The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by the Gelberg Behavioral Model of Vulnerable Populations. This project utilizes secondary data from the Criminal Justice Kentucky Treatment Outcome Study, a Kentucky Department of Corrections funded two-wave longitudinal study of individuals who participated in substance abuse treatment programming while incarcerated. Latent profile analysis is used to determine the patterns of pre-incarceration opioid PSU in aim 1. Analyses for aims 2 and 3 examine PSU profiles, along with variables drawn from the Behavioral Model for Vulnerable Populations, in order to predict important reentry outcomes of relapse and health service utilization 12-months post-release in a series of logistic regressions. Six unique profiles of opioid PSU were found among the current justice-involved population, which faced disproportionate risk of adverse outcomes at follow-up. Findings indicate heterogeneity of opioid use among a justice-involved population. The role of mental and physical health in PSU severity is also highlighted. Further, results from post-release analyses indicate that a continuum of risk exists among PSU such that PSU patterns are unique and important predictors of post-release outcomes which can be used to inform interventions during incarceration. The importance of accounting for vulnerability as conceptualized in the Behavioral Model for Vulnerable Populations is also discussed.

Inoculation is a robust theory applied to a variety of health behaviors. Social marketing is designed to change behavior by applying marketing tactics in the context of social change. This study combines inoculation theory with social marketing in the context of substance abuse disorders to promote long-term recovery. This is a pilot project that specifically focuses on the Beacon House, a residential recovery treatment center in Louisville, Kentucky. With the growing drug problem in America, it is necessary to implement effective recovery strategies in treatment programs. The social marketing plan focuses on the target audience to outline potential barriers, motivators, and competition to remaining in long-term recovery. Three intervention strategies were developed as part of the project: a core inoculation message, booster messages, and refusal skills training. These strategies utilize inoculation messages in various ways to address the complexity of long-term recovery. While this study focuses on the Beacon House treatment facility, the concepts can be applied to similar treatment centers.

Orientador: Mauro Pedrine Santamaria / Coorientador: João Manoel Theotonio dos Santos / Banca: Maria Aparecida Neves Jardini / Banca: Germano Emilio Conceição Souza / Resumo: A doença arterial coronária (DAC), assim como a doença periodontal (PD) são patologias muito prevalentes e apresentam vias em comum na sua fisiopatologia que é a inflamação crônica. A angioplastia coronária percutânea com implante de stent se estabeleceu como a principal forma de revascularização miocárdica no tratamento da DAC porém cerca de 16% a 44% dos pacientes podem evoluir com reestenose do stent. Se a doença periodontal, pelo seu estado inflamatório sistêmico crônico estaria contribuindo para um aumento nas taxas de reestenose de stents convencionais não está definido e não é uma rotina na prática clínica a avaliação da cavidade oral antes de um procedimento de angioplastia coronária. O objetivo primário do estudo foi avaliar a correlação entre a doença periodontal com a incidência de reestenose do stent, enquanto os objetivos secundários foram avaliar a prevalência da doença periodontal, o número de dentes, o grau de perda óssea e finalmente a gravidade da doença periodontal na população do estudo. Para isto realizamos um estudo pioneiro, retrospectivo, caso controle e em um único centro no período de janeiro de 2016 a fevereiro de 2018. Foram analisados 1685 exames de cinecoronariografia dos quais 283 apresentavam imagem de stent com e sem reestenose sendo incluídos 49 pacientes separados entre o grupo caso, com reestenose (n=15) e o grupo controle, sem reestenose (n=34). Excluímos os pacientes portadores de Diabetes Mellitus (DM) não controlados, portadores de sten... (Resumo completo, clicar acesso eletrônico abaixo) / ABSTRACT: Coronary artery disease (CAD), as well as periodontal disease (PD) are very prevalent pathologies and present common pathways in their pathophysiology which is chronic inflammation. Percutaneous coronary angioplasty with stent implantation has been established as the main form of myocardial revascularization in the treatment of CAD but about 16% to 44% of patients may evolve with stent restenosis. If periodontal disease, because of its chronic systemic inflammatory state would be contributing to an increase in the rates of restenosis of conventional stents is not defined and it is not a routine in clinical practice to evaluate the oral cavity before a coronary angioplasty procedure. The primary objective of the study was to evaluate the correlation between periodontal disease and the incidence of stent restenosis, while the secondary objectives were to evaluate the prevalence of periodontal disease, number of teeth, degree of bone loss and finally severity of periodontal disease in the study population. For this, we conducted a pioneering, retrospective, case control and single-center study from January 2016 to February 2018. We analyzed 1685 coronary angiography exams, of which 283 presented stent imaging with and without restenosis and 49 patients were separated between the case group, with restenosis (n = 15) and the control group, without restenosis (n = 34). We excluded patients with uncontrolled diabetes mellitus (DM), those with stents of the pharmacological type or those with restenosis from stents implanted more than two years ago. For statistical analysis, the chi-square test in the qualitative variables, ANOVA test for quantitative variables, Odds Ratio calculation and Equality of Two Proportions test were used to compare the restenosis groups with the distribution of the type of periodontal disease. We found no statistically significant ...(Complete abstract click electronic access below) / Mestre

