Family: the challenge of prevention of drug use.

CONTENTS OF THE BOOK From the original research for the knowledge and evaluation of family prevention programs in the five European countries we decided to enrich our study with different contributions in this field. Thus, some researchers have contributed to the organization of this book, having participated in the elaboration of some chapters. In the first chapter a description and a socio-historical framework of the evolution of the prevention concept are made. Throughout the years we have been learning how to better define and interpret the true meaning of drug use primary prevention. From the information to prevention as science a long way has been covered in a short period of time. In the second chapter we mention and describe all the existing theoretical models. We remind you that only some time ago preventive interventions were performed according to the idea that information on drugs was necessary and sufficient to avoid youngsters using them. The prevention models give support and frame the different preventive interventions, justifying the options made. In the third chapter, and based on the wider and deeper knowledge on protective and risk factors, we present the prevention strategies more often used. We also describe the preventive programs mentioned in the three areas we highlighted: Family – School – Community. In Chapter 4, after the definition of our research aims, we present the grids used in the reading of the selected projects in the five countries. They are two distinct grids that help us to understand the different levels of preventive intervention: a) one, which we call Level I grid, that refers to all the preventive interventions socalled occasional; b) Level II grid, which mentions long time actions with a theoretical framework. We also present and discuss the obtained data. In the fifth chapter we present the contribution of three of our researchers, approaching several themes. Professor Boyer, bearing in mind the results of IREFREA’s research (Mendes & Relvas et al, 1999) develops the issue of religion/spirituality as a protective factor. Dr. Susanna Pietralunga describes the preventive activities in family context and their evolution, from the Italian reality. Professor Paula Relvas approaches the family life cycle: a framework for primary prevention of drug use. In Chapter 7 the conclusions of our work are presented and a series of orientations are suggested, taking into account future preventive activities in family context

Demography of Dialysis and Transplantation in Children in Europe, 1985: Report from the European Dialysis and Transplant Association Registry

At the end of 1985 there were 5482 patients known to the Registry who started renal replacement therapy (RRT) between the ages of 6 months and 15 years. Of these, approximately 25% had died, 30% were still aged less than 15 years, and the other 45% were older. The acceptance rate of new patients over the last 10 years has slowly but steadily increased; six new paediatric patients per million child population probably represents the likely needs of the near future. Hospital haemodialysis remained the main form of renal replacement therapy in new patients, while 3 years after start of RRT, transplantation became the most frequently used replacement therapy; CAPD appeared to be used mainly in children with a short waiting time for transplantation. Out of the 384 grafts reported in 1985, only 16% were from living related donors; among 321 cadaver grafts, 24% were second and only 3% were third grafts. Glomerulonephritis and pyelonephritis accounted for 50% of all primary renal diseases. During the last 5 years, the proportion with glomerulonephritis seems to have decreased slightly. Hyperkalaemia and fluid overload have still to be considered the main causes of death. Only in 17% of all cases was the cause of death reported as unknown or undetermine

Resonant Raman Scattering by quadrupolar vibrations of Ni-Ag Core-shell Nanoparticles

Low-frequency Raman scattering experiments have been performed on thin films consisting of nickel-silver composite nanoparticles embedded in alumina matrix. It is observed that the Raman scattering by the quadrupolar modes, strongly enhanced when the light excitation is resonant with the surface dipolar excitation, is mainly governed by the silver electron contribution to the plasmon excitation. The Raman results are in agreement with a core-shell structure of the nanoparticles, the silver shell being loosely bonded to the nickel core.Comment: 3 figures. To be published in Phys. Rev.

Successful pregnancies in women on renal replacement therapy: Report from the EDTA Registry

This study reports the geographical incidence of successful pregnancies in women on renal replacement therapy (RRT) and related information on gestation and clinical status of newborns. The impact of successful pregnancy on graft function was assessed by means of a retrospective case-control study. Since 1977 special questionnaires have been sent to each dialysis and transplant centre which reported babies born to mothers on RRT on the yearly centre questionnaire. After 10 years of data collection, a total of 490 pregnancies and 500 babies were available for analysis. A percentage of 88.4 of the babies were born to mothers with a functioning graft, 11.2% to mothers on chronic haemodialysis, and the remaining 0.4% to mothers on CAPD. Almost 50% of all successful pregnancies werereported from the UK. The number of successful pregnancies increased steadily and in parallel with the increasing number of females of childbearing age with a functioning renal transplant. The majority of mothers delivered at age 24-32. For transplanted mothers delivery occurred most commonly during the 3rd and 4th year after successful transplantation. In approximately 85% of cases the duration of pregnancy was shorter than the lower 10th percentile of normal. Birthweight was reduced in accordance with gestational age. Newborn mortality was 1.8%. Fifty-three mothers with a successful pregnancy in 1984-1987 were computer matched with controls according to a number of criteria. The serum creatinine concentration recorded in coded form at the end of each year on the individual EDTA patient questionnaire was used to assess changes in graft function. In 94% of these cases the serum creatinine, recorded 0-11 months before delivery, did not exceed 160 umol/1. Graft function deteriorated in 18% ofmothers as compared to 24% of controls. Twentyfour to 36 months postpartum, changes of serum creatinine were similar in test cases and controls, suggesting that a successful pregnancy does not adversely affect graft function if this was stable and well preserved at the time of conceptio

