RESUMEN
INTRODUCTION: The use of illicit drug can affect workplace absenteeism, accidents, job turnover and worker productivity. The magnitude of the cost borne by employers has not yet been calculated. OBJECTIVES: Assessing the perception corporate directors in Belgium on illicit drug use and costs that the company has to bear because of this consumption. METHOD: An online survey on alcohol and other drugs was conducted in 2005 with 216 employers in Belgium, based on a stratified random sample of companies with 50 employees or more. Data on the costs related to illicit drugs incurred by the company were collected from 17 companies in the sample. The survey results were supplemented by data from a literature review. RESULTS: Employers have little data on the impact of illicit drugs on the company. A very small sample of companies has given us enough information for a first estimate of the cost incurred by the use of illegal substances in the workplace. Their estimates are still very close to the estimates found in the few articles from the literature. Reduced productivity is seen as the most important cost. CONCLUSION: The productivity of employees who use drugs was estimated reduced by 30%. Employers perceive the reduced productivity of drug users as the most important cost, rather than absenteeism, accidents and staff turnover.
Asunto(s)
Empleo/economía , Trastornos Relacionados con Sustancias/economía , Trastornos Relacionados con Sustancias/epidemiología , Absentismo , Accidentes de Trabajo , Bélgica/epidemiología , Eficiencia Organizacional , Humanos , Encuestas y CuestionariosRESUMEN
As personality may predispose, precipitate or perpetuate substance abuse and/or dependence, and as it is considered to remain stable across the years in a given subject, potential links with the drug of choice may help screen future patients before drug consumption. The present study compared three groups: 42 patients with heroin dependence (mean age: 31.2; standard deviation (SD): 5.5; 10 females), 37 patients with alcohol dependence (mean age 44.2; SD: 9.1; 9 females) and 83 subjects from a random population sample (mean age: 38.8; SD: 6.9; 20 females). Personality was measured by Cloninger's Temperament and Character Inventory (TCI). Pillai's MANCOVA with age as a covariate and gender as a cofactor was highly significant. Univariate ANOVA analyses using TCI dimensions as dependent variable showed most variables to vary in parallel for the two patient groups in comparison with controls. Post-hoc tests showed heroin patients to score higher in Novelty-Seeking and Self-Directedness than alcohol patients. Sub-dimensions Exploratory Excitability, Fear of the Uncertain, Responsibility, Congruent Second Nature and Transpersonal Identification were also significantly different in the two patient samples. Logistic regression showed Exploratory Excitability to segregate up to 76% of heroin patients from alcohol patients. In conclusion, personality profiles were linked to some preferential choice of drug and personality screening might be tested in preventive strategies.
Asunto(s)
Alcoholismo/epidemiología , Conducta de Elección , Dependencia de Heroína/epidemiología , Trastornos de la Personalidad/diagnóstico , Encuestas y Cuestionarios , Adulto , Conducta Exploratoria , Femenino , Humanos , Masculino , Trastornos de la Personalidad/epidemiología , Vigilancia de la Población , TemperamentoRESUMEN
STUDY OBJECTIVES: Reports on the reproducibility of apnea-hypopnea indexes (AHIs) across sequential polysomnography (PSG) sessions are conflicting, leading to a lack of clear recommendations on the optimal use of this technique: is one night of monitoring sufficient or is a second night required in order to safely reject the diagnosis? DESIGN: Retrospective comparison of two consecutive nights. SETTING: Sleep unit of a tertiary-care facility. PATIENTS: Two hundred forty-three subjects with suspected sleep apneas. INTERVENTIONS: Two sequential PSG sessions in a sleep unit. MEASUREMENTS AND RESULTS: Using analysis of covariance for repeated measures, with age and body mass index as covariates and gender as a cofactor, a classic first-night effect was found for sleep variables. In addition, a night effect was demonstrated for sleep respiratory variables. Moreover, the high variability of AHIs showed that many patients had their condition diagnosed on only one of the two nights, and more often on the second night than on the first. The gain in detection by adding a second night when the results of testing on the first were negative was between 15% and 25%, according to the AHI obtained on night 1. CONCLUSIONS: Considering the disability associated with sleep apnea/hypopnea syndrome, as well as its global cost for society, the present study shows that it is worth performing two consecutive PSG sessions or at least a second one when the result of the first one is negative in all patients admitted for apnea detection.