<p>The relationship between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is not entirely elucidated and a clonal relation may be present more often than previously believed. Mechanisms of tumour progression and resistance to therapy are poorly understood.</p><p>Between 1974 and 1994 all individuals in Sweden with both HL and NHL were identified. Thirty-two cases were studied using clinical, histopathological and immunohistochemical methods. The second lymphoma often appeared in an aggressive clinical form and a significant correlation between the expression of p53 and LMP-1 in the first and second lymphoma was demonstrated.</p><p>The treatment outcome for 307 patients with advanced stages of HL, in an unselected population was in accordance with the treatment results of large centres world-wide. Some patients were successfully selected for a shorter chemotherapy-regimen without inferior treatment results.</p><p>In 124 patients with relapse, the survival of those primarily treated with radiotherapy according to the National guidelines was in accordance with the survival of patients of initially advanced stages. A worse outcome was found for those who received both chemotherapy and radiotherapy initially, probably because of a higher frequency of bulky disease in this group. </p><p>Immunohistochemical analysis of the tumour suppressor protein p53 and retinoblastoma protein (Rb) of paired samples at diagnosis and at relapse in 81 patients did not reveal any specific staining pattern affecting survival.</p><p>A novel B-cell line (U-2932) was established from a patient with a diffuse large B-cell lymphoma previously treated for advanced stage and subsequent relapses of HL. An identical rearranged IgH gene was demonstrated in tumour cells from the patient and in U-2932. A p53 point mutation was detected and over-expression of the p53 protein was found. A complex karyotype with high-level amplifications of the chromosomal regions 18q21 and 3q27, i.e. the loci for <i>bcl-2</i> and <i>bcl-6</i> were demonstrated. </p>

Borderline Personality Disorder (BPD) is one of the more common personality disorder diagnoses observed in psychiatric inpatients and outpatients. Previous studies have found that individuals with BPD may be expected to experience difficulties throughout their lifetimes and they may repeatedly return for psychological treatment. Whereas previous studies have attempted to identify various factors related to relapse in other chronically recurring disorders such as depression, schizophrenia, and substance abuse, studies examining factors associated with relapse in BPD, and personality disorders in general, are absent from the scientific literature. This exploratory study examined whether specific risk and protective factors (dynamic and/or static) identified from the general relapse literature were associated with diagnostic relapse in BPD. Results revealed that variables related to an increased likelihood for BPD relapse included: substance abuse or Major Depressive Disorder, higher Neuroticism, and lower Conscientiousness. In addition, having a steady work or school status after remission was found to protect against a BPD relapse in the presence of various risk factors. Although this study has several limitations, these results provide some of the first insights to the processes of relapse and continued remission in BPD patients. Continued research efforts in this area can help to identify individuals who are at a greater risk for BPD relapse and potentially to design effective relapse-prevention strategies for the treatment of BPD.

