RESUMEN
Although use of important amounts of alcohol has clearly been proven to have a negative health impact, large epidemiological studies show that a moderate quantity of alcohol might be beneficial in terms of total mortality, probably through cardiovascular protection. Many countries propose their own official recommandations with regard to moderate or low risk alcohol consumption. In this review, we compare some of these recommandations. Furthermore, risks and benefits of alcohol for the main groups of disease are analysed according to alcohol quantities and drinking patterns. Our final objective is to evaluate the small margin between potentially beneficial use of alcohol versus low risk use, and provide some practical recommandations for the physician advising an individual patient.
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Consumo de Bebidas Alcohólicas , Depresores del Sistema Nervioso Central/administración & dosificación , Etanol/administración & dosificación , Guías de Práctica Clínica como Asunto , Consumo de Bebidas Alcohólicas/efectos adversos , Depresores del Sistema Nervioso Central/efectos adversos , Etanol/efectos adversos , HumanosRESUMEN
Since 2007, the number of people living in cities exceeds that of rural areas. Thus, cities and their organizations have a major influence on all spheres of human life, especially health. This influence may generate inequality, suffering and disease, but also represent an opportunity for health and well-being. This paper introduces the concept of urban health, particularly in terms of primary care medicine and presents solutions that encompass a wide field (politics, urban planning, social inequality, education). Improving urban health requires collaboration of medical with non-medical actors, in order to become of development (re-) urban structure and promotes the health of all.
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Promoción de la Salud/organización & administración , Salud Urbana , Urbanización/tendencias , Conducta Cooperativa , Humanos , Atención Primaria de Salud/organización & administraciónRESUMEN
This review of articles published in 2011 covers a large spectrum of topics that are of interest for the practice of general internal medicine and of primary care. Authors discuss public health issues, such as sleep disorders and their relationship with subsequent weight disorders, and the benefits of commercial weight reduction programs. Clinical topics, such as the management of victims of sexual violence and screening strategies for lung cancer, streptococcal pharyngitis, functional bowel disorders and hypertension in ambulatory settings are also reviewed. Besides, authors cover therapeutic issues, such as the treatment of hand arthritis with chondroitin sulfate and the management of plantar warts with salicylic acids and cryotherapy.
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Atención Ambulatoria/tendencias , Medicina Interna/tendencias , Humanos , Salud Pública/tendenciasRESUMEN
UNLABELLED: The prevalence and incidence of systemic sclerosis (SSc) in The Netherlands is unknown. The same holds true for its leading causes of death: pulmonary fibrosis and pulmonary arterial hypertension (PAH), for which effective treatment options have recently become available. OBJECTIVE: To establish the prevalence and incidence of SSc and its pulmonary complications. METHODS: Detailed information on patients in the POEMAS registry, "Pulmonary Hypertension Screening, a Multidisciplinary Approach in Scleroderma", consisting of 819 patients, was combined with a nationwide questionnaire. RESULTS: By combining the two sources the prevalence of SSc was found to be 8.9 per 100 000 adults. The incidence was 0.77 patients per 100 000 per year. PAH was diagnosed in 9.9% of SSc patients. The prevalence of interstitial lung disease in SSc varied from 19% to 47% depending on the definition used. CONCLUSION: This study clarifies the epidemiology of SSc in The Netherlands and confirms the frequent occurrence of pulmonary complications, based on 654 cases. This can and will be studied further in the ongoing POEMAS study.
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Esclerodermia Sistémica/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Métodos Epidemiológicos , Femenino , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/fisiopatología , Incidencia , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Prevalencia , Fibrosis Pulmonar/complicaciones , Fibrosis Pulmonar/epidemiología , Fibrosis Pulmonar/fisiopatología , Sistema de Registros , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/fisiopatología , Distribución por Sexo , Encuestas y Cuestionarios , Capacidad Pulmonar Total , Adulto JovenRESUMEN
Misuse of psycho-active substances is frequent in primary care and concerns patients of all ages and conditions. Physicians should screen for use of such substances, especially in the case of tobacco dependence and/or clinical symptoms. Independently from the substance used (or from the behaviour), screening can be performed through clinical interviewing, focusing on the frequency and the quantity of the substance used, loss of control and its consequences, or through screening tools. Questionnaires (ASSIST; AUDIT; FACE) allow both screening and evaluation of the severity of misuse, guiding appropriate advice, treatment or referral to specialist. Motivational interviewing is the best option to discuss and induce behavioural changes.
