Relationship Between Medication Adherence and Treatment Outcomes: The COMBINE Study

Within the alcoholism field, there is mounting evidence supporting an important relationship between medication adherence and drinking outcomes. Little is known however, about the complex relationships between medication and treatment variables and drinking outcomes. The present paper reports on the differential impact of medication adherence and treatment factors on drinking outcomes. Data derived from the COMBINE Study was used to investigate the interrelationships between medication adherence, combination treatments and drinking outcomes

Cannabis treatment outcomes among legally coerced and non-coerced adults

<p>Abstract</p> <p>Background</p> <p>Treatment seeking for cannabis dependence in general, and particularly the number of criminal justice referrals to cannabis treatment, has increased over the past decade. This study aims to compare the characteristics, psychosocial functioning and treatment outcome of those legally coerced into cannabis treatment compared to those entering treatment without legal coercion.</p> <p>Methods</p> <p>This study is a retrospective audit of the administrative clinical records of 27,198 adults presenting to public Texas treatment programs with cannabis as their primary drug problem between 2000 and 2005.</p> <p>Results</p> <p>Of the 69% legally coerced into treatment, there was less psychological distress and greater likelihood of having completed treatment compared with non-coerced clients. Participants who were legally coerced into treatment were also more likely to have received less intensive forms of treatment and to have not used cannabis in the month prior to 90-day post-treatment follow-up.</p> <p>Conclusion</p> <p>More public health information is needed on cannabis dependence and increased availability of subsidised early and brief interventions in a variety of primary health care settings would reduce the late presentations of the more severely impaired voluntary clients. The limitations of this dataset are discussed.</p

DUVET: Resolved direct metallicity measurements in the outflow of starburst galaxy NGC 1569

We present the results of direct-method metallicity measurements in the disk and outflow of the low-metallicity starburst galaxy NGC 1569. We use Keck Cosmic Web Imager observations to map the galaxy across 54\arcsec (800 pc) along the major axis and 48\arcsec (700 pc) along the minor axis with a spatial resolution of 1\arcsec ($\sim$15 pc). We detect common strong emission lines ([\ion{O}{III}] $\lambda$5007, H$\beta$, [\ion{O}{II}] $\lambda$3727) and the fainter [\ion{O}{III}] $\lambda$4363 auroral line, which allows us to measure electron temperature ($T_e$) and metallicity. Theory suggests that outflows drive metals out of the disk driving observed trends between stellar mass and gas-phase metallicity. Our main result is that the metallicity in the outflow is similar to that of the disk, $Z_{\rm out} / Z_{\rm ISM} \approx 1$. This is consistent with previous absorption line studies in higher mass galaxies. Assumption of a mass-loading factor of $\dot{M}_{\rm out}/{\rm SFR}\sim3$ makes the metal-loading of NGC 1569 consistent with expectations derived from the mass-metallicity relationship. Our high spatial resolution metallicity maps reveal a region around a supermassive star cluster (SSC-B) with distinctly higher metallicity and higher electron density, compared to the disk. Given the known properties of SSC-B the higher metallicity and density of this region are likely the result of star formation-driven feedback acting on the local scale. Overall, our results are consistent with the picture in which metal-enriched winds pollute the circumgalactic medium surrounding galaxies, and thus connect the small-scale feedback processes to large-scale properties of galaxy halos.Comment: 15 pages, 11 figures, accepted by MNRA

Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties

BACKGROUND: Most help-seeking substance abusers have comorbid psychiatric disorders. The importance of such disorders for the long-term course of substance abuse is, however, still unclear. The aim of this paper is to describe six-year outcomes regarding death and relapse among alcoholics and poly-substance abusers and to analyse the predictive value of lifetime psychiatric disorders on relapse. METHODS: A consecutive sample of substance-dependent patients who received treatment in two counties in Norway (n = 287) was followed up after approximately six years. Information on socio-demographics, Axis I (CIDI) and II disorders (MCMI-II) and mental distress (HSCL-25) was gathered at baseline. At follow-up, detailed information regarding socio-demographics, use of substances (AUDIT and DUDIT) and mental distress (HSCL-25) was recorded (response rate: 63%). RESULTS: At six-year follow-up, 11% had died, most often male alcoholics (18%). Among the surviving patients, 70% had drug or alcohol related problems the year prior to follow-up. These patients were, classified as "relapsers". There were no significant differences in the relapse rate between women and men and among poly-substance abusers and alcoholics. The relapsers had an earlier onset of a substance use disorder, and more frequently major depression and agoraphobia. Multivariate analysis indicated that both psychiatric disorders (major depression) and substance use factors (early onset of a substance use disorder) were independent predictors of relapse. CONCLUSION: For reducing the risk of long-term relapse, assessment and treatment of major depression (and agoraphobia) are important. In addition, we are in need of a comprehensive treatment and rehabilitation program that also focuses on the addictive behaviour

Biometric Analysis of Surgeons’ Physiologic Responses During Surgery

BackgroundMuch has been written from the social science perspective surrounding surgeons’ stress and burn out. The literature is sparse in reference to scientific investigations of the hemodynamic effect of that stress. This prospective clinical study quantifies the physiologic impact of performing surgery upon the acute care surgeon.MethodsOver 2.5 years, monitoring devices were affixed to surgeons prior to entering the operating room, and physiologic variables were documented every 30 minutes. Qualifying cases were projected as being greater than 2 hours with a baseline preoperative measurement obtained. Variables recorded included blood pressure (BP), heart rate (HR), rate pressure product (RPP), oxygen saturation (O2sat), and end-tidal carbon dioxide (ET CO2).ResultsStatistically significant differences ( P &lt; .05) were found between baseline data to the maximum recording during the surgical operation for: BP (min 101 ± 6.6 (mmHg)-max 117 ± 5.1 (mmHg)), HR (min 70.5 ± 6.2 (bpm)-max 83.7 ± 9.0 (bpm)), O2sat (min 97 ± 2.0 (%)-max 100 ± 0.22(%)), and ET CO2(min 34.1 ± 1.15 mmHg-max 38 ± 1.7 mmHg) ( P &lt; .0001). The RPP ranged from 10.49 mmHg/min to 15.88 mmHg/min with a mean of 14.00 mmHg/min.DiscussionThe practice of surgery is considered demanding in training and lifestyle in comparison to other medical specialties. This data is among the first to demonstrate the negative physiological impact of surgery upon the metabolic demand of the surgeon. The longitudinal implications of increased physiologic demand over time may have cardiovascular and cerebrovascular consequences.</jats:sec