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Objective: Theory and some preliminary evidence suggest that contingency management may be an effective treatment strategy or adjunct to psychosocial treatment for methamphetamine use disorders. An experimentally rigorous investigation on the topic was provided by a large multisite trial conducted under the auspices of the Clinical Trials Network of the National Institute on Drug Abuse. Method: The authors report data on 113 participants who were diagnosed with methamphetamine abuse or dependence. They were randomly assigned to receive 12 weeks of either treatment as usual or treatment as usual plus contingency management. Urine samples were tested for illicit drugs, and breath samples were tested for alcohol. The reinforcers for drug-negative samples were plastic chips, some of which could be exchanged for prizes. The number of plastic chips drawn increased with each week of negative samples but was reset to one after a missed or positive sample. Results: The participants in both groups remained in treatment for equivalent times, but those receiving contingency management in addition to usual treatment submitted significantly more negative samples, and they were abstinent for a longer period of time (5 versus 3 weeks). Conclusions: These results suggest that contingency management has promise as a component in treatment strategies for methamphetamine use disorder. (Am J Psychiatry 2006; 163:1993-1999)

Transitional care programs are effective for improving patient outcomes upon discharge from acute care services and reducing the burden of healthcare costs; however, little is known about the types of transitional care programs for older adults across Canada. This exploratory study gathered an in-depth understanding of Canadian transitional care programs and described how each program functions to support older adults and family/friend caregivers. Nine key informants were interviewed about the development of transitional care programs within four Canadian provincial regions including Atlantic, Central, Prairie, and West Coast. Key facilitators and barriers influencing the development and long-term success of transitional care programs included program scope, program structure, continuity of care, funding, and health system infrastructure. Future research is required to identify how a broad range of transitional care programs operate and to disseminate knowledge with health leaders and decision-makers to ensure transitional care programs are embedded as essential health system services.

Ruminating about a prior anger provoking event is found to elevate blood pressure (BP) and delay BP recovery. Delayed BP recovery may be associated with increased risk of hypertension. Interventions that improve BP recovery may be beneficial for cardiovascular health. The purposes of this study were to evaluate the influence of rumination and anger on BP reactivity and recovery, to compare the effect of an exercise intervention or distraction intervention on BP recovery and to explore if exercise improved BP recovery by distracting participants from stressor-related rumination and anger. Healthy, normotensive participants (n = 79, mean age 22.2 ± 4.0 years) underwent an anger-recall interview stressor task, 3 min of exercise (walking), distraction (reading) or no-intervention (quiet sitting) and a 15 min recovery period. State anger reactivity was associated with Δ diastolic (D) BP reactivity and approached significance with Δ systolic (S) BP reactivity. Trait rumination was associated with greater SBP during recovery. Δ SBP recovery did not differ between the exercise, distraction and no-intervention groups. Although there were no differences in Δ DBP recovery between the exercise and no-intervention groups, distraction improved Δ DBP recovery compared to the exercise intervention but not the no-intervention. The proportion of anger-related thoughts (state rumination) in the exercise group did not differ from the distraction or no-intervention groups. However, a smaller proportion of participants in the distraction intervention reported an anger-related thought during recovery compared to the no-intervention group with 76% of their thoughts relating to the provided distraction. Overall, post-stressor exercise was not found to improve BP recovery while reading was effective at distracting individuals from angry thoughts (state rumination) but had no effect on BP compared to no-intervention.

Résumé:Le but de cette conception qualitative et interprétative était d'examiner les perspectives des chercheurs, des pourvoyeurs de soins de santé et et des décideurs aux sujets des risques principaux, des préoccupations et des problèmes émergents rattachées à la sécurité de soins à domicile qui informerait une ligne d'enquête de recherche. La sécurité, tel qu'elle s'applique spécifiquement à ce context des soins à domicile, n'a pas encore été définie. Par conséquent, afin de profiter de diverses parties prenantes sur les questions de securité relatives aux soins à domicile est nécessaire afin d'informer les orientations stratégiques pour la recherche future. Afin de commencer à tracer un programme de recherche, une analyse en trois parties de l'environnement a été realisée: (a) une étude pilote avec les bénéficiaires et les fournisseurs de soins à domicile; (b) des entretiens avec des informateurs clés, les chercheurs, les fournisseurs de soins de santé, et les décideurs; et (c) une revue de la littérature dans trois domaines thématiques. Seulement les résultats des entrevues des informateurs clés sont présentés ici.Abstract:The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be described; consequently, gaining insight from various stakeholders about safety issues relevant to the home care sector is necessary in order to inform strategic directions for future research. To begin to map a research agenda, a three-part environmental scan was conducted: (a) a pilot study with home care recipients and providers; (b) key informant interviews with researchers, health care providers, policy makers, and decision makers; and (c) a review of literature in three topic areas. Only the results of the key informant interviews are reported here.