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Psicotrópicos/análisis , Trastornos Relacionados con Sustancias/diagnóstico , Alcoholismo/epidemiología , Humanos , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Suiza/epidemiologíaRESUMEN
BACKGROUND: While detoxification under anaesthesia accelerates the detoxification procedure, there is a lack of randomised clinical trials evaluating its effectiveness compared to traditional detoxification procedures, and a lack of data on long-term abstinence. METHODS: Prospective randomised clinical trial. Analysis by intention to treat and per protocol. SETTING: Specialised substance abuse unit in a psychiatric teaching hospital and an intensive care unit of a general hospital. PARTICIPANTS: Seventy patients with opiate mono-dependence requesting detoxification: 36 randomised to RODA (treatment as allocated received by 26) and 34 randomised to classical clonidine detoxification (treatment as allocated received by 21). MAIN OUTCOME MEASURES: Successful detoxification, safety and self-reported abstinence at 3, 6 and 12 months after detoxification. RESULTS: Socio-demographics were similar in both groups at baseline. No complications were reported during or after anaesthesia. According to the intention to treat analysis, 28/36 (78%) RODA patients and 21/34 (62%) of the clonidine group successfully completed the detoxification process (p=0.14). In the intention to treat analysis, 30% of RODA patients were abstinent after 3 months compared to 14% in the clonidine group (p=0.11). No difference was found at 6 and 12 months (both groups showed less than 5% abstinence after 12 months). The per-protocol analysis showed similar results with no statistical differences either for ASI mean scores or for the SF36 questionnaire. CONCLUSION: Although the detoxification success rate and abstinence after 3 months were slightly better for the RODA procedure compared to clonidine treatment, these differences were not statistically significant and disappeared completely after 6 and 12 months.
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Analgésicos/uso terapéutico , Clonidina/uso terapéutico , Dependencia de Heroína/tratamiento farmacológico , Dependencia de Heroína/psicología , Inactivación Metabólica , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Síndrome de Abstinencia a Sustancias/psicología , Adulto , Algoritmos , Anestesia General , Esquema de Medicación , Femenino , Hospitales Psiquiátricos , Hospitales de Enseñanza , Humanos , Masculino , Estudios Prospectivos , Recurrencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Four behavioural risk factors are common in primary care and are often clustered in individuals. Smoking is present from I cigarette per day, excessive alcohol use is defined either by drinking regularly more than 2-3 standard glasses per day or by occasional heavy drinking of more than 4-5 glasses at a time. Patients who don't have regular moderate physical activity of at least 30 minutes during 5 days of a week or intensive physical activity of at least 20 minutes 3 times a week are sedentary. A Body Mass Index of over 30 defines obesity. We propose a "generic" counselling tool in 5 steps, the 5 As, that can be used for any of the four behavioural risk factors during routine consultations. With this counselling guide, practitioners can help patients change behaviour in a motivational style that allows shared decision-making.
