research or counseling. Findings of this study suggest that one cannot assume subjects who belong to a given religion that has prescribed food avoidance practices are following them homogeneously and/or according to official doctrine. ^

The successional dynamics of lightning-initiated canopy gaps in the mangrove forests of Shark River, Everglades National Park, USA

Gap succession is a significant determinant of structure and development in most forest communities. Lightning strikes are an important source of canopy gaps in the mangrove forest of Everglades National Park. I investigated the successional dynamics of lightning-initiated canopy gaps to determine their influence on forest stand structure of the mixed mangrove forests ( Rhizophora mangle, Laguncularia racemosa, and Avicennia germinans ) of the Shark River. I measured gap size, gap shape, light environment, soil characteristics, woody debris, and fiddler crab abundance. I additionally measured the vegetative composition in a chronosequences of gap successional stages (new, recruiting, and growing gaps). I recorded survivorship, recruitment, growth and soil elevation dynamics within a subset of new and growing gaps. I determined the relationship between intact forest soil elevation and site hydrology in order to interpret the effects of lightning disturbance on soil elevation dynamics. ^ Gap size averaged 289 ± 20 m2 (± 1SE) and light transmittance decreased exponentially as gaps filled with saplings. Fine woody debris was highest in recruiting gaps. Soil strength was lower in the gaps than in the forest. The abundance of large and medium fiddler crab burrows increased linearly with total seedling abundance. Soil surface elevation declined in newly formed lightning gaps; this loss was due to a combination of superficial erosion (8.5 mm) and subsidence (60.9 mm). A distinct two-cohort recruitment pattern was evident in the seedling/sapling surveys, suggesting a partitioning of the succession between individuals present before and after lightning strike. In new gaps, the seedling recruitment rate was twice as high as in forest and the sapling population increased. At the growing gap stage, R. mangle seedling mortality was 10 times greater and sapling mortality was 13 times greater than recruitment. Growing gaps had reduced seedling stem elongation, sapling growth and adult growth. However, a few individuals (R. mangle saplings) were able to recruit into the adult life stage. In conclusion, the high density of R. mangle seedlings and saplings imply that lightning strike disturbances in these mangrove forests favor their recruitment over that of A. germinans and L. racemosa. ^