Efficacy of an intensive outpatient rehabilitation program in alcoholism: Predictors of outcome 6 months after treatment

Treatment of alcohol-dependent patients was primarily focused on inpatient settings in the past decades. The efficacy of these treatment programs has been evaluated in several studies and proven to be sufficient. However, with regard to the increasing costs in public healthcare systems, questions about alternative treatment strategies have been raised. Meanwhile, there is growing evidence that outpatient treatment might be comparably effective as inpatient treatment, at least for subgroups of alcohol dependents. On that background, the present study aimed to evaluate the efficacy of a high-structured outpatient treatment program in 103 alcohol-dependent patients. 74 patients (72%) terminated the outpatient treatment regularly. At 6 months' follow-up, 95% patients were successfully located and personally re-interviewed. Analyses revealed that 65 patients (64%) were abstinent at the 6-month follow-up evaluation and 37 patients ( 36%) were judged to be non-abstinent. Pretreatment variables which were found to have a negative impact (non-abstinence) on the 6-month outcome after treatment were a higher severity of alcohol dependence measured by a longer duration of alcohol dependence, a higher number of prior treatments and a stronger alcohol craving (measured by the Obsessive Compulsive Drinking Scale). Further patients with a higher degree of psychopathology measured by the Beck Depression Inventory (depression) and State-Trait Anxiety Inventory (anxiety) relapsed more often. In summary, results of this study indicate a favorable outcome of socially stable alcohol-dependent patients and patients with a lower degree of depression, anxiety and craving in an intensive outpatient rehabilitation program

HIV Risks and Seroprevalence Among Mexican American Injection Drug Users in California

Latinos in the United States are an ethnically diverse group disproportionately affected by HIV/AIDS. We describe HIV seroprevalence, HIV risk behaviors and utilization of health services among Mexican American injection drug users (IDUs) in California (n = 286) and compare them to White (n = 830) and African American (n = 314) IDUs. Study participants were recruited from syringe exchange programs (n = 24) in California. HIV seroprevalence among Mexican Americans (0.5%) was dramatically lower than Whites (5%) and African Americans (8%). Mexican Americans reported fewer sex-related risks than Whites and African Americans though injection-related risks remained high. Compared to Whites, Mexican Americans were more likely to participate in drug treatment during a 6 month period (AOR 1.5, 95% CI 1.1, 2.0) but less likely to receive any health care (AOR 0.6, 95% CI 0.5, 0.8). Exploring cultural and structural factors among Mexican American IDUs may offer new insights into how to maintain low rates of HIV seroprevalence and reduce barriers to health care utilization

Uniendo ingeniería y ecología: la protección costera basada en ecosistemas

En un contexto de crecientes impactos y riesgos socio-económicos en las costas del planeta, la protección costera basada en ecosistemas surge como un nuevo paradigma que une los principios de protección, sostenibilidad y resiliencia, a la vez que proporciona múltiples beneficios. Este artículo ofrece una perspectiva sobre qué son y cómo se pueden utilizar las defensas naturales en el diseño, planificación y gestión de costas. La política pública muestra un creciente interés por su implementación general y el cuerpo de conocimiento y experiencia alrededor de la también denominada infraestructura ?verde? es creciente, pero aún existen importantes barreras que salvar. Una de ellas es estandarizar su diseño en términos ingenieriles, así como reconocer los aspectos que los diferencian respecto a enfoques tradicionales. La adaptación climática y la reducción de riesgos son áreas en las que su utilización puede ser más significativa, debido a la variedad de servicios que ofrecen. Tanto desde el punto de vista técnico como económico, existen argumentos sólidos para evitar la degradación de los ecosistemas, avanzando su restauración y conservación, como también desde la perspectiva de la defensa de las costas.In a context of increasing socio-economic impacts and risks in the coastal areas of the planet, coastal protection based on ecosystem features becomes a new paradigm that combines the principles of conservation, sustainability and resilience, while providing multiple benefits. This paper provides a perspective on what these are and how they can be used in the design, planning and management of the coastal zones. Policy-makers are calling for further uptake and implementation across the board and the body of knowledge and experience around the socalled ?green? infrastructure is growing, but there are still major barriers for a widespread uptake. One of them is to standardize designs in engineering terms, recognizing the different characteristics compared to traditional engineering solutions. Climate adaptation and risk reduction are areas where its use may be more significant, for the variety of services they offer. Both technically and economically, there are strong arguments to prevent degradation of ecosystems and to advance in their restoration and conservation, as well as from a coastal defense perspective