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Conductas Relacionadas con la Salud , Rol del Médico , Humanos , Factores de RiesgoAsunto(s)
Autoanticuerpos/inmunología , Células Endoteliales/inmunología , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/inmunología , Autoanticuerpos/sangre , Células Cultivadas , Células Endoteliales/citología , Humanos , Hipertensión Pulmonar/patología , Estudios Seroepidemiológicos , Venas Umbilicales/citologíaRESUMEN
OBJECTIVES: Determine whether patients who have acquired the human immunodeficiency virus through injecting drug use receive less antiviral medication (zidovudine) than comparable patients of other risk groups considering access to, acceptance of, and compliance with treatment. DESIGN: Historical cohort study. SETTING: Human immunodeficiency virus outpatient clinic. PATIENTS: Human immunodeficiency virus-infected subjects eligible for zidovudine treatment between January 1, 1989, and January 1, 1992, comparing injecting drug users (IDUs) with non-IDUs ("others"). MAIN OUTCOME MEASURES: Proposal, acceptance, start of, and compliance with zidovudine treatment. RESULTS: One hundred fifty-one IDUs and 162 other human immunodeficiency virus-positive subjects became eligible for zidovudine treatment between January 1, 1989, and January 1, 1992. Both groups were proposed zidovudine as often, but zidovudine treatment was refused by 14.9% of IDUs compared with 7.1% of others (P = .029). The IDUs needed considerably more time than other subjects to accept zidovudine therapy (median delay between indication and start of zidovudine treatment, 61 days vs 30 days, P = .0001). After accepting, IDUs were as compliant with treatment as others: 81.3% vs 83.2% were good compliers, and rises of mean corpuscular volume of erythrocytes after 3 and 6 months of treatment were similar in both groups. Former drug users and IDUs receiving methadone were started on zidovudine treatment more often and complied better with treatment than active drug users. Absence of housing and presence of psychiatric diagnosis (both more prevalent in IDUs) were associated with less zidovudine treatment and worse compliance. CONCLUSION: Injecting drug users tend to delay the start of zidovudine treatment. However, once they have started, their compliance is no worse than the compliance of patients from other risk groups. These results have important implications for clinical trials, medical care, and public health.
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Infecciones por VIH/tratamiento farmacológico , Cooperación del Paciente , Abuso de Sustancias por Vía Intravenosa/complicaciones , Zidovudina/uso terapéutico , Adulto , Anciano , Estudios de Cohortes , Femenino , Infecciones por VIH/etiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVES: To evaluate the prevalence and incidence rates of infection with HIV, hepatitis B (HBV) and hepatitis C (HCV), in a cohort of drug users (DU) in Geneva, Switzerland. DESIGN: Prospective open cohort study. SETTING: Private methadone maintenance treatment (MMT) programme. PATIENTS, PARTICIPANTS: Over 700 DU in treatment between 1988 and 1995 were tested biannually for HIV, HBV and HCV infection. INTERVENTION: None. MAIN OUTCOME MEASURE: Prevalence for HIV, HBV and HCV at study entry, determined by gender, by injection behaviour, by year of start of MMT and incidence rates for HIV, HBV and HCV, assuming equal risk of seroconversion on each day of the interval between last negative and first positive test. RESULTS: The prevalence at entry into treatment declined dramatically over time for all three viruses. Comparing DU entering treatment before 1988 to those entering treatment after 1993, the prevalence of HIV was 38.2% versus 4.5%, of HBV 80.5% versus 20.1%, and of HCV 91.6% versus 29.8%, respectively. Follow-up rate was 80%. The incidence rates for HIV and HBV were 0.6% and 2.1% per person-year of follow-up, respectively. For HCV the rate was higher (4.2%) especially among women (9.6%). CONCLUSION: These data suggest that DU have changed HIV risk-taking behaviour in response to HIV prevention campaigns. Current prevention efforts should focus on improvement of HCV prevention, identification of high-risk individuals and maintaining safe behaviour.
