Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile.

BACKGROUND AND AIMS: Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them. DESIGN: National-level registry-based retrospective cohort. SETTING AND PARTICIPANTS: Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266). MEASUREMENTS: Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic. FINDINGS: A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups. CONCLUSIONS: In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.

From prison to work? Job-crime patterns for women in a precarious labor market.

Finding and retaining a job is one of the most challenging problems women confront after being released from prison. Given the dynamic and fluid interactions between legal and illegal work, we argue that to better identify and describe job trajectories after release, we must simultaneously consider disparities in work types and offending behavior. We leverage a unique dataset - the Reintegration, Desistance and Recidivism Among Female Inmates in Chile study- to describe patterns of employment within a cohort of 207 women during the first year after being released from prison. By considering different types of work (i.e., self-employed/employed, legitimate/under-the- table) and including offending as another type of income-generating activity, we adequately account for the intersection between work and crime in a particularly understudied population and context. Our results reveal stable heterogeneity in employment trajectories by job type across respondents but limited overlap between crime and work despite the high levels of marginalization in the job market. We discuss the role of barriers to and preferences for certain types of jobs as possible explanations for our findings.

A New Technique for Remodelling and Increasing the Diameter of the Legs through Lipotransfer and Vertical Subcutaneous Fasciotomy of the Posterior Tibial Aponeurosis.

OBJECTIVE: To describe a new technique for performing thigh and calf augmentation and remodelling through thigh lipotransfer, subcutaneous vertical fasciotomy and leg lipotransfer. METHODS: Patients with thin legs due to hypotrophy or hypoplasia of the medial portion of the thighs and legs as well as a patient with a prominent tibialis anterior giving the appearance of male legs were selected. RESULTS: A total of 214 surgeries were performed in 107 patients with minimal complications, and most patients reported a high rate of satisfaction. DISCUSSION: Lipotransfer with fasciotomy improves the standard results of liposculpture in body contour management, which allows balanced relationships among the waist, hips, thighs and legs to be achieved in many patients who are not candidates for the placement of silicone prostheses because their legs and thighs are thin and hypotrophic. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Meal synchronization and commensality in Santiago and Paris.

People eat on a regular schedule, at times that are shared within a society, and with others. While this phenomenon is theoretically formulated in sociological literature, few empirical studies have tested it, and the available evidence is incomplete. Against this backdrop, this article analyzes the association between meal synchronization and commensality using representative survey data in Santiago and Paris. We hypothesize that commensality influences having meals on a regular schedule because sharing a meal with others needs synchronization. Nevertheless, the strength of this association might be different across the two metropolises given the singular social value of gastronomy in French culture. Using logistic and multinomial regression models, we find that in both metropolises, sharing meals with others more frequently is positively associated with having meals in synchronized timeslots. Next, we find differences between Santiago and Paris. In Paris, commensality is associated with synchronization in all three shared timeslots, and in Santiago, in the midday and the evening slots. Besides, in Paris, sociodemographic characteristics have a stronger effect on synchronization than in Santiago. We interpret those differences as explained by variations in the social norms around food practices. Ultimately, our findings contribute to challenging the thesis of food modernity from an empirical and global perspective.