Asunto(s)
Ritmo Circadiano , Polisomnografía/métodos , Síndromes de la Apnea del Sueño/diagnóstico , Índice de Masa Corporal , Pruebas Respiratorias , Diagnóstico Diferencial , Evaluación de la Discapacidad , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/análisis , Reproducibilidad de los Resultados , Respiración , Estudios Retrospectivos , Sueño/fisiología , Síndromes de la Apnea del Sueño/fisiopatología , Síndromes de la Apnea del Sueño/rehabilitaciónRESUMEN
We compared the costs of acamprosate in maintaining abstinence in weaned alcoholic patients, to no pharmaceutical treatment over a 24-month period. A controlled trial (n=448) involving a 12-month treatment with acamprosate and a 12-month follow-up showed a significant advantage of acamprosate over placebo in the prevention of relapse. For the economic analysis, the average costs of relapses from the health insurance perspective were calculated based on a Belgian survey among general practitioners and on an observational prospective Belgian trial among specialists. Calculations resulted in net cost savings of 21,301 BEF (528 Euro) per patient over a 24-month period for acamprosate compared to no pharmaceutical treatment, explained by fewer acute hospitalisations for detoxification and less institutionalised rehabilitation. A global anticipated net saving of 70 million BEF (1.74 million Euro) over 2 years was estimated for the Belgian health insurance.
Asunto(s)
Disuasivos de Alcohol/economía , Alcoholismo/economía , Taurina/análogos & derivados , Templanza , Acamprosato , Disuasivos de Alcohol/uso terapéutico , Alcoholismo/tratamiento farmacológico , Bélgica/epidemiología , Humanos , Cadenas de Markov , Modelos Económicos , Placebos , Ensayos Clínicos Controlados Aleatorios como Asunto , Taurina/economía , Taurina/uso terapéuticoRESUMEN
Among the dimensional scales that measure personality, Cloninger's TPQ (Tridimensional Personality Questionnaire) holds a place apart in the literature, because the hypotheses it relies on are partially biological. The questionnaire (100 forced binary items) includes three axes: "Novelty Seeking", "Harm Avoidance" and "Reward Dependence", each theoretically bound to a preferential neuromediator, respectively dopamine, serotonin and norepinephrine. Each axis includes four minor subscales. The study presented here is the analysis of 104 control volunteers from both genders (59 males). This database is the first to be published with a French-speaking population. The comparison with Cloninger's normative database shows many similarities: the mean values for the 3 axes are relatively close. The population studied here is younger and this factor could play a role in the somewhat higher mean novelty seeking scores found here. The three axes show a normal distribution. Skewness and kurtosis are between -1 and +1 for all the subscales, except here for NS2. Factorial structure is quite similar to Cloninger's results. The three first axes correspond to the variables isolated in the first studies and the fourth one includes the same subscales as in the large American database. Inverse correlation between age and novelty seeking, positive correlation between female gender and harm avoidance and reward dependence were also found. However, no correlation was found between novelty seeking and male gender. A correlation was found between level of instruction and NS1 only, not with the whole NS axis. Eighty-seven % of volunteers presented with at least one standard deviation on at least one axis and 68% on at least two. This does not seem to have been described previously. It can be a sign of the difficulty of human beings to show a balanced personality. In conclusion, the database presented here shows many similarities with Cloninger's normative database. This underscores its value for comparisons in clinical trials in the future.
