Management of opioid-dependent patients: comparison of the cost associated with use of buprenorphine/naloxone or methadone, and their interactions with concomitant treatments for infectious or psychiatric comorbidities.

The objective was to estimate the annual interaction management cost of agonist opioid treatment (AOT) for opioid-dependent (OD) patients with buprenorphine-naloxone (Suboxone®) (B/N) or methadone associated with concomitant treatments for infectious (HIV) or psychiatric comorbidities. A costs analysis model was developed to calculate the associated cost of AOT and interaction management. The AOT cost included pharmaceutical costs, drug preparation, distribution and dispensing, based on intake regimen (healthcare center or take-home) and type and frequency of dispensing (healthcare center or pharmacy), and medical visits. The cost of methadone also included single-dose bottles, monthly costs of custody at pharmacy, urine toxicology drug screenings and nursing visits. Potential interactions between AOT and concomitant treatments (antivirals, antibacterials/antifungals, antipsychotics, anxiolytics, antidepressant and anticonvulsants), were identified to determine the additional use of healthcare resources for each interaction management. The annual cost per patient of AOT was €1,525.97 for B/N and €1,467.29 for methadone. The average annual cost per patient of interaction management was €257.07 (infectious comorbidities), €114.03 (psychiatric comorbidities) and €185.55 (double comorbidity) with methadone and €7.90 with B/N in psychiatric comorbidities. Total annual costs of B/N were €1,525.97, €1,533.87 and €1,533.87 compared to €1,724.35, €1,581.32 and €1,652.84 for methadone per patient with infectious, psychiatric or double comorbidity respectively.Compared to methadone, the total cost per patient with OD was lower with B/N (€47.45-€198.38 per year). This is due to the differences in interaction management costs associated with the concomitant treatment of infectious and/or psychiatric comorbidities.

El objetivo fue estimar en pacientes con dependencia a opiáceos (DO), el coste anual del manejo de interacciones del tratamiento sustitutivo con buprenorfina/naloxona (Suboxone®) (B/N) o metadona, asociado con tratamientos concomitantes por comorbilidades infecciosas (VIH) o psiquiátricas. Se realizó un análisis de costes (€, 2013), del tratamiento sustitutivo y del manejo de interacciones. El coste del tratamiento de B/N incluyó costes farmacológicos, elaboración, distribución y dispensación, en función del régimen de administración (centro asistencial o domiciliaria) y del tipo y frecuencia de dispensación (centro asistencial o farmacia), y visitas al especialista para prescripción. El coste de tratamiento con metadona incluyó, además, frascos monodosis, coste de custodia en farmacia, determinación en orina y visitas a enfermería. Se identificaron las interacciones para determinar los recursos sanitarios adicionales consumidos por la administración conjunta del tratamiento sustitutivo y concomitante (antirretrovirales, bactericidas/antifúngicos, antipsicóticos, ansiolíticos, antidepresivos y anticonvulsivos). El coste anual/paciente estimado del tratamiento sustitutivo fue de 1.525,97€ (B/N) y 1.467,29€ (metadona). El coste promedio anual/paciente estimado del manejo de interacciones fue de 257,07€ (infecciosas), 114,03€ (psiquiátricas) y 185,55€ (ambas) con metadona, y de 7,90€ con B/N por comorbilidades psiquiátricas. El coste total anual/paciente estimado de B/N fue 1.525,97€, 1.533,87€ y 1.533,87€ comparado con 1.724,35€, 1.581,32€ y 1.652,84€ de metadona, en pacientes que presentan comorbilidad infecciosa, psiquiátrica o ambas, respectivamente. Comparado con metadona, el coste total por paciente con DO de B/N fue menor (47,45€-198,38€ anuales) derivado de la diferencia del coste por manejo de interacciones del tratamiento concomitante de las comorbilidades infecciosas y/o psiquiátricas.

Perception of Spanish professionals on therapeutic adherence of dual diagnosis patients.

