An Alternative to Incarceration: Co-Occurring Disorders Treatment Intervention for Justice-Involved Veterans

Abstract Background Aeromedical evacuation of patients with burn trauma is an important transport method in times of peace and war, during which patients are exposed to prolonged periods of hypobaric hypoxia; however, the effects of such exposure on burn injuries, particularly on burn-induced lung injuries, are largely unexplored. This study aimed to determine the effects of hypobaric hypoxia on burn-induced lung injuries and to investigate the underlying mechanism using a rat burn model. Methods A total of 40 male Wistar rats were randomly divided into four groups (10 in each group): sham burn (SB) group, burn in normoxia condition (BN) group, burn in hypoxia condition (BH) group, and burn in hypoxia condition with treatment intervention (BHD) group. Rats with 30% total body surface area burns were exposed to hypobaric hypoxia (2000 m altitude simulation) or normoxia conditions for 4 h. Deoxyribonuclease I (DNase I) was administered systemically as a treatment intervention. Systemic inflammatory mediator and mitochondrial deoxyribonucleic acid (mtDNA) levels were determined. A histopathological evaluation was performed and the acute lung injury (ALI) score was determined. Malonaldehyde (MDA) content, myeloperoxidase (MPO) activity, and the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome level were determined in lung tissues. Data among groups were compared using analysis of variance followed by Tukey’s test post hoc analysis. Results Burns resulted in a remarkably higher level of systemic inflammatory cytokines and mtDNA release, which was further heightened by hypobaric hypoxia exposure (P < 0.01). Moreover, hypobaric hypoxia exposure gave rise to increased NLRP3 inflammasome expression, MDA content, and MPO activity in the lung (P < 0.05 or P < 0.01). Burn-induced lung injuries were exacerbated, as shown by the histopathological evaluation and ALI score (P < 0.01). Administration of DNase I markedly reduced mtDNA release and systemic inflammatory cytokine production. Furthermore, the NLRP3 inflammasome level in lung tissues was decreased and burn-induced lung injury was ameliorated (P < 0.01). Conclusions Our results suggested that simulated aeromedical evacuation further increased burn-induced mtDNA release and exacerbated burn-induced inflammation and lung injury. DNase I reduced the release of mtDNA, limited mtDNA-induced systemic inflammation, and ameliorated burn-induced ALI. The intervening mtDNA level is thus a potential target to protect from burn-induced lung injury during aeromedical conditions and provides safer air evacuations for severely burned patients.

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A Comparative Analysis of a Dual Processing Substance Abuse Treatment Intervention: Implications for the Development of Latino-Specific Interventions

Hispanic Health Care International ◽

10.1891/154041507783095812 ◽

2007 ◽

Vol 5 (4) ◽

pp. 162-168 ◽

Cited By ~ 2

Author(s):

Jessica Strolin-Goltzman ◽

Holly C. Matto ◽

Cristina Mogro-Wilson

Keyword(s):

Substance Abuse ◽

Comparative Analysis ◽

Substance Abuse Treatment ◽

Dual Processing ◽

Treatment Intervention ◽

Abuse Treatment

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On purpose of multiple cases: Quaternary prevention on mental health – “Primum non-nocere”

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.874 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S581-S581

Author(s):

K.L. Lazo Chavez

Keyword(s):

Mental Health ◽

Systematic Review ◽

Public Health Problem ◽

Treatment Intervention ◽

Sick Role ◽

Professional Activities ◽

Do No Harm ◽

Competing Interest ◽

Quaternary Prevention ◽

Different Levels

IntroductionQuaternary prevention, concept coined by the Belgian Marc Jamoulle, are the actions taken to avoid or mitigate the consequences of unnecessary or excessive intervention of the health system. The concept alludes to actions to avoid the over-diagnoses and over-treatment, trying to reduce the incidence of iatrogeny in patients, which is a serious public health problem and even more in mental health.MethodsSystematic review of bibliography.ObjectivesDo a systematic review of bibliography and through the results invite to the analytic and critic reflection of our professional activities and the current situation of mental health.ResultsThere is not enough studies about quaternary prevention in mental health.–Some studies found that about one-third of diseases of a hospital are iatrogenic, most of them for pharmacological causes.–There is iatrogeny at different levels of the attention of mental health: primary prevention, diagnosis and treatment.–Non-treatment indication avoids in multiple cases iatrogenesis and contributes to the correct distribution of the economic and care resources.ConclusionsSince one of the fundaments of medicine is “primun non nocere” that means “first do no harm” and one of principles of bioethics is “non-maleficence”, quaternary prevention should prevail over any other preventive or curative option.–We should define in a more realistic way the limits, benefits and damages of our interventions in order to not promote a passive and sick role.–Must be recognized the non-treatment intervention as a therapeutic and useful intervention, and one of the best tools of quaternary prevention.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Efficacy of early treatment with hydroxychloroquine in people with mild to moderate COVID-19: A systematic review and meta-analysis

Archives of Medical Science ◽

10.5114/aoms/143147 ◽

2021 ◽

Author(s):

Adrian Hernandez ◽

John Ingemi III ◽

Michael Sherman ◽

Vinay Pasupuleti ◽

Joshuan Barboza ◽

...

Keyword(s):

Adverse Events ◽

Early Treatment ◽

Meta Analysis ◽

Viral Clearance ◽

Treatment Intervention ◽

Quality Of Evidence ◽

Symptom Resolution ◽

All Cause Mortality ◽

Meta Analyses

IntroductionNo early treatment intervention for COVID-19 has proven effective to date. We systematically reviewed the efficacy of hydroxychloroquine as early treatment for COVID-19.Material and methodsRandomized controlled trials (RCTs) evaluating hydroxychloroquine for early treatment of COVID-19 were searched in five engines and preprint websites until September 14, 2021. Primary outcomes were hospitalization and all-cause mortality. Secondary outcomes included COVID-19 symptom resolution, viral clearance, and adverse events. Inverse variance random-effects meta-analyses were performed and quality of evidence (QoE) per outcome was assessed with GRADE methods.ResultsFive RCTs (n=1848) were included. The comparator was placebo in four RCTs and usual care in one RCT. The RCTs used hydroxychloroquine total doses between 1,600 and 4,400 mg and had follow up times between 14 and 90 days. Compared to the controls, early treatment with hydroxychloroquine did not reduce hospitalizations (RR 0.80, 95%CI 0.47-1.36, I2=2%, 5 RCTs, low QoE), all-cause mortality (RR 0.77, 95%CI 0.16-3.68, I2=0%, 5 RCTs, very low QoE), symptom resolution (RR 0.94, 95%CI 0.77-1.16, I2=71%, 3 RCTs, low QoE) or viral clearance at 14 days (RR 1.02, 95%CI 0.82-1.27, I2=65%, 2 RCTs, low QoE). There was a higher non-significant increase of adverse events with hydroxychloroquine vs. controls (RR 2.17, 95%CI 0.86-5.45, I2=92%, 5 RCTs, very low QoE).ConclusionsHydroxychloroquine was not efficacious as early treatment for COVID-19 infections in RCTs with low to very low quality of evidence for all outcomes. More RCTs are needed to elucidate the efficacy of hydroxychloroquine as early treatment intervention.

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