Asunto(s)
Inventario de Personalidad/estadística & datos numéricos , Adulto , Nivel de Alerta , Comparación Transcultural , Mecanismos de Defensa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apego a Objetos , Valores de Referencia , Reproducibilidad de los Resultados , Conducta SocialRESUMEN
This reports positron emission tomography and [18F]fluorodeoxyglucose (PET-FDG) in a 69-year-old woman who underwent resection of the left cerebellar hemisphere for an acoustic neurinoma 17 years earlier. Functional impairment in cerebral cortical and subcortical structures was evaluated by studying the level of glucose metabolic activity at rest. Relative glucose metabolism was reduced in the prefrontal cortex contralateral to the cerebellar lesion. Contralateral thalamic metabolism was reduced significantly. The results suggest that this phenomenon of "crossed cerebello-thalamo-cerebral diaschisis" is related to a functional depression of the cerebello-thalamo-cortical pathway.
Asunto(s)
Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Tomografía Computarizada de Emisión/métodos , Anciano , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/metabolismoRESUMEN
The ability of mammals to measure seasonal changes in daylength depends upon a circadian clock and the phase-relationship between this clock and the light: dark cycle. Recently, a number of pharmacological and nonpharmacological stimuli have been shown to have pronounced effects on the phase of the circadian clock of rodents. The objective of the present study was to determine if a drug-induced change in the phase-relationship between a measurable circadian rhythm (i.e., wheel running behavior) and the light:dark cycle would alter the effects of the light cycle on the neuroendocrine-gonadal axis. Adult male hamsters with regressed testes due to exposure to an inhibitory 10:14-hr light:dark cycle were daily injected with vehicle or the short-acting benzodiazepine, triazolam, while remaining on short days, while a control group of hamsters was transferred to a photostimulatory 14:10-hr light:dark cycle. Two other groups of hamsters with regressed testes were blinded and daily injected with vehicle or triazolam. The injections were timed to occur about 4 hr before activity onset because previous studies had demonstrated that injections of triazolam at this time can lead to a phase advance in the activity rhythm. The circadian rhythm of wheel running behavior was measured in all the animals maintained on the 10:14-hr light:dark cycle in order to monitor circadian phase. While no testicular growth was observed after 25 days of vehicle injections, growth was observed in the triazolam-treated animals that was comparable to that observed in control animals transferred to long days. Testicular growth in triazolam-treated animals was associated with an earlier onset of locomotor activity, when compared with the vehicle-treated animals. Importantly, triazolam had no effect on the testicular size of blind animals. These results indicate that daily injections of triazolam can stimulate neuroendocrine-gonadal activity by altering the phase-relationship between the cycle and the circadian clock involved in photoperiodic time measurement, and that agents which can affect the clock may be useful in altering seasonal cycles.
Asunto(s)
Mesocricetus/fisiología , Fotoperiodo , Triazolam/farmacología , Animales , Cricetinae , Masculino , Actividad Motora , Tamaño de los Órganos , Testículo/anatomía & histologíaRESUMEN
Recent findings indicate that stimuli which induce an acute increase in locomotor activity can induce phase shifts in the circadian clock of hamsters. Support for the actual role of the acute increase in activity in the mediation of these phase shifts is provided by the observation that immobilization can totally block phase shifts in the activity rhythm that are normally induced in response to exposure to two of these stimuli, either a pulse of darkness or an injection of a benzodiazepine. In order to further examine the effects of immobilization on the circadian system of hamsters, 3 studies were carried out. In a first study, the effects of a 3-h period of immobilization procedure on the phase of the free running circadian rhythm of locomotor activity were tested at 8 different circadian times. Immobilization during the highly active part of the animal's activity cycle resulted in phase delays in the activity rhythm, while immobilization at other circadian times had little or no effect on the circadian time-keeping system. In two other studies, we reported that immobilization had no effect on phase shifts normally induced by 3-h pulses of light or injections of the protein synthesis inhibitor, cycloheximide, two stimuli that are clearly not associated with an increase in locomotor activity in hamsters. Thus, the ability of immobilization to block stimulus-induced phase shifts in the circadian clock appears to be specific to those stimuli that induce an acute increase in locomotor activity.(ABSTRACT TRUNCATED AT 250 WORDS)