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Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Metadona/uso terapéutico , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Hepatitis B/complicaciones , Hepatitis C/complicaciones , Humanos , Incidencia , Masculino , Prevalencia , Estudios Prospectivos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Suiza/epidemiologíaRESUMEN
OBJECTIVES: To study differences in pre-AIDS mortality between European cohorts of injecting drug users (IDU) and to evaluate whether pre-AIDS mortality increased with time since HIV seroconversion and decreasing CD4 count. METHODS: The study population consisted of 664 IDU with documented intervals of HIV seroconversion from eight cohort studies. Differences in pre-AIDS mortality were studied between European sites; an evaluation of whether pre-AIDS mortality increased with time since HIV seroconversion and decreasing CD4 count was carried out using Poisson regression. RESULTS: One hundred and seven IDU died, of whom 57 did not have AIDS. Pre-AIDS causes of death were overdose/suicide (49%), natural causes such as bacterial infections/cirrhosis (40%), and unintentional injuries/unknown (11%). Considering pre-AIDS death and AIDS as competing risks, 14.7% were expected to have died without AIDS and 17.3% to have developed AIDS at 7 years from seroconversion. No statistically significant differences in pre-AIDS mortality were found between European regions, men and women, age categories and calendar time periods. Overall pre-AIDS mortality did not increase with time since seroconversion, but did increase with decreasing CD4 count. Evaluating cause-specific mortality, only pre-AIDS mortality from natural causes appeared to be associated with time since seroconversion as well as immunosuppression. For natural causes, the death rate per 100 person-years was 0.13 the first 2 years after seroconversion, 0.73 in years 2-4 [risk relative (RR) to years 0-2, 5.6], 1.83 in years 4-6 (RR, 14.0) and 1.54 for > or = 6 years (RR, 11.7). This rate was 0 for a CD4 cell count > or = 500 x 10(6)/l, 1.06 for 200-500 x 10(6)/l and 4.06 for < 200 x 10(6)/l (RR versus > or = 200 x 10(6)/l, 7.0). In multivariate analysis, both CD4 count and time since seroconversion appeared to be independently associated with death from natural causes; CD4 count appeared to be the strongest predictor (adjusted RR, 5.9). CONCLUSIONS: A high pre-AIDS mortality rate was observed among IDU. No significant differences were observed across European sites. Pre-AIDS mortality from natural causes but not from overdose and suicide was associated with HIV disease progression.
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Seropositividad para VIH/mortalidad , Abuso de Sustancias por Vía Intravenosa/complicaciones , Síndrome de Inmunodeficiencia Adquirida , Recuento de Linfocito CD4 , Estudios de Cohortes , Progresión de la Enfermedad , Europa (Continente) , Femenino , Seropositividad para VIH/complicaciones , Seropositividad para VIH/fisiopatología , Humanos , Masculino , Factores de RiesgoRESUMEN
OBJECTIVE: To examine the effect of gender on disease progression and whether gender differences in CD4 lymphocyte counts persisted for the entire course from HIV seroconversion until (death from) AIDS. METHODS: CD4 lymphocyte counts were modelled in 221 female and 443 male seroconverters following seroconversion, backwards from AIDS and backwards from death using regression analysis for repeated measurements. RESULTS: In the period before use of highly active antiretroviral therapy (HAART), progression to AIDS and to death were marginally slower in women than in men as assessed by proportional hazards analysis. Women seroconverted for HIV, developed AIDS and died at higher CD4 cell counts than men (women: 815, 146 and 44 x 10(6) cells/l, respectively; men: 727, 49 and 22 x 10(6) cells/l, respectively), although differences were only statistically significant at AIDS onset. Declines in CD4 lymphocyte counts were not significantly affected by gender and absolute differences between men and women were stable, with exception for the trajectory close to AIDS when the decline became steeper for men than women. CONCLUSION: These gender differences in CD4 lymphocyte counts suggest a delay of initiation of therapy in women compared with men (our model predicted that women reach the threshold of starting HAART at about 12 months later than men). If this delay unfavourably influences progression, treatment guidelines should be revised so that women can benefit equally from HAART.