OBJECTIVE: The aim of this study is to determine the health professionals perspective about the therapeutic adherence among dual diagnosis patients. It also analyzed the most frequently used pharmacological and nonpharmacological treatments. The aim is to learn the professional;s perception regarding the reasons for nonadherence and to identify the type of strategies that may improve adherence. METHODOLOGY: We performed an on-line survey that was answered by 169 health professionals (79.8%, doctors or psychologists) who were working in centers where the dual diagnosis patients could be treated (Mental Health Centers, Drug Outpatients Clinics, Inpatient Unit, private practice). RESULTS: A majority of the mental health professionals perceive the existence of non-compliance of dual diagnosis patients and they consider that 29.8% have no compliance and 39.15% have partial compliance. In addition, 96.2% believe that treatment nonadherence can be related with poor evolution in a severe or very severe degree. The reasons for the nonadherence to treatment are the poor disease awareness, side effects, low efficacy and complicated posologies. No differences were found regarding the difficulties and reasons for non-compliance between professionals or centers. It is proposed that using drugs with low side effects drugs and easy-to-manage can improve compliance. It is also proposed to use motivational techniques, psychoeducation and psychological treatment. CONCLUSIONS: The perception exists that a high proportion of dual patients have poor treatment adherence, which affects the therapeutical process. Efforts should be done to improve the pharmacological and nonpharmacological treatment.

Attention deficit hyperactivity disorder and central nervous system depressants dependence. A review.

The comorbidity between attention deficit hyperactivity disorder (ADHD) and substance use disorders is very common. A review of literature addressing prevalence, clinical features and treatment of the comorbidity between ADHD and CNS depressants was conducted. The prevalences found have a wide range (4.5% to 58%). ADHD has been associated with greater severity of addiction, early onset of consumption and addiction, more psychiatric comorbidity and more chronicity. In drug-dependent patients the diagnosis is a complex process because the frequent overlap of symptoms. The screening instruments should be used with caution. Drug therapy has shown efficacy in reducing ADHD symptoms, but there is no consensus regarding their influence on substance use. However, results should be interpreted cautiously, because the samples are small. Psychoeducational interventions are relevant, but treatment outcomes have not been described or studied systematically.

Effects of pregabalin on subjective sleep disturbance symptoms during withdrawal from long-term benzodiazepine use.

AIM: To evaluate the effectiveness of pregabalin as a tapering therapy on the subjective sleep quality of patients who underwent a benzodiazepine withdrawal program in routine medical practice. METHODS: Secondary analysis of a 12-week prospective, open noncontrolled study carried out in patients who met DSM-IV-TR criteria for benzodiazepine dependence. Sleep was evaluated with the Medical Outcomes Study Sleep Scale (MOS Sleep Scale). RESULTS: 282 patients were included in the analysis. Mean (±SD) pregabalin dose was 315 ± 166 mg/day at the end of the trial. We observed a significant and clinically relevant improvement in sleep outcomes at the endpoint, with a total score reduction from 55.8 ± 18.9 to 25.1 ± 18.0 at week 12 (i.e. a 55% reduction). Similar findings were apparent using the six dimensions of the MOS Sleep Scale. Moderate correlations were observed between the MOS Sleep summary index and sleep domains, and there were improvements in anxiety symptoms and disease severity. CONCLUSIONS: These findings suggest that pregabalin may improve subjective sleep quality in patients who underwent a benzodiazepine withdrawal program. This effect appears to be partly independent of improvements in symptoms of anxiety or withdrawal. However, controlled studies are needed to establish the magnitude of the effect of pregabalin.

[Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6)]. / Rendimiento psicométrico de la sexta versión del Addiction Severity Index en español (ASI-6).

This work analysed the psychometric properties of the 6th version of the Addiction Severity Index (ASI-6) translated and adapted to the Spanish language. A multicentre, observational and prospective design was used. A total of 258 participants were included, 217 were patients (35 stable patients and 182 unstable patients), and 41 were controls. The results show satisfactory psychometric performance of the ASI-6. The degree of the internal consistency of the standardized objective scores ranged between .47 and .95. As for test-retest reliability, the values were acceptable, varying from .36 to 1. The study of the internal structure revealed a good fit to a unidimensional solution for all scales taken independently. Regarding convergent-discriminant validity, the correlations between the primary and secondary scales of the ASI-6 and the Clinic Global Impression score were low, with values from .01 to .26. Likewise, 8 of the 15 scales differentiated between controls and unstable patients. The psychometric properties of the ASI-6 Spanish version seem to be acceptable, though it is necessary to carry out new studies to test metric quality with independent samples of patients.

Quetiapine in the treatment of sleep disturbances associated with addictive conditions: a retrospective study.

