Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
1.
J Subst Abuse Treat ; 46(4): 528-31, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24462241

RESUMO

The aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.


Assuntos
Aconselhamento/métodos , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Adulto , Feminino , Seguimentos , Hepatite A/prevenção & controle , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Masculino , Metadona/administração & dosagem , Pessoa de Meia-Idade , Entrevista Motivacional/métodos , Tratamento de Substituição de Opiáceos/métodos , Fatores de Tempo
2.
Am J Public Health ; 103(10): e81-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23947319

RESUMO

OBJECTIVES: We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. METHODS: We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. RESULTS: Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61). CONCLUSIONS: Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients.


Assuntos
Hepatite A/prevenção & controle , Hepatite B/prevenção & controle , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Vacinação , Adulto , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente/estatística & dados numéricos , São Francisco
3.
Am J Drug Alcohol Abuse ; 39(4): 247-51, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23841865

RESUMO

BACKGROUND: Universal Human Immunodeficiency Virus (HIV) testing and treatment are strategies to decrease AIDS-related morbidity and mortality and to reduce HIV transmission. OBJECTIVE: This study examined the feasibility and effectiveness of routine HIV rapid testing implemented in the largest New York City (NYC) Methadone Maintenance Treatment Program (MMTP). METHODS: A routine HIV rapid testing program performed by medical providers without pretest counseling or the provision of incentives was compared to HIV rapid testing done by referral to HIV counselors with pretest counseling and incentives over the prior 12 months. RESULTS: Routine HIV rapid testing proved feasible and effective when performed by the medical staff in the setting of a large urban MMTP. The program increased HIV testing in all genders, race/ethnicities, and ages. HIV-positive individuals were diagnosed and successfully linked to care. The elimination of HIV prevention counseling may have facilitated expanded testing. CONCLUSION: This study confirms that routine HIV rapid testing without HIV-prevention counseling or the provision of incentives for patients is feasible on a large scale in a busy, urban methadone clinic.


Assuntos
Infecções por HIV/diagnóstico , Soropositividade para HIV/diagnóstico , Metadona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Aconselhamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Cidade de Nova Iorque , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
4.
Harm Reduct J ; 10: 10, 2013 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-23786800

RESUMO

BACKGROUND: Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood. METHODS: Fourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions. RESULTS: Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility. CONCLUSION: Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.


Assuntos
Atitude Frente a Saúde , Hepatite C Crônica/diagnóstico , Adulto , Afro-Americanos/psicologia , Aconselhamento , Diagnóstico Precoce , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Hepatite C Crônica/complicações , Hepatite C Crônica/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Percepção , Pesquisa Qualitativa , Encaminhamento e Consulta , São Francisco , Abuso de Substâncias por Via Intravenosa/complicações
5.
J Subst Abuse Treat ; 44(1): 115-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22405884

RESUMO

We used a 25-item, self-administered questionnaire to assess staff's perceived barriers and willingness to engage in onsite treatment of hepatitis C virus (HCV) at the Beth Israel Medical Center methadone maintenance treatment program (MMTP) at its Harlem sites. Of 80 participants, 50% were counselors and 24% were directly involved in referral or HCV testing. Although 92% of the MMTP staff indicated that they discuss HCV evaluation and treatment with patients at least annually, 70% believed that less than 25% of patients accept referral for HCV treatment and attend their initial appointment. Most staff (66%) supported onsite HCV evaluation and treatment, although support was higher among those with a bachelor's degree or higher (p = 0.046). Lack of infrastructure was perceived as the greatest obstacle to onsite treatment. Educational interventions and skill building for staff to confidently engage and support MMTP patients in HCV treatment may be necessary prerequisites for onsite HCV management in MMTPs.


Assuntos
Atitude do Pessoal de Saúde , Hepatite C/terapia , Metadona/administração & dosagem , Centros de Tratamento de Abuso de Substâncias/organização & administração , Adolescente , Adulto , Escolaridade , Feminino , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta , Inquéritos e Questionários , Adulto Jovem
6.
Drug Alcohol Depend ; 128(1-2): 161-5, 2013 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-22951068

