RESUMO
OBJECTIVE: The purpose of this study was to determine the safety and efficacy of hypothermically stored amniotic membrane (HSAM) for the treatment of cartilage lesions of the knee using imaging, patient-reported outcomes (PROs), second-look arthroscopy, and histology. Patients were treated with HSAM and followed for 2 years. DESIGN: Subjects with focal chondral lesions of the femur (International Cartilage Repair Society grade 3-4) were enrolled in this single-arm prospective study. Standard of care imaging was completed. PROs, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Scale, and Visual Analog Scale (VAS), were collected at baseline and at 3, 6, 12, 18, and 24 months. Three subjects underwent an optional arthroscopy and biopsy of the repair at 24 months. RESULTS: Ten subjects were enrolled and completed the study. At 24 months, KOOS Sports & Recreation improved 173.3% and Quality of Life improved 195.3% from baseline. Marx Activity Scale increased 266.8% from 12 to 24 months. VAS scores improved 84.8% and 81.0% from baseline to 24 months for average and maximum pain. Modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring showed that 7 of 10 subjects had complete defect repair and filling by 24 months. Biopsy staining for collagen II revealed integration and remodeling of HSAM into a mix of hyaline-like cartilage and fibrocartilage matrix. CONCLUSION: This study provides evidence supporting the safety and efficacy of HSAM for treating symptomatic cartilage lesions. Subjects showed a high degree of defect fill and integration with the native cartilage and reported improvements in pain and function post-treatment. Results provide important original data for future clinical trials.
Assuntos
Cartilagem Articular , Qualidade de Vida , Âmnio , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Seguimentos , Humanos , Dor/etiologia , Estudos Prospectivos , Transplante AutólogoRESUMO
AIMS: Recent studies have demonstrated the efficacy of both methadone and buprenorphine when used with opioid dependent men transitioning from prison to the community, but no studies have been conducted with women in the criminal justice (CJ) system. The aim of this study was to determine the efficacy of buprenorphine for relapse prevention among opioid dependent women in the CJ system transitioning back to the community. METHODS: 36 women under CJ supervision were recruited from an inpatient drug treatment facility that treats CJ individuals returning back to the community. Nine were enrolled in an open label buprenorphine arm then 27 were randomized to buprenorphine (n=15) or placebo (n=12; double-blind). All women completed baseline measures and started study medication prior to release. Participants were followed weekly, provided urine drug screens (UDS), received study medication for 12 weeks, and returned for a 3-month follow-up. Intent-to-treat analyses were performed for all time points through 3 month follow-up. RESULTS: The majority of participants were Caucasian (88.9%), young (M±SD=31.8±8.4 years), divorced/separated (59.2%) women with at least a high school/GED education (M±SD=12±1.7 years). GEE analyses showed that buprenorphine was efficacious in maintaining abstinence across time compared to placebo. At end of treatment, 92% of placebo and 33% of active medication participants were positive for opiates on urine drug screen (Chi-Square=10.9, df=1; p<0.001). However, by the three month follow-up point, no differences were found between the two groups, with 83% of participants at follow-up positive for opiates. CONCLUSIONS: Women in the CJ system who received buprenorphine prior to release from a treatment facility had fewer opiate positive UDS through the 12 weeks of treatment compared to women receiving placebo. Initiating buprenorphine in a controlled environment prior to release appears to be a viable strategy to reduce opiate use when transitioning back to the community.
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Buprenorfina/uso terapêutico , Direito Penal , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Alabama/epidemiologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Transtornos Relacionados ao Uso de Opioides/psicologia , Projetos Piloto , Centros de Tratamento de Abuso de Substâncias , Adulto JovemRESUMO
OBJECTIVES: This study examined differences in cessation success based on smokers' self-initiated pre-quit reductions in cigarettes per day (cpd). METHODS: The study utilized data from a nicotine replacement+behavioral therapy smoking cessation intervention conducted in a female prison facility with 179 participants who were wait-listed for 6 months prior to intervention. We compared two groups of smokers based on whether they self-selected to reduce smoking prior to their cessation attempt (n=77) or whether they increased smoking or did not reduce (n=102). General Estimating Equations (GEE) were used to model smoking cessation through 12-month follow-up. RESULTS: Examination of pre-cessation cpd showed that those who reduced were heavier smokers at baseline, relative to those who did not reduce (p<0.001). By the week prior to the quit attempt (week 3) heavier smokers at baseline smoked significantly fewer cigarettes (p<0.001) and had lower CO levels (p<0.05) compared to baseline lighter smokers. GEE analyses showed that individuals who reduced prior to their quit attempt had significantly higher quit rates during early treatment but these gains were not sustained by follow-up points. CONCLUSIONS: Participant-initiated pre-cessation smoking reduction may be initially helpful in preparing to quit smoking, or may serve as a marker for participant motivation to quit smoking, but these differences do not sustain over time. More intensive interventions are still needed for successful cessation.