Sleep disturbances are a common finding in the clinical practice of addictions. Clinical management of insomnia is known to influence the prognosis of the addiction and the success of the detoxication process itself (Peles, Schreiber, and Adelson, 2006; Pace-Schott, Stickgold, Muzur, Wigren, Ward, et al., 2005; Bootzin and Stevens, 2005; Maher, 2004). Thus the relevance of controlling sleep disturbances from the very beginning of the detoxification process. However, managing this situation is often not easy for the clinician. The classical option of using sedating-hypnotic drugs to treat insomnia in polydrug users presents objections: the tolerance associated to high doses of benzodiacepines chronic abuse in many drug addicts obliges the clinician to use high doses of hypnotics, both in acute detoxification and the following de-habituation, with the associated resulting risk of dependence and undesirable side effects (excessive sedation, nocturnal enuresis, ataxia, etc).

Professionals' perception on the management of patients with dual disorders.

BACKGROUND: There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS: An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS: Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION: Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.

Formación académica de los médicos en las Facultades de Medicina y su relación con las necesidades de salud de la población en Cochabamba, Bolivia / Academic training of physicians in medical schools and their relationship to the health needs of the population in Cochabamba-Bolivia

Objetivo: establecer la relación entre la formación académica de los médicos en las Facultades de Medicina, y las necesidades de salud más frecuentes de la población. Métodos: corresponde a una investigación cuantitativa, descriptiva y transversal que tiene como universo todos los médicos internos de pregrado que culminan su formación académica (internado) en los diferentes establecimientos de salud del departamento. Para su realización se tomaron en cuenta por conveniencia dos facultades de Medicina de nuestro departamento como son las dependientes de San Simón y UNIVALLE, donde inicialmente se realizó una revisión exhaustiva del plan curricular, la carga horaria dedicada a las 10 patologías más frecuentes de nuestro país y departamento. Se tiene como muestra de estudio a 62 Médicos que culminan su formación académica (Internado) escogidos al azar; 31 médicos internos de San Simón y 31 médicos internos de UNIVALLE; cada una con características propias distinguibles, a los cuales se les realiza una evaluación de conocimientos sobre las diez patologías más prevalentes del país y la región, lo cual nos permite ver y comparar la formación académica en su amplio espectro. Resultados: la situación de salud del país, refleja altos niveles de morbimortalidad general y materno infantil en particular. Del 100%(UMSS= 6158 horas, UNIVALLE= 6498 horas) de carga horaria curricular en las facultades de Medicina en estudio, el 14% (843h) en la primera (UMSS) y 9%(589h) en la segunda (UNIVALLE), están dedicadas a los problemas de salud más frecuentes de nuestra población. La media de conocimientos fue adecuada en 6 de 10 patologías prevalentes del país y la región, estando más a favor de los médicos internos de San Simón que UNIVALLE. Conclusiones: el plan global y la carga horaria académica, en las Facultades de medicina de San Simón y UNIVALLE referente a los problemas de salud más frecuentes de nuestra población son insuficientes y puede ser extrapolables a otras universidades del país y la región. La preparación académica de los médicos que culminan su formación en la Facultades de Medicina de la UMSS como UNIVALLE, referente a los problemas de salud más frecuentes de nuestra población apenas alcanza el 60% , estando más a favor de los primeros. Finalmente no se encontró una relación directa entre carga horaria académica y grado de formación académica, lo cual significaría que existen otros factores que influyen en el proceso enseñanza y aprendizaje.

Objetive: to establish the relationship between the academic training of physicians in medical schools, and the most frequent health needs of the population. Methods: corresponding to a quantitative, descriptive and transversal research, it has as a universe all undergraduate internal doctors who complete their academic training (internship) in the different health facilities of the department. For its realization, two medical school of our department were taken into account for convenience, such as the dependents of San Simón and UNIVALLE, where initially an exhaustive review of the curricular plan was carried out, the workload dedicated to the 10 most frequent pathologies of our country. and department. It has as sample of study to 62 Doctors that culminate their academic formation (Internship) chosen at random; 31 internal doctors of San Simón and 31 internal doctors of UNIVALLE; each one with its own distinguishing characteristics, to which an evaluation of knowledge about the ten most prevalent pathologies of the country and the region was made, which allows us to see and compare the academic formation in its wide spectrum. Results: the country's health situation reflects high levels of general morbidity and maternal and child mortality in particular. 100% (UMSS = 6158 hours, UNIVALLE = 6498 hours) of curricular workload in the faculties of Medicine under study, 14% (843h) in the first (UMSS) and 9% (589h) in the second (UNIVALLE) , are dedicated to the most frequent health problems of our population.The knowledge average was adequate in 6 of 10 prevalent pathologies of the country and the region, being more in favor of the internal doctors of San Simón than UNIVALLE. Conclusions: the global plan and the academic work load, in the medical schools of San Simón and UNIVALLE referring to the most frequent health problems of our population are insufficient and can be extrapolated to other universities in the country and the region.The academic preparation of the doctors who complete their training in the Faculties of Medicine of the UMSS as UNIVALLE, referring to the most frequent health problems of our population barely reaches 60%, being more in favor of the former. Finally, no direct relationship was found between the academic work load and the degree of academic training, which would mean that there are other factors that influence the teaching and learning process.