Rehabilitation of young adults during renal replacement therapy in Europe: The presence of disabilities

The aim of this study was to analyse rehabilitation during RRT in 617 young adults from different European countries who started dialysis or transplantation before the age of 15 years. The data were derived from the EDTA Registry patient data files and a special questionnaire that was sent to centres reporting to the EDTA Registry. The duration of RRT was more than 10 years in 63% of patients. Fifty-four percent were living with a functioning graft and 46% were on dialysis. The prevalence and severity of motor, hearing, sight, and mental disabilities were analysed retrospectively. They were found to vary according to primary renal disease and method oftreatment. One-third of patients had one or more disabilities at the start of RRT. Although disability status had changed in many patients by 31 December 1986, some disability remained in one-third of the patients available for study. Disabilities were recorded as mild in the majority of patients. Both improvement and worsening of motor and mental disability occurred more often than changes of hearing capacity and sight. It is concluded that prevention and treatment of disabilities need special attention in children and young adults on RRT in order to improve rehabilitatio

Rehabilitation of young adults during renal replacement therapy in Europe: 2. Schooling, employment, and social situation

The educational status, employment rate and social situation were studied in 617 patients between 21 and 35 years of age who started renal replacement therapy (RRT) as children. The data were derived from a special questionnaire concerning disability and rehabilitation sent to dialysis and transplant centres reporting to the EDTA Registry. Fifty-six percent of patients completed secondary school and one in three went on to vocational training. Eleven percent of patients attended university, and 16% were reported to have gone to a special school for the handicapped. Up to one-third of patients who attended different school types failed to complete their education. There were notable geographical differences in schooling and in employment. Fifty-six percent of all patients were employed. Lack of schooling was considered to be a major reason for unemployment. Sixty-one percent of patients with disabilities and 34% without disabilities were receiving invalidity payments. The place of residence of these patients aged 21-35 was usually the parental home. Compared to the general population of similar age, only a few patients were married (13.5% of the total study group) and 8% had children. In summary, the present report shows that the major factors influencing rehabilitation on RRT are the presence of disabilities, the method of treatment, geographical factors, duration of RRT, and the underlying primary renal diseas

Kidney Transplantation in Primary Oxalosis: Data From the EDTA Registry

This paper reports the results of 98 first kidney transplantations in patients with oxalosis as the primary renal disease as recorded by the EDTA Registry. There were 79 patients who received a cadaveric (CAD) graft and 15 patients with a living related donor (LRD) graft; the type of donor was not recorded for four patients. Initial graft survival appeared to be better after LRD as compared to CAD grafts but at 3 years the poor survival was similar with 23% for LRD and 17% for CAD grafts. CAD graft survival did not differ between children and adults and was not affected by the waiting time on dialysis. A slight improvement was observed in grafts performed in the years 1983-1986 as compared to grafts performed in earlier years. The causes of failure reported were mainly rejection (33%) and recurrence of primary renal disease (31%). In view of the poor results related to recurrence of oxalosis in the graft, the potential ofcombined kidney and liver transplantation is discusse

The Use of Continuous Peritoneal Dialysis in Europe for the Treatment of Children with End-Stage Renal Failure: Data from the EDTA Registry

The demographic data on the use of continuous peritoneal dialysis in Europe for children starting renal replacement therapy under the age of 15 years was obtained from data collected by the Registry of the European Dialysis and Transplant Association—European Renal Association (EDTA Registry) on individual patient questionnaires 1980-1986. Continuous ambulatory peritoneal dialysis (CAPD) and its variants appeared to be increasingly utilised as treatment for children with end-stage renal failure (ESRF) and accounted for approximately 25% of all renal replacement therapy (RRT). Important differences in its use in various European countries are demonstrated. The proportional contribution of CAPD to treatment was higher during the first year of RRT and gradually decreased thereafter. No significant sex differences existed in the use of this treatment. Approximately 70% of all patients on CAPD were older than 6 years of age, but it is in those under 6 years that the highest proportion are put on CAPD as first method of treatment for end-stage renal failure. The most common cause of abandonment of this treatment was peritonitis, which contributed 50% of the drop-out rat

EDTA Registry Centre Survey, 1986: Report from the European Dialysis and Transplant Association Registry

This paper summarises the information given on the 1986 EDTA Registry centre questionnaire which was returned by 82% of the 2,065 known dialysis and transplant centres in 33 European countries. Information is given on the number of patients alive on haemodialysis according to the type of dialysis facilities available where the patient was receiving dialysis and the number of patients receiving special types of dialysis. The centre questionnaire also included questions on testing for HIV infection, serological evidence or symptoms of AIDS and the diagnosis of hepatitis B in patients and staff. The data given in response to these questions are presented together with data on the involvement of dietitians and social workers in the treatment of patients with end stage renal failure. Finally, information on transplant activity in Europe and the treatment policies of transplanting centres is provide