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Evidence from Mendelian randomization studies suggest that lipoprotein(a) (Lp(a)) has a causal role in the development of atherosclerotic cardiovascular disease risk. However, guidelines and consensus statement recommendations vary regarding how clinicians should incorporate Lp(a) into patient care. To provide practical answers to key questions pertaining to Lp(a) that clinicians will find useful when assessing and treating patients, a global think tank was convened. Representatives from seven national and international stakeholder organizations answered questions that were focused on: Lp(a) measurement; ethnic, gender, and age considerations; factoring Lp(a) into risk assessment; and current and emerging treatment options for elevated Lp(a). This manuscript summarizes the finding from this global think tank. Areas requiring further investigation were identified, and the need to standardize reporting of Lp(a) levels to ensure harmonization and comparability across laboratories and research studies is emphasized. [ABSTRACT FROM AUTHOR]

Lipoprotein(a) operates in causal pathways to promote atherosclerosis, arterial thrombosis, and aortic stenosis. It has been associated with rare cases of nonatherosclerotic arterial thrombotic stroke at any age. Inherited variation of lipoprotein(a) levels substantially increases cardiovascular risk in 20% of people worldwide. Recent progress in identifying the risk associated with lipoprotein(a) and in pursuing effective treatment has led to a recent Global Think Tank including representatives from the European Atherosclerosis Society, American Heart Association, Preventive Cardiovascular Nurses Association, National Lipid Association, and other groups. The need for standardized laboratory measurement in nanomoles per liter met with unanimous consensus. Atherosclerotic risk is linearly associated with plasma lipoprotein(a) levels, so that persons with the highest levels may have risk similar to other severe inherited lipoprotein disorders. Universal once-in-lifetime screening has been recommended by European and Canadian cardiovascular societies, but not by U.S. organizations. Current pharmacologic therapies are limited to 20-30% lowering of lipoprotein(a) levels, and no pharmacologic treatment for lowering lipoprotein(a) has yet been proven to reduce risk in a cardiovascular outcomes trial. Treatment for high-risk patients focuses on reducing low density lipoprotein cholesterol and other risk factors. New therapies targeting messenger RNA for apolipoprotein(a) can achieve 80-90% reduction of lipoprotein(a) levels. One such therapy using a liver-directed antisense oligonucleotide is currently being tested in a large cardiovascular outcomes trial. Increased recognition of lipoprotein(a)-associated risk and emergence of potentially effective therapy together lead to a mandate for a unified global effort on education, standardization, and clinical management. [ABSTRACT FROM AUTHOR]

Background Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data document how young Aboriginal people reduce sexual health risks encountered in their everyday lives.Methods: In-depth interviews with 35 young Aboriginal women and men aged 16-21 years in two remote Australian settings were conducted; inductive thematic analysis examining sexual health risk reduction practices was also conducted.Results: Participants reported individual and collective STI and pregnancy risk reduction strategies. Individual practices included accessing and carrying condoms; having a regular casual sexual partner; being in a long-term trusting relationship; using long-acting reversible contraception; having fewer sexual partners; abstaining from sex; accessing STI testing. More collective strategies included: refusing sex without a condom; accompanied health clinic visits with a trusted individual; encouraging friends to use condoms and go for STI testing; providing friends with condoms.Conclusion: Findings broaden understanding of young Aboriginal people's sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people's existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people's sexual health include: peer condom distribution; accompanied health service visits; peer-led health promotion; continued community-based condom distribution; enhanced access to a fuller range of available contraception in primary care settings; engaging health service-experienced young people as 'youth health workers'. [ABSTRACT FROM AUTHOR]

Objective: The World Health Organization's guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW. Methods: We surveyed 1886 women aged = 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively. Results: Across these provinces, high prevalence of HCV exposure (8.8-30.4%) and active infection (3.6-22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8-37.9), injection drug use (aOR = 23.3; 95% CI: 13.1-41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4-4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2-3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8-39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8-5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2-4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3-3.7) were independently associated with HCV exposure. Discussion: FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment. [ABSTRACT FROM AUTHOR]

Epipalaeolithic hunter-gatherer communities in the Southern Levant exhibit numerous complex trends that suggest that the transition to the Neolithic was patchy and protracted. This paper explores the changing nature of occupation at the Epipalaeolithic site Kharaneh IV, Jordan, through an in-depth analysis of the lithic and faunal assemblages. Focusing on the analysis of a single deep sounding (unit AS42), we address how Kharaneh IV occupations link to the local landscape and environmental changes. As an aggregation site, Kharaneh IV represents an interesting locale to explore the changing nature of aggregation and social cohesion prior to the origins of agriculture, as well as changes in technology and subsistence between the Early and Middle Epipalaeolithic. We explore the tempo and nature of transition from one archaeological culture to the next through changes in technology and how this reflects the people making and using tools, to understand how foragers adapted to a changing landscape. [ABSTRACT FROM AUTHOR]