Manejo de pacientes dependientes de opiáceos: Comparación del coste asociado al uso de buprenorfina/naloxona o metadona, y sus interacciones con tratamientos concomitantes para comorbilidades infecciosas o psiquiátricas / Management of opioid-dependent patients: comparison of the cost associated with use of buprenorphine/naloxone or methadone, and their interactions with concomitant treatments for infectious or psychiatric comorbidities

El objetivo fue estimar en pacientes con dependencia a opiáceos (DO), el coste anual del manejo de interacciones del tratamiento sustitutivo con buprenorfina/ naloxona (Suboxone®) (B/N) o metadona, asociado con tratamientos concomitantes por comorbilidades infecciosas (VIH) o psiquiátricas. Se realizó un análisis de costes (Euros, 2013), del tratamiento sustitutivo y del manejo de interacciones. El coste del tratamiento de B/N incluyó costes farmacológicos, elaboración, distribución y dispensación, en función del régimen de administración (centro asistencial o domiciliaria) y del tipo y frecuencia de dispensación (centro asistencial o farmacia), y visitas al especialista para prescripción. El coste de tratamiento con metadona incluyó, además, frascos monodosis, coste de custodia en farmacia, determinación en orina y visitas a enfermería. Se identificaron las interacciones para determinar los recursos sanitarios adicionales consumidos por la administración conjunta del tratamiento sustitutivo y concomitante (antirretrovirales, bactericidas/antifúngicos, antipsicóticos, ansiolíticos, antidepresivos y anticonvulsivos). El coste anual/paciente estimado del tratamiento sustitutivo fue de 1.525,97€ (B/N) y 1.467,29€ (metadona). El coste promedio anual/paciente estimado del manejo de interacciones fue de 257,07 Euros (infecciosas), 114,03 Euros (psiquiátricas) y 185,55 Euros (ambas) con metadona, y de 7,90 Euros con B/N por comorbilidades psiquiátricas. El coste total anual/paciente estimado de B/N fue 1.525,97 Euros, 1.533,87 Euros y 1.533,87 Euros comparado con 1.724,35 Euros, 1.581,32 Euros y 1.652,84 Euros de metadona, en pacientes que presentan comorbilidad infecciosa, psiquiátrica o ambas, respectivamente. Comparado con metadona, el coste total por paciente con DO de B/N fue menor (47,45 Euros-198,38 Euros anuales) derivado de la diferencia del coste por manejo de interacciones del tratamiento concomitante de las comorbilidades infecciosas y/o psiquiátricas (AU)

The objective was to estimate the annual interaction management cost of agonist opioid treatment (AOT) for opioid-dependent (OD) patients with buprenorphine-naloxone (Suboxone(R)) (B/N) or methadone associated with concomitant treatments for infectious (HIV) or psychiatric comorbidities. A costs analysis model was developed to calculate the associated cost of AOT and interaction management. The AOT cost included pharmaceutical costs, drug preparation, distribution and dispensing, based on intake regimen (healthcare center or take-home) and type and frequency of dispensing (healthcare center or pharmacy), and medical visits. The cost of methadone also included single-dose bottles, monthly costs of custody at pharmacy, urine toxicology drug screenings and nursing visits. Potential interactions between AOT and concomitant treatments (antivirals, antibacterials/antifungals, antipsychotics, anxiolytics, antidepressant and anticonvulsants), were identified to determine the additional use of healthcare resources for each interaction management. The annual cost per patient of AOT was Euros 1,525.97 for B/N and Euros 1,467.29 for methadone. The average annual cost per patient of interaction management was Euros 257.07 (infectious comorbidities), Euros 114.03 (psychiatric comorbidities) and Euros 185.55 (double comorbidity) with methadone and Euros 7.90 with B/N in psychiatric comorbidities. Total annual costs of B/N were Euros 1,525.97, Euros 1,533.87 and Euros 1,533.87 compared to Euros 1,724.35, Euros 1,581.32 and Euros 1,652.84 for methadone per patient with infectious, psychiatric or double comorbidity respectively. Compared to methadone, the total cost per patient with OD was lower with B/N (Euros 47.45-Euros 198.38 per year). This is due to the differences in interaction management costs associated with the concomitant treatment of infectious and/or psychiatric comorbidities (AU)