Craving is thought to play a predominant role in the persistence of alcohol dependence, which seems to bear a substantial genetic component. Based on previous results highlighting the influence of serotonergic and dopaminergic nerotransmissions in both dependence and craving for alcohol, we investigated the impact of three specific polymorphisms on craving in male abstinent alcohol dependent patients. Our results show that alcohol craving may be influenced by genetic differences in alcohol dependent patients. There seems to be a dual serotonergic and dopaminergic modulation of craving. During acute withdrawal, desire to drink is predominantly influenced by the C1019 allele of the 5-HT1A receptor. Conversely, carrying the A1 allele of the DRD2 increases craving only when patients are no longer hospitalized and protected from drinking cues. Furthermore, we showed that craving partially influenced relapse and that the S allele of the 5-HTTpro, responsible for a 5-HT hypo-functioning, was significantly associated with relapse in abstinent alcohol dependent patients, possibly through intermediate phenotypes such as personality features or lack of behavioral inhibition. Our results may be useful in evaluating and developing novel pharmacogenetic approaches to treat alcohol dependence and one of its core symptoms, namely craving. Le craving semble jouer un rôle prédominant dans la persistance des comportements dalcoolisation et de rechute chez les sujets alcoolo-dépendants. Cette pathologie semble par ailleurs très nettement influencée par des facteurs dordre génétique. Sur base détudes préliminaires illustrant linfluence des neurotransmissions dopaminergique et sérotoninergique dans lalcoolo-dépendance et le craving pour lalcool, notre objectif a été dévaluer limpact de trois polymorphismes génétiques spécifiques sur le craving chez des patients masculins alcoolo-dépendant sevrés. Nos résultats montrent que le craving est bien influencé par des différences génétiques interindividuelles et quune modulation bimodale sérotoninergique et dopaminergique semble sexercer sur le craving pour lalcool. Pendant la phase aiguë du sevrage, lenvie de boire est nettement influencée par la présence de lallèle C du polymorphisme C-1019G du récepteur sérotoninergique 5-HT1A. A linverse, la présence de lallèle A1 du récepteur dopaminergique D2 ninfluence le craving quà distance du sevrage, lorsque les patients sont à nouveau dans leur milieu habituel et soumis à des stimuli déclanchant une envie de boire. De plus, nous avons pu montrer que le craving influençait partiellement la survenue dune rechute et que lallèle court du polymorphisme du promoteur du transporteur de la sérotonine (5-HTTpro) exerçait une influence significative sur la rechute, peut-être au travers de phénotypes intermédiaires de type traits de personnalité ou carence dinhibition comportementale. Ces résultats pourraient savérer utiles dans lévaluation et le développement de stratégies pharmacogénétiques destinées à traiter lalcoolo-dépendance et lun de symptômes les principaux : le craving.

The relationship between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is not entirely elucidated and a clonal relation may be present more often than previously believed. Mechanisms of tumour progression and resistance to therapy are poorly understood. Between 1974 and 1994 all individuals in Sweden with both HL and NHL were identified. Thirty-two cases were studied using clinical, histopathological and immunohistochemical methods. The second lymphoma often appeared in an aggressive clinical form and a significant correlation between the expression of p53 and LMP-1 in the first and second lymphoma was demonstrated. The treatment outcome for 307 patients with advanced stages of HL, in an unselected population was in accordance with the treatment results of large centres world-wide. Some patients were successfully selected for a shorter chemotherapy-regimen without inferior treatment results. In 124 patients with relapse, the survival of those primarily treated with radiotherapy according to the National guidelines was in accordance with the survival of patients of initially advanced stages. A worse outcome was found for those who received both chemotherapy and radiotherapy initially, probably because of a higher frequency of bulky disease in this group. Immunohistochemical analysis of the tumour suppressor protein p53 and retinoblastoma protein (Rb) of paired samples at diagnosis and at relapse in 81 patients did not reveal any specific staining pattern affecting survival. A novel B-cell line (U-2932) was established from a patient with a diffuse large B-cell lymphoma previously treated for advanced stage and subsequent relapses of HL. An identical rearranged IgH gene was demonstrated in tumour cells from the patient and in U-2932. A p53 point mutation was detected and over-expression of the p53 protein was found. A complex karyotype with high-level amplifications of the chromosomal regions 18q21 and 3q27, i.e. the loci for bcl-2 and bcl-6 were demonstrated.