Background Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM.Aim: Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined.Methods: The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected.Results: Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users.Conclusion: Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use. [ABSTRACT FROM AUTHOR]

Background: In high-incidence Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) settings, annual re-testing is an important public health strategy. Using baseline laboratory data (2009-10) from a cluster randomised trial in 67 remote Aboriginal communities, the extent of re-testing was determined, along with the associated patient, staffing and health centre factors.Methods: Annual testing was defined as re-testing in 9-15 months (guideline recommendation) and a broader time period of 5-15 months following an initial negative CT/NG test. Random effects logistic regression was used to determine factors associated with re-testing.Results: Of 10559 individuals aged ≥16 years with an initial negative CT/NG test (median age=25 years), 20.3% had a re-test in 9-15 months (23.6% females vs 15.4% males, P<0.001) and 35.2% in 5-15 months (40.9% females vs 26.5% males, P<0.001). Factors independently associated with re-testing in 9-15 months in both males and females were: younger age (16-19, 20-24 years); and attending a centre that sees predominantly (>90%) Aboriginal people. Additional factors independently associated with re-testing for females were: being aged 25-29 years, attending a centre that used electronic medical records, and for males, attending a health centre that employed Aboriginal health workers and more male staff.Conclusions: Approximately 20% of people were re-tested within 9-15 months. Re-testing was more common in younger individuals. Findings highlight the importance of recall systems, Aboriginal health workers and male staff to facilitate annual re-testing. Further initiatives may be needed to increase re-testing. [ABSTRACT FROM AUTHOR]

Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission.Methods: Baseline CT and NG laboratory data (2009-2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2-4 months (recommended) and 5-12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used.Results: There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2-4 months, 26.9% at 5-12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2-4-month (16.9% v. 11.5%, P<0.01) and 5-12-month (28.9% v. 23.5%, P=0.01) periods. Women aged 25-29 years had a significantly higher level of re-testing 5-12 months post-diagnosis than females aged 16-19 years (39.8% v. 25.4%, P<0.01). There was a total of 858 people re-tested at 2-12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P<0.01).Conclusions: Just under half the individuals diagnosed with CT or NG were re-tested at 2-12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2-4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Remote Aboriginal communities in Australia experience high rates of bacterial sexually transmissible infections (STIs). To control the transmission and decrease the risk of complications, frequent STI testing combined with timely treatment is required, yet significant delays in treatment have been reported. Perceived barriers to timely treatment for asymptomatic patients in remote communities were explored.Methods: A qualitative study was undertaken as part of the STRIVE (STIs in Remote communities, ImproVed and Enhanced primary health care) project; a cluster randomised controlled trial of a sexual health quality improvement program. During 2012, we conducted 36 in-depth interviews with staff in 22 clinics in remote Australia.Results: Participants included registered nurses (72%) and Aboriginal health practitioners (28%). A key barrier to timely treatment was infrequent transportation of specimens to laboratories often hundreds of kilometres away from clinics. Within clinics, there were delays checking and actioning test results, and under-utilisation of systems to recall patients. Participants also described difficulties in physically locating patients due to: (i) high mobility between communities; and (ii) low levels of community knowledge created by high staff turnover. Participants also suggested strategies to overcome some barriers such as dedicated clinical time to follow-up recalls and taking treatment out to patients.Conclusions: Participants identified barriers to timely STI treatment in remote Aboriginal communities, and systems to address some of the barriers. Innovative strategies such as point-of-care testing or increased support for actioning results, coupled with incentives to individual patients to attend for results, may also assist in decreasing the time to treatment. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander people have higher rates of sexually transmissible infections (STI). The identification of the sexual risk and healthcare seeking behaviours of young Aboriginal and Torres Strait Islander people in a regional Australian setting was sought.Methods: A cross-sectional survey of 155 young Aboriginal and Torres Strait Islander people (16-24 years) in Townsville was conducted.Results: Most participants (83%) reported ever having had sex, with a median age of 15 years at first sex and a range from 9 to 22 years. While young men reported more sexual partners in the last 12 months than young women, they were also more likely to report condom use at the last casual sex encounter (92% vs 68%, P=0.006). Young women were significantly more likely than young men to report never carrying condoms (35% vs 16%); however, they were more likely to have had STI testing (53% vs 28%, P=0.004). Of those reporting previous STI testing, 29% reported ever being diagnosed with an STI.Conclusions: The sample of young Aboriginal and Torres Strait Islander people reported an early age at first sex, variable condom use and low uptake of STI testing. The high prevalence of self-reported STI diagnoses indicate a need for opportunistic sexual health education and efforts designed to promote the uptake of STI screening in this group. [ABSTRACT FROM AUTHOR]