Potential dermal exposure during the painting process in car body repair shops.

The object of this study was to assess potential dermal exposure to the non-volatile fractions of paints based on studies assessing potential exposure during the painting process in car body repair shops with water-based paints. The measurements were done during filling of the spray gun, paint spraying and cleaning of the gun. Potential dermal exposure was assessed using patches and gloves as dosimeters and analysing deposits of aluminium, a constituent of the paint mixture, which is used as a chemical tracer for these studies. The total body area used excluding hands was 18 720 cm(2) and the area of each hand was 410 cm(2). Dermal exposure to the paint during filling of the spray gun occurs mainly on the hands and ranged from 0.68 to 589 micro g paint/cm(2)/min, as calculated from the amount of aluminium observed and the concentration of aluminium in the paint. During spraying, the levels of exposure of the hands and body ranged from 0.20 to 4.35 micro g paint/cm(2)/min for the body and 0.40 to 13.4 micro g paint/cm(2)/min for the hands. With cleaning of the spray gun the hands were the principal area exposed, with values ranging from 0.44 to 213 micro g paint/cm(2)/min. Information on and observations of each of the scenarios were recorded in a structured questionnaire.

Percepción de los profesionales Españoles sobre la Adherencia Terapéutica en Patología Dual / Perception of Spanish professionals on Therapeutic Adherence of Dual Diagnosis Patients

Objetivo: Evaluar la percepción de los profesionales sobre el grado de importancia de la adherencia terapéutica de los pacientes con patología dual y valorar los tratamientos farmacológicos y no farmacológicos más utilizados. Se pretende averiguar cual es la percepción de los clínicos sobre las causas del incumplimiento y el tipo de estrategias que pueden facilitar una buena adherencia. Metodología: Se realizó una encuesta on-line que fue contestada por 169 profesionales (79,8% médicos o psicólogos)que trabajan en los diferentes tipos de centros españoles que atienden pacientes duales (ambulatorios de drogodependencias, centros de salud mental, hospitalización psiquiátrica, unidades de desintoxicación y centros privados).Resultados: La percepción de existencia de incumplimiento de los pacientes duales es mayoritaria, los profesionales creen que un 29,8% incumplen y un 39,15% cumplen parcialmente. Además el 96,2% percibe que el incumplimiento está relacionado con una mala evolución, de manera grave o muy grave. Ello se relaciona principalmente con la baja conciencia de enfermedad, la presencia de efectos secundarios, la falta de eficacia y las posologías complicadas. No existen diferencias en función del tipo de recurso en el que trabaja el profesional. Para mejorar el cumplimiento se propone utilizar fármacos con pocos efectos secundarios y fáciles de manejar. También se plantea utilizar psicoeducación, técnicas motivacionales y tratamiento psicológico individual. Conclusiones: Existe la percepción de que un alto porcentaje de pacientes duales presentan mala adherencia y que esto influye en el proceso terapéutico. Se deben realizar esfuerzos en el tratamiento farmacológico y no farmacológico (AU)

Objective: The aim of this study is to determine the health professional’s perspective about the therapeutic adherence among dual diagnosis patients. It also analyzed the most frequently used pharmacological and non pharmacological treatments. The aim is to learn the professional’s perception regarding the reasons for non adherence and to identify the type of strategies that may improve adherence. Methodology: We performed an on-line survey that was answered by 169 health professionals (79.8%, doctors or psychologists) who were working in centers where the dual diagnosis patients could be treated (Mental Health Centers, Drug Outpatients Clinics, Inpatient Unit, private practice).Results: A majority of the mental health professionals perceive the existence of non-compliance of dual diagnosis patients and they consider that 29.8% have no compliance and 39.15% have partial compliance. In addition, 96.2%believe that treatment non adherence can be related with poor evolution in a severe or very severe degree. The reasons for the non adherence to treatment are the poor disease awareness, side effects, low efficacy and complicated posologies. No differences were found regarding the difficulties and reasons for non-compliance between professionals or centers. It is proposed that using drugs with low side effects drugs and easy-to-manage can improve compliance. It is also proposed to use motivational techniques, psychoeducation and psychological treatment. Conclusions: The perception exists that a high proportion of dual patients have poor treatment adherence, which affects the therapeutical process. Efforts should be done to improve the pharmacological and non pharmacological treatment (AU)