RESUMO

BACKGROUND: This analysis explored the prevalence and correlates of pain in patients enrolled in methadone maintenance treatment (MMT). METHODS: Patients in two MMT programs starting a hepatitis care coordination randomized controlled trial completed the Brief Pain Inventory Short-Form and other questionnaires. Associations between clinically significant pain (average daily pain≥5 or mean pain interference≥5 during the past week) and sociodemographic data, medical status, depressive symptoms, and health-related quality of life, and current substance use were evaluated in multivariate analyses. RESULTS: The 489 patients included 31.8% women; 30.3% Hispanics, 29.4% non-Hispanic Blacks, and 36.0% non-Hispanic Whites; 60.1% had hepatitis C, 10.6% had HIV, and 46.8% had moderate or severe depressive symptomatology. Mean methadone dose was 95.7mg (SD 48.9) and urine drug screening (UDS) was positive for opiates, cocaine, and amphetamines in 32.9%, 40.1%, and 2.9%, respectively. Overall, 237 (48.5%) reported clinically significant pain. Pain treatments included prescribed opioids (38.8%) and non-opioids (48.9%), and self-management approaches (60.8%), including prayer (33.8%), vitamins (29.5%), and distraction (12.7%). Pain was associated with higher methadone dose, more medical comorbidities, prescribed opioid therapy, and more severe depressive symptomatology; it was not associated with UDS or self-reported substance use. CONCLUSIONS: Clinically significant pain was reported by almost half of the patients in MMT programs and was associated with medical and psychological comorbidity. Pain was often treated with opioids and was not associated with measures of drug use. Studies are needed to further clarify these associations and determine their importance for pain treatment strategies.


Assuntos
Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Dor/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pacientes Ambulatoriais , Prevalência , Inquéritos e Questionários
7.
J Addict Med ; 5(4): 289-92, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22107879

RESUMO

OBJECTIVE: The need for expansion of health services provided in drug treatment programs has been widely discussed since the beginning of the HIV epidemic among drug users. Service expansion has focused on various types of services including medical services (eg, primary care) and harm-reduction services (eg, provision of sterile syringes). METHODS: A staff survey was conducted in 8 methadone maintenance clinics in the New York/New Jersey area to assess attitudes toward the provision of harm reduction and other services in methadone clinics, and the relationship of these attitudes to other variables. PARTICIPANTS: A total of 114 staff members in 8 methadone maintenance clinics completed the survey. RESULTS: The majority of staff was supportive of adding services, over 90% supported medical services, and the majority supported harm-reduction services such as syringe access and disposal services. Higher education and HIV knowledge levels were significant correlates of favorable attitudes toward service provision. CONCLUSIONS: Support for providing harm-reduction services in methadone maintenance clinics was found. Enhancing knowledge of staff regarding various types of health services, and engaging them in how best to institute new services, should be undertaken when new services are planned.


Assuntos
Sorodiagnóstico da AIDS , Atitude do Pessoal de Saúde , Atenção à Saúde , Redução do Dano , Metadona/uso terapêutico , Programas de Troca de Agulhas , Tratamento de Substituição de Opiáceos/psicologia , Adulto , Coleta de Dados , Feminino , Hepatite C/diagnóstico , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , New Jersey , New York , Satisfação do Paciente , Reabilitação Vocacional
8.
J Interpers Violence ; 26(8): 1646-63, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20501899

RESUMO

The purpose of this study is to examine the extent to which drug-involved men who perpetrate male-to-female intimate partner violence (IPV) are engaged with various formal service systems as well as whether adherence to traditional male ideologies-thought to drive perpetration of male-to-female IPV-affects help-seeking behavior. This study also seeks to redress a gap in the research literature stemming from the general reliance on batterers intervention programs to acquire samples of IPV perpetrators. A sample of 126 men receiving methadone maintenance treatment who reported perpetrating IPV against a female partner participated in this longitudinal study. A large majority (88%) of participants reported use of additional services beyond methadone treatment (e.g., medical, employment/ vocational, etc.). Using generalized linear modeling, we found that greater endorsement of traditional male ideologies significantly predicted lower subsequent service utilization overall, except for legal services, for which there was a significant positive association. These findings suggest targeted assessment and engagement strategies may be required to involve a greater number of drug-involved men who perpetrate IPV with a wider spectrum of health and social services.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias , Violência , Adulto , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Violência/estatística & dados numéricos
9.
J Crim Justice ; 38(4): 835-840, 2010 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-20657804

RESUMO

Perpetrators of male-to-female intimate partner violence (IPV) may be likely to have multiple service needs, the extent of which may vary with respect to criminal justice involvement. The salience of the criminal justice system and the potential impact on service needs due to arrest and incarceration is underscored given the association between substance use and IPV. This study utilized a sample of men in methadone treatment who perpetrated male-to-female IPV in order to examine associations between criminal justice involvement and perceived additional service need(s). Results indicate that the likelihood of having a service need(s) significantly increased as time since most recent arrest or incarceration decreased. These findings highlight the need and potential benefit that can be derived from greater coordination amongst the criminal justice, IPV prevention, and drug treatment systems and service providers.