Unlabelled: Background This study aimed to describe sexual health behaviour, alcohol and other drug use, and health service use among young Noongar people in the south-west of Western Australia.Method: A cross-sectional survey was undertaken among a sample of 244 Noongar people aged 16-30 years.Results: The sample was more disadvantaged than the wider Noongar population. Sexual activity was initiated at a young age, 18% had two or more casual sex partners in the previous 12 months, with men more likely to have done so than women (23% vs 14%). Condoms were always or often carried by 57% of men and 37% of women, and 36% of men and 23% of women reported condom use at last sex with a casual partner. Lifetime sexually transmissible infection diagnosis was 14%. Forty percent currently smoked tobacco and 25% reported risky alcohol consumption on a weekly and 7% on an almost daily basis. Cannabis was used by 37%, 12% used drugs in addition to cannabis and 11% reported recently injecting drugs. In the previous 12 months, 66% had a health check and 31% were tested for HIV or sexually transmissible infections. Additionally, 25% sought advice or assistance for mental health or alcohol and other drug issues.Discussion: Although some respondents engaged in risky sexual behaviour, alcohol and other drug use or both, most did not. Particularly encouraging was the engagement of respondents with the health care system, especially among those engaging in risky behaviours. The results confound negative stereotypes of Aboriginal people and demonstrate a level of resilience among respondents. [ABSTRACT FROM AUTHOR]

While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced antitrafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers' human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia’s AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Diagnoses of chlamydia and gonorrhoea have increased steadily in Australia over the past decade. Testing and treatment is central to prevention and control but in some settings treatment may be delayed. Testing at the point of care has the potential to reduce these delays. We explored the potential utility of newly available accurate point-of-care tests in various clinical settings in Australia.Methods: In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with sexual health, primary care, remote Aboriginal health and laboratory expertise.Results: Participants reported that point-of-care testing would have greatest benefit in remote Aboriginal communities where prevalence of sexually transmissible infections is high and treatment delays are common. Some suggested that point-of-care testing could be useful in juvenile justice services where young Aboriginal people are over-represented and detention periods may be brief. Other suggested settings included outreach (where populations may be homeless, mobile or hard to access, such as sex workers in the unregulated sex industry and services that see gay, bisexual and other men who have sex with men). Point-of-care testing could also improve the consumer experience and facilitate increased testing for sexually transmissible infections among people with HIV infection between routine HIV-management visits. Some participants disagreed with the idea of introducing point-of-care testing to urban services with easy access to pathology facilities.Conclusions: Participants felt that point-of-care testing may enhance pathology service delivery in priority populations and in particular service settings. Further research is needed to assess test performance, cost, acceptability and impact. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting.Methods: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia.Results: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks.Conclusions: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment. [ABSTRACT FROM AUTHOR]

Background This study aimed to examine the knowledge, attitudes, and practices towards the use of facemasks among hospital-based health care workers (HCWs) in Hanoi, Vietnam. Methods A qualitative study incorporating 20 focus groups was conducted between August 2010 and May 2011. HCWs from 7 hospitals in Vietnam were invited to participate. Results Issues associated with the availability of facemasks (medical and cloth masks) and respirators was the strongest theme to emerge from the discussion. Participants reported that it is not unusual for some types of facemasks to be unavailable during nonemergency periods. It was highlighted that the use of facemasks and respirators is not continuous, but rather is limited to selected situations, locations, and patients. Reuse of facemasks and respirators is also common in some settings. Finally, some participants reported believing that the reuse of facemasks, particularly cloth masks, is safe, whereas others believed that the reuse of masks put staff at risk of infection. Conclusions In low and middle-income countries, access to appropriate levels of personal protective equipment may be restricted owing to competing demands for funding in hospital settings. It is important that issues around reuse and extended use of medical masks/respirators and decontamination of cloth masks are addressed in policy documents to minimize the risk of infection. [ABSTRACT FROM AUTHOR]

The article focuses on the Hepatitis C Incidence and Transmission Study-community (HITS-c), a community-based prospective observational study designed to inform future trials of candidate hepatitis C virus (HCV) vaccines, which found that opioid substitution therapy protects against HCV acquisition in people who inject drugs (PWID). It notes that HCV is highly prevalent globally among PWID. Figures are revealed on the percentage of people affected by HCV globally.