Rendimiento psicométrico de la sexta versión del Addiction Severity Indez en español (ASI-6) / Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6)

El presente estudio examinó las propiedades psicométricas del Addiction Severity Index-6 (ASI-6) en su versión traducida y adaptada al español. Se realizó un estudio multicéntrico, observacional y prospectivo donde participaron un total de 258 sujetos, siendo 217 pacientes (35 estables y 182 inestables) y 41 controles. Los resultados muestran que el ASI-6 presentó un buen comportamiento psicométrico. Los niveles de consistencia interna de las puntuaciones objetivas estandarizadas de las escalas del ASI-6 oscilaron entre 0,47 y 0,95. Por su parte, los valores de fiabilidad test-retest fueron aceptables, oscilando entre 0,36 y 1. El estudio de la estructura interna del ASI-6 informó que todas las escalas, considerándolas de forma independiente, se ajustaron a una solución esencialmente unidimensional. En cuanto a la obtención de evidencias de validez convergente-discriminante, las correlaciones entre las escalas primarias y secundarias del ASI-6 y las puntuaciones en la Impresión Clínica Global de Gravedad fueron bajas, oscilando entre 0,01 y 0,26. Asimismo, ocho de las quince escalas del ASI-6 lograron diferenciar entre controles y pacientes inestables. La versión española del ASI-6 presenta propiedades psicométricas que pueden ser consideradas aceptables, aunque sería necesario llevar a cabo nuevos estudios que continúen examinando su calidad métrica en muestras independientes de pacientes(AU)

This work analysed the psychometric properties of the 6th version of the Addiction Severity Index (ASI-6) translated and adapted to the Spanish language. A multicentre, observational and prospective design was used. A total of 258 participants were included, 217 were patients (35 stable patients and 182 unstable patients), and 41 were controls. The results show satisfactory psychometric performance of the ASI-6. The degree of the internal consistency of the standardized objective scores ranged between .47 and .95. As for test-retest reliability, the values were acceptable, varying from .36 to 1. The study of the internal structure revealed a good fit to a unidimensional solution for all scales taken independently. Regarding convergent-discriminant validity, the correlations between the primary and secondary scales of the ASI-6 and the Clinic Global Impression score were low, with values from .01 to .26. Likewise, 8 of the 15 scales differentiated between controls and unstable patients. The psychometric properties of the ASI-6 Spanish version seem to be acceptable, though it is necessary to carry out new studies to test metric quality with independent samples of patients(AU)

Complicaciones somáticas. Diagnóstico y manejo de la infección por VIH, VHB, VHC y tuberculosis en el paciente heroinómano. Interacciones farmacológicas / Somatic complications. Diagnosis and management of infections by HIV, HBV, HCVand tuberculosis in heroin patient. Drug interactions

El consumo de heroína se asocia con frecuencia a todo un conjunto de complicaciones físicas, infecciosas y no infecciosas, relacionadas tanto con las características de la propia droga o de sus adulterantes como con las prácticas de riesgo y forma de vida de los consumidores; que afectan a la calidad de vida del heroinómano, condicionando la evolución y ensombreciendo el pronóstico de la adicción. El cambio experimentado en los últimos años de la vía intravenosa a la fumada y la generalización de los programas de mantenimiento con metadona ha mejorado considerablemente la salud de esta población. Sin embargo, la aparición de nuevos patrones de consumos, principalmente unidos a la cocaína, han reactivado el uso de la vía intravenosa y paralelamente la reaparición de patologías en desuso en la práctica clínica diaria. Hepatitis, tuberculosis e infección por el VIH se encuentran entre las más prevalentes, aunque otras muchas pueden afectar con similar gravedad a los consumidores de esta droga (AU)

