Characterizing opioid use in a US population with migraine: Results from the CaMEO study.

OBJECTIVE: To determine the prevalence of and risk factors associated with opioid use in the treatment of migraine, we examined demographics and clinical characteristics of 867 individuals who reported using opioids for the treatment of migraine. METHODS: We analyzed data from the CaMEO study (Chronic Migraine Epidemiology and Outcomes), a cross-sectional, longitudinal, Internet study, to compare sociodemographics, clinical characteristics, and migraine burden/disability of opioid users vs nonusers. Covariates were entered as categorical or continuous variables. Factors associated with opioid use were identified using nested, multivariable binary logistic regression models. RESULTS: Of 2,388 respondents with migraine using prescription medications for acute treatment, 36.3% reported that they currently used or kept on hand opioid medications to treat headaches. Current opioid users had significantly more comorbidities, greater headache-related burden, and poorer quality of life than nonusers. Regression models revealed factors significantly associated with opioid use, including male sex, body mass index, allodynia, increasing monthly headache frequency, Total Pain Index score (excluding head, face, neck/shoulder), anxiety, depression, ≥1 cardiovascular comorbidity, and emergency department/urgent care use for headache in the past 6 months. Self-reported physician-diagnosed migraine/chronic migraine was associated with significantly decreased likelihood of opioid use. CONCLUSIONS: Of respondents who were using acute prescription medications for migraine, more than one-third used or kept opioids on hand, contrary to guidance. This analysis could not distinguish risk factors from consequences of opioid use; thus further research is needed to guide the development of strategies for reducing the inappropriate use of opioids in migraine.

Palm community transitions along a topographic gradient from floodplain to terra firme in the eastern Amazon / Transições em uma comunidade de palmeiras ao longo de um gradiente topográfico de uma floresta inundável à Terra Firme na Amazônia Oriental

Palms show clear niche segregation patterns along topographic gradients in tropical forests, with some species associated to terra firme and others to seasonally flooded areas. The aim of this study was to quantitatively describe the fine-scale spatial variation within a palm community, tracking the changes in species' abundance along environmental gradients associated with a perennial stream the eastern Amazon. The study of palm communities was based on 60 forest plots in which all adult palms were counted. We found a total of 566 palms in a community containing 11 species. Furthermore, we found a significant separation in the palm community between seasonally-flooded and terra firme forests. We found a gradient with various densities of the three most abundant palm species within the first 100 m away from the flooded area. Other species were located exclusively in the terra firme forest. The abundance of the six most common species were distributed in relation to humidity gradients from floodplains to terra firme, with palm distribution from the most flood-tolerant to the least flood-tolerant palm species as follows: Euterpe oleracea, Attalea phalerata and Socratea exorrhiza (species with floodplain affinity), Astrocaryum gynacanthum, Astrocaryum aculeatum, Attalea maripa (species with terra firme affinity).

Palmeiras apresentam padrões claros de segregação de nicho ao longo de gradientes topográficos, com algumas espécies associadas a florestas de terra firme e outras a áreas alagáveis. O objetivo desse estudo foi descrever quantitativamente as variações em pequena escala dentro de uma comunidade de palmeiras, investigando as mudanças na abundância de espécies ao longo de gradientes ambientais associados com um igarapé perene na Amazônia Oriental. O estudo de comunidades de palmeiras foi baseado em 60 parcelas florestais em que todos os adultos de palmeiras foram contados. Encontramos um total de 566 palmeiras em uma comunidade contendo 11 espécies. Além disso, encontramos uma separação significativa na comunidade de palmeiras entre florestas sazonalmente inundadas e florestas de terra firme e um gradiente das densidades das três espécies mais abundantes, ao longo dos primeiros 100 m de distância da área alagada. A abundância das seis espécies mais comuns variou em relação ao gradiente de umidade das áreas alagáveis para a terra firme, com a distribuição das palmeiras da mais tolerante a alagamentos a menos tolerante a alagamentos da seguinte forma: Euterpe oleracea, Attalea phalerata, Socratea exorrhiza (espécies associadas a áreas alagadas), Astrocaryum gynacanthum,Astrocaryum aculeatum, Attalea maripa (espécies com afinidade por terra firme).

Planting coconuts in Indian villages: ethnoecological aspects and evaluation of a "sustainable development" project / Aspectos etno-ecológicos do plantio de coco-da-Bahia em aldeias Kayapó do sudeste da Amazônia