10.
J Interv Card Electrophysiol ; 28(1): 19-22, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20177760

RESUMO

PURPOSE: Over the last decade, there has been a significant rise in reported cases of methadone induced QT prolongation (QTP) and Torsades de Pointes (TdP) in patients treated for opioid dependence. Optimal management of these patients is challenging. METHODS: We report a case series of 12 consecutive patients admitted to our institution with methadone-induced QTP and ventricular arrhythmias. RESULTS: All patients survived the presenting arrhythmia. Successful transition to buprenorphine was accomplished in three patients. QT interval normalized and none of these patients had recurrent arrhythmias. Methadone dose was reduced in five patients with improvement of QT interval and resolution of arrhythmia. Four patients, including two with ICDs, refused or did not tolerate a reduction in their methadone dose. CONCLUSION: Ventricular arrhythmias in patients on methadone are an uncommon but important problem. Buprenorphine, a partial micro-opiate-receptor agonist and a kappa-opiate-receptor antagonist does not cause QTP or TdP. Buprenorphine is a useful and effective alternative to methadone in a select group of patients, including those with documented ventricular arrhythmias on methadone. Pacemakers or defibrillators should be reserved for patients who have failed buprenorphine or a reduced methadone dose.


Assuntos
Síndrome do QT Longo/induzido quimicamente , Metadona/efeitos adversos , Antagonistas de Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Torsades de Pointes/induzido quimicamente , Adulto , Estimulação Cardíaca Artificial/métodos , Relação Dose-Resposta a Droga , Esquema de Medicação , Eletrocardiografia , Feminino , Seguimentos , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/terapia , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Medição de Risco , Amostragem , Índice de Gravidade de Doença , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia , Resultado do Tratamento
11.
J Opioid Manag ; 5(1): 27-37, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19344046

RESUMO

OBJECTIVE: To evaluate the features and modes of adaptation to aging among Methadone Maintenance Treatment (MMT) enrollees. SETTING: Beth Israel Medical Center in New York City. PARTICIPANTS: A sample of 156 MMT enrollees (103/66 percent males and 53/34 percent females) age 24-68 years. Twenty-nine percent of participants were aged 55 or older. DESIGN: A cross-sectional, multivariate, correlational design. OUTCOME MEASURES: Participants were administered the MMSE, ASI, BSI, as well as measures of impulsiveness and quality of life (QOL). RESULTS: Older adults were more likely to have had longer periods of treatment (p < 0.01), less likely to report current heroin use (p < 0.05) and overall drug use (p < 0.05), but were more likely to have a history of comorbid alcohol misuse (p < 0.01). Advanced age was also associated with less impulsiveness, hostility, paranoia, and interpersonal sensitivity (p < 0.01), more chronic medical problems (p < 0.05), greater use of medication for medical problems (p < 0.05), and more liberal take home medicine schedules (p < 0.01). However, no differences were found between older and younger participants with respect to their scores on the Overall Social Support scale (p > 0.05), the Personal Well-Being Index (p > 0.05) and the Satisfaction with Life Scale (p > 0.05), suggesting comparable levels of QOL. Furthermore, the rate of contact for older participants with medical professionals did not differ significantly from that of younger participants (p > 0.05). Only 7.1 percent of older participants reported regular contact with a primary care physician; a rate that is slightly lower than the rate in the overall population. CONCLUSIONS: The findings from the present study highlight at least two underappreciated challenges that clinicians are increasingly likely encounter in their work with the aging MMT population. These challenges are: (1) that despite numerous medical and psychiatric complaints, only a small proportion of MMT patients have regular contact with a primary care physician and the rate of contact does not appear to increase with age and (2) even with age-related declines in psychiatric comorbidity and illicit substance use, the suboptimal level of QOL that is characteristic of the MMT population as a whole does not improve with aging and length of tenure in MMT.


Assuntos
Envelhecimento , Metadona/administração & dosagem , Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Adaptação Psicológica , Adulto , Fatores Etários , Idoso , Estudos Transversais , Esquema de Medicação , Feminino , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Entorpecentes/uso terapêutico , Cidade de Nova Iorque/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Qualidade de Vida , Adulto Jovem
12.
Pain Med ; 9(3): 359-64, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18366514

RESUMO

Among the many patients served by methadone maintenance treatment programs (MMTPs) is a small population with severe, refractory pain that may be effectively managed using long-term opioid therapy. Pain specialists have begun to treat these patients, and in some cases, methadone has been selected as the opioid analgesic administered for pain management. The use of methadone for pain in patients treated by MMTPs may lead to complex management issues. We present four patients who illustrate different outcomes associated with one challenging scenario, specifically the expressed desire on the part of the patient to withdraw from the MMTP because the opioid has become available for pain. Research is needed to evaluate the phenomenology of pain and addiction in this population and the outcomes associated with varied therapeutic strategies.