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Recuento de Linfocito CD4 , Infecciones por VIH/inmunología , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , Femenino , Infecciones por VIH/tratamiento farmacológico , Seropositividad para VIH/inmunología , Humanos , Masculino , Análisis de Regresión , Caracteres Sexuales , Factores de TiempoRESUMEN
BACKGROUND: Human immunodeficiency virus (HIV) disease progression might vary by geographical region due to differences in the spectrum of HIV-related illnesses and (access to) health care. Therefore, the effect of geographical region, next to the effect of other potential cofactors, on disease progression in 664 injecting drug users (IDU) with documented HIV seroconversion from eight cohorts in Europe was studied. METHODS: Kaplan-Meier methods and Cox proportional hazards analysis were performed to assess the effect of geographical region, other sociodemographics, drug use and repeated HIV exposure on progression from HIV seroconversion to immunosuppression, AIDS and death with AIDS. We considered the confounding effect of study-design related factors (e.g. setting of follow-up), and accounted for pre-AIDS death from natural causes by imputing when each endpoint would have occurred, had they not died without AIDS. RESULTS: Estimates of progression to AIDS and death with AIDS were substantially faster after taking pre-AIDS mortality into account. Median incubation time from seroconversion to the first CD4 count < 200 cells/microliter was 7.7 years (95% CI: 7.1-8.3) and to AIDS 10.4 years (95% CI: 9.8-infinity). The 10-year survival was 70.3% (95% CI: 62.8-76.6). The relative hazards (RH) of AIDS for IDU from central and southern Europe compared with IDU from northern Europe was 1.9 (95% CI: 1.2-3.0) and 1.2 (95% CI: 0.6-2.3), respectively, before, and 1.5 (95% CI: 0.7-3.2) and 1.1 (95% CI: 0.6-2.3) after taking differences in study-design related factors into account. Accounting for these factors, the RH of death with AIDS was 0.9 (95% CI: 0.3-2.5) for central and 1.2 (95% CI: 0.4-3.4) for southern Europe compared with northern Europe. For the first CD4 count < 200 cells/microliter these figures were 0.8 (95% CI: 0.5-1.4) and 0.8 (95% CI: 0.5-1.4). Age at seroconversion was the strongest predictor of disease progression. No statistically significant differences in disease progression were found by gender, foreign nationality, drug use and potential repeated HIV exposure. CONCLUSIONS: We found no evidence for regional variability in HIV disease progression among European IDU. Future studies evaluating geographical differences should consider the confounding effect of study-design related factors and differential non-AIDS mortality. As age is an important determinant of disease progression, it should be considered in recommending treatment.
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Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Seropositividad para VIH , VIH-1 , Abuso de Sustancias por Vía Intravenosa , Adulto , Recuento de Linfocito CD4 , Factores de Confusión Epidemiológicos , Progresión de la Enfermedad , Europa (Continente)/epidemiología , Femenino , Infecciones por VIH/inmunología , Seropositividad para VIH/inmunología , VIH-1/inmunología , Humanos , Masculino , Modelos de Riesgos Proporcionales , Abuso de Sustancias por Vía Intravenosa/inmunologíaRESUMEN
RATIONALE: Little is known about patterns of opiate use by heroin addicts. OBJECTIVES: To describe opiate use over time among heroin addicts who had access to legally prescribed intravenous heroin and oral opiates. METHODS: Analysis of daily drug administration records of 37 patients enrolled in the Geneva heroin maintenance programme for 4-29 months (total 23,136 patient-days). RESULTS: The average dose of intravenous heroin was 466 mg/day; the total opiate dose, after conversion of oral opiates to heroin-equivalents, was 543 mg/day. Patients received intravenous heroin only on 39% of days, oral opiates only on 7% of days, and mixed regimens on 49% of days; the remaining 4% of days were spent outside the programme, usually on oral opiates. The daily dose of heroin-equivalents increased during the first trimester in the programme, by 30 mg/day per month (95% confidence interval 12-46 mg/day per month), but decreased gradually thereafter, by 12 mg/day per month (95% confidence interval, 8-17 mg/day per month). In patients who alternated between heroin and methadone, 1 mg methadone typically replaced 4.1 mg heroin. During follow-up, five patients switched to methadone maintenance, five underwent detoxification, and three were discharged for noncompliance with regulations. CONCLUSIONS: Heroin users who have facilitated access to legally prescribed drugs consume about 0.5 g heroin per day. Consumption patterns vary, but the daily amount of opiates remains stable or decreases over time. A substantial minority of patients elect for alternative treatments after several months of heroin maintenance.