• Clinical impressions suggest that thioridazine hydrochloride produces fewer extrapyramidal effects and more sedation than thiothixene. These drugs were given, each for three weeks, to 15 chronic schizophrenic outpatients in a counterbalanced, double-blind, crossover study. Spontaneous locomotion was recorded with an unobtrusive actometer toward the end of each three-week drug period. Surprisingly, patients were significantly more active with thioridazine, whereas parkinsonian scores, prolactin levels, and Brief Psychiatric Rating Scale scores remained about equal with the two drugs; thioridazine's extrapyramidal side effects were not "atypical." There are some explanations for why common clinical impressions and recent rodent studies have not predicted these results.

Smoking causes chronic obstructive pulmonary disease (COPD), but few controlled studies have tested anti-smoking treatments in COPD. With procedures likely to attract unmotivated persons we recruited 49 quite-ill, smoking COPD patients. During one or two daily home visits for 85 days, breath carbon monoxide (CO) and self-reports of daily smoking were obtained. Patients, given quit dates and nicotine gum (2-mg pieces, up to 30 per day), were assigned randomly to three groups: Experimentals were reinforced with lottery tickets for CO <10 ppm. Cigarette Self Report (CSR) patients were reinforced for reporting no smoking that day. Controls received non-contingent payments. Each group's mean CO level fell at the quit date. Thereafter, reinforced patients maintained significantly lower CO levels than Controls. Although many more 24-h abstentions occurred in the intervention period than in baseline, few patients sustained abstinence; the groups did not differ in that regard. Outcome was predicted by decisions to throw away cigarettes when intervention began, but not by motivation scales nor Fagerstrom dependence scores. Pay schedules apparently exaggerated self-reports of reduced smoking. Although results are statistically significant, there is still no proven, practical treatment for smoking in advanced COPD.

1-Alpha-acetylmethadol (LAAM) maintenance treatment has been proposed as a favorable alternative to methadone maintenance. With an un-obtrusive actometer we recorded two successive 24-h cycles of spontaneous motor activity from 12 patients receiving LAAM every other day, and from five receiving methadone every day. LAAM patients were about 50% more active on days of drug administration than on no-dose days (P<0.001). There were no significant day-to-day differences in motility of methadone patients. LAAM administered every other day may significantly modify the human circadian rhythm of spontaneous motility; further research is thus needed before this treatment is widely akopted.

Sixteen male students received bedtime placebo and flurazepam 30 mg at home in a counter-balanced double-blind, crossover design. For 24 h after each treatment the subjects' spontaneous motor activity was recorded each 15 min with an unobtrusive actometer, worn as the subjects attended classes. The circadian activity curves were submitted to cosinor analyses. The 24 h post-flurazepam activity was a mean of 15.1% lower than post-placebo activity (P<0.025). On the average, both the nocturnal trough and the daytime peak of motility dropped; the latter change was greater, reducing by a mean of 19.4% the amplitude of the circadian rhythm of activity (P>0.01). The timing, or phase, of the rhythm was not shifted. Although the drug did not consistently modify reports of subjective feelings on the Profile of Mood States (POMS), 13 subjects correctly discriminated drug from placebo sessions (P<0.05). A bedtime dose of 30 mg of flurazepam appears to significantly reduce spontaneous human motility that night and during the next day. Activity recording revealed an important residual, behavioral effect of the drug which was not reflected in POMS reports of subjective feelings, suggesting that activity recording may provide a more sensitive measure for psychotropic drug effects.

Outpatients receiving daily methadone-maintenance treatment were crossed over to alternating-day doses of l-alpha-acetylmethadol, receiving placebo on between-dose days. Spontaneous motility was dramatically higher on acetylmethadol dose days than on placebo days; activity on methadone days was intermediate between these extremes. Patients reported less vigor, more fatigue, and fewer ejaculations on placebo days than on acetylmethadol days, and patients' mood while on this drug was slightly euphoric in comparison to methadone. These effects are subtle, but such drug-induced variations in day-to-day behavior might adversely affect social interactions.

Monkeys receiving acetylmethadol thrice weekly were more active on dosing days, and less active on between-dose days, than while drug-free. Aggressive social behaviours increased significantly on drug-dosing days, while quiescent resting behaviors were much more common on between-dose days. Tolerance to these effects was modest, and the effects were not blocked by naltrexone. These subtle but potentially disruptive behavioral effects appear to parallel many of the actions of acetylmethadol in man.