Assuntos
Analgésicos Opioides/uso terapêutico , Metadona/uso terapêutico , Clínicas de Dor/estatística & dados numéricos , Dor/tratamento farmacológico , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Adulto , Doença Crônica/tratamento farmacológico , Feminino , Dependência de Heroína/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Addict Dis ; 26(2): 13-23, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17594994

RESUMO

Buprenorphine is an efficacious treatment for opioid dependence recently approved for office-based medical practice. The purpose of the study was to describe the background characteristics, treatment process, outcomes and correlates of outcomes for patients receiving buprenorphine maintenance in "real world" office-based settings in New York City, without employing the many patient exclusion criteria characterizing clinical research studies of buprenorphine, including absence of co-occurring psychiatric and non-opioid substance use disorders. A convenience sample of six physicians completed anonymous chart abstraction forms for all patients who began buprenorphine induction or who transferred to these practices during 2003-2005 (N = 86). The endpoint was the patient's current status or status at discharge from the index practice, presented in an intent-to-treat analysis. The results were: male (74%); median age (38 yrs); White, non-Hispanic (82%); employed full-time, (58%); HCV+ (15%); substance use at intake: prescription opioids (50%), heroin (35%), non-opioids (49%); median length of treatment (8 months); median maintenance dose (15 mg/day); prescribed psychiatric medication (63%). The most frequent psychiatric disorders were: major depression, obsessive-compulsive and other anxiety, bipolar. At the endpoint: retained in the index practice (55%); transferred to other buprenorphine practice (6%); transferred to other treatment (7%); lost to contact or out of any treatment (32%). Outcomes were positive, in that 2/3 of patients remained in the index practice or transferred to other treatment. Patients living in their own home or misusing prescription opioids (rather than heroin) were more likely, and those employed part-time were less likely, to be retained in the index practice. At the endpoint, 24% of patients were misusing drugs or alcohol. Co-occurring psychiatric disorders and polysubstance abuse at intake were common, but received clinical attention, which may explain why their effect on outcomes was minimal.


Assuntos
Assistência Ambulatorial , Buprenorfina/uso terapêutico , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Adolescente , Adulto , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Cidade de Nova Iorque , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prática Privada
14.
Violence Vict ; 21(5): 657-72, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17022356

RESUMO

This study tests the feasibility, safety, and short-term preliminary effects of a relapse prevention and relationship safety (RPRS) intervention in reducing drug use and the experience of intimate partner violence (IPV) among women on methadone. For this randomized controlled trial, 34 women who met IPV and drug use criteria were randomly assigned to either the RPRS condition (n = 16) or a one-session informational control (IC) condition (n = 18). RPRS participants were more likely than IC participants to report a decrease in minor physical or sexual IPV (OR = 7.1, p = .05), minor psychological IPV (OR = 5.3, p = .03) and severe psychological IPV (OR = 6.07, p = .03) at the 3-month follow-up. Data suggest that RPRS participants were also more likely than IC participants to report a decrease in any drug use at 3 months (OR = 3.3, p = .08). This study provides preliminary evidence that the RPRS intervention is effective in reducing IPV and drug use among women on methadone.


Assuntos
Mulheres Maltratadas/psicologia , Relações Interpessoais , Metadona/uso terapêutico , Maus-Tratos Conjugais/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , New York , Razão de Chances , Projetos de Pesquisa , Prevenção Secundária , Maus-Tratos Conjugais/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Saúde da Mulher
15.
Clin Infect Dis ; 37(12): 1686-92, 2003 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-14689352

RESUMO

Injection drug users (IDUs) were heavily affected by the tuberculosis (TB) resurgence in New York City in the 1990s. We assessed the effectiveness of screening for latent TB infection in methadone users and of selective treatment with isoniazid. Risk for future TB was classified as low or high on the basis of tuberculin, anergy, and HIV test results. The cohort of 2212 IDUs was followed up for a median of 4.2 years; 25 IDUs, of whom 20 (80%) were infected with human immunodeficiency virus (HIV), developed TB. In an adjusted Cox proportional hazards model of high-risk IDUs, the risk of TB was associated with HIV infection (HR 10.3; 95% CI, 3.4-31.3); receipt of <6 months of isoniazid therapy (HR 7.6; 95% CI, 1.02-57.1); a CD4+ T lymphocyte count of <200 cells/mm3 (HR 6.6; 95% CI, 1.7-25.9); and tuberculin positivity (HR 4.0; 95% CI, 1.6-10.2). Treatment with isoniazid was beneficial in HIV-infected, tuberculin-positive IDUs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/uso terapêutico , Infecções por HIV/complicações , Isoniazida/uso terapêutico , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Tuberculose/tratamento farmacológico , Adulto , Idoso , Feminino , HIV , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Teste Tuberculínico , Tuberculose/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...