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Dependencia de Heroína/psicología , Dependencia de Heroína/rehabilitación , Adulto , Factores de Edad , Ansiolíticos/uso terapéutico , Clorazepato Dipotásico/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metadona/administración & dosificación , Metadona/uso terapéutico , Morfina/administración & dosificación , Morfina/uso terapéutico , Narcóticos/administración & dosificación , Narcóticos/uso terapéutico , Recurrencia , Factores de RiesgoRESUMEN
Muscle ultrastructure and biochemistry in vastus lateralis muscle biopsies and the response to exercise of 8 lowland Tibetans (T) were compared with those of 8 Nepalese lowlanders (N). Blood hemoglobin was lower in T than in N (119 +/- 3 vs. 131 +/- 2 g/l; P < 0.05). Peak O2 consumption per kilogram of body mass was similar [37.9 +/- 2.2 (T) vs. 40.1 +/- 1.36 ml.min-1.kg body mass-1 (N)]. Maximum exercise blood lactate was the same [11.4 (T) +/- 0.5 vs. 11.3 +/- 0.6 mM (N)]. Muscle fiber type distribution was similar [type I, 58.6 +/- 3.4 (N) vs. 57.0 +/- 3.4% (T); type IIa, 24.1 +/- 3.5 vs. 27.1 +/- 1.6%; type IIb, 17.4 +/- 1.4 vs. 15.9 +/- 2.9%]. T had smaller fiber cross-sectional areas [3,413 +/- 677 (T) vs. 3,895 +/- 447 microns 2 (N); P < 0.05] but had similar number of capillaries per muscle fiber [1.35 +/- 0.23 (T) vs. 1.46 +/- 0.08 (N)] and muscle fiber area supplied per capillary [399 +/- 29 (T) vs. 382 +/- 65 mm2 (N)]. Total mitochondrial volume density was much lower in T (3.99 +/- 0.17%) than in N (5.51 +/- 0.19%) (P < 0.025). Mirroring mitochondrial volume density, citrate synthase and 3-hydroxyacyl-CoA dehydrogenase activities were lower in T than in N (P < 0.05). The activities of L-lactate dehydrogenase and hexokinase were the same in both groups. T had significantly less muscle fiber lipid droplets than did N, which correlated with the low activity of 3-hydroxyacyl-CoA dehydrogenase (r = 0.57, P = 0.02). In conclusion, lowland-born T have a low mitochondrial volume-to-specific peak O2 consumption ratio, which, based on previous measurements on altitude-born Sherpas (B. Kayser, H. Hoppeler, H. Claassen and P. Cerretelli. J. Appl. Physiol. 70: 1938-1942, 1991), appears to be an inborn feature.
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Altitud , Músculo Esquelético/metabolismo , Músculo Esquelético/ultraestructura , Adolescente , Adulto , Factores de Edad , Umbral Anaerobio/fisiología , Composición Corporal/fisiología , Estatura/fisiología , Peso Corporal , Ejercicio Físico/fisiología , Prueba de Esfuerzo , Femenino , Histocitoquímica , Humanos , Masculino , Mitocondrias Musculares/metabolismo , Mitocondrias Musculares/ultraestructura , Fibras Musculares Esqueléticas/fisiología , Fibras Musculares Esqueléticas/ultraestructura , Nepal , Grosor de los Pliegues Cutáneos , TibetRESUMEN
The aim of this study was to identify predictors of treatment success and of relapse, 1 and 6 months after inpatient opiate detoxification in an 8-bed unit in Geneva. Of all 73 patients admitted between June 1994 and June 1995, a majority (73%) successfully finished opiate detoxification. Detoxification was performed mainly with methadone tapering; the average duration of hospitalisation was 15 days. Factors associated with treatment failure were: cocaine abuse, presence of legal problems, and short duration of hospital stay. After 1 month, 65% of the patients were using drugs (half of them were dependent again, half of them had used occasionally) and 35% were completely abstinent (21% when excluding those in residential treatment). Predictors of rapid relapse were cocaine abuse and little concern with own psychological situation at baseline. After 6 months, 50% were physically dependent again, 13% had lapsed occasionally, 37% were abstinent (28% when excluding those in residential treatment). Only high benzodiazepine use at baseline was associated with medium term abstinence. Addiction severity index composite scores had considerably improved between baseline and 6 months. Prevention of relapse to opiate use after inpatient detoxification, especially for those with a concurrent cocaine abuse, should be improved.