Although scientists and policy makers embrace the general concept "sustainable development", there are few who agree on how to carry out sustainable development in specific situations. As such, sustainable development projects among ethnoscientists are widely critiqued as to how well they are inter-culturally formulated. Here we report on a controversial case of planting coconuts in Kayapó Indian villages of southern Pará, Brazil and offer our own self-critique. We began under the premise that reforestation and Kayapó general health/nutrition go hand in hand. Therefore, the flourishing of coconut culture will contribute to forest conservation in the long run, in itself, and simultaneously, maintain good nutrition for the Kayapó people who protect the forest from the threat of non-sustainable practices. We take an ethnoecological approach in discovering how Kayapó behavior affects the growth and flourishing of coconut culture when fostered with external supply. We present the results of two field trips to the Kayapó indigenous territory, where we found socio-ecological factors relevant to the success of our project supporting the culture of coconuts in indigenous villages. First, in November 2007, we visited Kikretum, Moikarakô and Aukre villages (among 10 villages which received coconut seedlings from our support program) to deliver a second shipment of coconut seedlings (the first shipment to these villages took place in April 2006) and quantitatively described one aspect of coconut seed-disperser's (the Kayapó's) behavior. We looked specifically at how the pre-existing coconuts palms were distributed among the Indian families, how they distributed last year's shipment, and how that shipment survived due to ethnoecological factors. Second, in July 2008 we visited Kokraimoro and Pykararankre villages and estimated the position of the previously existing and newly planted coconut palms in relation to other cultivated trees by making use of censuses departing from the village center to their outside limits. In the three Indian villages we visited in 2007, virtually all pre-existing coconut trees belonged to a select few families, and the coconut fruit distribution was, in most cases, highly concentrated among these family members. However, assuming that all the coconut saplings that survived the first year will reach maturity (from the first shipment in April 2006), they represent a remarkable increase in the projected number of adult coconut palms in the three visited villages (48, 195 and 101 percent in Kikretum, Moikarakô and Aukre, respectively), and a substantial reduction in the inequality in access to coconuts. In the 2008 field trip, we found that the Indians usually plant coconuts very close to their houses where competition with other cultivated trees may hinder the palms development.

Apesar de cientistas e tomadores de decisão abraçarem o conceito geral de "desenvolvimento sustentável", há pouco acordo sobre como se atingir esta meta em situações específicas. Assim, projetos de desenvolvimento sustentável são amplamente criticados por etno-cientistas quanto à forma como são inter-culturalmente formulados. Aqui reportamos um caso controverso de plantio de coco-da-Bahia em aldeias Kayapó do sul do Pará, e fazemos a nossa autocrítica. Nós partimos da premissa de que o reflorestamento e o estado geral de saúde/nutrição caminham lado a lado. Portanto, o desenvolvimento da cultura de cocos por si só deve contribuir para a conservação da floresta no longo prazo e, simultaneamente, contribuir para o bom estado nutricional do povo Kayapó que protege a floresta da ameaça de práticas não-sustentáveis. Nós buscamos descobrir como que o comportamento dos Kayapó afeta o desenvolvimento da cultura de cocos quando amparada com suporte externo. Nós apresentamos resultados de duas viagens de campo para a terra Kayapó, onde detectamos fatores sócio-ecológicos relevantes para o sucesso de nosso projeto de apoio à cultura de coqueiros nas aldeias indígenas. Primeiro, em novembro de 2007, nós visitamos as aldeias Kikretum, Moikarakô e Aukre (dentre 10 aldeias que receberam mudas de coqueiros de nosso programa de apoio) para entregar um segundo carregamento de mudas de coqueiro (o primeiro carregamento aconteceu em abril de 2006). E descrevemos quantitativamente um aspecto do comportamento dos dispersores de sementes de coco (os Kayapó). Especificamente, como as palmeiras pré-existentes nas aldeias são distribuídas dentre as famílias dos índios e como este carregamento sobreviveu a fatores etno-ecológicos. Segundo, em julho de 2008 nós visitamos as aldeias Kokraimoro e Pykararankre e estimamos a posição dos coqueiros pré-existentes e dos novos em relação a outras árvores cultivadas, fazendo uso de censos partindo do centro das aldeias para seus limites exteriores. Nas três aldeias indígenas visitadas em 2007, virtualmente todos os coqueiros pré-existentes pertenciam a poucas famílias e a distribuição de frutos era, na maior parte dos casos, altamente concentrada dentre os membros destas famílias. Entretanto, assumindo que todos os coqueiros jovens que sobreviveram ao primeiro ano chegarão à maturidade (do primeiro carregamento em abril de 2006), eles representam um aumento considerável no numero projetado de coqueiros adultos nas três aldeias visitadas (48, 195 e 101 por cento em Kikretum, Moikarakô e Aukre, respectivamente). E uma redução substancial na desigualdade de acesso aos cocos. Na expedição de 2008, encontramos que os índios geralmente plantam coqueiros bem próximos das suas casas onde a competição com outras árvores cultivadas podem limitar o desenvolvimento das palmeiras.

Topical treatments for onychomycosis: a historical perspective.

Topical treatment of onychomycosis, in contrast to systemic oral therapy, allows the patient to apply medication directly to the affected area, thereby decreasing the potential for adverse events and drug interactions. Historically, several topical antifungal agents have been used in the treatment of onychomycosis; however, the evidence for their effectiveness is based on very limited data or anecdotal reports. Recently, the development of new, effective topical agents has renewed interest in this form of therapy. As clinical experience with newer topical agents expands, they may be found to be an effective option for the treatment of onychomycosis.