This paper reports on the work carried out during the 2009 field season of the prehistory sub-theme of the Desert Migrations Project. The work consisted of detailed survey and small-scale excavations in two wadis that drain the Messak Settafet, near the town of Jarma. Both wadis were found to contain evidence of Palaeolithic and Neolithic occupation, as well as of having been used as migratory routes between the Ubari and Murzuq sand seas. One of the wadis (WJAR-E-O1) was surveyed intensely along a few kilometers of its tributary margins. "This revealed archaeological material ranging from Oldowan (Mode 1) to historic. The distribution of the various industries and structures had a distinct spatial patterning; the Palaeolithic scatters were spatially discrete, but Holocene remains were often found superimposed on earlier industries. Among the finds were a spatially discrete Oldowan assemblage, an extensive Acheulean industry which included the exploitation of fossil wood as a raw material, the identification of at least five major outcrops of fossil trees, and a number of more recent structures dating from Neolithic to Islamic times and consisting of graves, cairns, rock engravings, and stone features. Middle Stone Age lithics, so predominant over the surface of the Messak plateau, were absent. The second wadi (WJAR-W-02) was geomorphologically different, being comparatively narrow and deeply incised, and containing a number of terraces on the wadi bed resulting from cut and infill processes in the past. The surface of these terraces contained an extensive Aterian lithic industry, while evidence of late Holocene use of the area was also recorded in the form of Tifinagh inscriptions, rock engravings, cairns and graves. Besides mapping the archaeological distributions, a number of trenches were dug at the edge of the river terraces. These revealed an in situ stratigraphic sequence, within which Aterian lithics were found at a depth of > 1 m. Samples for OSL dating were taken. Overall, the work of the 2009 field season was extremely successful in that, besides the fascinating range of archaeological material recorded and studied, it provided important insights into the role of the north-south wadis that cross the Messak, the southern boundary of the area being explored by the DMP, and their differential use in prehistory. [ABSTRACT FROM AUTHOR]

The palaeoanthropological and geomorphological sub-projects of the Desert Migrations Project (DMP) focus on the Pleistocene and early Holocene environment and prehistory of Fazzan so as to assess the timing and extent of hominin and human movement across the Sahara through time. This paper reports on the findings of the 2008 field season, with a focus on the prehistoric evidence along the northern margin of the Ubari sand sea. The geomorphological record of the area preserves evidence of at least five past episodes of lake formation. The exact chronology of these, as well as the spatial extent of these lakes, remains the focus of further study. The archaeological record of hominin and human occupation of Fazzan prior to the establishment of the Garamantian civilisation is extraordinarily rich. Between 2007 and 2008, the DMP palaeoanthropological project surveyed thirty-five localities along the northern margin of the Ubari sand sea, recording a range of assemblages spanning all Palaeolithic industries. Most of the archaeological remains found consisted of stone-tools, while grinding stones were comparatively restricted geographically. Mode 1/Oldowan tools were found at two localities, contrasting with the widespread presence of Mode 2/Acheulean, Mode 3/Middle Stone Age and Mode 5/microlithic artefacts. This indicates that, although hominin presence in the area is probably earlier than previously thought, populations were comparatively sparse until the Middle Pleistocene. Twenty-one localities within the Ubari sand sea, as well as seven south of the Messak Settafet were also surveyed between 2007 and 2008. The detailed study of the lithics from these areas will be carried out next year, but preliminary results stress the different nature of the assemblages found within interdune corridors - very low frequency of cores, no Mode 1 and extremely rare Mode 2 lithics (found at a single locality). The 2009 field season will focus on obtaining further samples of palaeolake sediments for dating, on the evidence of Mode 1 assemblages south of the Messak, as well as on the refining of the archaeological indicators that may distinguish the different phases of hominin and human occupation of Fazzan during the Later Pleistocene and Holocene. [ABSTRACT FROM AUTHOR]

The article presents a study supported by AIDS- Fogerty International Research Collaborative Award of the U.S. National Institute of Health. It focused on the issue of how a variety of public policies may influence the behaviors, lifestyles, and consequences of active heroin users and injectors in Brooklyn, USA and Sydney, Australia. In several domains of health and social services, American and Australian policies are substantively different Australian policies provide national income support and national health insurance for all citizens; these supports are generally unavailable to low income Amen cans. Syringe exchange programs have been promoted by the Australia government, but have been strongly opposed by many key legislators and the U.S. government. The second author conducted a longitudinal ethnographic study involving 16 heroin users recruited in Brooklyn, compared with 16 carefully matched heroin users from the Sydney suburb of Cabramatta. Both samples were poorly educated and few reported legal employment.

Focuses on the implications of subacute care costs for health maintenance organizations (HMOs) in the United States. Criteria for defining subacute care; HMOs' benefits in providing subacute care; Demand to accredit subacute care facilities and programs; Strategies to obtain reimbursement for subacute care; Evaluating outcomes in subacute care.