Heroin consumption is often associated with a whole array of physical, infectious and noninfectious complications, related as much to the characteristics of the drug itself or its adulterants as to the risk practices and the consumers’ lifestyle, which affect the heroin addict’s life quality, conditioning the evolution and casting a shadow over the prognosis of the addiction. The change occurred from intravenous via to the inhaled version and the increase in methadone maintenance treatments have considerably improved the health of these drug addicts. However, the appearance of new consumption patterns, mainly linked to cocaine, has revived the use of the intravenous via, and therefore the reappearance of pathologies not so typically seen in daily clinical practice. Hepatitis, tuberculosis and HIV infection are among the most prevalent health problems, although the consumers of this drug can also be affected by many other equally serious illnesses (AU)

Uso de prótesis vasculares coronarias en el tratamiento de la cardiopatía isquémica: Estudio prospectivo con seguimientos clínico y angiográfico predominantemente en lesiones de novo / Use of coronary vascular prothesis in the treatment of ischemic cardiopathy:Prospective study with clinical following and angiography mainly in novo lesions

La angioplastia transluminal constituye un método aceptado para el tratamiento de la arterioesclerosis coronaria desde 1977, con las ventajas de practicarse bajo anestesia local y tener una estadía intrahospitalaria corta; sin embargo, ha encontrado 2 dificultades en su desarrollo, la reestenosis y la oclusión por disección, por lo que se diseñó un método complementario a la angioplastia convencional, el cual consiste en un refuerzo metálico tubular que mantiene permeable al vaso y estabiliza los fragmentos fracturados de la placa ateroesclerótica. Se presentan 66 pacientes a quienes les fueron implantadas 70 prótesis endocoronarias PalmazSchatz desde el 01/09/91 al 21/12/93, en los siguientes segmentos arteriales coronarios: tronco principal izquierdo, 1 caso (1,4 por ciento ); descendente anterior 25 (35,7 por ciento ); coronaria derecha 31 (44,3 por ciento ); circunfleja 7 (10 por ciento ); puentes venosos 6 (8,6 por ciento ). A cinco pacientes se les implantaron 2 prótesis en el mismo vaso y a otros dos pacientes 2 en 2 vasos distintos. Las indicaciones de acuerdo al estado de las lesiones a ser tratadas fueron: lesiones no tratadas previamente, "de novo", 55 (78,6 por ciento ); lesiones previamente dilatadas, reestenosis, 8 (11,4 por ciento ); disección aguda durante angioplastia convencional, 1 (1,4 por ciento ), resultado subóptimo durante angioplastia convencional 6 (8,6 por ciento ). Seguimiento clínico. Se pudo seguir clínicamente a todos los pacientes; antes del implante, 52 (78,8 por ciento ) presentaban angor II-IV y 48 de los 55 pacientes tratados antes de 6 meses (87 por ciento ) estaban en clase I-II (p<0,001). Seguimiento angiográfico cuantificado. De las variables angiográficas determinadas lo más importante fue el diámetro mínimo, la menor dimensión de la estenosis, como el pricipal determinante de la reserva de flujo coronario. Este parámetro se midió antes e inmediatamente después en 55 pacientes (83,3 por ciento ), media 0,9ñ0,39 vs 3,03ñ0,41 mm (p<0,0001). En 25 pacientes, 48 por ciento de los que tenían 6 meses o más del implante se determinó antes, inmediatamente después y posteriormente (6,2ñ1,4 meses), media 0,82ñ0,35vs 2,99ñ0,42vs2,14ñ0,8mm (p<0,0001) entre sí. Cuatro de 28 pacientes en quienes se midió el por ciento de estenosis media en el seguimiento presentaron >50 por ciento (reestenosis de 13 por ciento ) con evidencia de isquemia miocárdica; 3 fueron redilatados y 1 fue revascularizado quirúrgicamente. Complicaciones. 4 pacientes (6,1 por ciento ) presentaron complicaciones hemorrágicas y 1, trombosis de la prótesis, resuelto con trombolisis intracoronaria y redilatación. Se concluye que en pacientes seleccionados la implantación de prótesis coronarias en nuestro medio ofrece una nueva alternativa al tratamiento de arteroesclerosis coronaria con baja incidencia de complicaciones. La alta proporción de pacientes con "lesiones de novo" (78,6 por ciento ) puede explicar la baja incidencia de reestenosis en este estudio (13 por ciento )