<p>In the present study, we examined the predictions of an attentional-associative model (Schmajuk, Lam, & Gray Journal of Experimental Psychology: Animal Behavior Processes, 22, 321-349, 1996) regarding the effect of attentional manipulations on both discrete and contextual conditioned inhibitors.</p><p>The SLG model assumes that non-reinforced presentations of an inhibitory conditioned stimulus (CS) do not decrease its inhibitory associations. However, the model predicts that extended presentations will decrease attention to the inhibitor, thereby, decreasing both the expression of its inhibitory power in a summation test and the rate of acquisition in a retardation test. The model also predicts that subsequent presentations of the inhibitory CS with a novel CS will increase both its inhibitory power in a summation test and the rate of acquisition in a retardation test. Using a predictive learning design in humans, Experiment 1 examined the predictions involving the summation tests, whereas Experiments 2 and 3 examined the predictions involving the retardation tests. Experimental results were in agreement with the predictions of the model. </p><p>The SLG model also predicts that a salient extinction context (CX) becomes inhibitory and prevents extinction of the excitatory CS-unconditioned stimulus (US) association. Although some data seem to contradict that prediction (e.g., Bouton and King, 1983, Bouton and Swartzentruber, 1986, 1989), Larrauri and Schmajuk (2008) indicated that the CX might not appear inhibitory in a summation test because attention to the CX decreases with many but not few extinction trials. In a human predictive learning experiment, we confirmed the model's predictions that the inhibitory power of the extinction CX can be detected after a few extinction trials when attention to the CX is still high, but not after many extinction trials once attention to the CX has decreased (Experiment 4), and even after many extinction trials by presenting novel CSs to increase attention to the unattended CX (Experiment 5). Furthermore, using an eye-tracker, we confirmed the model's explanation of Experiment 4 results by showing decreased overt attention to the CX after many but not after few extinction trials (Experiment 6).</p><p> Importantly, the view that the extinction CX becomes inhibitory allows the model to explain spontaneous recovery (because attention to the excitatory CS increases before attention to the inhibitory CX), renewal (because the inhibition provided by the extinction CX disappears), and reinstatement (the inhibitory CX becomes neutral or excitatory), as well as a very large number of other experimental results related to extinction. Based on the prediction of the SLG, model the implications of our results for the treatments of anxiety disorders were discussed.</p> / Dissertation

Background: Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioural activation and physical exercise have not yet been directly compared. This study will examine the effects of these interventions, administered via the Internet. The added effect of providing a treatment rationale will also be studied, as well as a relapse prevention program featuring cognitive behavioural therapy components. Methods/Design: This randomised controlled trial will include 500 participants meeting the diagnostic criteria for major depression, recruited in multiple cycles and randomised to either a waiting list control group with delayed treatment, or one of the four treatment groups: (1) physical exercise without a clear treatment rationale; (2) physical exercise with treatment rationale; (3) behavioural activation with treatment rationale; or (4) behavioural activation without a clear treatment rationale. Post treatment, half of the participants will be offered a relapse prevention program. Primary outcome measure will be the Patient Health Questionnaire 9-item. Secondary measures include diagnostic criteria for depression, as well as self-reported anxiety, physical activity and quality of life. Measurements done via telephone and the Internet -will be collected pre-treatment, weekly during treatment period, immediately post treatment and then monthly during a 24-month follow-up period. Discussion: The results of this study will constitute an important contribution to the body of knowledge of the respective interventions. Limitations are discussed.

Många kvinnor som överlevt bröstcancer får en rädsla för återfall. Trots avsaknad av sjukdom kan människan uppleva minskad känsla av välbefinnande. Människans livsvärld kan påverkas av att vardagen eller den fysiska kroppen ändras. Studiens syfte är att belysa hur rädslan för återfall påverkar svenska kvinnor som drabbats av bröstcancer. Datamaterial har samlats in från nio biografier och självbiografier. Materialet har samlats in och analyserats utifrån metoden att analysera berättelser. Resultatet presenteras utifrån fyra kategorier. De fyra kategorierna är återfallsångest, känslan att inte kunna lita på sin kropp, påverkan på vardagen och rädslan för återfall minskar. För flera kvinnor är rädslan så stark att den utvecklas till återfallsångest. Rädslan för återfall har gjort att kvinnorna känner att de inte kan lita på sin kropp och att de då blir oroliga om något med kroppen inte är som det brukar vara. Rädslan påverkar också vardagen då vissa kvinnor lättare kan se det positiva i små saker medan andra kvinnor har svårare för det. Däremot minskar rädslan för återfall med tiden men kan komma tillbaka vid speciella tillfällen. / Many women who have survived breast cancer still have a fear of relapse. The human can experience diminished sense of wellbeing despite the absence of disease. The life-world of the human can be affected by everyday life or by changes in the physical body. The aim of this study is to illuminate how the fear of relapse affects Swedish women who have had breast cancer. Data sets were collected from nine biographies and autobiographies. The material was collected and analysed from the model analysing narratives. The results are presented in four categories. The four categories are relapse anxiety, the feeling of not being able to trust your body, impact on the daily life and the reduced fear of relapse. For many women, the fear was so strong that it developed in to a relapse anxiety. The fear of relapse has made the women feel that they can not trust their bodies and that they are worried about something that is unusual with their bodies. The fear also affects the everyday life as some women can more easily see the positive in small things while others find it more difficult. However, the fear of relapse is reduced over time, but can come back at special circumstances.