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Metadona/uso terapéutico , Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/rehabilitación , Adolescente , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Humanos , Inactivación Metabólica , Tiempo de Internación , Masculino , Trastornos Relacionados con Opioides/metabolismo , Trastornos Relacionados con Opioides/psicología , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Suiza , Resultado del TratamientoRESUMEN
The aim of this study was to identify predictors of treatment failure in a methadone maintenance treatment programme in Geneva. All patients (n = 149) starting treatment between May 1993 and May 1995 were followed until end of treatment or 31st July 1996. The proportion of depressed patients decreased significantly over time, as did the proportion of those injecting illegal drugs. The overall treatment failure was 21%. The probability of treatment failure was higher for women than for men (RR 2.2, P = 0.03) and decreased in successive cohorts. There was no correlation between the methadone dose at 2 months and treatment outcome, probably because doses were individualised and the associated level of psycho-social services high.
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Metadona/uso terapéutico , Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/rehabilitación , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Efecto de Cohortes , Intervalos de Confianza , Depresión/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Análisis Multivariante , Trastornos Relacionados con Opioides/complicaciones , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de Salud , Análisis de Regresión , Riesgo , Factores Sexuales , Centros de Tratamiento de Abuso de Sustancias/normas , Centros de Tratamiento de Abuso de Sustancias/tendencias , Análisis de Supervivencia , Suiza , Insuficiencia del TratamientoRESUMEN
The purpose of this study was to evaluate the quality of life of heroin dependent patients before and 1 year after the start of methadone maintenance treatment. Subjects were patients (n = 102) requesting treatment in a public methadone maintenance programme in Geneva (Switzerland). This was a prospective follow-up study using a validated questionnaire (SQLP). The SQLP was well accepted by patients and staff. Validity of the questionnaire was reconfirmed in this population. Compared to previously studied populations, the quality of life of heroin dependent patients before start of treatment was poor. More than half the patients were still in treatment after 1 year and their quality of life had clearly improved, in most domains. Like many of their peers in the psychiatric field, the patients had high initial expectations. Expectations decreased significantly over time. It was found that the higher were the initial expectations, the poorer was the quality of life after 1 year. The quality of life of heroin abusers requesting treatment is mediocre, and improved considerably after 1 year of comprehensive methadone maintenance treatment. Quality of life evaluation is feasible in this population and can offer an additional evaluation of quality of substance abuse treatment.
RESUMEN
The high mortality rate among drug users, which is partly due to the HIV epidemic and partly due to drug-related accidental deaths and suicides, presents a major public health problem. Knowing more about prevalence, incidence, and risk factors is important for the development of rational preventive and therapeutic programs. This article attempts to give an overview of studies of the relations between substance abuse, suicidal ideation, suicide, and drug-related death. Research in this field is hampered by the absence of clear definitions, and results of studies are rarely comparable. There is, however, consensus about suicidal ideation being a risk factor for suicide attempts and suicide. Suicidal ideation is also a predictor of suicide, especially among drug users. It is correlated with an absence of family support, with the severity of the psychosocial dysfunctioning, and with multi-drug abuse, but also with requests for treatment. Every clinical examination of a drug user, not only of those who are depressed, should address the possible presence of suicidal ideation, as well as its intensity and duration.