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Prisioneiros , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Adulto , Terapia Comportamental , Monóxido de Carbono/sangue , Feminino , Humanos , Motivação , Agonistas Nicotínicos/uso terapêutico , Prisioneiros/psicologia , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Resultado do TratamentoRESUMO
We assessed the contraceptive needs of women in jails and their sexually transmitted disease (STD) history and risk to determine effective contraceptive methods for this population. A survey of demographics, sexual health, contraceptive use, and preferred method of contraception was completed by participants recruited at jails in a medium-sized metropolitan area. Results from 188 women indicated high rates of STDs, inconsistent contraceptive use, and use of unreliable and user-dependent contraception methods. Intended contraceptive use following release varied depending on women's ability to bear children. Women planning to use condoms after release were more likely to have had an STD and more sexual partners than were women not planning to use condoms. Racial differences were found for participants' sexual health and contraception histories. These women were at high risk for STDs and appeared to need education about contraception methods. Therefore, they might benefit from education on safe sex practices provided prior to release.
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Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Conhecimentos, Atitudes e Prática em Saúde , Prisioneiros , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Negro ou Afro-Americano , Comportamento de Escolha , Anticoncepção/psicologia , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Infertilidade Feminina/psicologia , Intenção , Área Carente de Assistência Médica , Avaliação das Necessidades , Pobreza , Medição de Risco , Comportamento Sexual , Infecções Sexualmente Transmissíveis/etnologia , Sudeste dos Estados Unidos , População BrancaRESUMO
INTRODUCTION: While smoking rates are 3-4 times higher among criminal justice populations than in the general population, no studies have previously examined smoking characteristics in a community corrections population. METHODS: The current study involved descriptive analyses of self-reported survey data from 217 criminal justice supervisees reporting for urine drug screens during a 5-day period at a community corrections facility in the southeastern United States. RESULTS: Most participants were current smokers (72.3%), males (65.9%), and Black (50.2%) who reported smoking three fourths of a pack of cigarettes per day and had been smoking for about 15 years. More than half of smokers reported that they would be interested in receiving cessation assistance if free help were available and of these, 60% were interested in pharmacotherapy. White smokers used more cigarettes per day, were more likely to have already tried medication to help them quit smoking, and were also more interested in pharmacotherapies and less interested in behavioral therapies compared with Black smokers. Female smokers did not differ from male smokers on key smoking characteristics, but male smokers were more likely to have tried or regularly used other tobacco products, such as cigars. Female smokers were significantly more likely to report interest in using a pharmacotherapy agent for future cessation, while male smokers reported more interest in nonpharmacotherapy approaches to quit smoking. DISCUSSION: Results from this study highlight important differences among smoking groups and may indicate the need to test tailored smoking interventions.
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Prisioneiros , Fumar/epidemiologia , Adulto , Coleta de Dados , Feminino , Humanos , Masculino , Fumar/etnologia , Adulto JovemRESUMO
OBJECTIVES: We assessed the contraceptive needs of women incarcerated in jails in the southeastern United States to determine feasible and effective birth control interventions based on the needs of this population. METHODS: Participants were recruited from local jails around a medium-sized metro area. Participants completed a survey of demographics, sexual health, contraceptive use, and preferred method of contraception. RESULTS: The survey was completed by 188 women in jail. Participants reported high rates of sexually transmitted diseases (STDs) (50.5%), inconsistent use of birth control (36.5%), and use of unreliable and user-dependent methods of birth control. The majority did not desire to become pregnant in the future (61.5%) but intended to have sex after release from jail (76.9%). Women who were able to bear children were more likely to report intentions to use birth control or STD protection after release (77.9%). Additionally, significant racial differences were found. Specifically, nonwhites were more likely to be single and have more STDs and less use of a variety of birth control methods than whites. CONCLUSIONS: Women in this sample were at high risk for unplanned pregnancies. Therefore, a primary contraceptive need for this population appeared to be education about longer lasting, user-independent forms of contraception. Many of these women would be ideal candidates for such forms of contraception, especially if it was provided prior to release.