Integrating the methadone patient in the traditional addiction inpatient rehabilitation program--problems and solutions.

Physicians have reported alcoholism and opioid addiction as co-morbid conditions since the 19th century. From the inception of methadone maintenance treatment, heroin addicts with serious alcohol conditions have enrolled in methadone maintenance programs. Programs that treat alcoholism, including the traditional addiction inpatient rehabilitation programs of the Addiction Treatment Centers (ATCs) operated by New York State, have based their treatment regimen on 12-step abstinence models. Methadone maintenance was considered antithetical to this philosophy. It was regarded as simply substituting one drug for another and not a legitimate treatment for opiate dependence. Therefore, methadone patients were often not accepted into alcohol treatment programs, since they were perceived as active addicts taking a mood-altering drug. Alcohol-related conditions among methadone patients are major causes of liver disease and death, and behavior problems associated with excessive drinking are major reasons for discharging patients. To address these issues and the lack of treatment facilities, the administration of the New York State Office of Alcoholism and Substance Abuse Services (OASAS), which licenses both methadone programs and the ATCs in New York State, realized that many of the methadone patients with alcohol problems are in need of the services provided at the ATCs. They instituted, therefore, a rigorous educational effort for the medical and counseling staffs of the ATCs, designed to integrate methadone treatment into the ATC treatment framework. Eighty percent of the 220 methadone patients who entered the ATCs in a demonstration project during the 1997/1998 state fiscal year have been compliant with the treatment regimen. These results have led to acceptance of methadone patients into the ATCs.

[Reduction in frequency of pneumonia after stroke, following programmed swallowing evaluation].

Aspiration pneumonia is a frequent complication of cerebrovascular accidents (CVA). It occurs mainly in those with post-CVA swallowing disorders, which can be diagnosed by bedside swallowing evaluation. Evaluation is based on observation of components of the oral and pharyngeal stages of swallowing a drink of 50 ml of clear liquid. Changing the consistency of the diet and the mode of swallowing, following its evaluation, can reduce significantly the frequency of post-CVA aspiration pneumonia. In 180 patients admitted for stroke rehabilitation, aspiration pneumonia occurred in 10% and swallowing disorders were found in 28%. Planned swallowing evaluation followed by the above regimen was associated with a gradual reduction of pneumonia from 16% in the first group of 60 patients to 3% in the second group of 60; and of patients with dysphagia, from 27% in the first group to none in the second.

Eldercare and work-role conflict: toward an understanding of gender differences in caregiver burden.

This study investigated gender differences in caregiving tasks, role strains, and resources to account for gender variations in burden among a probability sample of employed, nonspousal caregivers (N = 413). Females were more likely to assist with care provision tasks, to report work role strains, and to experience higher levels of burden than males. After controlling for known sociodemographic dissimilarities in predicting burden, the effect of gender decreased at each step when caregiver tasks, work role strains, and resources were entered into the regression equation. Results suggest that these differences may partially explain the greater negative impact experienced by nonspousal, female caregivers.

[Incidence of neurologic diseases in children]. / O rasprostranennosti nevrologi cheskikh zabolevanii u detei.

Data concerning the distribution and the nosological structure of nervous diseases in children aged from one month to 14 years in the town of N. (76 thousand inhabitants, 16,716 children) are presented. Peculiarities of the dynamics of the disease entities with reference to the age, as well as the influence of the sex on the disease entity are shown. Ranging of the distribution data has made it possible to fix the principal rank places for individual disease entities. The data obtained served as basis for calculating the requirements for neurological beds in children's hospitals and other specialized medical institutions for children.

[Glucocorticoid function of the adrenals and the state of the sympathetic-adrenal system in newborn infants with an hypoxic lesion of the central nervous system]. / Gliukokortikoidnaia funktsiia nadpochechnikov i sostoianie simpatiko-adrenalovoi sistemy u novorozhdennykh s gipoksicheskim povrezhdeniem tsentral'noi nervnoi sistemy.

The convened studies demonstrated an activation of the hypothalamo-hypophysis-adrenal and sympathico-adrenal system in the newborn with slight and moderately expressed forms of CNS lesions. At the same time there was a relative insufficiency of such functions in children with severe forms of CNS lesions. The achieved data permit to substantiate the pathogenetical therapy.

[The pathogenesis of the convulsion syndrome in children]. / K patogenezu sudorozhnogo sindroma u detei

The report contains some results of clinical, biochemical and EEG studies convened in 24 children with convulsive attacks and in 34 children with organic lesions of the CNS and epileptiform syndromes. The authors point out to the important role of the diencephalic area in the pathogenesis of convulsive syndromes. Changes in the glucocortical functions of the adrenal system during the period of convulsive attacks are related to a disturbed regulation in the hypothalamo-hypophysar structure. The processes of readaptation are more disturbed in patients with organic lesions of the CNS in frequent attacks. The results of such studies speak of certain indications to hormone therapy in repeated convulsions in children, especially if the convulsions have an epileptiform character and occur in patients with organic lesions of the CNS.