A Multivariate Age-Structured Stochastic Model with Immunization Strategies to Describe Bronchiolitis Dynamics.

Bronchiolitis has a high morbidity in children under 2 years old. Respiratory syncytial virus (RSV) is the most common pathogen causing the disease. At present, there is only a costly humanized monoclonal RSV-specific antibody to prevent RSV. However, different immunization strategies are being developed. Hence, evaluation and comparison of their impact is important for policymakers. The analysis of the disease with a Bayesian stochastic compartmental model provided an improved and more natural description of its dynamics. However, the consideration of different age groups is still needed, since disease transmission greatly varies with age. In this work, we propose a multivariate age-structured stochastic model to understand bronchiolitis dynamics in children younger than 2 years of age considering high-quality data from the Valencia health system integrated database. Our modeling approach combines ideas from compartmental models and Bayesian hierarchical Poisson models in a novel way. Finally, we develop an extension of the model that simulates the effect of potential newborn immunization scenarios on the burden of disease. We provide an app tool that estimates the expected reduction in bronchiolitis episodes for a range of different values of uptake and effectiveness.

Psychosocial predictors of relapse in cocaine-dependent patients in treatment.

Relapses in cocaine abusers in treatment are an important problem. The majority of patients are incapable of sustaining abstinence over any length of time. To identify the factors associated to relapses risk in the cocaine use can be an optimal choice to improve the treatment strategies. The aim of this study was to analyze relapse-risk factors in cocaine-dependent patients on treatment. Participants were 102 patients who had begun outpatient treatment at a public health center in Spain. Some functional areas and cocaine use are evaluated for a period of six months. A structural equations model was used to identify possible predictive variables. The results show that social-family environment and economic-employment situation were associated with greater risk of relapse. Likewise, the social-family environment was related to severity of addiction. It is concluded that the incorporation of family intervention strategies and vocational/employment counseling may help to reduce relapse rates in cocaine addicts receiving treatment.

Psychosocial predictors of relapse in cocaine-dependent patients in treatment

Relapses in cocaine abusers in treatment are an important problem. The majority of patients are incapable of sustaining abstinence over any length of time. To identify the factors associated to relapses risk in the cocaine use can be an optimal choice to improve the treatment strategies. The aim of this study was to analyze relapse-risk factors in cocaine-dependent patients on treatment. Participants were 102 patients who had begun outpatient treatment at a public health center in Spain. Some functional areas and cocaine use are evaluated for a period of six months. A structural equations model was used to identify possible predictive variables. The results show that social-family environment and economic-employment situation were associated with greater risk of relapse. Likewise, the social-family environment was related to severity of addiction. It is concluded that the incorporation of family intervention strategies and vocational/employment counseling may help to reduce relapse rates in cocaine addicts receiving treatment (AU)

Las recaídas en el consumo siguen siendo un problema común en el tratamiento de las personas dependientes a la cocaína. La mayoría de los pacientes son incapaces de mantener la abstinencia de forma continuada, por lo que la identificación de factores que se relacionen con un mayor riesgo de recaída en el consumo permite mejorar las estrategias de tratamiento. El objetivo de este estudio fue analizar potenciales factores de riesgo de recaída durante el tratamiento en dependientes a la cocaína. Participaron 102 pacientes que iniciaban tratamiento en una unidad de tipo ambulatorio de la red sanitaria pública de España. Se evaluaron diversas áreas de funcionamiento y el uso de cocaína durante un período de seis meses. Para identificar las posibles variables con valor predictivo se utilizó una modelización matemática con ecuaciones estructurales. Los resultados de este trabajo subrayan que factores psicosociales como el entorno sociofamiliar y la situación económico-laboral tienen capacidad para predecir las recaídas en este tipo de pacientes. También que el entorno sociofamiliar influye en la severidad adictiva. Se concluye que la incorporación de estrategias de intervención familiar y de consejo vocacional puede ayudar a reducir las tasas de recaída en adictos a la cocaína en tratamiento (AU)

Community Reinforcement Approach (CRA) for cocaine dependence in the Spanish public health system: 1 year outcome.

INTRODUCTION AND AIMS: The development and dissemination of effective treatments for cocaine dependence is an important public health priority in Europe, and especially in Spain, given the increase in treatment demand over recent years. The aim of this study was to determine the effectiveness of the Community Reinforcement Approach (CRA) for cocaine dependents at an outpatient clinic within the Spanish public health system. DESIGN AND METHODS: A total of 82 cocaine-dependent patients were randomly assigned to one of two treatment conditions: Standard Treatment (n = 35) or CRA (n = 47). Dependent variables were treatment retention, cocaine abstinence and composite scores from the European version of the Addiction Severity Index at 12 month follow up. RESULTS: Of the patients who received CRA, 55% completed 6 months of treatment, versus 40% who received Standard Treatment. At the 12 month follow up, patients assigned to the CRA condition achieved higher rates of abstinence (95.2%) by comparison with Standard Treatment (69.2%). In the CRA group, 27% of the patients achieved continuous cocaine abstinence, versus 21% in the Standard Treatment group. The CRA group also obtained lower scores than the Standard Treatment group in all Addiction Severity Index composite scores. DISCUSSION AND CONCLUSIONS: This study showed that CRA is a feasible treatment for cocaine addiction in a public community setting in Spain.